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Home My WebLink About18763 CITY OF DIAMOND BAR ��`` DEPARTME'�'T OF COMMUN]"I'Y&bEVELOPIv�NT SERVICES J � -, 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 PRESS ��%� BUILDiNG PERMIT APPLICATION FIRMLY y JOBSITE l- _„�, � � APPUCATION �'O � PERMIT II'`L-�-�-,o'P/C o ADDRESS I �>�t 5 _ DATE � NUMBER � # c� ISSUE /!� � /y-� TYPE OCC APN LOT TRACT _ DATE ��v �� CONST. GRDUP °C OWNER �r � . I� ,--- O `L ADDRE l 7U �1.i'Im. �� '-- ZONING SETBACKS Zc FRONT RW ❑ _ CITY ��---� ZIP TEL.��' �/3r � APPLICANT TEL.� REAR ❑ o SIDE/SIDE STREET RW C] ¢ CONTRACTOR C-v SIDE C_ � ADDRESS t � /`_a `� r� PROPOSED USE � CITY`"�• •"� w'� ZIP TEL. �f�_J��Y'YY w ARCH/ENG/ __ z �ESIGNER � NO.DWEL. NO. NO. d ADDRESS UNITS STORIES BEDROOMS � CITY ZIP-- "� DESCRIPTION SC1.FT. FACTOR PSF ADJ.AREANALUATION cn . i Q OWNEFi-BUILDER DECLARATION SFR/ADDIREM O I HEFEBY AFFIRM UNOER GENAITV OF PERJURY THAT I AM F%EMPT FROM TME C RACTOqS LI� G8f0Q8/CBfPOfI �W CENSEUWFORTHEFOLLOWINGHEASON(SEC.'lo3t.56USINESSANOFR�FES510N ,OE'.FNYGTYOR (n U COUNTVWHICHREOUIRESAPERMITTOCONSTRUCT,ALTER,IMPFOVE.�EMOLISH RE7AIRANYiTRUC� W pa(10/DBCk Z TURE.PRIOR TO ITS ISSUANCE,AL50 RE�UIRES THE APPLIGANT FOR SUC RMIT TO FILE A SIGNE� W w STATEMENT THAT ME OR SHE IS LICENSED PURSl1ANT TO THE PAOVISI OF THE CONTAACTOFS U� � CENSE LAW(CHFPTER 9(COMMENCING WITM SECTION 7ao0�OF DIVI 30F THE BUSINESSAND PRO� � POOVSp2 � FESSIONSCADE�ORTHATHEORSHEISE%EMPTTFIEREFqOMAN EBASISFOPTHEALLEGEDEXEMP- (�J � TION.ANVVqLATIONOFSEC?ION7031.5BYANYAPPLICAN'F PERMITSUBJEC'(SiNEAPPLICANTTO Z Re-Roof � A pVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOL (f5oo).1: - Q Q ❑LASOWNEROFTHEPROPERTY,ORMVEMPLOV WiTHWAGESA5IHEIR50LEGOMPENSATiGN, COAITBtC12I Z WILL DO THE WORK.AND THE STRUCTU{iE IS NOT I NDED OF OFFERED fOH SALE{SEC.7044,BU!'I- ,_J NE55 AND PROFESSIONS CO�E:THE CONTRACT 5�ICENSE LAW DOES NO�AFPLV TO AN OWNEfl OF � PROPERTYNM06UI�OSORIMPROYESIHER ,ANDWHO�OESSUCHWORKHIMSEIFORHERSELFOR � � THROUGHHISORNEROWNEMPLOYEES, VIDE�THAT�UCFIIMPROVEMEMSARENOTINTENDEDOR m w OFFEREDFORSALE.IF,MOWEVER,THE LDINGORIMPPOVEMENTISSOLDWITHINONEYEAROFCOMPLE- n TION,THE OWNER-BUILDER WILL THE BURbEN bF PROVING'HA1 HE Oq SNE DIO NOT BUIlO OR Z IMPROVE FOR 7NE PUFPOSE OF LEI. _ ❑I,ASOWNEROFTHEP PERTY,AMEXCLUSIVELYCONTRACTINGWITHLIGENSEDCONTRACTORS W � TO CANSTRUCT THE PR T(SEC.7064,BUSINFSS AND PpOFE5510N5 COOE:THF CONTRAC?OPS LI- V3IU8110f7 ADJ.AREA W CENSELAWDOESNOT PLYTOANOWNEROFAPROPERTYWHOdUIID50RIMPROVESTHEREON,AND � WHOCONTRACTSF SUCHPR0.IECTSWITHACONTMCTOR(S�IICENSCOPURSUANTTOTriECONTRAC- QUANTITY DESCAIPTION FEE TORS LICENSE L . J t T Q CJ I AM EMP7 UNDER SFC. � H.3 P.C.FOR TNIS REASON Q �^�Y � � — � l G1 . ,'"—t.r'' `� — � o oWNEA � z -- W �'- � ,��1..�s .� � LICENSED CONTRACTORS DECLARATION w Q � � 1 HEHEOY AFFIRM I/NDER PENAITY OF PERIURY THAT 1 AM LICENSEO UNOER PROViSIONS OF G1IAPTER �. � � �'F' d 9(COMMENqNG WITH SECTION]000)OF DIVISION 3 OF THE BUSINESSAN�PP.OFESSiONS CODE,AND Z -� \�" L ��-2_C� (.�t e X MV LICENSE IS IN FULL fORCE AND EFFECT. � _ LU _--" r� � -'?-'t _J, ._ '. � LICENSECL45S _ LIC.NO.___�Z 1 � --- �r„�� ,�(`` vE% 'i'�� Z cor+TancroR_ - '.: �-'�--v a �nrE_� w �-"-5 � WORKERS'COMPENSA710N DECLARATION Q � 1 MEREBY AFFIRM UNDER PENALTV OF PERJURY ONE OF THE FOILOWiNG DECLARATIDNS: U � — ��^ � 4 ,.C>(.. �' -F'" l-r.�tiSlUt..: � I H VE AND WILL MAINTAIN ACERTIFICATE OF CONSE - F INSURE FOR WORKEFS' Y Z ROYIDED BY SECTIO THE LABOfl FOF TME PERFORMANCE U ¢ OF HK FOR CH THIS PE ISSUEO. � � w 1 HAVE AND WIIL MAMTAIN WORKERS'COMPENSATION INSl1qANCE,AS REOU�RED BV SECTION QQ 37000F THE LABOR CODE,FOR THE PEfi%ORMANCE Of THE WORK FOR WHICHTHIS PERMIT IS — ISSUEC.MV WORKERS'COMPENSATION INSURANCE CARRIER A ooucr NUM6EA naE: CONSTRUGTION _ j cnaaica �� +�..� PLAN FEVIEW � aoucvNUMeEa T 7k�,--�� -7-�1-�',�� ELECTRIC Z ¢ (1HISSEGTIONNE�NOTBE0.7MPLE�EDOFTNEPERMITIS�OkONEMMDREDDOLLARS(E1W)oqLEss). PLUMBING ___ � /'l w MECHANICAL U Z I CFRTI�v THAT IN THE PERFORMANCE OF THE WORK FOR WH- THIS PERMIT 155t1ED,I - � SHALL NOT EMPLOV ANV PERSON IN ANY MANNER SO NS T COME SUBJ TO THE � WORKERS'COMPENSA�ION lAWS OF GALIFOANI0..ANO A E THAT IF I ULD BECOME INS'�EGTION FEE = SUBJE TTOTnEWORKERs'cOM7ENSATlO ISI OFSECTI OOOFTHELABOR ' COOE SH L FORTHWITHCOMPLY WIT 03E 510 . S�JANCE � pDATE:�.�', � �� - aaai ir.4Nr:;.�r r� � �'� SMIP _.._ w ENERGY P/C --� WqRNINC� AILUPE TO SECURE WORKERS'COMP TION COVERPUE IS U UL,AND SI-.ALLBE "- J SUBJECTANEMPLOVEfl70CRIMINPLPENALTI GIVILFINESUPIOONEHUNDRE�THOU$AND � DOLL4R5 iS�oo 000).IN ADDITiON TO SHE GO F OMPENSATION,DAMAGES AS PROVIDED FOR IN ENERGY PERMIT _. � StGTION 37a8 OF THE LABOR CODE,INTEFl f,A nrroaNErs FEEs. RETENTION FEE: � � CONSTRUCTION LENDING A � CY pRE-ALT FEF� � O � IIfERE9YAFFtRMUN�EFiPENA�TYOFPERJUflVTHATTHE ACONSTF,UCTIONIENDINGAGENCY .,.. � FOp THE PERFORMANGE OF THE WORK FOR WHIGH l EFMITIS ISSUE�(SEC.3091,CIV.C). Z W S LENDEVi'S NAME _,. � H LENDER'SP.DDPESS � — � ICERTIFVTH0.TIMAVE ADTHISAPPIIC ONAM�ST0.TETMATTHEABOVEINFORMATIONISGORRECT. TOTAL FEES 2� •� w I AG41[E TO COMPLY WITHqLI CITY P GOUNTV OFDINANCES ANO STA7E UWS PELATING T09UyyyI'G�ING � CONSTRUCTION,ANDHEREBYAUi RREREPqESENTAT,VESOFTHISCOUNTVTOENTEeUPON� ZABovF-I.AF.NTIO PRDPEHTv R INSPECT OSES. � COMMENTS � �.. :� 'J�?� � � .11.�, _ ¢ EFMITTEE NA ) � �� ./ y � .__ _ ..., _ - ___—__ _ SIGNATURE ERMIT'E ..� \,._... DATE � � � RECPT NO. PA�D BY VALIDATION S ~ WHITE-DepaRment Co YELLOW-Finance Co PINK-Assessor Go GOlOE 06-File Copy.GREEN-ApplicanPs Co PY. PY� PY� PY �t� � : �� . �, . ._„� , �� . , . r� � �'�� .re �- ° � �,�� , ,��N. � ; � : o � ,� �� z l�'v� � � � �. � _ �y � _ �: _ � � �., � , _ _ � � ; ` , s ; _ , _ . __ _ .. . �� . p� _-. i .. . .�� ... . � . .. ..._ ... .. ... . � . .. ..... � . . ... ..... ... . . ... .._.. ... .... .. . . . . . ...... .. ... .. ....... . ... . ...... ...... . „y��; .pp.. . . ..... ......_.. ....... .. .... � �� .... . . . ... . . . .. ... ... ... .. .. . ... .... . ...... .... ...... . .... . ..... _...... ..... ....... ..... ....... ._. � F . .... .. . .... . ... ... .. ...... .. ..... ..... .. ..... .. ... . .. ..... .. ..... ..... ._..._.. ..... .. ....... .....,,........ ...p . . ... ... .. . . .... .. ...... .. .. ... ... . . . .. . . .. .. . .. .... .. ..... ...... . ..... . .... ..... ...: ;�� a.S � s%'u t;zy `nlr�@��'Pa"" e . .... . . . .... ... . . ...... .. . . .. ..... .... . ....... __.__ ...... : � , ' 4'� ��, p V E �,�n��.�*.� � E�� „ � _ _ __ _. __ _- `,- . __ _ _ _ i �aY � �� > , u , ., a m ,: . � ;. � _ t�° � � ' �' � _ _ � ,� � ��'� � " �� v� �� •� � � CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION PRESS FIRMLY JOBSITE ADDRESS APN LOT TRACT OWNER'A f I"7U, CITY ZIP TEL. APPLICANT TEL. CONTRACTOR-k3-, --e ADDRESS YE� -7 CITY -J 1^v w-C ZIP TEL. ARCH/ENG/ \ DESIGNER ADDRESS CITY ZIP OWNER-BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE C RACTORS LI- CENSE LAW FOR THE FOLLOWING REASON(SEC. 7031.5 BUSINESS AND PROFESSION . DE:ANY CITY OR COUNTY WHICH REQUIRESA PERMIT TO CONSTRUCT.ALTER.IMPROVE. DEMOLISH REPAIR ANY STRUC TURF. PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUC RMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISI OF THE CONTRACTORS LI- CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVI 3 OF THE BUSINESS AND PRO- FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AN E BASIS FOR THE ALLEGED EXEMP- TION.ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT F PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOL($500)): ^I,AS OWNER OF THE PROPERTY.OR MY EMPLOY WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK,AND THE STRUCTURE IS NOT I NDED OR OFFERED FOR SALE !SEC. 7044, BUTI- NESS AND PROFESSIONS CODE.THE CONTRACT S LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THER,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES,VIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE. IF, HOWEVER,THE LDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OFCOMPLE- TION,THE OWNER-BUILDER WILL E THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF LE). ^I,AS OWNER OF THE P PERTY,AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PR T(SEC. 7044,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- CENSE LAW DOES NOT PLY TO AN OWNER OF A PROPERTY WHO dUIIDS OR IMPROVES THEREON,AND WHO CONTRACTSF SUCH PROJECTS WITH A CONT RACTOR(S I I ICENS ED PU RSUANT TO THE CONTRAC- TORS LICENSE L CJ I AM EMPT UNDER SEC. e.A PC. FOR THIS REASON OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORCE AND EFFECT LICENSE CLASS LIC. N0.Z AT CO T i OR N D E NTRAC WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I N VE AND WILL MAINTAIN A CERTIFICATE OF CONSE-F-INSURE FOR WORKERS' PEN6.A ROVIDED BY SECTIO F THE LABOR FOR THE PERFORMANCE FOR OF RK FOR yy,CH THIS PE ISSUED. I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS'COMPENSATION INSURANCE CARRIER A POLICY NUMBER ARE: CARRIER--,�-�-"7.5, POLICY NUMBER i�L��-"� • 7 CSC-�^'��f�� (THIS SECTION NEED NOT BE COMPLETED OF THE PERMIT IS FOR ONE HUNDRED DOLLARS($100)OR LESS). I CERTIFY THAT IN THE PERFORMA WORK FOR WH -THIS PERMIT ISSUED,I SHALL NOT EMPLOY ANY PERSON IER SO AS T COME SUBJ YO TH WORKERS'COMPENSATION LAWS IA.AND A E THAT IF I ULD BECOME UBTRKERS'COMPISI OF SECTIO OF THE LABOR ODE SH L FORTHWITH COMPLE ISIO��($$$ / DATEAPPLICAN WARNINGAILURE TO SECURE WORKERS'TION COVERAGE IS U FUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS(5100.000). IN ADDITION TO THE CPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 3709 OF THE LABOR CODE,INTER ORNEY'S FEES. ATTORNEY'S CONSTRUCTION LENDING A-CY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THE A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH T ERMIT IS ISSUED(SEC 3097,CIV.C) LENDER'S NAME LENDER'S ADDRESS I CERTIFY THAT I HAVE AD THIS APPLIC ON AND STATE THAT THE ABOVE INFORMATION IS CORRECT I AGREE TO COMPLY WITH ALL CITY A COUNTY ORDINANCES AND STATE LAWS RELATING TO BUI DING CONSTRUCTION,AND HEREBY AUT RIZE REPRESENTATIVES OF THIS COUNTY TO ENTE�i UPON E gBOVEMENTIO PROPERTY RINSPECTI OSES. ERMITTEE NA T) SIGNATURE ERMITTE DATE APPLICATION 110 PERMIT( P/C DATE NUMBER# // ISSUE/TYPE OCC � DATE CONST.GROUP ZONING SETBACKS FRONT RW^ REAR SIDE/SIDE STREET RW^ SIDE PROPOSED USE N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION S0. FT. FACTOR PSF ADJ.AREANALUATION SFR/ADD/REM Garage/Carport LU Patio/Deck W LL Pool/Spa Z Re-Root Commercial Valuation ADJ.AREA QUANTITY DESCRIPTION FEE C CI: Yom-�� U C. 0 W 0 1, Z 1 \ m u {� t � 71 t CL CONSTRUCTION PLAN REVIEW I-N ELECTRIC PLUMBING MECHANICAL 0 INSPECTION FEE 3LANCEi SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES 2�, 50 COMMENTS RECPT N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy