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HomeMy WebLinkAboutNo Permit Number CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21825 E. Copley Drive (909) 860-3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION EXPIRED MAY 0 9 2003 PRESS FIRMLY JOBSITE q ") ADDRESS-r APN LOT TRACT OWNER ADDRESS P/kLK PL42.4 . L4afl It c:: CITY ZIP TEL.4'l' ly)7-403 / APPLICANT TEL. CONTRACTOR __fWn TC' X4 L. ADDRESS (p A 9J -t CITY Z T E L g / , 3 e y ).3 ? - I i S' ARCH/ENG/ DESIGNER ADDRESS CITY ZIP __ TEL. OWNER-BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT, ALTER, IMPROVE, DEMOLISH, OR REPAIR ANY STRUC. TURE, PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW (CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS ($500).): ^ I, AS OWNER OF THE PROPERTY. OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, BUSI- NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE. IF, HOW EVER, THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE- TION. THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). ^ I. AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). ^ I AM EXEMPT UNDER SEC. B. & P.C. FOR THIS REASON DATE 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 MV LICENSE IS IN FULL FORCE AND EFFECT. 44( ~ r _ , 1 ~ LICENSE CLASS LIC. NO. ~ ~, /f -~L74 £ L,c i DATE t/)U I t . / CONTRACTOR IFA% / rPiy WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY SECTION 3700 OF THE LABOFI CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE. (_ CARRIER U POLICY NUMBER ) O 31 4-N J THIS SECTION NEED NOT BE COMPLETED OF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($100) OR LESS). I CERTIFY THAT IN-HE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE, I SHALL FORTHWITH COMPLY WIT TH SE PROVISIONS. O r- APPLICANT. DAT WARNING: FAILURE TO SECURE WORKERS' PENSATION COVERAGE IS UNLAWFUL, AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENA TIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100.000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER FENALTV OF PERJURY THAT THERE IS ACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE (IF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3097, CIV. C.). LENDER'S NAME LENDER'S ADDRESS CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE CONSTRUCTION , ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. DC- 0 PER AME(PRINT)1 7 SIGNATU F PERMITTFI_ DATE E: a cri co 0 w 0 z m ir 0 0 w 0 w 0- C13 O 0 W U Z W O U Cn Cr W ci W w W H W 3-1 Z O d W 0 U w CO 0 C W F APPLICATION PERMIT P/C DATE NUMBER I # ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ^ REAR ^ SIDE/SIDE STREET RW ^ SIDE ^ PROPOSED USE NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTIONSQ. FT.FACTOR PSFADJ. AREA/VALUATION SFR/ADD/REM COGarage/Carport WPatio/Deck LL Pool/Spa ' k 3 LL) ZRe-Roof Commercial Ib Valuation ADJ.AREA QUANTITYDESCRIPTIONFEE QI1 U il4 W W 0 Z _J1:7 5- KVA 44 C, J Q _U Z Q 2 W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE , ISSUANCE L.. SMIP ENERGY P/C t~ qq 2001 ENERGY PER IT RETENTION FOE: PRE-ALT FEE:-4. TOTAL FEES COMMENTS RECPT. NO. PAID BY VALIDATION WHITE-Department Copy, YELLOW-Finance Copy, PINK-Assessor Copy, GOLDENROD-File Copy, GREEN-Applicant's Uopy CITY OF DIAMOND BAR DEPARTh4ENT OF COMMUNITY & DEVELOPMENT SERVICES 21825 E. Copley Drive (909) 860-3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION EXPIRED MAY 0 9 2003 PRESS FIRMLY Q 0 0 0 0 w z 0 0 z m O 0 w 0 z w d cn cn w z a x w O F- U w ~_ 0 z 0 w J Q 0 Z Q a U_ V F WHITE-Department Copy. YELLOW-Finance Copy, PINK-Assessor Copy, GOLDENROD-File Copy. GREEN-Applicant's Copy J -t . AD RESSO 1 Z APN LOT ~---- TRACE / - OWNER , II''1/( p ADDRESS CITY IP TEL. APPLICANT TEL. CONTRACTO r-, FA CL-4 ADDRESS CITY ZIP 7 Z X d TEL.7/DSO7-0ZII ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER-BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT, ALTER, IMPROVE, DEMOLISH, OR REPAIR ANY STRUC- TURE, PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW (CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS ($500).): ^ I, AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, BUSI- NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE. IF, HOWEVER, THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE- TION, THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). ^ I, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LI- CENSE LAW DOES NOTAPPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S) LICENSED PURSUANTTO THE CONTRAC- TORS LICENSE LAW.). ^ I AM EXEMPT UNDEFI SEC. B. & P.C. FOR THIS REASON DATE 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 FORE AND EFFECT. C• LIC. NO. LICENSE S ~ ~ !A ~ ~ ~cJ~e1 CONTRACTO Cry. G DATE "pK (1 4" 311 - I - O ' COMPENSATION DECLARATI N WORKERS I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' COMPENSATION, AS. PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. 1 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 E ATION INSS B CARRIE ND POLICY NUMBER ARE ISSUED. MY WORK ` CARRIER ~~.~/// G u N POLICY NUMBER THIS SECTION NEED NOT BE COMPLETED OF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($100) OR LESS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AST BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFO IA, AND A E THAT IF I SHOU D BECOME SUD C TO THE WORKERS' COMPENSATIO ROVISIO F SECTION 3700 T LARD COD HA FORTHWITH COMPLY WITH OSE PROM I NS DATE: APPLICANT. WARNING: FAILURE O SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SH L BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOU AND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE CF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3097, CIV. C.). LENDER'S NAME LENDER'S ADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE CONSTRUCTION , ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. r. PERMI NAME RINT) -^/ E j SIGNA OF E TT AT 0 °ao cr 0 0 w z 0 cc 0 tr 0 LU W U W 0 U Z I W C3 I w L O Z Q m U OF DIAMOND BAR CITY DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21825 E. Copley Drive (909) 860-3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION EXPIRED MAY 0 9 2003 PRESS FIRMLY APPLICATIONO 1RMIT P/C o DATEPE ISSUETYPE OCC DATECONST. GROUP ZONING SETBACKS FRONTRW ^ REAR^ SIDE/SIDE STREETRW ^ SIDE^ PROPOSED USE NO. DWEL.NO.NO. UNITSSTORIES BEDROOMS DESCRIPTIONSQ. FT.FACTOR PSFADJ. AREA/VALUATION SFR/ADD/REM U)Garage/Carport LIPatio/Deck L LLPool/Spa 0 ZRe-Roof Commercial 5 in ValuationADJ.AREA QUANTITYDESCRIPTIONFEE J U Cr I- U W J w 0 Z _ DO d U_ Z 2 U W t7 . D CONSTRUCTION S PLAN REVIEW ELECTRIC PLUMBING MECHANICAL i L) INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEESf 1 COMMENTS RECPT. NO.PAID BY VALIDATION WHITE-Department Copy, ELLOW-Finance Copy, PINK-Assessor Copy, GOLDENROD-File Copy, GREEN-Applicant's Copy CITY OF DIAMOND BAR DEPARTMENT OF COMMUNTI'Y & DEVELOPMENT SERVICES 2(825 E. Copley Drive (909) 860-3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION EXPIRED MAY 0 9 2003 PRESS FIRMLY JOBSITE /- ~E w ~~ ~ ~V ~ H '~ C~~ ADDRESS _ ~ ~ APN UDT TRACT OWNER ~j-,r+~~e-~_ ~11~i~/ ADDRESS CITY ZIP TEL. APPLICANT TEL. CONTRACTOR _ /~/L ~ %YA ~`~ ADDRESS~~~ ~ L w' CITY /F/1~,~-- 9.x/9- ZIP ~7Y TEL.~~,26 y.I'YJ7~~%(~ ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER-BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LI- CENSELAW FOR THE FOLLO W LNG REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT ALTER, IMPROVE, DEMOLISH, OR REPAIR ANV STRUC- TURE, PRK)R TO 175 ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI~ CENSE LAW (CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT H E OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7031.5 BV ANV APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO ACIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (f500).): ^ I, AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK, AND 711E STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, BUSI- NESSAND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE. IF, HOWEVER, THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE- TION, THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). ^ I, AS OWNER OF THE PROPERTY AM EXCLUSIVELY CONTRACTING W ITH LICENSED CONTRACTORS TO CANSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCI{ pRQIECTS WITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). ^ I AM EXEMPT UNDEFI SEC. B. 8 P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PE:NALTV OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 30F THE BUSINESS AND PROFESSIONS CODE, AND MV LICENSE IS IN FULL FORCE AND EFFECT. Q~ -^ ~ ~~ ~ ~ ~~ / /1~ d LIC. NO. LICENSE CLASS DATE S f /~d.')~ CONTRACTOR - WORKERS' COMPENSATION DECLARATION `• I HEREBY AFFIRM UNDER PI NALTV OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINTAIN ACERTIFICATE OF CONSENT TOSELF-INSURE FOR WORKERS' COMPENSATION, AS PROVIDED BV SECTION 3700 OF THE LABOR CODE, fOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WILL M/VNTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY SECTION 3700 OF THE LABOFI CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ARRIER AND POLICY NUMBER ARE: NSATION INSURA N C E C ERS' COMPE ISSUED. MY WO RK , ~ / J / ~ ~ / , A CARRIER L.L j)!)O / 7 ~ L L.' / 1 /w~ ~J /~ G 3 D -._ E P I ~ POLICY NUMBER _ , ~ (S )O (THIS SECTK)N NEED NOT BE ODMPLETED OF THE PERM(T IS FOR ONE HUNDRED DOLW~S . I CERTIFY THAT IN l'HE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLO'f ANV PERSON IN ANV MANNER SO AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 37000E THE LABOR CODE, I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE: _ APPLICANT: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIV IL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (flo0,o00), IN ADCIITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOH CODE, INTEREST, AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS ACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3097, CIV. C.). I LENDER'S NAME LENDER'S ADDRESS I I CERTIFY THAT I HAVE REP,D THIS APPLICATION AND STATE THAT THE AEIOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH 4LL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING ~ CONSTRUCTION, AND HER_BV AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. 1 ~ PERMITTEE Fy1 ) ~~ ~ ~ Ci ~ SIGNATURE OF PERMITTEI: DATE 0 O LL 0 w z 0 0 z m O 0 w z w rn w O W U Z W U H Z Q d X W U N ~_ W ~Q Z Q W Z (n 0 W J WHITE-Department Copy, YELLOW-Finance Copy, PINK-Assessor Copy, GOLDENROD-File Copy, GREEN-Applicant's Copy 11 RN fill 11 IfIl I ADDRESS? l(P80 APN LOT TRACT `i4o-71 OWNER ro- v- Me f \[/OcA) r_0 . ADDRESS I &o y s . Cwt ( t A.V\[„ CITY Gc ef_\[VIJU / IP _ 1-MTEL. APPLICANT TELIJ'-'L9-7ZN-1LIY CONTRACTOR ADDRESS CITY ZIP TEL. ARCH/ENG/ DESIGNER S ADDRESS aC Y vV- (U k !5U CITY Jry1/IP, /' A. ZIP 17(,,1' TEL.9y9-724- I ~{4 OWNER-BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REQUIRES/ PERMIT TO CONSTRUCT, ALTER, IMPROVE, DEMOLISH, OR REPAIR ANY STRUC- TURE, PRIOR TO ITS ISSUANCE. ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW (CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS ($500).): D I, AS OWNER OF THE PROPERTY, OR MV EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, BUSI- NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES. PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE. IF, HOWEVER, THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE- TION, THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). D I, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI' CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON. AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). D I AM EXEMPT UNDEFI SEC. B. & P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WITH SEC""ION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT, i ^~ ( u LICENSE CLASS B LIC. NO, DATE I - 3L D.;'- CONTRACTOR 7"i-r I Ai WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY SECTION 3700 OF THE LABOFI CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER -j t POLICY NUMBER _iA;` I 5 (THIS SECTION NEED NOT BE COMPLETED OF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($100) OR LESS} I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOI' ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR T PROVISIO CODE, I SHALL FORTHWITH COMPLY WITH NS. ' C / APPLICANT: DATE: 9- 7 WARNING: FAILURE TO SECURE WORKERS' C NSATION COVERAGE I UN WFUL, AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO N UNDRED THOUSAND DOLLARS ($100,0W), IN ADDITION TO THE COST OF COMPENSATION. DAMA AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3097, CIV. C.I. LENDER'S NAME LENDER'S ADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. PERMITTEE NAME (PRINT) Plf ke4o/1 or F 7 - SIGNATU i--~ ATE ~ Co 0 00 Cr 0 0 w z 0 z CO 2 O w U w 0 U w W im w W cc: W :lz 121, 0 LL 0 Q Cc 0 X W 0 U w Cn 0 Z Lu 0 W Cf) I O w J cC Cx- w d O FS CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21825 E. Copley Drive (909) 860-3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION EXPIRED MAY 0 92003 PRESS FIRMLY APPLICATION PERMIT P/C 7 DATE Z NUMBER # ISSUE 1'J TYPE OCC DATE r CONST GROUP R _ ZONING SETBACKS FRONT RW ^ REAR ^ SIDE/SIDE STREET RW ^ SIDE 6-P-0\\ PROPOSED USE CE° NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTIONSQ. FT-FACTOR PSFADJ. AREAIVALUATION SFR/ADD/REM CnGarage/Carport WPatio/Deck LLPool/Spa CD ZRe-Root Commercial2 ( QQ ~---- Valuation ADJ.AREA QUANTITYDESCRIPTIONFEE J U I- U w J W Z _ ca U_ Z W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE / SMIP ENERGY P/C ENERGY PERMIT A-0 RETENTION FEE: PRE-ALT FEE: TOTAL FEES t7 0 b' COMMENTS 1 9 t7 St. RECPT NO. PAID BY VALIDATION WHITE-Department Copy, YELLOW-Finance Copy, PINK-Assessor Copy, GOLDENROD-File Copy, GREEN-Applicant's Copy 0 °5-01 0 Y ~ fSl\\ k 44 U6 FYI DG-1. F"