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Home My WebLink About18429 ci�oF n�orm s�x �� T �� 1,�,�e�--" l '�o!��-- �� DEPARTIvfENT OF COIv�vIUNITY&DEVELOPMENT SERVICES � 21825 E.Copley Drive "� (909)860-3195 Fsx(909)861-3117 � PRESS Bl3ILDING PERMIT APPLIGATION � FIRMLY � JOBSITE I APPLICATION PERMIT P/C o ADDRESS 1�ZC� ��N ��GL �� DATE � �� 2 NUMBER # ��" I S L ISSUE �) TYPE OCC � n � uL••� CONST. GROUP r APN LOT TRACT___ DATE p OWNER _1►2R�i �U`l�—_ LL ADDRESS ZONING SETBACKS Z CITY ZiP TEL. r ,� FRONT RW ❑ g APPLICAN— T �� J TEL. SIDFJSIDE STREET RW ❑ m CONTRACTOR "{- C- �'�'• - �` SIDE __ Q � ADDRESS�� • � 'C'�"�' � �-� � ��' PROPOSED USE KI�'41 EN Ek,TEN�biJ o CITY �- ��` �'0-''J ZIP�_�� TEL. ?(��[�� w ARCH/ENG/ z DESIGNER ��P NO.DWEL. NO. /1 NO. � a ADDRESS �+ , �� UNITS STORIES BEDROOMS � CITY U ZIP_�1 TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � � OWNER-BUILDER DECLARATION SFRlADD/REM � I HEREBY AFFIRM UNDEfl VENALTV OF PERJUFV THAT I AM E%EMPT FROM THE CONTRACTORS LI- � Garage/Carport W CENSELAWFORTMEFOLLOWINGREASON(SEC.7o31.68USINESSANDPROFESSIONSCODE.ANYCITYOR U COUNTVWHICHRECIUIRESAPERMITTOCONSTRUCT,ALTEI7,IMPROVE,DEMOLISH,ORREPAIRANYSTPUG- W Pd�10/DBCIC w TURE,PRIOR TO ITS ISSUANCE.ALSO REQUIRES THE APPUCANT FOR SUGM PERMIT TO FlLE A SIGNE� w STr1TEMENT THAT HE OR 51-..E IS LICENSED PUPSUANT TO iHE PHCVISIONS OF T4E CONTflA�TORS LI� � CENSE LAW(CHAPTEF 9(COMMENCING WITM SECl10N lODO)OF DIVISION 3 OF THE BUSME55 AND PRO� � POOUSP2 O FESSIONSCODE)OFTMA7HEOHSHE�SE%EMPTTHEREFROMANOTHEBASISFORT LEGEDE%EMP� (� U TIDN.ANYYIDIATIONOFS�CTION7031.5BVANVAPFLiCANTFORAPEFMIiSUBJ THeAFPLIC.ANiTO Z RB-ROOf � A qVIL PENALTV OF NOT MORE THAN FlVE HUNOFEO DOLIARS(ESoo).)� � ❑I.ASOWNEROFTHEPROPERTY,ORAAVEMPIOVEESWITHWAG TNEIRSOLECOMPENSATION, � COff1!I18(C!8I Z WILL C10 THE WORK,AND THE 57RUCTURE IS NOT INTENDED OR CfiE�FOR SALE(SEC.]04a,BUSI- J N NESS AND PROFESSIONS COOE:THE CONTRACTOFlS LIC[NS W DOES NOTAPPLY'O HN OWNEfl OF ? PROPERTYYM�BUILOSOAIMPRCVESTHEA.EON.AND OESSUGNWORKHIMSEIFOHHE95ELfCR m Q THROUGHHISORHEROWNEMPLOYEES,PROVIDED TSUCHIMPROVEMENTSARENOTINTENDEDOR W OFFEREDFORSALE.IF,MOWEVER.h1EBUILDING MPROVEMENTISSOLDW�IHINONEYEAROFCOMPLE- � �IO�,'HE OW4ER�BNLDER Wll'.HAY'�TH RDEN OF VRO'J1NG'NAT HE OR SNE OID NCT BUILD CR Z IMPROVE FOFTHE PURPUSE OF SAIE�. _ ❑I,ASOWNEROFTHEPROPE ,AMEXCLUSNEI�CONTRACTINGWIT4LICENSE�CONTRACTORS � TO CANSTRUCT THE PROJECT C.7044.BUSINESS AND PROFESSIONS CODE'.THE CONTRACTORS LI- � Valuation � � � ADJ.AREA W CENSEIAWDOESNOTAPP OANOWNEROFAPROPERTVWHOBUIL�SORIMPROVESTHEREON,AND � WHOCONTFACTSFOR PqOJECTSWITNACONTRACTOR(5)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE TORS I.ICENSE LAW � J O ❑IAM MPTUNDEftSEC. B.&�C.FORTHIS HEASON � 7T ....— — � . � p OWNER U Z W � LICENSED CONTRACTORS DECLARATION W ¢ � I HERF9V AFFIqAI UNDER PENALTV OF PERJURV THAT IAM LICENSED VNDERPROVISIONS OFCHAPTER � d 9(COMI+IENCING WITH SECTION 1000)OF DIVISION 3 OF THE BUSINE55 ANO PROFESSIONS CODE,AVD Z �X MV LICENSE IS IN FVLL FOflCE AND EFFECT.,, m �ie- ( � � LICENSE LLASS�ry `�LIC.NO. � � ` J V DATE L�/r�,-r--r�—�— CONTRAC70R h�V u U l (� �� - W � WORKERS'COMPENSATION DECLARATION J Q � U N I HEREBY AFFIAM UNDEfi PENkLTY OF PERJURY ONE OF TME FOLIOWING�ECIARATbNS: Z Q � IHAV WIILMRINTAINAC ATEOFCONSENTTOScLF-INSUR WORKERS' 2 QEN TION,AS PRO D BV SE ON 3]ooOF THE lAB ,FOR THE PERFORMANCC �U THE W RK FOR THIS PERMIT I � 0 � w .�.LL�AVEAN�WILLMAINTAINWORKERS'COMPENSATIONINSURANCE.ASREOUIREDBVSECTION �C�,�] rl Q 370oOF THE LABOR CODE,FOR THE�EftFORMANCE OF THE WORK FOR WHICHTHIS PERMIT IS � � � � ISSUED.MV WORKERS'�uv FNSATION INSLIFANCE�6AHfE{i AND POLI V NUMBFA ARE: CONSTRUCTION 6 «/ JC� �---_�-'. j caaaiEa ` L�s �L-'l' �� PLAN REVIEW _. Z aoucvNUMeEq C�--��,�-� LL� �--'C��i�� ELECTAIC ¢ � (i}iIS5Ec7%7NNEmNO7BE00MREfEDOFTHEPEf$M6FOR�NEHUpqREDDOLLMS(E7[a10RLE55). PWMBING w MECHANiCAL Z I CERTIFY THAT IN THE�ERFOPMANCE OF THE WORK FOR W H THIS PERMIT IS ISSUED,I [} SHALL NOT EMPLOY ANV PERSON IN.1NV MANNEA AS T ECAME S .�CTTO THE INSPECTION FEE � WORKERS'COMPENSATIONLAYdSOFCAUfOpNIA.A REETHAT . OULDBECOME SUBJECTTO THE WORHERS'COMPENSATION PROV S OF SE N 31ao OF THE LABOR � COD ISH LFORTHWITHGOMPLYWITHT OS VI'� NGE .. - p DATE: � � ��- APPLICANF�.. �/� SMIP - —�-..= , — W � ENERGY P1C J WARNING:FAILURE TO SECVRE WOfiKERS'GO M�ATION CWERAGE IS UNLAWFUL,AND SMALLBE � SU&IECTAN EMPLOY[R TO CRIMINAL PENA�T 5/(Ntl CIVIL FlNES UP TOONE MUNDRED THOUSANO ENERGY PERMIT _.. �O':.AftS(Stal,000),INADCITICNTO'YECO, ObCONPENSATION,DFMAGE5A5PftOV10EUFORIN J SEGTION3]oBOFTHELABOflGODE,INTEHQST,ANUATIORNEY'SFEES. RETENTIONFEE: . � w CONS7RUCTION LENDING AGENCV PRE-ALT FEE: d O Q IHEREBYAFFIRMUNDEF1F�NhLTYOFPERJVRYTHATTMEREISACG!�S?RVCTIONlENO1NGAGENGY ._. __ __..,_ � FOR THF PFRFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED(SEC.309],GIV.G.). Z W � LENOER'S NAME F- LENOER'SADORESS �� -— �� '�� I CERTIFY TNAT 1 HAVE 9EAD TNIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS COFREGT TOTAL F EES j � W IACREETOCOMPI.'IWITHALLGITYAN�COUN7VORDINANCES4NDSTATELAWSRELATINCaT09UIL�ING � CON57qUCTION,AND HEREBY AUTHORRE REPRESENTATNES OFTHIS GOUN�V 10 ENTER UPON THE � A80VE�MENTKNJEO PRDPERTY FDF INSPEGfIGN al1RPO5E5. Z GOM ENTS � ��IJ'��1-� l�4iZ L$.�-�N _ �Pl"2�r'�� J 1 = 3�a Pb m PERMI77EFNAME(PRINT) ¢ C� D7/ � ' � SIGNATURFOFPERMITTFF DATE RECPT.�O. P�1D Y VALIDATION x � WH17E-Department Copy,YELLOW-Finance Copy.PINK-Assessor Copy.GOLDENROo--File Copy,GftE N-Applicanfs Gopy t.�� :'��^,�F�.� :i �^ i�3 ;��a Y,�� i� n� '� �a� .i�t.=t at� �� a ,� '_� � �� . � , . . . .��,i .�' -� , , ��"�. �S ,�-//6�- :�. l : - -o�- , �v�� .�� _ _ �- �� - _ �r-��Y �� c� , _ ,�� " ��' � _ _ . / �� : �� , _ � % _ ; r�:�� . �, _ _ �J° �' _ �� i��=� � ,�oK � �� o �, � � � � � �,�� C ��d� ��/ f�� ,� . �� _ __ _ �� .e ,.: � _ _ � _ ,�� , �� , �� q"� � ��„ ,� ��,s:� 4 ; , „ � � � _ . � � ,� � °� _�� a�� - �� a �� .,, _ _ _ . � 1� � �� E'' � .� :n� � �� a � �;, ° � a �'� � i �� _ _� k a � �, � � � �, _ _ —� �: av �,�� .e �� , � �: t �� _ s � '9 ` � " 6 . . ... . . . ... .. . .. . . . .. . . .. . .. . . ... ... �` �� E 3 � g � . . . . .. . � r. _ � .� ,�.� v i�., _. ..._. ... .... ... . CITY OF DIAMOND BAR �� DEPARTMENT OF COMMiJNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION PRESS FIRMLY JOBSITE �� N �� ADDRESS �� APN LOT TRACT OWNER MR«/s/��U�R.� ADDRESS CITY Z I P TEL. � APPLICANT TEL. CONTRACTOR'}-c >�__"E ADDRESS�' �7(-r�'�,� L+�-�(�+ CITY�= o�; L rl.-r J ZIP� ��TEL ?�C� ��c(� �f ARCH/ENG/ DESIGNER Yr�J�I�fa ADDRESS P.'+ CITY IJ ZIP-�1 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 BUSIN ESS AND PROFESSIONS CODE:ANY CITY OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUGT,ALTER. IMPROVE,DEMOLISH,OR REPAIR ANV 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 SHEIS EXEMPT THEREFROM AND THE BASIS FORT LEGED EXEMP� TION.ANV VIOLATION OF SECTION 7031.5 BV ANV APPLICANT FORAPERMIT SUBJ THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(5500).): ^I,AS OWNER OFTHE PROPERTY,OR MY EMPLOYEES WITH WAG THEIR SOLE COMPENSATION, WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR EKED FOR SALE(SEC. 7046, BUSI- NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENS W DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON,AND OES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES,PROVIDED TSUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE. IF,HOWEVER.THE BUILDING MPROVEMENTIS SOLD WITHIN ONE YEAROFCOMPLE- TION,THE OWNER-BUILDER WILL HAVE TH RDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). ^I,AS OWNER OF THE PROPE,AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT C. 7044,BUSINESS AND PROFESSIONS CODE'.THE CONTRACTORS LI- CENSE LAW DOES NOT APP OAN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FORS PROJECTS WITH ACONTRACTOR(S)LICENSEDPURSUANTTOTHECONTRAC- TORS LICENSE LAW ^I AM MPT UNDER SEC. B. &P.C. FOR THIS REASON D 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- 3 LICENSE CLA LIC. N0. I S S f DATE��' '� -�CONTRACTOR X�Vc��L;l(� �� WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: 1 I HAV WILL MAINTAIN AC CATE OF CONSENT TO SELF-INSUR WORKERS' EN TION,AS PRO D BY SE � ''�lON 37000E THE LAB ODE,FOR THE PERFORMANCE THEW RK FOR H THIS PERMIT ISIGS� ) �+.LkLAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BV SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MV WORKERS' ENSATION INSURANCE$',AFRIEfI AND POLL V NUMBER ARE: �,C� II� �Z� CARRIER �� aI POLICY NUMBER�� -L-�-%��,� (THIS SECTION NEED N07 BE ODMPLETED OF THE PERMR IS FOR ONE HUppRED OCLLAGiS(5100)OR LESS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR W H THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANV PERSON IN ANV MANNER AST ECOME S CT TO THE WORKERS'COMPENSATION LAWS OF CALIFORNIA,A REE THAT OULD BECOME SUBJECT TO THE WORKERS'COMPENSATION PROV S OF SE N 3700 OF THE LABOR H FORTHWITH COMPLY WITH Y.OS VI COD I S c � � � DATE: -APPLICANTi WARNING FAILURE TO SECURE WORKERS'CO ATION COVERAGE IS UNLAWFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALT S tl CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS(5100,000), iN ADDITION TO THE CO 0 COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTERJiST AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS ACGNSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC. 3097,CI V.C.). LENDER'S NAME LENDER'S ADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. 1 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. �i�J T„��I,��kl PERMITTEE NAME(PRINT) SIGNATURE OF PERMITTEE DATE WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy %'�v�� ;CYO