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Home My WebLink About17824 _ .-----', CITY OF DIAMOND BA.R � DEPARTMENT OF COMMUNT"I'Y&DEVELt}PMENT SBRVICES � 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 PRESS . .»� BIIiLDINc PERMt'r APPLICATION . FIRMLY � JOBSiTE , APPLICATION PERMIT a -� t�. P/C � ADDRESS�� '�'"'�� DATE.._� � CS�Z-- NUMBER ' �� " # � ISSUE TYPE OCC .- APN lQT� TRAGT — DATE CONST. _ GflOUP p OWNER A,^nr<�Wo � L�S.rb�,r- N'�rn+��ti��"�,'�,� � ADDRESS�+�,,.$.`��_a� ZONING SETBACKS � c�rr�c;.s.�,,,? nsaR-" zfP �i��.. �RONT _ �w �� APPLICANT 7�� _^ REAR :�__ o SIDElSIDE STREET RW O � CONTRACTOR SIDE � C ry ADpRESS -- PROPOSED USE ��- � �` 2 � CiTY ZfP TEL. _ � ARCH/ENG/ � DEStGNER � ADDRESS __ NfJ.DWEL. N(7. NO. UN3TS ST4RIES BEDR40MS � C1N ZIP__�.._ TEL. � dESCRIATidN ${].FT. FAGT{}R P8F AD.1.AREANALEIATIDN � OWNER-BUILDER DECLARATIC?N SFRlADp/REM O G] I HEREBY AFFIRM UNDER PENALTY Of PERJIJRY THAT I AIA EXEMPT FiiS7M THE CONfRACT4FS ll- � G8f8J0/G8fp01I Lll CENSEIAWFOR7HEPoL4..OW7NC.REASON(SEC.J031.S8U51NES5/4DPROF£SSION$CODE:ANYC4TY�ft � COUNTYWNiCHREOU63ESAPEiMAiTTOCONSTRUCT,AITER,IMPflOVE,OEMOLiSH,OflREPAiRANVSTRUG� � patio/Deck W TURE,PRIOR TO ITS ISSUANCE,ALSO RE�UIRES THE APpLICANT FOR SUCM PERMIT TO FILE A SIGNED � &TATEMENT TNAT#iE OFS SHE tS LiCEN5E0 PURSUANT TQ 7He PA�YISIONS QF T4E GONT'ftACTORS tl� � CENSE LAW(CHAPTEP 9(GOMMENdNG WITH 5ECTION 70001 OF DIVISION 3 OF THE BUSINESS AN�PRO� � Poal/Spa FESSIQNSG7DE)ORTHA7MEORSHEISE%EMPlTHEREFROMANOTHEBASISFORTNEALIEGEDEXEMP� (� U TION.ANYYKJIATpNOFSECTiON703tS8YANYAPPIiCAN�F4RAPERMiT5U8JECtSTNCAPPtiC.AHTTO z Re-Aoof � A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDREP�OLIARS IS500�.��. � ASOWNEROFTHEPROPERTY.ORMYEMPLQVFESWITHWAGESASSHEIRSQLECpMPENSATION, � G6li1ti18tCi8) Z W4L TNE WOF7K.AND THE STRUCTURE IS NOt IN7ENDE0 OR OFFERED FOR SAt,E t5[C.7P94,BVSi� _I � NE AND PROFESSIONS CODE:THE CONTFpCTORS LICENSE LAW DOES NOT APPL1'TO AN OWNER OF = AROPERTYWH68UIlDSORIMPROVEuTHLREON,ANDWNODOESSUCHWOftKH1MSEL+ORY.ERSE�FOR � (r 'fHROUGHHISORHEROWNEMPLOVEES,PROViDEDTHATSUCHiMPROVEMENTSAflENOT7NTENDEOpN llJ OFFEREDF6RSALE.IF,H4WEVERTHEBUILDINGOfi1MPROVEMENTI550LDWITHINONEYEAROFCOMPLE _ � TION,7HE QWN£R�BUI�OER Wi�l tiRYE TtiE BURDEN OF NRt�ViNG 7HAT HE CSR 5HE 610 NOT BUfL��R 'Z IMPR VE FOR TME PURP45E OF SALE). �j ASOWNEflOFTHEPRbPEHI'Y,AMEXCLUSNELVCON'flACTINGWITHLICENSEDCANTRACTOPS [� TO CO STRUCT TNE PR��IECT(SEC.70di,8tlSFNESS At�X7 PROFESSIIXJS CODE�TNF CON7RACTORS li� VdlUdti0tl ADJ.AREA_, LU CENSELAWDOESNOTAPPLYTOANOWNERIJFAPPOPERIYWHOBUILDSORIMPRC}VESTHEiiEON.AND � WHOCONTRACTSFORSUCHP90JECTSWlT4tACONTRACTOR{S)�ICENSEDPURSUANTTOTHECqNTRAC� QUANTITY DESCRiPT14N FEE TdRS LICENSE�AW.}. j' �y �� CL J �R K�7�-L�I�� s �Ct ��y t�i tM EXEMPT UNDEA SEC. .,, , B.S P.G FOR 7NI5 flER50N � > _ F � __ [[ �'i" DATE / �T.,,__� OWhtER � � Z W � LiGENSED CONTFiACTORS DEC�ARATt4N �j d � i HEHEBY AFFIAM UNDER PENAITY OF PERIUAY THAT IAM LtCENS[D UND[R PftQVISiONS q�CHAPTER � (L 9(CQMMENCING WITH SECT�ON 7600)OF OIVISiON 5 OF TfiE BUSINESS AND PROFES510NS GODE,AND Z ... W MV LICENSE IS IN FULL fORCE AND EFFECT. m � � UCENSE CLASS �..� LIC.NO.__� _ j � 6ATE CON7RACTOR d W . � WORKERS CdMPFNSATlON 6ECLARATION -� Q � U � i NEREBYAFFIRM UNDEfl RENAGTY 4=AER.IUftY ONG 6�1'HE FOIIOWlNG OECt,ARATiONS: Z Q C] 4HAVEANOWILLMAIN7AINACERTIFIGATEpFC�N5E�4TTOSE{F-INSUPFFpRWORKERS' _ � CqFAPENSATION,AS PROV@E6 BY SECTiON 3]W OF iHE IAeQR CODE,FOft THE V£R'.ORMAFlCE W OF TME Wf7iiK FOR WHICH THIS PEflMIT IS ISSUED. � � W _„ I HAVE nNP WILLMAINTAIN WORKEH9'COMPENSATION INSURANCE,AS REOUIREQ BV SEC'fION Q �3790 OF THE LABQA CODE.FOR THE PERFORMANCE OF THE WORK FOR WHICH TNIC PERMIT IS — ISSUEQ.MY WORKERS'C6lAGENSAti6N INSUFAM1I(:E GRRIER AND POL%CV NUMBER ARE: CONSTRIJCTION � caaaiea__. ... � PIAN REVtEW ...... ....�... � POLICY NUMBER ... ELECTFIIC �'+� , " � t «�* r.. � (n1I55ECilONNE�NOTBECd-AREfEDOFTHEPERMRISFCXi�NEHUPUREDDOILARS($7W)ORLESSI PLl1MBING �`^;'� �'-�� MECHANICAI. �.- � �CERTIFV TNAT IN THE PEAFOPMdNCE OF THE WORK FOR WNICH THIo PERMIT�.S ISSUED.i �- (,�J SHALLNOTEMPLOYANVPERSONiN+\NVMANNERSOAST08ECOMCS'J�JECTTO7HE tNSPECTIONFEE Uj WCftKEftS'COM?ENSATI�N I,AWS OF CAU�OriNiA.ANDAGREE THAT if i SMQUI�&£COME -- SVBJECTTOTHEWORNERS'COMPENSA714NPRC7VISIONSOFSECTiq43]OOOfTMELA50R �-�� = CODE,I SHALL FOftTHWITH C(7MPLV WITH THOSt PROVISIONS, ISSUANCE _. . � OATE;__ APPLICANT: .. SMIP __ ._ ' � ENEI�GY PIC _ .. J WARNING:FAILURETOS6CURE`NORKCIiS'COMPENSATIONCOVERAGEISUNI.AWFUL.ANDSHAILBE � SU&IECTANEMPLQVERTOCRIMINALPENAL7IESANDCIVILFINE5UPTOONEHJN�PEOTMWSAN� ENERGYPERMIT _.,__„ _.. ilOIiARS{$t00,9007.FN ARDITiON TO TNE CAST 6F GOMPENSATIIXi,DAMAGeS AS PHOV'6ED FOR W 1 ..rJ SEGTION3708oFT�iELAdoHCS7�E,MTEREST,ANDATTORNEV'SFEES. RETENTIONFEE: .. _,. 1 `�}�- f�C -' d CONSTRUCTtON LENDING AGENCY PRE-ALT FEE _.. _ �� CC i HERE61'AFFIRM VNDER PENAl.7Y OF PEFUURY THAT TNEftE 4S AGONSTftVCTiON IENQiNCi ACaENCY ,_ _., .�_ ... a- FORTHF�'E��ORMANCEOFTHEVJOflHFORWMICNTHISVERMITi515SUED(`uEC.J091,CIVC). � — W .,=y LENpER'S NAME_ __. � _„ > F� CEN6ER'S AS36RE55�.. — -- ��--��-- r/^� [' (j]�' � tCEftTiFYTHATiHAVERGAD'l�NSAP#'llCATiqNANCSTATETHA'.TMeABOYElNFOftMAT14Ni5CORRECI'. I1.ITAL(-E�S �� r+� � IAG(1[[TOCOMPLYWITMALLCITYAN�COUNTYOfl�INANCE5AND5TATELAWSflELATWCSIOBUILDING ' � CONSTRUCTION.AND HEREBY AUTMOHIZE REPRESENTATNES OF iHIS COUNTYTO ENTER UPON THE � +ZftQYEMENii�'EQPRQPcRTYFOfltNSPEGfIOF7Pt3APC!£ES. CpMMENTS ___ .._—... � ?`L1 tLN.�a4-, �ttiY N�irt o� ,_ m PERMIiTEE NAME(PRINTI l �� Q� � f --�.I��R��,—...,--^. � 1��r��-fr�t�.�'' � �r-`'""fnATE`� i `l- i�3�Z � �„ � r _ � --- � SI NA7 i�r OF = RECPT.M1t , , PAIp BY ._ _ VALIDATtON ~ WHITE—f7epartment Copy,YGLIOW—Pinance Copy,PINK—Assessor Copy,GQIDENROD--PBe Copy,GREEN—ApplicanYs Copy �t�q��,rv�t��,� ' - µ*r,��www�� & h 75 _ — �, Y 9 r. �+ �"i' �� &Y"I��Ir. - - - . . , a > . , aF r.1'�r< 1�1 . . .. �. ��/ (� �..��rv��u.. .�. .. ... . .... . ..... ..... .... .... . i (. �c�"�:"'-�v..�.�., . . .... .... . ..... ... . .... .... . .... .. .... ... .� ... ...... . ........ . ... .. ..... . . ... .: . .... .. . ._ .... .. ��-1.�t�3 ,�� _ .. ; � � m. ,:.� � �f�c�.�Z(;��( Q� c-cR,u�✓t�' � . �'`f 6 `�1� �+�J c�utor�3��v I.�& ,S�cf.l� 1 f�b Sc-4x-s 6�� _ _ _ _ , �� '� = ti� � _ �� a �~ - _ a�� t��«� �� !?�ix �, � � �' ��o-� � ur _.. .... . . . . .... ... ... . _.. . ... ... x �b`�'( �' s"ifi)€�.�°� �',�. a".��f-az� � `�r'��"�,�ri�,,�`„��.� � ��.. 3'°'��'�� A��'� r��p'"�'z��,��e'�`�.� � �2 ��axf 9 a � �-� . _ _ — �� ' _ _ _ �is �'"y�u ` ! � , »�, � � .... . .... .. . ... ._ .. � � .�u � 3" �. .. _ . . ... . .._. .. . . .... . .... .... � s � �k 7^t�� '�� k`�� i�; � ' � _. �f-�� .� t °� "6'ih � 'i j ., . .. .. ... .. . .._ . . .. . .. . .... ... . .... __.. _... . .... . .... .. ' � "�:� s r� � _ .�.'"+at r; � .�.. ,. , �r 7 � t ry . ti�, . ( i a 5€ �. .._. . .. .. � � ��2 � � .. . ... ... .. ... . .. ._. .. —. ... . . . . . .... _ _ _ n �� ;� � �� j ._.. _ . � �a.. � �'� �� n,�1 `�.�� ... .. w .� .�r,�t� .�..,. ... ...... .._. . ... .. ... ._. ...... .. ... .. 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 9 APN LOT TRACT OWNER Ar^rV-WC Pv-r",� lst ADDRESS'3 ^C.Ltw-c- CITY(A-ZIP 91_jig' EL. APPLICANT TEL. CONTRACTOR ADDRESS CITY ZIP TEL. 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).): AS OWNER OF THE PROPERTY,OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WIL THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC. 7044, BUSI- NE 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 IMPRE FOR THE PURPOSE OF SALE). AS OWNER OF THE PROPERTY.AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CO STRUCT 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 A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW). ^I AM EXEMPT UNDER SEC. B. &P.C. FOR THIS REASON DATE_4 I( D L 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._ DATE CONTRACTOR 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 LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MV WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER POLICY NUMBER (R-OS SECTON 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 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 WITH THOSE PROVISIONS. DATE:APPLICANT: WARNING FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES 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 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.). 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 CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. Key-a CIA-d e PERMITT,�EE EE.� NAME(PRINT) SI NAT OF ERM EE/DATE APPLICATION e .Z PERMIT 24 P/C 7 � I Z- O N a DATE UMB R � ISSUE If If TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW^ REAR ^ SIDE/SIDE STREET RW^ SIDE EI PROPOSED USE / e L )e2- (,.e- N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION S0. FT FACTOR PSF ADJ.AREAIVALUATION SFR/ADD/REM U) Garage/Carport W Patio/Deck LL Pool/Spa 0 Re-Root Z Commercial M Valuation ADJ.AREA QUANTITY DESCRIPTION FEE ED CJ Q Z U w CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING�'/ "_�� b_ MECHANICAL INSPECTION FEE ISSUANCE rr C7(� SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: . 00 PRE-ALT FEE: TOTAL FEES COMMENTS RECPT N I UUOyQ30'o'AID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy i' 1 uu 2 +o'�cj CyN,ocrto�I p2o 0 v.7