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Home My WebLink About18157 � ^..,�., CITY OF DIAMOND BAR % � ��` DEPARTMENT OF COMMUNITY&DEVELOPIv�NT SERVICES I � �� 21825 E.Copley Drive �`�� " � .. ...,. ...,. (909)860-3195 Faac(909)861-3117 pAE$S �%�� BUILDINC PERMIT APPLICATION FtRMLY o DDRIESS_✓C� �/ ��LC�hti4 [JY '. DATECATION �r �� U BER Jf plC O � ' � � — ISSUE TYPE OCC APN l_OT TRAGT DATE CONST. GROUP p OWNER ��i1 l4 LnD �.G_ R A//rI �-�/J�'2 p ADDRESS__�r=f "VI r- ZONING SETBACKS oCITY ZIP TEL. FRONT RW � p APPLICANT IeF�� -{�f,-�h e.�, rE�.�'i6'��3�vY REAR �_ z SIDE/SIQE STREET RW ❑ � CONTRACTOR ` ' /7 . SIDE __ � ADDRESS��CO C'P. �r�s� I.`i e-�l.� L✓f7 � CIIY L-r-�ni�A-Lc ZIP / PROPOSEDUSE �{� G R P/9/ _ L4Pt•vieQM �c.o �— �,�� TEL. �/�- :l v�9` o ARCH/ENG! �"�7 7 �� v� '�C�, z DESIGNER � ADDRESS -- NO.DWEL. NO. NO. cn UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECLARATION SFR/ADD/REM O � I HEREBY AFFIRM UN[)ER GENALTV OF PEPJL'RY THAT I AM EXEMPT FFOM THE CONTRACTORS LI- G2fd(J8/C8fP0it W CENSEUWFORTHEPoLLOWINGREASON�SEC.'lo3t.58VSINESSANDPROFE5S10N5CA�E:AN"CITYOR (n Z COUNTVWHICHREQUIRESI\PERMI7TOCONSTRUGT,ALTER,IMPROVE.�EMOLISH,ORREPAIFANVSTRUC- W P0�i0/DBGk w TURE.PRIOR TO ITS ISSURNCE,AL50 REOUIRES THE FPPLICAN7 FOfl SUCH PERMIT TO FILE A SIGNED w � STATEMENT THAT HE OR SIiE IS LICENSED PURSUANT TO THE PqOVISIONS OF THE CONTRACTORS LI- � CENSE LAW(CHAPTER 9(O�MMENCING WITH SECTION 700D)OF DIVISION 3 OF THE BUSINESS AN�PRO- � POOUSP2 � FESSIONSCADE)ORTHATHEORSHEISEXE-MPTTHEREFROMANDiHEBA5ISFORTNEALLEGEDEXEMP- (� V TION.ANV VIOLATION OF SECTION 70]1.S BY ANV APPIICANT FOR A PERMIT SUBJECiS THE APPLICANT T0 Z Re-Root � A CIVIL 7ENALT'OF NOT MORE THAN FNE HUNDRED DOLLARS(5500).�: � ❑I,ASOWNEROFTHEPROPERTV,ORMYEMPLOV[ESWITHWAGLSASTHEIRSOLECOMPENSATIO�, � Commercial Z WILI DO iHE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFfEFED FOR SALE(SEC.7044,BU51- _J N NE55 AND PROFESSIONS CODE:THE CANTRACTORS�IGENSE LAW DOES NOT APPL7 TO AN DWNER OF � , PROPERTVWMOBUILOSORIMPROVESTMEREON,/WDWMO�OESSUGMWOFiKHIMSELFORHERSELFOR Q THROUGH HIS OF HER OWM EMPLOYEES,PROVI�ED�HAT SUCM IMPROVEMENTS ARE NOT INTENDE�Ofl m O OFFEREOFOHSALE.IF,MOW'EVER,THEBUILDINGORIMPROVEMENTISSOIDWITHINONEYEAFOFCOMPLE- Z TIqJ,7HE OWNER-9UIL�EFI WILL NAVE THE BUqDEN OF PqOViNG THAT HE OR SHE DID NOT BUIL�OR � IMPROVE FORTHE PURPOSE OF SALE). w ❑I.AS OWNEROFTHE PROPERTV AM EXCWSIVELV CONTRACTING WITH LICENSED CONTRACTORS '�-�y � TO CANSTRUCT THE PROJI:CT(SEC.]046,BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LI- V8IU8IIOf1 S�v `��^ ADJ.AREA W CENSE LAW DOES NOTAPPLV TOAN O4MER OF A PROPERTY WHO BL'ILDS OR IMPROVES THEREON,AND � WHOCONTRACTSFORSUCHPp0.1ECTSWITHACONTqACTOR(5)IICENSEDPURSUANTTOTHECONTRAC- QUANTITY. DESCI�IPTION FEE Y TORS LICENSE LAW.). Q ❑I AM E%EMPT UN�Efl SEG. B.8 P.C.FOR THIS REASON Q ?j U � DATE OWNER H Z U � LICENSED CONTRACTORS DECLARATION W < � I HEREBYAFFIRM UNDER PI:NALTY OF PERJUqY THAT I AM LICENSED UNDER PFOVISIONS OF CHAPTER � � 9(GOMMENGNG WITH SEGI'ION]oCo)OF DIVISION 3 OF iHE 6USINESS AND PROFESSIONS CODE,AND Z `X MYLIGENSE IS IN FVLL FORCEAND EFFECT. m j� L"� � LICENSE/C�LASSe�V UC.NO. � � Yl� � U DATE �.=" /'L��'� CON7RACTOR�L'J S�17C+�q ry�� d W � WORKERS'COMPENSATION DECLARATION ¢ � U � I HEREBYAFFIRM UNDER PE:NALTV OF PERJURV ONE OFTHE FOLLOWMG DECLARATIONS: Z � IHAVEANDWILLMPMTAINACERTIFICATEOFCONSENTTOSELF-INSUPEFORWORKEqS' a Z = Q COMIPENSATION,AS PROVI�ED BV SECTION 3l0o OF THE LABOR GODE,FOR THE PERFOFMANCE U OF TME WOqK FOR JYHIGH�HIS PERMIT IS ISSUED. W O � w IHAVEANDWILLMAINTAINWORKERS'COMPENSATIONINSURANCE,ASREQUIqEDBVSECTION (� Q3lOD OF THE IABOR CODE,FOPTHE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS \, r1 • � ISSUED.MV WORNERS'COMPENSATION INSURNNCE GARRIERANO POLIGV NUMBEI7AFE: CONSTRUCTION u � J �_ �' _ � GARRIER S r j'�'(i� �'�__ PLAN REVIEW 'J 1►L � PO�ICVNUMBER_ � c�C 7 S7 Z � �J`-T ELECTRIC � (7HlSSEC710NNEmIJC1TBE00AAPLETE00FhEPERHNTISWRONEHUND{iED00LLAFiS(y10o)ORIESS). PLUMBING W Z I CEflTIFV THAT IN TIiE PERFORMANG�OF THE WORK FOft WHIGH THIS PEFMIT IS ISSUEU,I MECHANICAL C} SHALL NOi EMPLOV HNV PERSON IN:1NV MANNER SOAS�O 9ECOME SUBJECT TO THE �- � WORKERS'COMPEMSATION LAWS OF CALIFORNIA,AND AGfiEE THAT IF I SHOULD BECOME INSPECTION FEE � SUBJECTTOTHEWORKERS'COMPENSATIONPPOVISIONSOFSECTION3]OOOFTHELABOR � - � /rODE.ISHALLFORI"HWITHCOMPLVW.IT�H7�T.H�OSEPROVISIO✓N-S� ISSUANCE p DATE."' 4 G��' APPLICANT: ��[./�'�Z, /YI��+-L��r-- SMIP �D�� W J WAFNINGFAILUHETOSEGUREWORKERS'COMPENSA710NCOVERAGEISUNLAWFUL,ANDSHALLBE ENERGYP/C J � SU&IECTANEMPLOVERTOCRIMINALPENALTIESANOCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOLLARS(51oo.oCO),IN ADDITION TO THE COST OF COMPENSATION.DAMAGESlS PROVI�ED FOR IN J SECTION 3]080F THF I ABOR CO�E,INTERESi,ANDATTORNEY'S FEES. I �� w RETENTION FEE: O CONSTRUCTION LENDING AGENCY PRE-ALT F—E�, ,, � 1 HEREBV AFFIRM UNDEF PFNALTV OF PEFJURV THATTHERE i.S ACONSTRUCTION IENDING AGENCY U FOR THE PERFORMANCE OI-THE WORK FOR WHICH IHIS PEflMIT IS ISSUE�(SEC.309'!.CN.C.�. -", Z � w � LENDER'S NAME _ . H LENDER'SADDRESS w ICERTIFVTHATIHAVEREADTMISA�PLICATIONANDSTATETHATTHEABOVEINFORMATIONISCORRECT. TOTFIL FEES� ��N ,C��N�I � I AGREE TO COMPLV WITN ALL CITV AND COUNTY ORDINANCES AND STATE LAWS RELATMC.TO AJILDING � CONSTRUCiION.AND HERE3VAUTHORIZE REPRESFNTATIVFS OFTHIS COIINTVTO ENTER UPON THE Z A30VE-MENTIONEDPROPERTVFORINSPFCI�ON PURPOSES. rt �a COMMENTS � /T A II-/ ��='i�r h r I l m PERMITTEENAME NT� Q L � �1/�.cz'/ �-�� G�-'7� � SIGNATUREOFPERMIiTEE DATE � RECPT.NO. PAID 6Y VALIDATION WHITE—Depanment Copy,VE�LOW—Finance Gopy,PINK—Assessor Copy,GOLOENROD—File Copy,GREEN—Applicant's Copy '9�a j : _ i � �; �� '��' a.,k��w,�� ..a•��: �9 e� � 4� �� ,` �a"h . x ^�i,: Rt, Y t� �' yi �6 i R��-+, �' � ��.. ' _ ' . . ... . . .. . � .. � . t"��.ui��.,�,�k�fl�'i .t'x � �' , �/ I j'��Gf/�t4«d��:�.�' � �/l �t f `��'tl��. (`�" � ^��. . ,� � , � �� w _ �� ,�.�: s � �� . ,.�� . .. .. .. .. .. _ .... .... -. , x, „ ,-�,�r k..��a.a.�.a�� .. . .. . ........ ...... . ._.. . ._.. . ..... . ..... .. . .... ........ .... .. ...... .... . . . ..._. �:" ... . .. ... ... ... .... . _.. ... . . ...... . . .... ... .. . _... .... . . ....... ...... .._.. ...._ '�. ' ��, o =i� 7 .. ... .. . . ...... .. . ... .. .... . . . .... _.. .__. _... °� �"� � . .. ..._.. ....... . i � "" ��'�� '��n� � ��. � '��- �.� �n�1��.� �7 �y�� ,�r�w a' _.. .... ... ... ..- - -. . .. . ...... . ..... . . .. ... _... ..._ . .. tl�i' � i 5�' i s��°�i.��"�firryc°. . . ... ...... -;.'��, ��' a �. ��i x �kr �.- . . . . . .... ... . ... . ... .. .. .. .. .. . r�� .»r �i � � � .. � �'� € �'��6�' dt} .._ . .. .. ... . . . ..... . .. . . � �1 s; fl# . _ _._ _.. .,.. ."-�:, '�� r� �-�1��.la, .. - �'- ;�� ,�'�"rw a.h��_r,... ' --�� ... ._ ._. _ _.. _ .._.. .. -__ -. a'; �,� 5� ?"�.,r k�n: �` �Sz,m ,sY��, . . .. ... .... .. . . .... . ... . . .. ... . . �:� � � rd� "k�� ; , ��. z : E.., .... .. ..... . ...... ..... . .... . . . . _.. .... .. ...... ... ._.. ..... .... .. . � e �� A6. . .. _ ,} .IEI�... � ,'��'� E §loJs.'- . .. ..... .:,.. ..... ..... _._ .... ._..._ ... .. ... ..... ._.. . _... . ..._. ._... ....... ... .. .. CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION JOBSITE ADDRESS- 13A APN LOT TRACT OWNER/1/4 LI)D G-A//�} �DT 7 ADDRESS"-.'f4"A-i C- CITY ZIP TEL APPLICANT P:cl 111111 -i{f, Hn e.y TEL. fE'/� "7G 3 K yY CONTRACTORh ADDRESS_35e'0 c'. -r--,'j'�"�t L,1 () CITY L-r"_rt 06-LC ZIP 9'iaVJ'TEL. k/d•' I Y 9 � ARCH/ENG/7 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)% 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).): 111.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 OFCOMPLE- TION.THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). U 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.). U T 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 MY LICENSE IS IN FULL FORCE AND EFFECT. LICENSE CLASS LIC. N0. DATE G CONTRACTOR WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PE=NALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: -1 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. MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: r 7 CARRIER 7 I- ) POLICY NUMBER i -C 7 7 (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 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 ODE,I SHALL FORT-HWITH COMPLY WITH THOSE PROVISIONS. T DA 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 ACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF 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 CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. PERMIITTTEEEENNAME NT) SIGNATURE OF PERMITTEE DATE WHITE-Department Copy,YELLOW-Finance Copy, PIN APPLICATION j .. L'PERMIT P/C. DATE��UMBER# ISSUE TYPE OCC DATE CONST GROUP ZONING SETBACKS FRONT RW^ REAR^ SIDE/SIDE STREET RW^ SIDE^ PROPOSED USE�/G R PA9i_G4PE•c•4&Rao N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SC. FT FACTOR PSF ADJ.AREAA/ALUATION SFR/ADD/REM U) Garage/Carport W Patio/Deck LL Poot/Spa Z Re-Root Commercial Valuation ADJ.AREA QUANTITY. DESCRIPTION FEE J OC I- U w -J CD Z ca CT CL Q Z 2 U w I CONSTRUCTION v PLAN REVIEW'J ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: �V y PRE-ALT FEE: TOTAL FEES�Q QtIY\P' COMMENTS RECPT N0. PAID BY VALIDATION