The URL can be used to link to this page

Home My WebLink About16076 _ i� �� 1„� CITY OF DIAMOND BAR DEPARTM�NT OF COMMUNITY&DEVELOPMENT SBRVICES • 21 b6(}E.Copley I�rive Suite 140 ,_,/ w (909)86Q3195 Fa�c(9Q9}$61-3117 PRESS ��°� BUII.DING PERMIT APPLICATION FIRMLY � DDRIESS�_�Z_�S�'T _I�_tAlk.�� ^ DATE CATION � �- ? � NIfMBE `" L� ql��-r r� ISSUE TYPE OCC APN T TAACT DATE CONST. GROUP p QWNER � ADDRESS ZONING SETBACKS � CIT'�,[,�„�� ZI� - TEL FRC}NT _ RW G T APPUCANT _ TEL, REAR (� S{DE/SIDE STREET RW C7� � ADDRESST��x� �� SIDE _ ❑ � PftQP �S�ED��US CETV�d j��a . ZtP TEL€j �/S��qarf_k.. � ARCHIENG! � f�� OESIGNER ^ — N0.dWE� NQ. NO. � ADDRESS UN1TS_ STORIES BEDROpMS � CITY ZIP TEL. _ � — DESCRIPTION SQ.FL FACTOR PSF ADJ.AREANALUATION vs � ONMER-BU4LDER DEGSARATIQN SFR/AODIREM O � 1 MEREB�AFFlRM UPIDEfl PEN�V.TY OF PERJURV THAT I AM E%EMPT FROM THE CONTRACTORS U� G2f2�ICdfpOR � CENSEtAWFOftTFiEWIlOWM1GREA30N(5EC.70.3t_SHt?SINESSANDPR4FESSI6M1SSt;ODE-ANYCI7YOR (J� COUNfIYWHICHREWIqEE��APERMITTOCONSTRUCT.ALTERIMPpOVE,bEMOLISH,ORREDAIRANYSTaUC- W PatiO/DBCk TURE,PRIQR TO(TS ISSUMlCE.ALSfJ REOUIFlES TNE APpLIC4NT FOfl SUCN PERMIT TQ FIIE A SIONEQ � ,� STATEAtENT TN�T FIE OR:iNE IS�iCENSED PURSUtNT TO THE PPOVt$IONS OF THE COMRACTOFS U� � CEN$E UW(CFUPTER G(IXIMMENCINO WITH SECTION 7IXW)OF DIVISlON 3 6F THE BUSINE55 AND Pfl0- LL' POQ�SP� iES510NS Gf WE}OR THAT HE OA SHE i5 EXEMPT 7NEREf RCJM AND THE BASIS FOft TME AI�EGEV EXER6'- TpN.MtYVqLATKNiOf$ECTIpN7at1.38YANYAPPLiGANTFORAPERMITSU&IECTSTNEAPPLIGANTTO Z Re-Root r A CIVU.PENALTY OF NO?NIORE 7HAN FIVE NUNORED�OLlARS(f500).): � DI.A30WNEft�TMEPflOPEflTY.OFiMYEMM.6YEESW{THWA¢ESASTHERiStJLEC4MPENSASiON, � �ommercial WILL po THE wORK,uaD TME 9TRUCTUqE IS NOT MTENDED OR OFFENED FOR SALE(SEC.�oa4,BUsI• J NE55 ANO PROFESSIONS�COD£:THE COMRACTORS LICENSE LAW�OES N4T APVIk TO AN oWNER f1F � PR(N�ERTY Y�'tiQ 8llkO50R RdPRC3VES 7HEREON.ANO Wtib�0E$SUCN WONK H�AASEIF OR HERSEtF OR � [,t THROUGHHISORHEROWNEMPLOYEES,PROVIDEbTHATSUCNIMVR4YEIAENTSARENOTINTENDE00F m � OFFEAEDFCIRSALEIF,H01MEV6R,THEBUILOINGOqP.IPqOVEM6NTA5&QlQN1TMINQNEYEAAOFfAMPCE- � TqN,THE OWNERAUItbER VflLL HAYE TNE BURCEN OF PROVING THFT HE OR SHE DiD NOT BU�L�OR � IMPfNJVE F4HTN6 PURPqSE pF SALE�. [t i.AS RVMSf1 OF TNE PfM?PERTY,AM EXCLUStYElY GCNT'flAGSSNG WfM llCENSEO C"�JNTftACTQF{S � TO CONSTRUCT 1HC PROaECT(SEC.7oN,BUSINESS PNO PROFESSICNIS CQUE:TNE CONTRACTOflS LI- V3Illati011 ADJ.AREA L1J CEN56lAWDOE9NOTAPPLVTOANOWNERUF�PROPEFiTYWHOBUILOSOqIAAPRpVESTHEPEpN.ANp � 1RRro�NTFiAc75FOR5UC'.HpF%�cTSWiiHACON7RACTOR{S}llGENSEDFURSUtMT4TriECOPtiRAG flt7ANTITY DESCftIPTION FEE � TORS 4�CENSE UW.). — ---' -- _.—. �. ❑I hN EXEMPT tR�7DER SEC.� e.t P.G FOp 7HIS AEASON U � � DA7E _�.�OWNER�,..... U � J � L�CENSED CONTRACTORS DECI_ARATION —j � � w IFIER£BYAFFiRA/UNOERPEN,ti.'YOFRERlURY7HATiAMUCENSE4UNDERPRoviSKN7SOFCNAPiEFi L,} p� i(COMMENCiNO WRH SECTION 7000)OF D�VISION�DG THE BUSINESSANO pRDFE9510N5 CODE,ANU Z X MY UCENSE�S IN FULL fOflCE AN�EFFECT � ll� � LICENSE C4A55�� LIC.N0. � � r � W DATE�.�e.-=,.,�,L��!�'!5 / CDNTW4CT R d f � WOFKERS'GOMPEPISATION DECLARATIQN � ¢ � I HEREBY AFFIRM UIdGER PENALTY OF PERJVRV ONEOF TME FOLLOViiNG OEt'URATIOMS�. � C/? Z Q 0 _,_ENAVEANUVltLtAUSINtAWAC£RTifiCATEOFCfJNSENTiOSti.HNSUftEFORVtORKEftS' _ � COMPENSATION,�1i PROVIDED BY SECTION 3700 C1F THE LAAOR CADE.FOR THE PERFORMANCE `U OFTHEW4RNFOFWHICHTHI5PERMITlSISSUEb. � I � � � � �IHAVEANpWILLM:\IhTAWWURNEfl5'CAMPENSATIONINSURANCE,ASREOUIHED9YSECTION Qs7W OF T41E IFBUFt COpE,�4R?Hf PEftYOF@AANCE OF iNE WQRK FOft WHIfFtTHiS PERM3T IS �4 �� .,_ ISSUED.MV'WORKE:RS'COMFENSAT14N INSURANCE CARRIER AN�POLICY NUMBERARE: CQNSTRUCTION _ „�___� � cnRR�FR ��.�_f�` ~ � .—.—... —..— PLAN REVIEW _..�„!—L.�'� —_ 2 aa.icv nuMSEa_�_�.,,{l--��— ELECTRIC ..�.. . -- �4 � �+ss[cnoraNEcaworeEmr.a�ErtooFtv�aEw.rt�sw,aoraer+urtK�000t.inas�5iw)attFss� PLUMBING � _A_ � I C[G�TIFY iHl1T IN 7HE PERFbRMANCE OF THE WUHK FOF WMICH THI&PERMIT IS ISSUELI,i MECHANICAL �..._� ._...._. _'._ (,'3 SHALL NOT EMPLOI'A,tiY PEHSON IN ANY MANNER SO AS TO BECOME SUeJECT TO TNE 1K�4_, rfy WCRI(E#i5'f.9i.iPEN$ATIONCAWSOFCAt{F[}RNtA,ANDAGFEETHATiFlSH4ULU9ECOME �NSPECTIONFEE � .t• i9 R x /—�-- � SU&JECTTO THE WOFKERS'GOMPENSATION PROVISIONS OF SECTION 3]Oq OF TNE LABCIR ^ — coaE,i sHAu�on�rxw�rHcoMc�r win+n+ase o�ov�sbrvs. ISSUANCE ,,. __ + G�Y � SMIP �� DATE:_.�. __ APPLIGANT. _ —.....— .. �--��;�'�� —..—...---- •_�c1-�.L � ENEFGY P/C � � .. J WARNING FNLURE TO SECUqE WORKEFS'CAMPENSATION fY�VERnGE I5 UNtAWFUL,AND SHALL BE � SU&IECTANEMPIOYERTClCRIMWAIPENAl_TfESANDGYILFMESUPTOON6HUNOREDTtbUSAND ENERGYPERMIT x�{� y�5 � �� i `y,`''t:(. OC}LI.ARS(f10000t)1•7NAbOi"f�ONTO7HECO5TOFCOMPENSATiON,bAMAGESASPR6VIDE0FORW �` y i"" ' � �/}�(�'� � SECTIiIN 370!OF TNE LABOR CODE,INTERE6T,ANO ATTORNEV'S FEE9. RETENTION FEE ' ;T #Y€'�!k r �`� 4 1 ��t " - k�...�... � CONSTflUCTiONLENDWGAGENCY PRE-AL7FEE: , _....._ O � IHfREBYAFFiRMUNOEflPENAtTVOFPFRJURYTNATTHEREiSACONSTpUCTiaNL6ND�NGAGENCY _ � _ FOR TNE PERWPMANC�OI"TNF WORK FOR WHICH THIS PERMIT IS ISSUED(5EC.3oa'l,CIV C.�. W � IENpER'SMAME� _ —... _ F� LENDEiYSADDRESS_ » / � I CEflTifY THAT t HAVE REA6 TNiS ARPI�CATiON AND STATE THAT THE ABOVE�NFORMATpN is CORREGT. TIITAL F�GS � �1 �` � �Y C � {• �� I AGflEE TO COMpIV WITH A_I.CIiV ANO COUNTY ORDINANCES ANO STAiF LAWS RE4ATINQ TO BUIL�INCr � CONS7flUCT10N,AND NEREeY AUTH4ft�ZE ftEPRESENTATIV ES S7F THi$CWNTY T9 ENTEA VPpN THE ABOVf-FAE.NTIONED CROCEi2N FO INSPFCTION PURPO . � 2 COMMENT$,��j_y_(�____�.,�g�.U .� � �� J � � �I_�._— — ....—__.� — @ PERMiTTEE N E ' � — 'Q � � r �) � s�crtAT �FNFru��*E� �a� RECPT.NO._�_ _,_. PAIDBV VALIDATION_ �� 'f � WNITE--Department Copy,YELL W—Finanae Copy,FtNK—Assessor Copy,GOLdENROD—Fiie Copy,GREEN—Appiicant's Copy 4� . 4a�� b.,.��3�a.�'�.�„}�€��i�-n' ��tx"�� .��-�.r��.,5�i�� "'�i��.,:�� :a , . .. . Y .� A. ��;� 6„,.+'�, � � : � _ �' � „ � � j 3 � � 4��.�`� ,t � �" - ' ' a�, !" , � � r, � � '.. � _ ; . i � -� � _._ , _____.... _ _ . t.�. _ _ _ _ _ _ _ _ _ __ M, _.. r - � .;,. ,,��.-; .,�s��; , i =: r t . � � _, . _. ..._. ..... .. ....... .__. _... __. ..., ...... ..... ...._ ._... ..._ ... . ' . _ ..., E ., . . . _ . ��. �� 't � , = . .3 , � . . .:: �"." ..... ._. .._. ...._ .__ . . ._._ r .' '_.._ .. . _ ,..� . � ..�- ° .._.. . . .. . __ ___ .._. _r_.,_,.'r—„ .._ . .,,_ . . '... . .._. . ._.... , .._. ..... ...._ ,.._. .. . .. _ -.. . .._. ...._. .. .... . a - . . , -,.� ,,. ,.a�r- 3 i=y�b� i ..i"M1 � �.,k �., .. � ��.., . .r �-f,,., - :' . � _..: ' .. ` -__ _..,. __. . . ..__ _'_ .....,..�.. . 5_ �_ _.._ ., .._.�' .._ . _._. • '__ . _�,... �._... . . .. _ . . ..._-. ._. ... ._._ ___ .. _ .._... _ :. .. . __ e.__._ ...._ ._— .... .. ,. . . . ,: �� . -,_ , r . � r� . � S w- � ;C c , e_ , .. � r . �� ^_, ' ' : .' a. - �' � �i`�c-�,+��"' - '..�"..._�,!. . � r�� _ __ . . . �.�� ,�, 'Ea p,a�a�,�� ° ' �� , : _ , ._ , . 3 k.. .i � � w ._ . f�.. . .0 4 # ' 1 �' � _,. ... «�."'_ .. . .�_.. ...e-..,�. . . ..�._'...,,� .-...,,. t... . _ -. .._ .... .. .... .._... .._ .. ., � . , � /J� ��y s . � ,. "� ��t Z, �, :: �� '4�WV� ' � "� , `�;_. ... .. ..... .. ...... _ _..... ..,. . .... .. ..... . . . . ..... . �.. ... .._ ..... ...._ ... ... .. __ i . .. , _ _.., , .—. . .^ _ ..,...- ._._ .._ . . _ .. _.._.._.. : __ ..__ ...._ _.... _.. . . . , .J '. . n� `., j;�{^ . . ,� �. , �r w,i a i� . �. . �. . . ..... . ., , . . ,. .�,.. .. . . .... �� ' , �. . . . . .. .. .... ....... .... . ..._. . ....._ . . .., ..... ...... .... ..... ...... ._ ..... . . . . ..� . . . _.. �, ._ _._. ___. ._. _ _ ._.... _..._ �.._�...._. . .. . ..�. ....... . ... .. ...._. �,....._ . .... ._.... ... ... .__..._ _ a. ^ ♦ . � - r .. �p y�� -.. .. ,_ ... ,.__ ._ —��,� . _ . — ._ .... . 3 �� . ..�"?YeL.�n...�-+ � � �'� ' . . I . . . . . dFi�— _.. _ _ , _ . .. ... .. . ._. . _.. _. ._ ..._ _ .. ..... .. _ . .... . . . ffi•'�y� �Y i�Y C-�'��Fp'� i °'�' 6 3!. . � .... "�� + ��K,.^r,�-aY�S�k' '. �.^cW... �:'�. . ... .. _. . ... ... .. .... ........ ...... ...... ..... ..... ... . _.._. ..... ...... ....... ..... ._... .... .. . .... .. �........ . ... ... .... ... .... .... . ��. ... .. ..... ..._.. ....... ...... ...... ...... ...... ...... .... .. ... .. . . . ... . ....... . ..... ..... ... ... ... . � ...... ... ... ...... ...... .. .... ..,.... ...... ......... ..... ...... ._....... .. .. . ..... ... .. .. .. .. ....... . .. . .. .. .��. �� .. _. ..... ..... ... .... .. ... . ... . .. ... ... . ..... ...... ... .. ....... .. .... .. .... ..... ...... ..... � ,..... .,. .. . . .... .... .... .... .. ... ... . ... .. ..... ... ... ... ... .. . ... . . . .. .. .e �� A4 yi�� X �"�� 4' � ... .... ._ _.... .. .._ ... .,—. . _._ . _.... ... _. . r w a • fl ' �� ' �� `� S�'�� ` �., � � �; ,q"�t... ... ..... . .... . ...... .. ..... ... ... . ... ... . . . . . ..... .. .... . . `� @s� `,� � s �� r — . — _ � � � � a � � � r �� i:.,,a+ ��'�,�� -- — ... .. ._ ... .. .. .... ... . . . .. .. < e �� < r � � .� ��xr'�&su s °��' ... ... . . .... .. ... ... . . . ._ ... . . . ... � .� � �� ,� _. av� �'.,��`„� '� �� rarx� . «�`� ��%�'�a a�vr �s � �:, _ �_ -,�'4,�,�yr t ��'�.��y�� b�°€ � � �s`�;��.��a��.�"�"� �`" ' �� ` _ .. . . . . . .. ,.. .....,...,.w....:� .�..-.__�.. . ..»..wnrayrMMXwr,.. CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION JOBSITE ADDRESS�i-T APN T TRACT OWNER ADDRESS. CI ZI TEL APPLICANT TEL. 6k/A6"z_-RC D CONTRACTOR,. ADDRESS A&A app�F CITY24�ZIP TELf� ARCH/ENG/« DESIGNER ADDRESS CITY ZIP TEL. OWNER-BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PEFUURY 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 PERMITTO 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 EXEMPTTHEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION.ANY VIOLATION OF SECTION 7031.5 BYANYAPPLICANT 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 PRQ•.ECT(SEC. 7044, BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- CENSE LAW DOES NOTAPPLY TOAN 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_OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER Y(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. r DATE6.3r=,! /CONTRACT R 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,Ali 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. CARRIER POLICY NUMBER (TINS SECTION NEED OCT BE COAWLETED OF THE PERNT IS FOR ONE HUNDRED COLLARS($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 SECIJRE 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 ATTORNEYS 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 A_L CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION,AND HEREI3Y AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOFO INSPECTION PURP PERMITTEE N E R SIGNATILPRIE OF PERMIUTEE DATE WHITE-Department Copy,YELLOW-Finance Copy, PIN PRESS FIRMLY APPLICATION I� PERMIT �� P/C t 1 Z DATE NUMBE V/ # ISSUE TYPE OCC DATE CONST- GROUP ZONING SETBACKS FRONT RW^ REAR ^ SIDE/SIDE STREET RW^ SIDE ^ PROP SED US ft%zh :r N0. DWEL. N0. N0. 77, UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM U) Garage/Carport W Patio/Deck LL Pool/Spa 0 Re-Roof Z 0 Commercial Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U 0 W w C7 m 2 a Q U Z 2 U W 2-0 �p CONSTRUCTION , PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE i A If, ISSUANCE SMIP ENERGY P/C ENERGY PERMIT t" r k a,4d RETENTION FEE: 'y-'• ��ei'R.+ r��-r PRE-ALT FEE: TOTAL FEES COMMENTS If p L 1_ (014 L D RECPT N0. PAID BY VALIDATION