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Home My WebLink About18827 �,�_ —, �:Tl'Y OF DIAMOND BAR - � � ]�EPARTM��?T OF COMMUNTFY&�7BVELOPMENT SERVTCES 21825 E.Copley Drive � (909)&60-3195Fa�c(9A9)861-3117 PR�SS ..�,�:��' BUII.DING PERMI'I'APPLICATlON F�RMLY � o AD�RfESS��J'� �IK1I:7 ��[� �.J3�► aPPL[CATION � �""� {j°�UMB R {� �d� #� L}ATE a� ISSUE i y�' �� TYPE CC APN LOT TF[ACT _ DAT� 6� ONST. Gi3 UP p OWNER �`' ADDR SS ZOfVING SE7BACK5 ' oCITY � ZIP 7EL. FRONT RW ❑ APPLICAN7 im NOC 7��, ] r.� REAR I ❑ n SIDE/SIDE STREET RW ❑ z a C�IVTFWCTOR NOC�C PI'11111�J1I1 SIDE ❑ q� ADDRESS1161Z Knott St �� Z__- _____—____ ppOP05EDU5E � c�r�Garden Grove zi� 9�84i rE�. 714895I2�i6 � ARCH/ENG/ w DESlGNER NO.DWEL. NO_ NO. Q,. Ab�RES5 UI�ITS STpR€ES BED OOMS � CITY Z]P 7EL. � DESCRiPTION SQ.FT. FACTOR PS AD.7. REANALUATION � OWNER-BUIL6ER�ECL.ARATION g�q/AO�IREM � a 1 HEREBY AFFIRM UNDER PENALTY OF PERIl1ftY THAT f AM FXEMPT FROAS Th'E.."ONfRACTOftS LI- C�gfa96/C2fF30rt LLi CENSELAWF�RTHEWLLDwiNGREASON{SEG7o31.5BU51NE55AN�PROFE55lON5CDOE:Af2YGIT'!oR (J) U COUNTYWHICHRE�UIFESAPcNMiT70CAN5TRl1CT.ALTER.IMPA0VE,0EMaLISH,CRREPAIqANYSTRUc� �,J,J patiolDack Z TURE,PRIOA 70 ITS ISSUANCE,PL50 REQUIRES THE APPLICANT FaP SU�PERM3T}'O q4�A SiGN�p W W STATEMENT THAT HE OR 5}1E IS LICENSE�W FSUl3JT TO THE PiiOV7510N5 OF hIE WNTflACIORS L6 � � CENSE L4W[GHAPTEF 9(CGd14MENCING WVTH SEC?ION 7�}OF�!V!5lDN 3 OF THE 6U51NESSAN6 PRO- � Pool/Spa � FESSIDNSCOOE]ORTHATHEORSHEISEXEMPTTHEREFftOMAlJO7FE£BASISFOftTh'EALLEGEUE%EM?- (� a570N.ANYyIOly,7loNaFSECTIOI+l�031.5BYANYAPPLICANTFORAPERMIFSI]&;ECfSTHeAPPLiCANTTO Z REROOf I � � AC141LPENAlTYOFNOTMORETHANFIVEHUNfJRE0O0u,A.FS�ssaa}.J: ' Q pE,ASpWN�R�FTHEPROPER7Y,ORMYEMPLOYEESWiTHWAGESASTHEIR50LECOMPENSATiON, L� Cemmercial Z WILL 00 THE WORK.PNO THE STRl1CT�1RE IS NOT EN i EN�E'�CR OFFEREO FOR SALE(SEC.7044,BLi51- .J � t1E55ANOPiiOFE5510N5CODE:7HE00NTRAGTo05LECENs'cLAW�Oc5NO7APPLYTpAhOWNEROF � PFiOPEATY WHO8U1LD5 0R iMPRDVE57HEREUN,AN0 WHO OOES SUCH w0liK HIMSELF OF H�RS�LF OR � THROUGHHISORHEROWNEMPLOYEES,PFOVlDE6THATSUCNIIMPROVEAAEM'SARENOTINTFN�E�OR m - 0 OFFEAE�FORSALEIFHOWEVER,SF7EBIlILD;!dGOfiIMPROVEMENTi5SaSa7WiTHIkONEVEAPOFCOMPLE- Z TION,THE OWNER-BUlLDER WILL HAVE THE BUFDEN OF PROYING:NA7�!iE OR SHE 6fU NOT BUILtl Oti . � IMPROVEWRTHEPUiiP�S�OF5.44E�. . w CI,ASOWNEROFFHEPROPEFflY,AME%CLUSlYELYCOFITRAC71FlGWEiHLICEN5E�CONTAAC�R5 � TO CONSTRUC"f 7H�PR0.1ECf�SEC.704d,BI15lNE55 ANO PROFE551UIJS CP�E:TFE CONTRFCTOflS LE- V81118tI0T1 � ADJ.AREA � W CENSELAWOQESNOTAPPLYTOAN�MINEROFAPftOPERTY4YH02UIL�50HIMPROYESTHEREON,ANO — F WFIOCOKI'RACTSFORSUCFi7flOJECT5WITHACONTRACTpq�S}GIC�NSE�PUASUMlTT0T71ECONTRAQ QUANTITY DESCRIPTION �� Y TOFSLICENSELAW.). � J Q ❑I AM E%EMPT EJN�ER SEC. B.&P.C.FOA THIS REASON Q � U � � �A7E OWNEst �' � � U � LICENSED GONTRACTO£iS�ECLARATION � W . � � E HERE01'AFF1FlA 11NDER PENALT'OF PERJUR'!THAT iRM LICENSEU UN�FA PROVf5iOR15 OF CHAPTEA � �7 Q 9(GOMMENCINGWITMSECTIDN7000}OF91YISbN3oFTHE9U51MES5AM�PP.OFE55iON5C0'�E,AN� Z �`�t " IX M1'L�C�NSE IS IN FULL FOACEAND FFFECT. m � � 'f o �,��.,5��,�� C36 �,�.,�o. 707775 � F- � V DA7E CONTAACTOA NOCK 0- L11 � WORKEAS'COMPENSATION flECLARA7I�N ¢ = U � �HEREBY AFFIRM IJNDER PENALTY oF PE�uH`lONE OFTHE FOLLOWING�ECLAfa471oNS: UJ Q � IFfAVEN+IDW3LEMAINTAINACERTIFIGATEOFWNSENTiOSELF-INSUREFOPWOAK�RS' _ [OIAPENSATION.ASPROVI�EDBYSECTIOh370a�]F'7HELABORCO�E.FpRTHEP�RFOR�C� C� a OF TFiE WORK FOR WHICH THlS PESMIT IS ISSUEfl. � � x w IHAVEANbWIl.LMNNTAINWORKERS'COMPfN5A710NIN5URANCE.A5RE9lJIR£OBYSELTION Q 37004FTHELABORC06E,WR7hlEPERFOFMANCfOFTHEWORKF�RWHICHh1157�F3M1T15 � ]5517E�.MY WORKERS'COMPENSA7ION iNSUP.�NCE CARRIER AN�AOUCY�,uMg RAAE: CONSTRUCTION Q /"� > CARAIER °�'��7' �'�a✓ PLAN REVIEW � POLICYNUMBER� �~ �� ELECTRIC Q � i��ss[cnaaNEmnn�reew��erEno�rHe�awr�swaauewinn�ooa!nas�s�m�oq�Fss! PLUMBWG �FI.�O � I CERTIFYYHA7fNTHE PERFORMANCE OFTHE WOR3C FOR WHICH TFi15 PERMIT[S ISSIIE�,I MECHANICAL � (3' SFiALL NP5 EMPLOY pM'PERsoN INANY MANNEA 50 AS TO BECOME SU&IEf,T TO THE � �/j WOAKERS'ODMPENSATIONLAWSOFCALIFOPNtp,pNQAGAEE7MATiFI5HOULOBEODME INS?ECTIDNFE� /� = SllBJECTTOTHEWORK�fS'COMPENSATIDNPROVISIONSOFSECTION37060FTlFEL460R ISSUANCE 2S�VO COOE,I SHALLFOATHW7Th'COMPLY WITH THDuE PROYISION9. � ��"�7.�'" Tim Noclz SMIP p �ATE: PPLICAN7: � ENERGY P1C J WAFINING:FAILURE TO S�CUR�WORKERS'COMPENSATiON CAVERRGE IS UNLAWFUL,14NP Sli.a4�B� . � SU&IECTANEMPLOYERYOCFilMINALPENALT�ESANOCIViLFINESllPTOONEHIJNU3iEDTHOVSAN❑ ENERGYPrcRM1T �OLLARS(f1oo,IX10),IN AOOITION TO THE COSY OF LlMPENSATI�N.�AMAGES AS ARONi]E�FOR IN J SECTION 37aflOFT4E LABOR CO�E,IN3EqE5T,AN�ATfORNEY'S FEES_ AETENTIOPI FEE: Q p�_. CONSTRUCTlON LENDING AGENCY pR�-ALT FEE: � � � IHEREBYAFFlRMUNOEfiPENALTYOFPEFtlSJRVTHAT7HEflE15AGON5FAUGTIONLE�l�MGAGENCY � � FOR 7iiE PERFORMANCE OF7HEwoRK FOF3 WHICH'fHIS PERMI715 ISSUE�{SEC.3oB7.CIV.C.}: . Z W 2 LEN6Eii'SNAME - � F LEN�ER'SAJ�AE55 w TOTAL FEES 67.50 � IC^�RTIFVFHAFIHAVEREPDTHISAPPLICA710NPN�5iATETIiATTHEPBOVEINF�RMATIONISCAftRECT. � IAGREET�COMPLYW�THp11,.CfTYANOCOUNTVORDINANGESAN�STATELAWSRELATINGT08�IL01�G � WNSTRl3L710N,AN�HERE6YAl17HOFiIZEREFRES�NTATNE50FTH15'COLNTYTOENfERIJPONiHE > � AeOVE�MENTIONE�PROPEATY FORINSPEC7iON PUfiPOSES. COMMENT 0 �� m N ME(P Q _�„�� j SI ANREOFPERMRTEE �RtE � RECPT.�O. PAID 6Y VALIDATI N ~ WHITE—Qepartmeni Copy,YELLOW�--Finance Copy,PINK—Assessor Gopy,GDL�ENRO�FIe Capy,GREEN—Applicar�Ys Capy I ' I �� . �� .� ��E�y�� ' � � � �� , �;.. ,� � � � . � . ��.� � : ' �mm�c��;�c�; : � _ _ �.. ._ .__..� __ — _ _, - _ _�..._.�:__. -€-----.:-_- ��C��IF�C�i�Si�� !-3r�F��..��T� _ .__�__ � �__,_ __. � u�� W � — __ � � _:. �r ( ' . � ___..�—_._ �?��cr� �;�C��r�G��C1 _.,_.._ �-------� �.._ __ _. .....�. � _ ._ . ._.� v �T � ,.• ° . ._ ?EC?"F�'s��C's�f�t� c s��C}�C�Li �� :��r�li�c� -.�� iC�C�� t�� ? • _ - __._:_ 5��i=a�E�� : �� fE��P?.��C��3�Tl��ti �.; .��.. � - . __�_.�. __T_ ... ,_ _._. �. .,�_._. �_ T��'F'�� _.....�.�.' ___.. :._:. l ryiF�E�L�t�:c��1��.�i_.__�.? ..�__.. � ��t��f��iG��- l ��,��;. ��i�C��k� � _.._. __..._._ . .�_...___ ._._____._ ____ � �C3��5:��,�`��h�C� - _— � � _ ._.__.. .�� .W � ' ��. ��%�� _ ______..___ ` ___.___._ �"��vCal��4T1��i`•�C�1�;�.._.� �__._ _�._.__ �__ �I�s��.E3��C1��:4� I' ' � ..._..___��_ __. _ __ -_____ _......�.. �§C�C��CC�� i �. _ ��-�-�.�"��-�F�;�?�l�1� � .T �3£��l�F�§��f;�'��SC'a [ . i ��7�;�€�€� _ � f�C)��C�"F�� _ �C��lf�:-f��E�l�£= _. - —_ . ---.._._.__ ' ----....__..�.N___._ . ___wW..�._�__... _..._._.�� , ��lC�i-4 �'L��r��Ct�t� . �l��S�iaFtP,�€�a ._ �_..._ �sr.� y ._.��.__�u. _ � �_— --__._.__.. ��lC��E?.�C��"�a E�� . �.�.�� t�C7L�L�C7�� _ � �?t". L�1'�IS��ii�C`; � � '. ��L F��(id� � --,I=- � ____s �E"�� f�;4C --- ��?� �C��t�i�t�il�� ' t� , .....�.�_ � _r._ ...,.-�_ __._.._...__ __.._._--- � ��.€(��3�UL��'iC3�; � j � C3�F��?��5.� � __.. �__� _. a__ __._ _._.�.:� �..�.__._. ..� _.__�.�.___ � �3�°f�J��.�.s�;�I�I�9€� ; � � L��i��I��VS � - -- _� ___. _...___ _ -.�._.— ��'�F� � � { FE�AL��3(�. �� [��;} $��"8,�g�� _._ 7 p [�: _-�--.__ __ �Le.I-b'<4J S:b%�E1 ' 3 �..,. .._..�._...� � I,,.M��O.�'1.��Lfti��{��.�. � . . � ...._,��__....._........_ �..�..._...._,,,._,..,.-...� --•-- �' . _... . ��F��3 9��.L. � ' i a 't�l�=7k��F'..�: � � � � � _.�� y_ _ � ��.A?�T��"___. � -�---- ; � .�__.�_ ��i��i��:I�ifJC� __�__ ._....__ F�'��,�C?��T. ��.. _ -- � �E��C��C: ��3�� F1�dA�F��?�i"r�C`,a �� i — _ _._ F��r:LTr-{ t��°�' �d:�4� � �_ � �_. �._.��—_, .. F��?AL��"r��'' � ` � � j �� t�r��'.�€D.. -__.�� : �.F��€�,L F'LiJi�� .�.,_ . — ; , ��E�C�°l _.___ _____ �— _ — --- ��__ � �.___ � ��'�.'� � - � � �_._..�_�_� � � , , , � � .�.____.��_ ' _ _..._ � � � _ �____�_____� ; . _ _�_ _ —— -------n--- . .. ' —� � � � � � i ��€�� ..�..., �.�__T_.�_�_z � � _�� _ .w..��.- ._.._.__ _._.�____-_.�_��. _.�_� ___ .� _ � -�- — --____.___-- , _ _.. __ , � �_. _ ___. ___=��__� --. �_.._.�.. �_. � ,_ _ . . . �..._� _..__ , � ___�. --- -- --��_ __. � s��T1G��t�`s"� �4�� -___�.�_ _____. .�_ T �.�� :i f�a��..�.�_ ._.._ �,. ._. ._..._._ _.___ __..__ � � ��.T,� , ,, �-� _.__._ _...__.___. � _ __ � � I � � l I �, � '' � �_.�_ �----= � __�__- � � --_�. �___ _ � , � �� `�-�-- ...�.. � � ----�� , � �..__ _ � _ - • - -- ___... y 21825 E.Copley Drive acc B�I.pINGPERMIT$APPLICATION...PRESS FIRMLY OBSITE e-r4;pir'9•(Z;,.Ait/-'ifl A!). _f5_ _ RACTOR _ _ - ITV Garden Grove zi 92 4—TE�.714895124 6 RCHfENGI ESIGNER DRESS ITY 21P TE�. WNER-BUILDER DEC�ARATION I HEREBY AFFIRM UNDER PENA�TY OF PERIURY THAT I AM E%EMPT PROM THE CONTRACTORS� CENSELAW FORTHEFOL�OWWG REASON(SEG7071.5 BUSINESSAND PROFESSIONS CODE ANYCITYO COUNTYW111 CHREOUIRESAPERMITTCCONSIRUCT,AITER,IMPROVE,DEMOLISH,CRREPAIRANYSTR C TU9E,PRIOR TO ITS 155UANCE,A150 REpUIRES THE APPLICANT FOR SUGH PERMIT TO FILE SIGNE STATEMENT THAT HE OR SHE IS�ICENSED PJRSUANT TO THE PROVISIONS OF THE CONTRACTOR L CENSELAW GHAPTER9 CGAMENCINGWITHSECTION71n'ro OFDIVISK N30FTHEBUSINESSANDPRO FESSIONSWDE)ORTHATHEORSHESSE�EMPTTHEREFROMANDTHERASSSFORTHEALLEGEDE&EM.P TION.ANYVIOLATIONOFSECTION703LSBYANYAPP�ICANT PORAPERMIT SU9JECISTHEAPPLICANTT ACIVIL PENA�TYOFNOTMORE THAN FIVE HUNDRED DO�LARS 8SN O�AS OWNEROFTHE PEOPERtt,OE MYEMPLOYEES WiTH WAGES AS THEIR SO�E COMPENSAT/0 Wi��DO THE WORK.AND THE STRUCTURE IS NOT INTENOED OR OFFERED FOR SA�E(SEC.70<6 BUSI NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE L1 W DOES NOT APPLY TO A OWNER O PROPERTYWHOBUZLDSORZMPROVESTIIEREON,ANOWAODOESSUCHWORKHSMSELFORHERSELFO THROIIGH HIS OR HER OM EMPLOYEES,PROVIDED THAT SUCH IMIROVEMENTS ARE NOT INTENDE O OPFERED WRSP�E IRHOWEVER,THE BUILOINGORIMPROVEMENT ISGO�D WHE ONEYEAROPCOMP�E TK)N,THE OWNER-BUILDER WILI HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUI� 0 IMPROVEFORTHEWRPOSEOFSALE). C I,ASOWNEROFTHE PROPERTY,AM EXCLUSIVE(.Y CONTRACTWG WITH�ICENSED CONTRACroR TO CONSTRUCT THE PROJECT(SEC.70<d,BUSINESS AND PROFESSIONS OJDE:TH CONTRACTORS LI CENSE�AW OOES NOTAPPLYTOAN OWNER OFA PROPERTY WHO BUII.DSOF IMPROVES THEREON AN WHOOJNfR9G75FOR5UCHPROSECTSWSTHACCNTRACTOR(SlLlCENSEDPURSUANTTOTHECONTRA TOFSLSCENSE LAW). D i AM EXEMPT UNDER SEC.B.&P.C.FOR THIS REASO DATE OWNE LICENSED CONTRACTORS DECLARATIO 1 HEREBY AFFIRM UNDER PENA�TY OF PERJURY THAT I AM LICENSEU UNDER PROVISIONS O CHAPTE 9(COMMENCING WITH BECTON 700g)OP OIVISK7N 3 OF THE BUSINESS AND PROFESSIONS CODE AN MY LICENSE IS IN FU��FORCE AND EFFEC LICENSE GLASS C36 LIG.NO.70777 DATE CONTRACTOR NOC WORKERS*COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOL�OWING DEC�ARATIONS I HAVEAND WILLMAINTAIN ACERTIFICATEOFCONSENT TOSE�F•INSURE ME WOPKERS CCMPENSATION AS PROVIDED BY SECTION 37W OFTHE LABOR CODE FOR THE PERFORMANC OF THE WORK FOR WHICH THIS PERMIT IS ISSUED X I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,A$SECURED BY SECTIO 37000F THE LPHOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT I ENSATIONINSURIA'N,C-ECARRIER ANDPOUCYiUMB RARE ISSUED.MYWOrRK.-ER-S'-CO MT CARRIER--C2--W-171f7 n�_�_� -e POLICYNUMBER-1GI7JIS7J dIJ L--1 IHI59EC1NNNEEONJTBE07MRETEOOFIHEPEM411BRJROVEHJN7HED-.J-RSI5f070RLE55 I CERTIFY THAT IN THE PERFORMANCE.5 THE WORK FOR WHICH THIS PERMIT IS ISSUED t SHAL�NOT EMPLOYANY PERSON INANY MANNER 50 AS TO BECOME SU9JEf.TTO TH WORKERS'COMPENSATION�AWS OF CALIFOPNIAANDAGREE THAT IF I SHOULD BEMM SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 37UOOF THE�A90 COMP�Y WITH THOSE PROVISIO H L FO THWI t Y DATE:E T--FPPLICANT:Tim NOCr WARNWG:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNIAWEUL,AND SHAL B SUBJECT AN EMPIOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRE THOUSAN DO�LARS flo 000.IN ADDITION TOTHE COST OP COMPENSATION DAMAGES AS PRONOED FOR i SECTION 37050FTHE LABOR CODE INTEREST AND ATTORNEYS FEE CONSTRUCTION�ENDING AGENC I HE6EBYAFFIRM UNDER PENPLTY OF PEBIURYTHAT THERE 13 A W NSTRUCTION LENDING AGENC FOR THE PERWRMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED SEC.3007 CIV.C. LENDER'SN LENDER'SADDRES I CERTIPY THAT I HAVE READ THIS APP�ICATION AND STATE THAT THE ABOVE INFORMATION I CORRECT I AGREE TO COMPLY WITH ALL CRY AND COUNTYORDINANCES ANO STATE�AWS RELATING T BUILDIN CONSTRUCTION,AND HEREBY AUTHORI2E REPRESENTATNES OF THIS COUNTY TO ENTER UFO TH ABOVE MENTIONED PROPERTYPORINSPECTION PURPOSES NME P--- - '>---1 PERMIT'---p PI --•NUMBER lJ�# SSUE-�TYPE . CC ATE 6V ( ONST GR P ONSNG SETBACKS ' RONT Z W IDEISIDESTREET W I APPIICATI N DATE IDE IIII��JJIII O.DWE�.NO. NO NITS STORIES BE OOM DESCRIPTION SO.FT FACTOR PS ADJ. REANAL U ATION SFRIADDtREM _ Garage/Cacport ['1 PatiO/Deck PGOZ/Spa ' Re-Roof Commercial Vaioation-'ADJ.AREA QUANTITY DESCRIPTION FEE J 4 U w J w O z -TZ.JV m = 1 -V J or z 6 2 W CONSTRUCTION PI-AN Rewew ELECTRIC PLUMBING 41.50 MECHANICAL INSPECTION PEE ISSUANCE 25.00 SMIP ENERGY P!C ENERGY PERMIT RETENTION FEE: �.00 PRE-ALT FEE: TOTA�FEES 67.50 COMMENTI RECPT.NO.PAID BY VA�IDA I WHITEDepartment Copy,YELIOWFinance Copy,PINK•Assessor Copy,GOIDENROD-File Copy, Copy