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Home My WebLink About16928 �� CITY OF DIAMOND BAR � DEPARTMENT OF COMMUNITY�.DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Faac(909)861-3117 PRESS BUILDING PERMIT APPLICATION FIRMLY � JOBSITE '�� .L��`j` �` APPUCATION PERMIT P/C 'l ,��` �� o ADDRESS_/� � � DATE NUMBER # � o ISSUE TYPE OCC °T APN LOT TRACT DATE CONST. GROUP p OWNER �- G�7�� Cn��=C., " ADDRES �L)/ c L`�f�%��- /L ZONING SETBACKS Z CITY �"4 � ZIP TEL. '�!�'��'G FRONT RW ❑ � „ REAR ❑ � APPLICANT � � ! -�TEL '� SIDE/SIDESTREET RW ❑ Q CONTRACTOR SIDE ❑ o CDDRESS ZIP TEL PROPOSEDUSE ��n ,MJn�-'-t��SY.7� � w ARCH/ENG/ z DESIGNEfl NO.DWEL. NO. NO. � a ADDRESS UNITS STORIES BEDROOMS = CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � � OWNER-BUILDER DECLARATION SF D EM 1 � O Q I HEREBV AFFIPM UN�ER PENALTY OF PERIL�FV THAT I AM E%EMPT FftOM THE CONT{3ACTORS LI- G8I29B/CdfP01S W CENSEIAWFORTMEFOLLOWINGREA50N�5EG.7031.5BU5ME55ANDPROFES510NSCODE�.ANVCITVOR (n U COUNTYWHICHPEOUIRESAPEHMITTOCONSTRUGT,ALiER,IMPflOVE,�EMOLISH,ORREPAIRANVSTRVG W Patio/Deck Z TURE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W w STATEMENT THAT NE OR SHE IS LICENSED PURSUANT 70 THE PqOVISIONS OF THE CONTflACTORS LI� � CENSELAW(CHAPTEfi9(COMMENCWGWITHSECTION7000�OF�IVISION30FTHEBUSINESSANDPRO- � PooUSpa � FESSIONSCODE)ORTHATHEORSHEISE%EIAPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP- � � TION,ANYVIOLATIONOFSEC710NJ091.SBVANVAPPLICANTFORAPERMITSUBJECTST-IEAPPLICANTTO z Re-Roof V A CIVIL PENALTV OF NOT MORE THAN FNE HUNDRED D�LLARS(5500).): � ❑I,ASOWNEROFTHEPROPERTV,ORMVEMP�.OYEESWITHWAGESASTHEIRSOLECOMPENSATION, � WILI DO THE WORK,AND THE STRUCTURE IS NOT INTENDED Ofl OFFERED fOR SALE(SEC.10a4,BU51- J Commercial � NE55 AN�PROFESSIONS COOE:THE CONTRAGTORS LIGENSE LAW OOES NOT APPLY?O AN OWNEfi OF ? 7ROPERTV WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OH HERSEIF OR � THROUGHHISORHEHOWNEMPLOVEES,PROVIDEDTIIATSUCHIMPROVEMENTSARENOTINTENDEDOFl m w OFFEPEDFORSALE.IF,HOWEVER.THEBUILDINGOPIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE- � TION,THE OWNER-B111L�ER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR Z IM7ROVE FOR THE PURPOSE OF SALE). _ ❑I,ASOWNEROFTHEPROPERTV,AMEXCLUS ACT LICENSFDCANTRACTOFS W � TO CONSTRVCT THE PflOJECT�SEC.]oN,BUS A OFE5510 DE:THE CONTRACTORS LI- V8IU0IlOfl U ADJ.AREA W CENSELAWDOESNOTAPPLYTOA40WNE APR TYWHO RIMPROVESTHEREON,AN� � WHOCANTRAGTSFORSUCHPROJECTS ACTOfi(S)LICENS URSVANTTOTHECO - QUANTITY DESCRIPTION FEE Y ToftSLIGENSE�Aw.). � J O ❑I AM E%EAIP7 UNDER . B.8 P.C.FOR THIS REASIXJ Q � U � � DATE OYINER U W � LICENSED CONTRACTORS DECIARATION w d � IHEREBYAFFIRMUNDEflPENALTYOFPERJURY7HA71AMLICENSEDUNDERPROVIS10450FCHAPTER � d 9(COMMENCING WITH SECTION 7W0)OF OIVISION 3 OF THE BUSINESSAND PROFESSIONS CO�E,AND Z �X MV UCENSE IS W FULL FOPCE AND EFFECT. m � � � LIGENSE CLASS LIC.NO. � U DATE CONTRACTOR a W � WORKERS'COMPENSATION DECLARATION Q � U N I HEREBVAFFIRM UNDER PENAL7V OF PERJURV ONE OFTHE FOLLOWING DECLAFATIONS: C/) Z Q � IHAVEANDWILLMAINTAINACERTIFlCATEOFCONSENTTOSELF-INSUREFORWORKERS' _ COMPENSATION,FSPROVIDEDBVSECTION3�aoOF7HELABORCODE,FORTHEPERFOHMANCE U ¢ OF THE WORK FOR WMIGH THIS PERMIT IS ISSUED. � � w I HAVE MID WILL AIAINTAIN WORKFRS'COMPENSATION INSURANCE.AS FEQUIRE�BY SECTION � Q 3]OOOFTHELABORCODE,FORTHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMITIS �� ISSUED.MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION �� j PL4N REVIEW � Y ° CARRIER � POLIGV NUMBER ELECTRIC + Q Q (IHISSECTIONNEmNOTBE(l7MREfEDOFTHEPEMIf�ISFORONEHUNDRED�OLLJ1R51E100)ORLESS). PLUMBING W MECHANICAL Z I GEHTIFYTHAT INTHE PERiORMANCE OF T4E WORK FOIl WHICH THIS PERMIT IS ISSUED,I (,'} SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SOAS TO BECOME SU6JECT TO THE � WORKERS'COMPENSATIONLNWSOFGALIFOFNIA,ANDAGREETMA7IFISHOULOBECOME INSPECTIONFEE SUBJECT TO THE WOflKERS'COMPENSATION aROVI510N5 GF SECTION 3�ooOF THE LABOR I' �-"��.� � �'�'��-��.- ' ' -"� � � CADE I SHALL FORTHWITH COMPLV WITHTliOSE PROVISIONS. ISSUANCE � - � SMIP ' p DATG APPLICnNT - w ENERGY P/C �.�I�1��} %I.�� J WARNING:FAILURE TO SEGUFE WORNEFiS'[:OMPENSATION COVERAGE IS UNLAWFUL,AND SHHLLBE �� J � SUBJECTANEMPLOVERTOCRIMINALPENALTIESAN�CNILFMESUPIOUNEHUNOREOTHOUSAND ENERGVPERMIT DOILAftS(Si 00.00�),IN ADDITION TO THE COST OF COMPENSATION,OAMAGES AS PROVIDED FOR IN J SECTION 3]oe OF THE LABOP CODE INTEREST.ANDATTORNEY'S FEES. RETENTION FEE: � • d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: - ' O � 1 HEREBV AFFIRM UNDER PENALTV OF PERJURV THATTHEflE IS AGONSTRUCTION LENDING AGENGY � FOR THE PERPoRMANCE OF THE WORK FDR WHICH THIS PERM'�T IS ISSUEO(SEC.3091,GIV C.). Z LLI .._..._—_ = LENDER'S NAME � 1_ �ENDER'SADDRE55 __.... ..__. /'�l/'J� �/ w ICERTIFYTHATIHAVEREADTHISAPPIICF�IONANOSTATETHNTTMEABOVEINFORMATIONISGOPREGT. TOTAL FEES J.`1�7 J � I AGREE TO CAMPLV WITH ALL CITV AN�COUNTY ORDINANCES ANO SiAIE LAWS RELATING TO BUILDING V �� CONSTaUCTION.ANDHENEBYAUTHOPIZEREPRESENTATNESOFTHISCOUNTVTOENTERUPONTHE � � '� i �� '�'j�y�� Z ABOVE�MENTIONEO PROPERTV FOP INSPECTION PURPOSES. COMMENTS � �� -� � - �- i i✓�� r^t .. � •, ' m G EF ((�� ) /' ` �� —- - Q � /; ✓ ��> �. cn L�_ � SIGNNTUREOFPERMITTEE D E x RECPT.NO. PAID BV VALIDATION ~ WHITE—De artmentCo YELLOW—FinanceCo PINK—AssessorCo GOLDENROD—FileCo GREEN—A licant's o P PY. PY. PY� PY, PP PY . �� . i";�_ � g i a `. � fini � � ".�ia � ��y 3"�'�at��kffi . . _ . . . . n ,°'�if�t».�'7�c��.,�SI�eY�',. f(�� //-Z�"�'� ��!r� S.Za-�J3 �l�l�s .�=��-o� �� _ `�/��,�a3 � _ �`' ,5�l�� !�-'l�� r .� _ ��o� �� _�;ra�3 /�.� _ : . � a _ _ � . � � . �� . _ _ . _ _ _ _ _ _ � ; .�r _ _ �� . � _ � a , � _ . - � �r� �.� a � - . v _ . �� . � �a�� . �.� _ § . _ _ 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 iF/� 1f1jiL ADDRESS APN LOT TRACT OWNER-C��isl C ADDRES�U tL�f�/'rte�-/L CITY rat ZIP TEL. r� 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 REQUIRESA 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 BYANY APPLICANT 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 W ITHIN 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). ^ 1,AS OWNER OF THE PROPERTY,AM EXCLUS ACT LICENSED CONTRACTORS TO CONSTRUGT THE PROJEGT(SEC. 7044. BUS A OFESSIO DE:THE CONTRACTORS LI- CENSELAWDOES NOTAPPLY TOANOWNE APR TY WHO R IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS ACTOR(S)LICENS URSUANTTO THE CO TORS LICENSE LAW.). ^I AM EXEMPT UNDER B. 8 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 CONTRACTOR WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY 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 CARRIER POLICY NUMBER (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 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 AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE CONSTRUCTION } ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. P EE 3 SIGNATURE OF PERMITTEE D E vi DIE 0 0 w 0 w 0 Cr 0 0 w U W 0 U 0 J J U I APPLICATION PERMIT P/C'I 11 i� I DATE NUMBER # ISSUE TYPE OCC DATE CONST GROUP ZONING SETBAC KS FRONT RW ^ REAR ^ SIDE/SIDE STREET RW � L SIDE ^ SE ,'I�/ ��o �„�t� PROPOSED U -I N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION SF D EM 1 -zQ Garage/Carport LLI Patio/Deck LLI LL Pool/Spa 0 Z Re-Root Commercial Valuation U ADJ.AREA QUANTITY DESCRIPTION FEE U 2 I- U J W z m ) d J U 2 2 0 W r- CONSTRUCTION 67 PLAN REVIEW ELECTRIC $ PLUMBING MECHANICAL INSPECTION FEE ISSUANCE - SMIP I A ENERGY P/C ENERGY PERMIT en, RETENTION FEE: , PRE-ALT FEE: 1---� TOTAL FEES 95 301 COMMENTS . RECPT. N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy,PINK-Assessor Copy,GOLDENHOL-rue copy,(UNNEEN-Appllcanrs copy