The URL can be used to link to this page

Home My WebLink About16562 � � � CITY OF DIAMOND BAR �� DEPART'MENT OF COMMUNITY&DEVELOPMENT SERVICES � � 21825 E.Copley Drive /, /�� T.�� (909)8603195Faac(909)861.3117 �`��\�__C� 1 , PRESS � �� BUILDING PERMIT APPLICATION ''i .�,��1.�� ,i �� FIRMLY JOBSITE � /�� /,/ �� J� /'� APPLICATION (� ,l PERMIT `` , — p/c � ADDRESS� /`,JJ�C�NC3� � � �J � 1� 1, l > / � DATE `� 4��v� NUMBER_,1��+" /�g �° APN LQ�-±---;- TRACT ISSUE TYPE OCC p OWNER �� " ��G� DATE CONST. GROUP `�` ADDRES o ZONING SETBACKS � C�T�' ZIP TEL. 3 FRONT R�y �_ p APPLICANT _ TEL. REAR � z SIDE/SIDE STREET qyy C ¢ CONTRACT SIDE � �- � ADDRE$S �^ n� � ��T' ZIP TEL. PROPOSED USE ' �-� b" oARCH/ENG/ z DESIGNER a ADDRESS NO.DWEL. NO. � NO. � CITY ZIP TEL. UNITS STORIES BEDROOMS � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AFEA/VALUATION � OWNER-BUILDER DECLARATION O SFR/ADD/REM p I HEREBV AFFIRM UNDER FENALTV OF PERJURV THAT I AM E%EMPT FROM THE CONTRACTORS LI� G3fe 6/Ce W GENSELAWFORTMEFOILOWINGREA50N(SEC.7037.SBUSINESSANDPROFESSIONSCODE:ANYCITVOR (n 9 �pOrt z COUNTVWHICHREOUIRESAPERMITTOCONSTRUCT,ALTER.IMPROVE,DEMOLISH.ORREPAIRANVSTRUG w w TURE,PRIOR TO ITS ISSUANCE.ALSO REQUIRES THF APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck � STATEMENT 7HA7 HE OR SHE IS LICENSED PURSUPNT TO THE PROVISIONS OF THE CONTRACTOflS LI- � CENSE LAW�CHAPTER B(COMMENCING WITH SECTION]000)OF DIVISION d OF THE BUSINE55 AND PRO- u' POOUSPd O FESSIONSCODE)ORTHATHEORSHEISE%EMPTTHEREFROMANDTHEBASISFORTMEALLEGEDEXEMP- � V TION.ANVVIOLATIONOFSF:CTION'/031.SBYANVAPPLICANTFORAPERMITSUBJEGTSTHEAPPIIGANTTO Z Re-Roof � ACNILPENALTVOFNOTIX�RETHANFIVEHUNDREDDOLLAftS(SSoo).): 0 CI,ASOWNEROFTHE:PROPEFTY,OFMVEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION. � Commercial Z WILL DO TME WORK,AND iHE STRUCTURE IS NOT INTENOED OR OFFERED FOR SALE(SEC.7044,Bl1Sl- J N NESS AND PROFESSIONS C:ODE:THE CONiqACTORS IICENSE LAW DOES NOT APPLY TO AN OWNER OF VRDPERTYWHOBUILDSORIMPROVESTHEREON.ANDWHODOESSUCHWORKHIMSELFORHERSEIFOR � Q THROUGHHISORHEROWNEMPLOYEES,PROVI�EDTHATSUCHIMPROVEMENTSARENOTINTENOEDOa m QOFFEREDFOFSPLE.IF,HOWEVER,THEBUILDMGORIMGROVEI.tENTISSOLDWITMINONEVEAROFCOMPLE- z TION.THE OWNER-BUILOEFi WILL HAVE TNE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD Oa � IMPROVEFOFTHEPURPO5EOFSALE). w ❑I,ASOWNEFOFTHEPPOPEflTV,AME%CLUSIVELYCONTRAGTINGWITHIIGENSEDCONTHAGTOflS � TO CANSTRUCT iHE FRQI�CT(SEC.loa4,BUSINE55 AND PROFESSIONS COt7E THE COYTflACTORS LI- VHIU2SIOII ADJ.AREA W CENSELAWDOESNOTAPPLYTOANOWNEROFAPROPER7'YWH06UILDSORIMPROVESTHEREON,AND � WHOCONTflACT5FOR5UCHPROJECTSWITHACONTRACTOR(S�LICENSEDPURSUANiTOTHECONTRAG QUANTITY DESCRIPTION Y TORSUCENSELAW). FEE � ❑I AM E%EMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q �'t/� � U LL DATE OWNER � . Z U � LICENSED CONTRACTORS DECLARATION � � W I HEREBY RFFIRM UN�ER Pf=NALTV OF PERJURY THAT I AM LICENSED UN�ER PROVISIONS OF CHAPTER U, d 9(COMMENCING WITH SEC'ION 7000)OF DNISION 9 0F THE BUSINESSAND PROFESSIONS CODE.AN0 Z �X AIV LICENSE IS IN FIJLL FORCE AND EFFECT. O / m I F LICENSE C SS �~ �� LIG.NO, � �• � /� � A U �ATE .L _�_ GONTRACTOR d � W _. , � WORKERS'COMPENSATION DECLARATION Q / , � I HEREBV AFFIRM UNDER P[NALTV OF PERJURY ONE oF THE FOLLOWING DECLARATIONS�. U � Z � _I HAVE AND WILL MAINTAIN A CERTIFICA7E OF CONSENT TO SELF-INSI.'RE FOR WORNERS' a Z = ¢ COMPENSATION,AS PROVIDED BY SECTION 31ao OF 7ME LABOF COpE,FOR THE FERFORMANCE U OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. � � W � IHAVEANDWILLMAINTAINWORKERS'COMVENSATIONINSURANCE,ASREOl11RE�8Y5ECTION ` � .` Q3]0o OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS 1 1.�� /)� - ISSVED.MY W RKERSj'GOjM��PENSjA�TIOyN INSUFjANCE GARRIEH AND POIICY NUMBERARE: I.ONSTRUCTION Y� � GpRRIER ��/[/�_ T��'��G] �y J�r PLAN FiEVIEW � POLICV Nl1M6ER_/Y^.I/ �G/\/L ^F l I � Z -T a ELECTRIC 4 � ��J� � (iHI55EClI0NNEm110T8E00MPLEfEDOFhEPERMfTISFORdJEHUNDF7CD00LLARS(5100)ORLESS� PLUMBING i W - Z I CERTIr'V THAT IN T11E PERFORMANCE OF TNE WORK FOq WHIGH THIS PERMIT IS ISSUED,I MECHANICAL ��";�T C} SHALL NOT EMPLOY ANY PERSON IN ANY MANN"cR SO AS TO BECOME SUBJECT TO THE �; ��, h �~�"�, [Jj WORKEFS'COMPE�SATION LAWS OF CALIF RNIA,AND RGREE THPT IF I SHOULD BECOME INSPECTION FEE � " -- ' � SUBJECTTOTHEWORKER5COMPENS ROVISIONSOFSECTION3]OOOFT{IE�ABOR �5��_ � CODE I HA FOR'HWITH COMPLV H R I ISSUANCE �A I1 V �$ � �'1(�� O ,/{� �_�'-.'T /�.. p DATE: �/ _ APPLICANT SMIP W � ENERGY P/C J WARNINGFAILURETOSEGUFEWORNEFS'GOM NSATIONCOVERAGEISUNUIWFUL,ANDSHALLBE J � SVBJECTqNEMPLOVERTOCRIMINALPENALTIESANDCIVILFMESUPTOONENUNDREDTHOUSAND ENERGYPERMIT � �OLLARS(t100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDF�FOR IN � _ . . :, _._ J SECTION31080FTHELABORCODE,INTEREST,ANDATTORNEY'SFEES. RETENTIONFEE: � � � OCONSTRUCTION LENDING AGENCV PqE-ALT FEE: � I HEHEBYAFFlRM UNOER PENALTY OF PEflJURY THAT THERE IS A CONSTRUCTION LENOING AGENCV � FOF THE PERFORMANCE OF'THE WORK FOR WHICH TNIS PERMR IS ISSUE�(SEC.3097.CIV C.�. � f��- _ � w � LENDER'SNAME —� \ H LENDER'SADORESS w ICERTIFYTHATIHAVEFEACTHISAPPLICATIONANOSTATETHATTHEABOVEINFORMATIOM1ISCORRECT. TOTAL FEES � � I AGREE TO COMPLY WITNAI_L QTY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING � CANSTRUCTION,ANDHERE9VAUTHORREREPRESENTATNESOFTHISCO�NTVTOENTFRl1PONTHE Z ABOVE-MENTIONFD PROPEi1TV FOR MSPECTbN PURPOSES. � � COMMENTS J � - � QPE I EN RIN C � I � C/� 5 `�` DATE '- — � REGPT�O. • PAID BV VALIDATION WHITE—Depanment Copy,YELLOW—Finance Copy,PINK—Assessor Copy.GOLDENRO�File Copy,GREEN—Applicant's opy m �� a�er��^ = l�i �,�� . w � � " � � a u "� - . .��'�� ,��,�re�'� �r� �. .. . _. . .... . ...... ...: _. _. .. . . . . 3 r �r ..... .. .. .. .. .. . . ,. , �r .. , � ;�- �s+��„�� IlD ��;.- .c�t `�bv,� �,+.� �t.8+�4 �` �"� �� ,�'- _ o� , - � � . � J � -��-3��-� ��.��c %�%� �� F.�f�C� �.�;�_ �� .� ,. .. .. . � � � _ �.� �. � , s � 4. ry . . ... .. _.. ... ... .. . .. ' i�t ro.l� �� -`: , I ,�� r=` . .... .. .. .. .... . .. . .�. � � � ,,� '� C( ... .. .. .. . . _ .. . . . . .. T[ ��' 6 �'�:�1Vd"'`C3� r ''�" ,.s. . ,��-�"�� ,:�� %�g=� � ��=�'... .. { �� 'v y �� . �. .... . .... . .. . .... . . . . . ... , n a �„ � — L �4 � �� i` ' �'' ... . . . . .... ..... ...._ ,. � 3 ., y'. ., . . .. .. .. . .... . �.:a 4 ,� . . ... . . . . .. ... .. ' ..:. M 3 . , ��.. uel xuo s-x.l� xIN.. '"a.X�'#L'� f� ��..M1��r ....... �z . � f At.y. .. � 'I�c ��:.t g '�� ... .. ... . . . .. ... .... . ..... .... .. ...... .. .. . . CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT_SERVICES 21825 E. Copley Drive c'� (909)860-3195 Fax(909)861-3117 �� -�I BUILDING PERMIT APPLICATION =�, �?�rL��I�,i�� I 0 /• �� DDR ESS�Z�/',J/��NC3,L� A APN LQ�-�--;TRACT {� E vr" � iC I OWNE I� ADDRES CITY ZIP TEL. 3. APPLICANT TEL. CONTRACT 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- CENSELAW 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,PRK)R 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- FESSIONSCODE)ORTHAT HE ORSHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION.ANY VIOLATION OF SECTION 7037.5 BY ANV APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(5500).): ^I,AS OWNER OF THE: PROPERTY,OR MV EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC. 7044,BUSI- NESSAND 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). ^I,AS OWNER OF THE: PROPERTY,AM E%CLUSIVELY 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 OFA PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS W ITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW). ^I AM EXEMPT UNDER SEC. B. 8 P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER Pf:NALN OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH SEC'ION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE.AND MV LICENSE IS IN FULL FORCE AN EFFECT. D/ / Y LIC NSE C E LIC. N0. 'SS (r DATE 32J��CONTRACTOR II WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PE:NALN OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINTAIN ACERTIFICATE OF CONSENT TOSELF-INSURE FOR WORKERS' COMPENSATION,AS PROVIDED BV SECTION 37000E 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 BV SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS N INSUR ISSUED. MY W KERS'COMPENSA TIO A NCE CARRIER AND POLICY NUMBER ARE'. Y � CARRIER �/�1J r POLICY NUMBER z 7 a• (iH15 SECTION NEED PK)T RE ODMP EfED OF THE PERMfT IS WR ONE HUNDRED DOLLARS(5700)OR LESSt I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN ANV MANNER SO AS TO BECOME SUBJECT TO THE WORKERS'COMPENSATION LAWS OF CALIF RNIA,AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS'COMPENS 7 ROVISIONS OF SECTION 37000E T{iE LABOR CODE I HA FOR 1'HWITH COMPLY H R IS NS'S'-' I DATE: �t APPLICANT WARNING FAILURE TO SECIIRE WORKERS'COM NSATION COVERAGE IS UNLAWFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS(5100,000),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 0 F'THE WORK F WHICH THIS PERMIT IS ISSUED(SEC. 3097,CIV C.). 0 R / / � LENDER'S NAME��"�" LENDER'S ADDRESS I CERTIFY THAT I HAVE REAL THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH AI-L CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OFTHIS COQ NN TO ENTER UPON THE ABOVE-MENTIONED PROPEF IT V FOR INSPECTION PURPOSES. � / G PEIENRIN C 5 DATE D PRESS FIRMLY WHITE-Department Copy,YELLOW--Finance Copy, PINK-Assessor Copy,GOLDENROD�ile Copy,GREEN-Applicant's Copy 04A P(AU4 I F-oV ov z-,