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Home My WebLink About16790 ,-�- - _ � 7�� P� �� CITY OF DIAMOND BAR -� " -- DEP,ARTMENT OF COMMUNITY&DEVELOPMENT SERVICES f 216fi0 E.Copley Drive Suite 190 ,�v � PRESS I (909)86Q3195 Faz(909)861-3117 �� w BUII,DING PERMTT APPLICATION � I �"�� FIRMLY JOBSITE / APPLICATION �'� �:�;r � PERMIT ' �P/C /'�I � r� o ADDRESS I�NGl Bf`.C1IGP CrcL�r" �n�'L°E� DATE � � " <� �-��i NUMBER �� # `_:h ' � c� — ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER , T/)� �rc,1�+� G.�_�;Z_] " ADDRESS `" �.1 1 • I •S..J. l�.H C ZONING SETBACKS � CITY�� ZIP �CC �' EL..3? � FRONT RW ❑ -j=3 `3—�6 "� REAR ❑ APPLICANT _ TEL. SIDE/SIDE STREET RW ❑ � CONTRACTOR ��: ��'1C. SIDE ❑ � ADDRESS oZ , f..1 ' :`.'✓� l�r . ! CITY / ZIP��,j_� TEL.R"�l°11SY�-�l7 PROPOSED USE f"'� �� ARCWENG/ � DESIGNER.L� • �` I �iVL'++��✓IC. NO.�WEL NO. NO. � ADDRESS� Fira .SUa�e+_ �O/ UNITS STORIES BEDROOMS � CITY J-/✓.Nt� ZIP�� TEL.�I�/V�.S�I�'�� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECLARATION SFR/ADD/REM O � I HEflEOV AFFlRM UNDER PENAL7Y OF PERJURY THAT I AM E%EMP7 FROM THE CONTRACTORS LI- G2�8 JB/CBf�IOfI W CENSEIAWFOflTHEFOLLOWINGREA50N(SEC.70J1.5BUSMESSAN�PROFESSIONSCQOE:ANVCITVOR (n U COUNTYWHICHREWIflE5A7ERMffTOCONSTRUCT,ALTER,IMPROVE.DEMOL'SH,OPREPAIRANYSTRUG W pat10/DBCI( WNHE,PRIOR TO ITS ISSUIWCE,AL50 REW IRES THE APPLICANT FOR SUCM PERMIT TO FILE A SIGNEO W STATEMENT 7HAT HE OR SHE IS LICENSE�PURSUANT TO TME PROVISIONS OF THE WNTRAGTORS LF � CENSE UW(CHMTER Y(CAMMENCINO WITH SECTION 7000)OF�IVISION 3 OF THE BUSINESS AND PRO- � POoUSPO FESSqNS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE A�IEGED EXEMP- TqN.ANV VIOL�TION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SU&IECTS THE AVPLICANT TO Z Re-Roof F ACML7ENALTVOFNOTMORETHANFNEHUNDHEDDOLIAFS�f500).)� � ❑I,ASONTIEROFTHEPROPERTV,ORA/YEMPLOVEESWITHWAGESASTNEIRSOLECOMPENSATION. � COmmOfCiel V/ILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OP.OFFEFED FOR SALE(SEC.7aa,BU51- J NESS IND PROFESSIONS CODE:THE CONTMCTORS LICENSE LAW 00[S NOT APPLY TO AN OWNER OF � PROPERYYNTIOBUILDSORIMPROVESTNEXEON,ANDWHOOOESSUCHWORKHIMSELFORHERSELFOR m � TFIFqWHHI50RMEROWNEMPLOVEES,PROVIDEDTHATSUGHIMPROVEMENTSAPEN071MENDEDOR QOFFERE�WHSPLEIF,HOWEVERTMEBUILDINGORIMPROVEMENTISSqDWITHIfrONEYEAROFCOMPLE- Z TION,THE OWNER�BUIIDER WILL HAVE THE BURDEN OF PROVING THAT HE OR 5HE DID NOT BUILD OP � IMPROVE FOH iHE PUHPOSE OF SALE). . �.� .� ,., ' .`� . ❑I,AS ONMER OF THE DROPFHfY AM IXCLUSNELV CONTRRCTMG WITH LICENSED CONTflACTORS � TO CONSTRUCT THE PP.QIECT(SEG]04,BUSINESS ANU PROFESSIONS CODE:THE CONTRACTORS LI- V81U8fi0fl�� ADJ-AREA W CENSEIAWDOESNOTAPPLVTOAN04MEROFAPROVERTVWHOBU1LD50RIlUPfiUVESTHEREON,ANO � WFi00JNTRACTSFORSUCHPR0.1ECT5WITHACONTRACTOR(S�UCENSEDPVRSUMITTOTMECONTMC- QUANTITY DESCFIPTION FEE TORSUCENSELAW.). /� J �j //� O ❑I MI EXEMPT UNUE'�i SEC. ______B.8 P.c.FOF THI�REASON Q O �� `-" G�^ 3 ----- � s LL' DATE ___ OWNER_ _ � � - W � LICENSED CONTRAC'iORS DECLARATION � � W IHEREBVAFFIflNUNDEPPENALNOFPENURYTHATIAMLICENSEDUN�[RPpOVISION£OFCHAPTER � � 9(COMMENCWOWITHSE[TIONIOW)OFDIVISION30FTHEBUSINESSANOFROFESSIONSCODE,AND Z X MY UCENSE IS�N NLL FOFIGE AN�EFFEGT. m LLI � /� l � LICENSE^7CLASS q�,_y,____ LIC.NO. �-1 y O 1�I j V DATE l-a�_.�{.,,1.�.,,_� CONTRAC70R� 1-nC�__ n- W � WORKERS'C.OMPENSATION DECLARATION -� � ¢ vy U N IHEREBYAFFIRMUNDERPENALTVOF7ERJURYONEOFTHEWILOWINGOEClAR0.TION5' Z Q � � I MAVE ANO WILL MFINTAIN ACERTIFICATE DF CANSENT TO SELF-INSVRE FOR WORKEPS' _ � �j- CAMPENS�TION.ASPROVIDEDBVScC?IONPOOOFTNELA9UHCODEFOR7HEVERFORMANCE w _ � OF THE WORK FON WHICH THIS PERMIT IS ISSUED. � W `I, __ " I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION iNSURANCE,AS REOU!HED BY SECTION 1�i ( � Q 3�no Of THE iAPOR CODE FOR THE PERFORMANCE OF THE WORN FOR WHICN 7HIS PERMIT IS '.��'�. �'`�i i .` !�\�f "1�(� �'��J � ISSUED�MY WORKERS'COM�ENSATION INSVP4NCE CARP�IE+R��A�kD P�UCV NUMAEP ARE: CONSTFUCTION l � CARRIER_�� +�% ��7`f PLAN REVIEW > � aoucv Nu�sEa_�W.�Q�j�. � ---.--- ELECTRIC _�...�„�.�.� � (ili55ECTI0NNE9JN�TBEOOMPLE7EQOF11'IEPEMYT4SFORCN[t1lFN]F7E�OOLLAR51510o1�7LE55�. PLUMBING _ I ^��-i w MEGHANICAL � � � Z 1 CERTIFYTHAT IN'fNE PERFOpMPN��E OFTHE WURK FOF WHICN THIS PEHMIT IS ISSLIED,i ' (,'} SHALL NOT EMM.OY ANY PERfidJ IN ANV MANNER SO AS TO BECOME SUBJECT TO THC ' � VIORNERS'COM°E'NSA�IONUWSOFCALIFOPNIA,ANDAGREETHATIFISHOUL�BECAMF. INSPECTIONFEE .___________._— �� SU&IEGT TO THE WORKERS'COMPFNSATION PRUVi510N5 OF SECTION 37000F THE LABOR � � � CODE,I SH4LL FORTHW'.IH GOMPLY WITH TMOSE PAFOVISIONS� J� ISSUANCE __ � '] �� / f�^ ��J SMIP p DATE:�.�_Q.I_ APPLICANT: ��}V�'�'�Ir�l�— � / J £NERGY P/Q X J WARNINO:FAILUHE TO SECURE�WRKERS'COMPEI:SATION C.OVEFACE IS UNIAWFUL,AND SHALL BE -�i�� 3U&IEGTANEMPLOYERTOCRIMINpLPENALTICSAN�CNILFWESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT �� DOLLARS({I OO,D00),IN AODITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIPC�FOR IN — � J SECTION37080f7HEUBORCOOE,INTERtST,ANDATTORNEY'SFEES. RETENTIONFEE: —__ ___.. .___...___ r-! d CONSTRUCTION LENDING AGENCY pRE-ALT FEE: /' �� v � - r+.�� l.-. �1 � IMEREBYAfFIRMUNDER��ENALTYOFPERJURVTHATTHER'eISACONSTPUCTIONLENDINGAGENCY Y �'��^"�� " '� a- FOP TME PERFORMANCE OF THE WOFK FOR WHICN THIS PERMIT IS ISSUED(SEC.3091,CN.C.�. , Z /^.. ' ! . _ � �� W � , _, -� � � � LENDER'SNAME_____ _ _ i - H LEN�ER'SADDP.E55_, [ +.. � ICERTIFVTMAfIHAVEREADTHISAPPLICATIONAN�STATETHATTHEABOVEINFORMAT10NI5CORRECT. ,�1OT �� EES l/� � ` Il "u � � I AGREE TO CAMPLY WITIi ALL CITV AN�CWNTV ORDINANCES RND STATE UWS REUTING TO BUILDING �� f CONSTRUGTION.�NDHEHEBYAUTHORIZEREPRESENTATNESOFTHISCOVNTYTOENTEflUPONTHE '�„-- - . � 1 �� ABOVE�MEN�IONEDPqOPEFTYfORINSPECTIONPUPPO5E5. COMM� '�� ' �� J ._..,.......�- � _-'_ m PERMITT NAME(Pft/lJ�7I � /� -� �q 'y (n d.El s a��.....'t�{"�G� V":• �l�.U,_�Z •,l `..�[.7'-'�� —�--_ - __. � SIGNATUiiEOFPERMITTEE DATE i7ECAT.NO. PAID BY VALIDATION _ - ~ WHITE-Departmenl Copy.YELLOW-Finance Copy,PINK-Assessor CoDY.GOLDENRO�File Copy,GREEN-ApplicanPs Gopy y"1'"�'1� d"'6� �"it�A4�A"1ssa�""e ��F� E°�`�;� ,. .� �` �.. .�� ,�. � <,' ��° �" 6+ � >:.' �. , # ,� '° �. ��' � �. 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CONTRACTOR IQ : r�1C. r.'/4 ADDRESS'24cer fvt �� CITY P ZIP 744,3 L1 TEL.Q'195 1-y� ARCFUENG/ DESIGNER.r(jAr Le-mud( r D ADDRESS fA2 .44.,1 a. Silo 4c+W/ CITY J-r/. n t ZIP S TEL.g4 T-Sq5-' 1 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 A PERMI TTO CONSTRUCT,ALTER. IMPROVE, DEMOLISH,OR REPAIRANY STRUC- TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS UCENSED 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 ACML 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). ^ 1,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.0 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. ----LIC. N0. lg 90 751 LICENSE CLAS S QA -11 DATE. ., 3 3 t)CONTRACTOR Lt1C- 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.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 R AND POLICY NUMBER ARE. ISSUED.MY WORKERS COMPENSATION INSURANCE CARRI E 4 -3 CARRIER • POLICY NUMBER A---.-- (TIES SECTION NEED NOT BE ODr.WLETED OFT IE PERMIT LS FOR ONE HUNDRED DOLLARS($1 DO)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'ENALN 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 CONSTRUCTION.AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. D PERMITT NAME(P I/ 0 SIGNATURE OF PERMITTEE-DATE 3 CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 2166Q E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION I I'I� PRESS FIRMLY APPLICATION•' .� % r PERMIT P/C DATE NUMBER ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBAC KS FRONT RW ^ REAR ^ SIDE/SIDE STREET RW ^ SIDE ^ PROPOSED USE N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREANALUATION SFR/ADD/REM Garage/Carport W Patio/Deck W LL Pool/Spa C7 Z Re-Roof Commercial Valuation ADJ.AREA QUANTITY DESCRIPTION FEE Od c: �-, 9-ZZ a U S H U W W 0 Z a ) Z U W CONSTRUCTIO N PLAN REVIEW ELECTRIC PLUMBING M ECHANICAL INSPECTION FEE ISSUANCE SHIP IK ENERGY P/C ��T ENERGY PERMIT q RETENTION FEE: PRE-ALT FEE: r,,, } d " X I TOT L EES COMM RECPT N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLUENHUL)-I-ue copy, 1.*ID LN-. 4ik L A-) II-L-O 7