The URL can be used to link to this page

Home My WebLink About17031 ��-� � G� �- �o �.�� : �� ""`�� .� CITY OF DIAMOND BAR \ �^Q�`:'1 DEPARTMENT OF COI�Ilv1UNITY&DEVELOPIvfENT SERVICES � �1'�t� , p l �, 2]825 E.Copley Drive � (9 0 9)8 6 0-3 1 9 5 F a u(9 0 9)861-3117 1 PRESSh'` ""%.,�`� BUILDING PERMIT APPLICATION �,-; ' �`J I FIRMLY � JOBSITE / / APPLICATION � PERMIT !'�] nL� P1C o ADDRESS_ ' ' _��C G I .` ' DATE �� NUMBER I� �t��'� � ISSUE �`) TYPE OCC APN LOIT R T DATE V CONST. GROUP __ °� OWNER �, i^I �� C Q,' 1 � J � �� ' f U /,, ZONING SETBACKS o ADDRESS z CITY �P ��U �3'TEL. REART RW � � APPLICANT C ��C�C'� TEL. SIDEISIDESTREET_ RW ❑ ¢ CONTRACT05t, SIDE ❑ ADDRE 4 PROPOSED USE � CITY �� ZI ; �� TEL �� w ARCH/ENG/ 1 '�� .��f/ ' z DESIGNER NO.DWEL. NO. NO. d ADDR S�S � �� UNITS STORIES BEDROOMS � arv r C I',(�� ZIP TEL. � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADD/REM O � � I HEREBY AFFIFM UNDER PENALTV OF PERJURY THAT I AM E%EMPT FflOM THE CONTftACTORS LI- G8f2 JB/CBfPOfS W CENSELAWFORTHEFOLLOWINGFEASON(SEG7031.59USINESSANDPROFESSIONSGODE:ANYGITYOR (n U COUNTVWHICHREOUIFESAPERMITTOCONSTRUC'.,ALTER,IMPROVE,�EMOLISH,OFREPAIHANYSTRUG w pytiD/DeCk wTURE,PRIOF TO ITS ISSUANCE,AL50 REOUIRES iHE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED � STATEMENT THAT HE OR SHE IS LICENSEO 7VRSLIANT TO THE PROV15�ONS OF THE CDNTRACTOFS ll- � p00VS 8 � CENSE LAW(CHPPTER B�CO6IMENCING WITH SECTION]OaoJ OF�IVISION 3 OF THE BUSINESS AND PRO- ,rt P O FESSIONSCODE)ORTHATHEORSHEISEXEMpTTHEREFROMAN�THEBASISFORTHEALLEGEDEXEMP- u I V TON.ANYVIOLATIONOFSECTION7031.5BYANVAPPLICANTFOFiAPERMIT5U8JECTSiHEAPPLICANTTO Z Re-Roof � P qVIL PENALTY OF NOT MOftE THAN FIVE HUNDRED DOLLARS(5500).�: O ❑I,ASONT7EROFTHEPROPERTV,ORMYEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, 0 COffIRlBfCial Z WILL DO THE WORK,AN�THE STRUCTURE IS NOT INTENDED OP OFFERED fOR SALE(SEC.1oaa,BUSI� J � NESS AND PflOFESSIONS CODE:THE CONTRACTORS LICENSE LAW�OES NOT APPLV T�AN OWNER OF � PROPERTVMMOBUILDSOPIMPROYESTHEREON,ANDWHODOESSU�HWORKHIMSELFORHERSELFOR m 2 THROUGH HIS OR HER OWN EMPLOVEES,PROVIDE�THAT SUCH IM7flOVEMENTS ARE NOT INTENDE�OR w OFFEREOFORS.OLEIF,HOWEVER.THEB111LDINGORIMPROVEMENTISSOlAW1THINONEVEAROFCOMPLE- 0 TION,THE OWNER-BUILOER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BU1LD OR Z IMPROVEFORTHEPUflPOSEOFSALEJ. _ ❑I,ASOWNEROFTH[PROPEF7Y,AMEXCWSNELYCONTRACTMGWITHLICENSEDCONTRACTORS w TO CONSTRUGT THE PROJECT(SEC.]04a,B1151NE55 AND PROFESSIONS CODE-THE CONTRACTORS LI- VflIUBSlOf1 J.AREA Q W CENSELAWDOESNOTAPPIYTONNOWNEROFAPROPERTYWHOBUILD50RIMPflOVESTHEREON,AND F WHOCANiRACTSFORSUCHPROJECTSWITHACONTFACTOR(5)LICENSEDPURSUANTTOTNECONTRAC- QUANTITY DESCRIPTION FEE Y TORSLICENSELAW.�. J QC I AM EXEMPT UNDE�SEC.__... B.8 P.C.FOR THIS flEA50N � � � � �ATE OWNER ~ U Z W � LkCENSED CONTRACTORS DECLARATION � � w I HEREBYAFFIRM UNDER PENALTV OF PERJURV iHAT IAM LICENSED UNDEF PflOVI5iON5 OF CHAPTER � d 9�COMMENqNG WITH SECTION 7000)OF OIVISION 3 DF THE 9USINESSAND PROFESSIONS G CE,AND Z X 4AY LICENSE IS IN FULL F CEAND EFFECT. �} ('�� w � �f )� � � LICENSE ClASS LIC.NO. < <� � J V DATE GONTRAGTOR a W � WORKERS'COMPENSATION DECLARATION Q � U � I HEREBv AFFIRM UNDER PENALTV OF PERJURV ONE OFTHE FOLLOWING DECLARATIONS: Z Q � IHAVEANOWILLMAWTAINACERTIFlCATEOFCONSEMTOSELF-INSUREFORWOPKEFS' 2 ¢ CAMPENSATION,ASPFOVIDEDBYSECTION3]OOOK7NELABORCO�E,FORTHEPERFORMANCE w OF THE WORK FO%WHICH THIS PERMIT IS ISSUEo. � � w I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE.AS REQUIRED BV SECTION ��! � ^ " Q 3]OOOFTHE UBOR CODE,FOR THE PERFORMPNCE OFTHE WORK FOR WHICH THIS PEFMIT IS J V ISSUED.MV WORNERS'COMPENSATION INSURANCE CARRIEflAN�POJCV NUMBER ARE'. CONSTRUCTION j caRRiEa_ PLAN REVIEW 0 POLICV NUMBER, ELECTR�C Z G;/, ¢ (iHiSSEC11Cn1NEEDNo7BEmMPLEfEooFhIEPERMfiISFORONEHIMDREDDOLIARS(E100)ORLE55). PLUMBING ` � �� Z I GERTIFVTHAT IN THE PERFOFMANCE OF THE WOPK FOR WHICHTHIS PEFMIT IS ISSUED,I MECHANICAL "� > (,'} SHALL NO�EMPLOY TNY PEfl50N IN ANY MANNER SOAS TO BECOME SUBJECT TO THE INSPECTION FEE � �`J�� WORKERS'COMPI=NSATION LAWS OF CALIFORNIA,AN�AGREE THAT IF I SHOULD 6ECOME � � SUBJECTTOTHE'NORKERS'COMPENSA7IIXJPFovI510N50F5EC710Na�ooCFiHEIAeOR ISSUANCE � CO�E.1 SHALL FOR7HWIiM COMPLY WITH THOSE PROVISIONS. � � ^ O SMIP _��Q i .....� p DATE: _ APPLICANT w ENERGY P!C J WARNING:FAILURETO SECURE WOFKERS'GOMPENSATION GOVERAGE IS 11N,.FWFUL,AND SHALLOE J � LL SU&IECTANEMPLOVERIOCRIMINA�PENAL7IESAN�GIVI�FlNESL'PTOONEHUNDREDTHOUSAND ENERGYPERMIT � OOLLARS(f10o,o00).IN ADOITION TO THE COST OF COMPENSATION,DAMAGES AS PHOV9ED FOR IN q`�) J SECTION3]OBOFTHELANORCODE,MTEREST.ANDATTORNEV'SFEES. RETENTIONFEE: �` ` � � CONSTRUCTION LENDING AGENCV PRE-ALT FEE:✓p� � �_ \ � I HEFEBY AFFIFM UNDER PENALTV OF PERJUFI'THAT THEPE ISACONSTRUCTION 1EN01NG AGENCY � FORTHEPERFORMANCEOFTHEWORNFORWHICHIHISPERMITISISSUEO(SEG.3o9],CIV.C.). � Z W � LENDER'SNAME_ F_ LFNDER'SADDRESS_ _... _ / / � /��}. I � ICERTIFYTHATIHAVERF.ADTHISAPPLICATIONPNDSTATETHATTHEABOVEINFORMATONISCORRECT TOTAL,FEES 1 '�/ l �') � t W IAGREETOCOMPLVWITHAILCITYAN�COUNTYONDINANCE5HND5TATELAWSRELATINGTOBUILDING � � /� � CONS7RUCTION,ANOHERE6VAUTHOft12EREPRESENTATIV�OFTHISCOUNTYTOENTERUPONTHE 'j�y� C�� 6' ' I Ul+ Z A80 � TIONED PRO ERTY FOR INSPECTI N PURPO$ES � COMMEN7S �l� J o �� . � QPEFI.IITT E N0. E INJ � �\ C% � �„ , � Uj SIGNATUREOFPERMITT�_E OAT T� RECPT.NO. PAID BY VALIDATION S _ ~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD--File Copy.GREEN—Applicant's Gopy � N . . �� ' � �.��.sJ}��I . _ . . � . a t - �a..I«� . . .. .. .. . -y , ~ .. � . ... . .. . . .. .. . .. .. ... . �. . � .. ', .V"C�—L �t'�... '' ' . � . .. . . ... .. .. . . .... . . .... . � .� .: � . .. . ..�L��.J ...�_._.. , .. .�.. ... . . . . ... . ..._. ....� ..... ��. . . _7' . . .. .. . .. . .... . . . . .. . .. ... ... . . ._.. . .. . . �. � :� �J ;__�i': ' . . � %;� , . � ��. ! . .. . . . .. . ,.��.. �':.-- . .. ... . , . . .�... .. . ... ,.... . .... . . .... ...... . ... . �. � � � . . . . . . . �. . ... .. �. .. ..... .. . .... . . .. ... j� /��• ��. . ... . . . � �� '�f �1 /� . ' � , � ` ( _ . _ __ , � _ a , . � �" o� �. : , ' ' ( _ 1 " � � , — i�5�i-� � /�< < -�_ :�u_:�.. ,.r •1 ��`C �--:� �� !,t. �;�k._.��' _ . _ -- . t—_� � ,, ,_ r��l'�L� � �L` ..) � — L � - �' � �i ; �`T �`,�r?„f`� . � � � � . _...._ . � �,�,. �� ' �,,� ,�,� ' / ' ;�!��'r �`�,�,�,�f�-�� .�'��!� --� �/ �`�� _ _ _ _ . , . � 3 � � � ��rv�� r��" ,�°.� : � . � � + �. _ : � _ _ r =; �� 6 �� x ;�. �� , ., � �� _ �. � , . . � ` , ��',, , ; �, �� CITY OF DIAMOND BAR DEPARTMENT OF COIvIIv1UNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION npil a-I PRESS'� FIRMLY JOBSITE/ � (�CG � ADDRESS + �� APN LO1T R T OWNER�'(^I <=C Q+� 7 ADDRESS7� 1 ��U �- CITY I,P��G 3'TEL - APPLICANT C��TEL. CONTRACTO�t, ADDRE y CITY it ZI)TEL�� ARCH/ENG/ / rf I DESIGNER ADDR �I� CITY C cn c 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: ANV 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- CENSELAW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE)OR THAT ME OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION.ANV VIOLATION OF SECTION 7037.5 BV ANV APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(5500).1: ^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 SOIA 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 W ITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC. 704x, BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY W HO 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 GATE OWNER LkCENSED 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 C DE,AND MY LICENSE IS IN FULL F CE AND EFFECT.A(']�� J 1 LICENSE CLASS/�. LIC. N0. � DATE CONTRACTOR I i WORKERS'COMPENSATION DECLARATION 1 I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: ) 1 1 I HAVE ANO WILL MAINTAIN A CERTIFICATE OF CONSENT TOSELF-INSURE FOR WORKERS' COMPENSATION,AS PROVIDED BV SECTION 3700 OF THE LAROR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. 1 7 I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BV SECTION 37000E THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS � ISSUED. MV WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: J CARRIER � POLICY NUMBER . C (TM'ILS SECtIOf-1 NEED NOT BE ODMPLETED OF THE PERMR IS FOR ONE HUNDRED DOLLARS(5100)OR LESS). 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 j WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE'NORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR � CODE. 1 SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. � DATE: APPLICANT J 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 L DOLLARS(5700,000),IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LJ CONSTRUCTION LENDING AGENCY � I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS ACONSTRUCTION LENDING AGENCY � FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC. 3097,CI V.C.). u C LENDER'S NAME LENDER'S ADDRESS C I CERTIFY THAT I HAVE Rf:AD THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT LI 1 AGREE TO COMPLY WITH ALL CITY ANO COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING L CONSTRUCTION,AND HEREeV AUTHORIZE REPRESENTATIV�.�OF THIS COUNTY TO ENTER UPON THE j A80 TION ED PROPERTY FOR INSPECTI N PURPO$fS.\/ J (�I „Y 2 1 PERMITT E N E RIN)//� // � lj SIGNATURE OF PERMITTEE OAT S d 0 0 0 w z 0 z U Z J L. J L -WHITE-Department Copy,YELLOW-Finance Copy,PINK-assessor copy, uvw�rvnvu-r��d wpy, �r,��, �R��-� � ��QUA,i �-��-��