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Home My WebLink About18143 — ��i CIT�C OF DIAMOND SAR � ��'��`` t DEPARTMENT OF COh4vILTNTI'Y&DEVELOPMENT SBRVICES , ,' r j,F , ��"""� 21825 E.Copley Lkive �J ' � (909)860-3193 Fax(904}861-3117 PRESS `�~�� BLTiLDING PERMIT APPLICATION FI MLY JDBSITE i yry APPLiCATION PERMIT � P/C � ADDRESS�j-��.. L�� C U/""�./`"� G/�-- DATE � NUMBER # � � ISSUE /T"1 TYPE OCC .— APN LOT_ TRACT DATE 4 Y•� CONST. GROUP p OWNER ��i✓S �,�/�^1 � ADDRESS_��y�, t .�}�„ �,,,c��.,1v' �t� ZONING SETgACKS w FftQNT RW [7 � CITY ZIP TEL.�,�t 73g � APPLICAN�:r �L/L�YSA,✓ TEL REAR �m� SIDEiSIDE STREET RW [�___ � CONTRACTpR_�- �-- 1�- ��SS�at: SIpE ❑ � AdDREa L�4Rd�%� , 7;. � PROPOSED USE � GIN,�'@��'v c,.}O ZI P d 6 C.� TE ��..� ��"G,� � ARCWENG/ W DESIGNER NO.DWEL. NO. NO. cL ADpRE65 UNITS STt?RlES BEQRCIQMS_ � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR FSF AD3.AREANALUATION � OWNER-BUILDEF DECLARAT�pN SFRlADD/REM O Q I HEREBY AFFIRM UNJEFi PENAI:IY Of PERJURV TNAT I AM E%EMPT FROM THF CONTRACTOFS LI- � Garage/Carport W GENSEL4WFORTNEFOLLUWINGREASON(SEC.709�,SBU5INESSANDPROFESSIONSCOOE:ANYGITYOR ZCOUNiYWNK:t{REOUtRESAP£RMRTOCt3NSTRUCT.AtTER.9.fPR4VE,DEAA0U5Vf,OpREPA1RANYGTRVG W P8�10/DBCk � TURE,PflIOR TO ITS ISSUANCE.ALSO RE�UIRES THE APPUCANT FOR SUCH PERAAIT TO FILE A SiGNED w .,��- STATEMENT THAT NE OA SHE fS LICENSED PURSUANT TQ THE PROV1310NS OF TNE CONTRAGTQRS L1� � CENSE LAW itYtAPTER 9(C�.iMENCMG V.^TN SECTiON'i000;OF DIV�SION 3 pF 7HE BUSINE55 AND PRO� �' POOUSP9 FESSIfJNSCA�E?ORTHATHEORSHEIGEXEMPTTHEREFROMANDTHEBASI5FORTHEALLEGEDEXEMP- � � iION.ANYV{q{_A7l9NOFSE:GTX3Nio9�.58YANYRPPLiGANTFOftAPERMiT5U8JEGT5THEAPPLICF�N7t0 z Re�Root � A CIVIL PENALTV OF NOT MORE TFIAN FNE HUNDFEG OOLI.ARS(5500�.): � pI,A50WNEROFTHEPqOPERTV,ORMVEMPLOYEESWITNWAGESASTHEIRSOLECOMPENSATION, � Cpmmercial � Wilt 00 THE WORK,ANO iHE STRUGTURE IS N07INTENOED OR OFFFRED FOR SAIE(SEC.7od4,BVSi�� J � fVE55 AND PROFESSIONS CODE:THE CONTRACTORS LICFNSE LAW DOES NOT APPLY TO AN OWNER OF � PROVERTY WMO BUIlDS OR IMPROVES THE0.E�N.AND Nhip DOES SUCH WORK HIMS[LF Oft HERSELF OR (,'[ THAOU(3H H75 OR NER OWfd EMP�OYEES.PROViDEO THAT SUCH IMPROYEMEN'SARE NOi INTEN4EDOR m QqfFERE�FORSALF.IF,HOWEVER.THEBUILDINGORIMPiiOVEMENTIS50LDWITHINONEYEAf70FCOMPLE- Z TIDN,THE OWNEA�BUlLDEk WILL HAVE THE BUPOCN OF RROVING THAT NE OR SNE DID NOT SUILD OR � IMPROVEFORTHEPURPO£E�fSALE). ❑I,qS 6WNER OF THE PROPERTV,AM EXGw51VELY GONTFHGTIN6 WITH UCENSED CQNTRACTOpS g TO cANSTRUCT TNE P1W£CT(SEG.7o<a,BU9IkE35 AND PRaFES530h'S C06E TNE C4NTRACTORS�t� V8IUetiOti ADJ.AREA W CENSELAWDOESNOTAPPLYTOANOWNERC?FApROPERTVWHOBUILpSORIMPROVESTHEREON,ANp � WFqCI?NTRACTSFOFSUQiPRO.IECTSWITHACONTRACTOR(SIUCENSEDPURSUANTTOTHECONTRAG QUANTITY RESGRIPTION FEG � � T6RSUGENSELAW.}, � ❑I AM EXEMPT UN�EN SEC. J Q _„_,_,,,,_,,,, 6.&P.C.fOR THIS REASON Q � _ _. v � LL" DATE ,_ ._ OWNER__._ F Z ._...... U W � �U�ENSED GQNTfiACTQftS DEGIAfiAT10N W � I HEREBV IIFFIRM UNDER PE:NALTY OF PERJURY THAT IAM IICENSED LM�EH PROV1510NSOF CHAPTER � $(COMMENCB�f W17H SEC7 WN?600}OF DIVISi6N 3 6F TNE BUSIt1E5S AND GR6FESSI6VS CODG AND Z �'� K�� I� �X MY LICENSE IS IN FULL FORCE AND EFFECT ' 1.1 f , ,.. ft� � LICENSE CI,ASS "r T�� LIC,NO. �� ' �}�—�ry� j y "f p,►. /�. J � QATE�' s"" CONTRACT4R.. �� Z-"' '� a W a�'3 WCIRKERS'C6MPENSATION DEC�ARATION Q = U � I HEREBY AFFIAM UNDER PENAtTY OF PEAdURY ONE OF THE fO�IOWiNG DEGLAfiATiONS: Cr? Q CS I NAYE AND WILL MAINTAIN A CERTIFICFTE OFCONSENTTO SEIK-INSUHE FOR WOflKERS' 2 � �cOMPEA15AfiOD1,ASPROViDEbBYSECTIOt737q30FTHElA60fiCOD6.FORTHEPEAFOftMANCE �U OF TNE WORK FOR 1NHICH THIS PERMIT IS ISSUEp. � O � IHAVEANDWILIMA�NTAiNWOfiKERS'COMPENSATIONMSURANCE,ASFE�UIREDBYSECiION � 3�o00FTHELABORCOpE.FORTHEPEFFORMANCEOFTHFWORKFORWHICHTHISPERMITIS �SSVED.MYNK3FKERS"COMPEMSATIQNINSURANCECARRtERANDPO�iCYNUMBEFARE CLINSTRUCTIQN ,..,, ,_, � CnFRiER R��'_Y�'G'�N`k�- �6' -,�'1VS�F�RA/�'�C''6� � PLAN REVIEW ` � POLIC;Y NUMBER�+4,✓'Yt1 ��'� �E` 1 ELECTRIC _.. `� .r� � (MISSECTONN[EDN078EOJMFtEfEDOFiHEPERMRI5F7RONEHIA�UFED00I.1.ARS(EtO��ORLESS). PLUMBING �,,,,,,_, r w i GEftiiFT THRT IN THE PEftFORMANCE 6F THE KK3RK F4Fi WHICH iHiS PERMIT IS ISSt1E0,i MECHANI�AL � � (7' SHAL4NOTEMPI,qVANYPERSONIN.WVMAN4ERSOASiOB'eCOMESUBJECTTOTHE � WORKERS'COMPENiATIONLAWSOFCA�1FbPNIA,ANDAC,REETHATifISHOUl�BECOME INSPECTIONFEE ,T� _ '_ _ � SUBJECt T�THE WCtRKERS'COb1P6NSATION GROV�SIONS OF 5[CTION 3]OOOF THE LABOR � coos,i sN.u�FoarNwirH con+a�v win-i rt�ese waowsions. ISSUANCE _...... ... ' � SMIP p PA7E: �_ APPLICANT: ..._—....._�.—. — ..-- — W ENER6Y PIC J WAftN1NG:FAlLURE TO SECURE WORKERS'Ct)MPENSdTIpN CAVERAGE IS UNUtVFUL..AND SHALI.9E �- � SUBJECT AN EMPLOYERtOI:flIMINAL PENALTIES ANO CIVIL FINES UP TOONE HUNDRED THOl1SAND ENERGY PEPMIT ------�_— OOLLAliS i='��).�N AODI'ION TOTHE COST O�COMPENSATtON,OAMAGES AS PftOVtOED FOR IN �—�� -- - J 5ECTIpN 31080F'NE LA60R CODE,INTERESi.ANbATTOftNEY'S FEES. RETENTION FEE: � _ _-_ d CONSTRC3GTIOtJ IENC}ItJG AGENCY PRE-ALT FEE: ._ _,,., Q � I HEHEBY AFFIPM UhDER f+EVALTV CF PERJLIRY THAT TH6PE IS A GONSTEiUCTlc�N LENDfN�A�EHCY . FOA THE PEAFORMANCE OFTNE W6RK FOR wWCN TNIS PERMIT IS�SSUED tsCC.909'l,CiV C.). W _.._.. � tENDER'S NAME � i ^, _ F_ �ENDER'SADDRESS__,,, - � TQTAL FEES �'� � ICEPTIFYTHATINAYERERD7HISAPPUGATIONANpsTATET4ATTHEABOVEW�oRMATIONISCORPECT f w I AGREE TO C6MPLY WfTH Ai i_C�TV ANb COVNiY ORD�NANf.ES AND STATE LAWG REI.A7IhG TO eUItDMG d � GONSTRUCiION,AVD NEREBVAUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTE3 UPON THE ABOYE-MENTIONEO CROP£R7Y FpR IN5PECi1Q4 PUftPOSES. Z t, COMMENTS._.,�_ Q ��_7""' d��"'`�. :��t'✓ .._ —.. �. --..._ —...... m f+ERMI�'T�NAME(F�+RINTl . '/ . � � ......_... d � f L �,7 ... � �=�;_ �;��;�----�__...�- - --� � SIGNAi'UHE QF PEflMITT E DATE � RECPT.NO. ,,,,, -�+ PAID BY ___ VALIDAT�ON ~ WHITE—DepartmeM Copy,YEILOW—Financs Copy,PINK—Assessor Copy,vOIDENRflP—file Copy,GftEEN—AppiicanYs Copy � � ' �� !� �� `;�� .�.� . - �"'�0� �w. . .�._....,�,�a� .. „ .� . n. a �, _ _ , � . _ , o-a.. .,., s, . . . e � „ ,� y . . - , p�T�- , � � � � .��., .'. . .. . . . .. ... . . � .. .. . . ._ . ... ... _ . � . ` .,��, � � '„° ��. . . ..... . .. ... . . . . ... .. .... .. . .... .... ... .._..; ; ., ' , ��.. .. . .. . . . ... . . . . . .. . ., � i I�&a� ,r .. r '� .��t`� �., . . . . . . .. .. ... ... ... . . ... . . ... .... i ; � � �ai � �.�r'-+ ! � .. ... .... . . . , a�: `� r��i� - � � ...��.. �,��i � ��"� � �?�� . _ . ��, - } h . � � �0.. `...� .. ... . .�. A k . : �J �y � .�� ... . ... . ... . .. . . . . . ... . .. . . .. .. .... . ... _ . . . . � � d= 3 � ..�:° �3��a�` 6 (�� ro 9�:°�..: . ..fii" ��'Y II � � J L<.-. .. . . . . . .. .. .. ... . . . ... ... �q' �=� 9.�}y° . .. . . � .. _�� .. �9...� . . T i . �sal_i.' , .. . .. .. . .. .... .. . ... .. .. . ... _ . .. ��. •.�. a � ',.� �,h� Fic�., ... .. . .. .. .... .. , x p q. 2i ,,' _ 2 > � E,.� � ...�. . .. .. . . . ...... � f . :�'�. �_ �'i�.,:� .. . . .. .... . . .. ._...._ ... . . . a ,. , t�.�� y,y, .... _. ._ .. . CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION PRESS FIF3MLY ADDRIESS�3 L�, �� d U �(/'fir Jr� APN LOT TRACT OWNER�Ifel� � iC/��I ADDRESS 1 ; r,�t,�� ,s,e„/t,-fl t2 CITY ZIP TEL.S�� > 4! 7s.s APPLICANT�;� - �L/L z�,,.�TEL. d CONTRACTOR �, -- �-�S is C- ADDRE L�Al2,+GA� CITY,��•E' �•i�ZIP ! 6 Cj TEI.�.�tf 1'(d �I Z.tt 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 BUSIN ESS AND PROFESSIONS CODE:ANY CITY OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT,ALTER. IMPROVE,DEMOLISH,OR REPAIR ANY STRUC- TURE, PRIOq 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)OR THAT HE OR SHE IS E%EMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION.ANV VIOLATION OF SECTION 7031.5 BV 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 W ITH 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 Oq OFFERED FOR SALE. IF,HOWEVER.THE BUILDING Oq 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). ^ I,AS OWNER OF THE PROPERTY,AM EXCW SIVELY CONTRACTlNG WITH LICENSED CONTRACTORS TO CONSTRUCT THE PRO.IECT(SEC. 7044. BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- CENSELAW 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.). p I AM EXEMPT UNDEfi SEC. B. 8 P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PE:NALN OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH SEC110N 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE.AND MY LICENSE IS IN FULL FORCE AND EFFECT. 1 Q''} LICENSE CLASS LIC. N0. �� 7 DATE�� '�'CONTRACTOR/7 4�"" �' WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TOSELF-INSURE FOR WORKERS' COMPENSATION,AS PROVIDED BV SECTION 37000E THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR 1NHICH THIS PERMIT IS ISSUED. I HAVE AND WILL MA'NTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION 37000E THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MV WORKERS'COMPENSATION INS U ANCE CARRIER AND POLIC R Y NUMBE R ARE: ++ rY J d� ��6'-,f�/Vl �cKfi/V i� CARRIER R 4�V Nff( �� POLICY NUMBERIN�� ,�,i '�"1 �� ' � 1 (Oils SECTION NEED N07 BE OOMPLLTED OF THE PERMR IS FOR ONE HUNDRED DOLLARS(5700)OR LESS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANV PERSON IN:\NV MANNER SO AS TC BECOME SUBJECT TO THE WORKERS'COMPEN iATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 37000E 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 ANO CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS(f 100,000). IN ADDI'ION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOFI CODE,INTEREST,AND ATTORNEY'S FEES. CONSTRUCTlON LENDING AGENCY I HERERV 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 CONSTRUCTION,AND HERERV AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PRO PE R 'r V FO R NSPECTION P URPOSES. I / / f L p E PERMITT NAME(PRINT �-)�7�e- �/-v 2_ SIGN PERMITTEE� DATE WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy