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Home My WebLink About18142 (10) ! �f,�. CITY�F DtAMOND BAR ,_� � , � �� i DEPARTIv1ENT OF CQMMUN]TY&13EVEIAPMEN'£S�RVIC�S �A'�� r • 21825 E.Copley Urive � (409)860-3I95 Faac(909)861-3117 PRESS � ��r�' BUILDING PERMIT AFPLICATION FIRMLY } JOBSlTE � � ��u�0�,�,r, f1 APPLICATION i' � PERMIT P/C � ADDRESS_� �� ' �""n' DATE_ t`� Nt1MBER ""� # � ISSUE /ti'J T1'PE "—� OCC .. °-° APN�--� LOT�— TRAC7__ _ pATE �'�-• CONSL GROUP � OWNEq ►-�w ��✓ { Il/r`�✓.L'7) � ADDRESS�� L�t I��u�2�� (}j�I_ ZONtNG SETBACKS � CITY ZIP TEL.�,f G'j SY Y' !�' FRQNT RW '.:� � APPLICANT 7_ REAR p z �fFY �s.t/ TEL. SIDEtSiDE STREET RW U_ � CONTRACTpR?�� -�1��P• ,�"S1"v� _ SIDE � ❑` ADpRES5_ Z kt U itr2 w�� w p "—�r, f PROPOSED U5E � cirv�, �r_ � ziP 'f/l��` T . ��'�r�-t� � ARGWENG/ � DESlGNER w -- NO.DWEL. NQ. NO. q� ADDRESS � CITY ZIP TEL. UNITS STORtES BEDROOMS � �� — cn dESGRIPTION St�.FT. FACTflR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFRlADDlREM O (:1 t HEREBY AFfIPM UNUER PENALTY OF PEFJURY TNAT I AM EXEMPT FRpM THE CONTRACTORS LI- G818J8/C8fp011 W CENSEUWFORTHEFOILOWWGREASONf5EC.7031.5BU5WESSANDpPOFES510NSCO�E:ANYCITYOR {f) ,,. C.� COUNTYWNICHftEOiIiRESAPERMtTTOCAFlS7RUCT.Al7Efi,i}IPRQVE,DEM6ltSH,ORREPAiflANYSTRUC� � TURE,PRIOR TO ITS ISSUANCE,AlSO RECUIRES THE APPUCANT FOF SVCH PERMIT TO FILE A$IGNED W Patio/Deck .Ryr STATEMENT TNAT NE OR SiE IS LICENSEII PURSUANT TO THE PAOVIStONS OF THE CONTRRGTOftS k.i� � "" .,� CENSE UW(CHAPTEfl s(O�MMENCW4 WtTN SECTION�pQtl)OF DiVtSiON 3 OF THE BUSINE55 ANp PRp� POOUSpB ' � FESSIONSCODE�ORiHATHEOpSHEISE%EMPTTH[REFRQMANp7HE9A51SFORiNEFLLEGEDEXEMP� � � TION.ANYVI4lATbNOFSECT10Nl0at.S8YANYAPP1,iCANTfQRAPERM1T5l.'f3.lECiSTNEAPPLiCANTTO Z Re-RD6f � AqVI4 PENALTY 6F NOT MORE THAN FIVE MUNDRED DOLI.APS�5500).): � ❑I,A54WNEROFTMEPROPERTY,ORMYEMPLUVEESWITHWAGESASTNEIRS4LECOMPENSATION. � �qm�p9(GIB) WIll60 iHE wOftK,RNo T.-iE STflUGTURE IS N6T INTENDED dR 4FFEF{'cD F6fl SAt.E iSEC.7aaa,euSi� _.I � NESSAND PROFESSIONS CODE THE CANTRACTORS LICENSE'_AW DOES NOT APPLV TO AN OWNER OF � PROPER7V WHO 9UILD5 qP IMPROVES THEREQN.AND WHO OOE4 SUCN WORK HIMSEIF OA HERSELF Oft � iNFD�UGH HIS OR HER QYtN EMPCOYEE5.PR6VIDE�THAT SUCH IA�AROVEMENTS AR[NOT INTENDE�Ofl � W QFFE%EDFORSALEIF,HOWEVER,THEBl11LDINGORIMPROVEMENTIS50WWITHINONEYEAPOFCOMPLE� � TION,THE OWNER-BUILOER WfLL HAVE THE BltRDc'N OF nR4ViNG THAT NE Oft SHE DID NOT BUfiD Oft � IMPROVE FOR THE PURPOS'c OF SALEj. � ❑I,ASOWNEROFTHEPRORERTV,AME%C�U5NELVCpNTftAGTINGWITFUCEN9EDCONTRACTORS W ['[ TO CONSTRUCT 7HG�flOJECT{SEC.7P0<,BUSINES5/YCk FflOFESSIONS{{�}DE THE CANTRAGTOFS�I� VBIUHfi077 ADJ.AREA W CENSELAWpQESNOTAPP1.VTpANOWNEfl(7FAPflOPEP,'TYWHOBUILDSORIMPROVESTHEREON.AND — � WHOCONTRACTSFORSUC�IPROJEGTSWITNACANTRACtOR;S1,�ICENSEDPUfl5UANTTOTNECONTRAC- QUANTITY DESCRIPTIQN FEE � TORSUCENSEIAW.). _ � ❑I AM EXEMP�UNpER SEC. 9,8 P.Q FOR THIS flEASON J a ¢ � U � — -- .—._. ..—._ Q pATE _,__ 6WNEft_, __ ,_�, U � W �.c[ LIt;ENSED CONTRACTORS DECLARRTION � CC INEREBVAFFIRMUNDERPEVAL�VOFPERIURVTHATIAMUCENS'eDUNbERRROVISIqNSOFCHAP7ER � I. r-- . y�,�/�.. `. ' � 9{C9MFdENGiNG W�TH SEC710N 700�}QF DIVISION 30F THE 8t15INF55 AND PFOFESSIONS CADE,AN6 Z ��l I l� X MY LIC�NSE 19 IN FULL FORCE AND EFFECT. � LICENSE CLASS �"��,�`��. LIC,NO. ��fj`�-./}�,U�� ,,,, j �" DATE��„-L L.. CQNTRACT4R.....GZ_f,_p,�� a C.} uJ � W6RKER5 COMPENSAT3QN DEGIARATI4N a � l HEflEBV AFFIf7M UNDER PElJALTY OF PERJUflY ONE QFTt1E FOLLOWlN9 DECIARATIONS: Z ZI MAVGAN�WILLMAINTAINAGEflTIFICATE OF CONSEN7TC15ELF�INSURE FOR WORKERS' _ Q ��CQMPENSATl�N,AS I�F�3V�E0 BY SEG7ION 37DOOF TNE IABOR CODE,FbR THE P£RF6RMANCE �U OF THE WORK FOp NMICN THIS PEFMIT IS ISSUFD. � d � .,,,._�HAVE AN�WIIL MAiWTAtN WORKERS'COMPEfiSATION INSUflANGE,AS HE�UIflE�BY SECTION � 3�0o OF THE UBOR CODE,FOR THE PERFOFMANCE OF 1'HE WORN FOR WHICN THIS PERNIT IS i5SUE0.MY WQ�KER5 CK>INAENSAT7pN INSliRANCE CARRIER}.t�POIiCY NUtdBER ARE: CONSTRUCTION Q ` �T .,/ —..__..— �, CARqIER ��.Z'�'T�� `�L/v.1wY��C*' PLANREVIEW �. ... . . r� / — ..._... � PO�ICY NUMBER_t e' � 'L-'L �' �'� ' .y� ELECTRIC � �n+issEcna�r�mr�oTe�w�r�.ErEooFn�PEanur�sroaorvEHuwatpoa.tr�as��oo)oR�Ess�. PLUMBING � w Z' I CERTlKY TNAF IN TME PEflF4ftMANCE OF iNE WORK FON W}tICN THIS PEftM�T t5 tSSUED.i �ECHANICA� _ C'„}' SHAL4 NOT EMPL�Y hNV PERSCIN IN�1NV MANNER 50 AS TO BECOMF SUBJECT TO THE �/) WORKEFIS'COMP�NSATIONLAWSOFCALIFORNIA.AN�ACPEETNATIFiSHOVIDBECOME INSPECTIONFEE . � SU&7ECTT0 THE WQi3i{ERS'CQMFENSATI6N oR4ViS4avS OF SECT�6N 37ao 4f 7tiE UBOR CODE,I SHAL.L FORTFIWITH COMpL`/WITH 7HOSE P%OVISIONS. ISSUANCE a /'..�� (�f . p OATE�.�.l-�.�. APPLICANT j�,�,��_,��'y'-:�"�_..... SMIP J WARNlNG:FAI�UftE TQ SECUkE WORKEflS'COMPENSATi6N GYWERAGE IS UNI.4WFllL,AF3D SHALlOE ENERU'Y P/G _, ,,, _. _� � 5U&IECTANEMPLOVEflTOC91MINALPFNALTIFSANDCIVILFINESUPTOONEHUNDR[�THOUSAND ENEFIGYPERMIT QOLLAflS(5790.Op0),IMADDlTIONTQTHF.COSTOFCOMPENSATlON.DAMAGESASPAOYIDEDFOR'N ��—��-- � -.-.-- � SECTION37080FTNElA80RCDpE,iNlEREST,AN�ATTORNEV'SFEES. RETENTIONFEE: „ � CONSTftUGTIQN�ENdIN6 AGENCY PRE-ALT FEE: a � � INEREBVAFFIqMUNOERPF.NAL7YOFPERJURYTHATTHEREISAC�NS7ftUCT10NLCN�iN6AGENCY � FOR THE PERFbRMANCE O�lHE WORK Foa wNiCH THts PEaM�T�51SSVED(SEC.3o97,ciV.Gj. �—""'� -- � W � lEN6EH'S NAME __ �—rv — — !-J IENQfR`SJ7L)RESS — — � ..,—....., .. . � � TOTAL FEES ��, C� � I GEHTIFY TMAT I HAVE REAR 7HIS APPLICATION pN�STATE THAT SNE A6(7V£INFORMATl�N 15 C4R'riECT � I AGREE t0 COMPLY WITH ALL CITY ANO COUNiY OPDWANCES ANp STAT£tAW5 PEI,ATMG TO BUILDING n' CONSTRUCTION,ANU HEREBV AU7HOFIZE RE?RESENTATIVES CF THIS COUNTV TO ENTER UPON iNE ZABOVE�MEMIONEDPROPERTYfORINSPFCTiONFURPOSE$. 6 COMMENTS„ ,,, � __�'�L_C.._ �i�"�-✓'}:� .S;A-!^� — _ -- � PERMITT NA E�PRI ¢ ..�l � �J .�. _........ cJ) f � r... 1 !�� ✓,.� �--G �� /} 51G ATUREO�PERMIREE � OAT'E ��j��' — ',^(�A�DE�Y��VALIDATION�� = RECPT.NO.__ � WHITE—De artment Co YELLOW—Finance Co P7NK—Assessor Co GOLQENROD—File Go GRBEN— P PY. PY, PY, PY� ApPiicanYs GoPY (Ii kY14,� 4�9'G� i� " ��. ( � .,u�t", �� ` �"�� 4 .��.�� » . s.. _ ,. � �. •., � � �.- , .., ; � �. . �� a ,.b.. � �- �e��_ _ a�a, �� — � . �� -'� T �''�� . � �� _ _ �; �., ..�n;. w ,�.�. _ � u � � � � � t, �� ;o � � ��, ��c � ',� ��, _�,`��; �u�w.��;g. �w��f��'��g��,��_a � _ _ , � = _ � � ,� �r r�� L a�v — °� p a�, s � ` � o.; ° � � . . � q=.,, m�l,�rl�r s . . .. .. . .. ... ... ... . .. .. . . . . .. _ .. _ . . .. a . � . , . .. .. .. ._ . .. . � � � �-;,i.. w . ��i'��'�t � i�9.�� ='r i•.'. . . . . . . . . . . .. .. .. . .. .. ... a .a . ;° .. .. _ . . . _ . . i . '�, e . n r .. . . . . . . � � . . s=�r �a�r':. .. ... . . ....... .. . .. . . . .i ' i .. ... ... .._ ... .._ . . .. .. . ... .. ; � i µ; < � ',. � . �. .�. � f � Itl��:art �, . .. . ... �, �� m _r?�� . 3'in� .1..�, ... . . _ . . . .. . . _.. ... ..... .... . 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 Uf?.N �fpp /' ADDRESS- APN LOT TRACT OWNER i -v 1?) ADDRESS 1.3' 5'CA L P aY2x*OP CITY ZIP TEL._C/SAY' APPLICANT mar/TEL. CONTRACTOR A- L 4. P• .-Sf o4 ADDRESS 4 t/'.VZw'A-- CITY 11-p. 2 ZIP uI' .T.I t d7 1Z:Y_ 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 FOLLO W ING REASON (SEC 7031.5 BUSINESS AND PROFESSIONS CODE:ANY CITY OR COUNTY WHICH REQUIRESA PERM IT 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 BY ANY 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,HOW EVER,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). ^ I,AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTlNG 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.). ^ I AM EXEMPT UNDER SEC. B. &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. } Q LICENSE CLASS LIC. N0. 4!5 DATE. .._C'Z CONTRACTOR L/v 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 ISSUED. MY�WOPKERS'COMPENSATION INSURANCE CARRIERT/AND POLICY NUMBER ARE: CARRIER A/-jI Y U-C-r POLICY NUMBER G3 (rHIS 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 HOSE PROVISIONS DATE_�'APPLICANT: A{ > 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. CONSTRUCTlON 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.CIV.C.). LENDER'S NAME LENDER'S ADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT 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. P^ERMITT NA E IPRI rlrl SIGNATURE OF PERMITTEE DATE APPLI PERMIT P/C DATE v�• NUMBER # !1 ISSUE TYPE OCC 1� DATE CONST. GROUP ZONING SETBACKS FRONT RW REAR ^ SIDE/SIDE STREET RW ^ SIDE ^ PROPOSED USE N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION S0. FT. FACTOR PSF ADJ.AREANALUATION SFR/ADD/REM U) Garage/Carport W Patio/Deck t I1 Pool/Spa 0 Re-Roof Z 0 Commercial Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U U W W z (.ter f��iq r L 11 Z W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE i SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES C1. '0 COMMENTS RECPT. N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy