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Home My WebLink About18430 C� X��r'�''�'�1 �� CITY OF DIAMOND BAR � DEPARTMENT OF COMMUNTI'Y&DEVELOPMENT SERVICES � 21825 E.Copley Drive '� (909)860-3195 Fatc(909)861-3117 PRESS `%.vr'` BUILDING PERMIT APPLICATION FIRMLY o� JOBSITE �� Z �J'Ir� A R/ �T S APPLICATION � PERMIT OP/C ADDRE55_ _ DATE NUMBER # c� ISSUE TYPE OCC APN LOT TRACT _ DATE CONST. GROUP ¢ OWNER O `L ADDRESS —� ZONING SETBA KS Z CITY ZIP TEL,o G/S�7 S�� FRONT RW ❑ � APPLICANT � TEL._ REAR � � SIDE/SIDE STREET RW G z Q CONTRACTOR_ �� !O /w SIDE C Q ADDRESS d � � CITY ZIP �248 EL., PROPOSED U� / 2 a G oARCH/ G/ a� z DESIGNER_ __ — NO.DWEL. N NO. (J�.�- a ADDRESS UNITS STORIES _�__BEDROOMS .7�/ � CITY ZIP __ TFL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECL.ARATION SFR/ADD(REM O � I HEREBV AFFIqM UNDER PENALTV OF PEHJURY THAT 1 AM EXEMPT FROM TME CONTRACTORS LI- G8f098/C3l[IOff W CENSELAWFORTHEFOLLOWMGREASON(SEC.7031.SBUSINESSANDFROFESSIDNSCODE:ANVCITVOa (n U COUNTVWHICHREOUIRESAPERMITTOCONSTRUCT.ALTEH.IMPROVE.DEMOLISH,CRREPAIRANViTPUC- W pytio/DBGk Z TURE.PNIOR 70 ITS ISSl1ANCE,AL50 REOUIRES THE APPLICAhT FOR SUCM PEFMIT TO FlLE A SIGNED w w STATEMENT THAT HE OR SNE IS UCENSEO PURSI)ANT TO THF PROVISIONS OF THE CONTRACTORS LI- � CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 1000)OF DIVISION 3 C1F THE 9USINESSANC PRO- � Pool/Spa � FESSIONSCQDE�O{iTHATHEOPSHEISEXEM?TTH�REFPOMANOTHEBASISFORTHEALLEGEDE%EMF- C3 � TION.ANYYIOLATIONOFSECTION]031.SBVAN'YAPPLICAN�FORAPERMITSU9JEC�5 MFAPPLICPNTTO Z Re-Rool � ACIVIL PENALTV OF NOT MORF THFN FNE MUNDREO�O�IARS�f5o0).)�. 0 CI,ASOWNEROFTHEPROPERTV,OFMVEMP�OVEESWITHWqGE5A5TNE1950LEGOMPENSAT�ON. 0 COR1fi10fCIdI Z WILI DO THE WORK,AND TME STRUCTURE IS NOT INTENDED OH OFFERE�FOH SALE(SEG.1Dda,0U51- J NESS AND PROFESSIONS CODc'.THE CONTRACTORS LICENSE lAW OOES NO�APPiY TO AN OWNER OF � PROPERTYVMOBUIL�SORIMPROVESTHEREON,ANDWHODOESSUCHWORKHIMSELFORHERSELFOR m � THROUGHHISORHEROWNEMPLOYEES,PROVIDEDTHATBUCHIMPROVEMENTSARENOTINTENDEDOR w OFFEREDFORSPLE.IF,HOWEVF_RTMEBUILD'.NC.ORIUPROVEMENTISSOLDWITHINONFYEAROFCOMPIE- 0 TION,THE OWNER-BUILDER WILL HAVE THE BUR�EN OF GROVING'HAl HE OH SHE DID NOT BUILD OR Z IMPROVE FOR THE PURPOSE OF SALE�. � ❑I,AS ONMER DF THE PROPERTY.AM EXCLUSIVELY CONTRACTING WITH LICENSE�CONTRFCTORS Q TO CANSTRUCTTME PROJEGi(SEG.]044,OUSINE55 AND PROFES910N5 CODE:THF.CONTRACTORS LI- V21llS�lOf1 O O" ADJ.AqEA W CENSEUWOOESNOTAPPLY�OANOWNEROFFPROPERTYWMOdUII.D50RIMPROVESTHEXEON,AND � WMOCANTRACTSFORSUCHPROJECTSWITHAGONTRACTUR�SII.IGENS[DPURSUANTTOTHECONTRAC- QUANTIN DESCRIPTION FEE Y TORS LICENSE LAW.). � J O C7IAMEXFMPTLINDERSFC_ 0.8P.C.FORTHISREASON Q � _ U Q LL DATE oWNER � Z w � LICENSED CONTRACTORS DECLARATION w � I HEREBY AFFIRM UNDER PENALTY OF PERJURY TMAT��,AM LIGENSED UNDER PROVISIONS OF GHAPTER � � 9(COMMENCING W17H SECTION 7000)Of D�VISION 30F THE BUSINESS AND PPO=ESSiONS CODE,AND z X MY LICENSE IS IN FULL FORCE AND EFFECT �1 � LIGENSE CLA55 �_`� • IIC.NO. �+ r "'� j J V DATE �� CONTRAGTOR _ a, �- W � WORKERS'COMPENSATION DECLAFATION a = U � I HEREBVAFFIRM UNDER PENALiY OF PERJUflY ONE OF THE FOLLOWING DECLARATIONS�. C/J Q � I HAVE AND WILL MAIN'fAIN A CERTIFlCATE OF CONSENTTO SEIF-INSURE FOR WORKERS' $ Z COMPENSATION,FS PHOVIDED BY SEGTION 3]OOOFTHE IABOR CODE.FORTHE PERFORMANCE U' 4 OF THE WORK FOR WNICH THIS PERMIT IS ISSUEO. � O w I HAVE AND WILL MAINfAIN WORKERS'COMPENSATInN INSI/PANCE,AS RFOUIRED BY SECTION � Q3�OOOF TME LA80R CODE,FORTNE PERFORMANCE OFTHF WORK F R WHICH TNIS PERMIT IS � ¢ ISSVED.MV WORKER<'CO E 0.TI0 I SURAN�ND LICV NUMBER ARE: ��I CONSTRUCTION � ] GARRIEfl � FLfiN REVIEW � POLICV NUMBER_ O � ELECTFIG Z Q � (�HISSECTIOVNEmNOfAEQ7MRETEDOFTHEPERMfTISPJFONENUrDFEDOClLARS(5100)OPLESS). PLUMBING ._. w I CERTIFY THAT INTHE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL Z — �}' SMALL NOT EMPLOY AIVY VERSON IN ANY MANNEF SO AS TO BECOME SUpJECT TO THE � WOH11ER5'GOMPENSATION UWS OF GAUFORNIA,HND AGiiEE THRT IF I SHOVLD BECOME INS?ECTION FEE � SUBJECT TO TME WORKEFS'COMPENSAiION PROVISIONS f SECTION 3�00 THE LABOR � CODE.I SHALI FORTH'NITH COMPLY WITH THOSE PRO 5. ISSUANCE � SMIP p DATE�.� APPLICANT: � - w ENERGY P!C J WARNING�.FAILURE TO SECUPE WOflNERS'COMPENSATION GOVERAGE IS UNLAWFUL,ANO SHALLBE J � SU6JECTANEMPIOVERTOCRIMINALPENALTIESANDCIVILFMESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOILARS(f1CO.D0��,IN AODITIDN TO THE COST OF COMPENSATION.�AMRGES AS PHOVI�E�FOR IN J SECTION 370E OF THE LABOR CO�E INIEREST,ANDATTORNEV'S FEES. RETENTION FEE: �� , � _— � CONSTRUCTION LENDING AGENCV PRE-ALT FEE: � � INEREBVAFFIRMUNOERPENALiYUF�E�iJUFY'HPTTHEREISACONSTRUCTIONLENDINGAGENGY n- FOF THE PERFORMANCE OF lHE WOFK FOR WHICH TMIS PEFMIT IS ISSJED(SEG.309"/,GIY.G.). Z W S LEh�EN'SM1AME _ � F— LEI:�ER'SADDflESS ..._. . ___ -- � — TOTAL FEES , O � I CERTIFV TMAT I HAVE READ TMIS APPLiGAiIONAND STATE THAT THE ABOVE INFORMATION IS CORRECT w 1 AGHtE TO GUMPLY WITH ALl CIiV AN�COUNTV OR�INNNCES AND STNTE LAWS FELATING TO BU�LDING � GONSTRUCTION,AND HERE6Y AUTHORIZE HEPRESENTATIVES OFTHIS COUNTY TO ENTER UPUN?HE zABOVE�MENTIONE�PR TV FOR INSPECTI URPOS COMMENTS � J � -- QPERMITTEE NAME(PRIf _ � o �J S� 8-20�- � SIGNAiUqE OF PER TTEE �AT= = FECPT NO. _ PAID BY VALIDATION ~ WHITE—Department Copy.YELI.OW—Finance Copy,PWK—Assessor Copy, OL NRO�File Copy,GREEN—ApplicanYs Copy �� >.��P . . . . � . v b � q��. �y �y #�..n.w i@ �t9<¢ b "'� � .�� ` a^ " � i d A � ► p # ` s a m �. . . :�3 ��' ��. �� , ` /�. . .. � � . ... .... . .. . � ..� . . '/ , .. . .. � � 3�� _ _ _ �: . : _ __ _ _ �. � � _ _ _ _ _ _ __ _ _ _ _ ; _ . _ . ___ __ _ _, _ _ _ _ _ : ' � �� '� � �, _� �� a1�� ;� � _ _ _ , �� x� � � � �, � �, 4 , . _ _ ; . � � � , �� . � & _ .� � — ��e�� ,� � _ __. _ _ p�� _ __ __ �� e _ _ _ _ __ UI�1�II1�D 11,1K i �=ti CITY OF DIAMOND BAR DEPARTMENT OF COMMUNI"I1'&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION x PRESS FIRMLY JOBSITE��Z S AR � ,/rT ADDRESS APN LOIf TRACT OWNER/4�T�/2, ADDRESS CITY ZIP TEL.G I g7�� APPLICANT�TEL. CONTRACTOR��t7p/w ADDRESS d CITY ZIP_?ZL�EL. ;9�d �!S 6 ARCH/G/ DESIGNER- ADDRESS CITY ZIP TEL. OWNER-BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 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 PERMIT TO CONSTRUCT.ALTER. IMPROVE. DEMOLISH,CR REPAIR ANV STRUC- TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PVRSUANT 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 E%EMPT THERE FROM ANO THE BASIS FOR THE ALLEGED E%EMP- TION.ANV VIOLATION OF SECTION 7031.5 BV AN'Y APPLICANT FOR A PERMIT.SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS IS500).): ^ 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 FOH SALE(SEC. 70aa, BUSI- NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE IAW DOES NOS 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 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 EXCLUSIVELY CONTRACTlNG WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC. 7004,BUSINESS AND PROFESSIONS CODE:THE. CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WMO dUII.DS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS W ITH A CONTRACTOR(SI I.ICENS[D PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). U T AM E%EMPT UNDER SEC._,B.8 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 30F THE BUSINESS AND PP.OFESSiONS CODE,AND T MY LICENSE IS IN FULL FORCE AND EFFEC (�7 9 � r� � IIC. N0. LICENSE CLASS Gd CONTRACTOR_ DATE 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 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 37000E THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK F R WHICH THIS PERMIT IS ISSVED. MV WORKERS'CO E ATIO I SURANND LICV NUMBER ARE: CARRIER Q POLICY NUMBER_ (THIS SECTKJN NEED NO'T BE 07MPLETED OF THE PERMIT IS FOF ONE HUNDRED CCILARS(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 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 F SECTlON 3700 THE LABOR DE. I SHALL FORTHWITH COMPLY WITH THOSE PRO 5. C 0 L „ � °3 APPLICANT: DATE: � WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,ANO SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS(f 100.000),IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LAROR CODE,INTEREST,AND AITORNEV'S FEES. f:ONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PE RJURV THAT THERE IS ACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WOFK FOR WHICH THIS PERMIT IS ISSUED(SEC. 3097,CI V.C.). LENDER'S NAME LENDER'S ADDRESS- I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT 1 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�MENTION ED PR N FOR INSPECTI URPOS I PE RMITTEE NAME(PRI C7(C_J�/�y� 10�V! _{,��a 1 SIGNATURE OF PER TTEE DATE WHITE-Department Copy.YELL-OW-Finance Copy, PINK-Assessor Copy, �OLOENROD-File Copy,GREEN-Applicant's Copy