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Home My WebLink About17316 CITY OF DIAMOND BAR �'" � DEPARTMENT OF COMMi)NITY&DEVELOPMENT SE1tVICES 21825 6.Copley Drive (909)$60-3195 Fax(909)861-3117 PRESS ``;��' BUILDING FERMIT APPLICATION FIRMLY � JdBSITE �„[� � APPLICATION + PERMIT '�_'�;�'� P/C � ADpRE55�(��/ DATE NUMBER # _ � ISSUE TYPE OCC APN �OT TRAGT DATE C4N5T. GROUP p OWNE� G�ttiCE. l.={r��<.:�c"_� �'` ADDRESS �"t � «v`r�1�-'-1`E,�ts��-z*- ZONitdG SEfB CKS Q ^ � �ftONT RW ❑ � CITY �4+r-1�e;;�-al t'�>i+- ZIP'ttlGx TEI. 'z�t'! y..� . { gAPPLICANT ^ TEL. REAR [� � SIDEISiDE STREET RW ❑ 4 CONTRACTpR_ � SIDE _ C] pC AD4RESS PpOPOSED USE q GITY ZIP TEL. o ARCH/ENG/ Z DE$It'sNER NO.DWEL. NC1. NO, � ADDRESS UNITS STdRiES BE�ROOMS � CITY ZIP � TEL. � QESGRIPTION SCt.FT. FAGTOR PSF ADJ.AREANALUATION co � OWNER-BUILDER DECLARATIqN SFRtADDlREM O �] I HEREBV AFFIRM UNOER pENALTV OF PERJI.�RY THAT I AM E%EMPT FROM TNE CONTRACTORS LI- � G8f8JB/G8fP012 W CENSELAWFORTHEFOLLOWINGREASaN(SFC.�a37.5BU51NESSANDPROFESSIONS�DE:ANYCINOR G,) CQUNTYN4i�HflEOt1iRES0.PERMiTTpC6NSTRVCT,AITSR,iMPROVE,OEMOIiSH,ORREPAiRANYSTRUC� w pa110�DECK W7URE,PPIOR TO ITS ISSUANCE,ALSO REQUIRES TNE APPLICANT FOR 5UCM PERMIT TO FILE A SIGNEp .� 57ATEMENT THAF HE OR SHE fS LICENSED PUftSUANT T4 THE PROYISIONS OF TNE G03VTf1AG1UR5�I� � CENSE UW(CHAPTER 9(COMMENdN6 N"TN SEGTION]WOj OF UIVISION 3 OF THE BUSINESS AND pRO� � POOI/Sp8 FESSIONSCODE)ORTNA7HEORSHEISEXEMPTTHEREFROMP.NOTHEBAS15FORTNEALLEGEDEXEMp� � TpN.ANYYlOtAFK1N4F5ECTiON7431.58YANYAPPUCANTFORAPEGtM�TSUBJECTSTF+EAPPllCANTTO Z �-App{ � A qVIL PENALTY OF NOT MOFE THAN FNE HUNDRED DOLLARS(S5o0i.): � ❑I,ASOWNEROFTNEPROPERTY.ORMVEMPIOYEESWITWWAGE5A5THE1R50LECOMPENSATION. O �OtiM1lii6lCi31 � WILl DO THE W{IRK.ANO THE S'fAUCTURE IS NOi INiENOED Q!i OFFEREO fOR SAtE{SEC.70d4,BVSt� J NESS AND PROFESSIONS CODE:THE CONTPACTORS LIC6NSE LAW DOES NOT APPLY TO AN OWNER OF � AR07EATYWHOBUlLD54RIMpfiOVFSTHEREON,ANDWNODOESSUCHWOflKHIMSELFOPHEft5ELFQR � [[ THRpI,IGHHISORHEROWNEMPI.OVEES,PROViDEDTHATSUCHiMPROVEMEN"SAftENOTINTEN6EDOR QOFFEREDGbRSALE.IF,HpWEVER,THEBUILDINGORIMPR4VEMENTI55bLDWITHINONEYEAFlOFCOMPLE� 2 TPON,THE OWNER�BUItAER W1C4 HAYE THE BI1ftDEN OF PR4VMG THA7'HE QR SHE Di�NQT BUILD OR = IMPRpVE£bRTHEPURPqSEOFSALE). W OI,AStlWNEROFTNEPRtlPEFiTY,AME%CLUSNELVCONTfiACTINOWITHUCEN5EDCONTRACTOR6 (r TO CQNSTRUGT TNE PRQ/ECT{SEG 104a.BUSINESS AND PROFESStONS CODE:TNF CONTRAGTORS U� Vd7Ueti0ti AQl.AREA W CENSEIAWDOESNOTAPPLVTCIANOWNERQFAPROPERTVWHOBUIl�50PIMPR17VE5TNEReON.AND � WHOCONTRACTSFORSUCHPRQIECTSWITHACONTRACTc�N(5)LICENSEOPUASUANTTOTHECONTRAC- QUAPITITY DESCRIPTION FEE � TORS�.iCENSE tAW.}. --� J � ❑i AM EXEMpT UNDE7 SEC.„ „ S.b P C.FOfl THSS REASON U � _ . . . _ � �. ., CC on� .�1 ��-�—.�,"��awNEa�i�`��-�1�1i:. ��.a �4 -'� ��`�{ U w Q UGENSED C6NTRACT6RS DEGLAFiAT10N i W Q � I HEPE9Y AFFIRM UNOER PFtJP1.TY OF PERIURY TNAT I 4M LICENSEQ UNDER PROVI310NS OF CHAFT[R � �. d 9 i��ENGMG WiTFt SfCTtOtd 7o06J OF DIVISION 3 OF THE BuSfNESS AND PflO�ESSiONS CODE,AN� Z ' X MV LICENSE IS IN FVLL FORCE AND EFFECT m 11J � � UCENSE CLASS,v___.....—� LIC.Na. _ J U OA7E_...—.__ .� CONTRACTOR. ._—.... d w � WORKERS'COMPENSATION EtEC�ARATION Q _ � i HERESYAFRRM UNDEiI PC:NAI.TY 4f PER1UftY ONE OF THE fOlL6Vti4NG DeCIAftAI'IONS: � G!) Z ¢ �, � _I HAVE ANP WILL MAINTAIN A CERTIFICATE OF CONSENT TO SEIf-INSI;RE FOR WORHERS' _ C�MPENSATION,AS PRf}V10�6Y SECTION 3��(JF THE t�60R Ca6E.FOqTHE PERFOAMANCG U � OF THE W4RK FOR WHICH TH19 PERMIT IS I$SUEO. � w I HAVE AND WI�L MAMTAfN WQflKERS COMPENSAI ION INSURANCE,AS REQUIRED BV SECTION „w...� � �31oD OF THE tA84F CO�E,FOR THE PERFQRMANCE OF THE WORK FOR WHICH TNI5 PEpMIT IS � ISSUED.MY W(IRKERS'COMPENSATlON INSURANCE GAflPtER AN6 POUCY NtRAeeP AiiE: CONSTHIl{:TION J � canaiEa__— _. . Pv,t�aevtEw _ � POLICYNUMBEF_ ELECTRIC _ +L � �issecnorvNEe�rroraewrna�Erec,oF�PEwniT�swHaraei+unoa�000i,�nns�Siao)C�a�Ess). PLUMBING W i CEflftFYTNA7{ry THE PERFCfFIMANCE OF TFtE WORK FbR WhkC,N THIS FERMiT IS ISSUED,i MEC.HANICA(. Z, '_ (,� SHALI NOT EMPLOV ANV PERSON IN ANV MANNER 50 AS TO B6COME SUBJECT TO tHE INSPECTION FEE � WORKERS'COMPENS4TlON LAWS OF CALIFORNIA hND AGAEE THAT IF I SHQULD BEGOME SU&7ECT T9 THE WORK£RS'CCMPENSATION PROV�SIONS OF S£CTpN 97DOOF THE 1A84fl = COpE.1 SHALL FOR�HWITH COMPLY WITH T'HOSE PROVISIONS. �SSUANCE ,. a SM�P p pATE:_,_, _ APPLICANT: __.,_..__--�.., � ENERGY PtC � WARNiNG�.FAILUFE T6 SFCt1RE WORKERS'COMPENSATION COVERAGE IS UNtAWFUL,AND SHALI.BE ' � SUBJFCTANEMPI.OVEFTOCRIMINALPENALTIESANDCIViL�MESUPTOONEHUN6flEDTHOUSAND ENERGYPEFIMIT pOLLAPS{S/C0.006).�N A6DITiON TO TNE GOST OF COMPENSATION.DAMAGESAS?ftQY1t�ED FOR IN — ""'--"""—" � 6ECTION3]p80FTHELA@OHCi70E,INTERES7,ANOATTPRNEY'SFEES. RETENTIONFEE: _„ .,, _,. J, i� CONSTRUCTidN IENDING AGENCY PRE-A�7 FEE: _....�.... , CC 1HEREflYAfFtRtAUNOEAPENA�TYOFPERJJPYTNATTNEREI5AC4NSTiiUCTiQN�ENDWpAGENCY ,__ �- GnR THE PERF6RMANCE QF TNE WOAK FOp tVHiCN TH�S PEflM1T�5�SuVED i�EC.309J,CIV.C.j. t? _ {.Ll = LFNDER'S NAME �,._ ... .- � i F,_ �ENDGF7'SAllDRESS___ — /'� � _,�,� � IGER7liyTNAFINAVEPEAf17HISAPPI.ICATN?NANOSTATETHATTHEABWEINFORMATIONISCORRECT. TllTAL FEES � � . W I AGRFE TD COMPI.V WITN ALlC7TV AND COUHTV Op6iNANCES AND STATE LAWS RELATIN{i T08U�lD�NG � CONSTRUCTION,ANDHEREAVAUTHORIZEPE'RES[NTATNESOFTHISCOUN7YTOENTEflUPONTHE ZABGVE-AiEMiONEDPROPGRTYf-ORINSPECTiDNPVRPOSES. COMMENTS_ _ __..__... l� - � "` r . _ _� 'lt t`�...+C iriti �-t�. ��,, c'2 �_�C,�. _ � , .— —��- . _.....— m PERMIT7€ENAME(PRINT) i� �!"-'�' .... ... �s�� US J,^'�a.,'a7';�_��;-;�(„ ��"w ��r��''�at�j,',..'�....—,._ � SIG REOFPEflMITTEE :' OATE � � �� _ •i .- RECPT.NO. PAID BY VA�IDATI6N ~ WHITE—Department Copy.YELLOW—Finance Copy,PINK—Assessor Copy,GQLDENRQp—Fde Gopy.GftEEN—RpplicanPs Gopy y-` �,"�� a- ^�� ; �.,G�a ��i w� �w^'�y[ �yAp� �8 ..�' �P4 YW� �� ia �i ��1�MJ <�� u.��'� �tt� u ��o�j� ��sy wh�i r � a� � ��'� '� �� `� � � „ e � - f Y: � ,.. , � -„� .,� _ . t� w �.,,: , � � � � � w�, , , . �`� , ��, �o-C .. _.. �t� l��'� � _ � _ _ _ , % �`� � � �:.��'�� _ _ _. ; _ _ „ : _ _ t � _ , ;.�: � w , � , � � s B ti_� .�y. � _ ��. v' 3*e u�. . . .. . . RMEDMIM ADDRE ESS_(0 ADDRE�� APN LOT TRACT OWNER_V�E L L�&--,-c"_t ADDRESS C•'C"=9�i�Irt 1 \C.�Sj��l?c CITYZIP- it&TEL. � EtL.. (i APPLICANT TEL. CONTRACTOR ADDRESS CITY ZIP TEL. 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. 70315 BUSINESS AND PROFESSIONS CODE:ANY 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- 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 OFfHE PROPERTY,OR MY EMPLOYEES WITH WAGESAS 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). ^ 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 NOTAPPLY 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. &PC. FOR THIS REASON DATE OWNER rti\L�"'\i �� I\�'\"•�,y 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. LICENSE CLASS LIC. N0. DATE CONTRACTOR 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 WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE CARRIER POLICY NUMBER (THIS SECTION NEED NOT BE COMPLETED OF THE PERMIT LS 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 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. CONSTRUCTlON LENDING AGENCY I HEREBY 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.I. LENDER'S NAME LENDER'S ADDRESS 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. PERMITJEE NAME(PRINT) SIGN RE OF PERMITTEE DATE 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 APPLICATION NERMITi P/C 1 7 DATE N UMBER # ISSUE TYPE OCC DATE CONST.GROUP ZONING SETA CKS FRONT RW^ REAR^ SIDE/SIDE STREET RW^ SIDE^ PROPOSED USE N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION S0. FT. FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM Garage/Carport LU Patio/Deck LU LL PooVSpa 0 Re-Roof Z Commercial Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U U W W Z In J a- Q U Z 2 0 LU CONSTRUCTION(,J PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES(L I, COMMENTS RECPT. N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy