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Home My WebLink About19023 �� CITY OF DIAMOND BAR � - � DFPART]vTE'�1T OF COMMUNI"fY&bEVELOPMENT SERVICES �� 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 PRESS ' `%.�^ BUILDING PERMIT APPLICATION FIRMLY � JOBSITE ��A ,� / DATE Y i V� ¢ ADDRESS�G �-rinr bo�/ ��(-LF, Rfl APPLICATION ,^ �r PERMIT P/C o C' S� NUMBER � � ISSUE TYPE OCC °^ APN LbT TRACT DATE ONST. GROUP p OWNER � 0 ,,,��,��t� ADDRESS�C►�?�I C. Lfi4J�d�✓ QD6�� (� ZONING SETBACKS Z CITY OiA/+.dn A �Se'1�2 ZIP 9�_ 7EL.�� FRONT RW ❑ o APPLICANT �t...*�✓ 0�n/-/ TEL 7L1-e�Y77 REAR � Z — SIDE/SIDE STREET RW ❑ ¢ CONTRA�T��L STAR WATE HEATERS SIDE L ADDRES a es ore r. � Cirv Lake Els.inore Z�pCA rE�. 92530 PROPOSED USE o ARCH/ENG/ �Z DESIGNER --– NO.DWEL. NO. NO. a ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS � -- cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADDlREM O I HEREBY FFFIqM UNDER PENPLTV OF PERJURY iNAT I AM FXF.MPT FflOM TME CONTRACTORS l.l- GefaJe/Cef{10It W CENSEUWFORTHEFOLLONIINGREASON(SEC.7031.5BUSINESSANDFROFESSIONSCODE:ANYCITVOR (n U COUNTYWHICHREOUIRESAPERMITTOCONSTRUCT,ALTER,IAIPROVE.DEMOLISM.ORREPAIRANY:TRUC- W P2I10/DBCk w TURE.PflIOR TO ITS ISSUANCE.AL50 FEOUIRES THE AP7LICANT FOR Sl1CH PERMIT TO FlLE A SIGNED W STATEMENT THAT HE OR SMf_IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI� � CENSE L4W(CHAPTEfi B(fAMMENCING WITH SECTION)000)OF DIVISION 3 OF THF BUSINESS AND PRO- LL POOUSPB O FESSIONSCODE)ORTHATHEOi1SHEISEXEMPTTHFREFROMANDTHEBA515FORTHEALIEGEDE%EMF� � U TION.ANYVIOLATIONOFSEC710N7091.SBVANVAPPLICAN'FORqPEFMIT5U8JECfS�MEAPPLIGANTTO Z Re-Roof A CIVIL GENFLTY OF NOT MORE 7HAN FIVE HVNOREO DOLLARS(3500J.): � JI,ASOWNEROFTHEPfiOVERrYORMYEMPLOYEESWITNWAGESASTHEIRSOLECOMVENSATiON, � COmrtlefCial Z WILL DO THE WORK,AND THL STFUCTUflE IS NOt IN i ENDED OH OFFERED FCR SALE(SEC.70aa,BU�I� J N NESS ANO PROFESSIONS CODE:THE CANTRACTORS LICENSE UW DOcS NO'�APPLV TO AN OWNER OF PROPERTVNM1108UILDSORIIA7ROVESTHEREON.AN�WHODOESSl1CNWORKHIMSELFORHERSELFOR � � THROUGH HIS OR HER DWN E'MPLOVEES,PFOVIOEO THAT SUCH IMPROVEMENTSARE NOT INTENDED OR m QOFFEREDFpRSPLE.IF,HOWEVER,THEBVIIDINGORIM�ROVEMENTIS50LDWITHINONEVEP,ROFCOMPLE Z TION,THE OWNER-BUILDER 1NILL HAVE THE BVRDEN OF PqOVING�HA1 HE OR SHE DIO NOT DUILD OP � IMPROVE FOR THE PURPOSEOF SALE). �y,� ❑I,ASONlNENOFTHEFROPERTY,AME%CWSNELYC(INTRqCTINGWITMLICENSEDGONTqAGTORS � 70 GONSTRUCT TME PRQIECT(SEC.]ON,BUSINESS AND PROFESSIONS CODE:THE CONTqqGTORS ll� V8IU8110(1 � ADJ.AREA W CENSEUWDOESNOiAPPLYTOANOWNEFOFAPROPERTYWMOdUII.�50HIMPROVESTHEREDN,AND F WHOCONTRACTSFORSUCN7ROJECTSWITMACONTRACTOR(S�LICENSEDPURSUANTI'OTHECONTRqG QUANTITY DESCRIPTION FEE Y TOFS LICENSE UW.). � J O fl I AM E%EMPT 11NDER GFC. B.8 P.C.FOR THIS PEASON Q � U -__. _..__._.___--- - - __ � � DATE OWNER __ U Z W � LICENSED CONTRACTORS DECLARATION W , Q IHEREBVAFFIRMUNDERPEMALTYOFPERJUFYTNATIAMLICENSEDUNDERPROVISIONSCFCHAPTER � Water Heater d 9(COMMENCING WITH SECTtON 7000j OF DIVISION 3 OF THE BUSINESS 4ND PPO�ESSiONS CODE.AN� Z � X MV IICENSE IS W FtR�FORCI_AN�EFFFCT W (11 o C36 HIC 778156 � � IICENSE CLA55 __ LIC.NQ. � V DATE S/3 1 04 CON7RACTOR�1 Star Water a W � WOHKERS'COMPENSATION�EC�ARATION Q � I HEREBV AFFIRM UNDER PENALTV OF pERJURY ONE OF THE FOLLOWING DECIARP.T10N5: Z Z ._.... IHAVE/NDWILLMAR�TAINqCERTIFICATEOFGON5ENT705ELFJNSUREFORWOflKERS' _ Q COMPENSATION,ASPROVI�EDBVSECTION370onFTHEUBORCODE.FORTHEPERFORMANCE U y OFTHE WORK FOR W'HICH THIS GERMIT IS ISSUED. w � A I HAVE ANO WIILMAIHTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BY SECTqN � Q 3]0o OF THE LABOR CODE,FOR THE PERFORMANGE OF THE WORK FOR WHICH THIS PERMIT IS ISSVED.MY WORKEP5 COMPENSATION INSUFANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION J STATE FUND ¢ cnaaiea PLAN REVIEW zaoucvNUMe�_�._��_�----..._..�.__.......___,_,�.___......_..._...._.— ELECTRIC ¢ � (�HSSECTIOM1NEmNOTBECC7.17LEfEDOFTNEPEP1MISiOFONEHUnOREDDOl1A�iS(S1C0)OFLESS�. PLUMBING Z I GERTIF'/TMAT IN TME PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUEO,1 MECHANICAL (� SHFLL NOT EMPLOV I1NV�EFSON IN ANV MANNEq SOAS TO BECAME SUOJEl:TTO THE � WORKERS'COMPENf��ATION LAWS OF CALIFORNIA,ANDAGREE TMAT IF I SHOULD 3ECOME �NSi'ECTION FEE _ ? SU3JECT TO THE WORKERS'COMPENSAT�ON PROVISIONS OF SECTION 37ao OF THE IABOR - � � C(][)E.I SNALL FOFTNWITH COl.APIV WITN THO F PROVISION ISSUANCE � - It?3�`C�� SMIP p DATE. _ APPLICANT: J WARNING:FAIWRETOSECUREWORKER CD NSATIONCOVERAGEISUNLAWFUI,ANDSHALLBE ENERGYP/C � SVBJECTAN EMPLOVER TO C�.RIMINAL PE 5 AN�CIVII FWES UP TO DNE HUNDRE�THOUSAN� ENERGY PERMIT DOLLARS(floa.000),INA�DITIONTOTHE OSTOFCOMPENSATION.DAMAGESASPROVIOEDfORIN J SECTION 3]OB OF THE LABOP CODE,INTEFEST,ANO AiTORNEV'S FEES. RETENTION FEE: � � . d GONSTRUCTION LENDING AGENCY PRE-ALT FEE � O � IHEFEBYAFFIRMUNDERPENALTVOFPERJI,RVTHA�'THEREISACONS7RUCTIONLENDINGAGENCY . _.. _-_..___ ..'— FOF THE P'tHFOFMANCE OF I'HE WORK FO WHICH NIS MI IS ISSU U�SE .3097,CIV.C.). Z W = LENDER'S NAME � F— IEN�ER'SACDRESS � TOTAL FEES 67.50 � I CERTIFY THAT I HAVE READ TMIS APPLICATION AND STATE THAT THEABOVE WFORMATION IS CORRECT W IAGREETOCOMPIYWITHALLCITVANDCOUNTVORDINANCESANDSTATE'..AWSRELATINGT09UILDING � CONSTRUCTION,AND HEREBV AUTHOi71ZE REPRESENTATIVES OF TNIS COUNTY TO ENTER UPON THE � ABOVE-MENTIONED PROPER�Y FOR INSPECTION PURPOSES. Z COMMENTS 0 � J �1J�Q"tHA.,J vu.J� � m PERMtTTEE N ME�PRINT) � y7 �0�31-�Z � 5 AT �OF PERMI�. � DATE _ � RECPT NO. ._ PAID BY VALIDATION ~ WHITE-Department Gopy,YELI.OW-Finance Copy,PINK-AsseSsor Copy.GOLDENRO�File Copy,GREEN-ApplicanPs Copy � �r �� .�-:�' � '�, �' �' 1! � " ��°¢ � �' f � . . . .. . ; , . . ,^.�y �� S . ... _ . .. .. . . . . . . .� . . .. .,. �. �.. � i_ t t�� '� P+t1�lt�C�� /ll�l� �'�'� , , _ _ . � � -- - -- —, __ __ _— _ __— - -- , _ _ � _ __._ __. _ . _ _ _ _ : . __ _ __ _ . _ ; �r s� � � � <.„,��a��,��`��r'�� ' - . __ � , � � '�` �� + �� , ��,� � �� '�+�� !' _ �. ' .3, � �l54�G'+ . __ _ , � , �Ii � �, _ _ _ __ ___ _ i �` _y5. ' f '��.3� ' . ..... . . .... . .. .. .. .... ...... ..... . . ........ ..... ... ... ..._.... , , �F�� . ........ . +�. $ � i'. � � . ... ... . ... ... ......... . .. . ..... . .. ... . ...... ...... ..... ..... .. ... . ....... . �. �i CM-.4P JOBSITE ADDRESS-G�ryN 6 kl)(-aE, Rfl APN LOT TRACT OWNER ADDRESS 7 TI iF. CAl/Yam/RD6�fzcl, CITY 0144%.&11 A Q 2 ZIP 411759 TEL. --S-% APPLICANTr...r�/TEL._-70-c'Y7 T R L STAR WATE HEATERS CO NTRA Q ADDRES 12SSb a eS ore r. ciTY Lake Elsinore ziPCA TEL 92530 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 BUSINESS AND PROFESSIONS CODE ANY CITY OR COUNTY WHICH REQUIRES A PERMIT 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 MOFIE THAN FIVE HUNDRED DOLLARS(5500)): ^I,AS OWN ER 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, HOWEVER,THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE- TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAI HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). ^I,AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTING 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 ACONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW). ^I AM EXEMPT UNDER SEC. B&P.0 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 C36 HIC 778156 LICENSE CLASS LIC. NO All Star Water DATE 5/31 04 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 X 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 STATE FUND POLICY NUMBER + (THIS 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 37000F THE LABOR CODE.I SHALL FORTHWITH COMPLY WITH THO E PROVISION DATE 1(J-31_OZ APP ICANT L WARNING FAILURE TO SECURE WORKER CO NSATION COVERAGE IS UNLAWFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PE S AND CIVIL FINES UP 10 ONE HUNDRED THOUSAND DOLLARS(5100.000). IN ADDITION TO THE OST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES 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,CIV C.). 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. J��araw.a D PERMITTEE N ME PRINT) -SI-�Z S AT E OF PERMITTE7 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 APPL /C ICATION LT DATE NUMBER # 10 ISSUE TYPE OCC DATE- ONST GROUP ZONING SETBACKS FRONT RW ^ REAR ^ SIDE/SIDE STREET RW ^ SIDE ^ PROPOSED USE N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM W Garage/Carport w Patio/Deck LL.I LL � Pool/Spa 7 Re-Root Z Commercial 5 Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U ED U W W cD Water Heater C/0 41.50 z M z U w CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING 41.50 MECHANICAL INSPECTION FEE ISSUANCE 2j. uu SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: 1.0 PRE-ALT FEE: TOTAL FEES 67.50 COMMENTS RECPT N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy