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Home My WebLink About19070u5 d 0 w O 0 w z O 0 z m O 0 w in Z CD cn w cn Tn a O W v Z w C) U CJ IT- C) Z iY W Z 1I W W W 2 Y Z O cr a_ cn O F- U W In Q w W J ¢ 7 01 Z d CITY OF DIAMOND BAR DEPARTMENT OF COMMON ry & bEVELOPMENT SERVICES U 21925 E. Copley Drive (909) 860-3195 Fax (909) 861-3117 PRESS BUILDING PERMIT APPLICATION FIRMLY JOBSITE T� ADDRESS �J — APN LOT TRACT ` _ OWNER iL/ A ,1 ADDRESS ) r r CITY_t/✓1 ZIP -TEL.% APPLICANT ,SAA+it C TEL -37 CONTRACTOR _ ADDFESS. CITY ZIP TEL. ARCHIENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS U- CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTY 1VHICH REOUIRESA PERMIT TO CONSTRUCT, ALTER, IMPROVE, DEMOLISH, OR REPAIR ANY STRUC- TURE. PRIOR TO ITS ISSUANCE. ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LP W (CHAPTER 9 (COMMENCING WITH SECTION 7.01 OF MVISON 3 OF THE BUSINESS AND PRO FESSIOW CADET OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOP THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7031.5 BY ANY APP_ICANT FOR A PERMIT SUBJEC 15 THE APPLICANT TO ACNIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (f5W)). - ASOWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE!SEC. 7044, BUSI- NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NC7 APPLY TO AN OWNER OF PROP_ WHO BUILDS OR IMPROVES THEREON, AND WHO DOES SUCH WORK HIMSELF ORHERSELFOR 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). U I, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH UCENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 70AA, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE LAW DOESNOT APPLY TO AN OWNER OF A PROPERTY WHO B'JII.DS OR IMPROVES THEREON, AND WHO CENT RACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S1 LICENSED PURSUANT TO THE CONTRAC- TORS LICE JSE LAW) ❑ I AAI EXEMPT UNDER SEC. _ a. d P.C. FOR THIS REASON DATE [ OWNER LICENSED CONTRACTORS DECLARATION I HEREBYA -FIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESSAND PP.OFESS:ONS CODE, AND MY LICENSE: IS IN FULL FORCE AND EFFECT LICENSE CLASS _ _ LIC. NO. DATE CONTRACTOR__ WORKERS' COMPENSATION DECLARATION t 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 TERN 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 REOUIq ED BY SECTION T 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 4UMBER _ THIS SECTON NEED NOT BECOMPLETEDOF THE PERMIT IS PORONE FANDRED ODU ARS IE100)ORLE55). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHAL_ NOT FMPLOY ANY PERSON IN ANY MANNER 50 AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF 1 SHOJLD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE, I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATEAPPLICANT 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 (III M,000). IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 3703 OF THE LABOH CODE, INTEREST, AND ATTORNEY'9 FEES. CONSTRUCTION LENDING AGENCY I HERERY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WOFK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3097. CIV. C.1, LENDER'S NAME__ __—._—.- LENDERSADDRESS CERTIFY THAT" 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND S-ATE LAWS RELATING TO BUILDING CONSTRUCTION. AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPO THE ABOVE MENTIONED PROPERTY FOR INSPECTION PURPOSES. PERMITTE SIG I F E DATE APPLICATION ` 1 J,r PERMIT 19 NUMBER 61 qo #/C V ' �Y DATE 1 ISSUET TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR rJ SIDE/SIDE STREET RW ❑ _ SIDE O l �W PROPOSED USE NO. DWEL. NO, NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Ln Garage/Carport WPatio/Deck 'L- POOVSpa V z Re -Roof Commercial m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J a U J U W LU w m l Q U 2 Q 2 U W 2 CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING IV MECHANICAL INSPECTION FEE ISSUANCE SMIP �' V ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: tz TOTAL FEES U COMMENTS - �a - Y _ T / PECPT. NO. _ PAID BY VALIDATION v WHITE --Department Copy, YELLOW —Finance Copy, PINK—AssesSOT COPY, GOLDENROD—HIe. Copy, GHLEN—APpllcant's Copy CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21825 E. Copley Drive (909) 860-3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION JOB!"TE I Q) I N ADDRESS APN LOT TRACT OWNER 'c-/2 C} ADDRESS CITY 44w(;,-0 134/? ZIP 7EL. APPLICANT 54 w5 t TEL f - 7 CONTRACTOR ADDFESS 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. 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. FESSIONI 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 SUBJEC FS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS ($500) ) A S OWNER OF THE PROPER TY, OR MY EMPLOYEES WITH WAGES AS T HEIR SOLE COMPENSATION, 49 0 WILL 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 PROPERT' 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). C 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 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 LICE 4SE LAW) . 1 AM EXEMPT UNDER SEC. B. & P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY A=FIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PP.OFESS.ONS CODE. AND MY LICENSE IS IN FULL FORCE AND EFFECT LICENSE CLASS LIC NO. 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 IS FOR ONE HUNDRED DOLLARS ($100) OR LESS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHAL-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 3709 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I HEREBYAFFIRM UNDER PENALTY OF PERJURY THAT THERE IS ACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WOPK 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 UPO THE ABOVE MENTIONED PROPERTY FOR INSPECTION PURPOSES. FERMITTE SI I F E DATE APPLICATION I ' J.. NPERMIT UMBER t "1 q( P/ DATE ISSUET TYPE OCC DATE CONST GROUP ZONING SETBACKS FRONT RW REAR SIDE/SIDE STREET RW ^ SIDE ji— P P RO OSED USE NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport W Patio/Deck U' Pool/Spa 0 Re -Roof Z Commercial m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J 3 F U W J W Z Z 2 U W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP •—j L—/ ENERGY P/C ENERGY PERMIT L, V RETENTION FEE: PRE-ALT FEE: TOTAL FEES 0 4A COMMENTS RECPT NO. PAID BY VALIDATION WHITE -Department Copy, YELLOW -Finance Copy, PINK -Assessor Copy, GOLDENROD -File Copy, GREEN -Applicant's Copy