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Home My WebLink About18038 (10) � �/ �� CITY OF DIAMOND BAR DEPARTMENT 4F COMMUNITY&DEVELOPMENT SERVICES 21660 E_Copley Drive Suitc 190 C.- ] �� (909)86d-319S Fax(9Q9)861-311? � -y� PRESS '�.""''�� BUII.DING PERMTi'APPLICATION � PIRMLY a DDR'ESS��J�,3__,_l.Gui Or� LIiJt" C..�j�,f.*.�-. APPUCATlQN� � PERMIT �[ j�r'�y p/C � �J —� '� dATE NUM6ER O �l � { � APN_ LOT_,�__ TRACT �2 �7_____ �SSUE � + j1^ TYPE OCC p OWNER L Y DATE t U ONST. GROUP p ADQRESS I$�l� ��y1 � � , ,�d� 20NING SETBACKS �� CITY �svt.l%L Z!P 4 "1"�-- TEI.a4W--'7'PT �-j� ? FRON7 RW ❑ APPUCANT � TEL. REAR p � SIDE/5113E STREET RW O CONTRACTOfi_ Gtrt.s-- SIDE a ADpRESB � CffY ZIP TEI. PROPOSED USE _ � ARGHIENG! ('� ~ bESIGNER i� IjC- !1 ��`y-'�--•--�� NO.OWEL. NO. ADDFiESS_ '" #� -_��Ac4l3C..`�_ NO. � C!'MY !P TEL��1�^7GK?�l` UNITS STORIES BEDROOMS �? DESCRIPTION SQ.FT: FACTOR PSF ADJ.AREAlVALUATION � OWNER-BUItDER DECLARA710N p SFR/ADD/FiEM � i_� [] I HEREBV AFFIRM UNOER pEMALTY OF RERJURY THAT t Mi EXEAIPT FROM THE CONTRAG70A5 LI• G8f8J8/GetpOti � � ��{ t_�{"_ W CENSEUWFORTHEfOLLQWlNQNE0.50N(SEC.�031.SBVSINESSANDPROFESSIONSCODE�ANYCf7Y0A (J) ��. �. � J Z CC%1N7YWHICHFtEWIflE5APfiRiAtTTOCONSTRUCT,ALTEfl.IMPROVE,DE110USFI,bRREPAIPANYSTFiUC- W PBtiOlD9Ck � lURE.PRK�i TOlTS ISSUANCE.Ft50 R£WIHES THE AP7�ICPNT FOR SUCH PERM7T't0 Fl�E A SiGNEa � � STATEMENT T}1AT HE OR SNE�5 LiCENSEO PUHSUANT 70 THE PROYISIONS OF TME CONTPACTORS LI- - � CENSE UW(CHAPTEq 4 if,'OMMENCINq WITH SECTI�N l000)OF DIVISKtN 30F THE BUSMESS FNp pR0- +'t' Poo�Spa � fE55iQNSCObEjORTHATHEOflSHEISEXEMPTTHEREFROMANDTHEBASISFOR'THEAL;EOE�EXEMP� (� TKN7.ItN'f VidLA710N OF SECT�ON 7037.5 BYANY APPItCANT FOR A PEflMii SUOJECTS THEAPPLICANT T0 z Rs-Rooi � ACML PENALTV pF NOT MORE TMAN FIYE HUNDRED DOlURS(SSaO}.�: � ❑I,ASOWNEROFTHEPflOPEATY,QpA1YEi.tPtpYEESWiTNWAGESASTHFIRSOLECOMPEN5A710N, CORIl119lCIdI � 4YILL DO THE WOflI(,ANO THE STRUCTURE is NOt M7ENDED OR OFFEFEp FOR SALE(SEC.7P44,&1Si- � � NE5S AN4 PROFESSION$(X}p�:THE CONTpACTOR9 UCENSE LAW DOES NOT AFP�Y TO AN QWNEfl dF � � PROPERTY4rif0&N{.p$ppHAPqOyES7NEREON,AWDWNpDOESSUp�W4RKWMSELFORMERSEIFOP -�,� � ' 3 � THRd1OHHlSORHEROWNeAiPIOVEES.PROVIDEDTHATSUCHIMPROVEMENTSAiiENOTiNTENDE00R m � OffFEREOWRSKEIF.HDWEVERTHEBUI�DINGORIMPROVEMENT15501.DW17H1NONEYEAROFCOMPLE- � TlON,THE OWNER�8t11LDEC1 WiLL HAYE THE BURDEN QF Pf�6VING tttAT ME OR SNE DID N07 eliilD OR � IMPNOVE FOR T}tE PURGO5E oF SALE). W [7I,ASOWWEfiOFTHEPqtiPEW'Y,AMGXCLUSIVEIYCON7RpGTMCW�TNLiCEWSEQCONTRACTdftS � TO Cf?NSTRUCT 7HE PpGlECT CSEC.7044,9USlNESS AND PPOFe55�ONS CA�E:THE CONTfiACTOAS U- VeIU]ti071 F AUJ.AREA t1J CENSELAWWESNOTAPPLYTOANOWNEROFAPR09ERTYiMioBUiLDSpR1lAnqpVE5THEREON,AND '- �} � WIiOCONTMCT3FOR5UCHPR4,lECTSWtMACONTMCTOR(S)LICFNSEDPURSUANTTbTHECONTRAG OUANl7T`/ DE5CRtPTiON roas uaEr+se uw.p. fEE pO!AM EXEAdpT UNDEH SEC.�,. „�._ 8.E P C.FOR 7NIS REAS6N Q �',�.� � t C � U � i � ---- ----- ______ � �, - DATE __._..._._._DWNER__.._____.._..�. � , � t. l?+a' rt�!' C�. � IICENSEfJ CQNTAACTORS DECtARAT10N W � � S;,J , 1 HEREBYAFFIFAI Uf�ER PENf1TY O(PFR/URV THAT IAM LICENSED UNOE4 7ROVISlONS OF C;HpPTER �,{ �{� � Q S��ENCINLi YqTH SECTpN 7oWJ pF DIViSi(}N 3 OF 7HE 9liSINESSAND RpOFES3KNVS COD�,AND z � .l� M�� l MY IICENSE 151N FULL FORCE 6 EFFECT. � � LL1 �]�j � LICENSE4LAaSS_yVY.._..._..w.� LIC.ND._S�!/_y�],�____._.�' � {," . y'.. VDATE�l,`�L�sJ�-�`�'f ,.�.�_ CONTRAGTOR�„_C-'.11.j._,�.�„�_��. i L Z'n "� u' �` x .0 � WQRKERS'C4MPENSA710N DECtARATION q - V r 7� iY� � 1 HEftE$Y AKGKiM UN6£R 7ENALTV OF PERJUHV ONE OF THE FOLLDWING pEGt,ARAfiONS: Z "�"� f Q + CI HAVEAN4W�l.LMAWTA�NAGEf1TIftCATEOFCANSENiTOSELFiNSUREFORWOqKEFS' � �^/ �'— � CQMPENSATIGM/,AS PP.4Vi6E0 BV SECTI6N 9�060F THE IABOR CO�E,FOR THE AEftFf?RMANCE C) _„_l V \ t _ /S J(�F THE WORK FOR MhiiCHTHiS PERMIi IS ISSUE6. � " ��Q .��,C/-�+.� I NAVE ANQ WI4L MAIMMN WUflKEflS'COMPFNSAT;(�N iNSURANG[.AS REOUIRE�PV SECTION ,/ 3�M OF 7NE LABOft WpE,FOfi T}iE PERft�Rl.iANCE O�iHE WORiC FpR WHICH iHIS FEAMlT 15 _„_v.i. �� ISSl1ED.MY W:JRKERS'iXlMFENSATiON iNSURANCE CAHRIER D PO'ICY NUM6EHAAE'. CONSTRUCTION �y� l � /,� �„y _ � - �. rr,Raaea�.�_C�� _._�/�M�� PLAN REVIEW 4. - � _.�- - � POLICY NUM9EH � __` F .. -�-� ' . � �� ELECTRIC =�-j�._„�_. ��1 �� 3 W (n�ssECT`avr+Emr�ore=a:�.E�'FDo�T+fraEw.�r�sr�naafFn�aoct�an5ts�ro;�oa�ssx Pl.UMBING t 1 .� . �..3�:: _ --v._�..)..2 -��r - t 3 }a z I CER7111'TMAT IN THE PFFlFOHFAAtJCE OF TI'2 YJOqtt FOR WHICH THIS PERMITlS 1$$lIED,i MF_CNANICAL e � ��-.�.✓ r C;3 GHAI.LN47 EMPIOV ANV PEP.SON�H ANV MANNER SU AS TO 9ECOME 5UBJECF TO THE � —�- ' {/� `+YURNERS'COMPENSA7IOMI,AWSOFCALIFORNIA,ANOAGREETHATIFl5HWLQ8E(:OME INSPECIICINFEE "i!___ '� ._.�_ .._.. - SVB.tECiTO7HE�lGRKER�'CpMP�NSAiIONPROVISIONSOFSECS10N3�0oOFTHELA80R (� �, '��' COOE,�SHALL.FORTHWIT��COMpLY WITH TN45E PRqYkS10NS. ISSUANCE ___, ' ,�j � ,�V fj "___` �__.._..1 p �ATE:��'+' �_ APPLtCAN7: Lg ��_ $MIP _� _ �� . � W ..._.-_.. ENEFGY P/C _��,.}�v,-, � '� WARNlNQ:FRILUHETO SECURE WOAKEFS'COMPEN5qT10N COVERAGE IS UNLAWFUI.,AND SNALL 9E � � � SVe.lECTMt EMPi,OYER TO f.R�M�NAI.PENALTIES AND CIVII.FINES UP TO ONE NVNbRED 7'ti0U5AND �NERGY PERMIT � DOLLARS ji106,o06}.IN A[SDRION TO THE COST Of COMPENSATION,DAMAGES A5 PROViDfD FOR�N � SECTION 3�oH OFTNE LABOFl CODE,INTEHEST,ANDATT4RN6Y'S fEES. � � W � RETENTION FEE: .._._. _._... _._.i�,�� b CONSTHUCTION LENDING AGENCY PRE•AL7 FEE: v� ____ � 1 HEREBV Ai�FtRM UNDER oENALTV OF PEVi.1VRY THAi THEflE IS ACbNSTRUCTibN tEN01NG RGENCY �� F-0R TNE PEflFORMANCE OFTHE woRK Fqq WHICH THIS PERMI715 lSSVEQ(5EC.3097,CaV.C.). '�/ "-""- -��-��-- �w tENOEflSNAME ��✓�__„�t'�,��'�'""-" � t\ � �� _.._,��.___._"_'_ .�.�_. --11�_�T-.. ._._. .. F- lEN0Efl5ADDRESS . „_, A_ `� .,�, ICER7IFYTHA7iHAUEREA6THi5ApFLICATIONFNpS7ATE?NATTHEABUVEINFORMATiOtif5C6RRECT. TOTAL FEES � �"\ �f "�' f ACiRE£TA CQMPIV N7TH AL4 CiTV ANO COUfYTY OHDINANCES ANb STA7E CAWS pEl.nTiNG T6 9UILDING � ..,J � � CONSTRUCTIQN,ANDHEHEBYAUTHORIZEREPRESEN7ATIVESOFTNtSCi7JNTYTp�NTERUPONTNE ABOVE-MENTK3NED PROpERTV FOF InfSPEGTIQN PURPbSES. C,,OMMENTS L� . .i'. ._.__. � .._ =' _�:��4.,�.__ �'s�_�t'�__—� � — � PERMITT E NAME(PpINTJ '..... _ �r f""-..w r� - t� .0 ^ -�Z.- .C. ..� .l�..�t/' {n SIG RE OF PEFiMIrT � OA7E -�� " " � RECPT.N0. .._pAlD 8Y �4 „ Q VALI6ATlON _ WHITE--Depanment Copy.YELLOW--Finares Copy,PINK-Assessrn Copy,pOLDENROD-Fila Copy,GR£EtJ-ApplicanYs Copy ��` ��= ��>� �z=`: �`��.:� ��`��x ��`��`��:�� .n��x .<� �, . w�. � � � ��;� �� _ � � � . �. , s � �� x � � �,� . � � ° � � �� ° � �� . �� . . . .. .. .. . _ . . . . s.. E'r; p � „ _ .._ .,_. .. . . `j i �. . �,�r _. . . / �j? # i _ . � _._ . � � 4+C.,- ._ ,. _. _ .. .... — . ., U_...., _ . ._ _. .. ... » . . � . _ .. _,._. ... _ .. __ .. � . .. � �l�r -� _ ` , � . � �z � r ,, . , � � � � �� r .e � � �=-� �s�r�:�r�a.�-_ r� ` � - - r �a,� �� _ .�. r _ _,. � , , . ,,�.� � , � � , . . _, � _ � � . , .�� - � . � _ , , . _ __ - a � , _ ,� � _ _ _ __�._ , _ _. � � ,�� . � �_ . _ _ _,.,_ _ �� , .� r � , _ _.m � _ � _ _ , �. �. �,� � � _ �`w_ � � � �_ � ; ' � �� _Q�� . � _� _ � �. , _o � . _ _ �j_fj� _ _ a ... , ��- � _ � � � ' Y . t �e i'/f�Y .,.,� �� " � `. _ ._ .... ._.. ._ .. .... _ �L��G� , _ 1. : � /�2�_=4� ��- _ �,U ti - � _ - � ., .. _ 1 � �� '�- _ � _ _ � _ (� / _ _. 7t(v� /�,/�� ( � _ ��'.�� _ �� ' • , . _�,- �� ., u . .. � '. . ;� . ., ... . .. .. . .. .. .... ... . .... . .. j�r.: . . .. . f .. __� _; ,�_• .. ., ��:. . . .. �� .. . ... .. ...... ....... . ...... ... ...... .. .. .... . . . �V� _ _. ' m-.. _ _.... .., �.. . .._ .... .. ... . _ ��/�— �v��`�_�� _ � _ � � ^ - x� � � *�a��. �, � - _ ��,,.��,� .n:��.�.��.....��.t�`r_ __ _ _ _ _ _ .. _ _ __ _ _ _ . _ _ � � � � a � ��'�� ,�, �� - �af��`��,��g�^�.� z ��c �� a�"��'�� ' �t��`��,� _ _. _ �� '�**�� __ _ �+� � ��-� � � �'� i��*��r'' ._ _ _. .... � .._ .... .. ... . . . .... ... .. ._. .. . .s�; ��m-'F>�: '��"��e"'�n„�i�€;�k w . ... , .. .. .. .... ... .. �� y�,� �+ "'�': . .. ... .. ._.. .._ ... _. . �' '��a�'�t�`��.+�,�s-a�� ._. _.. ;,'"y*� r$ „ a.��s �,q� x�, ,, � ..... _ _....... .... .. .. ... ...... . ..... ... .. .. .. .... . .... . . .. ....... .. . . ... �'� ,��4�� °� �,��`rc�k�"' �� s ``�Y�� '�,�� _ _. _,_ _ �; � � ^,�'�� ,%w.� ��'��,��r ��5 ...,•�� s..,,�a��€��.. , � CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 ICS &s (909)860-3195 Fax(909)861-3117 CI BUILDING PERMIT APPLICATION PRESS FIRMLY JOBSITE-, i ADDRESS J Ca.t in Ili�a Qx .", APN LOTS TRACT Z G�7 OWNER PUILAC C 1 QLr'Vt,/M�IE STIR•. 2 dy ADDRES S CITY 1 i. b'L_ZIP 4 l lt--TEL,q"--71Z APPLICANT^TEL. CONTRACTOR- 75a ADDRESS CITY ZIP TEL. ARCH/ENG/ 0<,S DESIGNER d i/L i"Uh ADDRESS 12- CITY IP TEL. 9tt4_7CQ-Oy)- 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 COOS:ANY CITY OR COUNTY WHICH 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 A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW(CHAPTER a (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(3500).): ^ ,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,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). ^ 1.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.). 0 1 AM EXEMPT UNDER SEC. B. E PC. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER Y(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORCE D EFFECT. L C NO C 5'T5 I— LICENSE LASS-y_ DATE 1 �'vU 40J CONTRACTOR 01 WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: 4 NAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' �9 J II1'(COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE. FOR THE PERFORMANCE (f"F THE WORK FOR WHICH THIS PERMIT IS ISSUED. J fi I_HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION 3700 OF THE LABOR CODE,FOE.THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS'COMPENSATION INSURANCE CARRIER D PC! ICY NUMBER ARE. CARRIER_dLI SCE t �1�� POLICY NUMBER_p .-\lj�zlne CC-, M4S SECr)ON NEED NOT BE COMPLETED OF THE PERMIT IS FOR ONE HUNDRED DOL ARS ($100)CA LESS) I CERTIFY THAT M 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 NORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE,I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE:APPLICANT: �7'r 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.). LENDER'S NAME C n �!'��TL LENDER'S ADDRESS 1 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT, I 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 PERMIT'S SNAME(PRITJT) SIG RE OF PERMIT'S DATE PERMIT P/C APPLICATIONG V� D DATE NUMBER N ISSUE I I TYPE OCC DATE v t'CONST, GROUP ZONING SETBACKS FRONT RW ^ REAR 13 SIDE/SIDE STREET RW E3 SIDE ^ PROPOSED USE N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREANALUATION SFR/ADD/REM L-1 Li Garage/Carport I o W Patio/Deck LL Pool/Spa 0 Re-Roof Z n Commercial Valuation P ADJ.AREA QUANTITY DESCRIPTION FEE a x�t" C I fL Ma "S I I Y\ W SL.1 e 0. L am 1J } 4 7 IX T� n V \ W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL -;may ,M--� INSPECTION FEE ISSUANCE Jr - SMIP U 9 ENERGY P/C ENERGY PERMIT RETENTION FEE: . r J PRE-ALT FEE: PL kl\ TOTAL FEES COMMENTS RECPT. N0. PAID BY� L 0 VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy