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Home My WebLink About18019 (10) �,� CITY OF DtAMOND BAR �� DEPARTMENT 4F CC?MMUNTTY ck I}EVELOPMENT SERVICES 2(825 E.Copley Drive �9d9}860-3195 Fax(909i$61-31 I7 PRESS � ,— .-.. B Y�vG ttM1T �,I ATI -S �U� FIRMLY } JOBSITE { APPLICATION � r' PERMIT f'� � ADDRESS__ . / ,. _ .�1 OATE`_�,- �� NUMBER � ��3� �� /C � �LOT TRAC Z. ISSUE TYPE OCC »- APN_ � , , , � -'�. --__ DATE,— — _CONST. GROUP � p dWNER � o ADDRE S -f �},� �. �y.r'i, �s„ _-�'�. . ZONING SETBACKS 2 CITY.�/�Le�LArF' _ ZIP� TEL.�/�� ,"�►c''�� ; FRONT RW �, p APPIiCANT ,_ TEL.� '� REAR �,_`—__ � ��--" SIQEI5lQE STREET — RW—.. ! 1_.�_ � CONTRACTQR_--'��l�,E�� ' ` — SIDE �� ADDRESS_� �% - `� CITY ZIP TEL PROPqSED USE W ARCHIENG/ �^ — _ _... � .-,�� DESIGNER � C/`F ,�C_-�� -- NO.DWEL. NO. � ADpRESS ��„�� NO. ' t�Y� �Y"t UNITS STORtES BEDR04MS � CtTY�''' `�OT ZIP—.� TEL.--_—.—_ _ � QESGRIPTIOtJ SQ.FT. FACTOR PSF ADJ.AREA/VALUATION � qWidER-BU�LDER DECLAFiATIQN O SFR/ADD/REM 3 MEAtBY AFFtR3A UNDER FENAL7Y tYF PERJURV iHAF t AM EXEMpT FflqM THC CONiRACTORS LI� G8fa98/CdfPO/1 �W CENSELAWFORiHEFOLLOWMf.REA90N(S6C.�091.5BUa"INES>ANDFROFE9SION..CO��E;ANV�IiYCF (/) W COUN7YWNICHREWIRFSAPEPMITTOGQV&7ftUC7,AlT'eR,iMPftO'JE,DEMOtiSF{OftREPAiRANYSTRUG (jj paf10/DBCk TFtRE.PRIOR 7�IT51SSUhNCE,ALSp REQUIRFS THE APPLIGANT FOR SUCH PERMIT TO FILF A SIGNECJ w +L,e- STATEMFNT THAT HE Op 5HE IS LICENSED PURSUANf i0 THE PROVISION$qF TNF CCNTRACTOaS LI- � CENSE l4W(CHAPTER s({�pMMENGNG WlTH SEG�ipY]OQGj OF DiVISK)N 3 6�TNE BUSIMESS AND PRO� � PooUSpa � fESS10NS Cf}DE�ORTHAT HE OR SHE IS EXEMP7 T�If.REFROM AND i HE AASIS FOR THEALL[GCD FXEMP� � � TION.ANYVIOLATIpNOF51:CTION�031,5BYANYAPPLICAMPoRAGERMiTSUBJECTSTHEAPPLICANTTU Z Rg-Rpp} � A qVit PENM.TY OF N07 MaRE THAN FIVE HUNORED 6di�ARS iSSmj.): _ C;I,ASOWNEROFTHEPROPERTY,ORMVFMPI.nvEESWiTHWACCSASTNEIR54lECqMPtNSATION, � CommefCiaf WIIL W iHE WORK.AND THE STRUCTtIRE IS NOT INTENDEO OR OFFERE�fqR SALt jSGC.7044,BUSi� J � MESS AN6 PAOFESSIONS C:O�c^�TNE CCSNTRACTORS tiCF.NSE LAW fldES NGI APPLY TO AN OWNE{�OF ""-- PROPERTVWHOBUILDSOFtIMPROVESTHER�ON,ANJWHODOESSU(;fIWORKHIMS[LFORHERSE(FOP � � THRQUGH FfIS OR HER OWN EMPIOYEfS,PAOVtDB?THAL SU(:H iMPAOVEMENTSARE NOT iN7ENDE0 QH m _... � OFFEftEOFORSALE.IF,NOWEVER,TSiEBUILDMGORIMPRUVEMENTI550LDW11'HINONEYF4ROFCOMPLE� Z iION,THE OWNER BUILDCR WILL HAVE THE tiUii[JEN OF PROVING iHAT HE OR SH[D D NOT BNLD Ofi -'- � IMPRQVEFORTHEPUfiP09EOF5AlE). �y,� [:li,ASqWNEflOFTHEPqf?VEflTV,AMEXCLUSIVELVC;pNTqAf.TINC.WI7HUCGNSCDf.ONTFAGTOfiS (Y TO CONSTFVGT THE PROJf:CT(5EC.7044,6USINESS ANI]PROFESSlONS COUC�.Tt+f';GON7flACTOPS LI� ValU2(i0�i A6J.AFEA � CEkSE LAW OOES N67 APPI_Y TC}AN OWNER OF A PROPERTY WHD SUILCIS OR IMPROVES TFiEHEON,AND —""'"—"—"' --- r WHOG9N7RACTSFORSUCIIPR6JECTSwITHpCOhTRACTOR(S)UCENSFDPUIi5UAN7 fO7NECONTFAC� QUAAlTITY (�ESCRIPTIOIV FEE � TOFS�ICENSE LAW). � IJ I AM EXFMpT UND6F'�.SF_C.,_ `___ J (,� .....__.-____2�.A P.r FOF THIi qEA50N Q � � � .__�._.... ."___'_'___—`_ _'___. .._ � �AiE ,,, . nwNEH__„_ F- � � _.__—'...—.__.-_....._�___ U � LICEN5ED CONTRAC70ftS DECLARATlON � � `� u.3 �. CC I MEREBV AFFIRM UNDER PENALTY OF PERJUqv THAT I AM I,ICCN5E0 lJN6ER PROVISI(]NS OF I;HAPTER � a„ 9�COMME4CING WITH SECT��oN TOCo}�?F DIVIS�ON 3 qF THE 6USiNE55 AND PFK�FESSIDNS CODE.AND Z W MY CtCENSE IS IN FUI.L FORCE/A/�D EFFECi �,_ �-} K-� S �� , UCENSE CLR.S�,S1 1.s , UC.N6.„ � �� bATE�LL�(�'-'_.O�„_..— CONTRACTQft � ��__y��[+ yl w ,,._ �n^�2 � WQRKERS'G�MPENSATION DECLARATIpN ¢ -- � I HEREB AFFIRM UNDER PENALTY OF PERJVRY ONE UF THk FOLLUWING DECLARATiONS: V � Z � HAVEAN�WILLMAIIJiAINACERTIFICATEOFCONSENTTC)SELF�INSI/q&FORWORKERS' a _ Q , 3]0o OF THE�ON,AS PROVIDFD 6Y SECTI�N 3JOC OF ThE LA80R CODE.FOA THE PERFQRNANCE U (AM 'NSA �FTHE W4RK FOft WNI(:N TH�S PEqM��3S ISSl1ED. � � W INAVEAMDWILLMAMTAINWOflKER5GQMF"ENSATI(7NINSURANCE,ASREOUIRE68YSECTION �'—��- !-- 4 LABOH GODE,FOR 7HE PEFFORNAM10E t�F T f.WORK FOR WHICIITHIS FERM 5 _ IJSUEO.MV WOR �CpM¢ENSATION WSIARANCE A IEPA4(??Ot�CY NUMBERRR_� CONSTRUCTlON Q � CARRIER-._. �� Gy L; � `-r- ^ _......._.._.......��.._' _...._ > � -_� PLAN REVIEW _ -- � PoucvNur�BEn�� _��_� f.� _ ELEC7RIC Q ,/ r7 l'_Tr-- _. _ ...� a �n+�sscc�NE�r+craeo��r.ErEoc�r+-Et�E `r�r�Ror�E�RFo�a�ws{t,osloa�Es;}. ( PLUMBING �'��-„�� w - _ _ � I CEF7TIFY THAT INTHE PEftFORMANCE OF TNF WORK FOR WMICHTHIS PEftMfT IS�SSUED�! MEGHRNI{u'AL G3 5HAl(.N�T EMPLOY ANY PERSON IN aNY MdNM1IEq SO AS?O�ECOME SVBJECT TO THE �� ' �—' "'--'-- (/'j WOaNERS'COMPENSATION LAWS OF CALIFOPNIA,AND AGREE TNAT IF I SHUUI.�BECOME INS?FCTION FEE � SUBJECTTOTHFWI>FtKEHS'COMPENSATION?RQVISIpN5UF5EG7iCiN' 400FTNElA80fl ""' +�-y--�'y—,- \'-- � C�CIF,ISHAI.LFORLN.kITNCOMPLYWI7HTHS?fiEPfif}VISIONS. ISSUANCE JI�� l„�.,/ � __.._.... ___..—._. ..._S�. __— a - p C+AT[:_.,.... . AF'PElCANT ^��f,��„�Jk.j,�_� _, SMIP _ ^ _. Jw ENEftGY PIG �'�""� 1'"il' WARNINC.:F4lLUAET95ECUR�=WORKERS'COMPENSATIONGDYEftAGEISUNtAW'rUI,RND$NAL�BG — - {y_ SUBJECtAN EMPC6YERT0 CFtiMiNAL PENALTIGS ANp CIVIL FINES UP TOONt HUN�RED THpUSAND �NERGY PERMIT ! '� ` � pOLLAftS(f100,000),IN ADpITI�]N'fp THE COS`OF COlAPEVSAiION,UAMAGES AS PROVIDEU FOR IN J SfCFIpN 31980F THE�A801t�:ODE.4NTERE57,ANQ A!I�ftNEY'S FEES. ' �� w _ _ RETENTION FEE: .......—. --- Q CONSTAIIGT�ONLENDWGAGENCY pRE-ALTFEE: , _.. ._.—.-- � I HEREBVAFFIViM UNbFR PFNt.LTV OF PERJURV TIIAT'HERE IS A(;ONSTfiU('iION LENpING AG NCY FpRTHE PERFPRMAN�E O"T{IE WOR{fOR WI H iHi PcRMiT 15 tSSI p( C.3o9T C1V G: "'� — '—��--�—�- - _. `�, �e'�_/tr'�--��i'� .�-.¢".l� — � ---.— � LE:�NDER'S NAMF ._,. "_"___..._ _ ...�..__'__ . I-� Lf:NDER'SAC6HE55 �` �� ' W� � r(� ,l ICFRT'fYTHATIHAVFREADTHISAPPLICATIONAND574TETHAiTF�ABCVEMFUNMAI'ION��SCORq[CT TOTAL FEES j�f ,�� d IAGflEETOCOMPLYJJ:FHAI.l.t;liyANDCOUYiY6R61NANCE5ANO5FA'EtAWSRFtAf�MGT06Ul�DING �,V `.� � CQNSTRUC7�D4,AND 4iERENY lUTMORiZ6 �PI�iESEIu'7ATIVES OF Ih115 CGUNTY I'O CNTEA UPI'}N`HF Z AHOVE�MENTIONED PROPEHTY�OH INS TION PL1qPJ5F5. � ' COMMENTS_,_ J µ.. � ,er ' _- � ., J _,_._ �_ � _ ._ ��—_.._� _ ¢ AE.pMi��AME i�'RIN� . � _ . �� ' ��-�� _ _ � // - _ _ SII.�NF f'tHMITTE •-_ � _ -._.-/' "DAr ... -�."_-___ � �� E RECPT.NC7�� PAiD BY VALIDATION WHITE-Depa,timent Gcpy,VELLpW-Finance Copy,FINK-Assessor Copy,GOLDENROD--File Copy,GREEN-ApplioanYs Copy r:r4 �°��.��HM�1 "i ��'�`�� '�` � E- aIk i� t ty,5 91 J g`� ,g q^ a 4 � ti� � rv I _ _,�' ��`�` �"q. ��d�a„�t��`��`�'��-�� '� m �^ - _ ,. .�d'� ,. . ,• . � E �4—, _ .. .. � :, , . ,I� +s �.� � , � x�: ;.s� ,w ° r.y�.� — � � � .,, �� .,.:=�� _ � . �f �` �� _ : .... a : r. ; . _ �.� .;. � �. �� ,- / � ,/ �7 �,t / y /,�� /�J�c ��-��- _ _, � ��+ c� �/ �a 4L/�I�,h��., .� -��1�`N 4.`.... r/ ... . .. ... . .. �� " 3 :�7��.��"q�G��'.... _. . ... . ... ... , . 1 l . ... ........ .. ,. t. .. ., �...s. =aa. .. , . . . ...._ ....... � �: .. . . .. ... ... . .... ... .. ... . ... ... . .._... ._. . .._... ..._ t �� ,n ya`.�dk � P � .. _. .... .. ... p�i!�" E' ' �4�� .�q4"�� .... .. . .. ... _. ... ,�� !��' �S�W w's3 �4 �.�. . '��p�`�� J��* � � � ,� — , �} x b�� , � �S _ — �' ��1� � P '� � "��d`r�x.. .. .. ..... . . , �� E�,�� ., ..... . .... . . _.. .... .. . ." '° � .�� v��.�a ��,� .�� ..... _ ... ... . _ _ .. ._.. . ... .. ... ._ ..... . '��. 1 € s� � � � �fi h�� G��'��a i�� ` _ � � , �:,i ��`r� '��`'� ��a '` ... . . . .. a .�`_ ,.S � t��;+"� _ _. .... .... _ - � . ,�. . _ ._ . _. _. .-_. . � � � '. � m .. .. . . . . .. .... .. .... .. . ,. , �%� .. . ... . _ . w. a ; r • ` ",, ` '�t' � �q � �'"��. .. � � � . r : �. ��n�, ._ . .. .. . . . �.. , � - z � - !� _t�� . .... . .. � .... � .. '_ CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 c BLI,DING^RMIT MI�IcATIQ_�Irou PRESS FIRMLY JOBSITE ADDRESS_ APN LOT TRACT_ OWNER�S ADDRESS L�%J( lAXI CITY///L!215-ZIP TEL._ APPLICANT TEL. CONTRACTOR i41 ADDRESS(VI CITY ZIP TEL. ARCH/ENG/ DESIGNER_E ADDRESS I LYL�3 CITY/4 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 PERMITTO CONSTRUCT,ALTER,IMPROVE,DEMOLISH,OR REPAIR ANYSTRUC- 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 OF THE PROPERTY,OR MV 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 OFI 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 I I,AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCTTHE PROJECT(SEC. 7044, BUSINESS AND PROFESSIONS CODE.THE CONTRACTORS LI- CENSE LAW DOES NOTAPPI Y TORN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONIRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.) ,i I AM EXEMPT UNDEF'SEC. ._B A PC, 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 SECT ON 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORC'.EEFFECT. LICENSE LASS LIC. NO C DATE CONTRACTOR WORKERS'COMPENSATION DECLARATION I HEREB AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS. 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 F THE WORK FOR WHICH THIS PERMIT IS ISSUED I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION 3700 OF THE LABOR ODE. FOR THE PERFORMANCE OF TE WORK FOR WHICH THIS PERM S E ISSUES. MY WOR COMQENSATION INSURANCE AR AND POLICY NUMBER ARE CARRIER.�G G POLICY NUMBER (THIS SECTION NEED NCT BE COMPLETED OF THE PE MIT 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 SECTlON 00 OF THE LABOR CODE,I SHALL FORTHWITH COMPLY WITH THINE PROVISIONS. �� DATE._APPLICANT WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CFIIMINAL 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 HEREBYAFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AG NCY 097 CIV C M I FOR THE PERFORMANCE OF THE WORK FOR W S ISSUED(C . 3 F H THI PERR ITT / MI I C. LENDER'S NAME Mly_�=",_, "�-""' ' 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,IUTHORIZE'�rQPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INS FI ION PURPOSES. PERMI EE NAME PRIN SIGNA PE RMITTE DATE APPLICATION PERMIT P/C DATE ISSUE TYPE OCC DATE CONST.GROUP ZONING SETBACKS FRONT RW REAR SIDE/SIDE STREET RW SIDE PROPOSED USE N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION S0. FT FACTOR PSF ADJ.AREAIVALUATION SFR/ADD/REM U) Garage/Carport w Patio/Deck LL Pool/Spa 0 Re-Roof Z Commercial co Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J CC I- U Ed w 0 a J Z w CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING IS_ MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES COMMENTS RECPT. N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy