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Home My WebLink About18017 (10) �,,r;,,,� CITY OF DIAMOND BAR � � DEPARTMENT QF COMMUMTY&DEVELOPMENT SERVICES .:.-� ��-� 21825 E.Copley Ckive (909)860-3195 Fax(909}$61-3117 l PRESS B LDING PERM T AP�" ICATION r�Lr,.� / "�E`'�,L,�t'r'� FIRMLY � JOBSiTE APPLICATION �� ' � I \.r�� PERMIT � P/C o ADDRESS�, ' � - DATC ��.� NUMBER�� # � � ISSUE TYPE OCC APN�_ LOT i'RACT pAj� � - � -_ _CONST. GROUP p OWNER � �, ./�,�L�' _.. �Ialt.._–� - a ADDREBS I c�S"Y`f tU j L��^*�i�jy�-i3Cj7 �.r Z�NING SET$ACKS w �[_,_'�,,j✓!,�' ZIP�(:_C-_;� TEL�Y i�i'�`t'�"f FR�NT �.__. RW (�—_ .� C1TY � APPLtCANT ___ TEL.i REAR �� SIOEISIDE STREET � RW i::) CONTRACTOR� SIDE _ , � � ADDF?ES8 _ •k'j�,�'-c _ [1_._� � CITY _ ZIP__ TEL PROPOSED USE � '� _ w ARCH/ENGI �� ^ 4 z DESIGNER �1� � '�_'-'-STr -- � AODRESS,_ � . ^ NO.DWEL. NO. NO. �n �� -- UNITS STORlES BEDROC7M5 � GlTY�":.,.,�✓,��fyf� ZtP__.�_ TEL.,�--— _-- __ � ..� � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNkN-BUILDER DECLARATION SFR/ADDlREM O [] i HEREB'1 AfFiRY.{VNDER P[NALiY OF PERJURY TNAT I AM EXEMPT FRC1M THE CONTRACTORS I.I- G2f2JB/C8fp0l1 W CENSEL4WFORTHEFOI.LOWINGREASON(5EC.]Oa1.58U51NE$9ANDPROFE55'ANSCODE:A1aYCITVOF (n C� COUNTYWNICHREflUiRESAPEFiM:TTOC1'�NSTRUCi,A�TEft,i6tPROVE.DEt�ItSH.ORREPAiRAMYS�FlUC� �� TURE,PRIOR i0 ITS ISSUANCt,ALSq RE�UIRES TNE A?pLICANT FOR SUCH aERMIT TO Fll[A iIGNEO w Pa�10/D80k r�. STATEMENT THAT HE OR 5HE IS LJCENSED PURSUANT Tl�THE PqCVISIONS OF THf GaNTRACTORS tl- ,jr, GENSE tAW(GHAPTER 9(CflMMENCiNG WIFii SECTION JtbOi OF DIV.SION 3 0F THE Bt15ME55 ANU PqO� � POOUSPB � 6E5310NSCqDEIdF1THATHEORSHEISFXEMPTTHEREFHOMAN�THEBA913FORTMEALLEGEOEXEMP� (� TION.ANVVIOIATIQNOFSECTIbNroat.SgyANyAPPLICANTfORAPEftMIT5U8.lEC7'57HERPPLICAVTTO z R9-ROOf � ACtVIIRENAl7YOFNOTdMJRETHANFNENUNDRC060LLARS(E5o01.)'. � ❑I.ASOWNEROFTNEPROPERTV,Of7MYEMPLqYEEuWIiHWA(3kSA5THEIRSOLECOMPENSATI6N, Q COl4)til8fC13I ,�,` Wll!_lJOT}IE WORK,ANp THE STftUrTUR`c IS NOT It,ITEFFiJEU Df?QFFFRED F4R SAIE{SEC.7�a;,eU5l� J � NE55 AND PAOFES&IONS CODE',THE GONTRqGTUNS LICENSE LAW DOES N07APPI..Y TO AN OWNER OF � pROVERTV WNO BUILDS OR IMPROVF.S THEREON,AND WN,O DOE i SUCH WORK HIM5ElF OH HERSELF OR CL THFK3UGNHlSOAHEROWNEMI'I.�YcE5PROVIQEC}THA7Sl,CH-MPROVFFdE4T5ARENOtWTENCED03 � � OFFEREOFORSl�IE.IF,MUWEVER,THEBIIILJIYGORIMPROVEIAFNTiSSQL�WIiHINONEVEAROFCOMPLf� `, TION,TNE OWNEfl�@UIIDER WILL HAVE THE BUROEN C1F pqOVING T4AT HE OR SHE�IO N4T 9�ILD Oft �- — � IMPF40YE FQft THE P{1RPOSEOF SA�E). W fJI,A50WNEROF7HEPRCIPERTVAMEXCLUSIVELVGONT(1hCTIN{.yyRHLICENS[�";UNTRACfORS - ro eonsrnucr rHE aao�Fcr;sEc.�oaa,eusin�Ess n�c aaoressror,s ccve�+E coxranezoRs E.� Vatuation ADJ.AREA i1.1 GENSE�AWOClESNOTAPPLVTOANOVlNER6iAPliOPERTYWN05UILD50FlIMPflOV"tSTHERE0IJ.ANLY WHOCONTRACTS FqR SUCH PROJEC75 WITHACONTRAGTpR(5)LIGENSE]PUflSUANI'TO7HE Cf�NTRAC� FEE � QUANTI71` CTESCRtP?ION � TORS UCENSS iAW). QfJ I AM E%EMPl'UNDGR SF_C,__,,,,,_`_^_.. ^_ �3.g p C.FOR THIS FlEASON Q � _,_ V � �, .� .._ �... - � Z DA7E, .^i 4WNER .. _....�__ U " Q W LlCENSED GONTRACTORS DECL4RATION -r ,E",� W � I HERfAV AFFIRM UN�ER PENAL7V OF PEfiJJ%Y THAT I AM U(;tNSED UNUER PROVISIqNS pF CHAPTER � � 4 jCOMMENCiMG WITH ScCTiQN 70947 PF OiYiS10N 3 ilF TNE BUSINESS ANO PflOFE55IONS(XIDE,AND Z }C !AY LICENSE i^s IN�ULL FpFC qND EFFEC I. �..y rw _ • � �tCENSEC,ViSS_„__��_.,_._ LIC.NO. _ 'J,,,j-F �` �� /� __ � U DATE_,__��_..�`�-t4 I , GONTRACTQft..�...��-_— a W � WORKERS GQMPENSATl4N DECIAftATiON Q � I NEREp IAFFIRIN UNPER PENALTY OF PEFJUFY ONE OF?HE FOl4.OWM(:DECLARALIONS: Z Z I HAVEAND\NILLMAMTAINACERTIFICATE OF CONSENT 7C]SEI,F�INSUFE FOP WORKEHS' a 2 Q �CQMPENSATION.ASPAOVIOE08YSECTION31oGdFTHEtA80ftC6QE,FORTHEPERFORMANGE �U Q THE'NOpK FOI1 WHICH THIS PERMIT 151SSUtD. � � �tHAVEANDWlILMAINTAiMWORKEflS'CAMPFNSA1IfiN3N3URANCE.ASRCOUIRE08Y5ECTION � 3700 qF THE LABOR CObF,FOR THE pERFOC•MANCF,OI"fiE WORK FOR WMICN THIS NERMI715 � tSSUE�.MY W4 ft5'CO ENSATIbN Iy,SMR4NCE CAAftiEii AND PCJi. 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" ,.m-��.�"� ._. _. , ._ _.- �,r m, .. ., .. �,8�r. �"� . . . . ... .... . ._ _.. .... _ _� :e CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMI,T.APPLICATION PRESS FIRMLY JOBSITE ADDRESS APNLOT TRACT OWNER IIIe, ADDRESS 1 t?/G j 6'.+i: CITY_�,•+rl! ZIP TEL. APPLICANT TEL. CONTRACTOR��- ADDRESS_ CITY ZIP TEL. ARCH/ENG// / DESIGNER J' ADD RESS n CIT 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 MORE THAN FIVE HUNDRED DOLLARS($500)) ^ I,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) IT 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 OFA PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW). IJ I AM EXEMPT UNDER SEC 3&P C 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 FORT AND EFFECT �� 2 LICENSE CLASS LIC NO DATE/o-i T 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 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 WO RS'CO ENSATION I4SMF#ANCE CARRIER AND POL,OPR JMBER AREJ CARRIER(�'-� POLICY NUMBER (THIS SECTION NEED NOT BE OOMPLETED OF THE P RMIT 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 3700 OF THE LABOR CODE.I SHALL FORTHWITH COMPLY WITH TH901 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(51 00.000),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 PERFORMANC OF THE:WORK FOR WHICHHIS PERMIT IS I SUED EC 3097.CIV C.). S I E LENDER'S NAME/�' LENDER'S ADDRESS I 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 INSSPEEC�C ON PURPOSES .IIO M��ENNTT .M n PERMITTEE AME(P RINT SIGNA EOF PERMITTE E DATE APPLICATION PERMIT P/C DATE NUMBER# ISSUE TYPE OCC DATE CONST.GROUP ZONING SETBACKS FRONT RW REAR CI SIDE/SIDE STREET RW SIDE CI 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 W U_ Pool/Spa 0 Re-Roof Z Commercial m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U U W W Z a U Z U W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING 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