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Home My WebLink About16164 (9) (. .-- ,T___--�,. � " ' ' �" � ) � CITY OF DIAMOND BAR � -�� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �`---�_._--''� , 21660 E.Copley Drive Suiu 190 � (909)860-3195 Fax(909)861-3117 PRESS �� BUILDING PERMIT APPLICATION L- ��[ S P� f_ FIRMLY � JOBSITE J y APPLICATION �_��,\�I NUMB R � �t�) `� #/C �-J) � C o ADDRESS L��+ �S �.14'N f 0� ��+'�'� DATE � ISSUE TYPE OCC APN LOT '�'� TRACT i DATE CONST. GROUP p OWNER ' ' f -/�Lf � r ZONING SETBACKS ADDRESS /��/ s,a[_ �/1 Z CITY �rUtl1 f'" ZIP rJ�b12.TEL.��'f9 '��7��d � FRONT RW ❑ � APPLICANT `zi+rY�r' TEL. i.�Vr►� SI�SIDE STREET RW ❑ � CONTRACTOR �+ SIDE ❑ � ADDRESS � "a ✓1 � CITY �fyill(� ZIP ZE 1 TEL.��''l4'�-�/H(i PROPOSED USE �S�1� oARCWENG/ � � DESIGNER A�IE'Lf� �L'» �:f' O(.. NO.DWEL. NO. NO. ADDRESS L��"S./ �-MJ,�'�'7� UNITS STORIES BEDROOMS � CITY s.'t�'l�zt Gt1Ct ZIP�YZ�Q,i TEL.'%''/�)��•'`7.). N DESCRIPTION S�.FT. FACTOR PSF ADJ.ARE ALUATION OOWNER-BUIIDER DECLARATION SFR/ADD/REM �- `� �_�J 0 1 HEREBV AFFlRM UNDER PENALTV OF PERIURV THAT I AIA EXEMPT FROM THE CONTPACTORS ll- GdfBQB/CHfPOfI 1` t '� � �, � � W CENSEUWFORTHEFOLLOWINOREASON(SEC.7C31.SBUSINESSANDPHOFESSIONSCODE:ANVCITVOR (n C� pqJyTyWryICHREOUIRESAVERMITTOCONSTRUCT.ALTER,IMPROVE,DEMOIISH,ORREPAIRANVSTRUC- W patio/Deck �Z 7URE.PRqii TO 1T9 IS9UANCE,AL50 REOUIRES THE APPLICANi FOR SUCH PERMIT TO FIIE�SIGNED W STIUEMENT hiAT ME OR SME IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- � CENSE UW(Q1�PTER 9(CAMMENCINO NATH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 r1ND Pfl0- � POOVSpa FESSqNSCODEjOflTHATHEOR5HEI5E%EMP77NEREFROMIWDTMEBASISFOFiTHEALLEGEDEXEMV- (� TqN.ANYVqLATqNOFSECTION7031.5BVANYAPPLICANTFORAPERMITSU&lECTSTHEAPPLICANTTO Z Re-ROO} � A CML PENALTY OF NOT MORE THAN FIVE HUNOHE��OLURS(55001.): � ❑I,ASONMEROFTHEPROPERTY,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATqN. ❑ COffIrtIB�Ci I YALL DO iHE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFEPED FOR SALE(SEC.70u,BU51- J NESS AN�PROFESSIONS CO�E:THE CONTMCTORS UCENSE LAW DOES NOT APPLY TO AN OWNEP OF . � �\ � PIqPEiRYW1iOBU1LDSORIMPROVES7HEREON,ANDNM1IODOESSUpiMpRKHIMSELFORHERSELFOq � J Q THqOUGHHISORHERONMEMPLOYEES,PPOVIDEDTHATSUd/1MPHOVEMENTSARENOTINTENDEDOR m QOFFEREDFORSAIEIF,HOWEVER,THEBUILDINGORIMVROVEMENTI350LDWITHINONEVEAROFCOMPLE� z TpN,THE OWNER-BUILDER WILL HAVE THE BUROEN OF FROYINO 7H�i HE OR SHE DID NOT BUIID OR � IMPROVE FOR THE PURPOSE OF ShLE�. ❑I,AS OVMEROF 7HE PROPERTY,AM EXCLUS�VELY CANTMCTING WITH LICENSED CONTRAC70RS � TO CONSTRUCT THE PRQIECT(SEC.)04/,BUSINESS/JJD PROFESSIONS CO�E:THE CONTRACTORS LI- VdlUefiOn ADJ.AREA W CENSELAWDOESNOTAPPLY70ANOWNEROFAPROPEHTVWHOBUILDSORIMPROVESTHEREON.AND � 1NqCONTiUCT5FOR5UCHGqQIECTSWITHACONTMCTOR(5)LICENSEDPURSUANT70THECONTRAG QUANTITY DESCFiIPTION FEE � TORS IJCENSE UW.). J �-, i � O I AM EXEMPT UNDER SEC. B.6 P.C.FOR THIS REASON Q � '�� '�� 3 � �u � �' LL DATE OWNER �' `� Z �y . f1. �'" oL. �,� � UCENSED CONTRACTORS DECLARATION w `y � � I HEREBV�FFIRY UNDER PEN.LLTV OF PERIURV THAT I Atri LICENSED UNDER PROVISIGNS OF CHAPTER � � �jJ C �� a, •(COMMENCWOWITHSECTION70W�OFDIVISION30FTHEBUSINESSAND7POFESSIONSCODE,AND Z 'C � X MY LICENSE IS IN FULL FORCE D EFFECT. m � � ' t1J � UCENSE CUSS�_LIC.NO. � �� 1 i, � � 1 L O ~ ` J \f �� V DAiE I "F✓�/" �� CONTRACTOR � ' a �� U.� (r1 w V � WORKERS'COMPENSATION DECLARATION U � 7�� - � I HEflEBYAFFIRM UNOER PENALTV OF PERJURY ONE OF THE iOLLOWING DLQARATIONS: • � z n R-r r � I HME AND WILL MAIN7AIN A CERTIFICA7E OF CONSENT TO SEIF-INSURE FOR WOHKERS' 2 `� ti V�J � COMPENSATION,AS PROVI�ED BY SECTION 3ioo OF THE LABOR CODE.FOR THE PERFORMANCE W OF THE WORN FOR WHICM THIS PERMIT IS ISSUEO. � /,� � 4 W I HAVE AND WILL MAINTAIN WORKEFS'GOMPENSATION INSURANCE,AS RE�UIREU BY SECTION (� Q 37000F THE LABOR CODE,FORTHE PERGORMANCE OF 7HE WORK FOfi WHICH THIS PERMI7IS Il p`�' I.,�� I�L� j� ��_ ISSUED.MV WORKERS'COMPENSATION,INSLIRANCE CARRIERAND FOLICV NUMBER ARE: CONSTRUCTION �y cu�PoEa��s�� f"n'1 ^1 o'r1��c7 II1 S Gv P�nN aEviEw ZPoucYNUMBER WO(�G =11��__�.__ __. ELECTRIC _ l Q � flWssEc:i[XJNE�Par6EmMPLEfIDaFniEaERl+tr6fonordeHl,rnaEODa1APs(E'�aoloR�Es51 PLUMBING _ � �' � W `. Z I CERTIFY THAT IN THE PERfORMANCE OF THE WORK FOR WHICH iH15 PERMIT IS ISSUED,I MECHANICAL �� / (3 SHALL NOT EMPLOV ANV PERSON IN ANY IAANNEH SOAS TO BECAME SUBJECT TO THE ' � � WORKERS'CAMPENSATIONLAWSOFCAIIFORNIA,MIDRGREETHA7IFISHOUIDBFCOME INSPEGTIONFEE SU&IECTTOTHEWORKERS'COMPENSATIONPROVISIONSOFSECTION3]oaOFTHELABOR I�� '� OCADE.I SMALL FORTHWITHCOMPLY WITH SE PROVISIONS. ISSUANCE ��r �,/ �� p DATE:�/�'U Y APPLICAN7: �'�'��Ip C� LL?� SMIP ' \ w � . ENERGY P/C � J WARNIN�:FAILURETO SECURE VJORKERS'COMPENSATION COVERAGE 1511NUWFl1L,AND SMALL BE ,.�F LL SUBJECTANEMPLOVERTOCRIMINRLPENALTIESANOCIVILFINESUPTOONEHUNDREDTNOUSAND ENERGYPERMIT t� � DOLURS(Sloo,000).IN AD�I'f10N TO THE COST OF CAMPENSATION,�AMAGES AS PROVIDEO FOR IN J SECTpN37080FTHElABOFCODE.INTEREST.ANOATTORNEI^SFEES. RETENTIONFEE: Q d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O � 1 HEREBV AFFIRM UNOER PENALTV OF PERJURV THA1 THERE IS ACONSTRUCTION LENDING AGENCY n- FOR THE PERFORMANCE OF THE WORN FOR WHICH THIS VERMIT IS ISSUEO(SEC.3oW,CIV.G). ' Z _ �. '�' ►.ac�f„ P F-IP��e l�rc.vl � � IENDEH'S NAME V h_' LENOEfi'SAOOflE55 ; L (�1 Y � ICERTIFVTHATIHAVEREADTHISAPPUCATIONANDSTATETHATTHEABOVEMFORMATIONISCORRECT. TOTAL FEES • _l�� I � 1 AGflEE TO COMPLV WITH ALL CITV AND COUNTV ORDINMICES ANO STATE LAWS REIATING TO BUILOING __r ._. �j(� J � CONS7RUCTION,AND HEREBY AUTHORRE REPFESEN7ATNE5 OF THI$COUNTV TO ENTEfi UPON THE , �"f'.F) L., Lr I�!(_i� Z ABOVE�MENTKKJED PROPERTY FOR INSPECTION PURPOSES. COMMENTS � J � , . aPERMITTEE NMAE(PRINT) - � � SIGNATUHE OF PERMITTEE DATE = RECPT.NO. PAID BY VALIDATION ~ WHITE—DepeAment Copy.YELLOW—Finence Copy.PINK—Assessor CODY,GOLDENROD—File Copy,GREEN—Applicant's Copy �t�`�`�° �p�` ��°�� ° `��"� �=��C�� F � a� � . �. � _ � _ �� ,� , , ,� � � �`� � � �-,� � � , , � � � . � � t m • � �,, �'.az�:� �� .� � �f � � �_ � . _. .� R:�_�� e .__j. ,..,__ _. _. _ _ . __ _ _ �� , � n � � �_ . a, �.� a . _ _ �__ � _ __ � _ __ _ _ r. �� ' � .. : �� . _ � . , '.. �. �� _ _ �...# _ _ »�.}�d :..J�� . : ` .; �"� ... ,, . .. . . ... . . .» a . .. ._. . . .. . .. .... .._ ... j _ #1�,�' � � - � �_ � r � .�:.�- � . : �� , �� ✓,� . � . , � s.�� _ �� _ _ _ _ . _ _ _ . '� '-°��; � �F�;,�r� �,, �� .�._ .. _.. _______ _ _ _. _ �/�I� 1L�1 )�� F ` t'1t�1L7 E3�Az,' �.,� - _ �,sA BC�t�� R�ar�� - , � �, _ _ _ �. , . �-�� — - _ _. � � _.. .� _ __ _ _ _ �' s , � � , . . . . __ _ . _. . _ _ t �' :Oi " � � � � � ` _ Z . �" 1" - f�`� ' , , • , �: "� G:�+ , � , � � � � �� _ _ � � _ _ . _ _ __ _ � � �f � __ �.. _ _ �� . , . / �r - � _ �_/�_ _ _ _ �= , - ;_. n � . - _ _ _ _ �� `�-/ u' _. ___ �� _ ��mal _ _� � ._ _ __ _ � l(lfj��l ' . � ��z �� J. _. . ✓ .; . . .. eW..Mf . . .. _ . w �'��x r.��.»:.��'�,s�^^"�r��e;� �� »�,��'j�'��s��. � � . . . ... ..._. _... ._. . ., .... _..._... _.. ... . ...... ._.. .. ._._ _._.. ...._ ._..._ ... ._. ..... � . . . . . . . . . .. _ .... ..... _.. . . ..... ..... ........ ..... .. .... ... . ._. ... _ . .. ��. . .. .. ._. . . ....... _..... __.. ...... ..... ... ... ..,.... ... .. ..... .. ... ...... . .. .. _. . ._.. ..... .. ... ....�. . ... .... .. ... ..... . . .... __ .... .. _ . . . . . .._.. ._.. _.._. __.. ... ... . ..._... ....._ .._.. ....... ..._._ _..... .._. . ._. . . . ..��. . . .. ._... .__ _....... . . ..._. _.... ....... _... .._ . . . ...... .... .. .... . . .. ... . . ....� .. ... .. . . .. .. ... . .. . .. ._.. ..__ . .._ . .. . .._ ....... ._. .._ .......... . .. .... ... ... ... ..._.. .. . . . ... .. .. ..._. ._... ._... �s �t,s . . . .. � �q ��: r +� _ _ _ _ � ,�� '� � �� '�� ,?� � &� _ _ �" — �3k �� r, �5� +p�yi� � . . ... . o^.��Ry . ..._ ..,� :.. ... __ .._ _. , .._ .... .. . . ;4 1 �� M., �. �� . � �%�`��' � ' ; � �iR��r ,��t� _ _ , �� K�� '`� � � �� ; � — _ _ _ �� ,� � �� M k � � �a � �� a��,�€��r� � e _ _ _ _ _ � � � �� __. _.. .._ . tr. i � . .. ,. � � ��";3'� r�N'�i�d�.�.�" p��"�� .�-� � CITY OF DIAMOND BAR � `• DEPARTMENT OF COMMUNITY dt DEVELOPMENT SERVICES �w 21660 E.Copley Drive Suiu 190 `,� (909)860-3195 Fax(909)861-3t 17 PRESS ��~� BUII.DING PERMIT APPLICATION s� C� �� z,L� FIRMLY o A DRIESS Z3�135 L14tv'��1� �/�S'T1� DATEICATION � _�I�`� � NUMBER I I�J�O�/C � APN LOT 'fit.� TRACT SZZ-�'� ISSUE TYPE OCC DATE CONST. GROUP p OWNER �,.�� me�S fP LL ADDRESS�.�I�/f�%u;�n Ar/Y7ti.�3 ZONING SEfBACKS � CITY Iru�n� ZIP 9'7�+/ TEL�3'y�/"7�/�'YY ' t7 FRONT RW ❑ APPLICANT ��-MF�' TEL. �;:ti/'!'t�' SI�SIQESTREET RW ❑ � CONTRACTOR _ SIDE ❑ a[ ADDRESS `l� ` �tf Qi � o CITY � Ly� ZIP t Z-�� TEL�I�I�1 -7�I)-'�l4 � PROPOSED USE � Sc tiJ�� C_�7k'f�YL�"'C_ w ARCH/ENG/4 z DESIGNER Lt - 1'��.S S � � "s � ADDRESS�i35 ! �7�''IIS` irl �a..� NO.DWEL. NO. NO. � CITY'SLtirtt� fi1'1� ZIP�Q,�'TEL.�Y •- "3 •- • 7 UNITS STORIES BEDROOMS � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECLARATION SFR/ADD/REM 0 1 HEREBV AFFIPoA UNDER PENAL7V OF PERJUfiY iHAT 1 AM EXEMPT FROM THE CONTRACTORS L6 G8f290/CBIpOR W CENSE UW FOR11/E FOILOWING REASON(SEG 7031.5 BUSMESSANO PHOFESSIONS CODE:ANV CI7V OH (n C� COUNTYNMICHREIXIIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,�MOLISH,ORREPAIFlANVSTRUC- W Pa110/DBCK L NflE,PRIOR TO RS ISSUANCE,ALSO RE�UIRES THE APPLICANT FOR SUCH PEHMIT TO FILE A SIONED W STATEMENT T7AT HE OR SHE IS LICENSED PURSU�NT TO THE PROYISIONS OF THE CONTRACTORS LI� W � CENSE UW(CFUPTER Y(GOMMENdNG MATH SEGTION]000)OF DIVISION 3 OF TNE BUSINE55 PND PRO- � POOUSP3 FESSIONS CODE)OR TNAT HE OR SHE IS EXEMPT THEREFROM IW D THE BA515 FOFl THE ALLEOE�E%EMP� TION.ANYYIOLATIONOFSECTION7031.587ANYAPPLICANTFORAPERMITSU&IEC7STHEAPPLICAN7T0 Z RB-R00} � ACML PENALTY OF NOT MORE THMI FIVE Hl1NDRED DOLURS(=500).): � ❑I,ASOWNEROFTHEPROPERTY,ORMVEMGLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, � COrtIf118fLIBl WILL DO THE WORI(,�HD THE STRUCTURE IS NOT IMENDE�OR OFGEREO FOR SALE(SEC.70U,BUSI� J � NESS AND PROFESSIONS CODE:THE CONTMCTORS LICENSE UW DOES NOT APPLV TO AN OWNEP OF � PROPERTV NR10 BUILDS OR IMPROVES THEREON.AND WHO DOES SUCH WORK HIM&ELF OR HER6ELF OR � THROU�4 HIS OR HER OWN EMPLOYEES,PROVIDED THAT SUdI IMPROVEMENTS ARE NOT INTENDED OH m OOFFEREOFORSALEIF,NOWEYER711EBUILDINOORIMPROVEMENTISSOLDWITMNONEYEAROFCOMPLE� Z TION,THE OWNER$UIIDER YALL MI�VE 7HE BURDEN OF PROYINO THAT HE OR SME DID NOT BUIID OR = IMPROVE FOR TNE PURPOSE OF SALE). W �I,AS OWNER OFTHE PROPEHTV,AM E%CLUSIVELYCONTRACTINO WITH LICENSED CONTFACTORS Q TO CONSTRUCT THE PRQIECT(SEG 7011,BUSINE55 AND PROFESSIONS CODE:THE CONTRACTORS LI- VBIUetiOn ADJ.AREA � CENSEIAWDOESNOTAPPLVTOANOYRJEROFAPROPEHT'NMOBUILDSORIMPROVESTHEHEON.AND WFI�CONiRACTSFORSUCHPROJEC7SWITHACONTRACTOR(S�LICENSEDPUFSUANTTOTHECONTRAG QUANTITY DESCRIPTION FEE � TORSUCENSELAW.). J ❑I AM EXEMPT UNOEfl SEC. B.d P.C.FOR THIS REASON Q 3 � � � DATE OWNER � Q W � LICENSED CONTRACTORS DECLARATION W � I HEflEBY AFFIRM WDER PENALTY OF PERJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � d Y(COMMENCINO WITH SEC710N]000)OF DNISION]OF THE BUSINESS AND PROFESS'ONS CODE,AND Z X MY LICENSE IS M FUIL FOPCE AND EFFECT. m L11 � LICENSE CIASS_�,/�` __ LIC.NO. �� j V DATE__��1_y._C7 � CONTRACTOR � � � . d W � WORKERS'COMPENSATION DECLAflAT10N –i ¢ N1 NEREBY AFFIRM UNDER PENALTY OF VERIURV ONE OF THE FOLLOWING DECL�RATIONS: Z � 1 HAVE M7D WILL MAINTIUN A CER7IFICATE OF CONSENT TO SELF-INSURE FOR WORKEFS' _ � COIJPENSATION.AS GROVIDEp 8V SECTION 3]OOOF THE LABOR CODE,FOR h1E PFRFORMANCE 'U OF THE WOF7K FOR WHICH THIS PERMIT IS ISSUED. � � � _IHAVENiDWiLLMAINTNNWORKFRS'COMPENSATIONINSUMNCE,ASREOUIRE09YSECTKKJ O 37000f THE LA90R CODE,FOR THE VERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUE�.MY W (ERS'CO PENSATION INSl1RANCE CARRIER AND POLICV NUMBEfR ARE CONSTRUCTION � CARRIEH v � L 'jZ1 /�� t' IS l�O PLAN REVIEW � POLICV NUMBER_��G��L y y�t � ELECTRIC C, � (Iw55Ec;fk7NNE[DMo7eEaa.YI.EiEooFniEaEF7�lrsraRavEtAx�OREDDa1�ws�Sim)OaLEss} PLUMBING � '��: W Z 1 f.ERTIFV THAT IN THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSIIE�,I MECHANIGAL �J SHALL NOT EMPLOV ANY PERSON IN ANV MANNER SO AS TO BECAME SUBJECT TO THE � WORKERS'CUMPENSATION UWS OF CAIIFORNIA,ANDAGREE THAT IF I SHOULD BECOME �NSPECTION FEE = SU&1ECT TO THC WORKERS'COMPENSATION PFOYISIONS OF SECTION 3]00 OF THE UBOR �` CODE,I SMALL FOflTMWiTHGOMPLY WITM MOSE PROVISIONS. ISSUANCE ��•� v 0 { • . p DATE: ��L��U 1 APPLICANT: _. .LC_1_.�L�_ �Id�� SMIP �.. . � ENERGY P/C -� �� WARNINO:FAILURE TO SECVRE WOfiKERS'COMPENSATION CAVERAGE IS UNUWFVL,AND SHALL BE � SUBJECTPNEMPLOYERTOCRIMINALPENALTIESANOCIVILFMESUPTOONEHUNDRED7HOUSAN� ENERGVPERMIT DOLURS(i100,000),IN ADDITION TO TME COSTOF CAMPENSATION,DAMAGES AS PFOVIDED FOR IN J SECTqN 3708 OF THE LA90H GOOF..INTEREST,ANO ATfOflNEY'S FEES. RETENTION FEE: � d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O � I NEREBI'AFFIRM UNDER PENALTY OF PERJURV THAT THERE IS A CONSTRUCTION LENDING AGENCV fORTHE PERWRMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSVEO(SEC,3oe1,CN.C.). � LENDER'S NAME ��e I'�l�Cy'� PV�-� �I4'L£"`�..L�T�_ 1--' IENDERSAD�RE55 j ` T � ICERTIfY7HATIHRVEFEADTNISAPPLICATIONANDSTATETNATTNEABOVEINFORA/AT10NI5CARRECT TOTAL FEES F ER 7 ,p �I�i�9 fJIA •'J `-" � I AGREE TO COMPIV NATH ALL dTY AND COUNTY ORDINANCESAND STATE UWS REUTING TO BWLDINC '� �: v t� � � � CANSTHUCTIIXJ,AND HEfiEBV AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO EMER UPON THE Z ABOVE�MENTqNED PROVERTV FOR INSPECTION PURPOSES. COMMENTS 0 J � m PEflMITTEE NAME(PRINI) ¢ � N SIGNATURE OF PERMITTEE DATE (`�� = RECPT.NO. PAID BY X�.�� VALIDATION ~ WHITE—Depanment Copy,YELLOW—Finence Copy,PINK—Assessor Copy.GOLDENROD—File Copy,GREEN—Applicant's Copy �r. �v �.✓ s. 4 - �. ��;,{ P�-x'„1 `i: i��'��; .t� �a �*',��,��'r�� ' � 'j ', ,=a„�,�. �a4:,�^,�x�-y4•�'�� i)y � .�4 � `.P��: �",�;.x 1 � ��+2...> � - ;„��,g"S � tHE :,.��t& p '� �i � szL�� t r?�„` � � �"'ro�'� � � i �;- � � � � �. ,� 3 � _ � ._..;.�,we.�,.�...�,�^3u..�c�,1t;:�: , . , . . . . . . .. .. ��.., '. i'< (. . . � �.. �. .... ..... . . .. ...... ._... ..... . _. . . _ .._.. _. ._. . ... . .. __.... ....... . .... . ..._. .._.. . ... � . � . _. ' ... lQ'z�.Z D� /� �r �-� . � _ �. �.�� : . � � � �,�� . , ; � � . ,� ,,.��a.,�,.�� t,_,�._. _ , _ _ __ _ _ _ _ _ _ _ _ . _ _ ,.r� � ,I ; � a ,.� � � � � �`� , . _ _ _ �, : - , , : M �� _ �" ��xa�� s �� ; _ � �.. e _ � -� . .. . ...�.. _._ . . ... .. _.. . . �. �, , z , � ffi'�% ,�.,�'. .. . .. . ..... . .. .:�7 J. . . . _. � - a8 �� .��. �- E�� , .. ..; ;.. _ .. ... . ....... ... .... . ..... .. .. ... . . .. . . . ... . .. . .. . ... . .' ''., ��fi�*� �' .. .. �� . � i f, m �.>. ary _ s _ 'a�s 7 CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION C. PRESS FIRMLY JOBSITE ADDRESS L� �+3 S c i j o�yt�"+Ia APN LOT.910-co TRACT OWNER' ADDRESS CITY jrllt/llf'ZIP-r1Z&j1TELC1-ig'797'(10 APPLICANT �Xi Y I t TEL. i�:a ls 1� CONTRACTOR ALAW t L' ADDRESS; "a CITY I f1J t I1 e ZIP)'ZL'z TEL.q"711-qjv ARCH/ENG/ DESIGNER JI ilfk-_'» 'r OIi, ADDRESS L.t_",SI-4-Itlf>4i CITY S.'LaTI'1 Ail.-,ZIPdjZ 70.T_TEL.'7'1')-_551-- 'i 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 REQUIRESAPERMITTO CONSTRUCT.ALTER,IMPROVE,DEMOLISH,OR REPAIRANY 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. TON.ANY VIOLATION OF SECTION 7031.5 BYANYAPPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($500).): ^ 1,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- TK1N,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). ^ 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 NOT APPLY 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.). 0 I AM EXEMPT UNDER SEC. B.&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 FORCE D EFFECT. S17q - LIC. N0. LICENSE CLASS // DATE I "C/ �7"co CONTRACTOR FU. Me 5;- 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 W/O�RKERS'COMPENSATIONNJNSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER f LtL-r(1 L- .M I OL/e('IIIS. £c, POLICY NUMBER t.yOC(_9_�'_�� (THISSECTION NEED NOT BE CCMPLETED OF THE PERMIT S FOR ONE HUNDRED IXLLARS(3100)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 PROVISIONS. CODE.I SHALL FORTHWITH COMPLY WITH SE Y DATE: I_- 1)I„APPLICANT�_T�YI C_L i-� 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 ATTORNEYS 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.). /V. ne�L9 LENDER'S NAME IJ LT Iv eV Ne r LENDER'S ADDRESS I 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 AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE CONSTRUCTION ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. PERMITTEE NAME(PRINT) 3 SIGNATURE OF PERMITTEE DATE Z I APPLICATION NPERMIT UMB #/C Ir, DATE ISSUE TYPE OCC DATE CONST GROUP ZONING SETBACKS FRONT RW ^ REAR 0 SIDE/SIDE STREET RW ^ SIDE ^ PROPOSED USE r� S BIZ N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.ARE ALUATION SFR/ADD/REM U) Garage/Carport W Patio/Deck PooVSpa Z Re-Roof 0 Commerci I Z) c I LA (4 Valuation ADJ.AREA QUANTITY DESCRIPTION FEE -J Q o llo 110 U LU W Z m 14 U ,] a U n =r P z C4 U1.) I � PI � . ) CONSTRUCTION L � ( . 7 PLAN REVIEW ELECTRIC _ L PLUMBING MECHANICAL �•% } INSPECTION FEE ISSUANCE OI� SMIP ENERGY P/C , ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES I � rF,ci20111 COMMENTS PAID BY RECPT N0. '5 7 VALIDATION -A�11 WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION ssc.c.slk,-i3(F PRESS FIRMLY JOBSITE ADDRESS Z3 6?-5-CAA.i 1J V,S"TI APN LOT&Vl TRACT-<_Z-2_lz,-7 OWNER 00- ADDRES A CITY JrUlrif'ZIP 974+1 TEL�3�/!/-'7�7UY APPLICANT-e+-!YI P TEL. 4. .P'-e CONTRACTOR ADDRESS K-eLf Ilt CITY I rvi n P ZIP t L�I TELTl�/"'19)°'�I4 ARCH/ENG/ DESIGNER Att"V,-I S"S"s ADDRESS IC ii 5 rn CITY'SLtrb'tz i41'L ZIP'S-TEL.'Y- 3I•' 7 OWNER-BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE:ANY CITY OR COUNTY WHICH REQUIRESA PERMIT TO CONSTRUCT,ALTER,IMPROVE,DEMOLISH,OR REPAIRANY STRUC- TURE. PRIOR TO ITS ISSUANCE.ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS UCENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW(CHAPTER Y(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).): D I,AS OWNER OF THE PROPERTY,OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL 00 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 THROUG4 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 OFCOMPLE- TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). D 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 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.). ^ I AM EXEMPT UNDER SEC. B. &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 Y(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORCE AND EFFECT. ��- LICENSE CLASS LIC. N0. "] •s:l_ DATE_/I CONTRACTOR'h 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 W KERS'CO PENSATION INSURANCE CARRIER AND POLICY NUMBER A RE: e CARRIER L'.c-a L)0�P.e 1.5 CE� POLICY NUMBER}�GI �Ci y Q 1 7 (HIS SECTIDIJ NEED NOT BE COMPLETED OF THE PERMIT 6 FOR ONE HIR E)RED 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 THOSE POVISIONS. DATE: I LT�f� LT7 I APPLICANT: � RC Jljrl l 1 CJq7 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.). 11 LENDER'S NAME t J 1 f5 C' 1 I,i-e LENDER'S ADDRESS I 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. PERMITTEE NAME(PRINT) SIGNATURE OF PERMITTEE DATE APPLICATION C ! PERMIT P/C DATE NUMBER S ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ^ REAR ^ SIDE/SIDE STREET RW ^ SIDE ^ '6t L PROPOSED USE A -A!C& AZ IM AVE& N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREANALUATION SFR/ADD/REM U) Garage/Carport W Patio/Deck LL Pool/Spa 0 Re-Roof Z Commercial Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U Q I- UJ W J W zZ in 0 a- Q U Z Q 2 W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING I MECHANICAL INSPECTION FEE ISSUANCE JL -� J SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES FEB 2 0 2001 COMMENTS RECPT N0. PAID BY Y U VALIDATION 0 0 WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy GOLDENROD-File Copy,GREEN-Applicant's Copy