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Home My WebLink About17574 (10) r_. - -,'�=?'"� CTI'Y OF DIAMOND BAR �' �--'"' DEPARTMENT QF COMM[UMTY&DEVELOFMENT SERVICES �:'" �J/ _��",� 21825 E.Copley Drive tgo9>a�o-si�s F�tvo��a6i-a�i� PRESS �� BUILDING P�T APPLICATION FIRMLY o� JOBSITE ^4��i � APPLiCAT�O PERMIT `�^�, !C ADpRESS J.�,.� ��_ DATE_ � NUMBER � +� • � r° APN� LOT TRACT ISSUE TYPE OGC p OWNER � QAT� CONST. GROUP _ a ADD SS � 20NING SETBACKS FRONT z CITY I"`ZI TEL._ RW (� � APPLtCANT 4_(,a�_ TEL.�,�._�,�� REAR n SIDEtSlDE STREET RW C7 � CONTRAC C7R - � � �„y SIpE � ADDRES� � '� CITY�� 11�' ZIP TEL.ry - ppOPOSED USE � oARCHJENG! z DESIGNER � ADDRESS NO.DWEL NQ. NO. � �i�` _ Z!P TE�. UNITS STORlES ^BEDROOMS "—� DESGRlFTION 5Q.FT. FACTOR PSF ADJ.AREANALUATIpN � OWNER-BUILDER DECLARATION �� Q SFRlADOlREM p t HEREBY AFFIRM UNpER pENAL7Y OF PERJURY 7NAT 1 AM E%EMFT FRqM THE CONTRACTOFS LI� Garg9B/Gdfp012 W CENSEUWFORTHEFOI.LOWINGREASON(5EC.�091.5BU81NESSANDPROFESSION5CODE:ANVCITVOR (n � COUNTYWHICHAE9UIftESAPEflMITTOCONSTRUCT,pl7'eR.iMAftOYE,OEt�LiSH,ORflEPAIRANYSTRUC- {�a�lOIDBCk W Ti1RE,PRIOR Ta ITS ISSUANCE,AlSO RE�UIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNEG W ,� STATEMENT THAT HE OR SHE 19 LICENSED PURSUANi TO THE PROVISIONS�F THE CONTAACTOAS!I� .. � CENSE lAW(GHAPTER 9{f.QNMENGiNG WlTH SECTION 70Wj OF D'VISKiN 3 QF THE 91t5INESS 0.ND PRO• � POOUS(70 FESSIONS CODE)QFTHATFiE OR SHE IS EXEMPT THEREFROM AN�THE BASIS FOR THEALLEGED EXEMP� (� � TION,ANYVIOLATIONOF5ECTION7031,50YANY4ppL1CANTPoRAGERMITSU6IECTSTHEA?PUCAkTTU Z RB-R66S F ACFYILPENh1,.TfOFPIQTMORETHANFtVEHUN6REDDOtiARS{{600j.); , � ❑I,ASUWNEROFTHEPROPERTY,OqMVEA1PLOVEESWITHWAGE9A5THEIR50lECpMPEN$ATION, � COt71tt19tCldl WILL Qp THE WORK.ANp THE STRUCTURE iS NOT IMTENDED oft OFFERED Ft,}ft SAtE{SEC.'�<4,BUSt. J � NESS AN6 PpOFESSiONS((�6E:THE CONiqACTORS LIGfiNSE LAw OOES NOT APPL.V TO AN OWNER OF j PFOPERTY NMO BUILDS OR IIAPROVES THER'cON,AND WHO DOES SUCH WORK HIMSELF OR NERSELF Ofl LL THROUGH HIS OR NER OWN EMPIQYeES,PROYlD£0 THAT SUCH UAPROVFMEN7SARE N6T 3NTENDEDOR m ,�W„ OFFEqEOFORSALE.IF,HOWEVER,THEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE� y� 710N,THE OWNER•OUIL�ER WILI.HAVE IHE BURDEN OF PROVING TI�fAT HE OR SHE OID NOT BUILD OA � IMAFI4VEFORTHEPVRAOSEOFSALE}. ❑I,AS ONTJER OF THE PROPERTV,AM EXCLUSNELv CONTRACTING W1TN UCEN5E�CONTRACTORS � TO CpNSTHUCT THE PRQIECT{SEC.7�d4.BUSWESS AND PROFESSIONS CORE:TNE G4NTRAtTORSIi- VBIUdlIO(i ADJ.AREA Z GENSElAW00E5tN}TAPPLYTOANOWNEPb�APFOPEfliYWH08UiLD50fliMPRGVESTHEREQY,AND — � WHOCONTRAC7SGpR5UCHPR4,lECTSWITHACOM1'TRACTOR�S�UGENSEDPUHSUANTTOTHECONTRAG QUANTITY DESCRIPTION FEE x tORSLICENSEUWJ, � fJ I AM EXEAIPT UNDER SEC, -'� Q ._B.8 P C.FOR THIS RFASON """} U � �ATE ,,,,,, �OWNER i � '-�j_"-� LICENSED CONTRACT�RS DECLARATION � � � �C C� I HEREBY AFFIRM UNDER pENALTY OF pERJURV THAT I AM LICENSED UNDER PRONSIONS 4F CHAPTER � ['L 9{CpMMENGNGWITHSECT10N70W)pfDiVtS10NJOFTHcBUSME55ANDPftOfESStONSCOOF,AND Z �X MV UCENSE IS M G l FORCE ANb EFfECT. m a ��cEr�s ctass _ �ic.No.5�3� � � DATE - I "-� � CON7RACTQR_ 1 a, � `— � WORKERS'GQMPEN$ATION DECLARATION ¢ �- � 1HEREBYAFFIpMUNpERPENALTYOFPERJVRVONEOFTH�FOLIOWINGDECLARATIONS: V � Z 0 _IMAYEANOWILLMAINTAINACERTIFICATEOFfONSENTTtrSELF�INSUREFORWORKERS' ¢ Q CCNIPENSATION.AS PROVlQEQ BY SEC710N 3'loaoF ThE 4Ae:JR CODE.FOR TttE PERF6RMANCE U OFTHE WORK�OR WMCH THI&PEqMiT iS ISSUED. � � �W IHAYEANDWILLMAWTAINW4RKER5'C6MPF.t�tSATtONINSURANCE.ASREOUiREDBYSECTiON / 3]ao OF THE LABOR CODE,FOR THE PF,RFORNANCE OF TNE WOftK FOR WHtGH THI5 PEAMIT IS L � ISSUED.MY WORK ', MPEN TION WSUPANCE CARfttER ANO POtK;Y NUMBERARE CORISTRUCTION r � } CnRaiFP �Q}��hE7('�1��_. PLAN REVIEW � — � POtiCYNUMBER L - ELECTRIG �� 6 —— � {'MISSEc77cNNEH7rva7aE�biN.EiED4Fi}iEPERt�tlttSFc)Fia�tiUwaEo�tulstsiao7oRLEss). PLUMB�NG W —" Z I CEftTIF1'TNAT 4N THE pERF�AMANCE OF TNE WORK FOR WHIGH THtS PERMl7IS ISSUED,1 MECHAMCAL C`3 SHAtI N07 EMP�OY ANV PEFSON M ANV MANNER SOAS'O BECqME SUBJECT TO THE "' (,/) WOFNERS'C4MPENSATION LAWS oF CALIFOFNIq,AND AGREE THAT IF I SHOl1L0 BECOME INSP TION FEE � SUB.IEC.T TO THE WORKEftS'COM?ENSATIt}Y RROYISIOti50F SECTIDN 97UOOF THE IABOfl - . . �-�� "� � CADE,I SHALL FORTNWITN GOMPLY WIiH TMfJSE PROVISIONS. SSUANCE a — p DATE; APPCICANT: _„ _ ��'� ^_ � WAftNING:FAILUflE TQ SECURE WORKERS'COMPENSATION COVERAGE iS UNGWFU�,ANO SFfAtt 8E Y FI{`' � SiJ&IECf AN EMPLOVER TO CqIMiNAI PENALTIES ANp CIVIL FINES UP T04NE NUNDREp THOl1SAND �NERGY PERMIT fJOLLARS(f�00,000),IN ADDITION TO THE COS�'OF COMPENSATION,DAMAGES AS PRDYIDELI F�R IN W SECT16N8T9B4FTHElABOftCOQE.lN7EREST,APMIA7TOPNEY'SFEES. RETENTIONFEE: Q CQNSTFUCTION LENQING AGENCY i'�RE-ALT FEE: ,,,,,_ � � 1 N�RE9V AFFIqM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTI6N LENOING ACENCY �Z^ iOR 7HF PERfpRMANC£6f THE WORt fOR WMCM THIS FERMF7151SSUEO(SEC.3047,CtV.C.}. ' � �— � W � LENDEft'S NAME „ ,,. — — H LENDCR'SA�DFlESS _. ___ ....._._ _ a � w ICEflTIFYTHATIHAVEREADTNISAPPUCATIONANOSTFTETHATTHEA90VEINFQRMATION'SCORRFCT TOTAL FEES � l� rrr�� " p_, i AGflEE TO GCkApLy VtTM All CITY AND COUNTY OR�]INAhC[SANtJ STATE tAWa RELATING TO RUItDING ��/g�� CONSTRUCTIpN,AND HEREOV AUTHOqIZE REPRESENTATIVES OF TFIIS COUNTV TJ ENTER UPON THE V � � A60VE�MENTIONED PROPERTY F6R INSPECTION PIJRPOSES. {1� Z COMMENTS t p _ � � .. .._ .__ — ._ _ ..._ QP R TTEENAME( [!3 � �' � � EOFPERMITTEE DATE �� "—' -� �� RECPT.Nd. PAID BY �VALIDATiON WHITE—Department Copy,VELLOW—FinanCe Copy,PINK—Assessor Copg GOLOENROD—File Copy,GREEN—A�IicanYs Gapy u �''` �� .�" f . , � � �`fl��y� 'k�_"xb, , � . �fr , . .. . - . , ... � �, . . _ �, ;.. , _ , . '.� . , ,,. . . . �.:. �.... . ' . d,. �, r 3 .x „ . � s , . . . � r ..�. ^' c -� . _ ... sv`��(r '��'� � .. . . . �. � �. . . .. . �/ �,' . . . :. .. . . . ... . . .. ...... .. ... _. .. E . . .. . ... . i�� _ , _ : ; ,5 k� _ - . . . . . n.. ��.b �fi .. ... . .. .. .. . . .. .. . .. . ... . ... .. �� - r .. . .. . . _ .. . . ._. . ... . ....._ ...... ..... ��, �� . . . .. . . . . . ` �} � 4 � � - ... _.... - ', � i ri«.��. ��.,4 ': ��', '�.. . .. ... ... . . . . . ._ . . ._. . _.... "I 4� t. ��'�. ,� �� a Sr . . . . ... _. ��. . , . _ .. .. — . � � % n , :."� ...... . .. . ... ' ��' � r-� �S � A pd 7, '. .... . . . _ .. .. .... . .... .. . . > _ _ _ k k p � �. . . . . .. . . �� 4 : ' S N E�, �. _. ... . .. ..... . . ... . . . .. . � �-��'x j �'s:-ti��^�� ' . .. . . .. . . .. . . . .. .. . .. . ... � � ,, r,. ., �- • �-. a ^': .. . . . . . _... .. ... . ..... ��. ;�i ;' , ' " �:-� , .. . . _ . . . . .. . ..... . .. .. — —� , , , � ; ..... - � ,. ,'' � . � ,y� N , , r .... _.. . ... .... . � ^ �,. � � � , ,. �. �, .. . - _.._.. '4 " R " 'rr` r , " " ... . . ._ . . .. .. .. . � ._; CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION JOBSITE ADDRESS 13 n APN LOT TRACT OWNER ADDR SS 23 14-5 0.(1 cL 'N I r.CITY r-A TEL. APPLICANT TEL. CONTRAC OR LZIOCASM-ni ) ADDRES� CITY UJOAnt-L ZIP TEL Z)-J 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 REQUIRESA PERMITTO 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 HIMSELFOR 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 TI ]AT 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 NOTAPPLY TOAN 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.). ^ 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 F L FORCE AND EFFECT. LICENS CLASS LIC. N0. /I f 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 WORK C TION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER�+0/f•\0 POLICY NUMBER lf� 71 (THIS SECTION NEED NOT BE COMPLETED OF THE PERMIT IS FOR ONE HUNDRED COLLARS($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 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 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 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 INSPECTION PURPOSES. iane EE NAME( JT- RE OF PERMITTEE DATE APPLICATIO PERMIT'/C DATE NUMBER ISSUE TYPE OCC DATE CONST.GROUP ZONING SETBACKS FRONT RW^ REAR^ SIDE/SIDE STREET RW^ SIDE^ PROPOSED USE r- N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREANALUATION SFR/ADD/REM ri) Garage/Carport W Patio/Deck LL Pool/Spa 0 Re-Roof Z Commercial Ib Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U cc f- U w W GO CL Q Z S U w CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSP TION FEE SSUANCE 9 +c3 I I Y 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