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Home My WebLink About16109 � - J� CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY 8t DEVEL SERVICES 21660 E_Copley Drive Suite 190 �� - � „ � -� (909)860-3195 Fax(909)861-3117 •� PRESS � - •9�'�� BUILDING PERMTI'APPLICATION �.t,�}sg G.� �..n �r'� FIRMLY QJOBSITE !— C? � DATE CATION °l,C'—`,� i PERMIT ( j t P/C < ADDRESS�'IE/IPII� .�u'1��L�'�� NUMBER 1 � ISSUE TYPE ', OCC � APN LOT -- [�TRACT .��.�+7 DATE CONST. GROUP � OWNER �'° s' �` ADDRESS_L ZONING SETBACKS w � FRONT RW ❑_ � CITY ��'►. r,�'��_ ZIP TEL.'ry7��/-7�f�-`I`) REAR ❑ APPUCANT �+k rYl�„ TEL. Stti'�"L t' � SIDE/SIDE STREET RW ❑ CONTRACTOR �� 1 SIDE ❑ ¢ ADDRESS Dl_ r' c PROPOSED USE 5 EW��Y� �T�12{�i... � CITY �r^✓I!'!ir'. ZiP �L ic+i7 TEL.` '�..r - � v � ARCWENG/ /� � / DESIGNER I VIJ� � l.'�r'� � 4+ �, ADDRE 5 i S"'� "t'S:�;'11 f9 p NO.DWEL. NO. NO. y CITY ++ �i K ZI U`�TEL.�9'�S -�J'7 �NITS STORIES BEDROOMS y DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECLARATION SFR/ADD/REM O � �HEREBV AFFIRM UNbER PENALTY OF PERIURY THAT I AM EXEMVT FflOM THE CONTRACTOflS LI- GflfdQBlCBfpOfl CENSEUWFOf1T}IEFOLLCNYINGREASON�SEC.70.1t.5BU51NE55ANDPROFE5510N5CO0E:ANYCIT/OR (n GOUNTYWHICMHEWIHESAPEfiMf�TOCONSTqUCT,ALTERIMPROVE,�EMOIISH,ORREPAIRANYSTRUC- W patio/Deck NHE,PPIOH TO ITS ISSUANCE,ILLSO REOUIRES THE APPIICANT FOR SUCH PERMIT TO FILE A SIGNE� W BTATEMENT THAT HE OR SIHE IS LICENSED PURSUANT 70 THE PROVISIONS OF THE COMTRACTORS LI� CENSE LAW(CHAPTER Y(Q�MMENCINO WI7H SECTKKJ 7000)OF DIVISION 3 0F THE BUSINESS AND PR0- � POOUSDO FESSqNSCODE)ORTHATHEORSHEISE%EMPT7HEREFROMANDTHEBASISFORTHEALLEGEDEXEMP- (� TION.ANVVqL�TIONOFSECTION70�1.6BYMIYAPPUCANTFORAPERAlITSU&IECTSTHEAPPLICANTTO Z Re-Roof I � ACML PENAL7V OF NOT ANJRE THAN FIVE HUNDRED DOLURS(Koo).�: � ❑I,ASONTIEROFTHEPROPERIY,ORMYEMiLOYEESMATHWAGESASTHEIRSOLECOMPENSATION, � COR1ffI0fCl81 VALL DO iHE WORIC,AND 7HE STRUGNRE IS NOT INTENDED OR OFFEFED fOR SALE(SEC.70an,BU51- J NE55 Ml�PROFESSIONS CDDE:THE CONTRRCTORS LICENSE UW�OES NO�FPPLV TO AN OWNEfl OF y GiqPERTYVhIOBUXD50RIMPROVESTHEREON.ANDNMODOE55UCHWORKHIMSELFORHEHSELFOR � (t TMROUGHHISORMERONMEMPLOVEES,PROVIDEDTHA75UCHIMVROVEMENTSApENO71NTENDFAOfl m � OFFERmFORS/�LEIF.FIOWEYER7MEBUILDINGORIMPROVEMEMISSOLDWITHINONEYEAROFCOMPLE- Z TION,THE OWNEHEUILDEIi WILL HAVE THE BURDEN OF PROYINO THAT HE OR SHE DID NOT BUILD OR = IMiROVEFOHTHEPURPOSEOFSALE). ❑I.AS OVMER OF THE PROPEHTY,MI E%CLUSIVELV CONTRACTINO WRH UCENSED CONTMCTORS � TO CONSTRUCT THE PRQIECI'(SEC.10H,BUSMESS AND PROfESSIONS CODE:THE CON7RACTOHS LI- V8IU8�lOf1 ADJ.AREA W CENSELAWDOESNOTAPVLVTOANOWNEROFAPROPERTVYAIOBUILDSORIMPROVESTHEREON,AND � WFqCONTMCTSFORSUCHPflQIECTSWIhIACONTRACTOR(S�LICENSEDPVRSUANTTOTMECONTMG QUANTITY DESCRIPTION FEE � 70RSUCENSEUW.). ❑I AM E%EM�T UNDEH SEC. 9.8 P.C.FOR THIS REASON J Q U � � DATE OWNER U � W LICENSED CONTRACTORS DECLARATION -� � w I HEREBY AFFIRM UNDER PENALT/OF PERIUiIY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � (; i(COMMENCINO WITN SECiqN 1000)OF�IVISION 3 OF THE BUSINESS N1D PROFESSIONS GODE,AND Z �X� MY IICENSE IS IN FUIL FOf;CE AND EFFECT. m 0 UCENSE CLASS.��_ LIC.NO. S j ��oJr� n j V DATE I -�✓Y"�?f CON7RACTOR ' C_- ��{�-� d W � WORKERS'COMPENSATION DECLARATIUN -� Q y 1 HEREBV FIRM UNDER PENALTV OF PER/URV ONE OF THE FOLLOWMG DECLARATIONS: � y Z � � HAVEMIDWILLAUINTAINACERTIFICATEOFCONSENTTOSELF�MSUREFORV/ORKERS' _ COIAPENSATION,/�'i PflOVqE�BV SECTION 3�OOOF THE LABOR COOE,FOR THE PERFORMANCE U � UF 7HE WOR1(FOR WHICM TMIS VERMIT IS ISSUED. � 0 w 1 HAVEAND WILLMAINTAIN WORKEPS'COMPENSATIIXJ INSURANCE.AS REQUIqED BV SECTION Q 1 3]OOOF TNE LA60N COD[,FOR THE VERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUEO.MY flKL'RS'o/�y•PENSATION INSUR/WCE CARRIER AND POLIC!Y NUMBEF A/RE: CONSTRUCTION � CARRIER ��-`-L'[Z�� ma IOvF'C� �/7��S_ L•L% PLAN REVIEW � POLICYNUMBER_ I.fJ�J✓^C�. �C�I1�� rf ELECTRIC ! 0 f�ssEc,�rnr��mraoreEmr.aFrEnoF'nfaEwxr�swRovE�ooaloasRtoolaa�Ess� PLUMBING ---.---- 1 ��---- ZI CERTIFV TNAT IN TF1E PERFORMANCE OF THE WORK fOR WHICH THIS PERMIT IS ISSUE�,I MECHANICAL � SMALL NDT EMPl.OY ANV PERSON IN pNV MANNER 50 AS TO 9ECAME SUBJECT TO THE (n YVOHKERS'GOMPENSATKKJLAWSOfCALIFORNIA,ANDAGREETHATIFISHOI)LDBECAME INSPECTIONFEE �l S SU&IECTTO7HEW/ORKERS'COMPENSATIONPROVISIUNSOFSEGTION3]OOOFTHEUBOR ISSUANCE ��S .V�J COOE,I SHALL F9HTHWITH COMPLV WI7M THQ SE PRO/VISIONS. � .J�� 'I�� SMIP p �ATE�. � 't+�' APPIICANT: � ENERGYPlC ___ _ J WIIRNING:FAIIURE TO SEI:VRE WORKERS'GOMPENSATION GOVERAGE IS UNLAWFVL,AND SHALL BE � SUBJECTANEMPIOYERTOGRIMINALPENALTIESAN�CIVILFMESUPTOONEMUNDREDTHWSAND ENERGYPERMIT DOLLARS(5100.000).IN ADDITION TO THE COST OF COMPENSATION,ORA7NGE5 AS PROVI�E�FOF IN ¢ SECTqN 370BOFTHE UBOR COOE.INTENEST,ANDATTORNEY'S FEES FlETENTION FEE: � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: Q I MEREBY AFFIRM UN�EN PENALTY OF PEFJURV THAT THERE IS A GONSTRUGTION LENDING AGENCY d FOR THE PEHWRMANCE OF TME WORK FOR yYHIGH TMIS PERMIT IS ISSUED(SEG.3081,CIV.C.). � LENDER'S NM1E�(��i C' I�V��.� �"��P_ C'PI,{� / -- I_ LENDER'SADDRESS_ � ICERTIFYTHATIMAVEREADTMISAPPLICATIONqNDSTPTETHATTHEA80VE1NFORMFTIONISCARRECT. TOTAL FEES �� ,�� `�� I AGREE TO CAMPLY WITH ALL CITY AND CAVNTY OROINIINCES AND STATE LAWS REUTING TO BVILDING � CWISTRUCTION,ANDNEREBYAUTHORIZEREPRESENTATNESOFTHISCIXINTVTOENTERUPONTHE ABOVE-MEMIONEDPROPERTYFORINSPE TIONPUHPOSES. Q COMMENTS � -!?�� /- n i�-,� /" m _-��4� rFfY Q PER EE NMIE(PRI ) //�/� �'(] _. C/] � .-�[/ //f/t-c-�-a.- G' _/� "_�S� / � � 31GNATU F PERMITTEE DATE ) � RECPT.NO. PAID BY ` � � VALIDATION - WHITE-DepaAment Copy,YELLOW�inance Copy,PINK-Assessa Copy,GOLDENROD-File Copy,GREEN-ApplicanPs Copy .. � �.� �� .� �.>°r- . �E��.»�,. r �2� � �"�..,�. �,el. ' � "'�- d�W„��"ti� �°s,"�,� ,�`i �:.^�.w4�'�"�''. .�'� tx 4,��u�-!+�. . �`se�� . m +`� �� .s��" �_'��- _�� . ,.,� �i� @�«�� " "' '�� '" � , , �� r �� - t a � . t a.� � �.��;a�w� ��"�' �_..�_ � �\ ` . .�`��i � � _ _ ..-.. __ ��`°-s:.:-. ��-�r ' �. . . �(`�s-�c -�—----_—� _ __. � : `7°l�t � ,�----�-------.� _ � �� :.� �;. l�r.� ,f�..� � ,�-��"`` .-- � . . _ _ - _ _ _ �2�--�.. :�--..�.._._ . _ _ '� -f--�_ . � �� _ � � � �.� ��v�' '�' �! ��/ _ _ � e � �.� • �.T��,a�� : __ �� _. �- � K��.�.� ��1 � _ _ _ _ , �� jf _,..� 1 L�';..,�5 ��; w;� .. . .. . . . ....... . . . . . .. . . .... .. . ... ... .. ` .,. . 'q,: ��. ��,� s�„a��,a� ��d . .... . ...... .. .. .._ ..._..... . .. . .. _._ . ... . ... ... ... .. .... .. ... ... . .. . xr .� r�� z ` �x � _ _.,i .,. ,��,., .' _ CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVEL 5% 1 ADDRESS JOBSITE 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117• BUILDING PERMIT APPLICATION 9 S APN tl TRACT-S-J-2-k- 7 L-7 C42 OWNE,' ADDRESS_L CITY�cIe ZIP 744- 17-TEL.ry__7�f}-'_ APPLICANT',+k en TEL. !S.4_014? CONTRACTOR ADDRESS 1EY01 e r-c CITY 11-1111111?. ZIP gL 160 12 TEL. ARCH/ENG/ DESIGNER 1 N'Id:'I.�t i+ ADDRE S i S'7"L_'$L ii P CITY CIL, K ZI C)TEL��9'�S 17 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 REOUIRESA PERMITTO 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- T10N.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($500).): ^ I,AS OWNER OF THE PROPERTY,OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC. 7044,BUSI- NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE IF,HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE- TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). ^ I.AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTlNG WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC. 7044, BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS UCENSE LAW.). ^ I AM EXEMPT UNDER SEC. B. &P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE.AND MY LICENSE IS IN FULL FORCE AND EFFECT. LICENSE CLASS Y1 LIC. N0.S 1 '7 s"i 3 DATE/-01 '-C?1 CONTRACTOR Ile- 14i Le$ WORKERS'COMPENSATION DECLARATION I HEREBY FIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE "IHAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' 7//I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION E OF THE WORN FOR WHICH THIS PERMIT IS F R 3700 OF THE LABOR CODE,FOR THE PER 0 MANC ISSUED. MY RKIERS' PENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: .O 1 ��- � mp'OV CARRIER POLICY NUMBER (IRIS SECRON NEED NOT BE ODAW.ETED OFTHE PERMIT IS FOR ONE 1-K)rORED DOIJARS(St W)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 3700 OF THE LABOR CODE.I SHALL FORTHWITH COMPLY WITH TH SE PROVISIONS.,, �y DATE:APPLICANT: /J. '//o me-5 �-" 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 3705 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 WHICHITHIS PERMIT IS ISSUED(SEC. 3097,CIV.C.). LENDER'S NAME 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 INSPE TION PURPOSES. PERMrFTEE NAME(PRI� SIGNATU F PERMITTEE� Nac) DATE PRESS r3 FIRMLY CATION, APPLI Q-P5\ PERMIT I I E P/C ) DATE 1 NUMBER 9i 1 I ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBAC KS FRONT RW ^ REAR ^ SIDE/SIDE STREET RW ^ SIDE EI PROPOSED USE sr-tyo rt--"TFl 21�'__ N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREAIVALUATION SFR/ADD/REM U) Garage/Carport W Patio/Deck LL Pool/Spa 0 Z Re-Roof 0 Commercial 5 m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE U 0 w ww a Z GO J 0 Z Z U w CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING hl� ,6�b MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES COMMENTS RECPT N0. PAID BY VALIDATION 0 WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy