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Home My WebLink About16167 (9) , i 1�_ CITY OF DIAMOND BAR � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � 21660 E.Copley Drive Suite 190 PR ES$ � (909)860-3195 Fax(909)861-3117 �'°�'� BUII,DING PERMIT APPLICATION c L ' ��, ,3 FIRMLY � JOBSITE t APPLICATION Y PERMIT I � I � P/C ��' o ADDRESS Z��1�C� C��G eU {r�►S'i R DATE �� 1 NUMBER I �!?I `r+ ` p ��"'�J l� ISSUE TYPE OCC � APN LOT '�� TRACT S�LZ�a'7 DATE CONST. GROUP p OWNER �� '�t' Mr' ��!' o ADDRESS � ( YyY1 tc-!1 ZONING SETBACKS �W CITY Y ZIP�,TEL�`��f•74�-�jtiC REART pW �❑ APPLICANT TE�. _S�/h� SIDE/SIDE STREET RW__ ❑ � CONTRACTOR � SIDE ❑ p� ADDRESS iJ ! � CITY ZlPgitrl2TEL.��/�"VI�'f�-T1Yli PROPOSEDUSE ��Z oARCH/E G/ DESIGNER t L•��"k' �' ^SS O �.. NO.DWEL. NO. NO. ADDRE �'��,�� UNITS STORIES BEDHOOMS � CITY ec ZIP�.z TEL.� ' SG;-y�)] cn DESCRIPTION 5�.FT FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADD/REM , rj� O O 0 I HEREBY AFFIRM UNDER PENALTV OF VERlJRY THAT I AM E%EMPT FROM THE CONTRACTOfiS LI- W CENSEUWFOqTHEfOLLOWNGREASON(SEC.�o3156USINE55AN�PROFESSIONSCODE:ANVdTVOP � Garage/Caryort v � � � C..) �pJK{yyyHICHREWIRESAPERMRTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANVSTRUC� Z TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES iHE APPLICANT FOR SUCH PERMIT TO FRE A SIGNED w Patio/Deck � STATEMEM THAT HE OR SHE IS LICENSED PUFSUANT TO THE PROVISIONS OF THE CON7RACTORS LI- � � CENSE UW(CFIAFTER G(COMMENCINO WITH SECTION 1000)OF DIVISION 3 OF THE BUSINE55 RNO PRO- POOUSPd FESSqNSWDE�ORTYIATFIEOR5HEI5E%EMPTTHEHEFROMANOTMEBASISFORTHEALLEGEDEXEMP� (� TION.ANYVIOUTIONOFSECTICN7N1.5BYr1NYNPALICANTFORAPERMITSU&lECTSTHEAPPUCANTTO Z Re-Roof � A CML PENALTY OF NOT MORE TFiAN FNE HUNORED DOLLARS(i500�.J: � ❑I,ASOWNEROPTHEPROPER7V.ORMVEMPLOYEESWI7NWAGESASTHEIRSOIECAMPENSATION, � Commercial WILL DO THE WORK,AN�THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7oea,BUSI� J � NE55 AND VROFESSIONS COOE:hIE CANTRACTORS UCENSE LAW DOES NOT APPLY TO AN OWNER OF � � I ,�S PROPERTVNRpBUILD50RIMPROVESTHEREON.ANDWHODOE55UCHWORKHIMSELFORHERSELFOR � � THRDU(3H HIS OR HER OWN EMPLOYEES,PROVIOEO THAT SUCH IMPROVEMEN7S AHE NOT INTENOED OR m Q OFFEREDWRSAIEIF,FIOWEVER7}IEBUIIDINGORIMPROVEMENTISSOLDWITHINONEVEAqOFCOMPLE- Z TION,THE OYYNER-BUIIDER WILL MAVE THE BURDEN Of PqOVING THRT HE OR SHE DID NOT BUILD OR � IMPROVE FORTNE PURP0.5E OF SILLE�. w ❑I,ASONMEROFTMEPROPEHTV,MIE%CLUSNELYCONTMCTIN6WITF!LICENSEDWNTRACTORS � TO CONSTRUCT THE PROJECT(SEG 7041,BUSINE55 AND PPOFESSIONS��E:TNE CANiRACTORS LI- Velue�lOn '� ADJ.AREA CENSEIAWDOESNOTAPPLYTOANONMEFOfAPROPERTVWHOBUILDSORIMPROVE57HEREON.AND � � _. � Wf/OCONTRACTSFOFSUCHPR0.IECTSWITHACONTMCTOR�S)LICENSEDPURSUANTTOTHECONTFRG QUANTITY DESCRIPTION FEE TORS LICENSE LAW.). � ❑I AM EXEMPT UNDER SEG_. _ _B.8 P.C.FOR THIS ftEASON Q '�/ � U 3 �- ¢ LL' DATE __ OWNER � ' �' i, 2 'l.f,� 0 W t � LICENSED CONTRACTORS DECLARATION w �., S I. �.- � I HEREBV AFFIRN UNOER�ENALTY OF VERIUFV TNAT I AM LICENSEO UNDEfi PROVISIONS OF CHAPTER , d D(CUMMENCINO WITH SECTION 7000)OF DIVISION]Ot THE BUSINESS AND PROFESSIOhS CODE,AND Z ( �� - X MY LICENSE IS IN FULL FORCE D EFFECT, m Q � I' LJJ � LICENSECLASS_ LIC.NO. __ � . ~ ��' ' � V �ATE �U _ L1� CONTRACTOF :✓ ' ' 1 d. W � 'WORKERS'COMPENSATION DECLARATION Q � r � � I HEflEBV AFFIHM UNDEfl PENALTY OF PER/URY ONE Of TME FOLIOWING DECUPATIONS: Z /, \ 1� _�� /J�/ V O :��fiHAYE AND WILI MAINTAIN A CERTIFICATE OF fANSENT TO SELF-INSURF.FOR WOflKERS' = T �I/ � �/� (.`q,1pENSATION,/,S PROVIOED BV SECTION 3]00 OP THE LA80R CODE,FOR THE PERFORMANf.E U � ` 1 ; �' TN[WORK FOR WHICM TNiS PEAMIT IS ISSVED. �� !iy� � �' MAYE MIO WILL MAINTAIk WOHKEFS'COMPENSATION INSURANCE,AS PEDUIRED BY SECTION e� � �� i� �, QQ 3700 OF TME LABOR CODE,FOR THE PERF-0(iMANCE CF THE WORK FOR WHICH THIS PERMIT IS �� _ ISSl1ED-MVWDIIXFRS'C/A'AAPFN5A' WSURA,^lCECAFRIERpNDP/OLICVNUMB/ENtAPE� ONSTRUCTION ` � CAFRIER��C�f7 L' �I� I iiJY+C f�S_ C-f,�9_,_ PLAN REVIEW "`�� caicrNuueEa_� a tJ " c + � �" ELECTRIC ` .�l�� \ ,7�' � (iHSSEClqNNE�NOTOEQIh�.ETEDOFhiEPEfD.7fTI5WRtJNEF0.IPDREDWlWi5�E100�OqLESS). P�l)M�IN(�i I `��.�/`.� _ � , � W �j \ Z I CERTIFV THAT IN TiE PEPFORMANCE OF THE WORH FOR WHICH THIS PERAlIT IS ISSLIEO.I MECHANICAL ?�S.e�`�-� � (J SHAIL NOT EA1P'_OV ANY FERSON IN ANV MANNER 50 AS TO BECAME SUBJECT 70 THE � � WORKERS'COMPENSATIONLAWSOFCALIFORNIA,ANDAGREETHATIFISHWLDBECOME INSPECTIONFEE SU&IECT TO THE WORKERS'COMPENSATION PROViS10NS OF SECTION 3�OOOF THE UBOFl I �\ � � COOL,ISMALLFORTMWITMCOMPLYWI�L�,MOSEPROVISIONS. ISSUANCE ��/.�,�r�J p DATE:�L.�� APPLICANT: !Y��. 1ir�PS L.G • SMIP .��_ J WARNING:FAI�URE TO SECUflE WORI(ERS'CUMPENSAi10N CAVERAGE i5 UNIAWFVL,ANO SH�E ENERGY P/C I � �I _____.___ LL SU&IECTANEMPLOVERTOCRIMINALPENALTIESANOCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT �j � DOLLAPS(ft OD,000),IN ADDITION TO THE COST Of COMPENSATION,DAMAGES AS PROYI�ED FOfl IN � SECTqN3]OBOFTHEIABOR'UDE,INTENEST,AN�FT�ORNEY'SFEES. RETENT�ONFEE: _ OCONSTRUCTION LENDING AGENCY PRF-ALT FEE: � I HEREBV AFFlRM UNOEfi PENRLTY Of ACRJURV THAT THERC IS A CONSTRUCTION LENOING AGENCY FOfl THE PERFORMANCF OF THE WORK FOR WI IICl1 TH�S PERMIT IS ISSVED(SEC.30B],CIV.C.). � � Z } Z LENDER'S NAME�� ' � `•!� f7 1�_ 9 ' . • --`..-' � �� F-' LENOEH'SAODRE55 �\ I � 1 CERTIFV THAT I HAVE flE11D iHIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CARRECT. TOTAL FE ES '��-'� '�� O Ly�,J �� 1 AGHEE TO COMPLY WITH ALL CITV AND COUNTY OflDINANCES AND STATE LAWS RELATING TO BUILDING � ' � � CONSTRUCTION,ANDHF_flEBYAUTHORIZEREPRESENTATNESOFTHISCWNTVTOENTERUPONTHE ry Z pBOVE�MENTIONED PRUVERTY FOR INSPECTION PUflPOSES. COMMENTS �r � �� ^�� Y�(7�/L G � i�r�-� , � — m PERMITTEENAME�PFI T) ¢ '7.i � v� �� -��-_ �l> �� _1 � SIGNA7U OFPERMITTE DATE = RECPT.NO. PAIDBY VALIDATION ~ WHITE—De artment Co VELLOW—Finance Co PINK—Assessor Co GOLDENROD—File Co GREEN— IicanPs Co P PX PX PY. PY. 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JOBSITE Z V ADDRESS 3� Ip C„IkF, dcrV --siA APN LOT i '0 it TRACT S ZZ OWNER ADDRESS CITY 110%/ 1 Y_ZIP TELI� I-797-41 APPLICANT TEL S4,tflCe CONTRACTOR e' ADDRESS U ! CITY J III, iJj 11 If ZIP'ibll TEL.' 11 -Ct 7-11Y0 ARCH/E G/ DESIGNER s&r$0 1. ADDRE CITY 11:11,ec 41M 4-1 A ZIP .r 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 PERMRTO 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 VKXATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CML 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 YEAROF 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. 7041, 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 D EFFECT. LICENSE CLASS- LIC. N0. DATE f- U 4-401 CONTRACTOR :/I Le- 1 WORKERS'COMPENSATION DECLARATION I HEREBYAFFIRM 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 THE WORK FOR WHICH THIS PERMIT IS ISSUED. HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTlON 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS'COMPENSAT INSURANCE CARRIER AND POLICY NUMBER ARE CARRIER 4 POLICY NUMBER (THIS SECTION NEED NOT BE CON"ETED OF THE PERMIT IS FOR ONE WJ'CRED DOLLARS($100)OR LESS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMP-OY 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 OOL I SHALL FORTHWITH COMPLY WI HOSE PROVISIONS. PROVISIONS. C ,I DATE:APPLICANT: n i7YR PS L.G�P 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.). -4' •e 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 INSPECTION PURPOSES. PERMITTEE NAME(PRI T) �ff SIGNA7U OF PERMITTE DATE 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 L»I C-III, PRESS FIRMLY PERMIT I 1 I APPLICATION P/C I I DATE NUMBER r+ ' p JI ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW^ REAR ^ SIDE/SIDE STREET RW^ SIDE ^ PROPOSED USE Iy SFit N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM fj Q Garage/Carport ) W Patio/Deck LL PooVSpa 0 Re-Roof Z Commercial m .If Valuation ADJ.AREA QUANTITY DESCRIPTION FEE � � Y c i cc 1P.� H- / LU �I f6 , m I a KT- L) \ Z G I�L Q � 1 ', ICL) c i p R T 0 NST ION UC PLAN REVIEW ELECTRIC lah ,17 PLUMBING {{ I L It.J� MECHANICAL INSPECTION FEE ISSUANCE SMIP i ENERGY P/C I .� ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES � ! IOC-j �I COMMENTS F F 2 0 RECPT N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy