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Home My WebLink About16472 l CITY OF DIAMOND BAR �I� ^ --��- D E P A R T M E N T O F C O M M U N I T Y&D E V E L O P M E N T S E R V I C E S �- 21660 E.Copley Drive Suite 190 � �'��"��c�^ C'� ��j (909)860-3195 Fax(909)861-3117 PRESS �� BUILDING PERMIT APPLICATION S',�'��: FIRMLY � JOBSITE APPLICATION � ` � 1 PERMIT � ( (_J�P/C o ADDRESS Y � � DATE �✓ I 1 � { NUMBER� � � c� f ISSUE TYPE OCC APN LOT TRACT '✓�—�rI DATE CONST. GROUP p OWNER "' ADDR SS Y}'�. � ZONING SETBACKS � CITY . ZIP�I TEL. � REART R�N O APPUCANT TEL. SIDE/SIDE STREET RW ❑ � CONTRACTOR • SIDE ❑ � C'DTMDRESS IP E PROPOSED USE � ' �� ARCWENG! `1 DESIGNER v � ADDRES NO.DWEL. NO. NO. UN ITS STORI ES BED ROOMS � CITY �� ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF A�J.AREANALUATION v> QOWNEH-BUILDER DECLARATION SFR/ADD/REM 0 I HEREBV AFFlRIA UNDER PENALTY OF PERIURV THAT 1 AM EXENP7 FROM THE CONTRP.CTOPS LI- G0�3CJB/CdfPOA W CENSEUWf-0RTHEFOLLOWMGREASON�SEC.7a31.5BU51NE55ANDPROFESSIONSCODE:ANVCITVOR (/� C.� COUNI'IWHICHREOUIflESAPERMRTOCONSTRVCT,ALTER,IMPROYE,DEMOLISH,ORREPRiRANYSTHUC- W patio/Deck w NRE,PRIOR TO ITS ISSUANCE,ALSO REWIRES TNE APPIICANT FOR SUCH PERMIT TO FILE A SIGNED W � STIITEMEIY�TMl1T HE OR SME IS UCENSED PURSUANT TO THE PROVISIONS OF THE CONTMGTORS U� � CENSE UW(CMAPTER Y(COMMENCINQ WITM SECTION 7000)OF DIVISION�OF THE BUSINE55 AND PRO- � POOUSPB FESSqNSCODE�OqTHATHEORSHEISEXEMPTTHEREFFOMAN�THEBA515FORTHEALIEGEDE%EMV� (�] TpN.ANVVIOLATIONOFSECTION7031.58YANYAPPLICANTFORAPERMITSUBJECTSTHEAPPIICANTTO Z Re-Roof � A CML PEN�LiV OF NOT MORE THAN FIVE HUNORED OOLURS(f500�.)�, � ❑t,ASOV/NEROFTHEPR�PERTV.ORAAVEMPLOVFESWI7HWAGESASTHEIR50LECAMPENSATION. � COmm8lClal VYILL DO THE WORIC,NJD THE STRUCTURE IS NOT MTENDED DR OFGERED FOR SALE(SEC.7o4a,BUSI� J NESS AND PROFESSIONS COOE:THE CANTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF N PROPERTYVhIOBU1LD50RIMPROVESTHEREON,ANOWHODOESSUCHWOflKHIMSELFORHERSELFOp � Q THROUf3f7HI50RHERONTIEMPLOYEES,PROVIDEDTHATSUCHIMPROVEMEN75AHENOTINTENDE00R � QOFFEFEDiORSALEIF,FIOWEYERTME8UILDINGORIMPROVEMENTIS50LDWITHINONEVEAROFCOMPIE- Z TION,TNE OWNER-BUIIDEH WILL MAVE THE BUR�EN OF PRDVING TH�T ME OR SME DID NOT BUIID OR � IMPROVE FOfi THE PURPOSE OF SALE7. w ❑I,ASOWNENOFTHEPROPERTY,AME%CLUSIVELYCANTRACTINOWI7HLICENSEDCONTRACTORS � TO CONSTRUCT THE PR0.IFCT(SEC.70M.OUSINESS AND PROFESSIONS CODE:TNE CANTRACTOFiS U- V81118ti0n A�J.AqEA W CENSELAWDOESNOTAVPLYTOANOWNEROFAVPOPERTYWHOBUIL�SORIMPROVESTHEREON,ANU � VAqCONTRACTSFORSUCMPRQIECTSWITHACONTRACTOR(S)LICENSEDPIJP.SIJANTTOhIECONTRAC� QUANTITV DESCRIPTION FEE Y TOqS UCENSF UW.). � ❑IAMEXEMPTUNDERSEC.__ _B.3P.C.FORTHISRUSON Q U � � DATE OWNER _ r z W Q LICENSED CONTRACTORS DECUIHATION W � 1 HEREBV AFFIRM UNDER PENALTY OF PERIURV THA71 PM LICENSED UNDER PkOVI510N5 OF CHAPTER � (� G(COMNENCING WITH SECTKKJ]000)OF DIVISION a OF'HE BUSINESS AND PPOFESSIONS CODE,AND Z X MY LICENSE IS IN NLL FO CE AND EFFECT. LLl m 0 LICENS CLA 5_ _ LIG NO. : _ � J V DATE CONTRACTOR a � C�/�� WORKERS'COMPENSA710NDECLARATION -� Q � U � I MEREBY FFIRM UNGER GENALTY Cr PERJURY ONE OFTHE FOLLOWING DECLAflATIGNS: Z � s � HAVEANDWILLMAINTAINACEF?IFICATEOFCONSENTTOSELF-INSUREFORWORKERS' _ -- (`.GAIPENSA?pN,AS PNOVIGED B'f SECP.ON 3�W OF THE LA80{i CODE,FOR THE PFRFOPMANCF. U Q F TME WORN FOR W}IICH THIS PL�l�d1T IS ISSI'EO. � � W I NAVE AND WILL MAl14rAIN WORKERS'COMPENSATION IMSURANCE,AS PEQUIHED BY SEGTIUN ///A Q 37oa OF TME LABOR CODE.FOF THE VEP4"ORMANCE OF THE WO(iK FOfi WHICH THIS PERMIT 15 �/!y�J/ ISSUED.A1 FlNERS'� VEN54TION INSURANC�E CARRIER AN�FOLI V NUMBER ARE�. CONSTRUCTION /��`�1 W_ -' � CARRIER , , ' ,C�-' _ PLAN REVIEW -- Z [v��.ic/v�N/u�ue � � ELECTFIC I a fmdSECICf1 E'�� N o�.w_ErIDOF�r€a�w.rrswaonEturor�Eoax.�v�s�Sico7��Essb PLUMBING � W I CEP7ILV THAT IN THE PERFORAlANCE OF THE WORK FOR WHICH THIS PERMI'IS ISSUED,I MECHANICAL Z (,�} SHALL NOT EMPLOY ANY PEPSON IN ANV MANNER SOAS TO BECOME SUBJECT TO THE � WORKERS'CDMPENSATIONUWSOFCALIFORNIA�DAGREETHATIFISHOUL�BECOME INSPECTIONFEE — � � SU&IEGTTOTHEWORNEHS'COMPENSATIONPRCVISIONSOFSECTqNa�o00FTHEUBOR I i •,.) 7 i 1J � CODE,ISHALLiOR�HWI7HCOMPLI'WITHTHOSEPROVI510N5. ISSUANCE ��`.� ' �� - .1 �� ie�_t-t�nmL�_ sM�P p OATE: APPLICANT: .-r— W ENERGY P/C �� .; ,..��'-�: J WARNINd:FMWRETOSEWflEWORKERS'COMPENSA710NCOVERAGEISUNLAWFUL,ANDSHALLBE � SU&IEGTMIEMP�OVERTOCRIMINAIPENAL7IESANDCIVILFMESUPTOONEHUNDREDTHOUSANO ENERGYPERMIT OOLUFS(f100.000).IN AD�ITION TO THE GOST OF COMPENSATION,DAMAGES AS PROVIDFO FOR IN � SEC710N 3"!OB Of 7HE LABOR P7DE,INTEREST,ANO Ai IOHNEY'S FEES. RETENTION FEE: _ - d CONSTRUCTION LENDING AGENCV � � � �� PRE-ALT FEE: �.__:____-._.._.. O ----_�__.. __ . Q IHEREBYAFFIRMUNDERPENALTVOFVERJURVTHATTHEREISACONSiRUCTIONLENDINGAGENCY n- FORTMEPERFORMANGEOFTHEWORKFORWHICHTHISPEFMITISISSUED(SEC.3o9),CIV.C.). Z IV f)�'1P ,.�.L.�.-�-�� W � LENOER'S NAME _ F_- LENOER'SADDRESS_ � i CEPTIFV TMAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATqN IS CARRECT. TOTAL FEES 4 1 � `-� W I AGREE TO COMPLV WRH ALL GTV AND COUNTY ORDINANCES AND STATE L4W5 RELATING TO BUILDING � GONSTRVCTION,ANDHEREBYAUTHORIZEREPRESENTATIVESOFTHISCWNTYTOENTERUPONTHE �. ABOVEMENTIONED FROPERTY FOR INSPEGTION PURPOSES. COMMENTS 0 � �.�� J � m PERMITT NMAE�PRINT � ' �, �y.�j�._d� � SIG R_OF PERMI, E DATE � _ � RECPT NO. PAID BY � VALIDATION_ .. _.��__— ~ WHITE—Department Copy,VELLOW—Finence Copy,PINK—Assessor Copy,GOLDENRO�—File Copy.GREEN—ApplicanYs Copy �:�� `�°°��'� �'�� "��, � �� e �s _ �� ,� � G , �� , � - �� . �� 4�� !� 'v, � �� _ __� _ _ _ _ __ __ ----- --- __ � �.t. � "�;�. _ �� __ . __ __— _ __ _ _ � , , , , ,F .: E�t � [-; f, __ _. _._ , __ __ _ _ , � .— . , �._ �_ __ _ _. .. __ . _ __ _ ____ r� • �, ��„— s °"' � �� _�,;r _ _ _ _ _ __ _ _ _ �� ., , . _ __ _ _ r _ _ _ _ __ _ _ �• � m , , _ _ _ _ _ _ _ . c -��_, . _ ___ _ __�_. __ _ , � ., . . . � _ -r P 4 �,� . � ,F , �,: � __ __ __ _ _ � _ _ , .� T�� _.a=-� _ _ _.�.., . . _ �_— __ ___�. _ __ _— ____. __ _ _ � r � r:�: _ _. _ . __ . ..._._ _._..._ . � � _M_ ....w . .._ _ ..._ . .._._ ... . ,' R _ _ __ _ _ . _ _ ,; _ . ___ __ _ . _.. . _— � . , }P . 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' ... , ��;.,, �� y� ,, , � �� __ _ __ _ �� _ � � �� t � �fi . �� _ _ � _ k �r�,�� '� � �°�� +�,�a ��`�:�r��s� � � , a;� �,m.�,m ,.,� _ CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 �'I�i r r c T (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION PRESS FIRMLY JOBSITE tt Y 1 ADDRESS APN LOT_jE2_TRACT OWNER ADDRESS Y1 V CITY ly-v MIA ZIP-TEL. APPLICANT TEL. CONTRACTOR ADDRESS CITY IP E. ARCH/ENG/t HO DESIGNER 4 ADDRESS CITY. ZIP TEL. la- 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 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- 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).): ^ 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- 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 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 FULL FO CE AND EFFECT. LICENS CU S LIC. N0. CONTRACTOR DATE YY G/T�•WORKERS'COMPENSATION DECLARATION REBY FFIRM UNDER PENALTY Cr PERJURY ONE OF THE FOLLOWING DECLARATIONS. IH E HE - HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' COMPENSATION.AS PHOVIDED BY SECTION 37000F THE LABOR CODE, FOR THE PERFORMANCE //////��F THE WORK FOR WHICH THIS PERMIT IS ISSUED. HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE.AS REQUIRED BY SECTlON ii .. 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. M RKERS'PENSATION INSURANCE CARRIER AND POLI Y NUMBER ARE: CARRIER � ICY ,Me n/ SELTON NEC.OMELETEDOFT E PERMIT IS FOR ONE HUNDRED DX.LRRS($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. fa11 �5J 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(8100.000),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 ACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC. 3097.CIV.C.). LENDER'S NAME IV f)SIP. Lc,i ) 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. PERMITT NAME(PRINT 2 SIG R-OFPERMI E DATE : 1 APPLICATION I PERMIT(_ #/C 1N DATE UMBER lr)I ISSUE TYPE OCC DATE CONST.GROUP ZONING SETBACKS FRONT R)N ^ REAR^ SIDE/SIDE STREET RW^ SIDE^ PROPOSED USE A(L 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 a Z Re-Roof Commercial t b Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U U W W C) Z 0 Q U Z 2 LU �� g CONSTRUCTION-_/ PLAN REVIEW ELECTRIC PLUMBING �t MECHANICAL INSPECTION FEE ISSUANCEI ) SMIP ENERGY P/C_r-3 I 1 ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: --�- TOTAL FEES p L 1� �1 COMMENTS RECPT. N0. PAID BY VALIDATION I WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy