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Home My WebLink About18075 ._._ _ � _�� CITY OF DIAMt7ND BAR �_�' ,J-(,' ' ��` t , DEPARTMF.NT OF COMMt.INIfiY&DEVELOPMENT SERVICES � � _�� 21825 E.Capiey Drive (909)860-3195 F�(909)861-3117 PRESS \�� BUILDING PERMTT APPLICAT`ION FiRM1.Y JOBSITE ��l .-� � � fj APpLIGATION �y� PERMIT "`�P/C � AdDRESS_ ��G.- �.�'S- /G�- G�r f_,+' DA7E � �� 4l' ' � NtJMBER_1�7� # � ,0.PN �C}T TRAGT� ISSUE �, ^� „ .�� TypE OCC p C7WNER ___��JX+"'t^/'�' / r'C , DATE � ._, � � r: Ct}NST. �,ROUP _.�. —...�9-�;� , � ADDRES � C-'t:S'��K= -. • /r !`��J ZONING SETBACKS Z CITY �fr u ' c*Y'ZIP_��j�ri.��TEI. - �`iS FRONT RW Ci � APPIICANT '�`",��r�sg� !'f T��. '"7 c- � REAR � z� SIDEtSIDE STREET � RW ❑ � CQNTRACTQR ��1 7�7 _ /�-' '�r `''s SIDE � � ADDRESST . l `-i4.^r�'.J �UJ� p- �„� i�y"�E�� ,, s�.` ry/'7,�' a C1TY ! .�w.:�:Y�iP�L at,S TEL. Sc+� -Fr'C}3 " PROPQSEOUSE ��. ,��`� C.. � l'J`—��'t.-� z. � ARCHlENG/ � dES�GNER �--_ Np.DWEL. NQ. NO. c� ADDRESS rra — t1NITS STC}RIES _ BEDROOMS � CITY � ZIP TEL. � DESCRIPTICYN SGt.FT. FACTOR PSF ADJ.AREANALUATIQN � OWNER-BUILDEFI DECLARATION SFWAQOfREM O I NEREBV AFFIRM UNfI'eR PFNALIY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTOftS LI� G2P89BIC8fpOR W C£t,6EtAWFORTttEFatOW�NGREASCMa(SEG�fl31.58USINESSM`DAA4�ESStONSCaDE:ANYCiTYOP (f) C.a COUNTYWHICFiREOUIRESAPERMITTpCONS'RUCT,ALTER,IM7qOVE,DEMOLISH,OflREPAIRANY$TRUG W patio/Deck WTURE,PRIO%TO 1T8 ISSUM�CE,ALSO REOUIRES TFIE APpIICANT FOR 5UCH pERM1T TO FILE A SIGNFD � � $TATEMENi FMAT ME OR SHE IS UCENSED PUftSVANT TO THE FRffViS10NS OF THe CONTflACTORS ii. .� CENSE LAW(CHIIPTER 9(GOMMENGING WITH SECTION]Opp)oF DIVISIqN a OF TNE 6USINESS AND PRp� U"' POOVSpB � fES51QNSfADE}ORTHATNEaRSHE15EXEMPTTHEREFROMAND7HE0A515FORTH[AIlEGEOEXEMP� � U TION.ANVV�OIATpNOFSEl:TiON7631,58YANYRPPUGANTFORAPERMRSUBJECTST}1EA?PLICANTTC7 Z Re•Roof � pCIVILPENALTYOFNOTMORETHANFIVEHUNOREDDOL1,Aft5�S50o�J: - �I.AS{fWNERt�FTNEP(iOPERTY,OftMYEMPI(7YEE5WITHWAGESASiHEiftSpIECODdPENSATtON. 0 COtitti78(Ctd) � WILL DO THE WORK,AND THE STRUCTUFE IS NOT IN7ENpED OR OFFERED FpR SALE(SEC.70a4,BU51� J � NESS AN�PROFESSIONS CODE:THE CONTRAC70RS l ICENSE LAW DOES NOT APPLY TO AN OWNER OF � PROPEflTY WI�IQ$VIlQ50R IMRROVES 7HEREON.AND WHO DdES SUCH WORK NIFA56LF OR HERSELF 6R WTMROUGH H180fl FIER OWN EMPI.OVEES,PRqVIDEp THAT 5UCN IMVROVEMENTS AflE NOT INTENDED OR m � UFFEREDFOqSALE.IF,HOWEVER,7HE6UILDINGORIMPROVEMEN?ISSOLDWITMNONEYEAROFCOMPLE- �. � ThON,THE OWNEfii-BUILDEfl WiLL HAVE THE BUfiD£N OF PflOViNG THAT HE OR SHE DID N6T 6U14.D OR � IMPRpVE FOR THE PUfiPpSE OF SALE). W C71,ASbWNEROFTNEPROPERTY,AMEKC�USiVELYCONTRAC7INGWITHUCEN5EDCqNTRACTORS ('� TO WNSTRUCT TME PRA)F:CT(SEC.7044,BUSINE$S AND PROFESS�ONS CAOE:THE GON7RACT6flS ti� V21U2t1011 ADJ,AREA = CENSELAW�OESNOTAPPIVTOANONMEftQFAPROPERTVWHOBUILO50RIMPROVE5INERE6N,ANp � WHOCON7RACTSWRSUCHPRQIECTSWITHACQNFRACTOfli�i��GENSE4PUR5UANLTOTMECONTRAC� Q{fANT1TY DESGRIPTI4N F�� TORS LICENSE LAW). � ❑I AFd EXEMPT UN6ER SEC. g.8 v C F4R 7NIS REASON Q y U — . — ^..—...___... CL V" pATE OWNeR__,_,.,_ F- � _ . � U O W � UCENSED CONTRAGTORS DECIARATiqN � ,,,,� w � iNfREBYAFFiRMUNDfRP=NAlTY4FPER.1l�flYTNATIAMUCENSE4UNDERPR6V3S�PlSOFCNAPTEft � I[L 9(COMMENCING WITN SEO�ION 7000)OF DIVISION 3 OF THf_Bl15�NESS ANO PROFESSIONS CODE,AND Z �X MY LICENSE IS IN FULL FOFCE AND`EFFECT.w // .,(�.y/�, ) � "��1../��4� � \....-�� ; �ll i li:'Y:.i l�fl,/�f'4'.'+/1t"` .. � UCENSE CLASS � LIC.NO. __ j��'1� � � DATE�� CONTRACTOR 5..�r � "'�Y 7 V d , W .- '�„�"'i i't�� . � � v. (''jF-�, * . ' [�i WORKERS'COMPENSATION DEGIAflATiON � .r � � a ,` .�h4cue'.�',� L, /�v � IHEAEBYAFFIftMUMDERPENA�TY6FpERJURYONEQFTNEfOtIDWIN6DECtARATiDNS: Z ' �Vf•,_ S j..�„ ,,r2��t }�tN �,; Q . rr C� _i HAVEAND Wt A@�ITAIN AGERT:FlCATE 4F CCNSENT!O SEt.f-INSURE FOR riKSRKEft5' _ � COMPE N,ASPRbVI�e00YSECTION3700QFTHELABORCODE,FORTHEPEFFOFMANCE U �� N S i�'�K Z �'� � OF W4RKFOFWHICHTHI6PERMITIS155UED. W .� f� � .t�LR^ f..� ' ''/� W G � . I HAVE AND WILL MAINTAIN WpNKERS'COMPENSFTION INSURANCE,A5 REOIJIRED BV SECTION Q 3760 OF TNE 1A80R CODE,FOR THE PERF?RMANCE 4F tHE WORK FOft WHtCM THIS PEftMIT IS � ISSUED.MV WORKERS'C PFNSATION INSURANCE CARRIER�ry�FpI.ICY NUMBERFRE', CONSTRUCTION �_,,, l Y C ! ` ' _ � � CAfiRiEft___ � , �'t.`� � 'i '�" PIAN REVIE4V � aoucv NuuaEa.._ ��Ci,�,_ ��i(„iC_i " ~ ELECTRIC �.'� 4 � (n+�ssECTq�vNEEt�rardEaNnrtFrEooFmePEanuriswaau�HuwaEooau�s�aim�or��Es.�. PLUMBING __—_—� �'�(,_1 w --- t '_ ,Z 1 CERTIFV TVIAT IN THE PERF(]qMANCE OF 1NE W�FK FpR WHICH THIS PERMIJ+'IS ISSUEp.i MECHANICA�. � (� SHALL NOT EMGI.bY ANY PER50N IN ANV MANNER SOAS T00GCOMF$U&16CT TBTHE (j} WOflKERS'COMPGNSATIONIAWSCFCAtiFOflNSAA AY;REF�iHATIFIS tA.DBEC4ME INSPECTiONFEE SU6JECTTQTHE'NORKERS'OOM!'ENSATIONP 510 OFSECTION OOF �yAB!'�}t'-' --�+� ,,,,,,�-5 �,_�. �. . iptas,,,,r, ; ISSUANCE r� n �_,V�.�tr+yy ��..C/ �1` ITHGOMPLY W1Tri � SEP 13 . .. �r e�' DATBr. � G � �-7�pPLICANT _�_��-�-._,-._ SMIP - . � . . .� J WARNINO:fAILURETO SECUfl6 WORKERS'COMPENSATIQN COVF43AGE IS UNLAWFUL.ANp SNALLBE ENERGV PJC _�_,,,,,� J --I��Y _ � SUBJEGT AN EMPIOYEft 10 CRIM'�NAI.PENAL7IES AND CIVIL FINES LG TO ONE HUN6pE0 TNOUSAND ENERGY PERMIT OCiL4AH5(SI00.9W�.W AD61TiON T6 THE COSTO�COMP£NSATipN,DAMAGES AS PROVIOF�FOR iN ..`�J SECTION3]OBOFTHELAIIORCUUE.INTER�ST,HNpATTOflNEY'9FEES. CC RE7ENTION FEE: � .,�(,,,�) Q CONS7RUCTION LENDMG AGENCY PRE-ALT FEE: „ -...—....... ._-- __ � �HEREBYAFFIRMUNDERPENAL7Y4FPERJllRYTHATTHEftEiSACON$TRUC:tIONtENDiNGAGENCY � FOR THE PERFORMANCF OF THE WOFlK�OR WHICH THIS PERMIT IS ISSUEG�5EC.3091,CIV.C.). � - Z W � LENDER'S NAME� „_ � I— LENp[r75ADDRESS T W i cERTiFY TryqT i HAVE ft(:AO TNis aPPUCATiON AND STAi[THAT THE AflOVE iNFORMRTiON IS CCiRRECT. TQ�j't�(-��J � f `��L...�`� � I AGREE TO COMPLV WITIi ALL CITY AND COVNTV qPDINANCES AND S7ATE LAWS RELATINC TO BUILDING t � CANSTRUC710N,AN�HEREBYAUTHQflIZE RcPAEiENTATWES pF THIS COUNTY TQ EMER UPON THE � ABOVE-MENfiONEDPROi�ERTYfORiNSFECT�pNPURPQi[S. COMMENTS d / c T�� -J ��.+'� ..+- �ti�? i ' '-•-i'i..,.'�sE:.- � � � _ ^__—__.__ ... m PERMITT Ak�; RfN7�/� � , ' " '�" `ti�. f^7r� q .....'_."' � , % / ,//��,,�, `. . ...�-LyH/�j� ..J J�G. .�.,( �, . Uj N A P4Ri.it7t-.'E "� DATE �'�}��" —� . �' = RECPL N0._,(.._LJ ,,,,,,,v PAID BY� VAUDATION �� ~ WHITE—Departmer.t Capy,YELLOW—Pinanca Copy,PINK—Assessor Copy,GOIDENRQC�Piie Capy,GREEN—ApplicanYs Copy ��,a�_ ��'�_ € r�`£��` s r�� _ °�. �� `��rv F o � . . . . . . . . . � a . �J��.�� .��. ,r..,.� ��. �,r . ... .. .. ... ... .. ... , .. .. . .. .. . . ... .. .._ . . . . . , .... ... .. . ..... ._.... .._. ��.. ... ..... ... .. . .. . . ... . . ... .. ��.. .. �#�.g...... ... .. ...... ....... ... .. � ' , ,;�' i�w �r�-G�6�� '. . . . ... . � .... . . . �� . .. .,e t n .. ��h �„E: wnm�..... .. :. .. . .. . ... .. .. .. .... . . . . . .. .. .. . ... .. .... .. . ... . .. .. .... . _.. ._... ..... i . .... ... ....... _.. _..... ' ;�'., .� � .', . . , � �� . i. � . . .... .. .. .. . _ _ .. . . . . ".."r ' '" -. ... .... . .._.. _.... ...... ,. 0�79 `Pt'i 7P @� i "� ' � - �+s� ' . . .. . .. . . .. ... . ..... .. .... .. ._.. .._.... ... ._ U ,' a�Yhtl�� i ,P �#r��'', '��. _�s ta� i t . r� � � e . . ._. .._ . .. . . .. _.. ... 'N i, , � . .. . .. a . . .. ... ... .._... ...... , �;e�r _ a ,: .� m. .. . _ .... ... ._.. . . ._. _.. ... � , � � .. _ . .. ... - . . . . .... � ,� �� g � � � . . '. � � � � .� ' � ..�.�� 'td sl a � .. . . ... . . . .. . . . . .. � . . , ... .. . .. ... .... ... .. I _ ` ; . „ ; .', . .. .. _. . .. . .... .. .. .�i y .¢'� k ..�"_u. .. ... ... .. .. . ..._ . . .... . ._.. . .... .... . . �.. r; � n � °� ' .,.... ...:.. ..... .. ....... ...... .. . ... .. _._ . ...... .... . _.. ._.. . ...... ..... ... . ... . .. .. ..... ._..... ._.. . . ._..... ..... . ..... .._. __. CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION PRESS FIRMLY .3 L-/ G s-4-/e C- I t...� ,CL� ADDR ESS L APN LOT TRACT OWNER&JAJ/^/L'/^! ADDRES.S 2, 2 c . UJ CITY V._r t/0/^ ZIP 9) 7?C;s APPLICANT fi y�g�/7 TEL. •'coKa CONTRACTOR Z4�= X7 ' 'LA ADDDRESSI ZI CITY%w�LY P 7�4;7TEL. 5 C K U3 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 REQUIRES A PERMIT TO 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 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. 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. 8 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 FOP CE AND EFFECT. ASS-��4��1/'IC NO .�� ICEN C L SE L 114'ft E CONTRACTOR DAT WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WI "MAINTAIN ACERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' COMPE N,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE. FOR THE PERFORMANCE OF 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 'CC�MPENSATION INSURANCE CARRIER,ND POLICY NUMBER ARE ISSUED. MY WORKERS S CARRIER tf L Y\'�-.n �'yf 1�G/-- POLICY NUMBER_ (THIS SECTION NEED NOT BE COMPLETED OF THE PERMIT IS FOR ONE HUNDRED DOLLARS($100)OR LESS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMII7IS ISSUED. I C B TT THE SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJE WORKERS COMPENSATION LAWS OF CALIFORNIA,A AtREB'RHAT IF I S ULD BECOME SUBJECT TO THE WORKERS'COMPENSATIONP SIO OF SECTION 00 OF E191Y CODF�.I WALL FORTI-}WITH COMPLY WITH SE P ISIONS. DATE: 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 ACONSTRUCTION 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. PERMITT A TINT- n---� RPMEDATE CO �m Cr 0 0 w 0 0 m Er 0 Cn LL 0 d w 0 U W U3 C) LU LU W Z CO 0 APPLICATION 7 PERMIT P/C DATE z c NUMBER i7v# ISSUE L.. .7�TYPE OCC D ATE CONST. GROUP ZONING SETBACKS FRONT RW^ REAR^ SIDE/SIDE STREET RW^ SIDE^ PROPOSED USE S P�)C�i B v rro; � ,f I(,1��- N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM Garage/Carport W Patio/Deck EL PooVSpa C Z Re-Root 0 Commercial 5 M Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U CL U W J W Z //I xTZ"":-t-JC r 2 t I N IL 2 Q �S�I GC 4C"J C.-�/1 ) Z /r�G,%(_.PVG (711) Q W CONSTRUCTION PLAN REVIEW ELECTRIC L, PLUMBING (. r MECHANICAL INSPECTION FEE C) ISSUANCE.-9 SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: + �) PRE-ALT FEE: TOTAL FEES 7•�--�� COMMENTS RECPT N0. PAID BY C VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy