HomeMy WebLinkAbout18948 CITY OF DIAMOND BAR �x���rc�.��
�� 1 DEPARTA�NT OF COMMUNITY 8c DEVELOPMENT SERVICES
21825 E.Copley Drive PRESS
� (909)860-3195 Fax(909)861-3117
`""' BUILDING PERMIT APPLiCATION FIRMLY
o ADDRIESS �+ '`''���'T �����"� ��l'� Z D DATEICATION'� (� V�- NUMB R p/�_
c� ISSUE TYPE OCC
.— APN LOT TRAC�T DATE CONST. GROUP
p OWNE��' '� _ �Cfjj�l�S
p ADDRESS �S.S�f�{ rF'`SCL� St.(�- ZONING SETBACKS
Z CITY ZIP TEL. ��G� FRONT RW ❑
o APPLICANT TEL. t Z�"[� REAR ❑
� SIDE/SIDE STREEf RW ❑
� CONTRACTOR_(��-��v+��`3 _ SIDE ❑
� ADDRESS
� CITY 21P TEL. PROPOSED USE
w ARCHIENG/ � � ", '
� DESIGNER NO.DWEL. NO. NO.
a ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP __ TEL.
�
cr� DESCRIPTIpN SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFRlADD/REM
O
0 1 HEREBV AFFIRM UNDER PENALtY OF PERIURV THAT I AM E%EMPT FROM THE CONTMCTORS LI- G8fH98/COfpOII
W CENSEUWFORTHEFOLLOWINGREASON(SEC.�031.5BUSMESSAN�PROFESSIONSCADE:ANVqTYOR (n
U pWNTYYYHICMREOUIRESAPERMfTiOCONSTRUCT.ALTER,IMPROVE.DEMOLISH,ORREPA;RANYS7RUC� w
w NRE,PRIOR TO ITS ISSUANCE,AL50 REDUIRES TNE MPLICANT FON SUCH PERMIT TO FILE A SIGNED w Petio/Dedc
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS lL
� CENSE UW(CNAATER B(COMMENCINa WITH SECTqN 1oW)OF�IVISION 3 O�THE 9USINESS AND PiiO� � PODUSD9
FESSIONSCODE�ORTHATHEOHSHEISE%EMPTTMEREFROMANOTHEBA915FORTHEALL[GEDEXEMP- (�
V TpN.ANVVIOLATIONOFSECTION7031.58YANYAPVLICANTFOR�PERMITSU&lECTSTHEAPPLICANTTO Z qe-Roof � ,
� �QVII AENALTV OK NOT MOiiE MAN FIVE HUNDREU DOLUFS(3500J.):
� �(ASONMEROFTNEPROPERTY.ORMVEMPIOYEESWITHWAGESASTHEIR50lECOMPENSqT10N, � COfI1f11B�C181
1YIU DO THE WORK,AND THE STRUCiVRE 1S NOT INTENDED OR OFFERED FOR SALE(SEC.70U,6U51� J
� NESSAN�PROFESSIONS COOE:TIE CONTMCTORS IICENSE UW OOES NOT APPLV TO MI OWNER OF ?
PqOPERTY'Mp BUILDS OR IMPNOYES THEREON,AND WHO DOES SUCM WORK NIMSELF OR NEHSELF OR
Q THAIXJaHMISORHEflOWNEMPIOYEES,PROVIDEOTHATSUCi�IM7ROVEMENTSARENOTINTENDEDON m
QOFFEREDFOFSALE-IF,HOWcVER'�NEBUILDINGORiMPROVENENTISSOLDWITHINONEVEAROFCOMPLE-
Z TIDN.THE OWNER-BUILDEfl WILL HHYE THE BVRDEN OF PROVINO THAT HE OR SHE DID NOT 6UILA OR
� IMPROVE FOR 7HE PURPOSE OF SALE).
W ❑I,AS OMMEFl OFTHE PROPERTY,AM EXCLUSIVELY(:ONTMCTING WITM UCENSED CONTMCTORS �yh�
Q TO CONSiRUCT THE PRO.IFCT(SEC.70N,BUSINE55 AND PROFESSIONS COIJE:THE GONTMCTOR9 LI� VBIIlBtIOn ��C`+Rl ADJ.AREA
Ll1 CENSE UW DOES NOTAPVLV TO RN OWNEfl OF A PqOPERTV WHO BUILDS OF IMPROVES THEREON,AND
� WFIOCONTMCTSFORSUCHPROJECTSYATHACONTRACTOR(S)UCENSEDPURSUANTTOTNEQ7NTRAC- QUANTIT' DESCRIPTION FEE
i Y TOflS UCENSE LAW.�.
0 O I AN EXEMPT UNOEfISEC. B.b G.C.FO y�$.REASON Q
3 � � �
� ¢
DATE � OWNE��' U
0 W
F �ICENSED CONTI3 TORS DECLARATION W
� I HEREBY AFFIRM UNOER PENPLTV OF PERIUqV THAT IAM LICENSED UNDER PROVISqNS OF CHAPTER �
� i(COMMENqNO WITH SECf10N 7a00�OF DIVISION 3 OF THE B1151NESS ANO PROFESSION$CODE.AND Z
X MY LICENSE IS IN FULL FORCE M!D EFFECT m
LlJ �
0 LICENSE CU155„_ LIC.NO. �
� J
U DATE CONTRqCTOR a
W
� WORKERS'COMPENSATION DECLARATION Q
� I HEREBY AFFIRM UNDER PENALTY OF PERJURv ONE OF THE FOLLAWMG DECURATIONS: Z
� _I HAVE AND WILL MAINTqIN A CERTIFICFTE OF CANSEM TO SELF-INSURE FOR Ntt1RKERS' _
CONPENSA710N,IS vROVIOED BY SECTION J7000FTHE L4BOR COOE.FOR TNE PERFORMANCE U
�� OF THE WORK fOR WNICH THIS PERMIT IS ISSIJED. �
O
W _I HAYE AND WILL MAINTMN WORKEHS'WMPENSATION INSURANCE,AS REOVIRED BY SECTION
Q 370a OF THE LABOR CODE,FOR THE PEFiK1RMANCE OF THE WOfiK FOR WHICH THIS PERMIT IS T
ISSUED.MV WOiiNERS'COMPENSA710N INSUHANCE CARRIEfl AND POLIGV NUMBER ARE: CONSTRUCTION __ __�/D�
Q �
> cnnAiEA_ PLANREVIEW
z caicv NUMeea, _ ELECTRIC
¢
0 (n+ssEcnoruNEe�noree�ErmoFnea�a/.rrawaar�wwaEooa�.u�s�Sim�oaiEssA PLUMBING
w I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOq WHICH THIS PERMIT IS ISSUED,I MECHANICAL
Z
(} SHALL NOT EMFI OY ANY PERSON IN ANV MANNER SO AS TO 6ECOME SU&IECT TO THE
� WORKERS'CoIAPENSATqN UWS OF CRLIFORNIA,AND AGREE THAT IF I SHOULD BECOME �NSPECTION FEE
� SUBJEC7TO THE UbRKERS'COAIPENSATKNJ PROVISIONS OF SECTION 3700 0F TME LABOR
GODE,I SNALL FORTHWITH COMPLY WITH THOSE PROVISIONS. ISSUANCE
� _ SMIP ��C7
DATE:__ APPUGANT:
�w ENERGY P!C
WARNING:FA1lURETOSECUREWORNERS'COMPENSATIONCAVERAGEISUNUWFVL,ANDSMN.LBE
LL SUBJECTNJEMPIOVERTOCRIMINALPENA�TIESAN�CIVILFINESUPTOONEHUNDREDTFKKISAN6 ENERGYPERMIT
DOLURS(f100.OW),IN ApDITION TO THE COST OF COMPENSATION.DAMAGES AS PROYIOED FOR IN
� SECTION 3)09 OF TMe LABOR GODE.M7EflE5T,PNO ATTORNEYS FEES. RETENTION FEE: �`
d CONSTRUCTlON LENDING AGENCY PRE-ALT FEE:
O
� 1 HEREBY AFFIRM UNDER PENALTV OF PERJURY THAT TNERE IS A CANSTRUCTION LENDING AGENCY
FOH THE PENFOHMANCE OFTNE WORK FOR WHICII 7N15 7ERMIT IS ISSUED�SEC.70Y7,qV.C.).
Z
W
� LENDER'S NAME_
F— LENDER'SADORE55
� TOTAL FEES i ��,',(�
w I CERTIFV TMAT I NAVE READ THIS APO�ICATION AND STA7E THATTHE ABOVE INFORMATION IS WRREC7.
� I AOFEE TO COMP:Y WITH ALL CITY AND COUNTY ORDIN.WCESA/1D SUTE LAWS REUTING TO BUILDING
� GONSTAUCTION.AND H[:REBV AVTHORIZE REPRESENTATNES QF THIS COUNTV TO ENTER UPON TME
Z I1BOVE-MENTIONEDPFl6PERT'FORINSPFCTIONVURPOSES_
-s COMMENTS
o . �7Mev`'��
m � EE NhME(PFINT�",
Q �y d _
(/� - L✓' .4"......_�"r
Uj OF PERMI "EE DATE
= RECPT.NO. PAID BY VALIDATION
~ � � WHITE—Department Co YELLOW—Finance Co PINK—Assessor Co GOLDENROP—File Co GREEN— I t's C
vr. ax oY. PY. MW oav
* � a � ,.�''� �w :� ., . � ,.
�� ,_��:L 7 ' � ,. _,� �
. �.a� � '�'aw,�a �:���a� ..... .��,�t,�r�a,.Y ""� "�.�°'�`��:,Kg��cr, i���� `�t'�> R
�" � � �.� � �
� , `� . ��
�:
s f
x
, . �
�1���� �!� . _
�,
w � �,. r � . � �� ���
� _ ��_,�r. : r�� _; _. » �� � - � �
_ . . __ _ _ _ ___. _,
_ " _ _ _ , ___ . __ __. _..._-�
< , ,.
�a, . . , .�� ,, ����� ,
F >
f � __ _ _ . _ __ �._ _ _ � __. . — _ __ �
=� � �� � i
�� , � - .
� . _ ' _ _ : i
_ _ ,
� � s � - �� ,
a �G�, _
� ,, � � � ,
_ _ _ _ __ _ ,
�r� � �� � ����
_ _ ,
� _ .
�f:' .. . �.: - . = t
. . . .. .._.. ..... ....... ._.. . _ ._. _... . .-_. _.... _.._._ __.. ..._ ..
. , . {
ti , . � t t
, '. � . �r . ,.. '� '�.
_.. ... .._.. ._. . . . .._ _ _.. __... ___ __..
.. ...._ _. . . , ,.
.. _�. . . , _ . , ,v
� � ;: . . ; - a ��.
. . . ..._. . ._. ...._ .... ..__ _.. . .._. .._. ..._. ..._ _...... _..__ __._. ,
.,.:_ _ ,:, . � � u�� . i�� . 4
.�� .. . ., 3 .
_ . . __� __ _.... ..— ...... . _ , _.... . _._ i_. _.. . __. _ __ �
. ���
x ,- s. ��3 � _ , F . °
_. .. _... . . . . ..._. ..__ . .... .. ....... __.... __.... __... _.. ;
_ _. _ .. . . . ,
� . . ., - � "..
� . ,
a , . ... ._. ...._ ._._ . _ .. ..._ .._.. >..,. ..._ . ...�. . _..._ ._. _._[
. � . . ,.. �t� �.
_ �:a :., � . �
( _. _... . .. . . _.. ... . ._... .{
; �, �� �._.. ._. ..... . __. ...... ...._ .�. �.: � ...... ��:..... _.... ...._ .._.. .__ .__�
_. . .. .., . . ... _ : , (
.._. .. .... _... ..... ... ... _... ._ ._. ::- ��. � r� ...�,,i j .. _.. ... .__ :
� � ��� ���� � F
.. _...... ... . _.. . , . . . ,.. . ..
... .._ .. . ... .... .. ... ... .. .. . . . . . .. .. __ ._. :
r
i
� e � E
9 , E ...: _ __ _ '
� ,,��t _. _ ___ . _ __._ .__ _._ �
f �
� _ _ _ _ _ _ __ _ . _i
_ _ _ __. _ . _.__ _ . . . ,�
__ _ _ _ __ __ _�
I
._..... ... ... .. ... . .._. ...... ...... ..... ..... .. _... ..... .... ... . ..... ...... ...... ..... ...... � ...._. .�,'
'
; .... .... . . ..... ... ... ..... ..... ...... ...... ...... ..... ..... .. ... ...... ...... ........ ._... ...,.. . ... .y
I
...... .. .... .. .... ... .. ....... ._.... ...... ..... ....... . ...... ....... ....... .._.. _..... ...... ........ ..... . .....j
�
.. .. ...... ........ ...... ._.. ...... ...... .._.. .._... ....... ...... ...... ..... ._.... ...... ...... ..... .....E
F
�
...... . .... ...... .. ... . ..... .. .... ..... .... ...._.. ..... ...... . ._... ..... ..... ..... ....... _ ......_.. ..�
_,,. , ..... .... .. ... ... .. . ._.. ..... ..._. __. _...... . ... ._. � ._..' ."�
� y s o . 4 _.. .. .— E
, . _. ... . . €
+' mn �t t
�t r�(��� 1� �����I� Q��rl C��.. t .._ ..... ...... .._. ...., _. .. ._.. ..._. _.... .._. __ ._�._.. , .�
�� °�E
� , `
�. . ��j� q�� i .
� � 'I� ! j . � ._.. ._... ...... .... .. ...... ...... ..._. ..__ . �
E .._. ,.._ _..._. ,_ ;.
__..
:
i
t
q __. ..... ,__ __ _. _... ,._ .__ .�.._ _... y
� __ __
}
1 r
k
� 'a __. ..._ .._. . .... _... ._._ .. _. _ _.._ ._._,. ,_._ __.. _..�
t
k �
� .. ,_... . ..... ..... . . ..__ 2
.f — _ ...._ _ . _.. . ._. �.._ .
i _
a
i 'ro ..... ...._ ..... ...... ._.. ...... ...._ . __. ....... _..._ :�
�, 7b
Z
Ls
k
I
yL{�
i
ADDR
ESS
APN LOT TRACT
C�
�S
L
OWNE
)
ADDRESS EF lt-�St-Lk&L I<-
CITY ZIP TEL. :114 2 C41
APPLICANT TEL.t 2-- '
CONTRACTOR
ADDRESS
CITY ZIP TEL.
ARCH/ENG/
DESIGNER
ADDRESS
CITY ZIP TEL.
OWNER-BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS I.J.
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 UCENSEO 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 RENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($600).):
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 ACONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC.
TORS LICENSE LAW.).
^ I AM EXEMPT UNDER SEC. B. &P.C. FO REASON
DATE lip c)OVINE
LICENSED CONT6 TORS DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER
B(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND
MY LICENSE IS IN FULL FORCE AND EFFECT
LICENSE CLASS LIC. N0.
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 WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE:
CARRIER
POLICY NUMBER
(THISSEC ION NEEDNOT BE 0 PI-ETEOOFTHE PERMIT IS FORONE HUNDRED DOLLARS($100)ORLESS).
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
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.
ob
rn c
p EE NAME(PRINT
OFPERMI EE DATE
U)
Ir
0
ILL.
in
w
Z
0
c
2
0
w
w
0-
CIO
C")
Cr
0
LU
W
U
w
IS�
L..J
Z
U)
W
Xd
I--
W
U
N
in
LU
W
W
Z
CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
PRESS
FIRMLY
APPLICATION 11 I (z PERMIT P/C
DATE NUMBER #
ISSUE TYPE OCC
DATE CONST. GROUP
ZONING SETBAC KS
FRONT RW ^
REAR ^
SIDE/SIDE STREET RW ^
SIDE ^
PROPOSED USE 12 fC'&10'r
v kf? w
N0. DWEL. N0. N0.
UNITS STORIES BEDROOMS
DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION
SFR/ADD/REM
CD Garage/Carport
W Patio/Deck
L Pool/Spa
Z Re-Roof
Commercial
M
Valuation ADJ.AREA
QUANTITY DESCRIPTION FEE
J
U
cc
U
J
w
Z
M
J
Z
U
W
CONSTRUCTION DPI
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
SMIP ' 57
ENERGY P/C
ENERGY PERMIT
RETENTION FEE:
PRE-ALT FEE:
TOTAL FEES i 7' ',d
COMMENTS
RECPT. N0. PAID BY VALIDATION
21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117
BUILDING PERMIT APPLICATION
WHITE-Department Copy,YELLOW-Finance Copy,PINK-Assessor Copy,GOLDENROD--File Copy,GREEN-Applicalt's Copy