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Home My WebLink About18026 .-s* 'Y lC��Y'G"t', �,� CTTY OF DIAMOND BAR DEPARTMENT OF COARvfUNIT'Y&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Faac(909)861-3117 PRE55 �"��' BUILDING PERMIT APPLICATION FIRMLY � JOBSITE � APPLICATION. PERMIT �) /C o ADDRESS��t'If��y�t';�i '�N d� H DATE - NUMBER `�� # � � issuE /, TYPE occ APN LOT TRACT_ DATE `v CONST. GROUP °C OWNER z '�1._. C_�Lt..i i� " ) u 4/`- O �� `�F- � - I i+11"�='{:,_�}. ADDRESS ZONING SETBACKS z CITY ZIP TEL FRONT RW ❑ o APPUCANT J�� t`! ta"i__ TEL. _.___ __ REAR ❑ Z � SIDE/SIDE STREET RW ❑ m CONTRACTOR��,Q�"�y lu Ll a_:.(±J�i i:� SIDE ❑_ Oa CDDRESS�� ZI TEL. PROPOSEDUSE T' . � � -ttA !_('_ :~ . . � �l'-,�.� � r.,.�u�i,:.� C� � oARCHIENG/ V•�t,.. - � -�-.�'r � z DESIGNER � ;j ��a y i a ADDRESS NO.DWEL. NO. O. UNITS STORIES I� BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFRJADD/REM O � I HEREBV AFFIRM UNUER PENALTV OF PERJURV THAT I AM EXEMPT FROM THE CONTRACTORS LI� � Garage/Carpoh W CENSEUWFOFTHEFOLLOWINGflEASON�SEC_1031.SBUSWESSANDPROFESSIONSCODE:ANVqTVOR U CWNTVWHICHREOVIflESAPERMITTOCONSTRUCT,qLTER,IMPROVE,DEMOLISH,ORREPAIRANVSTRUG W patio/Deck Z TURE,PRIOR TO ITS ISSUANGE,AL50 REOUIRES THE APPLIGANT FOR SUGH PERMIT TO FILE A SIGNED w w STATEMEN7 THAT HE OR SHE IS LIGENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- � CENSELAW�CHAPTERe(COMMENCINGWITHSECTION7000)OFDIVISION30FTNEBUSINESSANDPRO- � PDOVSpO � FESSIONSCOOE�ORTHATHEORSHEISE%EMPTTHEREFROMANDTNEBASISFORTHEALLEGEDE%EMP- (!J � TION.ANYVIOLATIONOFSF.CTION7031.5BYANVAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO Z Re-Roof ,. G�� ACIVILPENALTVOFNOTMORETHANFNEHUNDREDDOLLARS(f500�.): O ❑I,ASOWNEROFTHE'.PROPERN.Of1MVEMPLOVEESWITHWAGE5A5TNEIRSOLECOMPENSATION, � COffIR1EfCIflI Z WILL DO THE WORK,AND T'HE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.]046,BU51- J NESS AND PROFESSIONS CODE:THE CON'RACTORS LICENSE lAW DOES NOT APPLV TO AN OWNER OF � PROPERTYWHOBUILDSOHIMPROVESTHEFEON,ANDWHODOESSI:CHWORKHIMSELFORHERSELFOR � Q THRWGHHISORHEROWNEMPLOYEES,VROVIDE�THA75UCHIMPROVEMENTSARENOTINTEN�EDOR m QOFFEREDFORSPLE.IF,HOY/EVER,THEBUI�DINGORIMPROVEMENTISSOIDWITHINONEYEAFOFGOMPLE 2 TION,THE OWNEF�BUILDER WILL MAVE THE E3UR�EN OF PROVING THAT HE OR SHE DI�NOT BUILD OR � IMPROVE FOR 7HE PURPOSE OF SALE). C I,AS OWNER OF THF PROPERTV,AM E%CLUSI`lELY CONTRACTING WITH JCENSED CONTRACTORS Q TO CONSTRUCT THE PRQIECT(SEC.7oda,BUSINESS ANU PaOFESSIONS CODE:THE CONTRACTORS LI- V21ua[ion ADJ.AREA W CENSELAW�OESNOTAPFLYTOANOWNEROFAPROGERTVWHOBUIL�SORIMPROVESTHEfiEON.AND � WHOCONTRACTSFORSUCHPRQIECTSWITNACANTRACTOR(5)LIfENSEDPl1RSl1ANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE Y TORS LICENSE LAW.). � J O ❑IAM EXEMPTUNDERSEC. 8.6 P.C.FORTHIS REASON Q � U � u' DATE OWNER ~ 2 W � LICENSED CONTRACTORS DECLARATION W � I HEREBV AFFIRM UNDER PENALTY OF PERJURV THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER � d 9(COMMENCING WITH SECTION]ooa)OF DNISION 30F THE BUSINESSAVD PROFESSIONS CODE,AND Z w MY LICENSE IS IN FVLL FOfiCEAN�EFFECT 4/ m � LICENSE CLASS�_��_ LIC.NO. l..��1�' j � J VDATE�� CON7RACTOR_��y71.e1��p11__�;�I a. w If�1'� D � WORKERS'COMPENSATION DECLARATION � � ¢ � I MEREBY AFFIRM UNDER CENALTV OF PERJURV ONE OFTHE FOLLOWING OEC,ARATIONS: U N Q � �IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSl1REFORWORKERS' _ COMPENSATION,AS PROVI�E[1 9V SECTION 3]o00FTHE LABOR CODE.FOR THE PERFORMANCE U ¢ OF THE WORK FOFI WHICH THIS PERMIT IS ISSUED. � � w I HAVE AND WILL MFINTqIN WORKERS'GOMPENSAiION INSURANCE,AS FEDUIRED BY SECTION /'� �'`� O 37ooOFTHELABORCODE,FORTHEPERFORMANCEOFTHEWOFKFORWNICHTHISPeRMIT15 � ' / V ISSUED.MV WORKERS'COMPENSATION INSURANCE CARRIER AN�PO'JCV NUAABER ARE'. CONSTFjUCTION F� � CARRIER�.�.��,I4�E(."` �.4,�Jy�� PLAN REVIEW Zaoucv Nun+eea_� - ELECTRIC ¢ (THISSECTIQ'JNEQiNOTBEQ)MF'LEIEDOFTHEPERM ISFORONEHIX�ORED00iJARS(5100)ORLE55). PLUMBING � w MECHANICAL Z I CERTIFV THAT MTHE PERFORMANCE OFTHE WORK FOR WHICH THIS PEFMI'IS ISSUED,1 (} SHALL NOT EMPIOV ANV PEFSON IN ANV MANNER 50 AS TO BECOME SUBJECT TO THE vj WORKERS'COMPE:NSATIONLAWSOFCALIFORNIA,ANDAGREETHATIFISHOULOBECOME INSPECTIONFEE � SUBJLCT TO THE INORKEFS'COM�ENSATION PROVISIONS OF SECTION 3]�00�THE LABOR GOOE,I SHALL FO13THWITH COMP�_Y WITH THOSE PROVISIONS. ISSUANCE Y � �/ 1 p DATE: l��. _ APPLICANT `�� LC�'vv'�+ SMIP w ENERGY P/C J WARNING:FAILURE TO SE�URE WORKERS'COM7ENSATION COVERAGE IS IINLAWFl1L,AND SHALLBE J � SUBJECTANEMPLOVERT�CRiMINALPENALTIESANDqVILFWESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT } DOLLAftS(51oo,Dco),IN AODITION TOTHE COST OF COMPENSATION,DAMAGES AS PROVIDEO FOR IN J SEGTIOY3�OBOFTMELAEORCODE.WTEREST,ANDATTOFNEV'SFEES. RETENTIONFEE: � � CONSTRUCTION LENDING AGENCY PRE-ALT FEE� Q IHEREBYAFFIRMUNDER'ENALTVOfPERJVRVTHATTHEREISACONSTRUCTIONLENDINGAGENCY � FORTHEP[RFORMANCE�JFTHEWORKFORWHICHI'HISPERMITISISSUED(SEC.3091,CIV.C.). W 2 LENDER'S NAME � F- LENpEF1'SAIJUNE55 /� � ICERTIFYTHATIHAVEREADTHISAPPLICATIONAN�STATETHATTHEABOVEINFORMATtONISCORPECT TOTAL FEES I � � � `J w 1 AGREE TO COMPLY WITF ALL GTY AND COUNTV ORDINANCES AN�STATE L4W5 RELATING TO BUILDING � CONSTRUCTION,ANDHEFiEBVAUTHORIZER[PfiESENTATWE50FTHISCOUNTVTOENTERUPONTHE ZABOVE�MENTIdJED PROFERTY FOR INSPECTION PURPOSES. COMMENTS � � /'a {# ��,1�„� — --- m PENMITTEE NHME�PRINT'T - . Q - Vj ,\ cn .._.✓��_ - "I , ,.��. 1.a ' ✓ � .n... ,.'" ,. N SIGNATUREOfP M EE. � AT _ . RECPT.N � PAID BY VALIDATION ~ WHITE—Depanment Copy,YELLOW—Finance Copy.PINK—Assessor Copy,GOLDENRO ile Copy,GREEN—ApplicanYs Copy � - _� �.ry g� �� i� ��rc� � . i'� �f . . . . . . . '&i ��"�`� �� —n��. �,: -�,�,�/� � � � � � � <r _ . �� s - a,��H�'� _ _ z ,� ( Sn!" i R � �.f�6 . 0 �.` r'( w�.�.'� � ��"� ��4 . . . . . . . .. . .. .. . .. ._ . .. . . . .. .. ......... .. .._. ....._ _._ . . � v��,�� m.=' . �r.- = 7 = . , .. .. ... . _ ._ ... . .. ... .. .. ... _._ . .. ...... ..... .. .. .._... ._ . _ .. .. � l� � �a � �a ", ry i s ,.. ... .. . . . . ... ... . . .. ... ... . ... ... . ... . ..... __ .. . ... . .. i �� f JOBSITE ADDRESS I A/d J A HAII APN LOT TRACT_ OWNER C,Lt..i t. F)14-(-jii)3.'I' ADDRESS CITY ZIP TEL. APPLICANT_T fy 7 114 a-i TEL. CONTRACTOR DA KyI(I 0 ADDRESS 7 CITY ZI 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 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).): ^ 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 ACONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). [7 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 7(=)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORCE AND EFFECT /4 r LICENSE CLASS LIC. N0. (V 3�L- DATE C I�..•�CONTRACTOR DECLARATION WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER F'ENALTY 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 FOFI 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_ (THIS SECTION NEEI NOT BE COMPLETED OF THE PERM IS FOR ONE HUNDRED DOLLARS($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. DATE: ! Y_APPLICANT,_IT'vti WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE SUBJECT AN EMPLOYER TD 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 3700 OF THE LAEOR CODE.INTEREST,AND ATTORNEY'S FEES. CONSTRUCTlON LENDING AGENCY I HEREBY AFFIRM UNDER'ENALTY 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 1 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 PROFERTY FOR INSPECTION PURPOSES. PERMITTEE NAME PRINT'. - 0 SIGNATUREOF_M EE.AT ui 0 0 z 0 CQ 0 0 Cn 0 W w Ci W I CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION r IC� �Y'G"tl, PRESS FIRMLY APPLICATION . PERMIT DATE NUMBER ISSUE TYPE OCC DATE CONST GROUP ZONING SETBACKS FRONT RW^ REAR^ SIDE/SIDE STREET RW^ SIDE^ PROPOSED USE T�I r?Jit�It-_['a-P(fit.-C� N0. DWEL. N0.0. UNITS STORIES r BEDROOMS DESCRIPTION S0. FT FACTOR PSF ADJ.AREANALUATION SFR/ADD/REM Garage/Carport W Patio/Deck LL PooVSpa Z Re-Roof 0 Commercial 5 M Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U U W J W a z m J a U Z S 0 LU 7 ,.,p CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES(t-i G COMMENTS RECPT. NO PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy 5/.P/