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Home My WebLink About18175 ,-�. Y x�,r��, �� CITY OF DIAMOND BAR � � DEPARTMENT OF COMMUNITY&DEVELOPIviENT SERVICES 21825 E.Copley Drive � � „° (909)860-3195 Fax(909)861-3117 ' PRESS � ` •.�w» BUILDING PERMIT APPLICATION F LY JOBSITE r^ �/' APPLICATION j ,>� { � �' PERMIT�' , �� P/C o A D D R E __ � » D A T E # i;1' N U M B E K a � ' # � ISSUE r - IYPE OCC APN LI�T TRACT DATE �: '� � ' CONST. GROUP p OWNER Ir 1� ��i �� o ADDRESS Z -'T ZONING SETBACKS Z CITY ZIP__ TEL._ �O y FRONT RW ❑ APPLICANT TEL. REAR ❑ o SIDFJSIDE STREET RW ❑ � Gh SIDE ❑ ¢ CONTRACTOR �'u '� o CDDRES��— ZIP �TEL..7?f� 6 z-g PROPOSED USE' � � � oARCH/ENG/ ��l^ rt' z DESIGNER NO.DWEL. NO. NO. J a ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADD/REM O Q I HEflEBY AFFIFM UNOER PENALTV OF PERJURV THAT I AM EXEMPT FROM THE CANTRACTOPS LI� Gdf8Q0/COfPOfS W CENSEUWFORTHEFOLLOWINGREASON(SEG7031.5BUSINESSANOPi70FES510N5CODE:ANVQTVOR (n ZCAUNTYWHICHREQUIRESAPERMITTOGONSTRUGT,AL'ER,IMPROVE.DEMOLISH,OFREPAIRANYSTRUC- W patio/Deck w TURE,PRIOR TO ITS ISSUANCE,AL50 REQUIRES TNE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PFOVISIONS OF THE CONTRAGiOPS U- � � CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 0F THE BUSMESS AND PRO- POOUSpa O FESSIONSCODE)ORTHATFEORSHEISEXEMPTTMEREFROMANDTHEBASISFORTHEALLEGEDE%EMP� (� U TION.ANYVIOLATIONOFSECTION]031.SBYANVAPPLICANTFORAPERMITSUBJECTSTHEAPPIICANTTO Z Re-Roof � ACIVILPENALTVOFNOTAACIRETHANFIVEHUN�REDDOLLARS(f50D).)� O ❑I,ASOWNEROFTHEPFiOPERTV,ORMVEMPLOVEESWITNWAGESASTHEIR50LECOMPENSATION, � CORIfi10fC18I Z WILL DO THE WOiiK,AND THE STRUCTURE IS NOT INTENOED OR OFFERE�FOR SALE;SEC.]044,BU51- J NE55 AND PROFESSIONS WDE:THE GONTRACTORS LICENSE LAW DOES NOT APPLV TD AH OWNER OF � PROPERTYWHOBUIL�SORIMPROVESTHEREON,ANDWHOOOESSUCHWORKHIMSELFORHERSELFOFl m [[ THROUGH HIS OR HEfl OWN EMPLOYEES,PROVIOED THAT SVGH IMPPOVEMENTS ARE NOT INTENDED OR W OFFEREDFORSALE.IF,HOWEVER.THEBUILDINGORIMPROVEMENTISSOL�WITHINONEYEAHOFCOMPLE- � 0 TION.THE OWNER-BUILDEk WILL HAVE THE BURDEN OF PflOVING THAT HE OR SHE DiD NOT 9UIL�VR Z IMPFOVEFOR7HEPURPOSEOFSALE). _ ❑I,ASOWNEROFTHEPR�PERTV,AMEXCLUSIVELVCONTflACTINGWITHI.ICENSEDCONiRACTOFS w �TO CONSTRVCT'.HE PROJF.CT(SEC.]044,BUSINFSS AN�PROFESSIONS CODE:THE CONTRqCTORS LI- V81UflIlOf1 ��c/ ADJ.AREA_ Q W CENSELAWDOESNOTAPF_VTOANOWNEROFA7ROPEATVWHOBUILDSORINPROVESTHEAFON,AND = WI-qCONTRACTSFORSUCHPROJECTSWITHACONTRACTOR(5)LICENSEDPURSUPNTTOTHECONTRAC- QUANTITY DESCRIPTION FEE ~ TOqSLIGENSELAW.). Y J � ❑I AM E%EMPT UNDEq SEC. B 8 P,C.FOR THIS REASON � � � � DATE OWNER ~ Z W � LICENSEO CONTRACTORS DECLARATION w I ¢ � 1 HEREBY AFFIRM UNDER P=NALTV OF PERJ�i1V THAT IAM LICENSED UNDER 7ROVISIONS OFCHAPTER � ' d e(GOMMENQNG WITH SEGfION 1000)OF DIVISION 3 OF THE BUSME55 AND PROFESSIONS GODE,AND Z `X MV LICENSE IS IN FULL FOFCE ANO EFFEGT. m �} � � LICENSE CLASS �'' LIC.NO. �� ` J� � U DATE�Z CONTRACTOR a W � WORKEAS'COMPENSATION DECLARA N -� � a � U N IHEREB�AFFIRMUNOEflPENALTVOFPERIURVONEOFiHEFOLLOwINGDECLARATIONS: Z Q � IHAVEANDWILLM4INTAINACERTIFlCATEOFCONSENTTOSELF�INSJREFORWORKERS' _ CAMPENSATION,AiPROVIDEDBVSECTION3'loaOFTHELABORCODE.FORTHEPERFORMANCE U Q OF WORK FOP WMICH THIS PERMIT IS ISSUED. � � ' s w �A4D WILL MAINTAIN WORKERS'COMPENSATION MSURANCE,AS REOVIRE�BY SECTION 1 � }� ��. Q 3�oaoFiHELAB�RCODE.FORTHEPERFORMANCE THEWORNFORWHICHTHISPERMITIS 1�' _ ISSUED.MV WORKEF$'COM7ENSATION I AI j/Ij.ARRIFR AND PDLICY NUMBER APE: CONSTRUCTION � � ^ 7C - r PLANREVIEW --___.__-_ CARRIER� Zroucv uun+eEa__�� ''� � ELECTRIC ¢ � fiHISSECTIOIJNEEI�NOTBECOMPLETEDOFTHEPERMfT15FORONEHUrDRE�LAlM515tW)oRLESS). PLUMBING w MECHANICAL Z I CERTIFVTNAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I (,�J SHALL NOi EMPLOYANY PERSON IN ANV MANNER SOAS TO BECOM=SU6JECT TOTHF � WORKERS'COMPf�:N5AT10N LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOUL�BECOME INSPECTION FEE � SUBJECTTOTHEWORKERS'COMPENSATIONPR ISIONSOFSECTID �OOOFTHELABOR � � _ ��I` � CODEI§HALLFOHTHWITHCOMPLVWITHTHOS ROVISIONS. ISSUANCE -__- � /'�/,'�� SMIP p DATE: L/Ll�� APPLICANi: w � � ENERGY P/C J WAFNING:FAIWRETOSECUREVJORKERS'COMPENSATION OVERAGEISUNLAWFUL,ANDSHALLBE J LL SUBJECTHNEMPLOVEftTOGHIMINALPENALTIESANDqVILFMESUATOONEHUNDREDTHOUSAND ENERGYPERMIT - DOlLARS(5100.000).IN A�DiTION TO THE COST OF COMPENSATION.DAMAGES AS PROVI�ED FDR IN J SECTION 370B OFTHE LAeOR CODE,INTEREST.ANUATTORNEV'S FEES. RETENTION FEE: � � CONSTFUCTION LENDING AGENCY PRE-ALT FEE' _. -- ._ ._. O � I HEREBV AFFIRM UNDER�ENALTY OF PERJURV Tf{qTTHCFiE IS ACONSTRUCTION LENDING AGENCV � FORTHEPERFORMANCEOFTHEWOHKFDRWHICHTHISPERMITISISSUED(SEC.3091,CIV.C.). Z W S LENDER'SNAME � F= LENDER'SADDRESS_ w �GERTIFY TNAT I HAVE READ THIS APPLICATIONAND STATE THAT THE ABOVE INFORMATION IS CORRECT TOTAL FEES r �F� � I pGREE TO COMPLY WITFI pLL GTY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTFUCI ION,AND HEIlEBV AI.THORIZE REPRESENTA VES OF T 5 COUNTVTO[NTER UPON THE zABOVE-MENTIONEO PR TV FOR INSPEG ON PURPO 5. COMMENTS ___._. � �Cd � � �J `�� PERMITTEENA (PR�1 /J� �/ Q /� �, cn S�, u � .. pA�� t _ � RECPT.NO. PAID BY �� VALIDATION r �� ~ WHITE—Department Copy,YELLOW—Finance Copy,PWK—Assessor Gopy,GOLDENROD--File Copy,GFEEN—Applicanf's Gopy '� „�s �as �i �a r ��'�3-rt- a�'� ��' ��r �� .. . .. �`�, � . . < , . . . , � ad. �u.n��°�� .�„ � .� �� ,. s F s� �� _ � � �� ' , % ,�, �. . ��.�.,,��_ -` �� a �3 r� ' � � 5” ._ ... . _. . _ _. .. .. ... ._ . . ._ . . . ....._ . . .. .. _ . ... ... . = 4`� ri€� ��. N � ��,�� !�. � ,�� ik ��£�� _ = a � �s �� t� _ ` � �d��a� ��&�'�'Ad��` � ,�� M— ��z � �i `� ��'ti��, � �' �� _ _ � �, _, _ _ �� ,�� h � �' _ __ � � �� wi�� , ;� �� i� �„ �� _ - d k `� �,�'��m�� ,��r��`��'' _ � � - r .. . . . . ... ,, � � #8 � �. �a �- . s k 5p R'L 5 b � �� ^ �� r � �'�, ;' �dc "'t�r`� k ,t�m� n,� ;� . .... .. . . . ... . .. .... ...... .. .. ... _...._... . .. � �� ,� ... ... . . a � if� � ��` ��i�:t. . � . _.,.u�-, . �?�'��"S�e �4,�,; .�` .. . . . . .. . .. . . . .. ..... . . . ._ .... . _. . .. _ .. .. . .. . vi JOBSITE i"' I= 0 Z 0 Q W Q W C3 Z J m Q ADDRE85�� '� CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION � APN LOT TRACT OWNERr�� '\��-� ADDRESS y Z_' CITY ZIP TEL.S APPLICANT.,TEL. CONTRACTOR ADDRESS CITY �% ARCH/ENG/ DESIGNER ADDRESS CITY ZIP 2 TE�I�Z-g ZIP TEL. OWNER-BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSELAW FOR THE FOLLOWING REASON(SEC. 7031.5 BUSINESS AND PROFESSIONS CODE:ANV 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(C(MMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONSCODE)OR THAT FE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED E%EMP- TION.ANV VIOLATION OF SECTION 7031.5 BY ANV APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MCIRE THAN FIVE HUNDRED DOLLARS(f500).): ^ I,AS OWN ER OF THE PROPERTY,OR MV 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,HOW EVER,THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE- TION,THE OWNER-BUILDEF 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 EXCWSIVELV CONTRACTlNG WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC. 7044, BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- CENSELAW DOES NOT APPi_Y TO AN OWNER OF A PROPERTY W HO BU ILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS W ITH 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 e(COMMENCING WITH SECTlON 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MV LICENSE IS IN FULL FOFCE ANO EFFECT. LICENSE CLASS DATE L :> � Z WORKERS'COMPENSATION DECLARA I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TOSELF-INSURE FOR WORKERS' COMPENSATION,Ai PROVIDED BV SECTION 37000E THE LABOR CODE, FOR THE PERFORMANCE OF WORK FOP WHICH THIS PERMIT IS ISSUED. AND WILL MAINTAIN WORKERS'COMPENSAT ION INSURANCE,AS REQUIRED BY SECTION 37000E THE LABOR CODE,FOR THE PERFORMANCE THE WORK FOR WHICH THIS PERMIT IS ISSUED. MV WORKERS'COMPENSATION I ANC�RRIER AND POLICY NUMBER ARE: �/-C� r((((((��_-- CARRIER POLICY NUMBER (THIS SECTION NEED NOT BE COMPLETED OF THE PERMR IS FOR ONE HUNDRED DOLW7S(f100)OR LESS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN ANV 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 PR�ISIONS OF SECTI0�700 OF THE LABOR CODE,I HALL FORTHWITH COMPLY WITH THOS ROVISIONS. DATE: Y L APPLICANT: WARNING: FAIW RE 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(f 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�ENALN OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC. 3097,CI V.C.). 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 REPRESENTA VES OF TIiIS COUNTY TO ENTER UPON THE S. ABOVE-MENTIONED PRO,(A6tiN FOR INSPECIJON PURPO PRESS FI6tMLY WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy