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Home My WebLink About10674 ' _ _.�*c�`.___ CITY OF DiAMOND BAR �� I TlEPAR7MENT 1?F COA�Ml1N1'1"Y 8c DEVEIAPMENf SERVICES c; 2I825 E.Copiey Dnive (4d9}E60-3195 Faac(909}861-3117 PRESS ."""'j BUILDING PERMIT APPLICATION FIRMLY Jt?BSITE ��,�� APPLICATION P�RMIT�� P/ a AdDRES5_ Z ��,�c:!7�t ��F � � p l�'��.—� �' DATE I I tJ�- Nt1MBER�__� � � APN_ Li7'f T CT €SSUE � /ta /��ry TyPE pGC }-�' f}A DATE t j U"7' CQNST. GRfJUP p OWNER _,.�ifr�-�ts�lt ��E%fl'�_,.___ p ADpRESS�/f_,�._, i'• a i'f= � ZONING 8Ef6ACKS S C(TY,�1��,r� n�l t"�� IP �t-�� TEL ' -�� -��. FFONT RW C7 REAR ❑ APPLICANT TEL. S1DElSlDE STREET RW ❑ � CONTRACTOFI l'�.+�`'J.t '� y�!� ��;<S s.G -t- SIDE ❑ � ADDR �J a. _ , c_ � RROPOSEDUSE �%'7cfi f.,-o i?e=,r�� f- � 7rzX � GlTY �:/,� ZtP t��° `7EL(4`�LS'..f•'� � i� :c [9i aRCWENGI ,"��, DESIGNER� n. ADDRESS_ NO.DWEL. NO. (�ip. � CITY ZIP TEI. UNITS STQRIES BEDRt70MS w rtn DESGRIPTION SQ.F2 FACTOFi PSF ApJ.AREANALUATiON p� OWtJER-BUILDER 4EGLARATION S�� O 1 HEqEBY FFFlflM UNDER PENALTY 4F P€RJl1RY TNAT t M!EXEilPT ti1OM THE Cf�NTRACTORv L4 (jgf8Q6✓C8[f10A W CENSEUWFOHiHEF7LLOWMCRF.ASONfSEC.�0.ai.68USWE35MDPfqFE5510NSGWE:ANYGlTY6R (�/� U CUS1NTl'KHI.tiREOUfiIESAPERMiTTDCONSTRUCT,ALTEN.IMPfiOYE.UE4pl.I5H.OpREPNflANVSTRUG (� W TUflE,PRIOH TO RS SSUANCE.AI:A REWIpES THE MP1.iCN1T FOR SUqi PEflMiT TO FllE A 5IGNED W P8tiO1DBCk � 57ATEMENT THAT NE pR SHE IS UCENSED MlflSUANT TO 1HE PFIDVISIONS�TNE CX7MTNACTOR9 Ct � � CEN5E 44W�CHAPTER I9�KbMMENCMG WI7H SECTIGN 70W)OF DIVI510N 30F iHE 8l1SMESSANO PR6 PooVSpa 0 FESSpNS{%7DE}�i'iTHATitEqRSHE{SIXENVTritEREiROMMA7NEBAS15FOR7NEpLLEGEDEXEAIP• (� � raN.�wrv�autnna=sEct+w+�e.sevnnvnrai.�csxTFOFtAv�antstre.�ectsn�;aavt+cnvrTo Z Re-Roof � A CML P�NALTY OF ND'f YOFlE TFiAN FNE 11UNDREO OOlAAHS{SSQD�.): � Cit.tSCMTiEROF'1HEPROPERT;ORMVEMI�IOVEESNATHl4AGE5A5TNEIR5f.1LECOMVEN$ATION, {�`pmm8(CiBt � N7LL f1D TNE MKJRN,M'O'F»E STRVGTURE 15 NOT BiT�MOED OR OFFEREB F6R Sl0.E�SEC.7aI,&,ISF � � NESS AND PqOFE55�ON5 COLIE:'ME GCNdTMGTORS LICENSE I.AW Of?ES N07 APPiX Tp AN pYNER� j PRDPERTYNM1iOBURDS OP 1MPRDVES THEPEQlL M1D WNO DOES SUCH VY�DHN HIMSELF oR HERSElf OR � 7tfF1WC�HNiSORMEftGNt7EMPtOYEES,PP6YIDE6TUT5UaiuAPROVEMENfSAREN07wTF?iDEDOR m OFFEFlEDibRSKElF.110WEYEF�THEBUYDUNi Wi9FPRbVE/AEM7iSSOLDYW'fHAiONEYEAflOfC6MR.E� z TION.TME OWNER�BUILUER WILL FIAVE 7HE BURPEN OF PpoVIN(i TNAT NE 9R SHE�W NQT BUILD OR � wPROVE FOR THE PURi'OSf#S�iLE}. • . O f,ASOYMEROF 1t1E PA[WERTY.N1 ExCtU5lVEtvGpNTMCiiNGMYTH llCENSED CONTMCTppS � ro carsraucT n��r�a�cT�sEc.�o...auswEss wHo rnocesswNs aaoE�e cavTancmis u- Vabation_ ` 4 ADJ.AREA W GEt6EUWpOESNOTAPPLYTOANOtNlEROFAFNbPEqTVWlIOBUNDSOpNIPRUVESTMEREON,ANO � NTIOp]NTRACTSFOq$iX]iPR6,lECTSYa1THACONTRACTOFt(S}LiCENSEDFUPSi,IpNT70TNECONTRAG Q�T�]'Y ES`(,A�PT�(�(•a FEE x TOilS LIC915F LAW.� �� p 1 AM EXE1A%'VNDER SEC. B.8 VC,FOH THIS RFASCIN Q V � - � DATE _ ONMER � Q W r�,{ UCENSED CONTRACTORS bECLARAT�ON � LC 111EREBV AFFIflN LNUER PENAITY OF PEAJURY THAT!AL t1GENSE[?41!lOER AR7Yt5pNS OF G}IAFTER � (L 11(COMMENCWG W17M SEGTqN 700D)OF DNISqN 3 oG TWE BU51NE5S ANO PpoF�5510N5 C�OE,qMp Z X W LiCERSE K H FUId WRCf AND EfFECT. LLI r.7,�( / ? � Q LICENSE GIASS/��_„�,_„__,,,_tiG.N6 �•..-.„/-��+�,� � U DA7E r�__,,,_„�.,�_„_��/�L..+ C4NTRACTOR #a =,��1 � � �E�G.{`"�� d W � � W6FKERS'COMPEtJSRTIphi DECI.ARAI'tON -+ � IHE fIF'WUNDEflPENAUYOFPEA.lLIRYONEOiTHEFOL40Wk1G4EGtAMFpNS: Z � �WmENR3WILtM+JNTAIN�4CfRT�FlCaTEOFCONSENiTo9ELFW5UHEFORWORKERS � �yd.�PEN5A7NNi.AS PflOV�DEQ BY SECTioN�oo OF THE tA84R COpE.FOR7HE PERFORMANGE � d %�FTHEWSlflICFORWHICHTMISPEW.9T1$lSSVEQ. .� Q� �� i NAVE ANtt V/ILL MIUNTPM WUflNERS'C4AMPENSATION IN5l1FANCE,AS RE[ll11REb BY SEGTpN "� (� � 3JnDt1FTNEtABONc.'WE,FOFSTFtEPERWRAIANC£pFTHEWOi1fCPoftWMIGHh115VEflM1T15 ~ / � � 4 ISSUEb.MY MORKE R/S'(C,.�ON�N50.T�ION IkSUAANCE C0.flR�R AN6 Pq.IC7 KK/M�ER ARE: �ON$TRUCTI �i � � GAFiRiER ��y_�- i'Z/,✓!'�tm.f-_ ._ 4Z, ra.Icvtx�aEr+_.,,1_/��3 ' L a' ELECTRiC ,_. .. c� 0 (tte5s[cTpnhkm�qiaE�'rma'�n+Ea�'rswtiar��DDOu.usls+cqat�.�ss} PLUMBING . , ZICEfRiKYT1ATINTIEPERFOflMANCEOFTHE'1VDflNFOflWF1�CNTHI4pEAWTt5155UED.1 �EC1'IANICAC C!S SHALL N6T EMPIOY ANY PERSON IN ANY MANNEH SO AS TO BEC.CME SU&1ECT TO TNE � � WOR14ER5'C(MAPENSAFqNUYlSOGCAtii0iW1AAN6AOREE74NTiFi61N%ri.DBECONE 1 FEE r SUWECT TO tNE YYORKERS'COMPEN5A VISICMS OF SfiC710N 3TW Of TFtE tA80F �p � CAf1E.IyHALL WRTIIWITl1 COMPIY Wffl� 6E�[IONSqNB. I UA�+1� �- t,� � _ � �/3' , ' �,_,� c , a wre:✓� � '_ nvc��ru�: » " �� , > J wWAflNIN0:FA0.41HETpSECUREWOfiK@RS`� P'EN,SATIONCAVEPA4EISUNLAWFUL,ANDSFIALlBE GYPM. ... V„ St16IELT AN EMPLOVEHTo CRIMttiAL P TIE5 ANO CIVN.FMES UP TO ONE NUNDRED TlqUSAND ENERGY PERMi7 00(lARS(;too,00D),W l�DptiMti TO T OF COMPENSATqi1.OMiACES AS PpONDED/OR IN - ¢ SECTION3lbspFTHELABOP',(X1DE, ERESf,ANDATTDANEY'SFEEB RETENTIONFEE: I. � CONSTpUCT�ON LENDIN6 AGENGY PRE-ALT�EE: „ � IMEREBVAFF1qMUNDERpEA1AL7YOFPEFWflYTMA7Tt1EREi5ACON5TW1GT10Nl,ENDiNQAC,ENCY F4R THE PEPW qMANS;E OF iM8 wORK FtlR W1nCH'MIS PER1M71S�S5UED{5EG.]49'1.CtY G}. W — � IENDER'SNhME ._..... !- LENOERSApDqE55_� � � ��,,,a,��,�p�,�s�T�,�s,,,�ET�„T�„�»,w�,,,��s��T. TOTAL FEEB d iAGf�E T6 COMPLY N71H Al tXiY AND COtINTY OAbllUNCES AND 6TATE UWS RELAT7NC TO BUKDIN(i � CqNE7HUCT10N,ANRMEflEBY�AUhYNYZEREPf1E5EtiT�TNESOfTHMCitUNT'TOEMERUPONTHE F Z A6DVE-MEMlONEDPROVER7VC-0RINSPECTIONPU0.POSE$. COMMENTS � � � `^� �� Q /��/,�-� � �"s.L�is.d_!_t_.�7 �f� !c�G' `� — � P��_�- ��" �/�,/�� pFPEAlAfTfEE �ATE _ � RECPT.NO. � PND BY ��"� YAllCTATION.. ~ WHtTE--Departmant Copy�YELLOW--�Fnence Capy,PINK-Asmessor CopY�GOLDENFiOD-Rls Copic GREEN-APD��M's CoaY 4 ��`'� �� I�� t�� . � - � � : � � _�� .��:��?�� ._�__ _. m_. _ __ � � � -� �.�r�� , _ _ . �=��{� r�=�� ,�_._ . , �.____ _ .__.___ _._---- �___,�__ _ _ _ � ___.__�__._ �__�.___ . � ... �. _ ._.._�_ .__�___ -_________ _ ___.___ __ _�._ � � r�e:i ��u€ �e�� _ _ t,��:�� .�c�r �`� _4 , __ _ : _ _.. _ _ _ _ _. _.. _._ . _ ;��}:�,.�sst�r��_��e<,�,�; t�¢�4��_��E��,�� , __ _ _ ._._. . . __ _...__. . ... ._._ ;.._ _ ......_ . _.__.._, __.._. . _... ___ _.. _.... }�;?:��3�;�sr�I�>�: : i t='�i�F��>�� rrC�!IIt�C��tT€�':` : ,._...__ ___ _.... __.. ._. ____ _..__ _...._.. . _..... � _ . .__.. , o-�f�i��;�:�,�� -- F;�?�PL.�.�:��'��ICF'E��11�': . _ �}bt _Y ' k�iStIL.,C FrrEC I"iT f'C��1�`'ES�`f�EL9 _ _. _ _._ _- _. _ _.. _ _.._ _.._ _._. __. ��..E��""""�}�r49�"��? �� j ��.�,"1��1�.t+ . ._ ..^r . .._ > _.._ .... . ...__. _.._. . ...... . ... . ...� .....g, (,� ._.,.. . __ ..._.._ _�..._.'_""___.._' [ .'1tk�:,,Ftr<_.t �f��...�;'t)L...'I.��'� _�iil��Y...x;�i��t'.a�'��ti$�. ),^ ..... .... ......._ . ..._,__ ....__ . __ --__._ -�r}{._ p _ ..._.._. . ....__ ..._. _. . . .. _...,_ �i4�{«l�`� t�l' �", .. .. .CF'��1.�"�'5��..� -,.«.. ..__ .._._. __.�«e... . __..___. ....... .........._ .. ..._.. . .. . .._... ... ....,..�. �.____' _-....�..�........._�......... _....._._.__.�.�.�_.�.. . �:xt>k�C��t�-i�s-��1"4� � :��°:a.i�-,'�"`a _ .Y____._.v___�__.____,._,__�:-_-_.__.�.____._______.__.____ __�. __.,._._�.�,��_. —_�_._.�___,��_ i�C."-,.�±✓�;��.�_��titF � ��;i�.r..r�`r�:amx�i;�;'s,��f: � � � �.�u�l�� .t�:.,'�v3E'i�e{'' __._ _._�._. _______, ______ �;€�'��;�?aa�Pt�_3�;a _ _______. _� _ __ _ �_______ . ____ ,___..__ �"� �.;i'<� r 1'.�-s €.` �`�t,"L t,E�T�it.� j -- � __ _ __ ___ .:__� ___ __ .__.__ _____.._._. __ _,____ „�_ .__ __ u_._.._. _ __..�„_________ _____.______r_____ ..;T �.,�tt��t€�IE�� F'f��t.��1CI,�� i __�_____�.._ �� _ _. � � fuFt L il��l,+L��"1�,�1'� _ fi��C?L�i 4FiL __ . __.�_.__ ��____�__ �t ciI�� P��C�I 7��d ��f`� �'41"� ��9�� . _ __v _ ___ __.�._ _ �._ __._ __ _ _ __ ___.__ _�. _____ �C°� �i'=<�,t E h��.1�i�ti ��"��1�1�Z�� _ . . . __._ _ __ _._.... _._ _.... _..... __ ____.. . _____ __ , � ��t'("F: F:�1�L E��:��. � ; ___. _ _.. _... _. —t .... _ �aE��`1C" ,.�� Ll?�1t��C°A��I�F3+� _.. � . _ i��.�� t .,. __ ��4 51�1�I�"�'` _, _ _._. _. � �t.�r�a r:�� 4 ( F i�1�L�t,sl�i��Ies__._�_ _ --..._._._. __ �r- __ ___ _ 4 i�;s�l_ �I� T �~�> C�, (,�.__. � (�c ��?`.i�{N�t? ; __._ ,__ ___�_ . _; �._._.._ _.� __._._. _ . ` l��.{._r,d-��Ii1i� }i�A�.l"�t,eEf�T �it�it� ; 1 _._ _._ ._�._._ __.�. _� ______ _.___ _._.. �_ --- .. _�.__ . .— -____. - -_.__ __ --�__.___.-----___. ___..._ _ __.. __.. �. � � �1��.4 t�E� ��€'�;v � � ;Ca�,� t=E�S P0.1� � _._ �.�,_�____ �..�..__ r____�.� .-- —� � ___ I E�.L.;'Lt,�„"�il��: ERi�€?�Y ' � _._ _ _ ��_____.__._ _____.�.___._ -- --a-- } ' � . ____._____� ____ --_ __.___.._�,� , __._. _ � ____� � • � � . _________:__.._____ __�_ ____. __ �____.__.._.______._______.___.� ; } � ' ��:�"�C��`:� __..�---____.._._.___,_______.�_____._____�__._ � � � ._____. .. _.__---._ __ _.._�:_._.._. ..._..�_�. _..._._.._.. .. �. __.____.___.____._._..,__ �__._. ___ � _ ._.._______w___.__.__. ..._ ----_._ � _ . ___._ � __.__ _. _ _ __ __ � _ __. _ ___ _i __. _ , — � _. _ . _ __ _ r _ __. ..__ ._. ___ _ _ _ _ _..__, . _ _-- ___ ,_ __ _..... . . ...... . � _.___. _._._,.__ _ __ ___..�.. ._.. � . _ �_.___ � _ __. ___ _______ ___ ____._ _�__.__ _ � . _ , �. ,___ .. ___ _ . ____ _.__ _ ._._ ________ ' _____ .___.___..____�._ __ ___._ __._.__ ._ � � _ _..._. --_____._ _.__ ._._ __.. ___�__. _.._.__.___. _� ____.__..._._.. _ I , _____ __ _ .-- -- ----_. _______.._____ _..__ ________. ___ __ ____.� 1 ;__._. __�_ --_ _____.___._____ _._____ .__. _.___�_�.��_.. �____ ________.� __�_ _�_ ._._ _._.____ .. _ � �u�?�cs r�,�� _._ ..� __ _ �w�F'€�1�`1�,��(�E __._.._ ____._-- — --- -- _____.. _. .. :.. � i�� Ilr�<<� „;� li fii�ll�l �yl _ _ ,e:. . �f�i�i �i��,�q� r '�i�� i pui,��Ai'�S�a�� __�._ _..__.___ _______�._,___�_._______ ___._ _____________._ — �. I I — I ____._._______.._____�._..__.________ ____________.�_______.___..._..,_..__.___V_.___ _.______w.._.._ ___ _ _. ____. _._ ..._. _..._..__ _....._._ __._ _ ._... _. . _�._.... _ _..__..._ , __. _ � ___________.____�__ _�___.__.___._�_________ __�_______�__._____..___.____._.___ �__�. . i � � Ft�MONA UNIFIED SCHUOL DISTRICT �(p g'L�� CAPITAL FACILITIES PI20GRt#M MANAGEMENT Form Number 804 SOUTH GAREY AZ'ENUE • P(}MC?NA • CALIFORNIA 917bb �'`ert%f'ication of Campliance �Jt��4-N 1�'��4-tal�-,�7� lf Z�� 0��`?�3G� t�ppiicant's Name �„ piicanYs one No. ��4�2.__��ill�' ,�lv�- �pt�c..j ns'� G4. `�'D 2. 4�c� AppiicanPs Maiiing Adc�ress (Include company name,it applicable.) ✓ ✓ I f�'U�/�s 4G AppiicanYs Signature Dake of nature Tiae applicant executing rhis de�^laratipn eerai�Zes under Fenalry of perjr�ry that:{I}t{xey are tlze Owaer anc1�'or Devetoper or they are autha�ized to sign on beJzalf q(the Otivr�r ancUor Develo�7er, (2)that tf�e infarrrtation prnvitted is irue eznd accurate to tlte best of the Owner's andlor Developer's knowledge, {.?)the {?wner atuUor Developer witt,fite an amended certi�r.atiort of comptianr.e and pay tite additional amount,r due i�'Owner unrUor Devedoper inereases fhe nurl�er of dwelling units r�ndJnr square.f�otage after the building permit is is�sa4ed or if the initial detenninnEion of unus ttrad/nr square,fr�otcege is fou�ut tn be i�rcorrect,and(4}iltiey haue rerad and fully understand tfi is side artd tlte rever,se si�e of;his d�>cument induding the 90-day protest perind poated r»z the reverse side of this dncu�nent. _._,�j��-htp h!��S �/' G�rrvs7"/�•'v�-�-�'-^�1 �" �Z� � C��S" 2S 3lv Owner's/Develop r's Name Ow�er'sJpeveloper's Phone No. ___�`S'`�2 �. �"l.�'��/"r-�' �Y�' . t�.�-�.v-�z �--.. Qwner's(DevelqpePs fv3aifing Address Develapment 7ype and Fee Schedule Check apyropriate box(es),,fill ira the fee[�er sq.,f[.and circle the fee leve[in ef'fect. ❑ Residentia! $ �►��(sq.ft. {Levef i - evel -Levei 3} Exempt status justification/notes: ❑ Manufactured/Mobile Homes$ lsq.ft. {Level 1-�evel 2-levei 3) _ ❑ Commerciai/Industrial $ /sq.ft. ❑ Senior Citizen Nousing $ /sq.ft. {See reverse side of sheet.} � ❑ Exempt $ -0- /sq.ft. (Providejustification.) FeB C81CU18tIOt1S Lach Certif'u�ati.on q�'CorrylLtt�e,�rnz t�s far five/S}prr�jects rzia,xirrzum. F}se addittona[forrns fvr additional projects, ,. �" 1��0�.5` --�"?�'�`�` �3• x.�,"' 793 sq.ft. � %�'?;7..2.,5' Trar,i No./Lot No./Address Plan GhsCk No. Fee per sq.ft. Area Fee 2. $ sq.ft. � Tract No./Lot No./Address Plen Check No. Fee pe�sq.ft. Area FeB � 3. $ sq.ft. $ Tract No./Lot No./Adtlress Plan Check No. Fee per sq.ft. Area Fee � 4. $ sq.ft. $ Tract No.i Lot No i Address Plan Check No. Fee per sq ft. Area Fee �, $ sq.ft. $ Tract No.I Lot No.l Address Pian Check No. Fee per sq.ft. Area Fee .�� TOTAL UNiTS: TOTAL�EES DtlE $ � � �77,2�" {Thi5 forrn only.} — (This form on(y.) �1£�/ -'�'�►�1' I/�ola� _ DistricUCFPM r ed Last Name�Titie} Date � Reeeipt of Fees Thfa'i.s to eertify that aCl,fees due to tice Potn�nu Un�f;ed Schpol District t<nder applicublw prvvtsaons t�f the Govenzment Code and!he Edrxcation Co�ie, as prerequt'site tr� the i,rsuance oJ a Builddng Permit by tli� CiGy/County, laave been r�eeeived. Based c�r7 ahe irifc�rrnntion presented above,thzs Certi�catfon<�f Coraplfance ts hereby ezesuted. � �,�� '� � j R� � Receipt No. � Check No. � ,� � - C31 3t��1 DisiricUFisca Sa�v�ces (Signature and Prinied Cast Name/TiNe) Date See reverse side fnr G:enerat lraformation, Senior Citizen Hausint�,Pa�ment of Fees.lVotice-Protest Periad and Anneuts Process. Distrilution ot Copies. W hita-Gi2ytCounty, Yeilaw•DistricUCFPM; Pink-DistricUFiscai Services; Goidenrod-OwnedDeveloper. Revised 71Q3 GENERAL TNFORMATION t7n November 4, 199$,SB 50 became effective.This bill grants California school flistrrcts the authority to levy faes in excess af those authorized by Government Code Section 65995 (Level 1 Fees}, if the district meets certain specified tests and appraves a School Facilities Needs Analysis. Alternative Leuel 2 fees tnay be levied when skate bond itmds are available for school constructian projects,and Atternarive L.eue]3 fees may only be levicd when the State Atlocatian Board certifies that it is no langer appraving apportionments f'or new construction due to lack of available funding. The [3aard of Education approved the Schaoi Facilities Needs Analysis and adopted a resolution ievying the atCernative fees vnder SB SQ, and has approved the fees on cammercaalfindus[rial developmcot by separate resolution. Copies of the resolutions and the SChool Facilities Needs Analysis are available for viewing in the Capital Facilities Program Management office. SENIOR CITIZEN HOUSING ' Pcr Gavemment Code Section 65995.1(c}, if a senior citizen housing projeck is]aker canverted to non-restricted use,the applicantldeveloper who is seeking the change in nse wi11 have to pay the ciifference between the current residential fee and whai was paid far dle senior citizen hoasing. PAYMENT OF rEES State law��rohibit� a city or caunty£rom issuing a bnilding permit unless the loeal sehool district has certified thak the application is 3n compliance with the Dislrict's cotlectian program for fees assessed deve]apers.The procedure for obtaining the reyuired certification foilows: ProiecC Pla�s-A set of praject plans stamped by the governing city or caunty building department,and valua[ion eeceipt indicating calculated square f��tage and ptan eheck number,must be reviewed by the District.The address follows: Gapittil Facilities Progranz Managerraent,Pomona Unifed Sehootl3istrirt,800 South GareyAvenue,Pomona,CA 92766. CaIculatin Area foa-Residentral ProjecCs - The District(evies fees an existing reside;nCial construction only if the resulting increase in assessable space exceeds 50fl square feet after deducking any loss of assessable space in the same residential strneture as a result af the same reconstruction.All assessable square footage in new residentiai structures is subject ta the fee levy."Assessable space"means all square footage within the perimeter af a residential structure, not inGluding any carport, walkway, garage, overhang, patio, enclased patia, detached accessory structure, or similar area. Residential projects aisa include the initia3 locatian,installation or occupancy af a manufactured home or mobile home. Caiculatin�Area for Commerciallindustrial Projects-The chazgeable covered and enclosed space of commercial or industrial construction shall nat be deemed to include the square footage of any structure existing on the site of that construction as of the date the fust building perrnit is issued for any portion af that co3istruction. "Chargeablc covered and encTpsed space" means khe covered arid enclosed space determined to be within the perimeter of a commerciai or industria} structure,no�including ariy starage areas incidentaJ ko the principal use of the constructian,garage,parking structare,unenclosed walkway,or uCility or di5posal area. Available Hours for Veritication-CFPM staff will verify project development type and square faatage and complete the Certification of Compliance during available hows. Available hours are from 8.30 A.M, - IZ:00 P.M. and 1':00 P.M. - 4:U0 P.M., Manday through Friday, except District halidays,fJther eimes a��e available by appointment by cailing(4f?9)347-4$00,ext.392Q. Available Hours for Pa�ment-Fees due are paid ta the District during available hours.Available hours are from 8;30 A.M. - 12:00 P.M.a:�d 1.00 P.M.-4:OQ P.M.,Monday through Priday,except District holidays.Copies of the campleted Certrfication af Compliance wil!be given the applicant for use in obtaining the building r„�rmit(s}and for the applicanYs��ecords. NOTICE-PKOTEST PER10D Sectian 6624 af tlae Cc�vernment Code requires that Pomona Unifed Schoal District provide a written natice ta the praject applicant,at the time oF payment of school development fees,mitigation payments ar other exactions{"Fees"),of the 90-day period to protest the imposition of these Fees. Therefore, in accordance widi Section 6b020 of the Government Code and other applicable law, ihis Notice shall serve to advise the applicant that the 90-day protest periad in regard to such Fees or che validity thereof,cammences with such payment or performance af any other requirement as described in Section 66020 of the Government Code. APP�ALS PROC'ESS Any claim by an appiicant ihat their project should be cxempk from assessment of fees,or that the fees levied are incorrect,must be made in writing and filed with the Pomona Unifed School District.The elaim must specify the fact�al and(ega]grounds supporting the elarm. In addition,the claim must cantain a statement specifying the nature of the prajecC and the data the project building permit application was filed. The llistrict's Superin[endent,or his designee,shall respond an writing to a claim within faurteen(I4}days frc�m receigt af the claim.The respanse shall contain the Superintendent's deeision an the claim and a statement of the reasans supporCing the decision. Any ciaimant who is dissatisfied wi[t�the decision rnay request review by the District's Board of Education.A request for review must be written and fi]ed with the Superintendent's or designee's affice not later Chan ten(1Q)days fror�s the date of the decision.The request must contain a statement af a11 faetual and legal grounds in supp�rt of the continuing clairn. The Baard of Education shall consider and act upon a request for rcview at a public meeting not later than thirty{301 days frorn�he date of filing of the request. A claimant inay appear and address the Board in regard to the claim The Board shall pravide written natice of its decision,ta be mailed to the claimant,within fourteen{7 4}days after pubiic meeting at which the 13oard acted upon the claim. Correspondence shall be addressed to: flssistar�t 9uperintendent,Business Services-Facitities,Pamonct Unified Schoot L3istrict,SDD South Garey Avenue,Pouzona, CA 91766. am CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION F PRESS FIRMLY JOBSITE ADDRESS APN LOT-�-�-T CT OWNERS/L 7� ADDRESS--4 7 I I i TEL. .'i CITY tI f- 'IP- APPLICANT TEL. CONTRACTOR fl,J ('r r� +L! : cf H �' .y ADDRE CITY A.T/. ZIP TEL�f ZGfGZi �f•, ARCH/ENG/ DESIGNER ADDRESS_ CITY ZIP TEL OWNER-BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LL CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESSAND PROFESSIONS CODE ANY CITY OR COUNTY WHICH REOIARESAPERMIT 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 LE CENSE LAW(CHAPTER E(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE)ORTHAI HE DR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THEALLEGED EXEMP. TION.ANY VIOLATION OF SECTION 703I.0 BY ANY APPLICANT FORA PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($500).): ^ 1,AS OVNEROFTHE PROPERTY,OR MY EMPLOYEES WITHWAGESAS 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 FORSALE IF.HOWEVEq THE BUILDING OR IMPROVEMENT IS SOLD WITHNONEYEAROF 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). 0 1,AS OWNER OF THE PROPERTY AM EXCLUSIVELY CONTRACTlNG WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC. 7044. BUSINESS AND PROFESSIONS CODE THE CONTRACTORS U CENSE LAW DOES NOTAPPLY 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.) 17 1 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 A(COMMENCNG WITH SE-,TON 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS N FULL FORCE AND EFFECT. / LICENSE CLASS LIC. N0. DATE��J I L)?CONTRACTOR WORKERS'COMPENSATION DECLARATION I HEREB FIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MMNTAN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' RENSAT[ON,AI PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE 1T HE WORK FOR WHICH THIS PERMIT IS ISSUED. 7 VE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE.AS REQUIRED BY SECTlON 37000F THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKS RS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER S C"4' 7C 74_1/7 17' 334-2'4 L,s R POLICY NUMBE (THBSECT NINEOO EpTBECMWLENIDOFTHE PEWAT BFOROEEMICFEDDOI.IARS($I00(ORLESS) I CERTIFY THAT N 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'COMPENSA VISIONS OF SECTlON 3700 OF THE LABOR CODE.I�HALL FORTHWITH COMPLY WITH E PROVISIONS. �� DATE: APPLICANT: 17 WARNING: FAILURE TO SECURE WORKERS: PENSATION COVERAGE IS UNLAWFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL P TIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($)(0,000),IN ADDITION TO DST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 370E Of THE LABOR CODE REST.AND ATTORNEY'S FEES CONSTRUCTlON LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAI THERE 15 A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC. 3007.CIV.C.). LENDER'S NAME LENDERS 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 REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE CTION PURPOSES. ABOVE-MEAT FO PROPERTY FOR INSP E )ej 7 NIaat e,G�o PERMITTE 1 PRINT)� SKN OF PERMITTEE DATE APPLICATION < PERMIT4 V I.A' P/ DATE NUMBERS III ISSUE TYPE OCC DATE ta o�CONST.GROUP ZONING SETBACKS FRONT RW^ REAR^ SIDE/SIDE STREET RW^ SIDE^ PROPOSED USE f//fI?f=AJM f 7�La( L « N0. DWEL. 'N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM U) Garage/CarpoR II Pallo/Deck I LL Pool/Spa Z Re-Root 10 Commercial 5 Valuation ADJ.AREA QUANTITY ESCRIPTION FEE J U cc I- U J w 2 Nn a Q W C�ONSTRUCTI � ��f ELECTRIC PLUMBING_ MECHANICAL_ I FEE I DANCE J Z c r� :J ,sM GY P/C ENERGY PERMIT RETENTION FEE: I . PRE-ALT FEE: TOTAL FEES COMMENTS RECPT. N0. 0 PAID BY VALIDATION WHITE-Department Copy,YELLOW-Fiance Copy,PINK-Assessor Copy,GOLDENROD le Copy,GREEN-Applicant's Copy a� S��PTIC TANK SIZE w�P F�11�.' IE Eu . . 60hOJ� UNDATION NID8EVI"I POMONA UNIFIED SCHOOL DISTRICT CAPITAL FACILITIES PROGRAM MANAGEMENT 800 SOUTH GAREY AVENUE• POMONA•CALIFORNIA 91766 Certification of Compliance /t,94L Form Number -JL)A-N MA-bi4-bo A�Z�)6y2s-2034r Applicant's Name plicant's hone No. '2E. FLe?i/c-�4-lpDownrG4. '102-IO Applicant's Mailing Address(Include company name,if applicable.) Applicant's Signature Date of nature The applicant executing this declaration certifies under penalty of perjury that: (1)they are the Owner and/or Developer or they are authorized to sign on behalf of the Owner and/or Developer, (2)that the information provided is true and accurate to the best of the Owner's and/or Developer's knowledge, (3)the Owner and/or Developer will file an amended certification of compliance and pay the additional amounts due if Owner and/or Developer increases the number of dwelling units and/or square.footage after the building permit is issued or if the initial determination of units and/or square footage is found to be incorrect,and(4)they have read and fully understand this side and the reverse side of this document including the 90-day protest period posted on the reverse side of this document. C�7vsT��.1 _,��c0 fr�vic es At Owner's/Develo is Name Owner's/Developer's Mailing Address Development Type and Fee Schedule information presented above,this Certification of Compliance is hereby executed. ^ Residential $3.2"/s q. ft. (Level 1 evel Level 3) ^ Manufactured/Mobile Homes$/sq.ft. (Level 1 -Level 2- Level 3) ^ Commercial/Industrial $/sq.ft. ^ Senior Citizen Housing $/sq.ft. (See reverse side of sheet.) ^ Exempt$-0-/sq. ft. (Provide justification.) Exempt status justification/notes: pIC 3s Fee Calculations Each Certification of Compliance orm is for five(5)projects maximum. Use additional forms for additional projects, /l/� 1.' L7L 5'--&� $,3. 2.S 793 sq. ft. $2-5 ./. 2.J Tract No./Lot No./Address Plan Check No. Fee per sq.ft.Area Fee 2. 3. 3C- Owner's/Deve oper's Phone No. Check appropriate box(es),fill in the fee per sq.ft. and circle the fee level in effect. Tract No./Lot No./Address Plan Check No. Fee per sq. ft.Area Fee sq. ft. $ 4. Tract No./Lot No./Address Tract No./Lot No./Address 5. Tract No./Lot No./Address TOTAL UNITS: (This form only.) AW District/CFPM Receipt of Fees District/FiscatServices(Signature and Printed Last Name/Title) 9 ac Check No �- 3�10� Date See reverse side for General Information,Senior Citizen Housing,Payment of Fees,Notice- Protest Period and Appeals Process. Distribution of Copies:White-City/County; Yellow-District/CFPM; Pink- District/Fiscal Services; Goldenrod-Owner/Developer. Revised 7/03 Plan Check No. Plan Check No. Plan Check No. $sq.ft. $ Fee per sq. ft.Area Fee $sq.ft. $ Fee per sq. ft.Area Fee $sq.ft. $ Fee per sq. ft.Area Fee TOTAL FEES DUE$6-77,Zg'* (This form only.) Date This is to certify that all fees due to the Pomona Unified School District under applicable provisions of the Government Code and the Education Code,as prerequisite to the issuance of a Building Permit by the City/County, have been received. Based on the GENERALINFORMATION On November 4, 1998,SB 50 became effective.This bill grants California school districts the authority to levy fees in excess of those authorized by Government Code Section 65995(Level 1 Fees), if the district meets certain specified tests and approves a School Facilities Needs Analysis. Alternative Level 2 fees may be levied when state bond funds are available for school construction projects,and Alternative Level 3 fees may only be levied when the State Allocation Board certifies that it is no longer approving apportionments for new construction due to lack of available funding. The Board of Education approved the School Facilities Needs Analysis and adopted a resolution levying the alternative fees under SB 50,and has approved the fees on commercial/industrial development by separate resolution. Copies of the resolutions and the School Facilities Needs Analysis are available for.viewing in the Capital Facilities Program Management office. SENIOR CITIZEN HOUSING Per Government Code Section 65995.1(c),if a senior citizen housing project is later converted to non-restricted use,the applicant/developer who is seeking the change in use will have to pay the difference between the current residential fee and what was paid for the senior citizen housing. PAYMENT OF FEES State law prohibits a city or county from issuing a building permit unless the local school district has certified that the application is in compliance with the District's collection program for fees assessed developers.The procedure for obtaining the required certification follows: Project Plans-A set of project plans stamped by the governing city or county building department,and valuation receipt indicating calculated square footage and plan check number, must be reviewed by the District.The address follows: . Capital Facilities Program Management, Pomona Unified School District,800 South Garey Avenue, Pomona,CA 91766. Calculating Area for Residential Projects-The District levies fees on existing residential construction only if the resulting increase in assessable space exceeds 500 square feet after deducting any loss of assessable space in the same residential structure as a result of the same reconstruction.All assessable square footage in new residential structures is subject to the fee levy. "Assessable space" means all square footage within the perimeter of a residential structure, not including any carport,walkway,garage,overhang, patio,enclosed patio,detached accessory structure, or similar area. Residential projects also include the initial location,installation or occupancy of a manufactured home or mobile home. Calculating Area for Commercial/Industrial Projects-The chargeable covered and enclosed space of commercial or industrial construction shall not be deemed to include the square footage of any structure existing on the site of that construction as of the date the first building permit is issued for any portion of that construction. "Chargeable covered and enclosed space" means the covered and enclosed space determined to be within the perimeter of a commercial or industrial structure, not including any storage areas incidental to the principal use of the construction, garage, parking structure, unenclosed walkway,or utility or disposal area. Available Hours for Verification-CFPM staff will verify project development type and square footage and complete the Certification of Compliance during available hours.Available hours are from 8:30 A.M.- 12:00 P.M.and 1:00 P.M.-4:00 P.M.,Monday through Friday,except District holidays. Other times are available by appointment by calling (909)397-4800,ext. 3920. Available Hours for Payment-Fees due are paid to the District during available hours.Available hours are from 8:30 A.M.- 12:00 P.M.and 1:00 P.M. -4:00 P.M., Monday through Friday,except District holidays. Copies of the completed Certification of Compliance will be given the applicant for use in obtaining the building r.ormit(s)and for the applicant's records. NOTICE-PROTEST PERIOD Section 6620 of the Government Code requires that Pomona Unified School District provide a written notice to the project applicant, at the time of payment of school development fees, mitigation payments or other exactions("Fees"),of the 90-day period to protest the imposition of these Fees. Therefore, in accordance with Section 66020 of the Government Code and other applicable law,this Notice shall serve to advise the applicant that the 90-day protest period in regard to such Fees or the validity thereof,commences with such payment or performance of any other requirement as described in Section 66020 of the Government Code. APPEALS PROCESS Any claim by an applicant that their project should be exempt from assessment of fees,or that the fees levied are incorrect, must be made in writing and filed with the Pomona Unified School District.The claim must specify the factual and legal grounds supporting the claim.In addition,the claim must contain a statement specifying the nature of the project and the date the project building permit application was filed. The District's Superintendent,or his designee,shall respond in writing to a claim within fourteen (14)days from receipt of the claim.The response shall contain the Superintendent's decision on the claim and a statement of the reasons supporting the decision. Any claimant who is dissatisfied with the decision may request review by the District's Board of Education.A request for review must be written and filed with the Superintendent's or designee's office not later than ten (10)days from the date of the decision.The request must contain a statement of all factual and legal grounds in support of the continuing claim. The Board of Education shall consider and act upon a request for review at a public meeting not later than thirty(30)days from the date of filing of the request.A claimant may appear and address the Board in regard to the claim.The Board shall provide written notice of its decision,to be mailed to the claimant,within fourteen (14)days after public meeting at which the Board acted upon the claim. Correspondence shall be addressed to: Assistant Superintendent, Business Services-Facilities,Pomona Unified School District,800 South Garey Avenue,Pomona,CA 91766.