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Home My WebLink About18195 (10) �_. c1�oF��orm a� � � �� ; �� j��"�`'' DEPAR7"MENT OF COMMt.JNPTY&DEVELOPMENT SEttVFCES i � � 4 '� 21825 B.Capley ihrve r� �qo9�s6o-�i9sF��9o�)sdi-3ii� PRESS ��^� BUILDWG PERMTT AF'PLICATIOPI FIRMLY � JOBSITE � . ApPLICATION � '� �'� PERMIT P!� e A4DRESS :� �,�� 7 �-�i''.�P. ��,�� c.-^!�� C1 — ----- DATE _ NUMBER # � APN �{}T TRACT �SSUE � 7YPE OCC p OWNER u t>;1: �I�gI'rtJ � DATE ��rv CONST. GROUP d ADDRESS z�i�-'�'� �rt�J/L+✓+..r:✓3 L��3-t�^�— ZONING SETBACKS � CITY �f+.r,rnv��`{�ZIP��TEL.rT�f�,s'�L'XY.iY FRC7NT Ryy � � APPLICANT � ' 7��„�,,,,,,, REAR r� � �'Tg"'T'��'"'— SIDEISIQE STREET_ RW_ � Q CONTRACTQR�.4.�F.l� .�J?'.��'` , SIDE L] ADDRESS ' " V' A— � CITY �Y u A��„i,. : ZIP l�t,S--T -rf��,.Ly?f a T,� PROPOSED USE � �+.i�, ARCH/ENG/ — Z dE51GNER � ADDRESS i NQ.DWEL. NQ. NO. c� UPIITS STORtES _.__ BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATI�N � OWNER-BUILOEFi DECLARATION p SFPIA6DJtiEM (� 1 HEREBY AFFIRM UN�ER PENAITY OF pERJURY THA1 I AM E%EMVT FROM THE CANTRACTOpS LI� Gdf098/C2fpOn LSJ CENSEtAW�OqTNf.F�tOWiNGREASON(SEC.703i.58USiNESSAN6PROFESSIOhSCX?6E:ANYClTYOR (J� � COUNTYWHICHREqU1RESAPERMITTO('ANSTRUCT,ALTER,IMPROVE.pEMOLtSH,ORRePAIRANYSTRUC� W pyi10/Deqk � TURE,PRIOR TO ITS ISSUA!lCE,ALSO REOUINES TNE APPLICANT F09 SUCH pERM1T TO FILE A SIGNEp W � STATEMENT THAT NE OR SHE IS UCEP7SED PURSVANT TQ SHE CRONSIONS OF THE LY}P:TRACTOPS lI� .� GENSE I.AW(CNAPTER 9(COMMGNCING WITFI SECTI4N�000)OF DIVISI(7N 3 OF THE BUSINESS ANb PRp. �' POOUSpa � FESSK/N5 CADE)6R THA7 HE OR SHE 19 E%EMPT TNEREFROM ANp THE BASIS FOH iME ALLEGEO E%EMP. � � TpN.ANYYIOtATIONOF3ECTiON703t,58YANYAPPUCANTFQRAPERMIT5UB.1ECT5THEAPPLiCANTTO Z Re-Roof � ACIVII.PENALTYOFNOTMORETHANFIVEHUNDRED�OLLAflS(SSOo�.): Cy G6ASdWNERO�TNEPRQPEflTY.OftMYEMPG4YEE5WlSHWAGESASTHEIRSpIEfAMPENSATtOfY. � �pR}�pB�C�di Z W�LL 00 THE WORIi,AND THE STRUCTURE iS NOT INTFNDEO OFf OFFERED FQq SALE(SEC.�oia,BUSi� J � NESS qND VROFESSIONS p��E THE C6NTRACTORS LICENSE lAW DOES NOT APPLY TO AN OWNER OF � PRpP�RTY WHO BUIIDS OR�MPROYES iHEREOM,AND WHO DOES SUCH WORH HIMSELF�R HERSELF 6R W THROUGHN190RHEPOWNEMPLOYEES,vROVIDEp'HAT5UCHIMPRpVEMENTSARENOTINTENDEDOR m Q 4FFEREDFORSAIE.IF,HOWEVER,TH68UILDINGORIMPR6VEMFIJ'fI55QLDWITHINONEVEAROFCpMPLE�� . T�ON,THE OWNER-6VILDEF WiLL HAY[THE BURDEN OF pR4WNG THAT HE¢R SHE DID NOT 6UI�D OF � IMPRQYE FOfl TME PURPOSE OF SALE). (y� �71,ASOWNEftOFTHEPR4PERTY,AMEXCLUSIYELYCONFFlAGTiN6WITHUCLN5EDCqNTRACTORB � TO CANS7AUCT THE PROJE:CT(SEC.704<,BUSINESS AN�PROFc55IONS CODE:THE CONTRACTORS LI- V0IU2tiOt1 ADJ.AREA LLJ CENSELAWDOESNOTAPPI_VTqANOWNEROFAPHOPEATVWHOBUILpSORIMPFbVESTHEPEON,ANp — � WHOCANTRACTSFpftSUCitP({p,lECTSWtTHAfANTRACTOfi{S)LIGENSEUPURSUANTT4THEGONiftAC- QVj�(�-[1'('y DESCRtPTI4N FEE � TORS I.ICENSE LAW). d ❑i Aid EXEMPT UF14Eti SEC.___. .. $.6 PC.FOR THIS REA56h7 Q � U � OaTE ^, ONTJER �� Z " U � UGEiVSED CONTRACTORS DECLARRTION w �K CC lHEAEBYAFfiRAlUN4Eftp'=NId.TY4FPERJURYTHA71AMi.iCENSE4UN0EflPRQViSiOP150FCHAPfEft � ��,�. � - � 9(COMMENCING WfTH SEC�ION�000�OF DIVISION 3 OF TME BUSINE55 AND PpOFESSiON6 CODE,AND Z � �lt-' . (;;r � MV LICENSE IS IN FULL FOFCE AND EFFECT. � LICENSE CLASSj�-�__�� IIC.NO. �� 7� r V�� .......�.... � OATE F'J" f 7"�ML- ___ CONTRACTOR„�.•L., .��.... _ p., W � WORKERS'GOMPENSA710N DECIARATiON Q � I t�R£HY AFFIftM UNDER FENAITY�F PERSURY 4NE OFTHE F61,l6WING DECIAfiATidNS�. U rn Z � ...—.,_(HAVfiANDWiiIMAINTAINACEflTIFiCA(EUfGONSENTTOSEIF-INSUREFORWOflKERS' a 2 q COMPENSATION,AS PROViDE�8V SECTION 3700 QFTNE LABOR CODE,FOR THE PERFORM0.Nc:E U � OF TNE WORK FOF,WHICH THIS PERMIT IS ISSUED. � � �I HqVEANO WILL MAINTAIN WORKERS'COMPENSATION INSUflANCE,A9 REQUIRED BY SECIION � 3760 OF TNE LA80i CODE.FOfl TME PEFlFORtdANGE OF 7ME WORK fOR WHICH THIS 9ERM1T IS ISSUEO.MVWJRKERS'COMPENSATIONINSUAANCECARRIERANOPpLiCVNUM6ENARE: CUNSTRUCTION ¢ ,�/��#"�'�"''Y4 � f/2-6r'— — _ . ,.— > c"AR�EA��%' .__ ., PIAN ftEViEW Z aour.vHUMeEa3�..,y��_! �� , 3 ELECTRIC Q —. � (i}11SSEGTR;NJNEE7:�NOTBECLMARETEDOFINEPERAYTI5Ff7RIXJEHUNDI'iEDD01.tARS�510C)ORLESS). PLUMBING � w - - Z' I CERTIfYTNAT INTHE PERFORMANCE OF 7HE W4RK FOR WHICHTMS PERMI'IS 15SUEG,1 MECHANICA(. C�S SHAI.LNOTEMP40VANVPERSONINANVMANNER50ASTO0ECOMESUBJECTTOTHE J K/} WQRNERS'COAApINSATiON LAWS OF CAt�FOFiNiA,AN4 AGREE THAT IF i SHUiFttl BECOM£ INSPECTION�EE SU@JECTTOTHEINORKERS'CdMPENSAT10UPRMISIONSOFSECTION37000FTNELABQR "' �" � GOpE,ISHALLFOi�THWITHCOMPLVWITHTHOSEPqOVIS10NS, ISSUANCE � � �,,,f�� _' p bATE;�: �7_y L_ APP41CAN7; V.�'�r.,-� +'J/T�l-+}�;J-�'/��"`� SMIP ` ` W J WARNING:FAILURE To SEvURE WORKERS'COMP�NSATION COVGRAGE IS UNLAWFUL,ANO SHALLBE ENERGY PJC J �- _.....'"" � SVBJECTANEMPLOVERTOCRIMINAIPENALTIESANOCNILFINFSl1FTOONEHUNDREDTHOUSAND ENGRGYPEFIMIT bIXIARS(5190,OW},IN AODITIQhi T6 TNE COST OF CCMPENSATAN,OAMAGES AS Rft6VlDE6 FOR iN J SEGTION3]UBOFTHELAEiORG4DE,IMTERE5T,ANUATTQRN[V'SFEE5. CL RE7ENTION FEE: � CONSTRUCTION LENDING AGENCY PRk-ALT FEE: ,,, ��^� � i HEqE6YAF71RM VNOER PENAITY OF PERJUF3Y THAT THEqE IS ACONSTR�CTI6N lEN4SNG AC.EAlCY FOR THE PEflFORMANCE OF TNE WOqN FOF WHICH THIS PERMI7IS ISSIIFD(SEC.J097.CIV CJ. ��- — �� U.Y � LENDER'SNAIAE,,,�^... .. . _._ ...� .. . ._ h LENOER'SADDAESS � ICEflT�`THATIHAVEREADTHISAPPt,:CA'�ONANbSTATE7HAThEABQVEM3FORMATKN}ISGORRECT TQTA�FEES ��r �/ j � IAGqEE TO COMPLV WITfI ALL CITV AND COUNTV ORDINANCESANO STATF LAWS RFLATING TO BUILDING V � CANSTRUCTION,ANO HF.REBV AUTHOfiIZE F[PRESEMATIVES OF THIS GOUNTV TO ENTEH UPON THE Z A80YE�MENTIONED PA6t'ERTY WR�NSFCCTION PUflP05£5. GOMMENTS � � (,��'�t�„T"Sr�/'l` -- � � ----- - _�� m PERMIli NAk1E{PR1N7) � �'C�� —_—_ . _ - �. � �� .,�7''� �.... : Uy Si ATUREOFPERMi77'i=E i... oATE ' _... .—"'. ..... �,��'*�--- � RECPT.NO. PAID BY � VAUDATIO-M--��.,--yjv WHITE—QepaRment Gopy,YEILOW—Finance CoRY.PINK—Assessor Gapy,GOLDENAOt�Fiie Copy,GREEN—AppiicanYs Copy i '- �� . . .. � ,k-� �i�('�P �<., "a'-,"ar��'�r��"!-�'��: � . .. ... .. . . ... .... . . . . ... ... .. . . ...... .. . ._. , . �.. �� . . ... . . .... .. .._ ..... . � � ... . _. .. ._ .. . .. .. . .... . ... . .. .. ,, , - .,�u � ��°.�. - . .... ...... . .. . ... ... .... . �W�, . .. . . . . .. . .. . _'��, .. ,. ��!, �s.��,�','��m�a.. . . . . . ... .. . .. . . . . ... .... .. .. . . .. . . .. ... . ..... .... . ...... ...... . ... .._... . . '��. ,�, _ � ... . ...... . .. . .. .. .. ... . . . ... .. ..... . . . ... ..... � .i, ,i - ..... ... ... . . � 3 5 �� ,m z i _. � . . . - . '��. r.�r ,= r e ��_ �� ... . .. ... . ... .. . .. . . . .... ....... .... . . �. r, s� J -- ... "«�? *�« -v „� � r- � r� � � �°'�'� '.'e; ��s •,� e; � � ;t� , ,. �, , .�� , � „ � , . _ ;, , 7 r i �� i ` . . ... . _ . . . . � € CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES JOBSITE el Z7� ��R N/v�4� �t-�L� ADDRESS APN LOT TRACT OWNER u 0.1.'Ci I?�1.1-i/ ADDRESS 2�i 2-'Z '� � rt�J2+/�,ta'� � !t-t� CITY pl�t„nviv„ZIP 1�TEL�IC��,r"LL'yY.i4/ APPLICANT-tl-��,�,T�Ej CONTRACTOR�, L� ,/� ,�?'f o c. ADDRESS V'A- CITY�4 u h�w ZIP�iv�'S��T./L'Y c��'�r Zy '7 ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER-BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAI'i AM EXEMPT FROM THE CONTRACTORS LI- CENSE UW FOR THE FOLLOWING REASON (SEC. 7037.5 BUSINESS AND PROFESSIONS CODE: ANV CITY OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT,ALTER,IMPROVE,DEMOLISH,OR REPAIR ANY STRUC- TURE, PgIOR 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 FESSK)NS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP� TION.ANV VIOLATION OF SE:TION 7031.5 BV ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(5500).): ^ I,AS OWNER OF THE PROPERTY,OR MV EMPLOYEES W ITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC. 7044,BUSK NESS AND PROFESSIONS ODE: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 Oq THROUGH HIS OR HEq 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 W ITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC. 7044, BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- CENSE LAW DOER NOT APPI_V TO AN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOq(S)LICENSED PURSUANT TOTHE CONTRAC- TORS LICENSE LAW.). �I AM EXEMPT UNDEf7 SEC. B. &P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER P'=NALN OF PERIURV 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 FOFCE AND EFFECT. � �� C.� LIC. N0. LICENSE CLASS / A DATE FJ••/7�L'�-�CONTRACTOR !7- L.�� WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINTAIN ACERTIFICATE OF CONSENT TOSELF-INSURE FOR WORKERS' COMPENSATION,AS PROVIDED BV SECTION 37000E THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOF WHICH THIS PERMIT IS ISSUED. �I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BV SECTION 37000E THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: ISSUED. MV WO R K / / �� CARRIER�y• + � POLICY NUMBERL�L 4�IL �� 5°2 4,L 7 (THIS SECTpN NEED NOT eE(YJAPLETED OF THE FERMR IS FOR ONE HUJDREDOOLLARS(E100)OR LESS) I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANV PERSON IN ANV MANNER SO AS TO OECOME 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. d^'Y/^' DATE: L'��,��-APPLICANT: �J'L" '/>'r-"JrTT3� �'� 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(5100,000),IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LAEIOR 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.). I LENDER'S NAME LENDER'S ADDRESS I I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT I AGREE TO COMPLY WITFI ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE RPOSES. ION ED PROP R T Y OR IN S PECTION PU ABOVE�M E NT E F // p 9 p / / �MITtT��N�AME(PRINT) � �P�E RJ rY��, � �� . GN �SI ATURE OF PERMITT[E DATE 0 0 0 0 w z 0 Z m 0 0 W U Z W U H Z 2 W Z W W 2 F- Y LL U w C/) Z Q 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION PRESS FIRMLY WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy