HomeMy WebLinkAbout12328 (13)CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
21660 E. Copley Drive Suite 190
(909)860-3195 Pax(909)861-3117
BUBMING PERMIT APPLICATION
joeSITE 114-0 cN 1SOLrn i /qAIL OA. —
ADDRESS
APN LOT T CT
OWNER. O
ADDRESS CW601f.ML
CITY DI M IJ ZIP TEL "0941-517'
APPUCANT rgI9Eb0fQID &TEL
CONTRACTOR
ADDRESS
CITY ZIP TEL
ARCWENG/
DESIGNER 6&940RIO 7VAII-57A JAI,
ADDRESS &I-
CITY / ZIP $rE f
OWNER -BUILDER DECLARATION
I HEREBY AFFIRM UP0FR PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LL
CRIME LAW FORTHE FOLLOWING REASON (SEC. 7077.5 BUSINESS AND PROFESSIONS CODE ANY CITYOR
COUNTY WHICH REOUIRESAPERMRTO CONSTMICTALTEIL IMPROVE DEMOUSFLOR REPAIR ANY STRUC.
7lIP.E, PRIOR TO figIssuANCE ALSO REOUIHES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS U-
OEMSE LAW tl%MPTER 0 (COMMENCNO WITH SECTION TOM) OF DIVISION S OF THE BUSNESS AND PRO-
FESSIONS CODE) ORTHAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FORTHE ALLEGED EXEMP-
TION- ANY VIOLATION OF SECTION TWI.5 BY ANY APPLICANT FORA PERMIT SUBJECTS THE APPLICANT TO
A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS 15500).}.
O LAS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION,
WILL DO THE WORK, AND THE STRUCNRE IN NOT INTENDED OR OFFERED FOR SALE (SEG 71M4- WSF
NESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF
PROPERTY W) to BUILDS OR IMPROVE$ THEREON, AND VA40 DOES SUCH WORM HIMSELF OR HERSELF OR
THROUGH
HS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED CMT
OFFERED FOR SALE IF,HOWEVER, THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OFDOMRE-
TION, THE OWT&R.B ALIDER WILL HAVE THE BURDEN OF PRCI THAT HE OR SHE DID NOT BUILD OR
IMPROVE FOR THE PURPOSE OF SALE} - -
O L AS OWNER OF THE PROPERTY. AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS
TO CONSTRUCT THE PROJECT (SEG 7044, BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LE
CEKSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON. AND
WHOOONTRACIS FOR SUCH PROJECTS WITH ACONTMCTg S)LICENSEDPURSUANT MTHE CONTRAC-
TO,TIAM
LAW
KEYPT PTUNDFA SEG B. l P.G FOR THIS REASON
DATE
LICENSED COAQA6T SD TION
1 HEREBY AFFIRM UNDER PENALTY OF PEPLIURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER
9 (COMMENCING WITH SECTION 7MM OF DIVISION 7 OF THE BUSNESS AND PROFESSIONS CODE AND
MY LICENSE IS N FULL FORCE AND EFFECT.
LICENSE CLASS LIC. NO. -- .
DATE CONTRACTOR
WORKERT COMPENSATION DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS
I HAVE AND WILL MAINTAIN ACERTIFICATE OF CONSENT TO SELF -INSURE FOR MARKERS'
COMPENSATION.AsPROVIDED BY SECTION VW OF THE LABOR CODE FOR THE PERFORMANCE
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.
I HAVE AND WILL MAINTAIN YORKERS' COMPENSATION INSURANCE, AS REQUIRED BY SECTION
57000FTHE LABOR CODE FOR THE PERFORMANCE OF THE WORK FOR WMCH THIS PERMIT IS
ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE-
CARRIER
RECARRIER - -- .
POLICY NUMBER
(THIS SEC ION7LIDNOTBE COMPLETED OFTHE PEFAXT8 FOR ONE HUNDRED DOLLARS MOM ORLESSI
1 CERTIFY THAT LATHE PERFORMANCE OF THE WORK FOR MOCH THIS PERMIT IS ISSUED -1
SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE
WORKERS' COMPENSATION LAWS OF CALIFORNIA AND AGREE THAT IF 1 SHOULD BECOME
SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 7700 OF THE LABOR
CODE 1 SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS.
DATE APPLICANT:
WARNINQ FAILURE TO SECURE WONKERT COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL BE
SUBJECT AN EMPLOYER To CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND
DOLLARS f5100D00), N ADOMON TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN
SECTION 7709 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
1 HEREBY AFFIRM UNDER PENALTY OF PERIUM THAT THERE IS ACONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEG 7017, CIV C.).
LENDERS NAME
LENDERS ADDRESS
I CERTIFY THAT I HAVE READ TMS APPLICATION AND STATE THAT THE ABOVE INFORMATION 15 CORRECT,
1 AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS REULTNO TO BUILDING
CONSTRUCTIOK AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES.
�ToI R15aMA A.
PERMITTEE NAME (PRINT) _ w
716 1? U9
910 ERMITTE - DATE
(tESS
FIRMLY
APPLICATION`, / to PERMITNUMBER � 3 28' x'_ -33,5--
DATE .b O
ISSUE ` ' _ TYPE OCC
DATE CONST. GROUP
ZONING SETBACKS
FRONT RW ❑
REAR ❑
SIDE(SIDE STREET RW ❑
SIDE ❑
PROPOSED USE LOFT ADDITION
NO. DWEL NO. NO.
UNITS STORIES 2 BEDROOMS
DESCRIPTION SO. FT, FACTOR PSF ADJ, AREA/VALUATION
SFR/ADD/REM
Tn
GanigalCarport
PatioJDeck
LWLI
LL
PocI
ZRe
-Rod
Commercial
5
m
Valuation 101'060 ADJ.AREA
QUANTITY DESCRIPTION - FEE
I
J
W
(7
z
m
J
a
Q
U
Z
Q
z
U
W
�
nQ 72 o
CONSTRUCTION i v
PLAN REVIEW
�1
9,(L�iB 2 0
ELECTRIC �1[i i
PLUMBING
MECHANICAL
INSPECTION FEE - - - -- - - ---- - -- -- - - - - - _----
�L�d
ISSUANCE
SMIP Lr�
ENERGY PIC
ENERGY PERMIT
RETENTION FEE:
PRE•ALT FEE
TOTAL FEES
(�
COMMENTS
RECPT NO. PATO BY VALIDATION
WHITE--Departmmtt COM YELLOW—Finance Copy, PINK—Assessor Copy. GOLDENROD—File Coq, GREEN—Applicants COPY
m
mm
cn
'��
(�
O
n
Z
T
Z
M
z
T
Z
M
D
w
m
m
w
m
'O
'(n
m
o
X
o*
m
y
m
w
2
m
0
w
0
w
0
x
O
m
9
a
m
O
E
g
-I
--i
m
m
�'
O
D
m
m
cn
m.'T7
y
r>
D
D
r>
D
(n
q.
m
a
m
D
r
z
r
r
f
O
C
L7
C
G7
C
f,)
O
T
0
-n
m
7J
ro
'17
O
O
C
Z
T
m
D
T
C
m
2
m
C7
O
2
-I
9
r
[Z»
C
D
c
m
2
T
S
m
S
S
0
O
2
G)
(n
S
cn
M
O
2
O
-r-
�?
O
O
?�
C
y
Z
�
Z!
-{
W
O
.,..t
Z
�
U)
vmi
r
Z
T.
z
C
O_
W
C
m
O
D
m
7J
m
Z
D
-i
G
m
7J
0
m
37
O_
Q'
NCn
-, -�
�
a 33
O
z�
O
z
m
z
a
�.;,
F
z
m
I,
m
CO
-m+
-•
mN
cn
G)
D�
z
zm
,
m
Z
z
r
i
O
m
S
m
T
-5
T
Z
O
Z
?t
z
O
m
O
T
'D
0
-0
0
-0
0
T
z
m
O
m
m
-u
37
:u
Z
3,'
T
x
T
x
C
Z
C
Z
T
T
m
2
<DmDmZDOTOOO�CzmD�Omm
T
-ri
O
r
-i
O
r
O
y
r
r
r
2
S
D
r-
�O
1
U
-V
o
M
O
9
D
m
O
O
0
a
C
moTO
M
N
m
n
m
D
-1
T
T
m
2
37
Co
p
-n
O
m
--Iz
-Ug
yz_imzmrL7OznOzmry�-n
�c>0E>czi���G�ozoOmM.0
O�
o
v
•
v-0
a
�Z�
-i
T
z
�m
�_
zm
cn
05
zD
-1
a2
p
..zOwz
Ommo
m'Ta,O<n
-i
'nzrmn
z0"OhU
.
t
G
-
.t.
-