The URL can be used to link to this page

Home My WebLink About18410 (11) � CITY OF DIAMOND BAR � , � � DEPARTLIENT OF CONIIvfUNITY&DEVELOPMENT SERVICES (, � 7I,j � ; � �,,� 21825 E.Copley Drive f (909)860-3195 Fa�c(909)861-3117 PRESS �?»� B U I L D I N G P E R M I T A P P L I C A T I O N F I M L Y o DDR'ESS_�;� �,f��Crec�K C�y�,► DATECATION � �� NU BER �" N/C � - ISSUE TYPE OCC APN I,,OT, T CT DATE � CONST. GROUP � OWNER ��T I� o ADDRESS T ZONING SETBACKS z CITY ZIP TEL. __ FRONT RW ❑_ � APPLICANT � TEL. REAR ❑_ __ o SIDEISIOE STREET RW aCONTRACT� __ SID� ❑_ ADDRESS �� - ` ^�-• PROPOSE�USE_ O C�Ty n US AV�IP , TEL. �- _ �� oARCWENGI ��'W00 ,CA. 9QJ12 W DESIGNER _ NO.DWEL. NO. NO. a ADDRESS UNITS ST�RIES BEDROOMS � CITY ZIP TEL._ N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECLARATION SFR/ADD/REM p I HEREBY AFFIRM UNDEP VENAL�V OF PERJURY THAT I AM E%EMPT FROM THE CONTRACTORS LI� G8f390IG8fPOR W CENSELAWFORTHEFOLIOWINGREASON�5EC.7031.5BUSINE55ANDPROFE5510N5CODE'ANYCITVOR (n G� COUMYWHICHREOUIRE54PEFMITiGCONSTRUCT.ALTEF.IMPROVF,6EMOLI511,ORREPAIRANVSTRUG W Pa[i0/D6Ck Z TUfiE,PRIOP TO ITS ISSUANCE.ALSO RE�UIRES THE APCLICANT FOR SUCH PERMIT TO fILE A SIGNE� w W STATEMENT TNAT HE OR SHE IS I ICENSED VURSUANT TO THE FPOVISIONS CF THC CONTRACTORS LI- g CENSE LAW�CHA7TER 9(COMMENCING WITH SECTION]000)O�DIVISION 9 OF THE BUSINE55 AND PRO� � PooUSpa � FESSIONSCOOE)ORTHATHEOFSHEISEXEMPTTHfR[FROMANDTHEBASISFORTNEALLEGEOtXEMP- (,�] v 710N ANV VIOLATION OF SE CTION 7091.5 B�ANV qFPIICANT FOR A PERMIT SVd1EG15 7HE AP?LICANT TO z qe-Roof � ACNIL PENALTV OF NOTMORE THAN FIVE riVNDRED DOLLAHS(5500).)�. � ❑I,ASOWNEROFTHEPROPERTVORMVEMP�_OVEESWITHWAGESASTHEIRSOLECOMPENSATION. � COr�mBfCiel Z WIlLDO THE WORK,AND iHE STRUCTURE IS NOT INTENDED OR O.'FERED iGR SALE(SFf.�oet,BU51- J NE55 ANO FHOFESSIONS CODE:THE CONTRACTORS LICENSE LAW�O�S NOTAVPLV TO AN OWNE{i OF � PROPERTVWHOBUILDSOFIMPflOVESTHEREON,ANDWH(7DOESSUCNWORKHIMSELFORHERSELFOp � � hIROUGM MIS OR HER OWN EM7LGYEFS,PROVIDED THAT SUCH 161GROVEMEN75ARE NOT IMENDE�OR m w OFFEflEOFOflSALEIF,HOWEVER.THEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCAMPLE� � TION,THE OWNER-BUILDE�I WILL HAVF THE BURDEN OF f'ROVING THAT HE OR SHE OID NOT 6UILD OF Z IAIPPOVE FOR 7HE PURPOSE OF SALE). _ ❑I,ASOWNEROFTHEPROPERiY.AMEXCLUSNELYCONTRACTINGWITHLICENSEDCONTRACTOqS � TO CANSTRUCT THE PftOJ[CT(SEG.'/o<6,9USINE55 ANO PROFESSIONS COOE�.THE CONTRACTORS L- V3IU8SIOf1 ADJ.AREA W CENSELAWDOESNOTAPP_YT011NOWNEHOFAPROPERTVWHOBUILPSORIMPROVESTHEREON,AND � WHOGONTRACTSFOFSUCNPROJECiSWI�HACONTRACTOR�S)IICENSEDPURSUANTTOTHECONTFAG Q�J{�NTITV DESCRIPTION FEE TORS LICENSE LAW.). Y J � ❑I AA1 EXEMPT UN�ER SEC. B.8 PC.FOR THIS REASON Q � U � � OATE __ OWNEq__ . __ V W � LICENSED CONTRACTORS OECIARATION W ¢ � IHEREBYAFFIRMUNDEHPFNAITYOFPERJURYTHATIAMLiCENSEDUNDERPROVISION50FCHAPTER � � 9�GOMMENCING WITH SECI�IOIr 7000�OF DIVISION]OF TME BUSINE55 AND PROFESSIONS CODE,AND Z `X MY LICENSE IS IN FULL FORCE AND EFFECT. �,.�_ ;^/q� �I i7 �/SL/L17 m � LICENS C �S/S�� UC.NO.�r�`�A-`��y�� U DATE tl��' 'I _ �� CONTRAGTOR'��1)�' d W �� WC)RKERS'COMPENSATION DECLAHATIO -� � Q � U � I HEREBVAFFIRM UNDER PENALN OF PERJURV ON�OF THE FOLLOWING DECLARATIONS: Z Q — Q I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORNER$' 2 MPENSAf IOir,AS PROVIDED BY SECTION��00 OF TNE LABOR CODE.FOR THE PERFOqMANCE U 4 � /�1FF THE WORK FOR 1NHICH THIS PERMIT IS ISSUEO. � � ��L�IHAVEANDWILLMAiNTAINWORK[RS'COMPENSATIDNINSURANCE,ASREQUIREDBYSEGTION Q 1F 3]0o OFTHE LABOR GOOE,FORTHE PERFORMANGE OF-E WORK FOR WHICH THIS PERMIT IS � ISSUED.MV RKEHS'�PE�ALON IN�S'J�E GA 7 AND POL�CV NUMBEF ARE' CONSTRUCTION Q �� /G � CAFRIER �..L�.s-�. PLAN FEVIEW _ ZPOUCYNUMBER_ — E�ECTRIC _ Q Q (Ril$SECTIONNEmnOTBE00MFLEfEDOFiHEPE�MfTISFORONEHIX`AREDO0.LARSjS100)ORLE55�. PLUMBING _ w MECNANICAL Z I CERiIFY TMAT IN THE PERFOFMP.N�E CF THE WORK FOfl WNICH THIS PERMI i IS ISSUED.1 � SHALL NOT EMPLOV ANV PERSON IN ANY MANNER SO AS TO BECOME SUBJECT To THE � WOflNERS'COMPENSATION LAWS OF CALIFORNIA.PND AGREF THAT IF I SHOULO BECOME INSPECTION FEE — � SUBJECTTG THE WORKEflS'COIA7ENSATI()N PPOVISIONSOF SECTION 3]OOOF THE LABOR � CODF,I SHALL FORTHWITH COMPLV WITHTHOSE PROVISIONS. ISSUANCE __ _ � SMIP �] DATE�. _ APPLIGANT: � `-- w ENERGY P(C J WARNING:FAILURE TO SECURE WORKERS'CGMPENSATION COVFRAGE IS UNIAWFVI.AND SHALL BE — � SUBJECT AN EMPLOYERTO I:RIMINAL PENALTIES AN�CIVIL FINES UP TOONE HUNDRED THOUSAND ENERGV PERMIT DOLLARS It100.000).IN AO[ll'fION TOTHE COSTOF COMPEYSATIOM.DAMAGESAS PROVIDEO FOR IN — J SECTION 3loe OF THE LABOH CODE,INTEREST,AND ATTORNEV'S FEES. RETENTION FEE: � __ a CONSTRUCTION LENDING AGENCY PRE-ALT FEE: __ — O Q I HEREBYAFFIRM UNDER DEIVAL7V OF PERJURV TMATTHERE IS 4CONSTRUCTION LENDING AGENCV d :OF THE PERFORMANCE OFTHE WORK FOR WNICH THIS GERMR IS ISSUE��SEC.309�,CIY.C.). Z w - S LENDER'SNAME ___. _ � F_- LENOER'SPAORESS__ � � ICEHTIFY7HA71HAVEFEA�THISAPPUCATIONANDSTATETHATTHEAFOVEINfoPMATIONISCORFECT. TOTAL FEES �� w IAGREETOGOMPLVWITHALLCITYANDCOUNTVORDINANCESANDST4TELAWSREIATINGTOBUILDING � CONSIRUCTION,PNDHEREBVAUTHORIZEREPRES[NTATIVESOFTHISCOUNTYTOENTERUPONTHE ZABOVE-MENTIONED PROFERTV FOR INSGECTION PURPOSF.S. COMMENTS � �( f i 1�� ._ .. — � m PEF EE ARIE T) �w /A�C _ _ —. _ — ¢ I r/ �l� � l.l �� _ � SiG ATUflE4FPERMITTEE �ATE = RECPT.NQ PAID BY VALIDATION _ ~ WHITE—Department CopX YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROC�FiIa Copy,GREEN—AoplicanYs Copy � '' s'�� "��'#��"�TM a�� '� �$z;. � �� i ��! �, � � � .�. a�x� :. � �a," �.' , . . e�.a� �, �' �:�..r��„. a . �. . .. ... ... ... ... .. s r ,�,c�- 't`��... ... ._. _. ... . . . . . . . ._ ... . �.»,.� �� . � � ..��. � , ' ` ��. n�� ... .. _. _. ... .. '�: 9 "n �t'�,. � , . ... . '� '�� L� 4 'i- ��R & , . .. . . . _.. ... ._... � I �i � �' S 1P9�� v, . . . . ... . ... .. . . b BM � � �!9S€�-p''°.�`'��w;,r�v q?' � � ro � �� i , ,k'��:. FV'-.�T�� °" i� ;d�w* .. _._ .. . � � .. ... .. � .r-�s��€ ��aF � , , � � ' .... . ..... . . . .. . — ._ : - �! ` , ^ s . -° k + � �.b ¢ �.�.,..�, . ... . .. .... .. . .... ... .... .. ... . .._.. ._. ._.. _... .. � , ` .� �. �. . . . ... . ..... . ' v �� w �� m.. n„ � , > _� _ _ _ � �.` �� " . _. . .... . . .._ .. . ... .. . .... . _. _.. ��. f � . .. ... .�ro °� _ �.� � � '�,� a w ,=y,'�. ��. a�x � �s �� +�w'� �a. _ � ^ �. �� _ = ro �_ _ _ _ CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION PRESS FIQMLY I �� C� ADDR ESS I.lu I.-� APN f,�O�T_� Tf�CT �(i( OWNER ADDRESS CITY ZIP TEL. APPLICANT TEL. CONTRACT ADDRESS C.V'1<') A �-� ��1'PUS nYPZIP TEL. � '� ARCH/ENG/C2T(nW00,CA,J07�Z DESIGNER ADDRESS CITY ZIP TEL. OWNER-BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSELAW FOR THE FOLLOW ING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE:ANY CITY OR COUNTY WHICH REOUIRE5.4 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- CENSELAW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONSCODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION.ANV VIOLATION OF SE CTION 7031.5 BV ANV 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. 704d, BUSI- NESSAND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OF 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-BUILDEFI WILL HAVE THE RURDEN 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 APP VTO AN OWNER OFA PROPERTY WHO BUILDS ORIMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS W ITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAG 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 IAM 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 FORCE AND EFFECT. (/1 nay�r LICENS C SS� LIC. N0. CJ DATE�,__CONTRACTORS WORKERS COMPENSATION DECLARATIO I HEREBY AFFIRM UNDER PE NALN OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TOSELF-INSURE FOR WORKERS' MPENSATION,AS PROVIDED BV SECTION 37000E THE LABOR CODE. FOR THE PERFORMANCE F THE WORK FOR 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 E WORK FOR WHICH THIS PERMIT IS V RKERS'CAMPE AyON IN�SU E CA I AND POLICY NUMBER ARE: CARRIER �/�/"C'{/�{tA//G POLICY NUMBER (RIIS SECTION NEED NOT BE 07MPLETED OF THE PERMR IS FOR ONE HUNDRED DOLLARS(E700)OR LESSI. I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,1 SHALL NOT EMPLOY ANV 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 PROVISIONS OF SECTION 3700 OF THE LABOR CODE,I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE:APPLICANT: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL.AND SHALL BE SUBJECT AN EMPLOYER TO I:RIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS(5700,000),IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOfi CODE,INTEREST,AND ATTORNEY'S FEES. CONSTRUCTlON LENDING AGENCY I HEREBY AFFIRM UNDER PEIVALN OF PERJURY THAT THERE IS ACONSTRUCTION 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. I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OFfHIS COUNTY TO ENTER UPON THE ABOVE- M E N n ONED PROPERTY FOR INSPECTION PURPOSES / A,' (^Nn / ' � ��y'- PER EE IALiE�T)��y�� 'I/ StG ATURE OF PERMITTEE DATE WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy