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Home My WebLink About18469 �r�. CITY OF DIAMOND BAR I I I� DEPARTMENT OF COIvllv1UNTCY&DEVEL�PMENT SERVICES 21825 E.Copley Drive ��' (909)860-3195 Fax(909)861-31 l7 pRE$$ %�� BUILDING PERMIT APPLICATION FIRMLY o DDRIESS��,`� �"��L'�� DATE'CATION Q .�,�,,�� NU B R I�_1� 1 #/C C� � ISSUE TYPE OCC APN--�— LOT TRACT DATE CONST. GFiOUP °C OWNER F-Ci�'��.. — o ADDRESS�.1js�� 7f�'DIZ.!� ZONING SETBACKS Z CITY 7/:7�Ic'Jt� Fi� ZIP 1�' 7EL�G� 'Z�`Y� FRONT RW L � APPLICANT TEL REAR n _ � —' SIDE/SIDE STREET RW O Q CONTRACTOR�,!� �J��1 SIDE ❑ _ ADDRESS �✓6 '�' p C��, �-�L��r��,y Z�P La�( PROPOSED USE 1•( TEL � � �� oARCH/ENG/ ' — Z DESIGNER w — NO.DWEL. NO. NO. a ADDRESS � CITY ZIP__ TFL._ , UNITS _ STORIES BEDROOMS v� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECIARATION SFWADD/REM O Q I HEREBV AFFIRM L1N�Ea PENALTV OF PERJUii�'HAT I AM FXEMv7 FROM iHE GONiRACTORS LI- GalB(J8/C8f(JOf[ W CENSEIAWFOqTHEFOLLOWWGREASON(SEC.]031.58VSINESSANOF90FESSIUNSCCDE.ANYCITYOR (� U COUNTVWHICHREOUIRESAPERMITTOCONSTFUCT,A�TER,IM�ROVE,�EMOLISM,ORREPAIRANVSTRIIC� W {�yI10/DBCI( Z TUFE,PRIOR TO ITS ISSUANCE,AL50 FEOU�RES THE APPLICANT FOR SUCN PERMIT TO FILE A SIfNED W STFTEMENT THAT HE OF SME IS'�.IGENSE�PURSUA��T TO THE PROVISIDNS OF THE COMTRACTORS LI� w � GENSE LAW(GHAPTER 9(CONIMENGING WITH SECTION 7000)OF DIVISION 3(tc TNE BUSINESS AND PRO- � POOVSPB � FESSIONSGODE)ORTH/TNEORSNEISE%EMPTTHEqEFROMAN�THEBAS��SFORTHEALIEGE�EXEMV� (� V TION.ANYViOUTIONOF5EC710N7031.5BYANVAPPI.ICAN'FORAPERAIITSJ9JECfSfHEAPPLiCANTTO Z Re-Roo( � A CIVIL PENAITY OF NOT MOR'�_TMAN FNF HUN�RED DOLURS�SSoo)��. � Z ❑LASOWNEROFTHEPROPERTY.ORMYEMPLOYEESWiTHWAGESAS1HEIfi50lECOMOENSATiON, � COmlilBfG101 WILL DO TlIE Wf)RK,AND THE STRUC7URL IS NOT INi ENDED OR OFFERED FOH SALE!SEC.70d0,BU�I� J' � NE55 RND PqOFE5510NS CODE�.THE CONTRACTORS LICENSE LAW OOES ND�AFPLV TO AN OWNER OF � GqOPERT'WHO Bl111D5�R IMPROVES THEREON,ANO WHO OOES$UCN WOFK MIMSELF OR MERSELF OR � iHROUGHHISORHEFOWNE�AGLOVEES,PROVIDEOTHATSUCHIMPROVEMENTSAFENOTINTENDEDOR � Q OFFEREDFORSALE.IFMOWEVER,THEBUILDINGOflIMVROVEMENTISSOLDWITHINONEVFaqOFCOMPLE- Z T10fi,TME OWNER-BU�LOER KILL HAVE TNE BURDEN OF PROVING'MAT HE OR SHE DID NOT BUILD oq � IMPflOVE FOfl TME PURPOSE OF SALEI. w ❑I.ASOWNEROFTMEPROPEflTVAME%CI.USIVELYCCINTRACTINGWITHUCENSE�CONTRACTORS � TO CANSTRUCT THE PR0.1EC1(SEC.7061.BUSINE55 qND PROFESSIUNS COOE:TMF CONTqACTORS L.I- l/alU8f10f1 � (�p,J.(,RE/{ W CENSEUWDOESNOTAPPLY'fOANOWNfROF�PROPERTYWNOdUIIDSORIMVROVESTHEflEON,AND — � WHOCONTRAf.TSFOqSUCMPqO,lECTSWRMACONTMCTOR(°1UGEh5CDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE Y TORSUCENSELAW). ¢ G IAM cXEMPT UNDERS�:C. B.8 PC.FORTHIS REASON Q D� ��" '�� y � � � —_. ..—_.'_" Q DATE OWNER _ _ U Z � LICENSED CONTRACTORS DECLARATION W Q � IHFREPYA�FIRMUNOERPENAL�YOFPERJURYTHATfAMUCEPISEDUNDERPROV�5�N50FCMAPTER � d 9(COMMENCING WITM$ECTIOM�000)OF DiV1510N 3 OF THE BUSINESSAND PP.OfESSi.7NS CODEAN� Z X A7V UCENSG IS IN FULL FORCE AND EFFEC�. '7 � LICENSE,G,JL4 S L L�' __ LIC.NO.�7 J s'� � V �ATE \' I� G'7i CONTRAC70R!_ __._ 4- W � WORI<ERS'COMPENSATION DECLARATION Q � ��2;', (r'"iv/ ��. .� O � 1 MEREBV I,FFIPM UNOER PENAI.TV Oi PEFJVRY ONEOf'HE FOLLOWING DECLARATIONS�. Z _ Q Z _IHAVEANDWILLIAAWT,fINACERTIFICATEOFCANSENTTOSELF�INSURE�ORVIOFKEHS' _ ¢ CAMFENSATION,AS PHOVIDED BV SEC'ION 3]o00F THE LABOR COOE,FOP THE PERFORMANCE U Q OF THE WOFK iOR WMI�H THIS PERMIT IS ISSUED. � w _I HAVE AND WILL MAINTI\IN WORKERS'COIAPENSATIDN INSURANCE,AS RCQUIRED BY SEGTION Q 370J OF THE LA90R COOE,FOp THE PERFORMANCE Of THE WORK FpR WMICH TH!5 PEHMIT IS � ISSUED.MV WORKERS'�OMPENSATION INSUflANCE GARRIER AND POLICI'NUMBERARE' CONSTRUCTION J ___ j cnani�a __ ___ I PLAN REVIEW _ � POLICYNUMBER_ --.. -.- ELECTRIC _ �.�� Q 0 (i}1155ECTIONNEmN0T13EOJMPLEfEDOFTHEPEFMRISFOFONENUnDREDDOLLARS(EtOo)OqLE55). PLUMBING . _ lJJ Z I CERTIFV THAT INTHE PERFORMANCE OF TNE WORK FOR WMICH 7H15 PERMIT IS ISSLIED,I MECHANICAL y��_ �'} SHALL NO7 EMPLOYANY'PEfl50N IN ANY MANNER SOAS T09ECOME SUBJE�T Tp T-IE � WORKER�CGMPE4SAT��OIVlAW50FGALIFOFN.A.AM1DAGF'eE7HATIFISHGVLDBECOME INS?ECTIONFEE _ = SUBJECT TO TMF WORK'�.=fl5'COMPENSATION PFOVISIONSOF SECTION 37DOOF THE LABOR - Co�E,I SHAL FORTHWITH COMPIV WITH THOSE PROVI51� �I67 ISSUANCE 4 � �7 � p DATE: � E Y qppLICANT: _ SMIP _ _ J WpqNiNG�.FAILURETOSEGURE'�NORKEflS'COMOE COV AGEISUNIAWFUL,ANOSHAI.LBE ENEflGYP/C _ � SVBJECTAN EMPLOYEf1T0 CNIAIINAL PENALTIES AND IVIL FIN UP TOONE Hl1N�RED THOUSAND ENERGV PEFiM1T DOLLAfl5IS1UC,WO�.INADDITIO�iTOTHECOSiOFC PEY ION.DAMAGESASPROVIDEDFORIN � SECTION 3'7oe0=THE LABOR CGDE.INTEREST,AND Er�s cEEs. qETENTION FEE: � � . 0 _ a CONSTRUCTION LENDMG AGENCY PREALT FEE: � O — - � I HEFEBV AFF�qM tiNDER PENAL-Y OF PERJURV THAT TMERE IS A CONSTP.UCTION LFN�ING AGENCV ._ _ FOR THE PERFORMANI;E OF THE WORK Fpq WHICH THIS PERMIT IS ISSUE�(SFC 3091,CIV.C.) Z w - = IENDEN'S NAME � ____ _ F- LENDER'SAGDRESS ____ _ w� TOTALFEES ICEflT'�FY'NqTIHAVEREADiH13APPLICAiIONAN�STAIETMATTMEABOVEW�ORAIATIONIS�DFRECi � IAGHEETOGOMPLVWIIHALLGIfYANDCOUNTVCRDINANCE5ANO5TATE.AWSHFLATINGT013UILDING � CONSTRUGTiON,AND HEREBV AUTHORI2E FE7RESENTA'NES OF THIS COUNTV Tp ENTER UPUN iHE Z A90VE�MENTIONED PRO>ERTY FOR INSPEC110N PURPOSES. COMMENTS Q _ - � _�_ — -' m NERMITTEE NAME�PflINT� �� ¢ P�-�1.� ---_ _ - � � SIGNATIiRE nF PERMITTE DA E _ ) RECPT NO. _. PAIO BY VALIDATION ~ WHITE-Depariment Go YELLOW-Finance Gooy.PINK-Assessor Co GOLDENROD-File Co GREEN-A licanl's Gopy PY. PY, PX PP s.. � � �.�� .�;b��, �a� �� ; ru � � �� , m � - y _µ .:_ _ � . ,„ � ., A . '�� . _ �. ' v � �, � � . � ' � , .; � _ _ y.��: �_ � �,.,�,��ti� � _ _ � � �.r i __ _ ' _ __ _ . _ . _ _.. . . _ . ,r�x ��u �#� �r�y a ,,��s° ,� � � — � ;i�', ��• � � ��; ,� �:i� :. __ ��'- _ Y, 3 . ,� � . . .. ._ . _..._ .._. .._ ... . _ ..... . �..: �. . . .. .. ... ..... .. ... _ . . .. _ . .. .. , � � I � �� ; i.�.� . . n,?� , .��, .. . . . .. . . . . . .. .... . . . .. .._ .... ..... . ._. . ... _._. . .. ..... : �k �, . r�-,.x;�� ` � .......... . . .. ... .. . . .. .._ ..... ._. ... _... ...... .. .... _... .. ..�� . .. .. � � < �. .. ... . .._. , � i' .. .. ...... ....... _ _.. ..... ..__ .. .._. ... ... CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION PRESS FIRMLY JOBSITE ADDRESS��, [-&,T f L e x„' APN -fib LOT TRACT OWNER I� 7C*T ADDRESS/I 1 2(L f fr!-IN CITY 71:71 C JP€-V-ZIP'l l U TEL f C C-e'Y-C APPLICANT TEL. CONTRACTOR,!A L'It ADDRESS/�ci AJ1 A 2 CITY i 1 i/G 'i ZIP!/off TEL-'-?,e ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL._ OWNER-BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE.ANY CITY OR COUNTY WHICH REOUIRESA PERMIT TO CONSTRUCT,ALTER,IMPROVE, DEMOLISH,OR REPAIR ANY STRUC' TUBE,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(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP' TION.ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJEC FS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(5500)) ^I,AS OWNER OF THE PFOPERTY,OR MY EMPLOYEES WITH WAGES AS T HEIR SOLE COMPENSATION, WILL 00 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, HOWEVER.THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE- TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING .'HAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE CIF SALE). ^ LAS OWNER OF THE PFOPERTY AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE LAW DOES NOTAPPLY TO AN OWNER OF A PROPERTY WHO AUII.DS OR IMPROVES THEREON.AND WHO CONTRACTS FOR SUCH P 90JECTS WITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW). ^I AM EXEMPT UNDER SEC. B. &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 LICENSE CLA LIC. N0.y E,4 DATE CONTRACTOR._ WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF INSURE FOR WORKERS' COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE. FOR THE PERFORMANCE OF 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 THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE CARRIER POLICY NUMBER (THIS SECTION NEED NOT 13E COMPLETED OF THE PERMIT IS FOR ONE HUNDRED DOLLARS($100)OR LESS). I CERTIFY THAT IN 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'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE.I SHAL FORTHWITH COMPLY WITH THOSE PROVISI 167 DATE:Y APPLICANT. WARNING. FAILURE TO SECURE WORKERS'COMPE COV AGE IS UNLAWFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND IVIL FIN UP TO ONE HUNDRED THOUSAND DOLLARS(5100,000),IN ADDITION TO THE COST OF C PEN ION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND EY'S FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENAL-Y 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 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 ABOVE MENTIONED PROPERTY FOR INSPECTION PURPOSES. PERMITTEE NAME(PRINT) SIGNATURE OF PEHMITTE; DATE APPLICATION Q( UrNk-PERMIT I /C ) DATTE U ! 1 # NUMBER ISSUE TYPE OCC DATE CONST.GROUP ZONING SETBACKS FRONT RW^ REAR Fl SIDE/SIDE STREET RW 0 SIDE Ci PROPOSED USE N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM U) Garage/Carport W Patio/Deck LL Pool/Spa 0 Re-Roo( Z 0 Commercial Valuation ADJ.AREA QUANTITY DESCRIPTION FEE W C7 m CL 2 Q 2 U W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL y-N,%- INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES COMMENTS RECPT N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy,IN Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy