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Home My WebLink About17160 (10) CIfiX OF DLAMOND BAR 1 r'�'` DEPARTMENT OF COMMtJNI[`FI'&I3EVELOPMENT SERVICES 21825 E.Copley I)rive (909)860-3195 Faac(909)8b1-3117 PRESS �`'%»� BUILDING PERMIT APPLICATION FIRMLY � J4BSITE �j� J"1Q2i� �' [,,,�� APPLICATION � PERMIT P/C �� ADDRESS��,� � � -"'� ' DATE � u� NUMBfR�� #� __�_..^,:_L � ISSUE (� /)`� � TYPE OCC APN LO7 TRAC7 DATE �rt� �+ l CONST. GROUP p OWNER � Y��C' � ADDRESS��C'1J��P�/N�.,'L s ZONfNG SETBACKS � CITY ✓K!��Q �IP TEL �' - FRON7 RW C�_ gAPPLICANT i TEL. REAR �� 81DEISIDE STREET RW � � CONTRACT(,�� .t_^ SIpE �� AdDFt S l S � GITY��C,�.�l��/✓1�,,+� Z!P I TEL. PROPf?SED U5E ��1 A—. � ARCH/ENG! ��- � --• -- z QESIGNER w NO.DWEL. NO. NO. a ADDRESS � C�TY ZIP TEL. ��ETS STORIES BEdR0f3MS cn DESCRIPTION 5Q.FT. FACTOR PSF ADJ.AREANALUATION p� 4WNER-BUILDER DECLARATIQN SFRlADDIREM O [] I HEfiEBV AFFIRM UNDER PENALI'V OF PERJURV THA71 AM EXEMPT FR(7M TNE CONTRACTORS 1.1� GdfB(Je/GdfpOft W CENSELAWFOHTNEFOLLOWINtlflEA$ON{$EC.7�81.5BUSINESSAN�PROFESSIONSCODE:ANYCITYOft ((} � CIXINTYNMIS:tiHEQUIRE5APERMITTOC�NSiRt/CT,AITeR,M+I7A6VE,pEMOtiSH,ORREPAitiANVSTAUC- L(J P0110/DBCk w TURE,PRIOR TO ITS ISSUhNCE,A150 PEQUIRES THE APPLICAN7 FOR SUCH PEPMIT i0 FILE A SIGNEp W .�r� STATEMENT THAT HE QF 9HE IS LICENSED PURSUANT i0 THE PROYtS�OMS QF 7NE WNfRACTORS U- � � CENSE UW f�APTER 9{C�IMENCMG W�TN SECTION 1p06)OF OIVISiC7N 3 OF THE BUSINESS AND PRO� PDtlUSp3 iES510NSCODEjOqTHA7HEOfl5HEluEXEMPTTHEREFFOMANDTHEBA51SFOfiTHEALLEGEDFXEMP. � . � TION.ANYVIOUTIONOFSECTION'03i,38YANYAPPLiGRMF6AAPEFUAiT5U87ECT$THEAPPIlCAb1TT.'3 Z ft8^flOOf � ACIVIL PENALTY OF NOT MORE THAN FIVE HUN�REU DOLLARS(;600;.): a GI,qSOWNEROFTHEPROPEFTVORMYEMPLOVEESWITHWAGESA5TNE1R50LECOMPENSATION. � GOtiittlBtGiel � WilF.00 THE YtOflK,ANO THE STPUCTURE IS NOT IMENDE6 OR OFFERED F4R SM1LE i5EC.7od§,BV51� J I � NESS AND PflOFES510N5 CODE:THE CON7RACTOpS LICENSE LAW DOES NOT APPLY TO AN O'NNER OF � / `� FROPERTYWNOBUIID$OFIIMPROVES7HEREON,ANDWNpDOE55UGNWOflkhllMSElF4RHERSEIFOrl � ' � THROUGH Ff150R HER QWtd EMPI.OYEES,AROViDEO THAi SUCH iMPRpVEMENTSARE NOT MITENDED OR m � OFFEREOFOflSALE.IF,HQN'EVER,THE9UILDINGORIMPRtlVEMENTIS50lDWITHINONEYEAROFCOMPLE� � TION,THE OWNEREUIIOEN WILI HAYE THE BUADEN OF PftOViNG THAT ME OR SHE DIO NOT BNi6 pR � IMGRpVEFORTtiEPURPOSEOFSALE). W ❑I,ASOWNEROFTryEPROPERTV,AME%GLUSIYELVCONTRACTINtlWITHLICENSE�CONTRACToq5 � TU CONS7RUCT'NE PHO,lEGT{SEG.70i2,BUSINESS ANO RROF[SSIONS CODE:THF CONTRACTORS li�� VZIU0Si0(i ADJ.AREA 4J CENSE LAW pOES NOTqPPLY TO AN OWNEH OF A PROPERTV WHO BIIIIDS OR IMPqOVES TNERE4N,AND — — � NM1IOCONTflACT5FOF5UCHPRO.lECTSWITNACONTFACTOR(S)I..ICENSEDPllRSUANTTOiHECONTRAC� QUANTITY DESCRIPTlON FEE Y TORSLIGENSEIAW.). � ❑1 AM EXEMpT UNDEFt SEC. _„_ J p.H P.G.FOft'ttls REAS4N Q "�„! U � —... ¢ DA7E OWNEA__,,,_ , _ U .^• W � �H;ENSED CON7RACTORS DECLARATI4N W � I HEREBY RFFIqM UN�ER P�NALTV OF PERJUNY THAT I AM LICENSED UNDER PR�YISIONS OF CHAPTER � q_ S{tSJMMENCING W17H SECTF6N 76W7 bF 6IVtSKKJ 3 OF TNE BUSINES$AND PftOFfS5�6NS CADE,AND Z X MY LICENSE IS IN FUI.L fOflCE AN�EF/FE�+CT � LICENSE LASS ��J,,,�,_ LIC.NO. �� /J� ��%�� ~ QATE "-L. ...j2^�____CflNTRAC,TOR. �. L-� iJW � —' � a � WGRFtERS'COMPENSATlON DECIARATION Q � I HEREBY AFFIFM UN�ER AEIVALTY OF PERJURY ONE OF 7NE F4LlqWiNG OEClARA110NS: z � _IHAVEANOWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-WSIJREFOHWOflKERS' _ GOMPENSATI6N,AS?ftOV�DED BYSECTION 3��(5G TNE 1A80R CODE.FOR TNE PERFOftMANGE U � OFTHE WORK FOR V/HICH THIS PERMIT IS 1S5UE0. � �W ,.�I HAVE AND WILL MAtlVTqiN WORNERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION a�oo OF iHE LABOR COOE,FDR THE PERFORMANCE OF TF!E WOflK FOft WHICH TH13 PERMIT IS ��"$�S ISSVEU.MY WO F'C PENSATlON INSU F C.ARR!ER�D PO�ICV NUMB[R pRE: COFISTRUCT(ON �y-��y�� V Q �` �r'V QcnaRlEa__.�� 2 .��y;�r ___ PLAN REVIEW c r _ — �, PaLICY NUMBER__ �"' ��-�+ ELECTRIC Q ......... � ��ssecnarr�mr��rseoormai.FrEooFn�vEw�u�r,swaarvENuwa600a.i.nas�siro)oai.Ess�. PLUMBING Z !CEF'i'IFY iHAF tN 7HE PERF4RMANCE OF TNE NYSPK FOH WHICH TitiS PEqM T IS iSSVED,I MECHANICAL _ (_,1'" SHALLNOTEMPLOYIINVPERSQNINANVMANNER50ASTOBECOMESUB TTOTHE Uj WORKEAS'COMPENSATtONLAWSOFCA11FbflN ETt T1fi OUIDeEGOME INSPEGTIC}N�Et __„ , � $UBJECT70TtiEWO�KERS'CAMPENSAT OY�SI F ,,,'7{ 'FTHELABOR �"7�Ga'_j ,� ��^ CODE,ISHAl6FOF'THWITNCOMPLY T E VISI ISSUANCE � �f� ',----- -- -��.0 p DATE: �� I �_ APPIICANT: SMIP W J ` ENERGY PJC � WARNING:FAI�URE TO SECUFtE WORKERS'COMPENSATiON COV[(IAGE IS UNLAWFUL,AND 51iNLL BE —� ----�� W SUBJECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUN�RE�TMOUSANp ENERGYPERMIF OOLLAflS(5100,o00j,W ADQIT�ON T4 THE COST Of CQMPENSATION,DAMAGES AS PflOViDEO FOft IN — � �� SECT70N3]086FTHELAB6RCDDE.INTEREST,pNDATTORNEY'SFEES. RETENTIONFEE: 4 +�ONSTRUCTI6N�ENDING AGENCY pRE-ALT FEE ��--� � I HEAEBYAFFIRM UN[1ER PENAIN Of PER.IURY THAT TNEflE IS ACOhtSTHUGTiON tENOit36 AGENCY ` FOR THE PERFORMANCE pf iNE WORK FOR WHICH 1NIS PERM'�T IS ISSUEO(SEC.3o9I,CIV.C.). —"""-- —' � W � IENDER'S NAME _�. ,,. _,,, t-- lENDEA'SADDAESS ^ '�L w I CEATIFY THAT i HAVE REAI�THISAPPLIGATION AND STATE TNA?TNE A9OVE INF�?RMATlON IS CUft"riECT TQ I A�(-EES t„�t w ; � iAGREETOCAMPIVWITHALLCITVANpCOUNTYOR�iNANCESANDSTATELAWSPELAfINGTO8UILDING � CONS7RLIC'ION,ANO HER�BV AUTHORIZE REPRESEN7ATNES OF 7HI5 CCHINTV TO ENTER UPON THE r+:,i ��( � AROYE�AtEMiOMEO PPOPEftTX fOR IMSPEGTION AUR?OS)'t�J'�y , COMMENTS�,�-�f�1 S_.�.��J�1`]�i_��_"_'^_� O /l n}7r�4' � ��n./ L..-"Y'�� —� (C...a�q�,�11.�iCV, .�� I �e � _ _— — ,�y�--�, _— � PE E NA (PRI -"' � � ¢ _ —��"�'.( � � —� � • c�.�.. � �— vj NATU P ..�. DA7E �-�� `----� = RECPT.NO. PAID BV VALIpATION F' WMITE—De aRment Co YELi.QW—Finanoe Co PINK—ASSessor Co GOIDENR D—File Co GREEN— P PY, RY. PY� PY. ApPficanYs CoPY �''i•4U ,i •�� ;�, aI�� , �,�� s-a �^� ,��e��T ��w ,��`.�°� . k�N � , s i 7> >, . . . �. ._. .. ... . . .. - v ,�: 3�� ... ._. . .—. _.. .... .. . .. . . ,. � �� .�. . . . .. -.:.—� :. .I 'N i `�a e�t�it��5.�� .. .. .. .. - . � .._.. ... ... .. .... ��': . .�. ._ , .., . wr :r : . �i `�4' � � !Ed� - . .... . ... .. . ..... ...... . ..__ ..... ._. _ w ..,, . ' .. .. . . �'� � a�'� � ��-�3'��5_ .. . ..... ... . ...... .._. . ..... �. �—�� _ ... . . . .. ... . � � t 7 4�i°:.� �1�Ad 'i .. _ .. .. .. . .. .. ... . �a st4 I��i �lt' - �.. . . . .. . . . . ... . ,� '.' ' �,�3 fl'�i.:ay.i . ... . _.. �� P 3, k +',.�am`�"��r�s r' �e i . . . .. . . ... . .. .... .. .... .. .. — ., P :— . . . . . .. . _ ... ... ... . _. . s t i �`� ; � � Ze� ik' � � . ._. .. ... . . .. 9 a •a .. . ..... . . _ ... ._ ...... a.i � � ....... . ...... . ... ... . . .. . _ a _ � .i �' - _; ,'�. .. -. � �. '�� W� � --a t ^5t"xs;u,'�.. . . ._.. ... ... ._. _ . . . . _. . . �� _ � .—� e...�n�y , . . _ _. ... .. .. .., . .. . .. __ -- CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION ADDRIESS 211 44 C-OLP v � 2j,)I 44, APN LOT TRACT OWNER � YLS' ADDRESS,2/ CITY/LI(+�$IP TEL APPLICANT TEL. CONTRACT ADDRESS CITY ZIP I TEL. ARCH/ENG/4- 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 REQUIRES A 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- 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 SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($500).): ^ I,AS OWNER OF THE PROPERTY,OR MY EMPLOYEES WITH WAGES AS 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 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-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 WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC. 7044, BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). EI I AM EXEMPT UNDEFI SEC. B. &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 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORCE AND EFFECT // 9 J C- LICENS�E LAS S J LIC. N0. DATE-F-=-1>--�--CONTRACTOR WCRKERS'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?ROVIDED 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 WOR F CO PENSATIONNIINSU/R��..AIy�E CARRIER D POLICY NUMBER ARE: CARRIER POLICY NUMBER'1 (THIS SECTION NEED NOT BE ODMPLETED OF THE PERMIT IS FOR ONE HUNDRED DOLLARS(5100)OR LESS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERM T IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUB T TO THE WORKERS'COMPENSATION LAWS OF CALIFORN E T T IF I OULD BECOME SUBJECT TO THE WORKERS'COMPENSAT OVISI OF TI F THE LABOR CODE,I SHALL FORTHWITH COMPLY T E VLSI DATE:� -0?APPLICANT WARNING: FAILURE TO SECUFIE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. CONSTRUCTlON LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION 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. PE E NA(PRI NATU P DATE WHITE-Department Copy,YELLOW-Finance Copy, PIN PRESS FIRMLY APPLI 1 PERMIT-10 P/C�_q •' DATE CATION NUMBER� # ISSUE f�, TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ^ REAR ^ SIDE/SIDE STREET RW ^ SIDE PROPOSED USE 51"an N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM U) Garage/Carport W Patio/Deck W LL PooVSpa 0 Re-Roof Z Commercial Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U cc I- U W W CD Z In a Q Z U W CI CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES 1-Du I COMMENTS 3]Z 0[� U 6 - '(J 4 1 tic, RECPT. N0. PAID BY VALIDATION 0'I.4C