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Home My WebLink About17970 �.x ! <"...,_?C,� �` � �'"<.�_'_�,..'`1 1�� CITX OP DIAMOND BAR i DEPARTMENT QF CC}MMI:�2dITY&,I7EVELt}PMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 PRESS BUILDING PERhiiT APPLICATION FIRMLY � JOBSITE '} j f./�) CC�I�LL � 5",,�, APPLICATION eJ' „7 �� PERMIT�J--=jl'°')� P/C CrG.-I-S� 4 ADDRESS�� / v"G p — --- I � � DATE NUMBE 1 j Jt 1 # � ISSUE TYPE � � OCC APN LOT—� TRACT DATE CONST._ GROUP p OWNER L � /�. L. + YIIJ P1ML"�.�{L o ADpRESS�I/af,. L>_�n [� r��,,l= .I ZdNtNG SETBACKS w ry —/— T FRONT RW ❑ z GITY JG f 141rflN� �A'2 ZIP TEL. AEAR � APPLICANT i TEL. � SIQE181IIE STREET RW (� m CONTRACT ��- (I L SIpE ❑ � CIT`!�V'�jZj � ZIP TEL.�V S+��S�� PROPOSEQ USE df",��"'..� "' f `C�� T�'��_1.F' c� !7 �� ^Y� /��n��i^' w ARGH/ENG/ f/�{ � �a,1 z OESIGNER "'�/ I�-�("'��`'"'�''` !^f G � ui N6.DWEL. NO. NO. c� ADDRESS � CIiY ZIP T[L. UNlTS STORtES BE6ROOMS cn ua DESCRIPTION SQ.FT. FAC70R PSF AdJ.AREAIVALUATIdN p� qWNER-BUILDFR DECLARATION � � SFRlADDlREM (� f HEAE6V AFfIRM Uh'DER PENALTY OF PEFJVRv THAI'I AM E%EMPT FROM THE CONTRACTORS LI� G8f0J8/C2fpOfl W OENSEUWfoqTHEFOLLOWINOREASON(5Ec.70.3r.5BUSINESSANDPROFES510N5coof�aNVClivoR (n ,,, C.? COUN7YWHiCNREQViRE5AFEAMiT74CDNSTRUCT,ACTER.tMPtiOVE.DEMOl.iSH,�RREPAiRANYSTRUG� w TURE,PRIOR TO ITB ISSUANCE,A�SO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A 91GNED w PaIIO/DeCk rd„ 5TAT5MENT THAT HE OR SHE I$LICEN5ED PURSUANT TO TNE pPOV1S�ON5 qF TNE CONTRACTORS l.4 � .� CENSE lAW i�APTER 9 fCOMMENCiNG WI7N SEC'ION�a}o}OF OlVi5i4N 3 OI"THE BUS�NE55 AND PRp• PoOVSPB � FESSItlNSC4DE)ORTHATHEORSHEISEXEIAPTTHEREFPOMANbTHE6A51SFORTHEAL4EGEDE%EMP� (�] �� TION.ANVVIOUTI4NOFSECTION70�158YAMYAPPLICANTFOflAPEAMITSI�BJEGTSTHEAFPLiCANTTO z R8-Rd6( A CYYiI PENALTY OF NOT AA6RE THAN FNE iiUNDRED DOLLAflS(fSOo).): ❑I,ASOWNEROFTHEPROPERN,ORMYEMPLOYEESWITNWAGESASTHEIRSpLECOMPEN5ATION, � . � Gommercial WILt p0 THE WOAK.AN4 THE STRUGTUftc IS N9T IN7ENDED OR OFFERED FOR SAIE{SEC.1eda,BUSi�� NE55 AND PRqFE5S1ON5 CODE:THE GUN�qqCTORS LICENSE LAW OOES NOT APPLV To AN OWN€R oF � PROPERTV WMO BUILOS pR IMPROVES THEREON,AND WHO�OE9 SUCH WOFK HIMSELF oft HERSELF OR � TMROtlGH MIS OR MEft OWN EMPCOYEES,PROYIOED PHAi$UCH N.APROVEMENTS ARE NOT INTE`7DL60ft � W OFFEREDWRSALE.IF,HOWEVER,THEBUILDINGORIMPROVEMENTISSOLDW17NINONEYEAROFCOMPLE� � TION,THE OWNER�BUILDER WILL HAYE THE BURDEN OF PROVtNG THAT HE OR SHG��D NOT eUIID OR �� Z IMPR6YE�6R 7HE PUAPt}SE OF SALE}. � OI.ASOWNEROFTHEPROPERN.AAAE%cLUSNELVCONTRACTINOWI7HUCENSEDCUNTRACTORS LLA [� TQ CAN'STRUGT TtIE PROJECT�SEC,704+.BUSINESS AND?R4F[SSIONS COUE THE CDNTRACFOflSIb Vfl1U&IiO�i ADJ.ARER LL1 CENSEUWGi0E5NOTpPPt.VTOANOWIVEROFAPROPEflTYWHOBUILPSOPIMPRpVESTHEqEQN.ANb �� — � WHOCONTRACiSFORSUCHPPOJECT3WITHAGOM1TRACTOP(S)UCENSEDPl1RSUANTTOiHECONTRAG QUANTITY DESCRIPTIQN FEE � TORS LICENSE LAW}, a ❑I AM E%EMGT UNDEft SEC. _.,. 9,a 0.C.FOR THIS REASOY Q � U ..—..�..._. . � � DA7E �_ OWNEfl`_.u._...�... ...... � � W `�—� LlCENSED CQNTRAGTCRS QEGIARATiON � CG I HEREBV nFFIRM UNOER PENALTv OF PERJURY THAI IAM UCENSE�UNDER PRUVISIONS OF CHAPTER � p� e{IXJMMENCING WITH SECT�GN iooa}(7t DIYtSiON 30F THE BUSINESS RND PR�ESSIONS{,�p�E,At� Z 7G MY LICENSE IS M FULL!FOHCE ANO EFFECT ' Q L(CENSE/CL'A^SS.%�`'�'''� � � LIC.NO..��-�-".�...-�` j � 6ATE, 7„'� /��-��_ C4NTftACTOR_��_L=.�'.'-J��,� a- W � � WORKEfiS G6Mf'ENSATtON DECLARATION d �� I HEREBY AFFlRM UNDEft PENALTY OF pERJURY ONE OFTHE FDI.LOWINC DECLARATIOMS: Z � _,_ IHAVEANDWILLMAINTAINACERTIFICATEO4'CONSENiTqSELP�INSU%EFGFWONKERS' _ Q C.OMP6NSATION,Au?ROY�DEO 0Y SECTiON 3�004f THE I.ABOfl C6DE.FOR THE PERFORMANCE w OFTHE WORK FOR WHICHTMI5 PEFMIT IS IS5UED. Cl � t w I HAYE AND Wtll MAINTAIN WOAKERS'COMFENSATION IN5tIftANCE,AS REOUIRED BY SECTION Q9]004F THF.IABOq CODE,FOq THE PERFORMANCE OF 7HE WOflK�OR WHIGH THIS PERMITIS „ � �� J ISSllED.MY W4RKEP5'CqMPENSATiON�NSURRNGE GARPoER AND AOCSCY NUMBER ARE: ��STRUGTICSN � j CAARIER .�.._._ PLAN REVIEW �g� "' .�......_. ^ � roucvNurnoea_ —. ELECTRIC _,.._....._ ¢ � (ni�sSECTaNr�mtasiaEmr�w.ErEaoFn+EaEa.nrriswnoN�rr�waeoaai,aas�a�ca7oR�Ess�. PLUMBMG . . w Z" i CEftTiFY THAT IN'HE AEftFOflMAHGE QF TFE WQHK FUFt WNICH THIS PEftMiT t51SSUED.i MEGHANICAL _„ _ (� SHALI NOT EMPLOY ANY PERSfJN IN r�NV MANNER 50 AS TO BECOME SUBJECT TO THE � WORKERS'COMPENSATION LHWS OF CALIFORNIA,ANDAGPEE TNAT IF I SHOULO BFU`�ME �ON FEE � St/8J6GT TO THE WOftKER�C{MdPENSATION PROV1530N5 aF SECT40N tTb�50f THE I.k80R —i` GO�E,I SHALL FORTFIWITH fAMPLV WITH THQSF PqoVISIONs. ISSUANCE , � � a �^^-} }- p DATE�� j'� � APPtiCANT: t �S - --r,. � —... —�_ � WARNING:FpiWRETOSECUREWQRttEHS'COMPcN$ATI6tJCOVERAGEISUt$.AWFUI..AN6SHAtlBE EIVERGYPIv � ^aU&IECTNN EMPLOYEq T4 GHIMINAL PENALTIESAND CIVIL FlNES UP TOONE H{JNOPFD TH4USAND ENERGY PERMIT OOLLARS(5�W,Oaol.IN AODITION TO THE COS f OF COMPENSATION,DAMAGES AS PROVI�ED f�R IN ��- -�— � SECTION 3Ja8 OFTHE 1A90R COOE.P7TERE5T,ANiY AT'�RNEYS FEES. RETENTION FEE: _„ C� '�__�. W CONSTRUCTION GENDING AGENCY PAE-ALT F£E: O — '— � INERE9VA�FIRMUNDERPENALIVOFPERJUHYTHATTHEREISACONSTRUCTIONLENCIINGAGENCY FOR THE PER£'�oRMAf�{GE OF TtiE WORK FOR WHfCN T1tS PEf1MIF IS ISSUED{SLC.349I.CiV.C y. � W _.._. .. .. � IENt?ER'9 NAb1E .._ i — F^ LENDEfl'SADpAESS .__�_.._......._...._..._ _..— t i � I CERTIFY THAT I HFYE flEAO THISAPVLICATIONANO STATE TNAT THE ABOVE INFOflMATIaN 16 CORRFCT. TOTAL FE�S? • � � I AGREE 10 f.pMPCY WITH ALl GITY AND C6VNiY OftpiNANCES ANO STAT£lAW8 RE�ATING T6 BUl�OtNG � G4NSTRUGTIUN,AM1UHERE9YAUTHOR2EREPRESENTATNESOF7HISC.QUNIVTOENTERUPONTNE � ERMITTEE ME R� RTY FqR INSPECTION PURPaSES. � ' COMMENTS_,_ _ A OV- � �� I--.. _ .. J � u ✓ m � � 'Z.._ ��-----.__._ ¢ , va �/y SIGNAT E .....�...��......—. DATE� � RECPT.NO._,,,,, PAID BY ., � VALIpAT10� ~ WHITE—Department Copy,YELLOW—Finaoce Gopy,PWK—Assessor Copy,GOLD NROD-�—File Copy,GREEN—Applicant's Copy "�" ��, p � ��p ��a��F a �� "��..��9a , a, �'� �� x � da�i� �� . . . . , . . . .. _wd� �c.,.�ir�� .. . i.. . .... , . .. . . .... . ..... .. _� ... . .... . .: �p-�� . . . .. . . . . .. .. . . ... .. � . �.t a��w� # .... � . . . . . , a, . . ��a _. . . _ . . � �� ; , _ . . . . .. _. . .. . . . . .. . �� c � t r� � � : ; .. . . J`i�P� -��u^�4-��,�� h � .. . .. . . . . . . . .. . _.... ... �`��'�� r��,t��4� � ra ! �' � � �� `9�^�� `��'�` �� _ _ _ _ _ — ur�'�a� �� ° a �E � � �� r � � �,° �� y �`��`:��^��.i � � � � e & 'L J h -s � .. . . . _ . .. ��'�yu�-��"z.�8 L"��3�-k��r��C ��. . .. . ... 3� 6`3b ; — 5�� :.. . . .. .. .... . . k � � �°'�'��i i-�� i,a rs �,;` .. . . . . . . . . _ . . . . . q � �� k� "� ��'�� `e, ' �`.�� . ��b�a��R�aa r�ra� ' .. . . . . _.. . . . . . .. � �� .... s �m��,.�'�- •� � . .. . _ ...... . .._. _.. . — X J) 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 (bo CC) P(-S slu ADDRESS I APN LOT TRACT OWNER L 1 j L Fin/AM t.. L ADDRESS I6 6 0 [j r7L j, CITY 081404D Q k(t ZIP TEL. APPLICANT TEL. CONTRACT(N 0-Tom'- F-I L ADDRES r C CITY 7u,TI ZIP TEL. 2 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 REQUIRESAPERMIT 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)): EI 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 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 THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). D 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.). ^ 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 7 v"a (�//� C-t lt LIC. N0,/.T�/ LICENSE CLASS.%� DATE�-/- I?OOO�v 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' -INSURE FOR 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 WORKEP,S'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER POLICY NUMBER (THIS SECTION NEED NOT BE COMPLETED OF THE PERMF 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 SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. AT D E:APPLICANT./L/ 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 I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. 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. M1J1 ERMITTEE ME FIN I�� SIGN AT E DATE ICATION APPL fi PERMIT P /CC1Z-IS 7 I, DATE NUMBEPd ISSUE TYPE OCC DATE CONST GROUP ZONING SETBACKS FRONT RW^ REAR^ L 1 SIDE/SIDE STREET RW^ SIDE^ PROPOSED USE C) . (Z e�CA 5�J292 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 PooVSpa Z Re-Roof Commercial 5 M Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J 0 u w w 0 z co 0 Q z s u LU CONSTRUCTION c PLAN REVIEW Slrj " ELECTRIC PLUMBING MECHANICAL ON FEE 7SS11110E ) v ENERGY P/C ENERGY PERMIT �^'{\ RETENTION FEE: D�.7 PRE-ALT FEE: TOTAL FEES 94b,).X 0 COMMENTS RECPT N0. r 1' 1 Lin PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy