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Home My WebLink About16643 �-- CITY OF DIAMOND BAR �__._.. � �� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES f,i 21825 E.Copley Drive �� .,.,�. �� (909)860-3195 Fa�c(909)861-3117 PRESS BUILDING PERMIT APPLICATION �- )3.,0� FIRMLY y JOBSITE APPLICATION �`��I PERMIT ��J P/C �_ '��( Q ADDRESS 2'I700 E. Copley 3rd FI Partitio o DATE NUMBER � #�_��r�+ � issue rrPe occ �p TRACT DATE CONST. GROUP PN-�I�IV��---- p OWNER o ADDRESS�Z� ZONING SETBACKS Z ciTyPhoeni;x ZIP TEL FRONT Ryy �_ � APPLICANT _ TEL. REAR �_ z SI�E/SI�E STREET RW O_ Q CONTRACT� ectr�ca � es�gn C. SIDE ❑_ o C�RES8tlt8-R�tlICB Z�P v�ev.�t�, �J�g��9 PROPOSEDUSE � {,L � 0 o ARCWENG/ ��gE Associates z DESIGNER w —'r! NO.DWEL. NO. p, a ADDRES � CITY �c�vina • ZIP TEL. UNITS STORIES EDROOMS_ � N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREA/VALUATION Q OWNER-BUILDER DECLARATION SFR/ADD/REM O � I NEFEBV AFFIRM UNDER PENALTV OF PERJURV THAT I AM EXEMPT FROM THE CONTRACTORS LI- G2f898/C3fp011 W CENSELAWFORTHEFOLLOWINGREASON(SEC.�03t.58V5MESSANDPROFESSIONSCODE:ANYCITVOR (n U COUNTVWHICHREDUIRESAPEflMRTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPPIRANYSTRUG- w TURE,PRIOF TO ITS ISSUANCE,A150 REQUIRES THE APPLICAM FOR SUCH PERMIT TO FlL:A SIGNED W Patio/Deck � STATEMENT THAT HE OR SHE IS LIGENSED PUFSUANT TO THE PROVISIONS OF THE CONTRACTORS U- � � CENSE LAW(CHpPTER 9(CAMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND Pfl0- POOUSpB 0 FESSIONSCADE70RTHATHEORSHEISE%EMPTTHEREFROMANDTMEBASISFORTNEALLEGEDEXEMP- � V TION.ANVVIOLATIONOFJECTION7031.SBYANVAPPLICANTFORAPERMITSUAJECTSTHEAPPLICANTTO Z RQ-ROOf A CIVIL PENALT'OF NOT MORE THAN FNE HUN�RED DOLL4R5(f 500).): � ❑I,ASONTIEROFTHEPROPERTY,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPCNSATION, � CORIff18fCIdI z WILL DO THE WORK,ANG THE STRUCTURE IS NOT INTENDED OP OFFERED FOR SALE(SEC.7004,BU51- J � NE55 AND PNOFESSIONS CADE:THE CONTRACTORS LICENSE lAW DOES NOT APPLV TO AN OWNER OF � FROPERTY WHO BVILDS OR IMPROVESTHEFEON,AND WHO DOES SUCH WORKMIMSELF OR HEFSELFOR wTHROUGMHISORHEROINNEMPLOVEES,PROVIOE�TMA75UGHIMPROVEMENTSAqENOTINTENDEDOR m � OFFERE�FORSALE.IF,MOWEVER,THEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE- Z 710N,THE OWNER-BUIL�Efl WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR � IMPROVEFOR7HEPURPOSEOFSALE). � w ❑I.ASOWNEROFTHEPROPERTV.AMEXCWSNELYCONTRACTINGWITHLICENSEDCONTflACiOqS Q TO CANSTRl1CT THE PRQIECT(SEC.]�d6,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI� V2IUB�1Of1 ADJ.AREA W CENSELAWDOESNOTAPPLYTOANOWNEqOFAPROPERTVWHOBUIIDSORIMPROVESTHEREON,AND � � WHOCANTRACTSFORSUCHPROJECTSWITHACONTRACTOR(5)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE Y TORS LICENSE LAW.J. � ❑I qM EXEMPT UNOER SEG. B.8 P.C.FOR THIS REASON Q � U � � DATE OWNER H z — U � LICENSED CONTRACTOFiS DECLARATION w Q Q I HEHEBYAFFIRM UNDEH PENALTV OF PERJURV THAT IAM LICENSED UN�ER�ROVISIONS OF CHAPTER � d 9(COMMENCINO WITH SECTION]000�OF DNISION 3 OF THE BUSME55 FND PROFESSIONS GODE,AN� Z X MY LICENSE IS IN FULI FORCE AND EFFEGT. � IICENSECLASSr_'jL'� C�� ,�.No. 632399 � V DATE ��I JO I O�� CONTRACTOR d W � VVORKERS'COMPENSATION DECLARATION a NIHERE6YAFFlRMIJNDEFPENALTYOFPERJURYONEOFTFEFOLLOWINGDECLAqATIONS: Z Z I HAVE AN�WILL INAINTAIN A CERTIFlCATE OF CONSENT TO SELF-INSURE FOP WOqKERS' a 2 ¢ COMPENSATION,ASPFOVIDEDBYSEC710N3]ooOFTHELABORCODE.FORTHEPERFORMANCE U OFTHE WORK FC�R WHICH TMIS GEaM1T IS ISSUE�. w W X � Q _IHAVEANDWILLINAINTAINWORKERS'COMPENSATIONINSURANCE.ASREQUIREDBYSECTION --�� Q 37000F THE LABOfl CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICHTHIS PERMIT IS ISSUE�.IAV WOR{EFS'COMVENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION h � �ARR,ER ;State Fund PLAN REVIEW ZPOLICV NUMBER ELECTRIC a 0 (6CSSECTKNJNEEDNO7BECOMPLEfEDOFiHEPEPMRISFORONEHUI�OREDDOLLAfiS(E1ao)ORLE557. PLUM8ING W _ Z I CERTIFv THAT IM THE PEFFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSI/ED,I MECHANICA� (� L} SHALLNOTEMPLOYANVPERSONIYANVMANNERSOAS70BECOMESIIBJECTTOTHE d i,,,,.�..` . Uj WOqKERS'COMPENSATION LAWS OF CALIFORNIA,ANDAGREE THAT IF i SHOULD BEGOME INSPECTION FE'�j� � � ? SUBJEGT TO THE WOFKERS'COMPENSATION PROVISIONS OF SEGTION 3]00 OF THE LA90fi 3 � � CO�E,ISHALLFORTHWITHCOMPIYWITHTHOSEPROVISIONS. ISSUANCE � � � �7 9 �–� e�._� • � p DATE� �I� /OL. qpp��CANT: �• M. Skaff SMIP 1 � �E � ENERGV P/C � ( J WARNING:FAIWRETOSE:CUREWOflKERS'GOMPENSATIONGOVEflAGEISUNLAWFUL,ANDSHALLBE � � SUBJEC7ANEMPLOVERI"OCRIMINALPENALTIESHN�CNILFINESUPTOONEHUN�ReOTHOUSAND ENERGYPERMIT �'- ' � J SEC ON370 O�F�THELABORICODEo,NTEROEST,ANDATTORNEV'SF �AMAGESASPROVI�EDFORIN .. _ .._ � EES. �� ''� ' p� RETENTION FEE: –�-� � � \ ) OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: �� Q I HEREBY AFFIRM UNDEF PENPIiV OF PERJURY THAT THERE IS HCONSTRUGTION LEN�ING AGENCY � � FOR THE PEflFOflMANGE OF TME WOflK FOR WHIGH THIS PEFMITIS ISSUE�(SEC.3�9],GN.C.�. W j LEN�ER'S NAME � F-- LEN�ER'SADDRESS I � TOTAL FEES j (((�� ^ ///�� ICERTIFVTHATIHAVEREADTHISAPPLICFTIONANDSTATETMATTHEABOVEINFORMATqNISCORRECT. ��.��_`''�� j '�/�I • 1� d IAGREE TO COMPLV WITH FLL CI�V AND GOUNiV ORDINANCESANO STATE LAWS RELAIING TO 6UILDING �, � T p / � CONSTRUCTION,ANDMEHEBYAUTHORIZEREPRESENTATIVESOFTHISCOUNTVTOENTERUPONTHE ../ Z ABpVE-MENTIONED 7ROPERTV FOR INSPECTION PJRPOSES. COMMENTS " � \}7 — ._ � �(i m PERMITTE I 1 � �/ � � � S U R DATE — fiECPT.NO. PAID BY VALI�ATION ~ HITE—Department Co YELLOW—Finance Co PINK—Assessor Co GO�DENRO�File Co GREEN—A licanfs Co PY, PY. PY, PY� PP PY �� r �� s�,� � � � �� E � € �. " ��.s� ��,� �'d� �� ,.��;��,s � � �' � �� '��b Z '� � ��, m:. � , ° , :- .�s'��'`��R '��r��r� _ _ =�� i�', tii�` _ , i.� a 3. �+�i��..� `�� f � �q� ` . r �: E, �°' �r "' ,'",�°i� s � � ,, - _ _ _ _ _ . a �, =r, �s r �_ ; = e ,� ._ � - ; � ��i .�� _ _ r � � � _ _ �, .y„ ' - � t�� ` • - y , .. i ;�s� ; a . , , _ : t� i„�� . " • .. . ... ._ . .,,ai _ ,. .. . ... .. ..._ . OI CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION JOBSITE ADDRESS 2'1700 E.Copley 3rd FI Partitio APN r�� TRACT OWNER ADDRESS-�� Phoenl:>< CITY ZIP TEL. APPLICANT_TEL. CONTRACT ectrica�es�gn C. ADDRESS cITY Santa mica zIP�0. EL. $65�+14'f389 ARCH/ENG/A8E Associates DESIGNER _,I..t ADDRES �cwina CITY ZIP TEL. OWNER-BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE UW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE:ANY CITY OR COUNTY WHICH REQUIRESA PERMIT TO CONSTRUCT,ALTER,IMPROVE,DEMOLISH,OR REPAIR ANV STRUC- TURE,PRK)R 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- FESSIONSCODE)ORTHAT HE ORSHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION.ANV VIOLATK)N OF SECTION 7031.5 BY ANV APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(f 500).): ^ I,AS OWNER OF THE PROPERTY,OR MV EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL W THE WORK,ANG THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC. 7044, BUSI- NESSAND 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 O1VN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE. IF,HOWEVER,THE BUILDING OR IMPROVEMENT IS SOLD W ITHIN 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 PRCUECT(SEC. 7064, BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- CENSE UW DOES NOT Af'PLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS W ITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.J. ^ 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 1 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 FOR CE AND EFFECT. C 632399 � ��p LICENSE CLASS j_ uc. N0. � �/30�0� DATE CONTRACTOR WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL INAINTAIN A CERTIFICATE OF CONSENT TOSELF-INSURE FOR WORKERS' COMPENSATION,AS PROVIDED BY SECTION 37000E THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. X I HAVE AND WILL INAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION 37000E THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MV WOR{ERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER'State Fund POLICY NUMBER (THIS SECTION NEED NOT BE COMPLETED OF THE PERMIT IS FOR ONE HUNDRED DIXLARS(ft m)OR LESS). I CERTIFY THAT IM THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I 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 P R OVISIONS. IL A �/�/02 M T Skaff DA E: .APPLICANT: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE SUBJECT AN EMPLOYER I"0 CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS(f 100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37080E THE LAI30R CODE,INTEREST,AND ATTORNEY'S FEES. CONSTRUCTlON LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY 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 RE AD 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 HERERV AUTHORIZE REPRESENTATIVES OFfHIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. �� SURDATE L"��d�l PRESS FIRMLY RITE-Department Copy,YELLOW-Finance Copy,PIN