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Home My WebLink About16645 (9) (,e�, � - ��.�� _ I�.�,t��T�` ^`" �� r� CITY OF I?IAMUND BAI� ,� ��j DEPAFLTMENT OF COMMTJNITY di DEVBLOPMENT SERVICES�i�-1�� +�l. �`�`i� � . - 2166dE.Copley DriveSuite l90 �— � PRESS {909)860-3195 Faz(909)$61-311? �^%'�-^"� �!'} ` ��TM'` BUII.bING PERMTT APPLICATION ,� FIRMLY y JOBSI7E -� �p �' APPLICATION � ,�" � PERMIT P/C � o ADDRESS� � � DATE '��r3 1l NUMBER #��,�3�, � APN LOT�(��I TRACT `� TE �`-� ��GONST.,,_�._,"„_ GFOI)P �� p OWNER __�� C ^ — ADDRES �,�;� a2Q O TONING SkZBACK5 W CI7Y FFtONT __. RW ❑___.._ 1j`,ll,� ZIP�.,�,,� TE�L�"� F � APPl1CAN TE f7� REAR ❑___ � SiDEi5{DE STREET_ RW — ❑_ CdNTRACTOA_ SIDE ❑� � CDqAESS ZIP TEL. PRdPOSE4 USE � � �S � ��+s ARCHtENGi � � � DESIGNER��. /��,Q�_ NO.DWEL. NO. N(7. ADDFtESS l�ll �n.11t ,Cnrh � ,3 � CITY,�_[��#[ ZIP��,� TEL. - % UNlTS STORIES BEDROOMS_ cn QESCRIPTION SQ.FT. FACTqR PSF ADJ.AREANALUATION Q 6WNEfi-BUiLOE�?DECtARATlON SFRtADD1REi�i n i t4E}iEBY AfFlPoA Ut�ER PENALTY OF PERJURY THAT I M1 EXEMPT�ROM THE CANTRACTORS LI- �a(dg8(Cd(pOtt W CENSEtAWFORTHEFOLLOWINGAEASbN(SEC.'7037.SBu5INES5ANpPPOPE55qN5GODE:ANYCiNOii (J� COUNTVNk11CHRE0UIqE5APERMITTOCQNSTRUCT.ALTEFi.IMpROVE,DEMOLI5H,47pREPpIRANVSTRUC- �,j,J Pa110/DOCk W TURE,A4ipR TO 7T5 1S9UANCE,A1S�NEOUtF�S TME APFLICANT�Oft 54tCH PERMIT TO FtIE A StGNED � � STATEl1ENT TNAT HE OF SHE IS LICENSEp PUfiSUANT i0 THE PROV1510NS OF THE Cqh1TRACTORS LI- GENSE UW{CHAPTER 9(COMMENCINO WITH SECTION 7000)OF DIVISqN 8 OF THE BUSINE55 AND PRO- �'�' PooUSpa FESSpNSCODE)ORTH.M1TN'eOkSNEISEXEMPTTHEFiEFROMANOTNEeASiSFOFiTHEALLEGEDEY.EMP- (!� TIOIV.ANYVqUT10NOF5EGTION7031.5BYANYAPPLIGANTFqRAPERMITSU&IECTSTMEAPPI,.ICANTTO Z pe-Roof � ACIVIiPENAL7YQFN6TMOFtE7wWFIYEMUNpREoOfJLUN5Sf5op).}: � ❑I,:4SOWNEROfTHEPROPEiiTY,ORMYEMOLOYEESWtTNWAGESASTHEiflSOLEtX7MPENSATqN, COrt1r118�CieI `ML4.00 THE WOPK,AND THE STRUCTURE IS NO7 IN7ENDEp OR OFFERE6 FOR SALE(SEC.7o1a,BUSI- J� � t�$S AND PHbFESS10NS'COOE:THE CONTRACTORS 110ENSE tAW OOES NQT APPtY TO AN OWNER OF = P{qPERTV NM110 8U41?S OR IMPROVES THEREON,AND WHO p4E5 SUCii WORK HIMSEIF OR HERSELF qR � iNfbUGHHI50HHEROWNEMPLOVEES,PHOVIDEDTFIATSUCHINpROVEMENTSARENQTIM'ENDEOOR � "'-- Q OFFERq3FORSXElF,HOW£VEA�HIkt.O1N�ORtAAPRDV£6�tiTtS50L6WiTHINON£Y£AftOFCOMPlE- � Z TIQN,TME OWNEfl-BUIWER WILL NAVE THE BURpEN OF vROVING THAT HE OH 5HE DI�NOT 9UILp OFi � IMPROVE FORTNE PURF'OSB OF SALE). W pi.lM$OYYNEft�FftiEPROPEPiTY.hME3(ClUSiV£IYCON7ftAC'�iNGWITNtivENSEDCON'fRACiORS - (r TO CONSTRUC7 ME PRQIEC7�SEC.7oN,BUSINE55 ANO PROFESSIONS CODE�.THE CONTPACTORS LI- V81U8flOn _ADJ.AREA tl� CENSEUWDOESNQThPPLYTOANQriMEftOFAPfl6PEftTYWHOBUttASORfMPROYEBTHEREON.ANO ' � wtacortTrucTSFonsucHaRaEcrstimn+,�corvrrucroa�siiic�nse�aupsuu+rrar�corrrcuc pUAN717Y DESCRiPTiON FEE Y TOpSLICENSEI.AW). _ 0 U T AM EXEMPT UNDER SEC. . ,__.,_�,B.d P.C.KOP TNIS REASON Q � �,,� � � ._ ��_-- - C[ � �i�- S u- o�TE �_-_.... -ownea_..,..—._ _ C,7 � O r LICENSED CONTRACTORS DECtARATION W � I N6qE8V AFFIRM UNOER PENALTV OF FERJURV THAT IAM I�CENSEO VNOEfl AROV�SItJNS O�GNAPT�R � d Y(fbMMENCINq WITH SECTN7N�000)OF pN151pN J OF THE 0U51NESS AND PROFE55�ONS CODE,RNp � X MYI�GfNSE751NFU11'=OtYCEdNDE�FECT � "'—"' L1J /� �f �7 .�r Q UCENSE GtAS5___I__J L�C.NO._�/S / JS � F / V UATE___yQ_�,�"U/ CONTRACTOR C�CC•S �_� 0�.. w � � WURKEHS'COMPENSATION DECLARATION � � I NEHEBV AFFIRM UNOCP PENPLTV OF PF.RJURY ONE OF THE FOLLOWING�ECLA,qATIDNS' Z � __,,,_INAVEI`NDWtitMAM?AiNACERTiFFCATEOFCONSENTTbSEtF�iNSUREFORWtlRKERS' x � CCfMPENSATION.AS PROVIpEO BY SECTION 97�JOOF TNE IABOR GODE.FOR THE PERK'ORMANCE W � OF TNE NFORK FOR WMICN THIS PEftMST SISSUE4. � � �I MAYEAND Wq1MAINTAiN WOflKERG'COMP6NSATItlN INSURANCE,AS AEOL11qE�OV 9ECTIfJN / Q 31000F THE USSOR COPE.FOR TNE PERFORMANCE OF TtiE W6RK WR WHICH THIS pERMR IS � � ISSLiEiJ.MYVJ�)RKERS'COMPENSAT�+INSURANCECARRI�RANDPO�ICYNUMBERApE: CONSTRUCTION t• � cn��H—._��....F-FFR-M ��nr�Rsview ��.�3� I�X�.la��.�. __.._ �� z ��y��,.R__aYG-ni u"M�'� OG17 y�j'7'� -- ELECTRIC t,}U.�"`� d �' � t�sEctaMtlttDNo7eE�blF�.EiEDOFOEs'EaAYI'1SaxlcvaEHu+L%tEDD�l1AR51E1rolaiLESSI PLUMBING _-._.. �__."_„ /_Q� W Y`} Z," 1 CFFTIFV THAT IN THE PERFORMANCE pF TNE WORK FOR WHICN 7HI5 PERMIT IS ISSUED,I MECHANICAL � C�} *' SOASi08ECf}MESU8lEG7TOTNE � "5'�- �-- -- GOD£,ESHAU��ftTNNft�COMRIOYWST}tT O EA�pAGH[ETMAT�FISHOVLL78ECOME (FISPECTIONFEE _,,,,,, j.-�,�u � /' "� � uU0.1ECTTo'INEWORKERSCOFAPENeATIONPROVISION50FSECTION77000FTHELABDR "-' �-��-�t � � ...� P�v s. iSSUANCE __ � ' .. .-�\} .... � p dATE: .. _It�lla� APPIiCANT: _ _ SMIP .. �� w i , ',��,U f ; _ � WARNINC:FAI4UFE Ti>SECUpE wORKERS'COMPE°�ATION COVERAGE IS UNLAWFUL.AND SFiAIL BE ENERGY P/C _ � SU&lECSAN£MPIOYERTOCRLNtNALP�NAL74ESANOCIVIIF�'ESUPTOpNENUNDREDTHOUSANU v— �W�_� D(7LUflS(f1U0,000�,IN ADD1110N TO THE CoSTqF CqA1PEN5ATION,DAMAGES AS PHpVIDE�FOR IN EF7ERGY PERMIT _ E � sEcrana�aeoFTMe��aeort�ae.wreassr,rwoanoau�rsv�Es. RETENTiONFEE: ��` ��_��_�_ S � - . a CONSTRUCTION�ENDING AGENCY pfiEALTyyyFryryryEE]1 �_ 4�� -"d � INEREBYAFFIFlMUNI7ERPENALTVOFVERIURYTHATTHEPEISACONSI'RUCTIONLENDINGAGENCY �_� �i' —_'__.. FOR TNE PEFlFORMNJCE OF THE W ORK FOR WNICH'fNIS PF,RMIT IS ISSUED(SEC.3J97,CIV.G.). W _-... � IENDER'SNAME_ _. - ^_i_ - F-- LENDER'S A�DRESS, ^�„�,,,,v�„ '1 �ryp W I CERTIf"Y THA7 1 HAVE REAp THIS APPLICATION AND S7ATETHAT THE ABOVE WFORMATION I5 CORRECT. TUTA��E ES � � '�� /� � f AGREE TO CAMPLV W1TH ALL CITY ANp CAUNfY OFbINANCESAN6 STATE LAWS RELATING Tq BUILDING r � CONSTRVCSIGN,Nit}HEftE6YAUTH6RiZEREPRESENTASiVFS6FTHI5IXN7NTYTOEN7EflUPqYTHE ABOVE�MENTpNED I>POPEfiTY Fqq INSPECTIqN PVRP0.SES. � �, i � + � COMMEN7S ^_ ,_,__ � lil'�C�-_ "'\�1.1�-.G�,,.. - —..� — � PEP4iiTTEE NhME iNqIN) '� � -- ,��• D � �cNAruaEOPr 1 � onre RECPT-NO. � PAIDHY _ . VALIOATION__±�.�. S r WHITE-pe ahment Co YEIi.OW--Finqnce Co PtNK-Assassor C p py, py, opy,GOk.DENROP-File Copy,GRE N-App4icanYs Copy „' B ',P` �.�� '�,�.3�”�.s ��,�� a�� `.�<�s S"�'a s��t�,"�r�:�,.�,�"� �"��-.` �,�,,,a�„�'i�.-�.. . �,.� ".-" "s � ' � '' ,. . � �� '� �� a� xr �� _ ��, �,. � � ,� � � � � � ,� ��u, �, " � �1��FI�Q _ } �'• �� _: , , � �-r,, „ 2,.-� _ . � ,_ �� --_._ ___ . _ __ _ _ . , *�. � � � . , � � � � � ___ _ _� _ _ __ _ __ .. _ _� � � „`— ilt a., _� , .. y �� _ , _. .- � ,� � � - �.� � .: ,; . o ��" � . . , � , ,:, - ,: . � � , �'v+.» °'^ �_� :;e - � _ . ... _ _ _ __ __ _ 4. �r}yt. .. . . � ;" � . , y . � : �c ' � ..._ . ... ... .. .. .. . . _ . . .__; ._ , . .... . . . . . °. 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P�v�-'(C?�t� 1-cq{� Au�S g p�"�.�" _ _ � `'�..`�d S7r+-'_'�ljlae�- 1� CtxS?Jz.�`�.f.�'4C..� _, . _ _ _ 9'(L-r)2._ �1�`t' i7) ,L'tC- ��t'_.iEu-G��f}4vy_�'_ .. � . �t ....4 . .. ...... . ..... ...... ....... .... . ...... .. i t�..�..� ! .a_.w...t �_. ....�'. , e+.}.S. .... . . ... ... ��. . ..... .. .. ..... . ..... ...... ...... . ..... ....... .. .... ...... ....... ... ... . .. ... ... .. ... . . . . .. ... .. .. . ...� "� . .. ... ....... ...... ..... , ..... ....,. ...... . ..... . ..... . ... ..... ..... . ..... .. • .. . ._ . .___ . ... . ._ ..... ._y _..:, ... . . . ... x. ..,. . .. . _. .... � a ` y u . .... . ._ .. .... ... . . �. ��'�.�� .�.;@ � '� � . ., .> ,._ _ . �. , ... .. . . . �� ,y�"atr��k'm ,,k"�'�"a'�"'�'a��^� .. . . .... _.. . . .. .... . . . ... . . . . _. _ � . ' __' '` ._ . ;�,',� a'` �r�d�-�-a� '�� .. � �;. .� .;. � �' '�- �3 a . � � �"��°`��'�� 1��`�� _ _ �,'. r��. � ' . �� ' � � � !� ,,,�� d, �� , ��" � `�� x� �� a g J '.';��'�'�.� :�WJ"+�;; .a �.ar . ... .... ..... .. . . _. ... ... ..... } .. .. . � ��"9 � q G��i �'��,'; ' t` .. � i� '��. K..� ... �.��.�',�"��i� ,,�" " � �`�:� . ._. _ ..... ...._ _.... . . . .. ..._ .. . ._. .. � �� _wPo ..._ __.... �— ( 'S . �� .�6 �,W+��?.a�$ � d�'�a,�:� . � � , �� ..' .. . .. s �7 ?"i � o..✓;�r `4 mtv. 1�.,.. . �. . . ._.. .. . �ftl a-. . .. ?�<� .�.,� � .. . , ___.� � r UI,1�II-J U f �lhl CITY OF DIAMOND BAR-�II �j DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES��1 � � �+�, L'�I �� 21660 E.Copley Drive Suite 190',��e� �� PRESS (909)860-3195 Fax(909)861-3117"� BUILDING PERMIT APPLICATION (��/ FNRMLY JOBSITE s�1.�D r' ADDRESSF� APN LOT��L TRACT �r OWNER��C ADDRES_2,;�oZ0 � CITY��ZIp��'TEL-Y APPLICAN TE� � CONTRACTOR ADDRESS CITY ZIP TEL. ARCH/ENG! � DESIGNER� L ADDRESS� � CITY-��-�---ZIP TEL. �Z?��'�i / OWNER-BUILDER DECLARATION I HEREBY AFFRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSELAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE: ANV CITY OR COUNTY WHICH REWIRESAPERMITTO CONSTRUCT,ALTER,IMPROVE,DEMOLISH,OR REPAIRANY 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(COMMENCNO WITH SECTKNJ 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- TK)N.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(f500).): ^ 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. 704s, BUSI- NESS AND PROFESSK)N;i 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 W ITHIN ONE YEAR OF COMPLE- TION,THE OWNER-BUIU)ER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURF�OSE OF SALE). ^ I.AS OWNER OF'rHE PROPERTY.AM EXCLUSIVELY CONTRACTlNG WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC. 7041, BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OF APROPERTY WHO BUILDS OR IMPROVES THERE-ON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAG TORS LICENSE LAW.). ^ I AM EXEMPT UNDER SEC. . 8.8 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 0 (COMMENCING WITH SECTKKJ 7000)OF DIVISION 30F THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL'.=OfiCE AND EFFECT. rq 7 7 S LICENSE CLASS-�J LIC. N0. ? S J DATE_�;,�,�-I1/CONTRACTOR dC�l WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PEPJURV ONE OF THE FOLLOWING DECLARATIONS: - I HAVE AND W!L L MAINTAIN A CERTIFICATE OF CONSENT TOSELF-INSURE FOR WORKERS' CCMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT;S ISSUED. -� 1 HAVE AND Wll l MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BV SECTION 3700 OF THE U180R CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS MPENSATIOj! INSURANCE CARRIER AND POLICY NUMBER ARE: ISSUED. MY WORKERS'CO r�t/�r/TLr�'j-IA"AA CARRIER- �! " N , — �� AI u'��AfT 0�4J�/�7� a POLICY NUMBER- 7 (iWS SF-CIXXJ f(EED NOT BE CL'N4'I.ETED OF of PE:FiNT IS FDR ONE HUNDRED DDI.LAAS If10D)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 SUEIJECT TO THE WORKERS'CC�I.IPENSAT,ON LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME SUBJECT TO'f HE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR E PROVI NS. CODE,I SHALL. FORTHWITH COMPLY WITH THO S r d �APPLICANT: ��(^'�j i DATE: � I T� 7 F I I WARNING: FAN-LIRE TO SECURE WORKERS'COMP SATION COVERAGE IS UNLAWFUL.AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS(i/00,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN I SECTION 3708 OF THE: LABOR CODE,INTEREST,AND ATTORNEY'S FEES. I CONSTRUCTION LENDING AGENCY i I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS ACONSTRUCTION LENDING AGENCY FOR THE PERFORMAICE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3097,CIV.C.). I LENDER'S NAME LENDER'S ADDRESS � 1 CERTIFY THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATKKJ IS CORRECT. I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING f CONSTRUCTIGN,ANU HEREBY AUTHORIZE REPRESENTATIVES OFTHIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED I>ROPERTY FOR INSPECTION PURPOSES. �� PERMITTEE NAME(PAIN) 0 GNATURE OF P I DATE \ r� 0 0 0 w 0 N Q 0 (D Z W F IA-. Z 0 d W U w v a 0 w Z f� 2 WHITE--Department Copy,YELLOW--Finance Copy,PINK-Assessor Capy,GOLDENROD-File Copy,GREEN-Applicant's Copy G rY' ql fii&F Ilz_ce4 bc&P�v��tla{C_ttP4 Akvx9 8 0 q-i z ti RQAU-r ro tii r° .tau-ca I c .7,