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Home My WebLink About16685 ��^� CITY OF DIAMOND BAR t � DEPART`MENT OF CQh�V[LJNITY&DEVELt�PMENT SERVICES 21825 E.Copley Ihive (409)860-3195 Fax(9Q9)8b1-3117 PRESS ��°� BUILDTNG PERMIT APPLICAT[ON FIRMLY � JOSSITE /� ,r � ADDRESS 21�do � C..O p�,�f �'� �""�• DATE CATIC�J g,jL� {-� ! NUMB R��#/C� L- (� lQ j -' � issue rvPe QGc� .- APN_ LOT_ TRACT paTE CONST. GROUP p OWNER� !/ � ADDRE S 217d0 �. � ��A ��G.� ZdNING SETBACKS W CITY_4�Nl��Q�' ZIP "fG�-•TEL. FRONT _.. RW Cl � APPLICANT .� TEL. REAR � � 81DElSIDE STREET RW ❑ � CONTRACT P ' �","r t" p�v SIDE �_ � C DRES✓ , ZIP TEL!r/ � _ PROPOSED USE tl� F-"'�+�' � L CZ-.. ,� � ARCH/ENG! tz DESI�NER NO.DWEL. � NQ. NO. � ADDRESS � tn UNITS STORlES _BEdRO{3MS � GITY Z(P TEL. _ � dESCftIPT10N SGi.FT. FACTOR P ADJ.AREANALUATION p� qWNER-BUILDER DECLARATIQN Q SFR�ADDlREM �HEAEBV AFiiRM VNDER PENALTY OF PERJURV THA7I AM EXEMPT Ffl4M THE CANTRACTORS LI� G8('dQ0/G8fP01I W CENSELAWFORTHEFOLLOWINGflEA$ON(SEC.703i.50USME5SAN�PROFES510N5CODE:ANYCITYOR (f} � GOVMTYMIHIGHfiEOUiRESAPEftM7T7t7t:OMSTRUCT,AITER,lMPR4UE,bEAiOUSH,ORREPAiRAHYSTFUC- �� W 7UqE,PRIOR TO ITS ISSUANCE,ALSO REOUIFES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Pdtiq/DBQI( .� BTATEMENT 7HAT HE OR$HE IS LICENSED pURSUANT TO THE PROVISIONS qF THG CAN7RAGTORS L)� .� CENSE LAW(CHAPTER 9{COMMENCIN�WITH SEC?ION 7Woj�F QMSION 3 OF THE BUSINE55 AND PAO� � PooUSpa 4 FESSIqNSCODE)ORTHATHEORSHEISEXEMPTTNEREFROMANDTHE6ASISFORTHEALLEGEDE%EMP� (!J � TION.ANVVIOLATIONOFSECTIONTO]1.SBYANYAPPLlCAN7FOflA?Ef4MiTSU&)EGT57MEAPPLIGANTTO Z Ra-Roof p CMi.FENAITY OF NOT Mt3RE THAN L7VE HUNORE6 DOILpRS(#Soo).): � � C11,ASOWNEROFTHEPfiOPERN,ORMYEMPLOYEESWITNWAGESASTHEIRSp�ECOMPENSATION, Q �e��T � � WILL 00 THE VJ�RK,AN�THE STRVCTURE 1S Al4T�NTENUEQ 4F OFFE({EO FOii SAt.E{SEC.7cst,eUSi�� J � � NESS ANO PROFESSIONS CODE:THE WNTRACTOqS LICENSE LAW OQES NOT APPLV TO AN OWNER Or' � �� PROPBRTV WMO BUILDS OR IMPROVES THEREON,AND WHO OOES SUCH WORK HIMSELF OR HERSELF OR CL THRIX)GH NIS OR HER OWN Et.�IOYEES,PROVIGED THA7 SUCH IMPFOVEMiENTS APE NDT INTENDED OR � � � OFFEREDFONS/LLE.IF,HOWEVER,THE6UILDINGORIMPROVEMENTISSOLOW17NINONEVEAqOFCOMP�E- y� TION,TNE OWNER-6UIlDER WILL HAVE THE BURDEN OF pROVING THAT HE 4R SME DID NttT BUIID OR � IMPRL7VE FOR THE PURPOSE oF SA�Ey. �,�„� OI.ASOWNEpOFTHEPROpERN,AME%GLUSIVELYCONTRAG7INGWITHUGENSEDC(7NTRACTORS [C TO CAMSTftUCT THE PROJECT(SEC.�044,eU9�NE$S AND PROFE55lONS COOE:THE C�TRACTOAS l�i� VelUdtiOti O '— _ADJ.AREA W CENSELAWDOESNOTAPPI.vT6,4NON?iEROFAPROPERiVWHOBUILpSORIMPRbVESTHEREON,ANp � WHOG?NTRACTSFORSUCfIGRbJECTSWITHAGONTFACTOR;S�LICENSEDPUflSUANTTOTHECONTRAG QUANTITY DESGREPTIORI FEE � TORS t.ICENSE IAW.). J �> ❑I AM EXEMPT UNOER SEC. .._„__ B.8 P.Q FOR TliIS(iEASON Q > V LL . __ ... . � DATE_, OWNEFi F � .... ._. ..—. U ��-' Ut:ENSED CONTRAC7QRS DECIARRTiflN � � I IIEiiEBV AFfIRM UNOER PEVALTY OF PERJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � d 9{CObiMENdNt3 WlTH SECTION 70W)OF 03YISION 3 pF THE BtISINE55 AND PAO=ESSIONS CODE,AND Z X MY LICENSE�5 1N FUI,I FOHGE AND EFF6CT. "' w / m � LICENSE CtASS � �LIC,NO.�t0 � � bATE�_�,._L,��_.. CbNTRACTOR „��LL.� a- - W � WORKERS'CQMPEN5AT14N DEGIARATiQN Q � 1HERE@VAFFIflMUNDEAPENALTVOFPEAJUftYONEOFTNEFOLLOWINGDECLARATIONS: Z �1 _,_.,_I HAVFAN�WILLMAUJTAINACERTIFlCATE OF CONSENT Tb SELF�INSUHE FOR WORKERS' _ � �� CAMpENSATiON,AS PROYIDED BY SEGTIQN 3]POQF THE I.A�R COOE,FOR TtiE REflF4RMANCE C} �. OFTHE WORK fOR N'HIGH THIS PERMIi IS ISSUED. � W _IHAVEANOWIIIMAttlTAfNWQRKERS'COMPENSATIqNiNSVRANCE,A5RE0UIREDBVSECI'ION � ,r� ` � r F- Q 3]OOOFTHEI,ABOpCODE,FOR7HEPERFORMANCEOFTHEWORKFOHWHICHTHISPERMITIS ��Q�-y � r7 � aSSUED.MY WORKEflS'COMPENSRTI4N iNSURANCE CARRiER ANR PQItCY NUMBEfl ARE� CC}NSTRUCTION I� fJt. t. J } cnaqiEa __ _. _, , PLAN REVIEW �� ZaoucvNurat�Ea_.._ ,._..... ...` --. ELECTRIG ¢ - g (rtissEclpr�t�IDNoraEa�.+a��ooFn+EaEanar�srocaav�i�n�norseooai.nAsry�w)ori�ss} PLUMBiNG — w Z' i CERTIFY iHAT IM THt:PERfORMANCE OF TNe WORK F6fl WHICt{THIS PERMIT IS ISSUE�.I MECMANIC.'A� �} SHALL NOT C-MPLDY ANY P�flSON IN ANY MANNEH SO AS TO BEGOME SUBJEC7 TO THF '�� '— (/j WORKfiRS'COMPEN54TION LAW'u OF CALIFORNIA.AND AGREE THAT IF t SHOl1LD BECOME (NSPECTION FEE �_� i � � uUBJECT TO'HE WORNERS'GOMPENSATI4N PR4VISI4NS QF SECTION aJ00 OF7NE tA80ii ♦ 7 � GODE,1 SHALI.FORrHWITH COMPLV WITHTHOSE PROVISIONS. t�}� ISSUANCE � L � ��`� �`--��(�'�. SMiP —._ . +� p 6ATE:.. APPLICANT: .. . __,,,,.. _ � WARNING:FAO.URE TO SECURE W4RRERS'CCkMPENSATIG7J CAVEftAGE IS UNCAWFti(.,AND SH0.LLBE ENERGY PIG _ � 5U&IECT AN EMPLOYEF TO GIiIMINAL PENALTIES ANd CIVIL FINES UP TO ONE HUNDqED THOUSAN� �NERGY PERM4T DOLLAFi5(ft W,Oao),IN AODIT4JN TO THE COST OF COMPENSATIpN.DAMAGESAS PPdVIDED fQR IN --j�.� —�-�,�..�.�- J SECTRYN 37080F FHE LABOR�:ODE.tNTEREST,ANDAiTORNEY'S FEES. �� /� � /� /J CL PETENTION FEE: __,,, � i__��__ � , � •- a {;OMSTRUGTION�ENDW6AGENCY PRE-ALTFEE: __� lT�.. � I HERE6V AFFIRM UNOER PEN�ILTV OF PERJURV THAT THERE IS A CCJNSTRtICTI(l4�ENDING AGEVCY FbA THE GERFORMAh�E t1F THE WORK F�ii WNtCH TN{$FERMIT IS t55UF�(SEf..3091,CIV C.}. — --""" -- W — � l.ENDEftSNAME _. _ �^ F- LENDER'SADaRESS / wICERTIFVTHATIHAVEREADTHISAPPLICAf10NANDSTATETNATTHEA8pVE1NFORMqT1�NISCORRECT TQTAL FEES [ .^f -t �` � � i AGREE TO COMPIY WITH qlt�Il Y AND COUNTY ORDINAMCES AND STAtE t AWS REtATiNG TO 8NLt71NG �'� �. � CqNSTRVGTION,ANO HEHEBV AUTHORITE REPRESEN�'ATIVES OF 1'NIS CDIINTV TO EN7ER UPONTNE Z ABOVE-MENi16NED PROPERTI'FORINSPECTION PUftPQSES. COMMENTS � �AtiD �A !("� �� _— m PF,HMIiI"EENA INT < ,�_ .Zf�_a� � , . — Uj SIGNATUR F PERMITTEE � DATE � � 1t �� j��j _ � REGPT.NO. _,,,, PAID BY VALIDATIO�I_-__t./ �--� ~ WNITE-De artment Copy,YELLOW-Finance Co PINK-Assassor Co GOLQENRQD--Fils Go UREEN-R plicanCs Go P PY� PY� RY. � P PY ` � �� f 9 �-*,„�,�� i r . � ;�+�'�� ..� ' � �+�,�.t��na�' {� i�� r k � �� . , ... _.,��.. . . . . .. �� .. . . . . .. . . .... ... . `.. ... . ..._ ,�. . n � ... _.. . . . ... . . , . . .. .. .. . . . a, R�*.��, '�. .. _ .. _. . . . . . ,.�` r ,�_,n� �. . . .. _. . ._.. . ..... . ._. „ '��!� ��. . .... . .. � � �� s E n �_ . .. _ ._ .. . ... . .. _. ... . ._ ... . � v�n �; � a t a .. ..... .. .. . . .. .. .. ., : i3 u ir�!s�n��q � : e s7,��.�� r-��G��.. � ..... . ... .. .. .. _. ... �. "^ a � �` ` .. . _. . . ... . _ . .. . .. _ -. _. ; i k�� y�'?9 r „ . ... ._ . . . — � . , ,� °.'�. �-� � t i .t�3 � m � - , . ... . . . . . � .,' s�; a , �i � . . _ . .. _ .._ - -.. .. � „��:� a°f$h ly b �.. . . .. .. . . . .. .. . .. .__ . � 4 t m k � �� p Y g� i .: . . . � '�'� n�,,�, � d..",'_�1'�K d hS .`�i;'` - . . .. . . . . .. . . .... ...... _ _.. _ .. ... � �.! �.:. "� '' .. . . .. _ . . . . . . � a�� , W, I 3E i ,.. , ..:- ' > , ; �', ', a .•.�. ' .sm '�.' ...._.. - .. ... _. . _ . . . ._ .. . . _ .. ., ��. ��.. . _.... . .. : .,, _ '.� g�,' .. .. . . . . . ., . .. . . y ,� . ... ... . . .. . ' � � ':. ; - . . . .... '�. ar e #"i� d : . . . . .. � i 1� - C ` �� .. . . . . - .. - �'��^�� ^tr> �.. � YS.�-11 -�_ .... .. ._. . ._ .. .. ._ .._ :.— .... —. _. 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 21 1440 eo II,.! APN LOT TRACT OWNER ADDRE S 2/700'. a"ies-to��G CITYAQNZJ 50C ZIP(i TEL. APPLICANT TEL. CONTRACT P t 0 ADDRES CITY/A r-,69,e U94 Z16qrM TEL 7/ ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER-BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 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 B (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 BYANYAPPLJCANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($500).): ^ I,AS OWN ER 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). ^ 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 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 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. 1 �� LICENSE CLASS LIC. N0.V � DATE CONTRACTOR 4_ 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 BE COMPLETED OF THE PERMIT IS FOR ONE HUNDRED DOLLARS($1 W)OR LESS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE,I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. /rte- -I •�nQ G�2a &AP DATE LIC NT D/T6A P A ' WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($ 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 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. 7A A„p A R.1 (A/ PERMITTEE NAt+�TNT pr"/�al SIGNATUR F PERMITTEE DATE DTEICATI PERMIT P/C DAATE_�ce) NUMBER r[• ISSUE TYPE OCC DATE CONST GROUP ZONING SETBACKS FRONT RW^ REAR^ SIDE/SIDE STREET RW^ SIDE^ PROPOSED USE :Z- N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR P ADJ.AREA/VALUATION SFR/ADD/REM Cn Garage/Carport LU Patio/Deck I W N LL PooVSpa 0 Re-Root Z --ft rtrrterclaT NI Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J I- U W W CO z a Q Z 2 0 W 0 50 CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCEL� SMIP ENERGY P/C N(f A ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES COMMENTS RECPT. N0. PAID BY I (A VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy