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Home My WebLink About17038 (10) J�� CTTY OF DtAMOND BAR i� L}EPARTMENT OF COMMUNITY&DEVELC}PMENT SERVICES P � 21825 E.Copley Dtive (909)$60-3195 Fax(909)861-3117 P�E�$ `"�»r BUILDING PERMIT APPLICATION FIRMLY d AD R(ESS_�+ �Q y APPLICATIdN 'j7� '�' �UMB R�--�---�;�#/C o CyZ� l�G P�- �C� r✓ DATE V' r� ISSUE � TYPE OCC APN LOT TFiACT pATE � C4NST. GROUP —�^. p l7WNER —„�-�� YM..a.L.t�-Csu-- �'`" ADC�RESS ��`�-3) ✓'�� '��- U�*-+-^="'""P ZdNING SETBRCKS S� r � . 'F��a�% FRONT _ RW ❑ CITY��-�-'4 �1 a�S{�' TEL. ^ APPLICANT � T��3TEL. SlDEISlQE STREET RW ^ O 2 �d CONTRACTOR��-�.�R-2 -�✓�-CS SIpE �] ADDRESS_�.,; �.[` i v+�J/E-r� t�-�^S -F PROPCJSED USE ��-1 S Ll�-�--7 1 U.--� P/Z +.( a.r��_ � C17Y �1��:J�7r N�Z!P ��'�"�y TEL.��,52-=_` �- n. �T't �;,� �— oARCWENG/ j�C,C� - �� z QESlGNER N(7.DWEL, NO. NO. � ADDRESS UNITS STQRIES �__BEDROOMS � CITY 2!P TEI. � DESCRlPTIQN SQ.�T. FACT4R PSF ADJ.AREANALUATION p� pWNER-BIJILDER DECLARATION SFR/ADD/REM a �HEHE6V AFFIRM VNOEP PENALTY OF PEPJUHY THAi 1 AM E%EMPT FROM THE CON?RACTORS LI� (�jgf8J6/G8fp01Y W CENSELAWFpRTHEFOILUWINGREASKIN�SEC.�08i.5BU51NESSANDPROFESSIONSCODE�ANVCITYOp (n G� COItNTYWHICNREC1UiRESAFERMtTTCYfAN$7RUCT,AITEA.IMPflbVE.DfMO�tSH,4RREPA7RANY5TRUC�� W P3tlp/DeCk W TURE,PRIOR TO IiS ISSUANCE,ALSO REQUIRES?HE APPUCANT FOR SUCH PERMIT TO FILE A uIGNED w � STATEMENT THA?HE OR 5HE IS LICENSEO PURSUAVT TO THE PAOVISIONS 4F THG CONTRACTORS LI- .� CENSE 1AW(CHAPTER 9(COMMENC}NG WRM SECiIQN�006}OF DIVISION 3 6F THE BUSiNESS ANp Pfl0- � PooUSpa FESSIl7N5CO�E)ORTHATHEORSHEISEXEIAPTTNEREFROMANpTHE6ASISFORTHEALIEGEDEXEMV� (] � TION.PNYVI4LATIOMOFSEC710N]OJt.bBYANYAPptiCANTFORAPEf4MIT6U9JECT9THEAPRLiCANTTQ Z R8-R�4{ ? � � A CIVIL GENAI.iV OF NO7 hNJRE TNAN fiVE HUNDREI3OOlL4ft5($500).): � OI,ASOWNE%OFTHEPROpEFTY,ORMVEMPl.OYEESWITHWAGE5A5THEIRSOLECOMPENSATION. 0 G0t71mefCid! Z WIIL DO FHE WINiK,AND THE STRUGIURE iS N�T 1NTENC}ED 4R 4FF£RED F�R SdtE(SEC.704<.BttSi� J ... NESS AND PR6FESSIONS GOOE THE CONTqACTOR9 LICENSE LAW�OES NOT APPLY TO AN OWNER OF � PROPERiYWHOBUILDSQPIMPROVESTMEREON,ANDWNQDOfiSSUCHWORKNIMSELFOpNERSELFOft � CC THRal)GHHt50RHEROWNEMPI�YEES,PROVIDEDT}1AtSt1CHiMPROYEMENTSARENOTiNTENC3EDOR � � OFFEREOFORSALE.IF,HOYr'EVER,7HEBUILDMGORIMPFOVEMEN715SOWWITHINONEVEAf10FCOMPLE- � TI�N,TNE OWNER-0UILDEFI WILL HAYE 7HE BUADEN OF pROVING THAT HE OH SHE OID NOT SUI4D Op = tMPROVE FOR TNE Pt1RPOSE OK SAlE). fl I,AS QWNER OFTHE PROPERTV,AM EXCLUSNELV CONTRACiING WITH UCENSED CONTRACTORS �y �+� � 70 CANSTAUC7 THE PR0.7ECT{SEC.104i,BUSINE55 AND RHOFESSIJN5 G6DE:TNE CON'ftACTQRS LI� �V87U8ti0tt ii'� v ADJ.AREA W CE775ELAWDOESNO7APPLVTOANOWNEROFqpROPER7rWHU9UIlA50RIMPRpVESTHEREON,AND � WHOCONTRAC7SFORSUCHPROJECTSWITHACONTRAC7pR(S�LICENSEDPURSUANTTOTHECONTRAC� QUANTITY DESGRIPTIQN FEE � TORSUCcNSEItW.). � ❑I AM E%EMPT UNDEFl SEC. ^_B.&P.C.FOR THIS REASON J O V `'... _ ¢ "-- onTe owiveft_^........_ — � � � w `—�� H:ENSED GQN7RACTORS DECLARATIOM � d - CC I NEREBYAFFIRM UNDER PENAITY OF PERJUHY THA7 IAM LICEN&ED UNDER PROVISIONS OF ChAPTER � � e(CflMMENClMG WITH SEC(KKY 70tra}pF 6IYISION 30F THE BUSIWE55 AND PRQFESSIONS CO6E,AN6 Z }{ MY LICENSE IS IN FULL FORI:E AND EFFECT. m / � Q UCENEE CLAS Y� .,_LIC.NO. �y�� J � DATE____��7 "�r� GpMftA4'TOfR ... ' •�-- _ ._ d .. W � WORKEfiS'COMI'ENSATIpN DEC�AftAT14N � Q � I HERE9V.4FRIqM UNOER RENALTV OF PERJURY ONE OF THF FOLLOWNG DECIARATpNS: U fJ> Q C) IHAVEANbWILLMAINiAINACERTIFICATEOFCONu^ENTTOSELF-INSUREFORWO%KEFS' _ CAhdPENSATiO,�J,A5Pft4ViDEDBYSEGTfCNJ76o4FTHEtA80HCWE,FOflTHEPERF6RMANCE C} Q OFT N FOR\VMIGN THIS PEqMIT IS ISSUE�, � � � _I FfAYE AND Wlll MAINTAIN WbRKERS'COMPENSATION MSURANCE,A5 REOUIRED 8Y SEOT�ON / � Q 3]00 OF TNE LABOR CObE,FOfl THE PEFFORMANCE OF THE WOFK f6R WHICH THIS PERMIT IS ��"'� �y�! / ISSUED.MY WOftKG1?S'COMPENSAT70N INSURANCE CAftRIER AN�POttCY NUMBEft ARE: CONSTRUCTION .,, �' W Q �._ �, caaaiEA_�>.."'7/t"S�L- �' C^_ ""C} . .__. PLANREVIEW naoucv uurneEa v ELECTRIG _ . <[ � (iHiSSECTqNNEEDN�TBEmIiREfEDOFn+EPEw%TSFORONEMH�DREQD7tJ1�3i5(Sim}ORIESSj. PLUMBING ,,,,, ZW i CERTIFY THAT R!THE FERFQflMANCE OF TME W4ftK FOR WMICH THIS PERMIT IS ISSUcD.I MECHRNIGA� —_. _--. (� SHAL4NOTCMPLpY4NVPER50NINANYMANNERSOASfOBECOMESUBJECTTOTHE � WORKERS'COMPEN:SATIONLAWSOFCALIFOFNIA,ANDAGREETHATIFISH4ULDBECOME INSPECTIONFEE , � SUBJEGT70THEWORKERS'COtdPEN$AT14N Vt$lON56F56CTIpN370aQFTHFLAROR ----��—�� CODE,I ALL FO THWITH COMPLV WITH iH E PFOVI510NS. �SSUANCE _, . � SMIP � p bATH__�k�,��I APPLICANT. -- '� -,-_. w ``� ENERC�Y PIC „�j WAIWkt6:FhilUftE To SECVRE WOf2KER5 COMPENSATION COVERAGE iS t7NlAWFU�,ANp SHAlI.BE — ' � SUBJECTANEMPLdVER14CRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOLLARS 55100.o0a),IN AD011'ION TO THF.COST OF CpMPENSA�ION,DAMAGES AS PROVIDED F�R IN --- �-- � � SECTION37C80FiHECABQfiCODE,tNTEREST,ANOATTflRNEY5FEE5. RETENT�ONFEE: � GQNSTftUCT16N 4ENDING AGENCY pAE.A�T FEE: _,,, _ ___.,.,.�, O � IHEREBVAFFIRMUNPERFENALTYOFPERJUflYTHA7THEREISACONSTRUCTIDNLENDWGAGENCY n- FOA THE FERkbRMANCE OF(HE W�RK F6R W}iiCN THIS AERddIT IS ISSUED(SEC.308],CIV.C.j. �� -� —� � W ' � l[NDEfl'SNAME�..� ..._ �__. ' 1— LENDEft'SA�bRESS_._,,,,_ _ W ICERTiFYTNA7IHAVEqEAD7HISAPPLICAnONANpSTATETHAT7NEA90VEMPoRMATIONISCOFRECT Tf�TAL FEES � IAGFEETOCORdPIYwITtiAii_CtTYANDC011N'YORDINANCESANpSTATc'LAWSRElAT1t�RiT68Uil6kNG � GONSTRUGTiON,ANPHEREBVAUTHORIZEREPRESENTATIVE50F1HISCOUNTVTOENTERUPON7NE -„�„ ABOVE�MENTIONEO PROPERTY FOR INSPECTION PURPOSES. COMMENTS ,,,_, _._ ..._... � ,iV/1 /� _ �_Ls._i._._� i{'�..! • � l•J� ' � PE EE NAME(PRINT) ,._ - � �e � _.�–=�.�.—_�'..��- e�� NA RE pF PER DATE = RECPT t�0. „_�. PAtD BY VAUDATION ~ WHITE—Deparlment Gopy,YELLOW—Finance Gopy,PINK—ASSessor Copy,GOLDENROCI—File Copy,GREEN-��-Applicant's Copy � � �,� �� '�� ; 5 ,��,�� , ��,.�. � ��"a��, '�� a � ��" � ��i � ��4.n � �.. �: w�; � /� � _ � ^ _ , •- ,,._ �� ... .^- � =. ��... .�.�,..� � - 1..� vOl � _ _ �� 'p`L .� � . � � � �� _, � ! a � �� 2.`i-�� Nc� �3�F'�.�-�(�c� ; c��^�Stw�� c}a?L1E' � _ _ _ __ _ � � �� _ 3 a � � k �� ' .. '. .� � xk�i�,.�' t� . .. ._.. ._ .._... .-. .- _ h m- � _. _.. . -.... , � es m �` � !, . ... . . . ... . . ; - �� ! s �r:�Q , t.0�,�� .� .... . . . ..... ._ .. . .. ...... .... ..... .. �A.� ° ,rc;a`, � m' � 3 .. .... .. .. . _. — ._ ... - .. , ,, . ... . ., '�,� , �� : :c ? .-., . ..��' 9 . .��;.; ... .. .. . . _....- . a . . ... . ... ... .. . M � . : .. . ... _ . . �� .�, � , , , .. ,: , _ . ........ . . : , ., �^ , . ia �. � ... . _ ... .. . . . . ... . . .... . . .. ... ._ ... ... �g . o; P G' , . .� ... ... . . . _. - . M ,c.: q :. �' ... .. .. .. .�.. . . � � -, � - ... .. . ..... . . .. .... . . —� . .. 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 I 0 + OU ADDR ESS P C,j 0 APN LOT TRACT OWNER\t&.-e�- � ADDRESS 3")5.)1 I'A5co C.,'I- CITY ti--i4 1++,8$)TEL. APPLICANT_TEL. CONTRACTOR-j•4.2-_6 e-0 ADDRESS_L i v til.k-{ CITY S Ur.)/k 4tc"ZIP TEL St- 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 CITYOR 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).): ^ 1,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). ^ 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 TOTHE CONTRAC- TORS LICENSE LAW.(. ^ I AM EXEMPT UNDEFI 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. LICENSE CLA $ LIC. N0. S J DATE 5( 1 3�.. i LI CONTRACTOR, WCIRKERS'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' COMPENSATIOf LAS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OFT K 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 T=-n 1 POLICY NUMBER (THIS SECTION NEED NOT BE COMPLETED OF THE PERMIT 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 q OVISIONS OF SECTlON 3700 OF THE LABOR CODE,I ALL FORTHWITH COMPLY WITH TH E PROVISIONS. DATE: (APPLICANT: 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. PE EE NAME(PRINT) NA RE OF PE DATE APPLICATION 7 PERMIT Q /C DATE V N 3 # UMBER FLO ISSUE J TYPE OCC DATE V CONST. GROUP v ZONING SETBACKS FRONT RW ^ REAR ^ SIDE/SIDE STREET RW ^ SIDE ^ PROPOSED USE � P S u L 12 %s-Y L t? N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION S0. FT FACTOR PSF ADJ.AREANALUATION SFR/ADD/REM Garage/Carport w Patio/Deck LL Pool/Spa Z Re-Roof ? 0 Commercial Valuation C ADJ.AREA QUANTITY DESCRIPTION FEE J Q U U w W 0 z m a Q Z S 0 W -7 i2 CONSTRUCTION V PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES RO1. io COMMENTS RECPT N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy