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Home My WebLink About18292 ��,�.. _ CITY OF DIAM(JND BAR �w� DEPARTMENT OF COMMCLINCTY&L}EVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Faac(909}861-3117 PRESS `'�»�»' BUILDING FERMIT APPLICATION FtRMLY JOBSlTE °' /^ � APPLIGATION'7�� PERMIT � P/C '7' � ADDRESS� D� �~ � C- DATE.� �� NUMBER_��,�_{�L�# ��`L'�� ISSUE r� � TYPE OCC APN LQT�--�� TRACT _ � DATE �� R! ��dNST. � GROUP p OWNER ,. (�lic.= G�f7�,� WADdRESS_��-�1'?t�Le i l�bY�l t�-i.% �_. ZONING FFiONT �$ RW ❑ Z GITY��Q,kg; l�—��ZE L.. REAR [� � APPLICANT � TEL. g�pE/g�DE STREET RW C] �m� CONTRACT _�- .% SIDE f l � ADDRESS C� � �2 _. , .—��.�,-� PROPOSEQ USE �/I'� � � � CITY��,"�''�/• Gl 21P '�{%/� TEL,/��.- w ARGH/ENG/ WDE$IGNER NO.DWEL. NQ. NO. �y ADpRESS UNITS� STdRiES BEDROOMS = CITY ZIP TEL. � DE$CFtIPT!{?N SQ.FT FACTOR PSF RDJ.AREAtYAlUAT1QN cn � � 4WNER-BUILDER DECLARATI4N SFRlADD/REM (_] I HEFEBY AFFIRM UN�ER PENAL�V OF PE0.IURV THAT I AM EXEMPT FflOM TNE CON7RA�TORS LI� � Garage/Garport W CENSEL4WfORTHEFOLLOWINGREASON(SEC.709!.50USINESSANDPROFESSIDNSCODE:ANYCITVOP � COUNTYVAi�HRE�UIRESAPEFiMITTOCOtiSTftUCT.AITFR.9APR�VE,DEMOtiSH,ORRcPAbtANYSTflVG W Pa�IOJOBCk W TURE,PRIOR 70 ITS ISSUANCE.ALSd RE�IJIRES THE APPIICANT FOR SUCH PER�11T TO FILE A SIGNED w .� STATEMEM THAT HE OR SHE�S UCENSED PUFSUANT T�TFlE PA�Vl910NS f}F TNE CONTERGTORS U� .� GENSE lAW�CHAPTER e(COMAiENCING WITH SEC71Ott 7096j OF 61VISION 3 OF iHE 6USfNESS FNU PRO� � PooUSpa .� FESSIONSCi7DE�tlRTHATHEORSHEISEXEMPTTNEREFiiOMANDTHEBA51SFOflTHEAL4EGEDEXEMP� (,� U TI�N.ANYVIOLATIONOFSECTION343t.58YANYAPPUGANTFOftAPEflMi75tt8JECT$THEAPPLICANTTC} Z Rg•RWj � ACIVILPENALTVOFNOTMORETHANFIVEMUNDREDOOLLAR5�55D0�.)�. ^ ❑I,AS4WNEROFTHEPROPERTY,ORMVEMPLOYEESWITNWAGESASTHEIRSOLECOMPENSATION, � (`,p�pmBtCial � `,�� Witl D6 THE YtOAK,ANO TFIE STFiUCTUAE I$NOT INTENDEO OR OFFERED FOR SdtE{SEC.�o4n,BUSi� _7 NESS AND PROFESSIONS CODE:THE CON'RACTORS LICENSE LAW�OES NOT APGLV To AN oWNER pF � PROVERTYWNOBUILOSORIMPRavESTHEREON.ANOWHO�oESSUCHwoRXHIMSEIFoaHER&LLfoR � CL THRW1GFi NI56R NEROWN EMP�OYEFS.PROVIDE(7 TNAT SUCH IMGAOVE3dENTS ARE t-0Ot INTENdEDOR � OFFEREDFORSPLE.IF,HOWEVER,THEBUILDINGORIMPROVEMEN71SSOlDWITHINONEVEAROFCOMPLE- y` TIQN,iHE DWNER�BUILOE0.WILL HAVE THE BVRD=N OF PROVING PiA7 HE QR StfE{IID NOT BUIED 4R = IMPRpVEWtiTNEPURPCJSEOFSALE). O I,AS ON?JER OF TH[PROPERTY,AM EXCWSIYELY CONTRAGTING WITH LICENSED CCINTRACiORS "W� TO CbNSTftUGT Tl1E FFlWECF(SEC.?Ad+t,8V5lftESS AND PftOFE55i6N5 COpE:TH6 CONTRACTORS U� V8IU8tiQti �"E'� ADJ.AREA 41J CENSEUY/DOESNOTAPPLY70ANOWNEFOFnPROPER�VWHOBUILD50RiMPRCFVESTNEAEON.AND � WHOCONTFACTSFOR54CHPFOJEG7'SWITHACON'fRACTOR(5)LICENSEDPURSUANTTOTHECONTRAC� QUANTITY DESGRIPTION FEE � TQRS t,IGENSE CAW}. - � J � ❑I AM EXEMPT UNDER SEC. _B.8 P.C.FOR THIS ftEASON Q _ � _.__— ... � � u` DATE, OWNEit_ __ U W � � UGENSED CONTRACT4RS DECLAAATION W �t CC IMEqE@VAFFIRMUNDERPENALIYOFPERJURVTHA7IAMLICENSEDUN�ERPROVISIONS4FCHAPTER �, � 9{CGIMMENCU�iG W+TH SECiWN 76aa)OF DIViS�N 3 OFTHE BUSlNESS AND FRbFESSIONS C6D�,ANO Z W MY UCENSE IS IN FULL FOHCE AND EFFECT. (�` m � UCENS LASS � LIC.NO.� ��'f! � � � DATE� �� CONTRAGTOR_�e��1r_.._'� d W a� WORKERS'COMPENSAT}ON DEGLARATION J I = ¢ � I HEREBY AFFlFM UNDER PENALTY OF PEiiJURY OSJE oF THE FOI.LOWING DECLARATIONS�. U CJ? Z C] I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSIJRE FOR WORKERS' S C041PENSATION,AS Pft4YiDEtX 0Y SECTION 3IW PF TH`t LABOR COUE.FOR TNE PERF6RMANCE U... 'd OFTNE WOPN FOR WHICH'HIS PERMIT IS ISSUED � C] W i HAVF ANp WILL MAINTAIN WpflKER$'COMPENSATION INSURANCE,AS REOUiRED 8Y SECTION ^� 1. Q � 3]0�OF TNE LABOR CODE,FOR THE PERFOFMIANCE OF THE WORK FpR WHIGM TNIS PERMIT IS �`j ��+ � ISSUGD.MY WORKEftS'COMPENSATf6N INSURANGE GAHRiEft h4D P�UCY NUMBEftARE' GONSTRUCTION p� � cqqaiea.. ..� PLAN REVIEW � CJ ."` � � POLICVNUMBER__„ ELECTRIC �_.,, „�.,,,, 4 � massEc�rxaNEmaorpEo�na�ErEaoFn�Ea�wMTSwRONEr+uwr3EoocN.ti,astbioo)oR�Ess�. PLUMBING _ . W I CERTIFYTHAT IN TNE PER�OflhiAtJGE OF TNE Wqfi1C WH WH7CH THIS PERMtT IS ISSt1E0.I MEGHANIGAI. � _w..�.. (,�} SMAI.L NOT EMPLOY ANY PEFSQN IN 1lNY MANNER 50 AS TO BFCOME SUBJECT TO THE INSPECTION FEE � WORKEFS'GOMPENSAi'ION LAWS OF CAUFORNI0.AND AGREE THAT IF I SNOUID BECOME . `_--y..—n.�--•, � SVSJEGiTOTHEWOftKERS'COMPENSATIONPRGYIS�NSOFSECFKSN376QOFTHE�ABOR U� ��p7bE, HALLFORTHWITHCQMPLYWITHT EPRO ISIONS. ISSUANCE l� p DATE:`/ ��APPLICANT: �_ SMIP _.,. _. W ENEftGY PIC � WARNING'FAkVAETOSEGUftEWORttERS`GUMPEnSAT10NCDYERAG[ISUNLAWFU�,ANDSHAt.t.6E �y SU&IECTAN EMFItiVER f0 CRIMINAL PENALTIES ANp qVIL FINES UP TOONE HUNbRED THOUSAN� ENERGY PERMIT _�_ �OLLARS(3100.009),IN ADDITION TO TNE COST OF COMPENSATION.DAMAGES AS PqoVI�FD Foq iN ' { � SECTION 37pe�F TNE 1A86R C06E.INTEREST.AN�ATTOANEY'S FEES. RETENTION FEE: _„�, 1 v�� W CONSTRUGTIQN lEND1N6 AGENCY FRE-AlT FES: p,. ....__ �.^ .. _ � I HEREB�AFFlflM UN�ER PENALTV OF PEftJJRV TNATTHERE IS ACONSTRUCTION�ENDING AGENCY � P4R itiE PEft�ORMANCE OF SHG X'ORK FOF WHICN THIS PERMiT IS ISSUEf3(5EC.3031,CIV.C.}. �� W � IENDER'S NAME _. ... J..... .. .. !— LFN�Eft'SADDf7ES5�__.. _ �.-- �^- � ICEiiTIFYTHATIHAVEREADTHiSAVPUCATIONANDSTAT�THATTHEABOVEINFORMAT10NI5COflRECT. TOT/'�L FEGS �{�/��, , �, � �AGftEE7DCOMP�YWiSHAILCITYANDCt'}UNTYOR6NANCESANOSTATEtAWSAEIATiNGT08Uitn�NG V CONSTRUCTION,AND HEREBY AUTHOHIZE REPRESENTATIVES OF THIS COUNTY TO ENTEp I.ippN 7HE � ABOVE-MENTIONEUPRO�PERTYFORIN5PECTIONPURPO5ES. �QpJMENTS . G�] / / , N!�'� � � �,"c � �/1/! 1t f,Z E/,,,� -�- � PEFMITTEENAME(PRINt� . .. ��- _. _— � -- (� -�_� "�'' _ � --ry � SIGNATUREOFPE MITT E � �A'E �—J = RECPT.R4. _ f_PAID BY " � VAtJDATiOh'_,_ �� r WHITE—Department Gopy,VELLOW—Finance Gopy,PINK—Assessor Copy GOLDENRpD—F'�le Copy,GREEN—Applica 's Copy �s �� x�.��si r. .��''�� 5 -� b €, ��°��`r�� '�.. a�� :� �"'� e � � ��°��u��;�_ � ` ,�� -�5•o z �c.t-�s A��Y��sa�. P.�a-�-c.�4 �-z �d' �- stt�� p�us L ►3o rr�cwl i°e 2 ��Tel-�� 13 � , , .. � , � o�u. �.� , a �. _ — s ,� — '` �� y � � ' � � :"s ,�G � ss� ��'� _ t� , �- � °a,� ` _ _ _ ;.; ;� = _ _ fl� � ,n �� 7 `; ��': : � .. .. .._. ... . . .. . ._. . . .. . .. . . .. ... . ... . . ... , t , .. . . ... _ . . _. �;�� ,.��g� a. e"� ��°�F�� ... . .. ... . . ... .._ �'�.. , _; , � .. .- �" . . ... . . ... .. ... . .... . :.I g i x 3 = . . is 'P �] ... . ..... .. . ... . . . ... ... .. .— _ . .. ._ �'i '` d jp a .. . . _. .. . . .. . . � ��. f ,i � �t.�� ` `€ I �� ... .... � ��. ,: .y� .s.e.la — ` t,..� . .... .._ . . .._ .. . .... ... . DLVIIIXD BAR i �^ 0 JOBSITE OO ADDRESS- 2. �� APN LOT TRACT Gp OWNER ADDRESSGUI CITY D I A M PV,f A,'I?ZI L. APPLICANT TEL. CONTRACT ADDRESS b 2 CITY 7?)-Ch ZIP TEL/.L 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 FORTHE 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 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).): ^ 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 HIMSELFOR 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. Lr I/ LICENS LASS LIC. N0. V sG DATE CONTRACTOR 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($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 DE.�}ry�HALL FORTHWITH COMPLY WITH T E PRO ISIONS. C") -APPLICANT: DATE!/- 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 I CERTIFY THAT I HAVE READ 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 HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. PERMITTEE NAME(PRINT)2/I C SIGNATURE OF PE MITT E DATE 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 APPLICATION-7 PERMIT -- 9/C' 7^'y DATE ! -1 U - L NUMBER ISSUE.�1 rte-i� TYPE OCC DATE !1-j\J Ci ONST. GROUP ZONING SETBACKS FRONT RW ^ REAR ^ SIDE/SIDE STREET RW ^ SIDE ^ V I' PROP C' SED S 0 U E N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREANALUATION SFR/ADD/REM Garage/Carport W Patio/Deck L LL PooVSpa 0 Re-Roof Z Commercial 5 tb Valuation GOB) ADJ.AREA QUANTITY DESCRIPTION FEE J U U W W 0 Z m a- U z 2 U W �1 CONSTRUCTION • �� PLAN REVIEW V'e ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE L W SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: U Is' PRE-ALT FEE: TOTAL FEES COMMENTS RECPT. N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applica 's Copy �5•vz NcG�S IILb(Yt4ro.U.c(Tt-f r St(c3 pjUS L 130TZcw�P6--Q- L �Til•7