The URL can be used to link to this page

Home My WebLink About18507 (11) �` CITY OF DIAMOND BAR � DEPARTME'�iT OF COMMUNITY&DEVELOPIvfENT SERVICES �� 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 PRESS '�%a� BUILDING PERMIT APPLICATION FIRMLY } JOBSITE -.?I r-1 d1l1 � C� APPLICATIO PERMIT � P!C ? ' o ADDRESS�X � iJCV � DATE .? G�+Z. NUMBER � � �� # � � � o ISSUE TYPE OCC °^ APN ,�L(JC1T J TRACT DATE_ �'�~ CONST. GROUP p OWNER _1��1�^ �-�. p ADDRE S��,,;�� 'C:' -G � �7 -"Gl. 3� G� ZONING SETBACKS Z CITY t� ZIP TEL: U4"��^� FRONT RW I1 o APPUCAN Y 3 ��' SiDEISIDE STREET RW ❑ z ¢ CONTRACTOR 1' f Y rG� C'L �`� _ SIDE ❑ _ Q ADDRE� r PROPOSED USE " � CITY L . C . ZIP �z�;�1 TEL. L � -- � ARCH/EN / � `�� ` — �Z DESIGNER NO.DWEL. � � Np, a ADDRESS____ UNITS STORIES BEDROOMS,_ � CI7Y ZIP TFL. � -- — cn DESCRIPTION SQ.FT. F TOR PSF ADJ.AREANALUATION p� OWNER-BUIL�ER DECLARATION SFR/A�D7REM O � I HEREBY AFFIRM UNDEf�PENALTV OF PERJURV THAT I AM CXEMPT fROM THE LONTRPC70R5 LI� G2f0CJ0/CB�OfI W CENSEL4WFORTHEFOILOWIVGREASON(SEC.l03f.5�USINE55ANOPqOFE55�ON5CpDE:ANVC'TYOP (n _ U COUNTYIVHICHREOUIRESAP6RMITTOCONSTFUCT,ALTEfl,IMPFOVe,DEMOLISH,CRPEPAIRANViTRUC� W pyI10/OBCK Y Z TURE,PPIOq t0 ITS ISSUANCi=,AL50 REtlUIRES TME NPPLIGpNT FOR SUCH PERMIT TO FIIE A SIGNE� w STqTEMENT THAT HE OR SHE IS IICENSE�PVPSUAtl��O THE PROV',SION3 OF THE CONTRACTCRS LI� w � CENSE LAW�CHAPTEP 9(COMiNENQNG WITN SECT�ON 1000)OF DIVISION 3 nF THE 91151NE55 AND PRO- LL POOVSPB � FESSIONSCADE�ORTMATHEORSHEISE%EMPTTHEpEFROMANOTHEBASiSFOHTHEALLEGEOE%EMP- � U TIpN.ANYV10Lq(IONOFSEC1�ON1031.SBVANVAPFLIChN�FnRAGERMITSJBJEGf51HFAPFLICANTTO Z Re-Roof � A CIVIL PENALTV OF NOT MORE THAN FNE HUNORED DOl.l.4R5�f500)): � Q ❑I.ASOWNEROFTHEVR7PERTV.ORMVEIAPLOVEESW�THWqGESA5IHE'�9SO�ECOMoENSAf�ON. ❑ CORIrt10fC10I Z WILL DO THE WORK,AND THE SiRVCTURE IS NOT INTENDEJ OH Of FERED fOH SALE(SEG.7�44,BU51- J � NESS AN�PqOFESSIONS COOL:TML CONTRACTORS LICENSE lAW DOES NO�APPLY T(]qN OWNER OF PROPERTVWNOOUILO50RIM�'ROVESTHEFEON.nNOWHODUE55l1CN.YJ00.NHIMSELFORHERSELFOF � Q THROUGHHISORHEROWNEuipLOVEES,PqOVIDEDTHATSUCNIMPROVEMENTSARENOTINTENDE00R m w OFFEREDFORSPLE.IF,HOWEVI:R,iHEBUIL�INGORIMPROVEMENT15SOLilWITHINONEYEAROLCOAAVLE- � TION,TME OWNER�BUf.CER W'�.LL MAVE'HE BURDEN Oi FRDVING'HAT NE OP SHE D4D NOT BVIL�OH Z iMPROVEFORTMEPUqPOSEOFSAIE). wL'I,ASOWNEROFTHEPFOPERTY.AMEXCLUSNFIYC(1NiR4CTINGWITHLiCENSEDCONTAACTORS ��-.� � TO CONSTFI.'CT THE PROJECT(SEC.]OM,BUSINE55 AND PROFESSIUNS CODE�.THE CONTRqGTORS LI- Va1110110f1 �> :G � ADJ.AREA = CENSEUWDOESNOTAPPLVTOANOWNEROFAPROPERTVWHOdV�1.D50HIMPflOVEST4EFEON,AND e 1 � YMOCANTRACTSFORSUCHPi1Q1ECT5WIiHACONTRACTOR(9�1ICENSEDPURSUANTTOTHECIXJTAAG pUANTiTY DESCRIPTION FEE Y TORS LICENSE UW.). � n.I AM EXCMPT UNOEfl SEC. B.8 GC.FOR�HIS REASON Q � U � — � DATE _ _ OWNEA __,__ � Z W � LICENSED CONTRACTORS DECLARATION W � I HEREBVAFFIRM UNDER PENAI.TY OF VERJURY THAT I AM LICENSED JNOEF PROYISIONSOF CHAP?E�1 � d 9(COMMENCMG WITH SECTION]Oa0)OF DIVISION J UF THE BUSINE55 AM1D PiiOFE55iJN5 CODE,AND Z X MY UCENSE IS M FVLL fOR/CfE PND EFFECT — � LICENSE� �/'�_ UC.NO. �� J _ U DATE � _ CONTRACTOR � 4- - W � WORN:ERS'COMPENSATION pEC�_ARATION t-v �vl A/i a . u7 � S� �� CJ — -- � 1 HEHEBY AFF;RM UNGEA?ENALTV OF PERJl1HY ONE OF TFIE FOIIOWING DECURATION : Z � IHAVEANDWILLMAINTO,INACERTIfICA'EOFCONSENTTOSELf-INSUREFOFWORKEF5' _ Z CAMPENSATION.AS VROVIDED BV SECTION 3]OOOF THE IABOR CODE,FORTHE PERFORMANCE `U Q_ OF THE WORK FOR WHICH THIS PEPMIi 19 155UE�. � � w �i HAVE ANU WILL MAINTAIN WORKERS'CDMPENSATION INSURnNCE,PS REOUIRED BY SECTION Q 3]OOOFTHELABOFCODE.FORTMEPERFORMANCEOFTHEWORKFORWHICHTHI PERMITIS �I ' ISSUEJ.MV WORkFRS':O GENSq7IO�N INSUR CE CARPoE AN�GOLICY M1UMBE ARE: CONSTRUCTION � .�_ J �� j caaaiEa____�/l�l.�.� � PLAN REViFW _ YU r,. =r� `,{.` . _. o aaicvNUMeEA_ ELECTRIC Z —. G 0 (iH155ECTIONNEmNOTBECUM1IPLETEDOFIHEPEPMfi1SFOFONEHU�DRF.D (f100)OqLES�). PLUMBING _ __ W Z �CERTIFV THAT M THE PERFORAIANCE O�THE WORK FGR WHICH THIS PERMIT IS ISSUE�,I MECHANICAL _ __ _ (.�} SHAILNDiEMPLOVANYPERSONINANYMANNER50hSTOBECOME5U8JEC:TTOTHE � WORKERS'CONPENSATlJN�.AWS Of CAIIFORNIR,AND AGREE THAT IF I SHOl;LO HECOME �NS�ECTION FEE _ . �,_ SUBJECTIOTH[WORKFRS'COMPENSATI PRO'lISIONSO SEC N37UOOFTHELABOR y � C/p�p, I SHA FORTFIWITM GOMPLY WI OSAE PROVISION/ ///,w /'� ISSUANCE , y� __ p OA7E: y' Z � � APPLICANT ,��YYILM1/ 'V ✓'+��/"'�' SMIP __, �i��_. J WARNING:FAIWRE TO SECURC VVOPKERS'COMPENSATION GOVERAGE IS UNLAWFIIL,AND SHALL BE ENERGY P/C . _ � SUBJECT AN EMPLOYER TO CFiMINAL PENALTIES AND GIJIL FlNES UP i00NE HUN�RED 1HOUSAND ENERGY PERMIT OOIURS(f'.Oa.oDG).IN ADDI'ION i0 TME COST GF COMPENSA'ION,DAMAGES AS PFOVIDED FOfi IN --- � SECTION 3108 OF ThE LABOH COJF.INTEREST AND ATTORNEY'S FEES. RETENTION FEE' I �'� � — — d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � O _ —__ � IH[REBYPFFIRMUNDE(iPENAl1YOFPERJUFYTHATTMEREISACOYSTR.UCTIONLENDINGAGENCY _. _ FOR THE PEHFORMA4GE OF TNE WOFK FOR WMIGM TMIS PERMI I IS ISSUED(SEC.7097,CIV C.). Z w —. — S I.ENOER'SNAME � ___ . — F— LENDER'SnDDRE55 wICFRTIFViNATIHaVEREADTHISPP�LICATIONANOSTaTETMATTHEABaYE1NFpRMAT!pY15CORRECT. TOTAL FEES �_ I � i AGNEE TO COIAPLY WITH ALL C11Y ANO COUNTV ORDINAIJCESANO SiAIE LAWS HELATING TO BUILDING � � j j �� CONSTRVCTION,ANDHEREBVAUTHORIZEf1EPFE5ENTA�IVESOFTHI$COUNT�V/TOEN�TE�qJ�7PONTHE Z A90VE- ENTIONEC�PRpPER'Y F��R IN�PEG�IGN V'JRPOSES. � /•/,�J�!� , GOMMENTS 0 /�' ��C�f/�f J v _ .— .._ . _ � • 'LvL�✓ �''11�C�!'l _ —Y — — m PERMITT A E[PfiINT� �� ¢ �. ✓ � /' t�� G�' --- - � SIGNATU OFPERMI� DA � \ = HECPT.NQ � PAID BY VALIDATION ~ WHITE—Department Copy,YELLOW—Fnance CoOY�PMK—Assessor Copy,GO�DENR �File Copy,GAE —Appl�icanY Copy e m.�, :` � � . -r�'x �,,as�`- e,�,±m�z� ;,� ,�„,- � :. �+. . * s . " � �� "� � ,a � � �, �,r t � t�r^.�a� �` '�i � c er. � a� , ��",�� "`� �`��, .g� . �.,. . �. . .�r..a,.�.,. t ::� .i��,,.�.�n�'s.°�#�. . .. . . ... .. . . _ ,��a �,�, �s�a��,v . ��, . � ,.�',�.� " �� _ . _. _ ! _ ___. _ __.. . . ' �� ' ��,�= t:. � . � �g J�� . . . . .. . ..... . ... .... . ..._. .... . ...... .... . �� r�! �'�� . . . . . . - ? , �c ��. . . ... .. _ . .. ._ .. �;°.�; . � . . . .... .. .. .. . . . . .. . ... _.. . ... .. .. .... ._. .� , � �;Y �� ag �� ,�23� :. . . _. . . ... . . . . .. .. .. ... � .,, , . .,. � . . - �,�'. 4� � : . .. .. . ... .. . . . . .. . . ... ... . . ... ..... . . ...... �� . i� ... . ._ .. . . . . r�t , ` � ; . .. .. .. . ... . . . ... . . � .4 . .. . .... . .._.. ... .. .. . . �� .,.se. . ,._ ... . . . . _ _... . . . . _. . . .. CITY OF DIAMOND BAR DEPARTME?�3T OF COMMUNtIl'&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION PRESS FIRMLY JOBSITE.'}) rl d511 G C � � 1 iJ V ADDRESS- APN LC1T TRACT OWNER ��u --�-- ADDRES_aZ_.�„� , 7Z� L"G � �?"Gt$C CITY t.ZIP TEL.-UL7-� APPLICAN�"� �L, I�� CONTRACTOR 1'f Y r� �G Jf� ADDRE CITY L I ZIP TEL. � .L ARCH/EN DESIGNER ADDRESS CITY ZIP_TEL._ OWNER-BUILDER DECLARATION I HFREBV AFFIRM UNDEFI PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI� CENSE LAW FOR THE FOLLOW tYG REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE:ANY CITY OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT,ALTER,IMPROVE, DEMOLISH,CR REPAIR ANV 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(COMMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO FESSK)NS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION.ANV VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLWRS If 500).)'. I,AS OWNER OF THE PROPERTY,OR MV EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK,AND THE STRUCTURE IS NOT INi ENDED OH OFFERED FOH SALE(SEC. 7044, BUSI- NESS AND PROFESSIONS CODL THE CONTRACTORS LICENSE LAW DOES NO'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 ENIPLOVEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE. IF,HO WEVE:R,THE BUILDING OR IMPROVEMENT IS SOLD W ITHIN ONE YEAR OF COMPLE- TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING 'HAT HE OR SHE DID NOT BUILD OH IMPROVE FOR THE PURPOSE OF SALE). L'I,AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTING 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 d'JII.DS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PFIOJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). CT I AM EXEMPT UNDER SEC._,B.8 P C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENAL N OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH SECTION 7x00)OF DIWSION 3 OF THE BUSINESS AND PPOFESSIONS CODE,AND MV LICENSE IS IN FVLL FO/R/C�E AND EFFECT. LICENSE C 5 �� LIC. N0. DATE�CONTRACTOR�I WORN:ERS'COMPENSATION DECLARATION (-��q j� / I: I HFREBV AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECIARA TION I HAVE AND WILL MAINTP,IN ACERTIFICATE OF CONSENT TO SEIf�INSURE FOR WORKERS' COMPENSATION,AS PROVIDED BV SECTION 37000E THE LABOR C00 E,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BV SECTION 37000E THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THI PERMIT IS ISSUED. MY WORKERS' :0 PEell A7NS ION INSUR CE CARRIES AND POLICY NUMBE ARE: CARRIER POLICY NUMBER (THIS SECTION NEm NOT BE COMPLETED OF THE PEPAAIT IS FOF ONEHUNORED rytW)OH LES�). I CERTIFY THAT IN THE PI_RFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER 50 AS TO BECOME SUBJECT TO THE WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS'COMPENSATI PROVISIONS 0 SEC N 3700 OF THE LABOR DATE: Cgp�G/FORTHWAPPLICANTWI OS�E]P,�ROVISION/�/J//�� WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL RE SUBJECT AN EMPLOYER TO 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 3708 OF THE LABOR CODE. INTEREST,AND ATTORNEY'S FEES. CONSTRUCTlON LENDING AGENCY I HFREBV AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTPUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WOFK 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 70 COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION,AND HFREBV AUTHORIZE REPRESENTATIVES OFTHIS COUNTY TO ENTE PUN 1HE ABOVE ENTION ED PROPERTY FOR INSPECTION PURPOSES. 4x (,� � � 'l�t�� -IiL �� 4 PERMITT A E�RINT)J �� +� �y�� SIGNATU OF PERMITTE V DA E(/jj WHITE-Department Copy,YELL-OW-Finance Copy,PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy