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Home My WebLink About18655 CTI'Y OF DIAMOND BAR � l� � �'� DEPARTMENT OP COivIIviUNTIY&DEVELOPIvIENT SERVICES � � 21825 E.Copley Ihive '��% (909)860-3195 Fex(909)861-3117 PRESS '��'%.�� BUILDINC PERMIT APPLICATION FIRMLY � JOBSITE �l�� t� � � Q ADDRESS__r D � 1'tY� APPLICATION �Z PERMIT P/C o --�— DATE NUMBER It � � , ISSUE �'� _ T,, TYPE OCC APN--�---- LO T C7 DATE � CONST. GROUP p OWNER J � � eiC� �� ► � p ADDR S J (�-'L ZONING ETBA KS z CIN ZIP �7EL. � • FRONT qW ❑ � APPLICANT TEL�^ REAR ❑ z ,_ SIDE/SIDE STREET RW ❑ Q CONTRACTOR SIDE ❑_ ADDRESS '( � � CITY � ZIP TEL. � ^G�ZO PROPOSED USE C oARCH/ENGJ . � � z DESIGNER IhL 7 t�_____ - w NO.DWEL. /1 NO. NO. a ADDRE�u UNITS rl STORIES �_ BEDROOMS � arv /�'C ZIP�� TFL �d I cn DESCRIPTION SQ.FT. FACTDR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLl+RATION SFR/ADD/REM O p I HEREBV AFFIRM VNDER PENALTV OF PERJUHV THAT I AM E%EMPT FRDM iHE CONTRACTOqS L: G2f2Q0/CBfpOR W CENSEUWFORTHEFOLLOWINGREASON�SEC.T031.5BUSMESSANDPROFESSIONSCOOE:A4YCITYOR (f� U COUNTYWHICHREOUIqESAPEaMITTOCONSTRUCT,ALTER,IM�ROVE.OEMOL15H2ORREPAIRANVSTRUG W TURE.PRIOR TO ITS ISSUANCE,ALSO RE�UIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck � STATEMENT THAT HE OR SHE�S LICENSFO PURSUANT TO THE PqOVISIONS O�TFE CONrqqGiOPS LI� LL � CENSE LAW(CHAPTER D(COMMENCING WITN SECTION�000)OF DIVISION 3(�F 7HE 6USINE55 AND PRP POOUS(J8 FESSIONSfADE)ORTHATHEORSHEISEXEMPTTHEqEFROMANDTMEBASI5FOR7HEALLEGE�E%EMV- � � TION.ANVVIO�ATipNpfSECTION�03t.5BYqY'+AP?L!CnN�FOHAPEftMI'SU9JEGt5�MEA°PLICANTTO Z Re-Roof � A CIVIL PENALTV OF NOi MOqE TMAN FIVE MUN�pED DOLLARS�5500)): - Q OI,ASOWNEROFTHEPROPERTY,ORMYEMPIOYEFSWiTHWAGESASiHE?RSOIECOMPENSATiON, � Gommercial Z WIL'.DO TME WONK,AM1�THE STRUCTUFE IS NOT IN'ENDEJ OH OFFERED FON SALE(SEC.;014,BV.^•I� J � NE55 ANO PflOFE5510N5 CODE:THE CONTRACTORS l.l^.ENSE LAW DOES NO�APPiY TO AN OWNER OF � FROPEflTY WHO BUILDS OR IMPROVES THEREON,AN�VMO DOES SUCH WpRK HIMSELF OR 4ERSELF pq � THRPJGHMISORMEROWNEMPLOYFES,PROVIDEDTHATSUCHIMPROVEM[NTSARENOiINTENDE�VH m QOFFEREDFO{iSALEIF,NOWEVER,THEBUIL0INGORIMPROVEMFN71S50LOWITHINONEVEAROFGOMPIE� .Z TION.TNE OWNER-BN�DER WILL HAVE THE BUROEN OF PqOVWG"MA1 HE�R SHE 010 HOT OUILD OR � IMPROVE FORTHE�UR70SEOF SAL[�. w ❑I,ASOWNEROFiHEPROPERTV,AME%G�USIVELYGONTRACTWGWITMIICEM1'SE�CONTRACTDPS � TO CONSTRUCT TNE PROJECT(SEC.'Da4,BUSINE55 AN�PRUFESSIUNS CODE.THF CONTRAC70R5 LI. VBIlldliOfl ADJ-AREA = CENSEUWDOESNOTFP7LYTOANOWNEROFAPROPERTYWHOdUI1DSORIMPfiOVESTHERE�J,AND — -- � WHOGONTRAG7SFOq5l1CHPRWEC7SWITHACONTRACTOR(S11.ICEM1SCDPURSU4NTTOTHECOMRAC- Q�;ANTITY DESCRIPTION FEE � TORS LIGENSE LAW�. Q Q � O i � Q CJ IAM E%EMGT UN'JER SFC. __ B.6 P.C.FpqTHli PEASON � _ U � Q DATE OWNER � O __' " W f � l � UCENSED GONTRACTORS DECLARATION w �, d � I HEREBY AFFIRM UNDER PENAL7Y OF PENURY TNAT IAM UCENSED UNDER PROVi510NS OF CHAPTEF � e(COMMENCiNG WITH SECTION 7000)Oi DIVISION 3 Ui THE BUSINESSAND�POFFSS�ONS CO�E,AND `X MY LICENSE�S IN FULI FOR■C E AN�EFFECT. � LICENSE S I"l LIC.NO.� ` r. —___ y� U DA7E � ' OI CONTflACTOi .. �'� W � WORKERS'COMPENSATION DECLAFATION '� � � I HEREBY AFFIRM UNDER PENALTV OF PEPJI!RV ONEOF THE FOLLOWING DECLARATIONS. � � INAVEANOWILLMAINTAINACERTIFICATEOFCONSENTTOSEIF�INSUREFORWORKERS' ldO .�/ � , � COMPENSATqN.AS P POVIDED BV SECTION 37D0 f>F THE LABOR COOE,FOR 1HE PERFORMANCE � Q OF THE WURK FOR WHICH 7MI$PERMIT IS ISSUED. �. 1` �� / /� �`'� 7 1 L, W I HAVE AND WILI MAINTAM WORNEPS'COMPENSATION INSURANCE,AS FEOUIRE�BY SEGTION Q 3lao OF THE L480R CODE,FOR jHE PERFORMAhCE OF THE WORK FOR WMCH THIS PERMIT IS ISSUE�.lA/y��o RKERS'COMPE1�SFT:O I SVFANCEGA� IEFA�Nr�DPOL'�CYNUMBFAARE' CONSTRUCTION jcnaaiea_`m'r'�i��'h-��' .��a,_Y�''�'u�-� PLAN REVIEW � ZPOLICYNVMBER � �C ��G ._—_. ELECTRIC _ � �• t " Q �i Q (iNASSEC'IONNEmNOTBEOJMREfEDOFTHEPERMIfISFO�iONEHUhDREDDCl1AR5�b10D)ORLE55). PLUMBING w I CEftTtfv T!1AT.IN THE PERFORMANGE OF THE WOftK FOft WHICH TMIS PERMIT VS iSS'JED.i MECHANICAL Z — C} SHALL NGT EMPLOY ANV PERSON IN ANY MANNER SOAS TO BECOME SUBJEf,T TO TNE � WOFKERS"COMPENSP�IONLAWSOFCALIFORNIA,ANDAGREETHATIFISHOULDPECOME INS?ECTIONFEE � SUBJECTTOiHEWORNERS'COMPENSATIONPqpV1510NSOF5ECTiON3]DnGFTHELABOR �� CODE,I SHALL FpRTHWITH COMGLV WI?H THOSE PROVISIONS. �SSUANCE _ _ � SMIP p DATE'. _ APPLICANT �- J WARNING.Fp1�VRE TO SEGURE WORNERS'COMPENSPTION COVEHAG£IS VNUWFUL.AND SHAI L BE ENERGY P(C � SUBJEGTRNEMPIOVERTOGftIMINALPENALTIESANDCNILFWESUPTOONEH�NDREDTNOUSAND ENERGYPERMIT } OOLURS(f100.000),INAO�ITIONTOTHECOSTOFCOMPENSATION.DAMAGESASPROVIDE�FORIN �..-- J SECTIDN 37DB OF THE LABOR CODE.IN7ERFST,ANDATT�RNEv'S FEES. RETENTION FEE: � • � - � CONSTRUCTION LENDING AGENCY PRE-A�T FEE: � O � IHEFEBYpFFlRMUNOERPENnLt�OFGERJUqyTHATTHEREI$ACONSTRUCTIONIENDMGAGFNf.V � fOR TNE VERPoRNANCE OF T WORN FOR WHiCN THIS PEFMIT IS ISSLIED ISEC.309].CIV C.7. -- Z �t K.�l.* w - j LCN�EH'SNAME_ _ ... � !— LENDER'SADORESS, . —— -- wI CERTIFV rHAi I HAVE faEA�THIS APPLICATION AN�SiATE THAT THE ABOVE INFORMATION IS CORRECT TOTAL FE ES � '�AGREE TO CONPLY WITH ALL CITV ANO GOUNTY OFDINANCES AND STATE UWS REUTiNG TO AUiI nING ��o � CONSTRUGI�ON,AND HEHE9YAUTHORIZE REPRESENTATIYES OF THIS COUNTY TO ENTEii UPON THE Z 4gpy�y[.1EN�fIONEO PROPEflTV FOR INSPEC710N PURPOSES. COMMENTS __ �� (.Jf7H� (it n t k !'� .. � m PE E AME(P Tl ' � • /��' � _D - �\ ' Q � _-- _ i � SI,N4TURE OF PE 1 EE DATE _ 2 RECPT.\'Q PAID BV VAUDATION � WHITE—Department Copy,YELLOW—Finance Gopy,PINK—Assessor Copy.GOLDENROQ-Fiie Copy,GRE N—Applicanfs Copy � ,,�„,. '�;u"c�°,= � �`��^� ��u��"� �s ; ;�� ' � . �� f �� t�"" � " � � � � � _ !_�.�,� � „�..,, _ .�a > _ _ ��:� �. i _ _ ____ . ____ __ , _ _ .. _ _ _ _ __ _ _ ; _ __ _ _ _ , _.__ -- ___ . _ ; __ _ � _ _ _ _ ._ _ �� _ �� s� �� - ,�, _ __ ` t � a��. � r�,�'� � � < „ y �. : _ _ � ..wp � � � , � �, `P (�; �! di. �, � . . . . .. ._ .. . . .. . ... .. . .. .. ._ .... _.... . . . ... ._ .._. . .... .. , � __. __..., I �� ... ,r�..,. . �. , +G _.. . . . ... ..._. ... ..... .. . ...... . ._ . .. , _.... .. .._ _.. ...... ..... . _. . .. m, : � �.�� .�.,� JOBSITE ADDRESS lu5�- OWN LO T CT OWNER ER f ADDR S-e' CITY ZIP TEL. APPLICANT TEL CONTRACTOR ADDRESSI CITY ZIP TEL.-d2.0 ARCH/ENG/71 III rill DESIGNER M"Aw ADDRESS CITY/(L ZIP T d - 3 EL- 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 CITY OR COUNTY WHICH REQUIRES APERMIT 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).): 0 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 BUB.DS 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). LI I AM EXEMPT UNDER SEC B&P.0 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 FOR E AND EFFECT. LICENSE S_LIC NO „NNw .ss" DATE CONTRACTO�7 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. M KERS"COMPERSATIO I SURANCE C I ER AND POLICY NUMBER ARE # CARRIER Y-'-�IIC-A.>-�. ' �-'-J S�7w"�� / 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 CODE,I SHALL FORTHWITH COMPLY WITH THOSE 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 ACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OFT 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 ABpyyUdENTI NED PROPERTY FOR INSPECTION PURPOSES. J'// � J�&kLlIri PE E �ME D SI NATURE OF PE 1 EE 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 PERMIT FI DATE Z" NUMBER P/C ISSUE C T, TYPE 94 # DATE CONST. OCC GROUP ZONING SETBA KS � FRONT RW � REAR RW ^ SIDE/SIDE STREET � SIDE PROPOSED USE r -tki C N0. N0. DWEL. N0. -_BEDROOMS/I UNITS STORIES DESCRIPTION SQ. FT FACTOR PSF ADJ.AREAIVALUATION SFR/ADD/REM U) Garage/Carport �W Patio/Deck LL PooVSpa Z Re-Roof Commercial Valuation ADJ.AREA QUANTITY DESCRIPTION FEE tj 0 Q W {' ' ]I 4 1';A-fj w L ! �� 5v%/ )CJ .c) CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES COMMENTS RECPT N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy