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Home My WebLink About15178 ` �.,� CITY OF DIAMOND BAR 1 ` DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � �� w . 21660 E.Copley Drive Suite 190 �" (909)860-3195 Fax(909)861-3117 � "'�' PRESS '�'� BUILDING PERMIT APPLICATION '� � FIRMLY o DDRESS�� `W q ��-t ` C��, DATE CATIO `✓ ��;� PERMIT i��F�L%'�/C NUMBER / ��) � OCC APN LO TRACT DA EE � ONST. GROUP p OWNER � p ADDR SS `' �/ ZONING SETBACKS �W CITY ZI TEL`r �Q FRONT RW ❑ APPL CANT TEC.7 6-��``' REAR � � SIDE/SIDE STREET RW ❑ - CONTRACTOR SIDE � o CITY E ZIP � o TEL"� ��D Ioi�J� PROPOSED USE oARCH/ENG/ Z DESIGNER � ADDRESS NO.DWEL. NO. NO. cn UNITS STORIES BEDROOMS N CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNEF-BUILDER DECLARATION SFR/ADD/REM O p I HEREBV AFFlRM UNDER PENALTY OF PERn1RV THAT I AA1 EXEMPT FROM 7HE CON7MCTORS LI- Gere e/Ca Ort W CENSE UW FORTHE FOLLOWING REASON(SEC.7031.5&1SINESSAND PROFESSIONS CADE�ANV CITY OR (n 9 � COUNTV NMICH REWIRESA 7EfUAlT TO CONSTRUCT.ALTER.UAPROVE,OEMOLISH,OR REPAIR qNYSTRUF TURE,PRIOR TO ITS ISSUANCE,AL50 REQUIRES THE APPLICANT FOR SUCM PERMIT TO FlLE A SIGNED w Patio/Deck W STATEMEM TXAT HE OR SHE IS LICENSED PUpSUANT TO THE PROVISIONS OF THE CONTMCTORS LI- � CENSE UW(CHAPTER D(COMMENCINO WITN SECTqN 70W)OF DIVISION 3 OF THE BUSINE55 HN�PRO- � POOUSPd FESSqNSCODE�ORTHATHEORSHEISEXEMPTTHEREFHOMANDTMEeA515FORTHEALLEGEDE%EMP- (� TION.ANY VpUTqN OF SECTION 7031.5 BV ANVAPPLICANT FORAPEFMIT SU&IEGTS THE APPIICANT T0 Z Re-Roof � A GMl PENAL7Y OF NOT MOqE THRN iNE HUNDflED�OLLI.RS(5500).�', � ❑I,ASOWNEROFTHEVFOPERTV,ORMYEMPIOVEESWITHWAGESASTHE1fl50�ECOMPENSATION. � COmfilBfGial Y/ILL DO THE WORK,AND iHE STRUC7URE IS NO71N7ENDE�OR OPFERED FOR SALE(SEa�ou,BUSI- J � NESS AND PROFESSIONS CODE:THE CANTRACTORS LICENSE LAW�OES NOT APP�Y TO AN OWNEP OF PipPERTVWF108U1LD50RIMPROVESTHEPEON,ANDWNODOE55l1CHWORKHIAISELFORHERSELFOR � � THNIXIOHHISDRHERONMEM7LOVEES,VROVIOE�TMATSUCHIMPROVEMEN75ARENOTMTENDE00q m �� OFFERED�ORSALEIF,HOWEVERTMEBUILDINGORIMPFOVEMENTISSOLDWITHINONEYEAROFCOMPIE- Z TION,THE OWNER-BUIIDER WILL MAVE THE BURDEN OF PHOVINO THAT HE OR SHE DIO NOT BVILD OR i � IMPROVE FOR THE PURPOSE OF SALE). w OI,ASOWMEAOFTMEPROPEHTY,AMEXCLUSIYELYCANTRACTINGWITMLICENSEDCONTqACTORS � TO CONSTRUCT THE PROJECT(SEG.104�,BUSINE55 AND PROFESSIONS CODE:THE CONiHACTORS U- V81UefiOn ADJ.AREA W CENSEUWDOESNO7APPLY70ANONMEROFAPROPERTYWHOBUIL�SORIMPROVESTHEREON,AND � NRqCONTRACTSFORSUCHPR0.IECTSWITHACONTRACTORIS)LICENSEDPURSUAMTOTHECONiRAP QUANTITY DESCRIPTION Y 70RS IJCENSE LAW.). FEE 3 ❑IAM EXEAIPTUNDERS�C. 8.8 P.C.FORTHIS REASON U v �� LL DAiE OWNER F- Z — U � LlCENSED CONTqACTORS DECLARATION W � I HEREBY AFFIRM UNDER PENALTY OF PERIURV THAT IAM LICENSED UNDER PROVISIONS oF CHAPTER � f(COMMENCINO WITH SECTKKJ 7000)OF DIVISION 3 OF TH�BUS'�NESSAND PpOFESSIONS COOE,AND � �C MY LICENSE IS IN FULL FORCEANO EFFECT. Z LLL m u f _ � UCENSE CLA55 � � �IC.NO. \JJ � V DATE �` ��,�� CDNTFACTOR __,__ d W � WOFKERS'COMPENSATION DECIARATION ¢ � I HEREBYAFFIR�I VNDEA PLNALTV Of PEiLURV ONEOFTHE FOLLOWING DECLARATIONS: � � Z � IHAVEANDWILLM�INTAINACERTIFlCATEOFCANSENTiOSELFINSUHEFOFWOqKERS' a Q COMPENSATION,AS PROVIDE�BY SECPION�10a OF THE LABOR CODE.FOR THE PERF`JRMANCE C� Q Oi THE WORN FOR WHICM THIS PERMIT IS ISSl1EG. � Qw I HAYE AND WILL MAINTNN WORKERS'COMPENSRTION INS ANGE,AS RE�UIRED BY SECTION 37000F TME IABOfl CODE,FOR TME PERFOHMANGE OF T E IOFK FOR WHICH THIS PERMIT IS ISSUED.MY WO S'COMP NSAT 6URANCE CA IE AND POLICY NUMBER ARE: CONSTRUCTION jcARRtER PLAN REVIEW Z ral.ICv Nu�.�eEa (� �C � �'��_ ELECTRIC � -- � 1 Q — � (l/YSSCGRIONNEmMDTBEWM1PLEfIDOFTHEPE{YA'TISFJRdJEFM11PIXiEDDOI.IPFiS($1o0)OFiLE55). PLUMBING � W Z I CERTIFY THAT IN THE PERFORMANCE OF THE WORN FOR WHICH THIS PEFMIT IS ISSUED.I MECHANIGAL C} SHALL NOT EMPLOY ANV PEflSON IN ANV MANNER SO AS TO BECOME SUBJECT TO THE (n WOFKERS'COMPENSA710NlAWSOFCALIFORNIA,ANOAGflEETHATIFISHOULD6ECOlAE INSPECTIONFEE � SUflIECiTOTHE WORKERS'COM7ENSATION PROVISIONS Of SECTION 310o OFTHE LABOR � fADE,ISHAI.LFORTHWITHCO,UPLVWITHTMOSEPROVISIONS. ISSUANCE � p DATE:_ _ APPLICANT' _ SMIP W J WARNING:FAILURETOSECUREWORKERS'COMPENSATIONCAVERAGEISUNLAWFl1t,ANDSHALLeE ENERGYP/C . __ �y SUBJECTPNEMPLOYERTOCRIMINALPENALTIESANDGVILFWESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOLURS({10o,000),INADDITIONTOTHECOSTOFCOMPENSATION,DAMAGESASVROVIOEOFORIN • � `� � SECTION 3]OB OF THE UBOR W�E,INTEREST,AND ATfORNEYS FEES. RETENT�ON FE�f.r.yZ_QT�,lAMo O CONSTRUGTION�ENDING AGENCY PRE-ALT FEE: 1 L 1 <J1 f�Np C A�' J � I HEREBY AFFIRM UN�ER 'NALTV OF PERJURV THAT THEPE IS A CONSTRUCTION LENDING AGENCV ��: FOH THE PERFORM CE THF WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3oe1,CIV.C.). - Z � () � /4 f�` IENDER'S NAME V �� I'— LENDER'S ADDRESS � TOTAL FEES � E �/ v, � 10EflTIFVTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATIDNISCAqRECT W I AGREE TO COMPIY WITH ALL CITV AN�COUNTV ORDINANCES AND STATE LAWS RELATING TO BUILDING I � CONSTFUCTION,ANDHEREBVAUTHOR12EREPRESEN7ATIVESOFiHISCWNTYTOENTERUPONTHE l � ABOVE-MENTIONED VROPEi�TY FOq MSPECTION PURFOSES Z COMMENTS � n , _ � ..� ' `�� m PEHM NAME(PNINT��\V�e��/""\` — -- Q ..�� N � (/), SIGNPUREOFPERMITTEE DAT �� RECPT.NO. 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' _ � ._.... _ _ �! � ,�h � i • _ ,'.1 f , __ _ , �o � � �_� �� ; � � ;` , _ _ _ _ ; , ., . __ , �' . " .f __ _ _ . ___ _ ' r� ��.,� � �� A i 0 In w wo Co C 0 wW H Cr W D Z W Q w CC 9 LL 0 w co N 0 In W w CC CC W a- 0 cr d W C1. DO Q I-- I11.111111SI1 IIAIt I CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION JOBSITE C ADDRESS 3 o"r g q (EZ^' 1^'Q-A 9 APN LO TRACT OWNER ADDR SS a/ CITY ZI TEL1 APPLICANT L�_4a,('1^ UP U,TEL-7 CONTRACTOR ADDRE Pi CITY ZIP V(6J J 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 REQUIRESA 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 Y(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 CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($500).): D 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. 7064. 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). D 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 11 (COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORCE AND EFFECT. LICENSE CLASS � LIC. N0.C n��g DATE CO CONTRACTOR WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATONS: 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 INS ANCE,AS REQUIRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OFT E ORK FOR WHICH THIS PERMIT IS ISSUED MY WO S'COMP NSAT ANCE CA IE AND POLICY NUMBER ARE CARRIER pp POLICY NUMBER V_ THIS SECTION NEED NOT BE NNWLErED 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($1 W,000),IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. CONSTRUCTlON LENDING AGENCY I HEREBY AFFIRM UNDER P'NALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORM CE THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC. 3087,CIV.C.). LENDER'S NAME LENDER'S ADDRESS 1 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. C PERM NAME(PRINT] \ Q S S c7Ca SIGMA USE OF PERMITTEE DATE WHITE-Department Copy,YELLOW-Finance Copy, PIN PRESS FIRMLY APPLICATIO/- PERMIT p/C DATE c 6 NUMBER/C1 # ISSUE TYPE OCC / DATE 'CONST. GROUP ZONING SETBACKS FRONT RW^ REAR^ SIDE/SIDE STREET RW^ SIDE^ PROPOSED USE N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION SFRJADD/REM Garage/Carport W Patio/Deck L LL Pool/Spa Z Re-Roof Commercial M Valuation ADJ.AREA QUANTITY DESCRIPTION FEE Q fi r � .) U w W a Z OD d Q U Z Q 2 U Lu CONSTRUCTION PLAN REVIEW ELECTRIC-- b PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT A� 0 RETENTION FEE1,,;.4T11.11�_�IAM ll ��p J PRE-ALT FEE: { J- p TOTAL FEES L-cl 0 COMMENTS RECPT N0. PAID BY VALIDATION