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Home My WebLink About18736 �� CITY QF DIAMOND BAR � DEPARTME?�T OF COMMUNTCY&bEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 PRESS �%r� BUILD NG PERMIT APPLICATION FIRMLY � JOBSITE ��— �� APPLICATION � CJ2 NUMBIERJSLl��' #/� Q ADDRESS - DATE � ISSUE TYPE OCC APN L T TRACT DATE � � � t'�CONST. GROUP p OWNER � ADDRESS ZONING SETBACKS oCITY ZIP TEL. REORT RW � Z APPLICANT TEL._ SIDFJSIDE STREET RW ❑ QCONTRACTO SIDE L 1 � ADDRESS �� PROPOSED USE ''�`� 9 � CITY TEL w ARCH/ENG/ �Q ��– �/'��J� z �ESIGNER "' "' �-- NO.OWEL. NO. NO. a ADDRESS UNITS STORIES BEDROOMS � CITY ZIP__ TFL.__ � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � Q OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HEREBV AFFIqM UNDER PENALTY OF PERJURY'HAT I AM F%EMPT FROM THE CONTRACTORS LI- � Garage/Carport W CENSEUWFORTHEFOLLOWINGREASON(SEC.7031.SBUSWESSAN�PAOFESSIONSCODE:ANVCITYOR U COUNTVWHICHREOUIRESAGERlAITTOCONSTRUCT,ALTER,IMPROVE.DEMOLISN.ORREPAIRANVSTRUC- W PefI0ID0Ck Z TURE,PRIOH TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANi FOR SUCH PERMIT TO FILE A SIGNFD W w STATEMENT THAT HE OR SHE IS LICENSED PURSUAMT TO THE 7ROVISIONJ OF THE CONTRACTORS LI- � CENSE LAW(CHAPTEfl 9(COMMENCING W�TH SECTION lo0a�OF DIVISION 3C�F THE BUSINESS AND PRO- � POOVSpB � FESSIONSCOOE)ORTMATHEORSHEISEXEMPTTHEREFROMAN�THEBASISFOFTHEALIEGEDEXEMY- � � TION.ANYVIOLATIONOFSEG'ION]031.SBVANYAPiLICAN�fORFPERMIT5U9,:EGfSlHFAPPLICANTTO Z qe-Roof U ApVIL PENALTY OF NOT MORE THAN FNE MUNDPED DOUARS�SSao).�'. � � ❑I,ASOWNEROFTHEPROPERTY,OFIAYEMPLOVEESWTHWAGESASIHFIRSOLECOMPENSATiON, � WILL Do 7HE wOiiN,nND THE STRUC7URE IS NOT IMENDED OH OFFEREO FO�i SALE!SEC.7oae.BUSI- J Commercial Z NE55 M1D PPOFESSIONS CODE'THE CONTRACTORS LICENSE LAW DOES NO`APPiV TO AN OWNER OF � PROVERTVWHOBUILDSORII.IPROVESTMEREON,ANDWHO[lOESSUCHWORKHIMSELFORHERSELFOfi � � THROUGH HIS OR HER OWN EMPLOVEES,PROVIOED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OF m W OFFEREDFORSALEIF,NOWEYER.THEBUI�DINGORIMPROVEMENTISSOIDWITHINONEVEAROGCOAIPLE- 0 TION,TME OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING:HAT HE OR SNE DID NOT BUILD OR Z IMPROVE FOR THE�URPOSE OF SALE). _ ❑I.ASOWNEROFTHEPROPEflTYAME%CLUSIVELYCCINTRACTINGWITHLICENSEDGONTRACTORS W � TO CONSTflUCT THE PROJECT(SEC.7060,BUSINESS AND PPOFESSIONS CODE:TMF CONTRAGTORS�I� VdIUdllOfl ADJ.AREA W CENSEUWDOESNOTAPPLVTOANOY/NEROFAPROPERTYWHOdU11D50RIMPROVESTHEREON,AND FWHOCONTRACTSFORSUCHPROJECTSWITFIACONTRACTOR(S)I.ICENSEDPUFSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE TORS LICENSE LAW) � J Q G I AM EXEMPT UNDER SFC. 8.A PC.FOR THIS REASON Q � -.. _ � LL OATE _..__-. OWNER U � LIGENSED CONTRACTORS DECLARATION �j Q � I HEREBV AFFIRM UNDER PENALTV Of PERJURY THAT 1 AM IICENSED UNOER PROViSIONS CF CHAPTER � d 9(COMMENCIN WIT ECTION To0010F DNI510N 3 0F THE BU5 ESS AND P.QFESSi NS CODE,AND Z `X MV LICENSE I FU O CE AND EFFECT. //1 �I m � LICEN LIC.NQ. " � � F- - VDATE __ CONTRACTOR d w �' _ � O ERS'COMPENSATION DEGL R TION��i,�� C.l � I HEREBYAFfIRM UNDER PENALTV OF PERJUFY ONEOF THE FOLLOWING DECLARATIONS: Z O I VEAN�WILLMAINTAINAGERTIFICATEOFCONSENTTOSELF�INSUREFORWORKERS' _ CO PENSATION,AS PROVIDEO BV SECTION]7o00F THE LABOR CODE.FDR THE PERFORMnNCE U ¢ OF E WORN FOP WHICN THIS 7ERM171$ISSUED. � 0 W I HN E AND WILLMAINTAIN WORKERS'COMPENSAiION INSURANCE,AS REOUIRED BV SECTION Q 3 OF TF BORCOOE,FOR T E ERFORMANCE OF THE WOflK FOR WHICH THIS PERMIT IS SSUED.M -rOpAPEN p RANCEGARFIERANDPOIICYNUMBERARE' CONSTRUCTION � CARRIER � � PLAN REVIEW � POLICV NUMBER ELECTRIC Z , • Q 0 (iHISScCT10NNEm reE�na�Erm � E s Eooa�ails(sioo�oa�Ess). PLUMBING w MECHANICAI Z I CERTIFV THAT IN THE PERFORMANCE OF TME WORK FOF WHICH THIS PERMIT IS ISSUED,I �' ShALLNOT EMPLOYANV PERSON IN ANY MPNNER SO AS TO BEGOME SUBJE�:T TOTHE � WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOUID BECOME INS"ECTION FEE _ U,�JECTTOT EC�Wp7ORKERS'CAMVE ATIO P OVIS �NSOf EC ION3]OOOFTHELABOR � ~ �1 H L �j�THCOMPLV THT OS / 1 N � ISSUANGE __ Q J�J �.� { � p �ATE'. T C��OPPLICANT: I ' SMIP ___ _ J ENERGY P/C _— � WARNWG.FAlllJfiE�O SECUPE WORKERS'COMPENSATION COVERAGE IS UNLAWFUI,ANO SHALL BE � SUBJECT AN EMPLOYERTO CRIMINAL PENALTIES AND CIVIL FINES UP IOONE HUNDREO THOUSAND ENERGY PERMIT DOLLARSIS1oo.o00).�NADDITIONTOTHECOSTOFCO6IVENSATION.DAMAGESASPROVI�EDFORIN - 1 r J SECTION 3]OB OF THE LABOfl COOE.INTEREST,ANDATTORNEV'S FEES. RETENTION FEE: _ � � CONSTRUCTION LENDING AGENGY PRE-ALT FEE: O � I HEREBV AFFIRM 11NOFF PENALTV OF PERJURV THAT THERE IS ACONSTFUCTION LENDING AGENCY � FOR THE FEHFOHMANCE t]F THE WOFK FOR WHICH THIS PERMIT IS ISSUE�(SEC.309],CIV.L.�. - - � Z W � LEN'�EF'SNAME _ .__ _ F- LENOER'SAJDFESS__ � ICERTIFVTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEMFOFMATIONISCORFECT TOTAL FEES w I AGREF TO COMP�Y WITH ALL CITV 4N0 COUNTY ORDINANCES AN�STATE LAWS RELATINC TO AJIL�ING ��I � ONSTRUCTION,AAD NEREBV ALITHOFiIZE REPRESEM1TATNES OF TNIS COUNTV TO ENTER UPUN THE ZVE� ENT NEO OP V FOR INSPECTION PURPOSES. GOMMENTS O �� ,dv ——. � m P MIl"TEE NAME(P T� -.-- �-- Q � —_ —"_ � 51 T OF � IL ATE� = RECPT.�O. _ PAID BV � VALIDATION ~ WHITE-De artmeni Co YELLOW-Flnance Co PWK-Assessor Co GOLDE O�File Co GREEN-A licant's Co P PY, PY. PY� PY� PP PY � � ,,��; . s = _a :�� .�.��,��- .� � �.._ � �"�� ' . �� '. , �'�� e � �� i _ __ _ _ _ , _ � . , _ � �,/f . _ . ' �� _ _ ' �t ; _ : ��,�.a �tw, _ __ _ �e�y� �, � _ __ ___ : _ __ __ _ _._ __., _ _ � _ _ _ _.... . _, __ _; ; � _ _ --- _ _�_ _--- _ _� __ . __ _ ; _ _ __ __ � r � ` �� t� _ . _ _ . _ �� ,��r#�� <,. �� , �'� � f��ri. � � ' �:� ,�, _ _ { "i ,,, „,: � - , _ _ _ _ .. i � ��.. i � M1. r i. _. _ . . i'� �r _ _ __ _ ; �.,, , �� l.s __ __ _ _ �� DIAMOND BJAK 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 JOBSITE ADDRESS APN L T TRACT OWNER ADDRESS r-t CITY ZIP TEL. APPLICANT TEL. CONTRACTO !N LLERS ADDRESS 3820 if Puy mu.JLjU/Cty_) TEL CITY P CA.90712- A CH/ENG/pp 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 CITY OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT,ALTER,IMPROVE. DEMOLISH,OR REPAIR ANYSTRUC- 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 7(00)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 SOBJEC)S THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(5500)): 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 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). ^ 1.AS OWNER OF THE PROPERTY AM EXCLUSIVELY CONTRACTlNG WITH LICENSED CONTRACTORS TO CONSTRUCTTHE PROJECT(SEC. 7044, BUSINESS AND PROFESSIONS CODE.THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO SU11.OS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW) . U T AM EXEMPT UNDER SEC. 8.8 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 NS CODE,AND 9(COMMENCIN WIT ECTION 7000)OF DIVISION 3 OF THE BUS ESS Wh MY LICENSE 1 FU 0 CE AND EFFECT,+ LICEN_LIC N0. DATE CONTRACTOR 0 ERS'COMPENSATION DECL R TIONr II j I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: WILL WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' N =T CO PENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE F E WORK FOR WHICH THIS PERMIT IS ISSUED. 0 AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION F TSOCODFORT E ERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS D M Oy1PEN 10 RANCE CARRIER AND POLICY NUMBER ARE J CARRIER 7 I a POLICY NUMBER (THIS SECTlON NEED Ter APLETED E S ED DDLLAAS(5100)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(SHOULD BECOME ERS'COMPS ATIO P OVIS NS 0 EC ION 3700 OF THE LABOR RK U,3JECT TO T E WWO ��F{{{ JJJIII .1 H L gR7FjM�ITH COMPLY THT S N CQQjRR J J �1 f� DATE'. PLIGANT. 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 ACONSTFUCTION 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 ONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE VE-ENT NED OP V FOR INSPECTION PURPOSES w D NAME(P T) I T SITOFATE cri 0 ELI 0 U 0 Q Cr LU 0 F- U w 00 Cf> CI) 0 w Q APPLICATION c�7 PERMITS P DATE NUMBER ISSUE TYPE OCC 0 fCONST GROUP DATE 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.AREANALUATION SFR/ADD/REM Garage/Carport LLI Patio/Deck W LL Pool/Spa 0 Z Re-Roof Commercial m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J r I- U W J W C3 a Z 2 0 W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INS?ECTlON FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: I- PRE-ALT FEE: TOTAL FEES COMMENTS RECPT. N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy,PINK-Assessor copy, LiULUtNHVU-rue copy,Or+ttN