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Home My WebLink About17260 C'ITY OF DIAMONi3 BAR - .,A - �"' DEPAR.TMENT OF CQh4vtLINITY&DEVELOPMENT SERVICES �� 21825 E.Copley Drive /"�t " � �" (909)860-3195 Faac(909)Sbi-3117 �4i�/�� PRESS �'-Y�� BUILDING PERMIT AFPLICATION FIRMLY JdBSITE �, APPLICATION PERMIT ,r P/C � ADDRESS_�""�� DATE_,�°�/��NUMBER�,�W� # � — ISSUE TYPE OCC APN L07 TRACT 4ATE CONST. GROUP � OWNER O _ � ADdRESS f C- /�lTI/IA�I�f i ZdNING SETBACKS � CITY / ,/�IP TEL. FRONT RW ❑ p APPLICANT _ TEL. 5 DEISIDE STftEET RW t� � d CONTRACTpRG� � �' _ SIDE ^ ❑ Q GITI'W��_ Z!P ��f .- PROPOSED USE T�� L.�j-�� o ARGH/ENG/ W DESIGNER __— Np.DWEL. NO. NO. � ADDRESS � - t1NiTS STORt€S BEDRQOMS � CITY ZiP TEL. _— cn DESCRIPTION SQ.FT. FACTQR PSF ADJ.AREAlllALUATION � OWNER-Bl11LDER DECLARATION SFRlAODlREM O I NEFE9V AFFIRM VNDER F€NALTY OF PERJUHY TFIAf I AM[XEMPT FROM THE CONTRACTORS LI� G8f898/C.Bf�10lI 111 CENSELAWFORTHEFOLIOWINGREASON(5EC.�031.5BUSWESSANOPROFESSIONSCOOE:ANVCITYOR {f) ,,,,, C.) CO[RdTYV7i1CHREIXtIRESAFEPMt7TOCOrlSTRUC7.AlTER.iMPRpVE,DE},XSU$H,oRREPA7RANYSTRUC- (jj patio/DBCk W '?UflE.PRIOR TO ITS ISSWWCE,AL50 REQUIpES iHE ApPLICANT FOR SUCH PERMIT TO FILE A SIGNEp w ` +� STATEMEM THAT HE OR£.HE IS LICENSED PURSUAMT TO THE PROYISIONS OF THE CONTRACTOR9 LI- � � CENSE CAW(CHAPT£R 9 jC:OMMENCiNU"WiTti SEC7ION T000}OF DIY�SKSN 3 OF THE BUSINESS ANU PRO- POOUSPO FESSIONS CODE)OR THAT HE OR SHE I5 EXEMPT 7HEREfROM AND THE fiA515 FOR THEALLEGED E%EMP� V TI�N.At3YV10lATlON4FS[GTfONT031.58YANYAPFLiCANTFOftAPERMiTSU8JEC7STHcAPPi7CANTTO z Re-Roof A CMt PENALTV OF MOT MOFE THAN FIVE HUNDREO OOLIAflS(5500�.)� C I,AS OWNER OF THF:PR4PERTV,OR MY EMPI.OYEE9 WITFI WAGES AS iHEIR SOLE COMPENSATION, � � Commercial Witl DO THE WOHtC,AMD i HE STRUCTURE IS NOt INTENOED 6R OFFERE6 F�R 9AI.E tSF.C.To44,BUSi� J � NE55 AND PROFESSIONS C:ODE:THE GON'RACTORS LICENSE LAW DdES NOT APPLV TO AN ON/NER OF � PROPERTV WHD BUILDS OFl IMPROVES THEREON,AND WH�OOE&SUCH WORK HIMSELF OR HERS£LF oR [� THF�UGH HIS OR NERQWFJ EMPl6YEES.PflOVi6E't)THAT SUCH IMPAOVEMENTS AR6 NOT INTENDEDOR m QOFFEREDFORSALE.IF,HONlEVER.THEBl1ILDINGORIMPROVEMENTISSUIDWITHINONEYEAROFCOMPLE^ ! y� TIQN.THE OWNER�BUILDEI;Wlti HAVE TNE BUROEN OF AROYINQ Tf-0AT HE 4R SM6 D!D NOT BUILD 4R _ lMPROVEPoRTHEPUPPOSE6FSALEj. W ❑I,A54YMEROFTHI:PROPEF7Y,AMEXCIUSNELYCONTRACTINGWITHLICEN5E000NTRACTOfiS '— [� TO cANSTRVCT THE PF0.IECT(SEG.704a,BUSINE55 RNP PRO�ESSIpN5 GQDE:TNE COY?RACT(}ftS tF V8iUetiOtl ADJ.AREA W CENSEUWOOESNOTAPPLYTOANOWNEFOfAPROPERTVWHOBUILD50flINPRC7VE5THEREON,ANp � WHOCONTRACTSFORSUGHPRGJEGTSWITNACANTRACTOR(5)LICENSEDPURSUANTTOTHECOMRAG Q�j1,NTITY DESCRIPTIQN FEE Y FoftS IiGENSE lAW.). / /� � ❑I AM E7CEMPT 11N0E1i SEC. e.a P.C.foR Tws REASON Q t! {J' ""�i —.._.. � .� �G.� � DATE OWNER_ F � z - _ � w `�—� �4vEN5ED CONTRACTORS DECIARATION � ^eX CL I HEREBV AFFIRM UNDER P[NALTV OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � � 8(VOMMENCWGWITHSECTION70W)OFOiViSiON30FTNEeUSWESSaN�PROFESSiO.USCODE,AND Z � �X MY UCENSE IS IN FULL FORCE AND EFFECT m � LICENSE CLASS..,�.,,�r�.,,,___.,_ LIC.N0. I�d'�a,_.�_�" � � �aTE /O�,�„_!�'iS"�� CONTRACT6G1t�/Y7GJ� , �f_ d w � WC)RKERS'C4MPENSATtON DEGLARATI(3N Q � I HERE&Y AF�IpM UNDER PENAITY OF PERJURY Okc oF 2HE fO1.lOWlNG DECLARATfONS: Z � .�,„IHAVEANDWILLMAINTAINACERTIFIGATE4FCON5ENTi'pSELF�IN5t1REFbFWOpKERS' _ COMPENSATbN.A5P3iqV@E08YSECT16N976DpFTHElA80FiCODE.F4R7HEP�RWRMANCE U � OF TME WOflK FOR INHICH THIS PEqMiT IS ISSUEf7. � O w ,�t HAVE AND WIIL MA'�MAIN WO(1KERS'COMRENSATION MSURANGE,AS REWIRED BY SEGTION Q 3]0o pF THE UBOR COpE,FOR TNE PEFFGRMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED_MYNK}RKE!i5 COMPENSATM7N INSURAF7CE CAftPoEft AN[}P{XICY NUAiBER AftE� CONSTRtICTIlJN �_ 4 GARRIER��' ��y�_/!� / PLAN ftEVIEW ZPOLICYNUMBER��'"�� 2.�/�/ ^��_u . ELECTRIC ... . �O Q � (i}iiSSECitONr4E�N0T8E�MF'EfEDOFhiEPER�NTiSWRONENUNDREDDq.INS�S100�OflLESS). PLUMBMG ,_, W �CERTIFY iHAT MTHE PEftFOftMRNC'e QF TNE WORK FOR WH CN THIS PERM�T t5 i.SSUE�,i PIECHANICAi. � � — - --— � SHALl,N07'EMPLOYANYPERSONINANVMANNERSOASTOBECOMFSI:BJECTTOTHE - r� WORKERS'GOMPEMiATION�AWS OF CAUFORNtA,Au0 AG0.EE 7HA71F I SHOULDBECOME �NSPECTION FEE � SU$JECT TO THE WORKEFS'�MGEN5ATk1N PR6V15�6tVS OF s'£CTtON 3�oo4F THE�ABOR ��_��^�� CO�E.I SHALL FPRT♦WITH COMPLV WITH THOSE PROYISIONS. ISSUANCE � � ,��_1g_,^lSf_ �L/CJ�"/� ._L_... �� SMIP .P p DA7E� �` APPLICANT /� �.._ ��-y--- wWnF#�I�PtG:FAIIUflE T6SECURE N16RKERS CC7MPENSATIDF!cnVFRAGE tS uNIAWFUI,ANp SHAII BE ENFRGY PIC .� !��'ji _ � SUBJECTANEMPLOYERTpCRIMINALPENALTIESAN�CIVILFINESUPTqONEHUNDREDTIiQl1SAND ENERGYPERMIT ' � pOLURS(S10Q.000j,IN ADI}Il'ION TQTHE CQST OF COMPEN5ATN}N,DAMAGES AS PftQY1DEp FOf31N '�'� - ' _..i SECTION 3lON OG TNE LABOFl CODE,WTEPE5T,AND ATTOflNEV'S FEES. RETENTION FEE: �,,,_,,,,, ,.�__.,. � —.�. � CONSTRUCTI6N�ENDlNG AGENCY PRE-ALT PEE: p -- — � 4HEREBYAF�IRMUNDERPENAITYOFPERIUMTHAT?HEREISACONSTRUCT10kiENDINGAGENCY F�R TNE FEftFORMANCE O�THE W6RK FOR WHICN TH�S PERMIT IS ISSVED(SEC.3097.CIV C.j. W __ — � IENDEH'S NAME _ '_ _.,_F._ `Y k,_- LEN�ER'SAC6RESS�„_._�_,_,,. d / � IGEFiiFYTNATIHAVEAEADTHI$APPI.ICATIONANDSTATFTNATTHEA80YEWFOAMATIONISCORRECT TOTALFEES I_� �(r W IAGREE TO C.OMPIY WITN AG_qTV AND CAUN'Y ORDINANCES ANO S7ATE tAWS REIATWG TO eUiLDiNG �� GONSTRUCiION.ANDHEREBYAl1THORIZEREpRESENTATNESOFTHISCOUNTYTOENTEPl1PONTHE � ABOVE-MENTNJNEDPROPERrvfOR�NSGEc7ipNPUftPOSES. � COMMENTS. ___ � ^�f� t7'_t9�CJt4/.t/ —_ ._ ._. m _._. �. —_ ¢ pERMI E NAAAE(P171NT) � � � —_�...�...� j;,.��-,�7�'��- � S E PE%MITTEL DATr ----'�-----"-�%'Y'�_.� Z RECPT,n0. PAID BY VALIDATION �" WHITE—Oepariment Co YELLOW—Finance Co PINK—Assessor Go C�OIDENftOU—File Go GREEN— PY. PY� PY� PY, ADPlirant's Gopy s k tiiJ��w�i,�; , t^�ti'�L;� '�^s '�' o-9 a � � �'�P&�� _ � . �� . �� a. �. fl�. sa 7 9 . �� ., ,' . .. .. . . .. ��.. - - . - '. (' (.�,.,' . . . .. . ... . � . . � . r�r� �i i� \.„.,.� . . � . � ..�. . � . . .... .. . .. ....... . .._. .... . .. � . . . ..,j. rr- .`. .... .. ....... . � . � .. .. . ... . ... .. _... . � .. � : ;�d�:�.e ��.�.:✓ .. . .... .. . .. � � � , . .. . ... ... ... . _.. .. � . �.. . .. . . .. . , "'+ . .. . . . - . .. . . _... .1� _ ,. ..... . . �� , � . _ ..,,, . �_- --,. � �,� _ ; � . � 4 .. ... . . fi"`ta b n��.. .... .... ,5 ax��..�.v,� :._.. . .... .._. .. ��.. � ... . .... ..... ..�. . _��. L � . �� . 4 m : ��, nA�x =I ' .. ....... .. .. . ..._ ... � f�� A?�� _ .. .. . . . ... . . . .. . . .. . �'I 5 ' v��u g .rR �, "� :. . . . ... .. . .. . . .... . . ..... . . � �§ i. -p �,,.P ,:� ��, � ... ... . ... . . __ .. 't � � �dp�q� . �.� � � ... � .. .. . .... .. _ . . .... . . .. .. . .. . . . .. _. ... 3." "... � -j , ;" �� ,n i i ,�I-� � �.:, .. ... . .. . ... . . .... . .... . . . <> .. .� . . . .. .._ ,.. . � _ �, ._ ... .. .. . ... ... .. '��. r � C —°[ : M1' " � . � ��: _ < �� ... . u �I � .... ...... . �, r . . ..... . �: -� ,� v =3 .... . _ . .. ... . . . . .._ ��, � �' `. =.. '. . . .. . �� - Z. .. ��.. > i.. �_. . ,.,��, _.. , . - . ` �' t„� '. + �� . . .. .. ... .. . .. ... .._ . .. -� �� ... ...... � DIAMOND BAIL i 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 'r ADDRESS_ 1�YID APN LOT TRACT OWNER ADDRESS CITY/$IF TEL. APPLICANT TEL. CONTRACTOR<J.6- ADDRESS 3 k: !�G CITY(Cow ZIP7/7f/TEI� ^ 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 FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE: ANY CITYOR COUNTY WHICH REQUIRES A PERMITTO 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(C:OMMENCING 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).): DI,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 OFI 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 CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC. 7044, BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- CENSE LAW DOES NOTAPPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S)LICENSED PURSUANTTOTHE CONTRAC. TORS LICENSE LAW.). D 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 SEC1'ION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE.AND MY LICENSE IS IN FULL FORCE AND EFFECT. LICENSE CLASS LIC. N0. DATE-C)CONTRACTO 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 SELFINSURE 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' COM PENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: 'C MP CARRIER 4c.,[_Vllr rY � M POLICY NUMBER_/lam (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 WI TH OSE PROVISIONS. T IT DATE//SH D--at-APPLICANT: �A�/3� 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 LABOFI 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 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. NI 6',9 de,uv-y PERMI E NAME(PRINT) S E PERMITTE DATE APPLICATION PERMIT P/C DATE 0 NUMBER# ISSUE TYPE OCC DATE CONST,GROUP ZONING SETBACKS FRONT RW^ REAR^ SIDE/SIDE STREET RW^ SIDE^ ��// PROPOSED USE(I4-(L,�Ly-TL N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM U) Garage/Carport W Patio/Deck LL Pool/Spa 0 Re-Roof Z 0 Commercial m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE < AP 4,16 #71F W d Q U Z Z U W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: 's PRE-ALT FEE: TOTAL FEES 5 COMMENTS ECPT. N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy