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Home My WebLink About16138 ��l �/:' <' �i�-�" ' CITY OF DIAMOND BAIt +' - ��'�— DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �Y 21660 E.Copley Ihive 5uite 190 ' (909)86Q3195 Fax(909)861-3117 PRESS �"�'��w BUILDING PERMTT APPLICATION �j' -// FIRMLY Q ADDRESS !�� L.� �U�j�jl�J APPLICATION a ��l PERMIT f ,I �� P/C 0 / � � DATE `-'` � I�-�"� NUMBER I # � APN LOT TRACT 2� D TEE �� NPE OCC p OWNER L• CONST. GROUP WADDRESS '� 7 ZONING SETBACKS � CITY�-��.�_ ZIP Z /`1-TEL.�7 yy 7 r7��/" FRONT Ry� � APPLICANT _ TEL. REAR � � SIDE/SIDE STREET Ryy � CONTRACTOR SIDE n ADDRESS - � C�T1' ZIP` TEL. PROPOSED USE J�l�_ �Q w ARCWENG/ z DESIGNER�� NO.DWEL. NO. � ADDRE (�' i �— NO. � C�TY - ZIP �fEL. -Zy UNITS STORIES BEDROOMS y DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION ¢ OWNER-BUILDER DECLARATION O SFR/ADD/REM � 1 MEREBY AFFlqM UNDER PENAITV OF 7ERJUNY TN�T I AM EXEMPT FqOM THE CONTMCTORS LI� G2f2 B/Ce W CENSEUWFORTHEFOLLOWINGREASON(SEC.7031.SBUSINESSANDPROFESSIONSCODE:ANVCITVOR (n 9 �� C� COUNn'YM1iICHREOUIRESAPERMRTOCONSTRUCT,ALTER.IMPROVE,DEMOLISH,ORPEPAIRANVSTFVC- W pgtl0/DeCk W NRE,PRIOR TO IT3 ISSUANCE.AL50 REW IflES THE MPUCANT FOR SUCH PERMIT TO RlE A SIGNED W � STATEMENT THAT HE OP SHE IS LICENSE�PUilSUAM TO TNE PROVISIONS OF THE CONTMCTOftS LI� C CENSE UW(CHADTEP Y(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � POOVSP3 V FESSqNSCDDE)OflTHATHEORSHEISEXEMPTTHEREFROMANDTHEBA515FORTHEALIEGEDEXEMP� (� V TION.ANVVpI.ATIONOF5ECT10N7o31.5BYANYAPPLICANTFOflAPERMITSU&lECTSTHE/VPLICANiTO Z Re-Roof � A CINL 7ENALTY OF NOT MORE THAN FIVE HUNORED DOLURS(i50D).j: � ❑t,A50WNEROFTIEPROPERTY,ORMVEMFLOYEESWITHWAGESASTHEIR50LECAMPENSATKKJ, COmrtIBfCi01 YALL DO 7HE WORK u'1D THE STRUCTURE IS NO7 INTENDED OR OFFERED FOR SALE(SEC.7od1.BUSI- O N NESS N!D PROFESSIONS COOE',THE CONTRACTORS LICENSE UW DOES NOT APPLV 70 AN OWNER OF PfpPEfRYWFpBUtDSORIMPHOVEShfEREON,ANONM1I0DOE55UCHWOpKH1A�SELFORHERSELFOq � w THf10UGHHISORHERONMEMPLOVEES.PROVIDEOTHATSUCHIMVqOVEMEMSARENOTINTENDE00R m Q OFFEREDFORSALE.IF,IpWEVERTMEBl11LdNGORIMPROVEMENTIS50lDWITHINONEVEAROFCOMPLE � TpN,THE OWNERAUILDER WILL NAVE TNE&1ROEN OF PROVING TNAT HE OR SHE�ID NOT BUILO OR IMPNOVE FORTHE PURVOSE OF S�LE�. W ❑I.AS ONMEROF THE PROPERTV,AM EXCLUSIVELY CANTMCTING WITH IIGEN5E0 CONTRACTOqS � TO CONSTRUCT THE PRPIECT(SEC.]oa1,BUSINE55 MID PROFESSIONS CODE THE CONTqACTORS LI� VelllOfiOn ADJ.AREA � CENSEUWDOE3NOTAPPLYTOPNOWNEROF�PROPEATYWHOBUR.DSORIMPROVESTHEREON,ANO - WHOCONTMCTSFORSUCHPROJECTSWITH�CONTPACTOR(5)LICENSEDPURSUANTTOhiECONTMF QUANTITY DESCRIPTION FEE � Y TORS UCENSE IAW.). O �I AM EXEMP7 UNDER SEC. 8.s F.C.FOR7HIS REASON Q 3 � LLZ DATE OWNER � O U � LIGENSED CONTFACTORS DECLARATION w � 1 HEREBY AFFIRM UNDER FENALTV OF 7ERIURV THAT I AN LICENSED UNDER PROVISIONS OF CHAPTER � � Y(COMMENCIN(7 WI7H SECTION 700a)OF OIVISION 3 DF THE BUSINESS AND PROFESSIONS COOE,AND Z �� GV UCENSE IS IN FULL FORCEAN�EFFECT. � �LIL'.NO. �I / �� LICENSE CLASS � ~ DAtE�=�Cj_�_ CONTRACTOR � W -7� _ � WORKERS'COMPENSATION DECLARATION ¢ � IHEREBVAFFIRMUNDERPENALTYOFPER1UqVONEOF7HEFOLLOWWGDECLARATIONS: V � Z O �HAVEANDWILLMAINTNNACERTIFIGATEOFGONSENTTOSELFdNSUREFORWORKERS' _ Q V COMPENSATION,AS PROVI�E�BV SECTION J7000F THE LABOF CODE,FOR THE PERFORMANCE U DF THE WORK FOR WHICH TMIS PERMIT IS ISSUED. W � � � w � IHAVEANDWILLMAINTNNWORKERS'CAMPENSPTIONINSURANCE,ASREOUIREDBYSECTION Q37000F THE LABOR OODE,FOR THE PERFORMqNGE OF THE WORK FOfl WHICH THIS PERMI71$ ��' `�'�J ISSUED.MY WOR 5'GOyPENSATION INSUFAN CARRIER D POLICY NUMBER AREA: +r CONSTRUCTION .�f[�'L jCARHiER ___ '�'C - � /✓.J pLAN REVIEW Z ��cY Nur.�eER_ —t-�_�� EL[CTRIC � Q — � (nussEcipNr��r�o7eEmx�IDOFn�xan�7tSFoaoraeHurnr�ooalnas(tioo)ort�Ess� PLUMBING LLl ..�� W — - h — Z I CERTIFY TFIqT IN THE PERFOFMANCE OF THE WbRK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL 'L} SHi1LL NOT EMPLOY ANV PERSON IN ANV MANNER$O AS TO BECOME SUBJECT TO THE (n WOPo(ERS'GOMPENSA7pNlAW50FCALIFORNIA,ANDAGREETHATIFISyOULDBECDME INSPECTIONFEE � �"' SUBJECT TO THE N'ORNEFS'COMPENSAiION PROVISIONS OF SECTION 3 6a OF THE LABOR �� CADE.ISHALLFORTHWITHCOMPLYWITHTH SEPROVISIONS. I$$UANCE < I �.�1 � � r � p DATE:��,�qppLICANT: � � . � SMIP '" w ENERGY P/C � J WARNING.FAILIJRE TD SECURE WORKERS'COMPENSATION COYEflAGE l UNLAWFIIL,AN�SHALL BE � SU&IECTANEMPLOVERTOCRIMINALPENALTIESAN�CIVIIFWESUPTOONEHUNDREDTHOUSAN� ENERGYPERMIT ��' DOLLARS(fiD0,000),IN ADDITION TO THE COSTOf COMPENSATION,OAAIAGES AS PROVI�ED FOR IN J SECTION 3)OB OF T/E IA60R GbDE,MTEREST,AND ATTORNEV'S FEES. w RETENTION FEE: O CONSTRUGTION LENDING AGENCY PREALT FEE: � IHEREBVAFFIRMUNDERPENALTYOFPERJl1fiVTHAT?HEREISACONSTRUC710NLEN�INGAGENCV � � FOR THE PERFORMANCE O.TH WORK FOq WHICH THIS 7ERAl1T IS ISSUEO(SEC.309'l,CIV.C.). -- W `f� � LEN�ER'SNAME�_�! � F- LEN�ER'SADDRESS � I CERTIFY TNAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFOHMATqN IS CARRECT. p� � I AGREE TO CAMVLV WITN ALL CIN AND COUN7V ORDINANCES AND STATE LAWS RELATING TO BUILDING TOTAL FE ES A J � � CONSTRUCTION.ANO HEREBY AUTHORI2E RE7RESENTATIVES OF THIS COUNTV TO ENTER VPDN THE Z ABOVE-MENTIONFD�pOVERTV FOF INSPECTION uavosEs. COMMENTS � �`��'�L'�J/yl_______��/Z'�� _ � PEPMITTEE NAME(PRMT) � �C-c-- — –�J � � SIGNATU . DATE � � RECPT.NO. PAID 8Y VALIDATION WHITE—Department Copy.YELLOW--Finance Copy,PINK—Assessw Copy,GOLDENRO ile Copy,C,REEN—Applicant's Copy ��a.,.� �� ;,� ��`�� .� � « � � , � � � � ;� y � � �, � �+_ _ . � � 7� � �f�— � �� ., , , . �_ _ _._ , �___.__— --� �__. _ _ .._ _ d . ___ . — — — _ __ _ _ __. _ E r} .�,.,;C�, ..,'`c �. . ,.. � r- 3 b ,.,,°;i t`� ` ��.. ; ._ __ . .._.,_ _._.__ .�_...,_.�. ._._... _,....___� . ; .. .__ ..__ . ..__ ___ ..__ ._... ._. . � ° �m: a �...s' ,.�tF�i(�?��"'a:: i _ -t, x. ;_' � �j� �. , _ _ _ _ _ _._.. _ ,_..__ __ _ _.�_._ e _ _ _. . _ 3 �_":� ai..t�at�: . ,s= ,[' ,.' i � ; - � G ,� � �j w, ., �._ _. ....- - -- -.__.. .... . �. �+_ _ .. _ __. .._... . _-, ..... ._�..,.._..__. �. �_... .... . ..__. _.. �.. ._..... ......_...._ �. ,� . � � . . ..__ .'"t.d. r ._.'_�t�� :� „_ _ .._ _... --.,..._. ._. �_..... .....ti ...__..._._ . . . ._. _ , ....._ ___ ___, ._.. . . . ... � , � _. � � � �� . 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'_.,� ..0 .. ..,._„ .._......._�., . . _ � .. .- �,f' . .. . ._ . ..__ _ __.... �.___,._ _,...__�_._ _..__ .___.___ .__..,_.....w,._._....._ ___.. . _._. ,_._.,. .. .._ _...,. .., ...__ ___,..�,.. . 3 . _.. ._ . ...._ ._.. .. ... ._ ��., . .. _... .. -_ ... .. ._ _. ,_ ..,. ...��*�.'�r. ��.�!rti`�.��!�"�'��e�,r=_�._ ,a��... .�.. ...... ....... ._.. .... .. . .._. , _ p �.�^� "i�5�j4 ' t t'�'. 7�;. �' '. �,. ��- :a� "„ E �; �,s" - .._.__ __.. ...... ...... .. .__ ._.... . .... . . ..... .. . ...... _..... .. .. � i� - �G ��4.�1 : . , . ..� 4 S �. � , S � ..�.�. ..- .__ .... .. .... _ . . .. ... . .... ....... _ ._.... .._ ._.. _.. � .��.�'. {� _...._ ,._..._.. _" _.. .. _ ... .. .... ..._. . � �� ; `{ _. _ .. . _ _ __ � 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 PRESS FIRMLY JOBSITE / 2 L' ADDRESS( ADDRESS APN LOT TRACT OWNER ADDRESS 2 7 CITY_-/IlA,,;'f ZIP 7(1-TEL5Zyy 7 r7 APPLICANT_TEL. CONTRACTOR ADDRESS-- CITY ZIP TEL. ARCFUENG/ DESIGNER ADDRE !1" i CITY ZIP'TEL Z> OWNER-BUILDER DECLARATION 1 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 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 CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(9500).): ^ 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. 7041,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). ^ 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.). 0 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 SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORC AND EFFECT. LICENSE CLASS LIC. N0._U--7/]_- DATE/CONTRACTORS; L WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: 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 DF THE WORK FOR WHICH THIS PERMIT IS ISSUED. f 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 WOR S'COMPENSATION INSURANC CARRIER D POLICY NUMBER ARE: CARRIER POLICY NUMBER-I D (THIS SECTION NEED NOT BE OOMFLETEDOFTIE PERMIT IS FOR ONE HUI-DREDFIT 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 IS BECOME SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS-FS Ec".N 3 60 OF THE LABOR CODE.I SHALL FORTHWITH COMPLY WITH TH SE PROVISIONS. _� DATE:/ APPLICANT. WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE I UNLAWFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS(9100,000),IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3700 OF THE LABOR 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 TI-I WORK 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 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 ONED PROPERTY FOR INSPECTION URPOSES. ABOVE-MENT I PERMITTEE NAME(PRINT) SIGNATU TTET DATE APPLICATION, 'L /C 3Q ff� ERMIT # DATE P R% 1 ISSUE TYPE OCC DATE CONST.GROUP ZONING SETBACKS FRONT RW^ REAR^ SIDE/SIDE STREET RW^ SIDE^ PROPOSED USE 4-VzIx N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREAIVALUATION SFR/ADD/REM U) Garage/Carport W Patio/Deck L L.I LL PooVSpa 0 Re-Roof Z OJ Commercial D] Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U W UJ 0 Z OD EL Z 2 W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTlON FEE e ISSUANCE SMIP L ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES c- COMMENTS RECPT. N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENR00-File Copy,GREEN-Applicant's Copy