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Home My WebLink About16982 (10) P, _�..,,� crrv oF ptaNtalvn�s� DEPARTN[ENT OF CC}R31�iLJI3ITY&DEVELOPMENT SBi2VICES ` �, �! .� I:�� 21825 Es.Copley Dtive .� tiJi- � (909)860-3195 Fax(909)861-3117 PRESS BUILDINGPERMITAPPLICATIUN � � FIRMLY � JOBSITE APPLICATION/._"./'� �;_., PEFiMIT � " dv.. ADDRESS E.� ,r` y PIC� �� -�� --��"�-��` DATE C.f ! ' E"'' NUMBER �.� f .i J�#_.3.L`�_� � APN �OT RACT ISSUE TYPE OCC DATE Ct�NST. GROUP p OWNER;��_ a ADDR j�8��r , � �' 1 � 20NING SETBACKS � C1TY E]��,�'11-� ZIP . TEI. FRONT RW ❑ a APPUCANT TEL. . � REAR n z SIDElSIGE STREET_ RW ❑ � CONTRACTOR �� SIpE ❑ ADDR � r "1� '� ' a GITY "�� ZIP Et. +" � PROPOSED USE � }�H � w ARCI-VENG/ �z pESIGNER Np.DWEL. NQ. / NO. d A4DRESS � ��1�T� _ STORIES BEDR�YMS � CITY ZIP TEL. � �" 4ESCRIPTIOF2 SQ.FL FACTflR PSF ADJ.AREANALUATION � OWNER-BUILDEFi DECLARATION SFRfAODJREM O (� I HERE9V AFFIflM UN6L=R PENALTY OF PERJURV THA'f I AM E%EMPT FRCIM TME GONTRAC70R5 LI� G0I'8JB/C8fP01I LU CENS£tAWFORTHEGOLl6WWGPEASON{SEC.7�31-SBVSINESSAN6PqOFE„SIONSGO�E:ANYCITYOft {f) C� COVNTYWHICHAEOUIRE5APEqMITTOCONSTRUCT,ALTER,IMP%OVc.DEMOLISH,ORREPAIRANVSTRUG W PaI10/DOCIS W TURE.PqIOR TO I�S ISSUAMCE,ALSO REQUIRES TNE APPUCANT FOR SUCH pERM1T TO FII�E A SIGNED W �-d., STA7EMENT THAT HE 4R SNE tS�ICENSED PURSUAM TO�NE PRONS��lS O�THE tXJNTRACT6R5�I� � '� CENSE LAW(GHAPTEfl 9(COMMENqN4 WITN SECTION 7000)OF pIVI51pN 3 OF THE BUSINESS ANq PRO. u' PooVSpa fESSIONS�!)E}ORTHATHEORSHEISEXEMPTTHEflEFApMANpTHE�ASISf�RTHEALl.6GEDEXEMG� � � T10iJ.ANYV�QLATIONAFSEGT10N703t,38YRNVAPPLIGANTFORAPERMiT5U8JECTS7Y,EAPPLiCANTTQ Z Re-Roof A qVIL PENALTV OF NOT MORE THAN FIYE HUNDREO�OLLAPS(i5oo�.�: a �I,ASdWNEf$OFTHERftOPERTY,OftMYEMPWYEESWiTHWAGESASTNEIR50lEG6MPENSATl4N. � �OtTV(T18�CISC � WILL 60 THE WORK,AND 7NE STRUCTUFE IS NOT IN7ENpED OR OFFERED FOR SALE(SEC.70d4,9VSi� J � NE55 AN�PROFESSIONS C;ODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF � PR�AERTY WNO 8Ui{.DS OR Ii.iRROVES?HEREON,ANb WH004E5 SUCH W�2K HIM5EtF Qfl HERSEIF OR W THROUGH HI$OR HEfl OWN EMPLOYEES,PftqVIDED TNAT SUCH IMPROVEMENTS ARF.NOT INTENDED OR m � pFFEftEDFORSALE.IF,HONA=YER,THE9UILDINCORIMPpOVEMEN7ISSOLDWITNINONEVEAROFCAMGLE� Z. iiOM,TNE OWNER•BUILDEfl WIL1.HAYE THE BURDEN aF PROYIN^v THAT Hf OR SHt'DID NOT Lt3:10 OR � IMPROVE FOR T1E PURPOSL-OF SALE). (y,� ❑I,ASbWNER4FTHEPftOPERTY,AMEXCLU51YEtYCANTRAC7INGWITHLICENSEDCONTMC70RE [[ 70 CONSTiiUCT THE PR0.IECT(SEC.7044,BUSINE55 ANf3 PPOKESSIONS CODE:THE CONTRpCTOPS Li� VeIU0ti0t1 ADJ,AREA W CENSELAWpOESNOTAPPI.VTOANOWNERQFAPROPERTVWH06UILU50RIMPR�VESTNEREQN,ANp � WHOfANTRACTSFpRSUC}{PROJECT5W4TNAC4NTRACTOfl{S)UCENSEDPUHSUN.'iT07'HEC4NTRAG Q�ANTITY DESGRIPTIOh7 FEE � TORS I,ICENSE LAW,). ( �4 � ❑i AM EXEAtPT UNDEFt SEC. „ B.&P.C.FOR'HIS REASON Q l,__ .(� � "ya^ U W — CL DATE ,,,�, OWNEF_ F- � � — U � IiCENSED CONTRAGTORS DECLARATiON W d CL iH£RE9YAFFtRMUHOfRPLNAtTYOFPER.IURYTHA7IAMUCEN5EDUN4ERPRQVi510NSCFGHRPTER tJ:_ -�P {y e(COMMENCING WI7H SEC710N 7000)OF D'.VISION 3 OF TH�;eUSINESS AND PROFESSIONS CODE,AND Z i /F w MYLICENSE ISlN FUIL Po�{1 AND EFF r/'� (/ I l� m t � r', '�� .4 t',.. � LICENSE SS�s��-+y�y�' LIG.NO. �•;. � ,. 1 e ,1 / � � QATE_-�=`�=�i ..1T,_._CONTRACTOR, � � a '^`%�- '� '� W � Wi�RKERS'COMPENSATION DECLARATIdN Q ., _ _ � �e�C.. �(�i� NIM£REBYRFFiRMUNDERPENA�TYOFPERIURYONEOFTHEK?tIOWiNf..DECIARATiONS� Z � � � .._i HAVE AMD WtLL MAINTAtN AG£RTIfiCATE 9F CON5ENT(p SEIF�iNSURE fOR WOPoLEflS' a ,� CAMPENSATION,AS�ROVIDE6 BY SECTION 3700 OFTME lpB�R CO�E,FOR THE PEHFOPMANCE U �) OF h7E WORK FOR WHICHTHIS PERMIi IS ISSl1E6. w W ___C�.._�HAVEANOWILLMAINTAINWOflKERS'COMPENSATIONIN5URANCE,A5RE4UIREDBVSECTION � � 37POOF THE LA80R GODE FOft TtSE PERfOHMANCE OF iME WORK FOR WHICH THIS AERMIT IS �� C.� �'/� ISSUE�.MY W(�jjK S'C PENSAT INSUPANCE CARR� ANCJ POLICY NUMBEN ARE CCJNSTRUCTION �j�''� � CARRIER_y� ��'�. . PLAN REVtEW ! � �._ .. 7� � -�—----.-.-��--� QPOLICV NUMBER_ �I ELECTRIC ~y �` y � �TF113SECTKNJNEFI�NOTBEOOMREfEQOFTiEPERMITISFORONEHUNDREDWLIMS�S1aa)ORIESS). PLUMBING . �'„ W - ( � . Z I CERTIFv TNAT IN THE PERFORMANCE OF T`1E WOPK FOR WHICH THIS PERMIT IS I$$UE�,1 MECHAN{CA� _:_�__. � - � C!T SHALL NOT EMFLOV ANV PER5CIN 1N ANY MANNER 50 AS TO 9ECOME SUBJECT TO fHE (p W6RKEftS'C6MPF.NSATION LAWS OF CALIFi�RNiA.AND AGRE£THAT tf 1 SHIX7'.0 BECOME INSPECT(ON FEE � SV6JECT T4 THE INOHKGRS'COMPENSATIpN PROVISIOMS OF SECTION 9]�OOF THE LABCIR _ �1 cooe.i snau Fcnvrf+wrrn caMa�_r wiTH n�+osE vnovis�or�s. 1SSUANCE �.,I' 7 � _ p �ATEr. __ APPLICANT: �, SMIP �,,.. }. c3�t; W ""'� WARNING FAILURETO SEvURE WORKERS'COMPENSATI(1N COVEflAGE IS UNLAWFUL,ANp SHALL9E ENERGY PJG J � SUBJECTANEMPIfJYEflTOCRIMINAIPENAI.TIESAN�CIVILFINE5l17TOONEHUNUFtEDTHOUSAND ENERGYPERMIT ODLLAPS($500,000},!N AGDiTiQN TO Tk�tE C65T Of OOMPENSATH?N,DAMAGES AS PFOYIDED FaR N J SECTIf7N3]OBOFT'HELAkiOFiCODE,INTEREST,ANpATTORNEY'SFEES. CL RE7ENTION FEE: � CQNSTRUCTION LENpiNG AGENCY PRE-ALT FEE: ,%��i ....—.... ... _ � iHEREBYAFKM{iMUNDf({PENAtTYOFPERJUPYTtiATTHEREtSACONSTFIUCTiONt,ENDINGAGENCY '_ FOR TNE PERFORMANGE OF TM[WORK FOR WHICH iHl$PERMIT IS ISSUEO�SEC.3097.qV.C.). � � 2 W y LENCIER'SNAME� � , � I— LEN6ER'SAp�RESS W ICEftTIFYTttA7iNAYEftF:A6TNi5APPtiCATIONANOSTATETHATiHFA9QYE�'F4FIMAT�ONISCpRRECT TOTAL FEES .�, t� . .+ / (-�� ' }� � I AGREE TO COMPI.Y WITH qLL CITV AND COUNTV OLiDINANCESAND STATE LAWS RFLATING TO�UILDING E GONSTRUCT'ION,AND HF.I�E6Y AUTHOR12E 11EPR[SENTA7NES OK THIS CAUNTy TO ENTEft I IPON THE � A80VEMENTIONE�PRQPERiT' O NSPECiiONPURPO5E5. �(�� yi � � /, t / f � CCJMMENTS ",,,�.�� 4 4t� .�4/� �..,f ��°f "�fi 0 . . ,.� y . -. � R ITfEENAME(PftINI i ' �^' (' ��;��,,—Y�+"1 . . �— C,n � �, �� ..i\�,f� � " � .. _ __ l J�. �� —.' , , -.. � AT R OF PEPM]TT1=E DATE � r S RECPT.NO.^,' � � � PAID BY l � VAUDATI6N � � ~ WNITE—departmeni Copy,YELLOW—Finanoe Gopy,PtNK—Assessor Gopy,G4lDEMRO�File Capy,GREEN—AppNcanYs Copy �`'t +F � s.,�'r��'`'� ��.�3�� G ;�-� � .�" . - (ZI2o� �=" . � � _ ' �`5.'�i _ _ ... . . .... . ..... . .. . . . .. . .. . ... ... ,_ g � 4 E... .... . .. ...... .. . .. .. .. . �. , . ... �. . ��. . . n .. _b< ��w ..� 8.�.._ ��. �'1'3 'G� �t�l.— IS(� �]Gy' ,8i�1C� iP� ,P�4+�• �� 'E�21G� _,,� _ _ _, _ _ �— ; ,. � , 1i� � t ,�, , . _ _ � �� r �� . . . � � , _ ,. _, � � ` �. � ��,�a: " , ! _ '� °.,� � a:_�� ,�.,`= �� ,� . �� . - � �� . � Er 0 w 0 Q3 Cr 0 JOBSITE ADDRESS lyt I (• �W APN LOT PACT OWNER ADDR S(G 1 CITY ZIP TEL.Wit, APPLICANT y]�TEL.I CONTRACTOR�-c ADDR; CITYyc ZIP EL. � 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 CITY OR 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(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).): ^ I,AS OWNER OF THE PROPERTY,OR MY EMPLOYEES WITH WAG ES 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 FORSALE. IF, HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WITHINONEYEAROF 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 NOTAPPLY TOAN OWNER OFAPROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(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 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FO c�AND EFF 1 LAC. N0. �' LICENSE SS DATCONTRACTOR- 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 FOP 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 NUMBER ARE: K PENSAT INSURANCE AND P CI ISSUED. MY S'C S I F -n>/a/ CARRIER T r i POLICY NUMBER (THIS SECTION NEED NOT BE CDMRETED 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. I CONSTRUCTION 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 I 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 0 NSPECTION PURPOSES. CI 11A( R ITTEE NAME(PRINT C AT R OF PERMITTI-E DATE Cr 0 M W U W 0 U LL 0 W 0 U w N 0 W 0 J C Z 0 W M Cr -I Z 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 P/C DATE NUMBER p ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBAC KS FRONT RW ^ REAR ^ SIDE/SIDE STREET RW ^ SIDE ^ PROPOSED USE j klk)91 })1 N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREANALUATION SFR/ADD/REM U) Garage/Carport W Patio/Deck LL Pooi/Spa 0 Z Re-Root Commercial Valuation ADJ.AREA QUANTITY DESCRIPTION FEE Q �_r LC W J W U Z J J Z W CONSTRUCTION PLAN REVIEW _ ELECTRIC PLUMBING 1. , MECHANICAL t 1,J,L INSPECTION FEE ISSUANCE SMIP �..d t ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES C } COMMENTS I' -lI 1 f RECPT. N0. PAID BY 1 .K VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy -13-cl lbot,j 3j%-jGr,col IT p 6A_Pu4+3/-LG 4y t fj�,-rj.;�,2z;F Z