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Home My WebLink About17307 __=y,:,-----•-� r_-_ . . _.�., CITY OF DIAMOND BAR - `�._^ �� J�`` DEPARTMENT'OF CC}I�4vfi}N'[TY&,DEVELOPMENT SERVICES � /) 21825 E.Coptey Ihive �' �-' (909)860-3145 Faac(909)$61-3111 �RES$ BLTILDIIYG PERMIT APPLICATION FIR � JOBSITE � �� qPPLICATION � /�,� PERMIT t�_='/y��PIC Q ADpRESS___ � p — DATE �✓ NUMBER 1 � # � 16SUE TYPE � OCC APN^ LOT TRACT pATE CONST. GROUP p OWNER '''� �� v � S ( 1 � `S� i1 'k�L�i� ZONtNG SETBACKS z CITYREL�iGi XN�4J•,.t �t r•'L!P�� ' TEL. FRONT RW ❑ � APPLiCANT _ 7EL. REAR � 4 , — StDE131DE STREET RW I.� m� CONTRACTOR ��i5 '��'-� .��y,� �'w✓"l`-�[14'-!��'� Iw SIDE AdORE88 `�v3., � - � ,; �{;, . „�.. U � p ' . �^ .v PROPOSED USE � CITY—1.J.:tii,.'�1..^{_ ZIP�:;,,�'� 7EL. � ARCHlENG/ � � DESlGNER w -- NO.DWEL. NO. NO. � ADDRESS = CtTY ZIP TEL. — UNtTS STORIES BEDROOMS cn — cn DESCRlPTIQN SCt.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDEF DECLARATIpN SFFUADQlREM p i HEREBV AFFiRf.i UMDEP PENALTY OF PEFJURY THAT 1 AM E%EMPT FROM THE CONTRACTOFS I.I. G8f898/C8fG7011 LLI CENSELAWFORTNEFOLLOWINGREASON(SEC.l�31.5BUSINE5$ANDPROFESSIONSCObE:ANYCITYOR (J� C-� COtJNTYWttiGHRECrikRESAPERMtd7QCONSTRUCT,AITER,lMPROVE,!?EMQI.tSN,ORREPAtRAttYS7RUC- W TURE,PRIpR TO ITS IS5UANCE,AL50 REqUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNEp W Patio/Deck .� STATEMENT THAT HE OR SHE I$LICENSEO PURSUANT TQ THE PROVISIONS OF THE CONTRACTpRS i.h � .� CENSE lAW{CHAP7ER 9(COMMENCING WITN SECTION JOW}OF ONISION 3 C?G 7HE OUSMESS AND PRCI� gOOVSP2 � FESSIONSCODE)ORTHATHEORSHEISF%EMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMN� (� TION.ANYVIOLATpNOF5ECT10N]031.SBYANYAPPLICANTFORAPERMITSJBJECTSTHEAPPUCANTTO Z F{Q�Rap� � A CiYI(.VENAITY OF NOT M�RE THAN FiVE NUNDR[�DOLLARS('j50c).): ZI"11,ASONMEROF7HEPROPEPTY,ORMYEMPLOVEESWITHWAGESASTNEIRSOLECOMPENSATIOV. 0 CO(lif7lBfC�d! WILL 00 TiiE WORK,AN6 THE STRUCTURc IS NO;�NTENpED OH 4Gr�ERED FOR SA�E{$EG.764a,BUS6� J � NESS AND PROFESSIONS CODE'.THE CONTRAGTORS LICENSE LAW DO[5 NOT APPLY TO AN OWNER OF � PROpERTv WNO gUILDS O�i IMPROVES THEFIEON,AND WNO DOE5 SUCH WOpK HIMSEIF OR HERSELF aR CC TFIt�UGHFfi50ftHEROW3NEMP�OYEES,PROViDEpTHA7'SUCHIMPROVEUENTSARENOTIMENDEOOR � Q OFFEREDFpIiSN.E,IF,MOWEVER,THE6UILDINGORIMPR6VEMENTIS50lDWITHINONEY[AROFCOMPLE� � TION,THE OWNEfl-BUILAER WIIL HAVE THE BURQEN OF pROYING TIJAT HE OR SHE DI�NOT BUItD bfl = IMPRqYE fOR7HE PURPIJSE OF SAIE}. w ❑I,AS ONMEFiOF 7HE PROPERTV,AM EXCLU,R.NELV GONTRACTING WITH JCENJ'E�CANTqACTOFS [L TO CANSTRUCT THE PRWECT(SEC-7oa4,OUSINESS AN6 PROPESSIONS CL}pE:THE CONTRACTORS Lt- VryIU2tibti ADJ.AREA W CEN5EiAWDOESNOTAPPLYTOANOWNEROFnPROPENTVWHVBUILO50RIMPRpVESTHEREpN.AND — � WNOCONTRACTSFORSUCHPROJECT9WITNACONTRqCTOH(S)UCENSEDPURSUANTTOTHECpNTRAC- {��,qj.JTITY QESCRIPTIQN FEE TORS UCENSE NW.}. � ❑I AM E%EMPT UNOER SEC. , 8 8 P,C.FOR THIS PEA50Y Q T�� t � � _� _ _' � �L� �� .' is�? � . � pATE 4WNER � (� —.. _. _ W ... � LICENSED CON7RAC70RS DECLARATIQN � d CC I HEREBV AFFIRM UNDER PENALTV OF PERJURY TNqT 1 AM UGENSE�UNDER PROVISIONS OF CHAPTER 7 �-7 7 y��` (,y 9{COhqAENCING WiFH SECTION 7oaP}OF QIYISIINi 3 oF THE BU31NES5 AND PROFES5iON5 CObE,AMD Z '�'}' {,at �+��=�-..,,. . yv-+, � � MY LICCNSE IS IN FUL�FpRCE AND EFFEGT. y� �;I � � m Q LICENSECtASS � �� '. z�,�,,.� LIC.fJO. �`1` ��` �X�� /��( j ..... � DATE � i- - ��.- " L� � CONTHACTOR__,�„�Y:i"�,A�-= d W � WORKERS'COMPENSATIqN DECLRRATf4N Q � IHERE6VAFFIRMUNDERPLNALTYOFPERJU%YONEOFTNEFc7L.lOWMGOECLAAATl�NS: Z � _I HAVE AND WILL MAINiAIN A CERTIFICATE OF CONSENT TO SELFINSURE F4R WORKERS' _ Q CAMPENSATiON,AS PftOViDED BY SE�TION 3T0o Of TNE LABOR C�DE,FOftTNE P£RF4RMANCE U � OFTNE WpRK FOR WMICH TMIS PERMIT IS ISSUEd. � � , t HAUE AFX}Wltl MAtNTAIN WOPKER5 C6AAPENSATION INSURANCf,AS REQU�ftED BY SEGiION ,'KC,� 37000FTHEIAB4RWOE,FORTNEPEFFORMANCEOF7HEWdRNFpRWHICHTHISPERM1T15 iSSUED.MY WOAKERS'COM}PENSATI4N INSURANCE CARRIER AP1D F'O;.ICY t�Rtl18ER AftE'. CQNSTRUCTIQN � caaqiea_...�..t.L�L 1�.•{� r'�Lt,."�_.__._.. PLAN FIEVIEW ... � 2 POLICYNUMBEA� ,� ��L�T L ,:rT.Y,,i_ � ELECTRIC T �� "t'C T � (ltiissEc�r��riarBEcon�p�FrEooFr.+�vEatirrrswaon�Eu�co�s�5,o�aniEss�. PLUMBMG _. , ."Z' i CEfiiiFY TNAT IN TNE REftfORMANCE OF TNE WGRK GOR WH.Cti THIS YEftMl7 I9 1SSUE0,M MECHANICAt _ (,�} SNAtI NOT EMPLOV ANV PEL1SqN W ANY MANNER 50 FS iU BECOME SUBJECT TO THE ^� � WORNERS'COMPENSATIQN LAWS OF GALIFORNIA,AND AGREE THAT IF I SHOULD HECOME INSPECTION FEE � SUNECTTOTHEWQftKeRS'GpAAPEN5ATk7NFftDV�S30NSOFSECF16N3T6QOFTHEtABOR � Co�E,I SHALL FORTHWITH COMPIY WITH THOSE pHOVI510NS. ISSUANCE � • �� — k� p DA7E: _ APRL.ICANT ��1��_ SMIP _ � WARNING:FAlIURE TO SECVRE WOftKERS'GUMPEN5AT16N COVERAGE IS UNtAWFU(.,ANO SHA�I.BE ENERGY PIG __ ` � GUBJECT AN EMPLOYERTO CRIMINPL PENFLTIES AND CIVI4 FINES UP 100NE HUNDf1ED THOIISAND ENERGV PERMIT POLLARS(i�W.000),IN ADDI rION TO THE C05T OF COMPENSA'ION,DAMAGES AS PROVIOEp FOR IN -- , � SEGT�ON 37680F iHE IABOA COpE,INTEAEST.AND AT7flRNEY'S FEES. RETENTION FEE: _,_„ __ l,. —_ � C4NSTRUCTIdN�ENDING AGENGY PRE-AlT FEE: " �__ � 1 HEREDYAFFIRM UNDER PENALTYOF PEHJIIqV THqT TNERE IS ACONSTRUCTIQN LEPJDINGAGENGY _ FOR FNE PERFt}ftMANGE OFTHF W4NK FOA WH�C}i THIS PF.ftMiT IS iSSUED i5EC.3047,CIV G}. � W S I.ENDEA'S YAME J __ _ 1_- LENDGR'SA�URESS__.. _.. —'... ..' ...�... --- �— � ICERTIFVTHATIHAVEREADTHISAPPI,IGATIdNANq5TFIETHATTNEA60VEINFORMATION15CORFIECT T(JTAL FEES ! �� , �_ W IAGftCE t6 COM7lY WITH ALL c�TY ANO GUuti(Y ORDtNAMf,ESAND STATE LAWS REI.ATiPlG TO e�1 t.O�NG � CONSTRUCi:6N,ANb MEREBV AUIHOflIZE REPRESFNTATNES Of THIS COUNTVTD FNTER UPON THE � ABOVE-MENTIONEP PPOPERTV Fpft INSPECTION PUFPOSES. � COMMENTS�. , ._�. � � � ---� .. . . �.� _. � PERMI7'fEE NAME(PRINT) y � I � _. � ' f��J ��' ' � , { L,..-�(� .�../�. �,y� SIGNATIIRE4F-PCR.I'%IIEE-'._ '_. ,_ .�� OATE � _ � RECPI t�+J. PAID OY VALICYATIQN �� WHITE—Department Gopy,YELLOW—Finance Copy,PINK—Assessor Copy,GOL�ENROD—File Copy.GREEN—ApplicaM's Copy I'�s-}�"'�«Cs� ¢�»�5 ` t ��7 � „ �'I,M i I 4'B Y� "�` �' � §�y � eiil k��r�T�� _�� . z:' �, e . �. . - �I.� �_ . . . _ . . . � .. . .. ... � .. . . ./r"/ ? '�� . ....� i .. � � .. .. . . ... . ... .. . ... ... ..... .. .� .. . .� �t._ . j� . .. ..� .. . . .... . ... ..... . . .. .. .. ��.. . .. . . . �� . . . . . . . .. . � �� . �� .. . ��. ... ..... ...... .. Ii - _ � ; / _ _ � _._;�' _ _ �1 _ � _ _ , � , �; � ��is�� 4 � .. '" °'= :._ € M-! vK^m�..:�-�asvK . ,,.a _ _ ... ... ... .. '. „ � a .,.: , _ _j- ... . . . ._.. . .. .. .. .... . .. , � �.. `� c . . = H��i .� ....m:.,. � � . ... .. _. . . _. _.. ... . .... _ � ` ,. � t ._ . . .. . . . . .. . ..... . :. i »d - I= _,. ��,_ . ..... . _.. ..... . . ��f c�.3�,�� ,+F � i,y..��. . ._... . ._ . . .... . .. _ .. . ... . .. . ... ,. , �: a ' �.�.. =s�� t i �G�� . . .. . . . . . . ... ... .. ... .._... �. : ._ . .. .. . . . . . °" � M b w^�-c�`�t w a. : _ ... ... .. , � �ti � _ � _ -�. ' ' .. ... . . . .. .. . ... ._ .... .. . .. }� . . . . .. . .. .. . �� r. S :�;. e. .,- � ... .. ... .. . ... . ... . . DIVIO%D BAR i CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION CRESS FIRMLY JOBSITE-7 1 ADDRESS(, APN LOT TRACT OWNER^ 72 ADDRESS CITY D,LYT).-_J r1ZIP TEL. APPLICANT TEL. CONTRACTOR s v i/(S[C�'t"�I-� ADDRESS-e-' CITY ZIP TEL. 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: ANYCITY 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 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 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). ^ 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.). ^ 1 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 FORCE AND EFFECT. LICENSE CLASS �•'•LIC. N0. °}"I k DATE L• CONTRACTOR L"'b,I 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 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'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER 44-64--k-F{. ,pt POLICY NUMBER_L-7 I. f. .; Z• (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 WITH THOSE PROVISIONS. / C DATE:APPLICANT. L.- � i 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 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. PERMITTEE NAME(PRINT) SIGNATURE OFP6 E'. OATE PERMIT APPLICATION frii P/C t +� 'J I DATE NUMBER# 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.AREAIVALUATION SFR/ADD/REM Garage/Carport W Patio/Deck U. Pool/Spa 0 Re-Root Z Commercial co Valuation ADJ.AREA QUANTITY DESCRIPTION FEE a ?Lt7 U F U W z a Q U W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE �.y SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES �j COMMENTS RECPT N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy