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Home My WebLink About18768 . ..--� CITY OF DIAMOND BAR ---��' - DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �' j , ,�� 21660 E.Copley Ihive Suite 190 PRESS (909)860-3195 Faz(909)861-3117 �� "-� BUILDING PERMIT APPLICATION �l� FIRMLY a� JOBSITE �F ' y APPLICATION 1 � '� NUMBER I` / "` P/C(/✓ yI U ADDRESS L'' � �I�PJ I E�i�b`� DATE L # ISSUE �- TYPE OCC � APN LOT_ TRACT DATE � CONST. GROUP p OWNE� 4' � �; ZONING SETBACKS ADDRESS_� ' W CITY�r.rl4�t� ` ZIP TEL. FRONT RW ❑_ � APPLICANT ��' TELr,rd�Ii�/�.. � REAR ❑— SIDE/SIDE STREET RW ❑_ � CONTRACTO �% `'�'�' t% �• 1� `+�(, '�r' � SIDE ❑_ Q ADDRESS ' r,' ,�'G�'r' jc4:t`L', �� , t PROPOSED USE CITY��c }'b:;`� ZIP ,!I� TEL. w ARCWENG/ �r�`1 �� Z DESIGNER_ NO.DWEL. NO. NO. � ADDRESS UNITS STORIES BEDROOMS_ � CITY _. ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION N � OWNER-BUILDER DECLARATION SFfUADDlREM O 0 I HEREBY AFFlRM UNDER PENALTY OF PER.IURV THAT 1 AM E%EMPT FROM THE CONTRACTORS LI- GefffJ6/CefPOR W CENSEUWFORTHFFd.LOWINGRE4SON(SEC.lo315BUSINESSANDPROFESSIONSCODE:ANYCITYOR (/J U COUNTYWHIp1HEWIRI:SAPEtiMITTOCANSTRUCT,lLLTER,IAIPROVE,DEIAOLISH,ORREGAIRANVSTRl1C- W Pa�iO/DBCk _ W7URE,PRIDR TO ITS ISSUANCE,ALSO REOUIRES TNE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W � STATEMENT TH�T HE OFI SME IS LICENSED PURSUANT TO THE PPOVISIONS OF THE CON7RACTORS LI- �,L, poOUS H � CENSE UW jCH117TER Y(COMMENCING WITH SECTION 7000)OF DIVISION 3 0F THE BUSINE55 ANO PRO- lR P FESSqNS CODE)OR iHl1T HE OR SHE IS EXEMPT TMEREFROM ANO THE BA515 FOR THE ALLEGED EXEMP� v TION.ANVVIOLATIONOFSECTION7031.SBYANVAPPLICANTFORAPERMITSU&IECTSTHEAPPLICPNTTO Z Re-Root � A CIVIL PENALTV OF NOl MORE THAN FIVE HUNDRED DOLLARS(i�).): � QI,ASOWNEROFIHEPROPER7V,ORMVEMPLOVEESWITHWACaESASTMEIRSOIECOMPENSATION, � COmm6fCial WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENOED OR OFFERED FOR SALE(SEC.701�.BUSt� �1 � HESS ANO 7ROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APVLY TO AN OWNEF OF ? GROPEfiTYMR10BU�WSORIMPROVESTHEREON,ANDWHODOESSUCHWORKHIMSELFORHEPSELFOR . Q TNROUOMHISORHERC�WNEMPLOYEES,7ROVIDEDTHATSUCHIMPROVEMEMSARENOTINTENOE00{i m � OFFEREDFORS�LEIF,MONlEVERTMEBUIL�INGORIMPROVEMENTISSOIDWRHINONEVFAROFCOMPLE- � TION,THE OWNER-BUILDEF VYILL HAVE TXE BURDEN OF PROVING THAT HE OR SHE DID NOT BVILO OR � IMPROVE FOR 7HE PURI'OSE OF SALE). W ❑I,ASOMMER OF'fHE PRUPEHTV,AM E%C�USIYELY CAN7RAC71Nc WIiH LlcErvsEU CONiRACioRs ��n Q TO CONSTRUCT THE PRQIECT(SEC.70l1,BUSMESS ANO PHDFESSIONS CADE:THE CONTRACTORS U- V81U0110I1 �' �+� ADJ.AREA W CENSE UW DOES NOTAPPLV TO AN ONMEF OFA PROPERTV WHO 6U!LDS OR IMPROV[S THEREON,AND S W}q�ONTRACTSFORSUCHPHO.IECTSWITH�CONTRACTOR�S)UCENSFD7Uq5UANTTOTHECONTMG QUANTITY nESCRIPTION FEE f� TORS LICENSE LAW.). � J O ❑1 AM E%EMPT UNDER SEG __ _B.8 P C.FOR THIS fiEASON Q � — � u' D�TE OWNER_ __ U O W l_ICENSED CONTRACTOAS DECLAHAiION -� � w 1 HEREBYAFflflM UNDER PENALTV OF PERIURV TNAT 1 AM LICENSED UN�ER PFOVISIONS OF CHAPTER � p. 9(COMMENGNf3WITH:'•ECTION7000)OFDIVISION30FTHEBUSINESSANDPROFESSIONSCODE,ANO Z X AIY UCENSE IS IN FV1.L 1=0RGE AND EFFECT m LLl -i �a�� _ Q UCENSE CLASS��G � U LIC.NO. J �'4 �/. �' �* �'� a V DATE__��y=Lr '' CONTRACTOR� '� — W �P � WORKEFIS'CQMPENSATION OECLARATION -� ¢ N U � I HEREBV AFFIRM UN�ER PENALTV OF 7ERJURV ONE OF THE FOLLOWINO DECLAfiATiONS�. Z Q � 1 HAVE AND WILL MAMTAIN A CERTIFICATE OF CONSENT TO SELF-iNSUP.E FOR WORNERS' 2 � COMPENSATIdJ,AS PROVIDED BY SECi!ON 3]OOOF'HE LABOA CODE.FOR THE PERFORMANCE W . OF THE WORK 1=0q WHICH THIS PERMIT IS ISSUED. � !.] w I HAVE/WD WIIIMAIMAW WORKEFS'COMPENSATION INSUFANCE.AS HEOU��RED BY SEGTION �C• Q 3�W OF TNE 1190R COOF.FOR TME VERFORMANCE OF THE WORK FOR WHICHTNIS PERMIT IS /l ISSUED.MY WORKERS'(S/MVENSATION INSURAN CARRIER AND POLICY NUMBEF ARE: GONSTRUCTION "/• , j �! :� �' �'.TS.L __ PLAN FEVIEW � ` - GARRIER__. - - ..�•......-- � PO�:CYNUMBCR °'I�� — ELECTRIC __ Z Q U� (iF11SSFCi1CNNE�NOTBE�M14'I.E7EDOFTHEPEfYXT�SFa7IXJEHUPDREDO[%.J3iS(E1ao)ORlE55] PLUh781NG — — w I CERTIFYTHAI"IN THE PFRFORMANCE OF THE WORK FOR WHICH TNIS PERMIT IS ISSUED.I MEGHANIGAL _ Z (�} SHPLINOTEM�LGYANYVER$ONINANYMANNERSOAST06ECONESUBJECTTOTHE INSPECTIONFEE Uj WOflKERS'CQ'NPENSATION LAWS OF CALIFCVINIA,ANO AGREE THAT IF I 51qULD BECOME SU&IEGi TO THE V10RKER5'WMPENSATION PflOVIS10N50F SECTION 3]OO JF 7HE LABOR ISSUANCE L�' �� CODE,I SHALL FORTNWI7H COMPLY WITH 7HOSE P�VISIONS. — - • .�_Z ' { ,^ SMIP � DATE:�_4�^�� APPLICANT . i{f i.�--- � � ,� ENEfiGY P/C J WRRNING FAILUflE TO SEGURE WORKERS'COMPENSATION COVEHAGF IS UNI.AWFUL,AND SHALL BE � SU&IECTANEMPLOYERTOGRIMINALPENALTIESANDCIVILFINESl1GTOONEHUNDRE�THOUSAND ENERGYPERMIT DOLUFS(5100.000).IM ADDITION TO TNE COST OF COMPENSiVION,DAM�GES AS PROVIDED FOR IN -7�� J SECTION 71080FTHE LABOR COOE,INTEREST,ANDATTOflNEY'S FEES. RETENTION FEE: __ 2 w CONSTRUCTION LEND�NG AGENCY PFiE-ALT FEE a O � 1 HEREBV AFFlRM UN�Efl PENALTY OF PERJVRV THAT THERE IS A CONSTPUCTION LENDING AGENCV _ d FOR THE PERFOPMANGE OF THE WORK FOR WHIGH THIS PERMIT IS ISSVED(SEC.JOB�,CIV.C.). Z W � LENDEF'S NAME___ - t_- LENDER'SAD�RESS _. � TOTAL FEES ��J�GZ "z°t W I CERTIFY THAT 1 MAVE FEAD THIS APPLICATION AND STATE THAT THE ABOVE MFORMATION IS CORRECT. ��+ c,= � I AGAEE 70 COMPLV YJ1TH ALL GITY NNO COUNTY ORDINANCES AND STATE LAWS PELATING TO BUILDING / � CANSTRUCTION,ANDHEREBYAUTHORREREPRESENTATIVESOFTMISCOUNTVTOENTERUPONTHE Z ABOVE- ENTIUNEDpaOPERTV FOR INSGECTION PURPOSES. COMMENTS 0 L/.f' 7�i'C!�) J �:� —y't. . � � F EE E(PF' 3 UR OF OATE RECPT.NO. PAID BY VAIIDATION °� HITE—Department Copy,VE�LOW—Finance Copy,PINK—Assessor Copy.GOLDENROD—File Copy,GREEN—Applicam's Copy �� ,��'�� ,� ��"�m�� C�� ,��"� ' �� , � . � la � � � . � � m � F�, Q , r � i � �x°. ;� . � — — — _ _ � � ' �,l �� ,..��'l/ ' " � �._ , ii h � � �. . ;. i� _. _ � � t ., �� < _ �., _ , _ ___ . _ —._ . _ _ _. _ _ ,. � � _ . _ � _ _ _- � - � -, „ , _ _ _ _ _ _ -- -- - � �s,m :� . _�� -, , � ,,- �,��, a __ ___ -- - _ _...._ _- > � �. � � r. _ . � _y(�� //.JJ- -- - - � � �l ..: ^y f iir (//�/ ", C .l _ _ , .... .._ �_ —. _ ... .. � � I�/ � - �*i L. . . .. .�--�-- , . t� i 1 ,.,. ._ . ....... _ ...... .__._. .. ..... .. ...... .. . . .. ._ ... ..... , ._- . ..._ ..... .. � ._ _ _._. ...��, , . ._. _ . ........ . ....._.. ...... _...... . . . .. .._ ...... .._.. . . .._... .... . ., �,- _ "" . ...._ ._. ..._ 3' � . . .. ..._. ....... ..,_. .... . . ._ ._.. ,.,...,." "".. .—_ e ._.... ..._ ...."_ _. ... . . ,R'"i{ P �' ?t3��" .. . . . _._ ___ -._. ._._ __. ___ _. _ _.... _..,.__ _ ,. _...__ _ _.. -,' ,�, �,. - .� ., .__ . _ ._.. _..... �: Y3� � E . 3�t�.: . . ..`___ _._. _...... .,__ ....... .._.._ —... .. ,. , .� n . ... '.�. a � ± t ' �—, +� . _. . . ?[ �t= .. ...... ... ... _..: . ....._ . .... ...... .......... . ..... ..... ....... .... ....... ..... ..... _.... ....... ......�. $ . .._ . �—_ �� 'i'�� . _ .� —...e. o � � ... .. .._ ... ... . ._. . 1 � .. _.. ._. � � — �� — _ � � _ _ _ __ _ _ _ _ _ _ . .. � � F �� _ . �� _ _ _ _ _ r.,.� _� � ��. �'`,.��..��o��, �� _ _ __ __ _,__ _ _ __ ._..._ . __ _ __ _ _ __ _ _ _ _ _ _. __ _ __ _ _ __ _ _ _ _ _,._ __.. _ _ _ . _ �� ?�� . �� r� a.�°� i� � � � � � ��;�- �, �� _ __ _ S k , �M `�t 4�,' . .. t +f�.�� , ... - n;� ' . __. ,._..... ...... ...... ...... _.... .._. ...... ._.. ...... ...... .... � ``'�� _ � � �� , _ _ _ _ � �'. � � �� ; � , , _ _ __ �� _ � � � �, � � � : _ __ _ � � . �� ' _ � �� . F _ . _ _ __ . I . �`a��",� �� =.aY,"a,-��'9�.. .� . . • . rri 0 Ix 0 0 w 0 v v 0 UW Z W C� Q W 17 Z W LL Z QO 2 �d W 0 U W N Z� Q W Q J Z Q W Z /'PRESS FIRMLY RITE-Department Copy,YELLOW-Finance Copy,PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy U1,1�IIIJU CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 (909)860-3195 Faz(909)861-3117 BUILDING PERMTT APPLICATION JOBSITE I o ADDRESS�� I � rp� �� ice/ APN LOT OWNE TRACT ADDRESS°�' CITY�Jr JI41h t;J ZIP TEL. � APPLICANT�/��I�a�-c-rc'�TELr��I �i�r';.. ADDRESS".; ZIP�" �-t TEL. CITY Jr r�;,� ,a,r< r ARCWENG/r� 1 -�J DESIGNER ADDRESS CITY ZIP TEL. OWNER-BUILDER DECLARATION I HEREBY AFFRM UNDER PENALTY OF PERJURY THAT I AM E%EMPT FROM THE CONTRACTORS LI- CENSE UW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE:ANY CITY OR COUNTY WHICH REOUIRE:S A PERMI7T0 CONSTRUCT,ALTER,IMPROVE,DEMOLISH,OR REPAIRANY STRUC- TURE,PRK%i TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OFI SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE UW(CHAPTER 9(COMMENCING WITH SECTKN! 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- FESSK)NS CODE)OR THI1T HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TKNJ.ANV VKxAT10N OFSECTION 7031.5 BY ANV APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLURS(S50o).): I,AS OWNER OF7HE 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, BUS4 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 CWN EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE IF,HOWEVER THE BUILDING ORIMPROVEMENT ISSOLD WRHINONE YEAR OF COMPLE- TKX1,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'fHE PROPERTY,AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC. 7011, BUSINESS ANO PROFESSIONS CODE:THE CONTRACTORS LI- CENSE UW DOES NOT APPLY TO AN OWNEF OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAG TORS LICENSE UW.). ^ 1 AM EXEMPT UNDER SEO B.A P C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH"•ECTKXJ 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL 1,ORCE AND EFFECT. LICENSE C�U4SS�/��C� U LIC. N0. '�_� DATE n,J/, rl i CONTRACTOR��')aj ��-� WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECURATIONS: I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSUP.E FOR WORKERS' COMPENSATIONJ,AS PROVIDED BV SECTION 37000E THE LIBOR CODE. FOR THE PERFORMANCE OF THE WORK 1=0R WHICH THIS PERMIT IS ISSUED. I HAVE/WD WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION 3700 OF THE U90R CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSIIED. MY WORKERS'COMPENSATION INSURANC CARRIER AND POLICY NUMBER ARE: CARRIER_G� pp�� ' PCILICY NUMBER o-1 4 L'f� - (iFiIS SFCTICN NEED N07 BE I�NFT-EfED OF THE PERAYT IS FOR ONE HUNDRED OOI.LAIiS(E1 W)OR LESSa I CERTIFY THAI'IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHPLL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS'CONPENSATK)N UWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS'WMPENSATION PROVISIONS OF SECTlON 3700 OF THE LIBOR CODE,I SHALL FORTHWITH COMPLY WITH�THOSE Pq)/p,VISIONS., DATE: �� c0��APPLICANT: 1.- �.le^'d 4'� WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNUWFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLURS(5100,000).IM ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37080E THE LIBOR CODE,INTEREST,AND ATTORNEY'S FEES. CONSTRUCTlON LENDING AGENCY 1 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.). I CERTIFY THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY VJ1TH ALL CITY AND COUNTY ORDINANCES AND STATE UWS AEUTING TO BUILDING CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OFfHIS COUNTY TO ENTER UPON THE ABOVEMENTKNJED PROPERTY FOR INSPECTKJN PURPOSES.