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Home My WebLink About18897 - -.��. !�.- �` CITY OF DIAMOND BAR � �� - DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �J � a 21660 E.Copley Drive Suite 190 �-�� (909)8643195 Fau(9l)9)861-3117 PRESS ��' BUII.DING PERMIT APPLICATION FIRMLY o DDRESS �[Jr I C�1'PS�V J•�__ DATE CATION 1 �_�.,!` ��MBEF��q/C �� L ��_ � ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER S�n o ADDRESS S ZONING SETBACKS � CITY � ZIP TEL. � S FRONT RW ❑ APPLICANT TEL. REAR ❑ � I SIOE/SIDE STREET RW ❑ � CONTRACTOR S C M SI�E ❑ � ADDRESS �p CITY ZIP TEL. � PROPOSED USE o ARCWENG/ J�,S� z DESIGNER NO.DWEL. NO. NO. � ADORESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION N � OWNER-BUILDEF DECLARATION SFplADOiREM O � I HEpEBV AFFI{UI UNDER PENAL�V OF PERNRY TFU7 I AM E%EMPT FAOM THE CONTRAC70RS ll- Gd�O(J6/Cd(f10�I W CENSEUWWNTHEFOLI.OWINGREASON(SEG703/.SBUSINESSANOPROFESSIONSCODE:ANYCITVOR (n C� COUNTYNMICHREWIRESAPERIAITTOCONSTRUCT,ALTER.IMPROVE,DEMOLISH,ORREPAIRIWYSTflUG W P211D/DBCK W TJRE,PRpR 70ITS i55UANCE..LL50 REaU1RE5 THE AVPLICAY7 FOR SUCH PERMIT TO FILE A SIGNED STATEMENT h1�T ME OR SHE IS LICENSEO WRSUANT TO 7HE PROVISIONS OF TME CANTMCTORS LI� � CENSE LAW(CHAVTER 9��MMENpNO WITH SECTION�000)OF DIVISION 3 OF THE BUSINESS AND PR4 � PooUSpa FESSqNS COOE)Ofl TMA7 HE OR SHE IS E%EMfT TMEAEfROM AND ThE BASIS FOR THE A1 LEGE�EXEMP- (� TION.ANY YKKATION OF SECTION 70J1.5 BY ANY APPLIGANT FOR A PF,RMIT SU&IECTS THE APPLICANT TO Z Re-Roof � A qNL PENALTV OF NOT MORE TNAN FIYE HUNDRED DOLURS(f5a0).): � �I,ASOWNEROFTHEPf10PERTV,ORMYEMP�OYEESW1tHWAGE5A5TMEIR50LECOMPENSATKKJ, � COmfflOfCiel VALL DO 7NE WORK,ANO THE STRIICTURE IS NOT INTEN�ED OR OFFERED FOR SALE(SEC.7044,BU51- _J NESS AND PROFESSIONS CODE�TNF CONTMCTORS LICENSE UW DOES NOT AVPLY iD PN oWNER OF � VROGERTYNRIDBUIIDSORIMPqOVESTNfREON.ANOWHO00E55UCHWOFKHIMSELFORHERSELFOR � Q 7HiWU6H HIS OH HER ONM EMPIOVEES,GHOVIbm THAT SUCH IMPROVEMENTSARE NOT INTENDEOOR m QOFFEfiEDiORSALEIF,MOWEVEi�THEBUILDINGORiMCROVEAAEMISSOL�WITf71NONEVEAROFCOMPIE- Z TION,TME OWNEREUIIDEH WILL HAVE THE BVfipEN OF PROVING THAT HE OR SME DI�NOT BUIID OR � IMPRDVE FOR THE PURPOSE OF SAIE). I ❑�.AS ONR7ER OF THE PROPEHTY,AM E%ClUSNEIY fANTRACTING WITH LICENSED COMTRACTOqS � TO CONSIRUCT THE PRWECi(SEC.704/,BUSINE55 AND PROFESSIONS CADE:THE C(NJTRACTOFS LI- V]IU2ilOf1 ADJ.AREA_ W CENSEUWDOESNOTAVPLViOANOWNEROFAPPOPERTYWHOBUILOSORIMPROVESTMFREON,AND � YVHOCONTRACTSFORSUCIiPRQIECTSWITHACONTRACT�R(S�LIGENSEOPVRS'JANTTOTHECONTFAC- QUANTITY DESCRIPTION FEE Y TOR6 LICENSE LAW.). _ � J O ❑I AM EXEMPI UNDER SEC._.____ ...___.._ _8.8 P.C.FOq THIS REASON U 3 -- ¢ �'L' DATE DWNER__ � F' Z W � LICENSED GONTRACTORS DEGLARATION W � 1 HEREBY AFFIfiM UNOE�7 PENALTY OF PERJURY THAT I�l.l LICcNSED UNOER PROVISI�NS OF CHAPTER Z �"� � 9(COMMCNCINOWITHSECTM�N]Ooo)OFDIVISION30F�MEBUSINFSSANDPROFESSIONSGO�E,AND �� MYIIGENSE IS M FVLL fCRCE AND EFFLCT -7 m � LICENSE CL4S5��LZ� LIC.NO. S � J � DATE �O��'�� _ CUNTRACTDR 4- W �/ � WORKER5COMPENSATIONDECLAHATIO�X /��'W -� � ¢ � I HEPEBV qFFIRM UNOER PENPLN OF PE0.IURV ONE OF THE FOLLOWING OECLARATIONS: v `n c � __IHAVEANOWILLMAINTAiNACERTIFIGPTEO'CONSENTTOSELF�INSUREFORNqfiKERS' _ � COMPENSATI(>N,AS PROVIDEq BV SECTION J7000F rHE IABUR GOOE,FOR THE PERFpRMMICE W OF TNE WORN:CH WHICM THIS PERMIT IS iSSUE�. � 0 w I MAVEAND WIIIMAINTqIN WORKERS'COMPENSATION INSURANCE,AS FEOUIRED BY SF.CTION Q ]70POF TNE LABOR COC1E.�OR TME%'ERFORM/�N OF TI IE WORK FGR WHICH THIS PERMIT IS r �^ ISSUED MV WO 5' PENSATN7 INSURnN ..GARRIER AND PC,.ICV NUMBEF ARE: CONSTRUCTION . �--��' �� C � t'.'O��I. � -- PLA,N REVIEW �V.�� CARRIER�_ . - � POLICY NWABER___��' � ._ ELECTRIC _. Q � (lHSSEcnGr+rvEEONorREoor.lPLtrEooFn+Er[ar.YrlSroRONEM.r.OaEDoauRs(s�oolaa�Ess). PLUMBING . � w I CERTIFV THAT INTHE PERF6RMANCE OFTNE WOHK FOF WH;CH THIS PEHMI1151SSUED,I MEGHANICAL Z �J" SHAL!NO7'cMPLov pNY FERSON IN PNY MANNER SO AS TO BEGGM[SUBJEGT TO THE (/j WORNEFS'G(kAPEN5AT10N LAWS OF CALIFOHNIA,PND AGREE THAT IF I SNOULO BECAME INSPECTIO�V�FEE � SU&IECT TO 7HE VJiJRKERS'COA/PENSATION PROVIS NS OF SECTION�7o00F iHE LABOR (` (� � CAOE.ISHA4FOftTFlWiT'r/CONVIYWiTNTH EP O i ISSUANCE __.,_ V V �`+ Q jJ� 1 1 . � p DATE' ��'. �.^a�AMPUCANT. ' SMIP _'_'_ `� � - ENERGY P/C J W�pNING FAILURE TO SECURE WbRKERS'COMPE SATION CAV A IS NUWFUL,AND SMALL BE - J LL SU&IECTAN EMP�OYEp TO CRIMINAI PENALTIFS ANC CIVIL FME P ONE HUN�RE�THOVSAND ENERGY PERMIT DOLURS(S1o0.000).W ADOITION TO THE COST OF COMPENSATI ,DAMAGES AS PNOVI�EO FOR IN � J SECTION 3IOB OF THF LABOR CODE,INT[FEST.ANO ARORNEV'S FEES. RETENTION FEE: � . �-+�/ Q d CONSTRUCTION LENDING AGENCY pRE-ALT FEE�. /�.'y��__ � 1 MEREBV AFFIRM UNDER PENALTV OF PEPJl1RY THAT THEflE IS ACANSTRUCTION LENOING AGENCV j�`� _ FOfiTHE PERFORMANCE OF THE WORK FOR WHICN THIS PERMI7IS ISSUED(SEC.309/,GIV.C.). Z W — � LENDER'SNAAIE_ - F=- IENDER'SADDRE55 --- '` � I CERTIFV ThIAi I HAVE READ THIS APPIICATION AND STA7E TNAT TME ABOVE INFORMATION IS CARRECT. 1 OTAL FE ES J " �� ~ f�� w I AGHEE TO CAMPLY WITH/.LL CITV AN�COUNTV ORDINANCES AND STATE LAWS FELATING TO BUILDING � � CONSTFVCTION,ANDHEFEBVAUTVk']RIZEAEPFESFN'ATIYESOFTHISCOVNTYTOENTERUVONTHE ZFBOVE�MENTqNEDPROP�RTVFOFINEPECTIONPURGO5E5. Q COMMENTS __. _' r I i� " - ,.�-� i.� � m PERMITTEE N (VRINT� � � , �,� ��J��_,�'�< _ - � SIGNATUREO P DATE _ - RECPT.NO. PAID BY VALIDATION_ . ~ � WHITE—De anment C p opy,YELLOW--Finence Copy,PINK—Assessor Copy,GOkDENROD—File Gopy,GREEN—Applicant's Copy � �i�•..,�g �@° ��;,�,a�"B�,.,�d�'��.� ��.�dr""��".r;. ��°�`'�#�` �'��'�-��; µ, � �; � a �., '��.� � °� �°�� ¢ — ��,� . _ . , � _r : �� °�� . � � < _. _ ____ — _ __ . __ _ °"3'" � s i`...'�9 .,... ... ,. : >>q. .. . . ... � .. ... ,_. ...... .... ....... . .... . .. ....._ .... ...... ........ .. .... ... .. . ... . ., s,_ t. �� .. r.irA . �.. � �" 9 �� . . . . . . . ... ._... ..... . ....... _...... ....... . .. .. . . . ..... ......... ... ... . ...... . . zf. .. _ . ... .. ... _... ,.._. .,_, ._.. _... ._ .. .. . .. ....... ._.. _._... _.. ... . . = x's.- ... . . . �; . , , p. .. _ . _.. . ....._ . . ._.. ._. .__ . _ _ . . ...___ � ....__ ....... .__. ..._.. ....... .... . ;'4,' — 1. r< _. _ __ ._ _. .».. _. ..._ .. ._. _... �. .. _ .. _ _�_ _ _. ..—. ._... ._.. .... 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'. _ .. . . .. . .. . .. .... . r — �.�. li�,� - �� . .. �. < . ��Slt=�1,i. . . , �- . . . � , .;..�. ..,, _ - . � : .j.ti ; � ... ..+J . .., . .,, ._ _. . �� -�� - �.�._ � . . . . _ _ _ _- - __ _ __ � �� ' �� ,�� — — ' � ��. � �, � � n, � � ��t��+��`�� _ _ _ _ . __ _ . ,. ._ . _ _ _ __._ __ _._ _ _ _ _ _ _ . _ _ _ _ _ _ _ _ _ . __ _.. _ . __ _ _ ____ _ _ . _ _ _ _ _. _ _ _. __ _ _ _ _ _ _ _ _ _ 4��#��ik'��.f�it�':�t{'W� 4�� . . .. ... . _. .... . . .. .. . .._. .. ..... .. ... ... ... .. ., � �c;. _... ._._ .._. _,.. _.. . ._ �' <� , r,� x � , x . ,s . . ...... ._... ....._ . .. . .... .._. _.. ... ..._. .... .. ... .. _..... .. ... .._. �� :� '� �� _ ,� , _ a _. — s �t �.' r.t _ _. _ _ �n „ a� �,. � � �� f� � � a . ;. �� . . .. . ... ...... _. . .� _.. _._ . .. _. - _.. _ _ .._ �•�R � x � �.�� _�"..� .,.- � � ,..., ... . ....._ ...._. ..... .. .._. ...... ... . ... ... ... ...... . ._. . ... ..... . ... _.. . . . . � �;.. '�` m ,�•- � . �� : h � m �'s�"� a ,�:. ��°� ��{ . .. ._ ..... .... ._. ... _.. . . ._ _. _ .. ... . . . ti ,. < i,�� . : , .�;»� 's�,. , ,,fia f'�« . . .. . . . . .. .. ... ... . 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 JOBSITE 7 0 ADDRESS 6 APN LOT TRACT OWNER S��I ADDRESS S r 5 CITY z"WIA ZIP TELTi7 MA. APPLICANT TEL. CONTRACTOR S C K ADDRESS fpv Re) 12(Ar-S CITY ZIP TEL. ARCH/ENG/Ffj5 1 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 0 R COUNTY WHICH REQUIRESA 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).): D 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). D LAS OWNER OF THE PROPERTY.AM EXCLUSIVELY CONTRACTlNG WITH LICENSED CONTRACTORS TO CONSTRUCTTHE 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 PURSUANTTO THE CONTRAC- TORS LICENSE LAW.). D I AM EXEMPT UNDER SEC. B. &PC. 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. LICENSECLASS LTC. N0. DATE CONTRACTOR WORKERS'COMPENSATION DECLARATION�4'If&k 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 SECTlON 3700 OF THE LABOR CODE. FOR THE.VERFORMAN OF THE WORK FOR WHICH THIS PERMIT 15 URAN .. CARRIER AND POLICY NUMBER ARE ENSATIO INS P ISSUED. MY WO SU { CARRIER �� POLICY NUMBER qT (IHLS SECTION NEED NOT BE COMPLETED OF THE PERMIT IS FOR ONE HUNDRED DOLLARS($100)OR LESS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS'COMPENSATION PROVI$i NS OF SECTlON 3700 OF THE LABOR CODE. I SHALL FORTHWITH COMPLY WITH TH E P 0 1 DATE: -0 APPLICANT. WARNING: FAILURE TO SECURE WORKERS'COMP SATION COV 11-WFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINE P ONE HUNDRED THOUSAND DOLLARS($100,000). IN ADDITION TO THE COST OF COMIEN SATI . 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 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 ABOVE_MENTIONED PROPERTY FOR INSPECTION PURPOSES. (f PERMITTEE N(PRINT D SIGNATURE 0 TWITTEIT DATE r- L APPLICATION/C 0 �� MBER_,.. # D IvL 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.AREANALUATION SFR/ADD/REM U) Garage/Carport W Patio/Deck LL Pool/Spa Z Re-Roof Commercial 5 I Valuation ADJ.AREA QUANTITY DESCRIPTION FEE U U W -J Z .-G m J IL Z U LU CONSTRUCTION J- PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE('A' SMIP ENERGY P/C ENERGY PERMIT �� Y RETENTION FEE: 1 .J PRE-ALT FEE:y TOTAL FEES Cr--3 COMMENTS RECPT. N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy,PINK-Assessor Copy,GOLDENROD--File Copy,GREEN-Applicant's Copy