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Home My WebLink About15961 � . J�_ CITY OF DIAMOND BAR � DEPARTMENT OF COMMUNITY 8c DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 PRESS ��9��w BUILDINGPERMTTAPPLICATION "Estates" Plan 2CR FIRMLY � JOBSITE APPLICATION ��l PERMIT �, P/C o ADDRESS 73� Crestview DATE ✓S `�' I NUMBER I'S # � APN LOT �O TRACT S 2 2 6� ISSUE TYPE OCC DATE CONST. GAOUP o OWNER P �1 e Hom .c .�r� ADDRESS �$4�� VOI'1 Karman ZONING SETBACKS � ciTy Irvine ziP 92612rE�. 9497974400 FRONT aw ❑ APPIICANT TEL. REAR ❑ � SIDE/SIDE STREET RW ❑ CONTRACTpR SIDE ❑ � ADDRESS PROPOSEDUSE SEWER LATERAL CITY ZIP` TEL_ oARCH/ENG/ //"/�!1-'_ %�� ` n y-/�3<��L DESIGNER_ ✓�� Y NO.DWEL. NO. NO. ADDRESS �� UNITS STORIES BEDROOMS � ciTv�7y 6�{�Al� zi9f�'y�.._.�' TE � � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFWADD/REM O � I HEREBY AFFIRM UNDER PENALTY OF PEPJURV THAT I AM E%EMPT FROM THE CONTRACTORS LI� G0f89fl�C8fPOfl W CENSEUWFORTHEFOLLOWINGREASON�SEC.1o31.5BU5MES5ANDPROFE5510NSCODE:ANYCITVOH (f� C.� COi1NTVWHICHREWIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC- W P8f10/DBCk WNRE.PHIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOFi SUCH PERMI7 TO FILE A SIGNED W � STATEMENT TH�T HE OR SHE IS�ICENSED PURSUAN7 TO THE PPOVISIONS OF THE CONTRAC70R5 LI- � CENSE UW(CHAVTER Y(COMMENqNO WITH SECTION 7000)OF DIYISION 3 OF THE BUSINESS AND PRO� � PooUSpa FESSqNS ODOE)OR TNAT HE OF SHE IS E%EIAPT THEREFROM AN�THE BASIS FDR THE ALLEGEO EXEMP- TION.ANYVIOL�TIONOF&EC710N7031,SBVANVAPGLICANTFORAPER1AIiSUBJECTSTHEAPVLICANTTO Z Re-Root � ACINLPENALTVOFNOTMORETHANFIVEHUNDREDDOLURS(f500).): � ❑I,�SOWNEROFTMEPROPERiY,ORMYEMPLOYEESWITHWpOESASTHEIRSOLECOMPENSATION, Q COfI1R18fC181 Y/ILL DO THE WORK,ANO iHE STRUCTURE IS NOT INTENDED OR OfFERED FOR SALE(SEC.�oaa,BU51- J NE55 AND PROFESSIONS CODE:THE CONTFACTORS LIGENSE LAW DOES NOT HPPLY TO AN OWNER OF � VROVERTYNTIOBUILDSORIMPROVESTHEREON,ANDNTi000E55UCHWORKHIMSELFORHERSELFOq m � 1Hq0UGH HIS OR HER ONM EMPLOVEES,PROVIDED THAT SUCH IM7ROVEMENTSARE NOT INTENDm OR W OFFEiiEDfORSPLEIF,IiOWEVERTIEBUILDINGORIMPROVEMENTI550LDWITHINONEYEAROFCOM%.E- � TKKJ,THE OWNER-BNL�ER WILL HAVE THE BIIRDEN OF PROVING THAT HE OR SHE DID NOT B111L�OR � IMPpOVE FOfi THE PURPOSE OF SALE). ❑I,AS OVMEROF THE PROPERTY,AM EXCLUSNELY CONTRACTING WRN IICENSED CONI"RACTORS � TO CONSTRUC7 iHE PRQIECT(SEC.10M,BUSINESS AND PROFESSIONS CODE:THE CONTRACTOflS LI- VflIU8hOf1 ADJ.AREA W CENSEUWDOESNOTAPPIYTOANOWNEHOFAPROPERTVWHOBUILDSOHIMPROVESTHEREON.AND � NrtpCONTR�CT5FOR5UC11PROJECTSWITMIICONTRACTOR(5)LICENSEDPURSUANTTOTNECONTFl.4C QUANTITY DESCRIPTION FEE Y TORSl10EN5ELAW.). O ❑IAM EXEMPT UNDER SEC._ _.._ _ B.8 P.C.FOR THIS PEASON � 3 -- � � DATE OwNEH_ ___ _ U . gW � LICENSED CONTRACTOFS DECLARATION J � � I HEREBYAFFIRM UNDER PENAL-V OF PERIUFlY THA�1AM LICENSED UNQER PROVISIONS OFGMAPtER � � Y(COMMENCING WITH SECTION 7000)Of CIVISION 3 OF THF BUSINESS ANO PROFESSIONS GO�E,AN� Z X YY LICENSE IS IN FULL FOHCE AN�EFFECT. m LLJ �,/j�� g � LICENSE GLASS _.j_/y / __LIC NO. � c---,;�[�'Y"�L- � ~ DATE ��_�_ CONTRA�TOR��F a W � � � WORKERS'COMPENSATI0IJ DECLARATION � Q � U � I HERE Y AFFIRM uNCER PENAl7V OF PERIUPV ONE OF TME FOLLOWING DECLAFATIONS: Z Q � IMAVEMIDWI!LMAIN�qINACER'IFICATEOFCANSENTTOSELF-INSUREFORNlORKERS' $ � COMPENS1ITION,ASPFOVIDEDBVSEGT'�.(XJ3IOOOr-TMEUdORGODE,FORTHEPERrORMANCE �U OF7ME WORK FOR WHICF;THIS PERMIT 15ISSUED. � W � 1 HAVEANp Wlll MAIN�AIN WORi(ERS'COMPENSA'ION INSURANCE,AS RE(]UIRE�dV SECTION Q 3�00 OF TT7E LAOOR CODE,FOR THE PEflFJRMANCE OF THE WORK fOfl WHICH TH15 PEPMIT iS - ISSUED.MV WO�ER,/S'COyAAPEKSATION I�NS.URANC�Cf'�RIER M!D POLIGY NUMBEF AtRE: CONSTRUCTION j .�1'L_�*��1��')�---��—�—;,_�1 ��J. �C PLAN REVIEW CARRIER_ Z POLICY NGMBER__ � "�C ��S i"I� � �J� ELECTRIC Q �� n-nss[ctxwHEEor�oraEaxatt�oFn�aEanrrswnuwEt+unv�Eo[ou.nas�siao)oA�Ess). PLUMBING ��-� w MECNANICAL Z I CF.RTIFV THAI'IN T4E PF.ftFOHMANCE OF THE WORK FOH WMICN THIS PEHMIT 15 ISSUED,1 — (} SHAL:NOT EMPLOY M!V PERSON�N ANY MANNER SQ AS TO 9ECOME SUBJECT i0'HE V� WORNE�iS'COMPENSATIbNUW50FCALIFORNIA,ANDAGREE7HATIFtSHOUI�BECOME INSPECTIONFEE _ SU&IECT TO THF Nh�RKF.HS'COMGENSATION PRpVISIONS OF SECTIDN 37000F THE LABOR � c/po i s�H coarHv.nr,�ca,ia�v w�rN rHo�e�aowsioNs /��iJ ISSUANGE �,_- � `' � � / /�� . �� I� d, SMIP p �ATE:�__ APPLICANT W ENERGV P/C J WARNING:FAILURE TO SECUflE WORKEFS'COMPENSATION COVERAGE IS UNLAWFUI,AND SHALL BE �y SU&IECTANEMP�OVERTOCRIA/INALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOILARS(f�W.00O).IN ADDITION TO iHE COST OF COMPENSATION,DAMAGES AS PHOVIDED FOR IN � SECTION3]OBOFTH[LABORCODE,INTEREST,ANDATTORNENSFEES. RETENTIONFEE: d CONSTRUCTION LENDING AGENCV PRE-ALT FEE: � 1 HEREBV AFFIRM UNDER PFNALTY OF PERJURV THAT TjjjIII ERE IS A CONSTRUCTION LENDING AGENCV n- FORTHEPERFOFMANCEOFTHEWORKFOpWHICH�PERMITISI55UE0(SE .3097.qYC.�. Z W � �ENOER'S NAMF � �__..____ /� F" LENDER'S ADDRE55 � I CEFTIfY THAT I HAVF READ THIS APPLICATION AND STATE THAT TNE ABOVE MFORMA710N IS CARRECT. TOTAL FEES '� .�� w I AGFlEE TO fAMVLV WITN ALl CITV ANO COUNTV�RDINANCES AND S7ATE UWS RELATING TO BUILDING � CONSTFUCTION,AND NEFEBY AUTNORIZF REPRESENTATIVES OF THIS COUNTV TO FNTER UPON THE ZABOV[-MENTIONED PFOPERN FOR NSPECTION PVRPOSES. COMMENTS_ 0 __— � -- — m VERMITTEE NAME(P�INT) /) /� � ___^L�� •'/I —� . � � SIG R OF PERMITT � DATE = RECPT.NO. PAID BY J VALIDATION �-"" ~ WHITE-Department Copy,YELLOW-Finance Copy,PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy ��*,�� „� �,.�� $"� < ��z18'� a=�' i g+��e&�e�;� ,.s�n�a�:.. � �'""�� "�.�.a� . , ` � � -, � �,... -.,.; . . , . 4,= ; w �� ¢�,g j' � � s � ` � ° � � ' "' �� e��*' � � �� ° �L�')� e� . � � �_ _ . _ _ , . _. _ _ '� , . � _ � . _. _ _ __ _ _ �� , , � 3�= � � � � , . __ _ _ ._._ _._ __ _ . � ' _ _ __ _ .. ;r . �— " , �� __ __ _ _ __ .e _ __ _ r. ,_ _. _. _ _ . . , y�..r . ,�J r,,�,_ ._ __ .. .. ,. ... ._. .. ..... . ..... _.. .. .., ��., . ._ .. ...... ... .._. .._. ___ _._ _.. . �' _ �r: . . . _ .__. ___ .._.. . _.. ..._ _ . . . . . .. ._. _., . __ . __. ___ ...._.—_ . _ ,. ?t� �� .. . .. . ... �>.. ._... ...... ...__. ..... ... .. .... .._... .._.. .._._ ..._. ...... . .._. . .: . . . �' . I .. ''... . 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P'- �� . �m�.��&��.. � �'xa� �1 _ _.. _ _ � �� a ; � �� ''- ��.; .��: t��.��!�� a� _ _ _ . . � "`� _ _ __ _ �, d� �' a� , �� . �6� � , �o�, ��.�� a�� _ .... ��I�III • i� f � CITY OF DIAMOND BAIi �---�"'�� DEPARTMENT OF COMMUNITY&DBVELOPMENfi SERVICES 216G0 E.Copley Ihive Suite 290 (909)8bQ-3195 Fau(444)861-311'7 `� � •, /� PRESS ��;9�^`�W BUII.DING PERMIT APPLICATIdN ��Z�� „..(Q►� �`�- � FIRMLY � JOBSITE ��4 / '��.� i 1��,�� APPLICATION �- �,l� k NUMB R � �� l #(C �J ' �I� A ADARESS �, t_,�� \„}� pATE i_ c� ISSUE TYPE OCC APN LOT�_�____ TFiACT ��Z-�r7�' pATE CONST. GROUP p OWNER -'l Y � � ADORESS ' VE�� L p �y� ZONING SETBACKS � c+T`r � ' �►�!� zi�1`Z,dr�.ZZ_T �tM } �U REdRT Rw � APPLiGANT TEL. SIDE/SIDE STREET RW T ❑ �S _ yF,-c.,`� L'Y- SIDE `. ❑ a GONTRACT{?R, � ADpRESS��;l1� //'✓"e �-.q/\ S 'L-- —.� Ci'ry S.-f"v�v'LL 21P��t_3 TE �`� " � t! PROPOSED USE � ARChUENG! �, _ : DESIGNER��-; ��'�� U'�-- NO.DWEL. NO. NO. � �+F'� "{-�t�,.}��r� . ADDRESS t . 5 � � --t-. N�TS STORIES BEDROOMS � CITY� �_�- ZIP�f�=7`"_� TE .��,.1�`�.:t_`.�. � DESCRIPTION S{Q�.FT. CTOR PSF ADJ.AREANALUAy�TIQN OOWNER-BUtL6EftDECLARAFIQN SFWADDIREM '7� \ + O 'J Q l HEflB@Y AFFlPAI UNDER PENALN OF PERIURY TNAT 1 M1 E%EMPT FROM THE CANTRACTORS ll- ('jHf9�6IG2Tp01t •CJ�C�t''�� ,�Ya�. 11! CENSEUWfORTNEFt7t.lOW1NGAEASON(SEC.7N1.s0USWESSANDPq6FES54QNSCODE:ANYCtTYOR � (.� CdJNTVWHICHREWIRESAPERM1T7000NSTRUCT,ALTEA,IMCROVE,DEMQLISH,OflFlEpAIftANYSTRUG �f,f Qg=j0/DBCI( �'� � , � �1, C��,� LNRE,PRpR TO 4TS ISSUMiCE,ALSO REWIqES 7MtE APAIiCANT Wft SVCM PEflMiT T6 Fl�E A SIGNED � ,� SIATEM@!T hUT HE Ofi SHE I5 LiCENSED PUiiSUANT TO TM6 PflDVISiONS OF TffE CONTflACTORS 4i� � CEN9E UW(CHAPTEq Y(CAMMENqNa WITH SECTpN 7WD)OF�NISiON 3 OF THE BUSINESS AND Pp0- V' PtlOV$p� � FE39pNSWDE)IX;7NRTt#EORSttEiSEXEMPi7NEftEFROMANDTNEBASlSFOHTHEALl.EGEDEXEMP- {� TpN.AN1'VKKATR]NOfSECTION7031.5BYANYAPPLICANTFORAPERMITSUBJECTSTHF.APPLICANTTO � Ra-Roof � ACIVIL PENAL7Y OF NOT MOflE THAN FNE HUNORED DOlUR5{f5oa).)� � � ❑i,ASQWNER�FTNEPROPER7Y.ORMYEMPtOYEFSW;LHWAG65ASTHE4RSOtECOMPENSATIbH, CORIrt16fC18I WILL DO THE WORK.AN[J T1E STPoICTURE IS NOT INTENDED OR OFFEf1E0 FOR SALE�^uEC.'I94I,BUSI- J �--��--- NE$$AN�PAOFE$SIONS CWE:TN£C-0NTRACTpHS LICENSE lAW DOES MQi APPIY T4 AN pWNER Of � PPpPEHTYNM1iOBU�tDSORIMPROVESTNEREON,FNDNMOObE55UCHWORKMiMSELF(JRHEflS£IFOR m , � Q THpCMIOH HIS OR HER OWN EMPLOYEES,PROVIDE�THA7 SUCH IMPFOVEMENTS AflE NtiT INTENDED OR ��—��—��i Q �FFEREDFORSKEIFtf44YEVERNE8Uk01NG�RIMPROYEMENii55CiDWiTttlNDNEYEAROFCOMPI.E- Z TION,THE 4WNEfl-BUILGEfl WILL MAVE THE BURDEN OF PROVING THpT HE OR SHE DID NOT BUILD OR � IMPROVEF4Rhi6PUflPO5Et7F5/U.E�. W C�i,AS 61kNEfl 6F THE PflOPEFTY.t3d EXCCU3IVElY COtfTRAC7ING WtTH UGFF7&E6 GdNTRACT6AS (= TO CONSTRUCT THE PRQIECT(SEC.10N,BUSINESS ANO PROFESSIQNS CAOE:THE CONTRACTORS LI- VOIUa�10f1 - �� ADJ.AREA W CENSEUWDOESHOTAPPLYTOMIOWMERQFAPR07EftttWHOBUI4DSOHIMPROVE6THEREOM.ANR � � vnqcor�rrrucTswnsucuarcarECTsvnn+xcourancToats�uc;sNSEaPuasu,wTTomecaxrruc pUANTI'TY DESCRIPTION FEE 7ops ucENSE uw1. � Op i AM EXEiAPT VNDER SEC. __.,,,,,, 0.S P,C.FOfl THI5 IiEP56N U � ��.L� 3 _ - � G�/ .} . LL DATE � OWNEq�_._.... .�_�'_ U g � � � �ICENSED CONTRACTORS DECLARATION -� � � � .� I HEREBV�iiflfiAt UNDER PEWLLTY OF PERAIRY THAT i AM LICENSED UN�ER PftOV15�ON5 OF GHAPTER �'y D(bJMMENCIN(3WI7HSECTION�oaa)OFDNISION30F7NE9USINESSANDPROFESSION9WDE:.AND z Q ' 4'��' _ MY IiCENSE 1S IN R!LL FCACE M+D"eFFEC7, m � UCENSE C,(ljASS�_..... 1.IC.NO. S�jj/��Sj,,�,�.,.,--�+ � t � � V DAtE�(��.�U..•�'1 _ CONTFACTbR_l_1!1_L-_ �,-�-..�� . W `�� . � WORKERS'COMPENSATfON pECIAAATION a �� •� � �I� � � �� 1 HEREB,AFfIRM UNDEP PENA4TY pF PER.IUflY ONE Of THE fCiLLGWWG DECURATIONS: Z �� L3 HfNE fNR WILL MAINTAIN A C.£flTlFif:A7E 4F CANSENT T6 SSLf-INSURE GUR WOFiKEfl r' _ V - ( . +��- CCIMPENSATpN.AS PROVIDE�BV SECTIpN 3104 OF TNF.LABOR COCIE,FOR TME PERFOHMANGE U " �'" THE WOfl!(FQfl WrtICH TNIS FEAMtT i5I55UED. � ""�� d ! I HAYEMlO Wlll MAINTAIN WORKERS'COMPENSATION INSUflANCE.AS AE6UIRED BY SECTION f ,,./ i Q 37060FTHElASORC:ObE.F{MiTHEPERfOflMANCEbFTNEWOR%FORWHICHi4ii5AERMITiS —T_ � ��\ ;-��j� �/,M1 ISSUED.MV WOflKEq£' MPENSA7k)N INSUflANGE CARRIER�ANO P0jy GY NUMBER ARE: CQNSTRUCTION { � ��..1 � ¢ CAPPoFR��F��,1�V��,,��y,� �_�.��Q_5.�..!��c�-i I PLAN REVIEW i ..�� ' ,/�� > �y� � � P ICY NUl:�Efi YY U�L �.� ) ��_g�—. E�£CjFj�� ' l d �.1�p. �� r.- .... � -��. .* `�_....1 Q (1}tlSSEC�N�6�NOTBECXJAW.EfEDOFTF�PENN��SF�RIX:EHUM%tEDLXJLLANS(S;ao)CRLESS} PLIJMBItJG ,�iyj� _._ ZI C6RTIFYTHAT MTHE PERiORMANCE 0�7HE WSJRK FOfi WH�CH TMIS PEqMIT IS ISSUED.I MECHANICAL ___�}r'V �` � !� � (,�} SNALl.NbTEMP4QYANYFEflSflNiNRNYMANNERS!�A9T00E�OMESV9JEGiit}THE INSPEGT�ONFEE ., � WGHKERS'COMPENSNT�ON LAWS G7f cALIFORNip,nfvD AGREE(HAT IF 1 SHOULD BECOME ��--- �� ;�.�'�� SU&IEGiTOTHEWOPKER5'GOMPENSAfIONPflOVI51GNSOFSECTION37000FTHEUBpR —^^ G60E,7 SHAIi FORTHW3TH CqMPIY WITH 1tiOSE PFK1YiS70�N/S. ISSUANCE p DATE�..�..��C� APP�ICANT: �4 i'�t �j t. r}1C.+.f _v SMIP ��"''� � __ '._.___ W ENERGY P/C �� J WAflNING:FAIWRE TO SECUFE WORKERS'COMPENSATIQN GOVERAOE IS UNIAWFUL.ANU SHALL 8E —�-�" — � SU6./EGT tN EMAIOYEp TO CfllMINFd.PEN1�t31E5 AND CIViI Flh'ES UP TO�iE HUNDRED fMOU$AND ENERGY PERM�T �,,,, __.. ' DOU.ARS(ii o0.000).IN A��ITIQN TO THE COST Of COMPENSA710N,OAMAGES AS PROVIDE�FOP IN " � SECTION 37tle OK THE 1A00R CODE.INTERE5T,AN�ATTORNEY'S FEES. RETENTION FEE: d CONSTRUC710N LENOING AGENCY PpE-ALT FEE: '" � CC I HEREBV AFFIRM UNOER PENAITY OF PERJURV THAT THERE I$A CANSTRUCTION LENDING AGENCY � ..__,,, d FOR 1'HE PER WRMANCF oF THE WORK FOR WHI/C^�N THIS PEft}M1T IS IS5U)ED(5EC.909�.CIY C.), .�.� � LEN�ER'S NAME . '4 N� �—._I..1� I��4��ILr �.li�^�'( �. _._.... � —_....^ F- IENDEfYS ADORE5S_,.` _..—,�—.- (; � - �{ -r{�-y -�=�-�� ;,�l.��, � WICEqTIFVTHATIMAVEREADTNISAPPLICAI`IONANUS7ATETHATTHEABOVF;NFORMATIONISCORRECT. TOTAL FEES 1 -� � IAGREET4COMPLYWITHqLLGITYANDCOUNTYCRDINANCE5ANOS7ATELpWSREIATINGT08UILDINC, CONS7RVCTiON,AND HEfiEBY AU7FIQAIZE REGRESEMAi IVES pF 7HIS COUMY TQ EMTEA UGON itiE Z A60V6MENTpNED PR4FERTY FOp INSPEC ION PURPl75E5. GOMMENT$ � � J c �_ _ � m PEflMiTTEE NAME(PRINT . � ----� � , � �T � ... --�,v- Cq __L-_� - _ � SIGN R OFPERMITf OATE _ x RECPT.NO. 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',- ^ �i w �f a. � � . .. .. .. ..- . ... . .... . . . e`r rr�,��'�� Y 4 �� .. . ... ._ -. ... �,��, � r��c�,��°��`�� ' �s�i� m��°-��"��i�`x��^��`_` _ � � �� i;4�'3'.�,IW k� '/ 4- I� ` . ._ ._ ... .. .. ... . i: '� k '� "� ��"�- w� '-� . . _. ... .. . ... _. .. . �� 9� ��r-��f7�� _ _ _ _ � �� _ �� . � ra �� 's �' ;�_� _ ,�.�" s -,,e�r �, .��,x,��ts., .•;� . __ ._... _. ... .. . . _. ,.. ... III 4 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 EE ADDRESS 731 Crestview ADDRESS APN LOT 10 TRACT 52267 Corp OWNER Pit a Homes ADDRESS 18401 on Karman CITY Irvine ZIP 92612TEL.9497974400 APPLICANT TEL. CONTRACTOR ADDRESS CITY ZIP TEL. ARCFI/ENG/ � n y DESIGNER 2 7�&3 ADDRESS �� p CITY 7ZII 7 ZbC_TE 7 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 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).): C 1,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). C I.AS OWNEROF THE PROPERTY,AM EXCLUSIVELY CONTRACTlNG WITH LICENSED CONIRACTORS 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.). I HEREBYAFFIRM 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 J�__LIC N0. Z-/ DATE: OAPPLICANT. 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. DATE 3 OCONTRACTOR I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: T I SUED IS S OF THE WORK FOR WHICH THIS PERMI I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' COMPENSATION,AS PROVIDED BY SECTION 3700 Or THE LABOR CODE,FOR THE PERFORMANCE 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY W ,1 AND POLICY NUMBER ARE: CARRIER � �ATION INSURANC C'AR J( POLICY NUMBER - � P�—N — � � �a*' C I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMITS 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 (THIS SECTEW NEED NOT BE COMPLETEOOF THE PERMIT IS FOR ONE HUNDRED DOLLARS($100)OR LESS). CONSTRUCTlON LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT T ERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OFF THHE}W�ORRK/F/FOO�R WHICH T PERMIT IS ISSUED(SE. 3097,CIV C.). LENDER'S NAME,.._.._.,._J�/�'!_i f 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 JNSPECTION PURPOSES. E, 1 .SH FORTHWITH COMPLY WITH THOSE PROVISIONS. I Pal 7 "Estates"Plan 2CR PRESS FIRMLY APPLICATION I s (', PERMIT I P/C S1 J # DATE NUMBER ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ^ REAR ^ SIDE/SIDE STREET RW ^ SIDE ^ SEWER LATERAL PROPOSED USE N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION S0. FT FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM Garage/Carport W Patio/Deck LL Pool/Spa 0 Z Re-Root Commercial m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE U F 0 W J Ili z J EL J Q U Z x U W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES (w �� COMMENTS RECPT. N0. PAID BY J VALIDATION B JOBSITE L ADDRESS �� C�i T tl '�1 APN LOT I 0 TRACT SZ- 1-L? 1- OWNER V' ADDRESS�kLj I� U� L't CITY'1--(111 ZIP Z_T 41 1 }' APPLICANT TEL. CONTRACTOR-GI 1� ADDRESS 0/"! wb+=•'N� CITYSsvul-ZIP'] p1.TE4 ARCH/ENG/I is DESIGNER ADDRESS CITY ZIP TEA, 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 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 B(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORCE AND EFFECT - 76 LICENSE CLASS LIC N0. DATE CONTRACTOR WORKERS COMPENSATION DECLARATION I HEREB•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 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' MPENSATKNJ INSURANCE CARRIER.AyND PD CY NUMBER ARE: Fj, S C CARRIER t Y Y� e A ICY NUMBER�pI�JfLr Y-NEEEDDNO BE OOMP-ETED OF THE PERMR IS FOR ONE HUNDRED DOLLARS($! 00)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. n t it T J 1C DATE: C _�y 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. 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 C a C" IV OC C lie Me-0 W LENDER'S ADDRESS CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. 1 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 INSPEC ION PURPOSES. A66 z-5 PE E NAME(PRINT Z G2 SIG)' R OF PERMITT DATE PRESS FIRMLY APPLICATION- •-S' 1J NPERMIT UMB R I S C) #/C DATE ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ^ REAR ^ SIDE/SIDE STREET RW ^ SIDE ^ PROPOSED USE N0. DWEL. N0. N0. NITS STORIES BEDROOMS DESCRIPTION SQ. FT. CTOR PSF ADJ.AREANALUATION SFR/ADD/REM 44 •0 Garage/Carport a U Lj W Patio/Deck LL Pool/Spa 0 Re-Roof Z Commercial m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE Q LA„L U U W J n Z a ,s m al v Z 2 .:�Lr Q u YN V C� CONSTRUCTION 1 L 1 JI PLAN REVIEW i ��.!'J L! ELECTRIC PLUMBING MECHANICAL I.. • !J INSPECTION FEE ISSUANCE SMIP ENERGY P/C t- _ ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES �+� COMMENTS RECPT N0. PAID BY VALIDATION 0 WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 n BUILDING PERMIT APPLICATION Z��Z�C1�pC(4�Z(2 If� . � e R pt3EJ .I ZU sb_GRdb t Px, per')UP T 00 5i re