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Home My WebLink About15962 ,.--. , �,f,� CITY 4F L7IAMOND BAR � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 1� � 2166()E.Cop2ey Thive Suite 390 P �S ,,,._..,.� {909)860-3195 Fa�(9O9?$61-3117 �� __. •»� BUII,DING PERMIT APPLICATION �S��S�t ��,r'1 Z�� FIRMLY � JOBSITE y 1 " APPLICATION c-' � PERMIT �r`' P/Ci'''� � ADORESS��'��{'G�''�� a{�-A� OATE �� +"•.� � NUMBER�� t G' �# t J "'`�I� � ---- ISSUE TYPE OCC APN L T TRACT Z�- pATE CdNST, GROUP � OWNER , � 4t- ADDRESS f� IIZM4, i►�1f 20NING SE'TBACKS w C1TY ��,_t1 Z{P TE �k', . �' � r FRONT RW ❑ __ � APPIICANT -��''�-�.- TEL. �y+rw+l_ REAR ❑ SIDEISIQE STREET RW [7 r� CdNTRAGT0�4 ��'�, c�arj l��i)V+� SIDE � � �DORE$S Z�P TEL. PROPQSED USE _ .� � � �� ARCH/ENG/ DESiGNER �►('� ��' — NO.4WEL. Np. NO. ADDRESS__�� b UNIT5 � STORIES BEDROOMS N CITY .S� ZIP�� TEL ��(�;�� ,� dESCRiPTION S�.fT. FACTOR PSF ADJ.AREA/V LUA'T�ION` � OWNER-6UILDER 4EGLARATIQN SFRlADDIREM CP .. � , v � I HEREBY AfFIRM UNDE%PENALTY DF PERIURY TNAT i AM EXEMPT FliOM TNE CON7RAC70RS U� G8ld99JCdfpOR �� ti! GENSEtAWFOR?MEFOILOWit�('iRE+1SOH{SEC.703i.58US�;ESSANDPROFESSKK7SCaDE:ANYCI7YOR {n � C,� COUNTYwR11CHRE4UIRE5APERMITTOCONSTRUCf,ALTEF,IMpROVE.DEMOlISH.ORRE7AIRANVSTRUC� W pry�i0/D6Ck ZNRE,PFK7R TO ITS ISSUANCE.ALSQ REdUIFlES THE APPIICANT FOR SUCH PERMI7 TO FILE A SIGNEO W STATER�NT THAT IiE flR SHE IS LlCENSEQ PURStiANT TO THE PR6VISIONS oF TFiE CONTRACTORS i.t� � CENSE LAW�CHAPTER 0(COMMENCINQ WITH SECTION 7k0o)OF DIVISION 30F 7HE BUSINESS AND PHp� � POOUSPe �� FESSIONSfXJQE}OHTHATNEORSHEISEXEMP7THEREFHOMAN07HE9ASISF4RTHEAA.LEGEDEXEMP� U TpN.ANY VK)LATIpN Oi SEC7�ON 7031.5 BY ANV APPLiCANT FOR A PERMii SU&IECTS THE APPLICANT iCl z RB-ROOf � ACML 7ENALTY bF NOT MOFiE TNAN FIVE HUNORED DOl.URS(S50o�.j: � (]I,hSOWNEROFTHEFROF£ftTY,OflMYEMPLOYEESWiTHWAGE5A5TMEiRSOLECQMPENSAT40N, C� {�`Q�me(Cjy) YALL 06 THE YVOPK,ANP THE STqUCTURE IS NOT INiENpEO ON OFFERED FOfl SALE($EC.7044.BUSI- J. NESS AND PHOFESSIONS CODE:TNE C-0NTRACTbRS LICENSE LAW OOES NOT APPLV TO AN OWNER OF � PROPERTYWFK)BU�DSORMIPRQYESTF�REOH,ANDV1ti600ESSUCHW6RKHIMSELFGIRHERSEIFOR m ('t TMNOUdI HIS OR HER OWN EMpL�YEES,PROVIOED TFIATSUCM IMPpbVEMENTS ApE NO7�NTENDED OF L}� OFFEPEDFpflSAI.EIF,HOWEYERTMEBUILOMGORIM?R04EAIENTISSfJL.DWI7HINONEVEp.ROFCOM?lE� � TqN,7}tE QWNER�BUILbEfl VtILL HAVE 74iE BURDFN OF P4tOVMG THAT NE OR SHE DiD NQF 6UilD OR � IMPRDVE FOR 1HE PURp9SE 4F SALE). � CIIASQWNEROFTNEPR6FERTY,AME%CLUS1YElYCONTAACTItN3WfTHLlCENSEDCONiRACTOftS ` � ��` �'� ADJ.AREA � LO C6NSTRUCT THE PRbJEC(�SEC.77at,BUSiN£SS ANd pROFE55i0N5 CODE',THE CVNTflACTOFS Li- V8I118ti011 CENSE LAW OC1E0 NOT APPLV TO AN OWNEFl OFA PROPERTY WHO BUIL�S OH IMPftOVES TMEREON,ANp YhqCQNTiLlGT9F6RSUGHPflOJECT5t4TCHACCNTF.ACiOH{5)4�ENSEOPURSiibPITTOTkCtX�NTRAG �'{�+ pESCR1PSION FEE � TORSIJCENSEUW.�. � Cl 1 Mi£XEMk�T ttt1DER SEC.__.. . B.R P.C.FOfl THIS REASON Q 3 — _ ��_ ¢ +a.�t� �S I'1' �ATE _.. PWNEF__..__�_._.. �—_,. ~ � � - Y l.. +�. �+ --- W - ,-c,.,,, f- , � LiCENSEQ CONTRACTOFiS DFCtARATIQN W . � _,.+ ;��' "_ ,�,,. jr i t#EREBYAfFIRAi UNDEA PENALTY Of FERJURY(i1AT t AM IICEN5E0 UNDER PROYISI�NS OF CHAPTER ur �1� �+ �_�� : � Y�CQMMENCNK3WITFISECItOM7000)OFDIVISION30F?HEBUSINES5AN6VROFESSIONSCODE,ANO Z '' 'V „ � X MY LICENSE IS 7N FULL FQRCEAND EFFECT � " �* �� t3J y"��f, � � LICENS�E+CLAS3`'!__� LIG.NO.�� , �� ' DATE T/ ! ��'�I GONTRAGTOR � d [�.� / .v _�"�..-_� � W � W0�7KER5 COMPENSATION PECLARATtON Q � � � � cn � � I HEREB AFF7RM UNCER FENhCTY OF PEFilURY ONE OF 7N'c K}iLOWiNG DEC4.ARATiONS; Z � � '/'� y r � � � i NAVE.4ND WfLL MAINiNt1AG�AFIFIGATE OF CONSENT TQ SEIf-INSURE fOfl WQRKERS' _ � i�� '1 COMPENSATION,AS PROVIDCO Bv SECTibN 3�00 OF 1 HE LABOR COCE,FOR THE PERFOqMANCE U Y ��` � ' ��v fOFTHEWORKFOHWHICHTHISPERMITI9�SSUEU. � � ,,) y\j;� iyy; W �[j ^ �jj_.I HAVF ANQ WILI MAINTAIN WC7RKER5'COMPENSATION INGJRANCE,AS REpUIREp 0Y SECTION (�� 'j(� Q /�� sTO90F TN6 k.A80R COlJE,fOfi THE PEHFORMANGE Uf THc WORN POR WHiCM THIS?ERMIS IS — � `•{{,ry {t 1 iSSUED.MY WORKERS'/'AMPENSATION INSURANCE CAHHIEfl AND P6UCY NUMBER RE: GON.�iTFUCTION +- J_L]v��,L._._� � ��4 I N�f'•. _ � • P!_AN RGVIEW _�V CARPoER � � Pa.�c��,�ER�b -l1�__�__---_— E�.EcraGc ( , '_/y` ? _ � � Q (n�uSSFcr�NErorroTaEaw�a.E�ooFnE'vEw.Tr�srr�acwEw.�Eocrxivasryiro)oa�Essa PLUMBING _.._ ' .J-.��.. -- � } — � wr �� 2 I CERIIFV YMAT IN THE PERFONMANCE OF iHE WORK FqR WHICH THI5 PERMIT IS ISSUEp,� MECHANiCAL _,,.,__iJ�'" � 4� �� f � (,� SHALL.NOT EMPLOV MVY PEFSON IN ANY MANNEH SO A5 i0 9ECOME SUBJECT TO iHE / („7 V '�/ � WORKERS'GOMFB•ISATpN tAW's Of CN.IFdRNiA,AN6AGAEE THAt IF i SFtOUID BEG6ME (NSPECT(ON FEE j �J • S SU0.IECTTOTHEV/OFiKERS'COM7ENSATIONPpOVISIONSOFSECTIQN37000fiNFlABOR �SSUANCE � (:ORE,1 SFIALL fpRTHWITM C(MAPLY WITH THOSE PqOVI51oNS. ---�------ �}, ' � DATE: I�Z.'I �C�D APPUCANT �U�� aM�� SMIP ..y. �� a ___� � ENEfiGY FJC _�. � ,J WARNING FAILURE TO 5ECUHE WORKEFS'COMVENSATION COVERAGE IS UNIAWFUL,ANp SHALL BE -- ��—""'"—i'� + LL SU&IEGT AN EMP�OYEF TO CAIMINA:.PENALTIES ANO CNI�F WES UP TQ ONE HUNORED TNOUSAN� ENERCsY PERMIT _�, _ �V� DOLI.ARS(5106,OOa},iN A66ITipN TD THE C4ST OF COF�iPENSATIQN.bAMAGF&AS PRaVIDFO FaR IN - � SECTqN 3708 OF 1HE LA90R IX]DE,INTEREST AN17 ATiI?HNEV'S FEE5. RETENTION FEE: � . ....__ Y�_f^^µ�=Y�'.Y—.. d CONSTRUC710N LENDWG AGENCY PRF-ALT FEE: ' � IHEHEBYAFFIWAUN6bRPENAl7YOFPFFUURYTHATTH'eRE4SACONSTRUCTlONlEN6INGAGENCY .___ � FOR TNE PERFORMANCE OF�HE WORK fFO(F'�WHICH THIS PERMI}T IS ISSUED(SEC.309�.CiV C � LENpEF'S NAME_,�`jfl.I.y�.__,�L ��"�-�-e%'=4-� �• "� _� � _ � CENOER5A60RE96___..,.,,__„..... ..— . --- T C `y''�+� W ECERTiFYTMAiInAVEftEPDTHiSAPPUCATqNANDSTATETFtATTHEAB�VEiNFORMATiONiSGOftftECT. TQFAL(�ES � �.�/ � � IAGHEE TO COMPLY WI7N ALL CIN AN�COUNTV ORDINANCES ANO STATE LAWS REUTIN(3 TO 6UIL�INf CANSTRUCTION,AN�HEREBY AUTHOAIZE REPRESEMTATIYES OK THIS COl1NTY TP ENTER UPON THE Z ABOVE-MENTI6NE0 FROPERTV F6RlNSGECTidN PURPOSES. cQMMENT$_,„, n �fz��'v�j.. � - m PEAMI7-FEE N�AtE RIN7) ,,/��,,, /}� - (n �� .��Z""��V[/ /��'�� i""=� .. �s-.�- '')'t'� � SI TURf OF MiTTEE baTE - , �� ( 2 RECPT.N0.��—' PAID BY �• VALIDATION_ �y._ ~ WHiTE—Departm�i Gopy,YELL4W—Finam�Copy.PINK—AssaSSOr COpy.GOL6ENRGD—File Capy,CiREEN—Appiicant's Copy �2�a��P ��'"� �e i,�:�€. '�'�a �' ';:v?�a a'° ��:��.�'�� -��;��a�„.a�:.� v ��,� ��. �.. _,� . � . � � ,,, � � � $ �'.Y��:w � , �. � � � ,.w �. , � _ _.. � _ � � . _ _ _ ,_ .. � = se 2-2—Gt � _ _ - n , f ,_ , ,. , .�r ,. � _,v , _ _ . _ � _ _� � �� -�� . � � �� „- � �, � _ � ,.. , � ' � � �_�.t ,.,r F1tE�. � . _ _� _ . ; , �� F� � ,�, , , � �� , - � _ � , , _ _ . � � �� E �� ,� .� _ � — , , . _- t-,. _ . , ._ , . . �, �� . . m _ ._ . _ �� F.r . , , , . �. e . . � . , _ � } .�,;, , � �: � - , ._ .. _ __ �__. _ _ __ _ . .. _ _ � � . � ,, , .. . � , . � _ - _.. �r—�� „�,� n _ .�_� n �, � _ __ , _ _ `�.�� -� � (,1; _.. �. „ : �� . _ _ ��`� _ _ _ ._ _ � . _ � � . , - __ : � _ . �-�� . � ., � : C . : .. .. , . ... .. �. � . . ... I. . � . . . ___... } .. .. .... . .... ..... . ...... .. ... . ....... 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E� t� ��"� �t�""'�`"" tw .. . .. ... ... .. . . . . . ... . . .. e� ^R=`" _ .< . ... .. ... -� , �� _ .... v , . . _ �x .�k w��+rq��'��; nx ... .... ... .. . .. . .�,� �.,��,,:uz ,,x . ;,�". _ ._ ... .._ . . . .. .,-.,w......,a..� ..�....._....,,.w ��.r�..w...d.,.-�.: �..-.,--..,s....._....__.... . .. ._ .. CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 BUILDING PERMIT APPLICATION Lt 9_5f-t-(ems?L An 2-A PRESS FIRMLY JOBSITE p-- '� 0� ) ADDRESS o L St x-11 t APN LT U TRACT ZZ OWNER r ADDRESS f one,iAr CITY e-111II ZIP TE 4'y- •-I APPLICANT t+__TEL. 'j iro-r+e_ CONTRACTOR !&PrAe cti I�hZ141� ADDRESS CITY ZIP TEL. ARCH/ENG/ & c/C DESIGNER* ADDRESS �� CITY S ZIP-k+-2 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).): U 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 NOTAPPLY TO AN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). o 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 FORCE AND EFFECT ly I N S C � 00. 0. LICEN E LASS 30-4:51, 1 DATE CONTRACTOR WORKERS'COMPENSATION DECLARATION I HEREB AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: 1 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 KERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBE ISSUED. MY WWOOR RR RE: / CARRIER•/'-._�I �/1'• '�� POLICY�1 tlt.lER--Z4J (THE SECTION NEED NOT BE COMPLETED OF THE PERMIT IS FOR ONE M-BORED DOLLARS(5100)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.f DATE: 2-- ! 00 APPLICANT PU 17'r.4 em e_�g 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 3700 OF THE LABOR CODE. INTEREST,AND ATTORNEY'S FEES. CONSTRUCTlON LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS ACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC. 3097,CIV.C. LENDER'S NAME P-IPti I+P LENDER'S ADDRESS I CERTIFY THAT I HAVE HEAD 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. ds PERMITTEE NAME(RINT) SI TURE OF MITTEE DATE APPLI DATE CATION NPERMIT UMB R 1 CH #/C J �' 1 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 S0. FT. FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM Garage/Carport W Patio/Deck LL PooVSpa 0 Re-Root Z IJ Commercial valuation ADJ.AREA ITY DESCRIPTION FEE e-5 L-,j, S LU Z Ir �d f� 1 r {L T-i AIL CIL '12-40 LJ�I lam(/ z rte 4 Q a-T C A i-FO CONSTRUCTION PLAN REVIEW V ELECTRIC 'n a PLUMBING f�00 MECHANICAL INSPECTION FEE ISSUANCE SMIP ,5 . ENERGY P/C I�.I ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES S COMMENTS RECPT. N0. I I. PAID BY J-J VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy