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Home My WebLink About18007 �' � CITY OF DTAMOND BAR �� I7F,PARTMF,h3T OF CONIMt.JNTTY&L3BVEL�PMENT SERVICES 21825 E.Capley Drive (409)860-3195 Fax(909)861-3117 PRESS � �'�� BtTILDING PERMIT APPLICATItJN FIRM�Y �� JOB8ITE / /+ \ APPLICATION� /L �'� �UMBER +/UCl( #,C *✓�� t.t�'-�� AdDRESS �� i ��'� VQ E�i�'v' DATE < � APN LOT TRACT ISSUE L/ TYPE OCC ��G�� U�� - DATE � �r ��- CONST. GRdUP p 4WNER � ADDRESS ' ,>-��,/��t��.,) ZONING SETBACFiS w / FRONT RW (i � CITY�ic3H*+�r Z1P.�1'_Zj�_;_> TEL.��, �� J � APPUCANT G'� r TEL. (K " r S DEtS1DE BTREET_ RW {� � q GQNTRAGTOR t'�,r""��'� �f�� "�l � _ SIDE ❑ p� ADDRESSs�i%� E•'b' � c}�IF"S � Y I j "T, PROPOSED U3E ,� p C(TY �nJ�3.l.tLi�l� Z1P --.. TEL jft��.�,. w� ARCWENG( " z DESIGNER w -- NO.DWE�, NO. NO, � ADClRESS _ UNITS STdRtES SEDROOMS � CITY ZIP TEL. cn cn DESCRIPTIOt�t SQ.FT. FACTQR PSF ADJ.ARE,4tVALUATtpt+i p� QWNER-6UILDER DECLARATION p SFWADDIREM p I HEREBV AFFIRM UNDER GENALTV Of PEPJURV 7HAT I NA EXEMPT FROM TNE CONTRACTORS LI- Gd70JB/C3Ip011 W CENSELAWFORTHEF�t.IOWWGtiEASOD1tSEG.l0.3i.58USiNE5SANORfi�FESSiONSCODEANYCITYQR (n Z GOUNTVWHICHREdUIRESAPERMITTOCANSTRUCT,ALTER,IMPROVE,�EAAOLISH,ORREPAIRANYSTRUG W P81i0/DOCk � TUflE,PRIOR TO ITS ISSUANCE.AL50 REQUIRES THE APPIICANT FOR SUCH PERMIT TO FILE A SIGNE6 W +� STATEMENT 7HAT H�ON SHE IS LtCENSED PURSttANT TO TH[PF}OV�SI6NS OF THE CpNiRACT4R5 U- LL .� CENSE LAW(CHRpTER 9(COMMENGING WI7M SEGTION 7000)pF DIVIuION 3 pF THE BUSINESS ANO PRO- POOUSp2 � GESStONSWDE)ORTHATHEdftSHEiSfXEMPT7'NEREPROMAN07NEeASISFORTHEAIIEGEDEXEMP- (� � T�ON.ANVVIOLATIONOFSEC716N7U3�.58YANYA>PL�CANTFOHAPERMiTSJ&(EGTSTHEAPPLICANTiO Z Re•Rooi � A qVIL GENALTY OF NOT MOFE THAN FIVE HUNDRED DOLLARS(5500).): � I�I.ASOWNEROFTHEPROPERTY,bRMYEMP�OYEESV+"I7NWA�ESAS7'HEIRSOtECOMPENSA(KJN, GOITSRf8lGi8) WILI DO TME WORK,AND THE STRUCTURE IS NOT INiEN�ED OR OFFERED FOR SALE(SEC.7tla4,BUSf� � � NESS AND PROFESSIONS CODE:TME CONTRACTOFS LICENSE LAW DqES NOT APPLV TO AN OWNER OF � � PftOPEftTY Y{MO 6UItDS 6R IMPROYE5 THEREON,AN4 WNO DOES SUCH WORK HIMSELF Ofl HERSf�F OR � THROUGHHISORNEROWNEMPLOYEES,PflOVIDEDTHATSUCHIMPROVEMENTSApEN071NTENC1F00F m � O'rfEREDWR5ALE1G.MqWEYER,TNE&11LpMGORIMPRdVEMENTI550LDW1iHWONEVEARO�COMPLE� Z T'AN,TNE OWNER�BUILDER Will HAVE THE BURpEN OF PROYMG THAT H£OR SI�iE OiD NOT BUIL6 OR = IMPRpVE FOR TM�PUFPOSE DF SALE). W CII,AS�WNEROFTN£PfiOPERTY,AMEXCLUSiVELYGOMflRCTiNGWfTHL.GENSEDCONTRACTQfiS � TO C4NSTRVCT THE PFtlJECT(SEC.7044.aIISINESS AND PRpFESS�ONS�DE'.THE GONTRACTORS tt- VBIVfl�l011 ADJ.AREA W CENSEUlW00E5NOTAPPLVTOANOWNEROFAPFOPERTYWHOBUIlDSpRIMPROVESTHEREON,ANO � WiiOCONiRACTSF6flSUCHPflOJEC75WiTNACOtrTftACTOFi(S}LICENSEDPURSUA.YT707HcCQNiRAC- Q(JAN-(��(Y DESGRIPTlON FEE � ToqS LICENSE LAW.). Q 'J i AM EXEMPT UNDER SEG.__, __8.8 P.C.FOR T4iiS RfASON Q � U � -_..-._ CL OATE_ _OWNER__„__ _ U Z W � L�CENSED CONTFIAG70RS DEGtRRATiON w ¢ � fL t H�ftEBY AFFtRlA UN6Efl PEt3AtTY OF�EFJURY iHAT 4 AM t ICFNSED UND£R PROV4S14NS OF CHAPTER � d 9(GqMMEMCING WITH SECTION]000�OF OIVISION 30F TNE BUSINE53 AND pROFESSIONS CO�E.ANO Z X MY UCENSE IS fN WLL FOflCE AND E\FFECT. � LIC[NSE CIASS� S �" �`� L.IC.NO._�'�[._ �+ } ... � U DATE CONTRACTOR�,�,.��,_ ;'ti"'� o`' '� �y a. W �^ � WORKERS'CQMPENSATION DECLARATION d � I4IEREBY AFFIAM UNDEfl PENAl1'QF PERJVRY ONE OFTHE F{3lLOWiNG DECIARATKJNS: Z Z ,i NAVEAND W�Lt MAMTAIfJACERT:fiCATE OF G(7NSENT i4 SELFINSUftE FOR WORKEHS' ¢ _ Q CqMPENGRTION,ASPROVipEDBvSECTION3�DOOFTHELABORCO�E.FOfliHEPERFORMANCE W � OF THE WOflN FOR WNICH TNIS PERMIT IE ISSUED. � QW ��.I HAVE AND WILL MAWTAIN WORKERS'COMPEN9A'ION INSURANGE,AS REQUIREp BV SECTION 'y' /� 3TPti 4FTHE LAHOft CADE.FOfl THfi PERFORMANCE C}F THE WOP,K FQR WHIGH TH15 FERMiT IS �� .��f I ( -C' � 1SSI�ED.MV WORKER5'COMpENSATION INSUPANCE CARRIER AND POLICY NUMBERAflE: CONSTRUCT{ON _ � + ��j�`�� jJ ' __� cbaaiefl ��ct�L-� � .__.._� P�AN REViEW ' / ��_— zPOUCV NUMBER � %1:+__�_.... . ELEC�RIC ¢ Q (rHISSEC'f10NNEmNC7TBECUFAPLEfED(k�THEPERMfT15FORQNEHUVpREDDOUARu�5100)ORLfSS). PLUMBING _._,,, , W Z I C[RTIFV THAT W TFIE PERFORVAANCE Of THE WORK FOP,WHICHI"NIS PERMIT IS ISSUED,1 MECHANICAI. .�_ ,_ ,__ ('3 SHALL NOT EMPLOY ANY PEpSON IN ANV MANNER 50 AS TO 9ECQME SUSJECT 70 THE Uj WbRKERS'COMPElJSATK3NLAWSOFCALiFORN;A,AN GREETH4fSFISHOi7LD8ECOME ��SPEGTIONFEE ,_ = SUBJEGT TO THE WORKER$'COMP�NSAI'ION PROVI O SECTION 3]Da OF TNE LABOF � �� GOOE.ISHALL�QRTH�}WITHCOMPl,YW1THTM $EP I �SSUANGE -��-��•- p OA7E: '��4" "L'4��APPLICANT: _. SMIP ^ ..,� 'i'� J WARNING:FAILURETO SEW%E WORKERS'GOM SATION C E IS U TAWFUL AND SHALLBE ENERGY PJC _ LL SUBJECTAN EMPLOYEfl TO CRIMINAI PENAITIEu ANO GVI�FI S UP ONE HUNDFEO THOUSAN� ENERGY PERMIT DOLLARS(St00.000j,MADUiTiONTOTHECOSTpPCOMPENS 14N,DAMAGESASPROV16E6FORIN - ...�_ � SEC710N3)OBOFTHELABORCODL,INTEREST,qNDATTpRNEY'SFEES. RETENTIONFEE: �, �-� a CONSTRUCTIpN LENDINC�AGENCY PFIE-ALT FEE: O � IHEREBYAFFIRMUND[PPENAtTYqFPERIURVTi+ATiNEREISAC6M5TRUCTiONLEN6INGAGFNCY �__ ,_ FOR THE PERFOHMANCE OFTHE WOPH FOR WHICH TIV16 GERMIT IS ISSUED(SEC,3041.CIV.C.). Z w _ � lENOER'SNAME_....... _....... ..-._ _...__� F-- LFNOER'SADDRESS ' � � Tt�TAL FEES ' � � iCERiiFYTHALiriAYEREAQTHiSAPPIiCAT{ONANDSTAiETHATTHEA3QVFiNFOF�,tATIONiSCpftREC7. w IAGREETDI:OMGLYWITMALLCITYANDCOUNTYOfiDINANCESANDSTATELAWSRELATINGTOBUILDING d � CONSTRUCTION,ANDHERE&YAUTNORIZEREPRESENTATIYEGOFTHISCDUNTY70EN7ERUPdNTH� � /\/ �j /' Z ABOVE-MEMIONE�PROP�RI'YFOHtM1SPECTiONPtiRPU5E5. „��lJ(,lry� �,.lL,o_.._�`� _ Q COMMENTS � � -..—.. -- -- �-- � .. ..�..— m PFRAAITTF.ENAME{PHINT} Q (f} _ _._... _�._ _ . .�.. Uj SIQNATUftEOF@EFlRiiT.`EE DATE = RECPT.IQO.- PA1D BY _,,. �VALIDATION ~ WHtTE-6e artment C p opy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENR6Q-File Copy,GREEN—App{icant's Capy �, �� ,��f.� �� . �� m�� a � �� -a.,��a� �--��`=—,�s�Gl` : G �� ! �'Z:��[J � _ _ � _ _ , ��,�� . �_ � �ms o�,��sa.E �� _ _ _ _ _ . _ _ , �� ; � � _ _ � � � � � �� `�� . s � � �� r�� t*—�� r � �✓r,�s� ��'��a��; r�`. w"'�,7 ,r� m . � - T �k M �p : �g`fB�� Y � � .- .' 4� `�� - . . ... ... ... . . ...... ._ _. ... . . . .... � i � i� �g4 _ ' ,�� .. . . ... ��} ��4"��F-L l��ev�� .. } _� V b��r � ¢� ��+pg 3,': .. ..... . .... . . .. .. . ..... _.. _ .. .. .. .. ... .. � �t++$. �' u"'`�•. ��: .. �.�'a � �',+rv' . = _ � . . .. . . .. . .. . ..... . . . .... ... . ..... . . � � . l9 �� .. IP 2 t �. . .. .. . ... . . . . �� 1.�, �p . » . .. .. ... .... ... .. . . . . . . . . .. ... .. . .. .._ . .. . 3�6��i,� p�.�x . � ,. . CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION E 76" A DDRE ADDRESS SS LOT_TRACT_ OWNER A'-0(1 Otl ADDRESS ��-y CITYPi.,T+_ZIP T"�'!)TEL. APPLICANT C'r TEL (X7 1} CONTRACTOR%�� C{1/" (1L�S("cA�,/I1� . ADDRESSaC� CITY f_)Qjj 1 ZIP 1-75"TEL./GI{'/"iYY.J 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 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.). I AM EXEMPT UNDER SEC. B a 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 T. MY LICENSE IS IN FULL FORCE AND EFFE C 7/ JI � � LICENSE CLASS ^ LTC. N0. (({ DATE CONTRACTOR 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 E CARRIER AND POLICY NUMB ER ARE ISSUED. MY WORKS S'COMPENSATION INSURANC I 2f I r CARRIER POLICY NUMBER (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.AN GREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS'COMPENSATION PROVI 0 SECTlON 3700 OF THE LABOR CODE. I SHALL FORTHWITH COMPLY WITH TH SE P I ICANT S)-_4^7-C�Z"APP DATE: L WARNING: FAILURE TO SECURE WORKERS'COM SATION C E IS U LAWFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FI SUP ONE HUNDRED THOUSAND DOLLARS($100,000),IN ADDITION TO THE COST OF COMPENS ION, 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 15 ISSUED(SEC. 3097, DIV.C.). LENDER'S NAME 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 INSPECTION PURPOSES. PERMITTEE NAME(PRINT) SIGNATURE OFPERMITTEE DATE APPLICATION PERMIT/� DATE�6 L (/NUMBER 7 #IC�f ISSUE TYPE OCC / t DATE ---CONST. GROUP ZONING SETBACKS FRONT RW ^ REAR ^ SIDE/SIDE STREET RW ^ SIDE ^ PROPOSED USE PATf C) N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM Garage/Carport W Patio/Deck LL Pooi/Spa Z Re-Root 0 Commercial Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U CL t- U w J W Z 19 IL U 2 U W T CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES �� O- $ -oc2 COMMENTS " RECPT N0. - PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy