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Home My WebLink About17523 � CITY OF DIAMOND BAR � DEPARTMENT OF COIvIIv1UNITY�DEVELOPMENT SERVICES �� 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 PRESS �� BUILDING PERMIT APPLICATION FIRMLY � JOBSITE y� C,� � � '� � � APPLICATION �� Zj �1 I PERMIT �-� `�-�PlC/1I _IJ/� o ADDRESS__.��"�� ` �1 1n(`y DATE G' � NUMBER J y,x�_!`�' 1 � — ISSUE/�_�7_�/ ONST. GROUP APN I�OT TRACT DATE p OWNER G;�;�L�l`�ls �:.�h=�"-e " ADDRE S�3 2-�:: �/A�LL-k"S-� >�S'i✓�' p'�" ZONING SETBACKS � i ' � FRONT RW ❑ o CITY i .1 . �-�/� iL ZIP��1 TEL.�'�6�-7,`�l-.�':1:�, APPI.ICANT _ TEL. REAR ❑ z SIDE/SIDE STREET RW ❑______ m CONTRACTOR_ �� OU%N�%�t'� SIDE ❑ ¢ ADDRESS .��=F A��'.��'' " °� PROPOSED USE S '\y � �l-`l= �'� :; �iJ' �,,`� \ � , n•� . o CITY ZIP TEL. - T7 Y� t T + e�-� 'rl i6' `W,1�� w ARCH/ENG/ f� � � � k' i-(-!(i�=�" z DESIGNER --��=v � "''"- � a ADDRESS �.('! kf 't iGif � � NO.DWEL. + NO. NO. ' �' ' � �� `"s UNITS l STORIES BEDROOMS � CITY �l2V t N(�Ci ZIP�� TEL.�4�i'-�1�%I�j��J � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BIJIL�ER DECLARATION SFR/ADD/REM i� I�� •��✓ O � I HEREBV AFFIRM UNOER PENALTY OF PERJUFY THAT i AM E%EMPT FfiOM THE CONTftACTORS LI� � GaragefCarport �-"� W CENSELAWFOHTHEFOLLOWINGflEASON(SEC.7031.50USMESSAN�PROFESSIONSCODE:ANVqTYOR U COUNTVWHICHRE�UIflEuAPERMITTOCONSTRUCT,ALTER,IMPROVE,D'eMOUSH,ORRE�AIRANYSTRUC- W pat10/DBCk �'�� WTl1FE,PRIOR TO ITS ISSUANCE.AL50 RE�UIRES THE APPLICANT FOR SUCH PERMIT TO FlLE A SIGNE� W � STATEMENT THAT HE OR SHE IS LICENSED PURSUAN7 TO THE PROVISIONS OF THE CONTRACTORS LI- � CENSE UW(CHA�TER 9(COMIAENCING WITN SECTION]000)OF�IVISION 3OF THE B1151NE55 AND PRO� � POOUSPB O FESSIONSCODE)ORTHAI'HEORSHEISEXEMPTThEREFROMANDTHEBAS�SFORTHEALLEGEDEXEMP� � — V TION.ANV VIOLATION OF SECTION 7031.5 BV ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO Z Re-Roof � A CIVIL PENALTY OF NOT IAOflE TMAN FIVE HUNDFED DOILAFiS(f500�.): Q ❑I,ASOWNEFOFThEPROPERTY,OflMYEMPLOYEESWITNWAGESASTMEIfl50LECOMPENSATION, � CORIf710fC18I Z WILL DO THE WORN,AND THE STRUCTURE IS NOT INTENDED OR OFfEFED FOR SALE�SEG.7044,BU51� J NESS AND PROFESSIONS CAOE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF � PROPERTVWHOBUILOSORIMPROVESTHEFEON,ANDWHODOESSUCHWORKHIMSELFOFHERSELFOR m � THROUGH HIS OR HER ONIN EMPIOYEES.PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTEN�ED OR �j�� w OFFEREDFORSALEIF,HOWEVERTi'�E9UIL�INGORIMPROVEMENTISSOLDWITHINONEYEAROfCOMPLE� L� � TION,THE OWNER-BUILDGR WILL HAVE THE BURDEN OF PROVING TNA7 HE OR SHE DI�NOT PUIL�OR Z IMPROVEFORTHEPURPOSEOFSALE). � :71,�SOWNEROFTHEPROPERTY,AME%CLUSNELVCONTRACTINGWITHUCENSEDCONTRACTORS QTO CANSTRUCT TME PROJECT(SEG.7041,BUSINESS AND PROFESSIONS CODE:THE CONTfiACTORS LI- V81l1BIlOf1 ADJ.AREA W CENSELAWOOESNOTRPPLYTOANOYINEROFAPROPERTVWHOBUILDSORIMPROVESTHEREON,AND = WFpCONTRACTSFORSUCHPRQIECTSWITHAGONTRACTOR(S�LICENSEOPURSUANTTOTHECONTRAG QUANTITY ESCRIPTION FEE ~ TORS LICENSE LAW). Y J Q ❑I AM E%EM7T UNOER SEC. &IP.C.FON T f5 REASON � �i --- � � OATE OWNER U Z . W . � I_ICENSED CONTRACTORS DECLARh'FION —� � I HEFEBYAFFIRM UNOER PENALTV OF PERJUFV THAT I AM LICENSED UNOEH PROVI5lON50F GHAPTER d 9(COMMENqNG WITH SECTION 7000)OF D'.VISION 3 OF THE BUSINE55 AND PROFESSIONS CODE,AND `X MV LICENSE IS IN FULL FORCE AN�EFFECT — � LICENSE CLA55_ LIG.NO. � J U DATE CON7HACTOR W � WORKEfiS'COMPENSATION DECLARATION � � � I HEREBY AFFIRM UNDER PENALTV OF PERIURY ONE OF THF FOLLOWING OECLARATIONS: (� Q 0 IHAVEAN�WILLMPINTAINACEFT�IFlCATEOFCONSENTTOSELF-INSUREFORW KE S CAMPENSATION,AS PROVIDED BV SECTION J70o OF THE LABOR GODE.FOR T E R�O NGE U Q OFTHE WORK FOR WF11CH THIS PERMIT IS ISSUE�. � 0 w I HAVEAND WILLMAINTAIN WORHERS'COMPENSATION INSURANCE,AS R U D BV CTION Q9]OOOF iHE LA6JR CADE,FOR THE PEFFORMANCE OF THE WOftK FOR HICH IS P IT I � " 5� ISSUED.MV WORNERS'COMPENSATION INSURANGE CARFIER AND PO Y UM Re: CONSTRUCTION ��..��,—, �,,—��--y��j�� j CARFIER PLAN REVIEW 1�.J4`'•lY 1�1 —1 h• 7 Z POLICY NUMBER ELECTRIC Q Q (iHISSECTIONNEIDNOTBENMPLEfEDOFTHEPERMfTISWRCNEHJNDRED0011AAS( o)ORLESS)_ PLUMBING _._._ w I CERTIFV THAT IIV THE PEFFORMANCt OF THE WORK FOR WHIGM THIS PERMIT IS ISSUEC,1 MECHANICAL Z C} SHALL NOT EMPI.OV ANY PERSON IN ANV MANNER SO AS TO BEGOME SUBJEGT To THE � WOflKERS'COMPENSATION LAWS OF CAl1=0RNIA,AND AGREE THAT IF I SHOULO BECOME INSPECTION FEE Sl1BJECT TD THF WORKERS'CAMPENSATION PROVISIONS OF SECTION 3700 OF THE L480R ~ COOE.I SHALI FOqTHWITH COMPLV WITH THOSE PROVISIONS. ISSUANCE -.. - � � SMIP i'�!' �,. .. � - / � DATE: _ APPLICANT _ � W ENEAGY P/C J WARNING:fAILURE TO SECURE WORKERS'COMPENSATION COVEHAGE IS UNLAWFUL,AND SHALL BE - J SUBJECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND f � f� � � �� ENEFGY PERMIT � DOLLARS�f�oo,000),IN e.DD�TiON 70THE cOSTOFCDMPFNSATION.�AMAGESAS PROVIDED FOR IN �—�y l J SECTION 3]oeOF TIiE V�BOR CODE.WTEREST,ANDATTORNE�'S FEES. RETENTION FEE: ' v'`�,,� {T` CL , a CONSTRUCTION LENDING AGENGY pRE-ALT FEE: a`� l;� CL I HEREBV AFFIRM uNOER VENAITV OF PERJURV THAT THERE IS ACONSTRUCTION LENDING AGENCY ) ` V , n- FOR THE FERFORMANCI=OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.C.�. � Z w � I.FNDER'S NAME_ .._. ._ � F_- IENDER'SADDRE55_ � ICERTIFVTHATIHAVEP.EA�THISAPPUCATIONANDSTATETHATTHEABOVEINFORMATIONISCORRECT TOTAL FEES 1 � � r/"�� .��\ l/ W IAGREETOCOMPLYWIINALLCITVANOCOUNTYOR�INANCESAN�STATELAWSRELATINGTO8U1lDING 1� ��' S � CONSTPUCTION,ANDHEREBVAU�NOR2EREPRESENTATIVESOFTHISCIXINTVTOENTERUPONTHE , ZABOVE-MENTIONE�PROPERTV FOR INSPECTION�URPOSES. COMMENj S \ � �_ �� r,Y.�t.l � � ��' 1,r�5 � fi l''A�t �i; �t�- �i J / ¢ PEflMITTEE NAME(PRINT� `/ �? � T � �% �, Uj SIGNATUflEOFPERMIT�'EE �� - .. �ATE � �j = RECPT.�O. PAID BY VALIDATION � ~ WHITE—Departmenl Gopy,YELLOW—Finance Co PINK—Assessor Co GOLDENFOD—File Co GREEN—A IicanPs Co L�� PY. PY� PY. PP PY � _ �,�'' .�i�K�'� �a �,&�r�,"�. o � _ i � �i� �..I;. &•xi Y �(' . . . . . . . _ , �..�t.�� . (�'r . . � �i.�— . . . .. ... � i_ ' � — ,.�. .. . � a _ .. . .. � J,u�� . ._ . .. . . .. .... . ..... C ` ,�,.... . .. .. ... . .. . ... ..... ,. ��-a�- ;� .� • _ : o ��,�(� i �j�7 �2 �� , �� , ;�� „�� :�� .. . �� --. �� . . � . ., .. _ . , . �-�, ,. _ �- �x-o� ,'�.Rct:�e.-� pi�j .f,t�� c+t; sr��= 'r�—' _ # g ' h _' . . .. . . .. . . _ ... . .._ .. ._. ,. — y , a�...g y �� ff,; ,��. <, i -;�! e� �� ...�; ; .... . ... .. .. .. ... , . ; . .. ... . .... ..... .... .... ... .... ... � �t ��'�.5' _ . . � �`- ; � � : , ... ... . _.. .__ . ._._ . .._. . ...... ..... . . ... . ,,� � Eu�aA �e� LL.. r = s r � 3 � ��. 't ��t +3`.� � �€ eN„ � ...... .. _ .. .. ._.. ...... .. .. . . . . _.... . ... . .... _. .... . . . �'-.R i ' � �rv e= ... ..._ . ! " � ' ;� .: 5, . ... .. .. .. ... .. ... . . ..... . . . .. .._. .. . .... .. . .... .. .. .. ...... �� CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION PRESS FIRMLY ADDRIESS_(t?L C�tl 1/S�y 1� APN L,OT TRACT OWNER$: (L r li s-NC e .-s' ADDRESS_j2 7 ) CITY i 4 ZIP I J1110 TEL. �'k i Li APPLICANT TEL. CONTRACTOR_ ADDRESS SC A�=• CITY ZIP TEL. ARCH/ENG/ <li DESIGNER ADDRESS(('i �Cf)-I iGif�. r jt,'6 fS CITY 0-4 i v'-ZIP&1 u. i TE045-�5 %1"146 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 REPAIRANY 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 TH E 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). U 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 AP PLY 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. &IP.C. FORT REASON L 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 LICENSE CLASS LIC. 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 W KE' COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE. FORT E RFO NCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS R U D BY CTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR HIGH IS P IT I ISSUED. MV WORKERS'COMPENSATION INSURANCE CARRIER AND PO Y UM RE: CARRIER POLICY NUMBER (THIS SECTION NEEDNOT BE COMPLETED OF THE PERMIT IS FOR ONE HUNOREDDOLLARS( )ORLESS). I CERTIFY THAT III 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 SECTlON 3700 OF THE LABOR CODE,I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE: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 ACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC. 3097,CIV.C.). LENDER'S NAME LENDER'S ADDRESS CERTIFY THAT I HAVE P EAD THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE -CONSTRUCTlON ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. PERMITTEE NAME(PRINT)j .( } � (p^'/ Fj SIGNATURE OF PERMITrEE DATE APPLICATION e-1 PERMIT I] P/C D_I J DATE G�NUMBER I] '!W ISSUE TYPE OCC 14)-1 7-K�CONST GROUP DATE . ZONING SETBAC KS FRONT RW EI REAR EI SIDE/SIDE STREET RW EI SIDE Fl PROPOSED USE L Y i c, 1--, 'rP I r �'yLl 0 N0. DWEL.t N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM W Garage/Carport _-- W Patio/Deck -- u- Pool/Spa -.- 0 Z Re-Roof Commercial lub, 19 Valuation ADJ.AREA QUANTITY ESCRIPTION FEE U U V I V CON STRUCTION PLAN REVIEW '•,� b• 7 ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: I d '•'� �� PRE-ALT FEE: -fvx TOTAL FEES COMMENTS •1 RECPT. N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLUENHUU-fue L;opy, UKEL14-. V1 C v L/ 1 ,Pcz:'e„J Pi A.ti�j 4 r cW)S Ct-(=AL