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Home My WebLink About17908 CiTY OF DIAMOND BAR � 1�� DEPARTMEI+IT OF CQMNIUNITY&DEVELOPMENT SERVICES __ _ .� 1 1 21825 E.Copley 1)rive (909)860-3195 Fax(9U9)861-31t7 PRESS BUILDING PERMiT APPLICATION FIRMLY � JQSSlTE � { � j f`(`�L.� �_(LJ L— Q ADDRESS�'� � y.-. APPLICATION��-""� �� RERMIT P/C o — - ----- pATE_ ._ NUMBER,_F_,_._ # °'° APN_.. LOT �ACT �_._ dA E j"1 G�",� TYPE OCC p OWNER "��17K � ^ CdNST. GROUP ��.�..--- o ADDRESS�' ' r � , ZONING SETBACKS z CITY Dv;'iewu.'� `1�reY- Z _� ' �' TEL. � .`"j i > FRONT _. RW ❑` � APPLICANT � TEL. REAR �_a z� SlQEiSiDE STREET RW ❑ $ CONTRACTQR_ SIpE � ADDRESS ty � C1TY _, ZIP TEL PROPOSED USE �V " � . w ARCH/ENG/ �► -' " _ ,�' L"" z DESIGNER ��-- �C�'��" � w — N0.DWEL. " NO. � NO. � ADDRESS_._� � G' � GlTY - ZtP_ � " �L. •. f �1�ITS STQRIES _BEDROOMS � dESCRIPTI4N SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR1ADp(REM O p i HER60Y AFFIRM VMDER PENALTV OF PER.f.IPY THAT�qM EXEMVT FROM THE CONTRACTqRS LI- G2fa9B/Cefppll W CENSEUWFOR'fHEFOI.LOWINGREASON(SEC.703i.5BUSINESSAM1�PROFESSIONSCODE:ANYCI7YOR (J� C1 GOUNTYWHIGiRE�UiftESAPERMiTT4CONSTRUCTAtTEftIMiPR6VE,�EidO!ISH,ORREPAIftANYSTRUC� W 7VflE,PRqq TO ITS ISSUANCE,ALSO REOUIRES THF APPLICANT FOR SUCH PERMIT TO FILE A SIGNEp W Patio/Deck .� SiATEMENT THAT HE Ofl!iHE!S UCENSE�FUASUANT t0 THE PRoviuloNS QF THE GONTRAGTOHS li� � +� CENSE lAW(CHAPTE#19(t'AFaMENdNG WITH SECTI6N 7006}OF DIV�SION 3 OF TME BL'SMESS ANO PRO� POOUSpO Q FESSIONSCADE�ORTHA7HEORSHEI5E%EMPTTNEREFROMAN�THEBASISFORIHEALI.EGEDEXEMP- (� U TlON.ANYVlOLATIONOFSLCTION743'.58YANYAFP�IGANTFOf}APERMITSUBJECTSTfiEAPPi1CANTiO Z Re-ROO{ � A qVil PENALTY OF NOT MORE THAN iIVE NUNORE6 DOI.LAHS(5500).)�. � C71,ASOWNEROFTHGPR4PERTY,ORMVEMPLOVEESWITHWAGESASTHEIRSOLEC.OMPENSATION, � COtTitii$(Ci3( � V1iLl b0 THG W4RK,AN4'HE STRUCTURE IS NO'INTENDED bN 4FFEREO FOR 5ACE i$E�.�od4,BU:a� J � NESS AND PROFESSION5 I:OOE:THE CONTRACTORS LICENSE LAW�OES NOT APPLV TO AN OWNER OF � PqOPERTY WHO BUIL�S Oli IMPROVES THEFEON,AND NM�0065 SUCH WOflK HIMSELF Oft HERSELF OR � TtiftWGtiNISORNEROWNEMPtOYEES.PqQVi6£Q7NATgUCH�MPROVEMENTSAR[NOTWTENDEDOP � � "' 0 OFFENEDFORSALE.IF,HCIVVEVER.hiEBUIL�MGORIMPROVEMENTISSplDW17HINONEYEAROFCOMPLE� �y TION,THE OWNER�BUILDER WILL HAVE THE BUADEN O'r PROViNG TNAT HE OR SHE DtD NpT BUI�f3 OR = IMPROVE FbR TNE PURPC}SE OF SALE}. ❑I,AS OWNEfl OG THL=PROPERiv,AM EXCLU51VELv CONTRqCTING WiTH IiCENSED CANTRACTORS � TO CbNSTAUCT TNE PROJECT{SEC.76C4,$USINESS AN6 PflOFE5510NS CODE FHE tbVTRACTORS ll� V81UBYi0t1 "�`` �""} ADJ.AREA LL1 CENSE LAW DOES NOTAPPLV TOAN OWNER Of q PROPERfV WHD BUILDS OR IMPRpVES THFRE4N,ANb '` — � WHOCANTRACTSFORSVCHPqdJECTSWITHACONTRAC70R(5)LICENSEDPUfISUANTTOTNECONTRAC�� QUAI*ITITY DESCRIPTION Y, TORSIiCENSEIAW.). FE� � f7 I AM EXEMPT UNDEI�SEG.__. _,,, B.8 PC.FOfl TNIS REASON Q � U � ___ +� OATE "� -'�� „_GriNER r_ „ F— O �• _— W � �VCENSED C4N7RACTORS DECIAftR ION W 4 CL I MERE6YAFFIRM UNDER PFNALTY OF PERJU%V TNAT I AM LICENSED UNDER PROVI510NS OF CI-APTEFI � d, 8{GOMMENCIP3GWITHSECTION?OQO)pFDtVISION'sQFTHEBtlSINESSANOPROFESSION£CODE,AND Z � MY LICENSE IS IN FULL FORCE AND EFFECT m " � UCENSECLASS _ LIC.NO..�_. _ � � OATE CpNTRACTflR....—.,.� ,_ a W � WC)RKERS'C4MPENSA7lON DECIARATION a � !NEREBY AFFIRM UNOER PENALTV oF PERJURV ONE OF t4E fOLLOW1NG DECI.ARATlCNS_ Z � I HAVE ANO WILL MA'NTAIN A CERTIFIGATE OF CONSENT TO SELF�INSURE FOR WOqKERS' _ � `yC9MPEtiSATiON,ASPrl6ViDE08YSEGT10P787000FTHElA66RC40E,FORTHEPERFORMANCE U � OF THE WOflK FDR WHICH THIS PERMIT IS ISSUEb. � � _I NAVE AND WItL kAWTA�N WQPKERS'COMPENSATION INSURANGE,AS HEQUIflED BV SECTION 4� 3�ooOFTHELABpRCO0E,F0%THEPERFORMANCEOFTNEWpRNFQqWHICHTHISPERMITIS � /"'aZ �,�� ISSUGD.MY WONKERS'GQMPENSA7lCht INSUftANCF CAflR�Eft ANO POtICY NUM6ER ARE: CONS7RUCTIQN Y'1 � " Q �'"j�� —'y4. ♦ -„ GARRIER _�, ,,.__ _ PLAN REVIEW SJ�/�,__ � POLICVNVMBER` ELECTRIC � � .�... �_ a - � (IH�SSECTKYJNEB5N�T8EOJMti.EfEDOFiHERERMTiSFGFlONEHUNDREDOIX.IpAS(5100)09LE55). PLUMBING � i GERTiFY THAT IN THE PERFORMANCE�F 7HE WORK FOR WHICH THIS FERMIT I5ISSUEO,i MECrNANICAL _ C�"S SHALLNOTEMPL9V�CryyPERSQNINiANYMANNERSOA5TO8ECOMESUBJECTTOTHE �� '— (,n WOFKERS'COMPENSATIONLAWSOFCALIFOftNIA,ANDAf�ftEETHATIFISHOULDBEGOME INSPECTIONFEG i � SU&lECT TO THE N7flRKEflS'CAMPENSATION PROVISlONS OF&ECTION a10o OF THE LABUft ..�— COOE.I SHALL FOil'iHW17H COMPLV WITH TNOSE PROVISIONS. ISSUANCE � � _ _ p DATE: _ APPLICANT: ^ �SMIP ___,1_ J WARNING:FAitUAETOSECUREWOftKER5COMPEIVSATt�NCOVERAGEiSUM.AWfU1.,AN'3SNAlLOE ENERGYP/C , �_ W 5UBJECTANEMPLOYERTQCRIMINAIPENALTIESANDCIVILFlNESUPTOONEHUNDREDTHOUSANp ENERGYPERMIT DOlLAfl5(51170.OW).IN AUU�110N TO THE COST C1f CQMPENSATpN.OAMAGES AS PRpVIDED F�R IN -.....—... � SECTiON3Td8dFTHELA00RCORE,iNTEAEST,ANDATTORNEY'SFEES. RETENTIONFEE: � CONSTRUGTION LEN6tNG AGENCY PRE•ALT FEE: _..� , � IHEPEBVAFF�RMUNDERpE�ALTY�FPERJURVTHATTHERE1SACt�NSTRUCTIONL[NDINGAGENCY _ fOft 7HE PERFORMANCE OF�:NE WORK FOR WHICH TH�S PERM�T IS ISSUEO(SEC.3097,CIV C.). �� W —, — S� l.ENDEN'S MAME�"`_....._... ...._ I .�r _— � _ }^ LEMDEH`SADORE55 .. � '—"—_ ... . � TC�TAL FEES {�� I GERTIFV THAT I HAVE ftEAO THISAPPLICATIONAYO STATE'fNAT TNE A84VE INfCTRMATIQN 1 i CQPRECL �, \{ � i AGREE 70 COMPLV WITH A71 CITY AND Cc�UNTY OR6MANCES AND SiATE IAWS RELATiNG 70 BUILDiNG � � � CONSTRUCTIQN.AND HEREB�'AUTHORIZF REPRESENTATIVkS OF iH15 COVNTY TO ENTER UPON 7HE f�� "��f"l� ,�. � ABQVE�MENT14NEDPROPE9TYFOAINSPECTKtNPUt1pO5ES. COMMENTS_,D�I..iV�� V P l ��" O ti"" � �j�� -� _ � '} �Y't' �i2D '�i_'_��,,�_:_"~ � � � PERMITTFENAME(PRINT) � t � ,_—�_.--_ar�r��I�^ �� - ._..... � r _. __.—_— —._. .. � gIGNATUREOFPEFMITTEE DAT u � = RECPT.�O.� PAID 6Y „ ALIQATION_,,,,,, ~ WHITE—DeAartment C�py.YELLOW—Fina�ce Copy,PlNK—Assessar Gopy,GOLDENFiOD--File Capy,GREEN—ApplicanYs Capy � �� ; � ° �� , �= � � . � �� r � '��. N �� -a�:�,� ��, � � � �� _� � � _ � _� ._ � ��.�� s : � a�� _ _ _ �� s�� ,;�� P�� ;��a�� ° _ ��;��,� �� ,� '� ��"'��'� �� a�'� _ _ � � ��v��',��-� ��: � �, � , �� Rr-�� r . ....... .. .... . . . .... . . . ... . .... .. . . .. . ... .. . . ... . .. ��.. ��`� '� 94��SZ ar��'��+,'"��.,�s��' 'r �t r � �� .: . . . .. .. . .. . . ... .. .. . .. . , � t�„�i§ � � ��,' ;�? �§x w� � � E y � � � ,r �,�; a :r d �-r';`°' .. _ .r,a , s r ; ti . . . ... . . . .... .. . . ...... . . .......... . . ......._ .. _ . .. . .. .. F _ � .� � �� x��. ;� � k + � �� ;. �. �:. i ;33'? i F'�-sS�, '� �'k .:`.. .. . ';n. ?`.... .. ;� _ .. ... . .. . .... . . ...... . .. . .... ... .. .. . . . .. .. .... ... ... ._ . .. .. .. . .. . .. CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION I ADDRESS-'f APN LOT JB CT OWNER ADDRESS i�; CITY Z'TEL. APPLICANT TEL. CONTRACTOR ADDRESS CITY ZIP TEL. ARCH/ENG/ DESIGNER FO ADDRESS CITY ZIP TEL. -A i 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).): D I,AS OWNER OF THE_PROPERTY,OR MY EMPLOYEES WITH WAG ES AS THEIR SOLE COMPENSATION, WILL DO THE WORK,AND'HE 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 I,AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC. 7044, BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TORN 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.). ^ I AM EXEMPT UNDER SEC. B. &P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARAfION 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 MANTAIN 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 37000F THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: 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,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. 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 A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OFi HE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC. 3097,CIV C.). LENDER'S NAME LENDER'S ADDRESS I CERTIFY THAT I HAVE READ T HIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT 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)-��-, /, 1 - �II{ SIGNATURE OF PERMITTEE DAT WHITE-Department Copy,YELLOW-Finance Copy, PIN F PRESS FIRMLY APPLICATION PERMIT C�P/C 1 00 0 DATE NUMBER/ # 1 v� ISSUE TYPE OCC 4 DATE I CONST.GROUP ZONING SETBACKS FRONT RW^ REAR EI SIDE/SIDE STREET RW^ SIDE^ PROPOSED USE fkg Ali N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREAIVALUATION SFR/ADD/REM U) Garage/Carport LU Patio/Deck LL PooVSpa 0 Re-Roof Z Commercial CO Valuation I�ADJ.AREA QUANTITY DESCRIPTION FEE J 0 'IF I'- 0 W -J U 2 J EL 0 U Z 2 U W CONSTRUCTION 5d Ao y PLAN REVIEW 3 ! ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES I�� / I(� cop k i COMMENTSD 1 V iy T;�r r b 1) �'-2 'A-7 fA RECPT N0. In 7 PAID BY ALIDATION