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Home My WebLink About18270 1,�,,,� CI'TY dF DIAMOND BAR � 1 DEPAR'I'MEIYT OF CC}h4viUNiTX&DEVEL4PMENT SERVICF,S 21825 E.Copley Thive (909)860-3195 Fax(909)861-3117 PRESS BUILLtING PERMIT APPLICATION FIRMLY � JOBSITE ,' o> �,�,,, APPLICATION�;, PERMIT r� ��p/� ADDRESS=Z� �.�� DATE .�_NUMBER� . ! " # � =-° APN LOT_. T AC7 ISSUE �j � TYPE QCC p OWNER ` dAFE %' �� dNST. GROUP a ADpRESS ZONING SETBACKS z CITY ZIP TEL. FRQ�T RW (1 o APPLiCANT TEL._, REAR � SIdF1SfDE STREET ` RW �l � CONTRACTOR SIDE �� ADQRESS Q CITY Zlp TEL. PROPOSED U8E o — w� ARCHI6NG/ z DESlGNER NO.DWEL. Np. � ADpRESS_, NO. � GlTY ZiP TEL. �Ni�� STORlES BEDROOMS � DESCRIPTtON SQ.FT. FACTOR PSF ADJ.AREANALUATION qC (7WNER-Bl1fLDER DECLARATIQN O SFWADO(REM Q !kiERE$Y AFFlRM UNOER RENALTY OF RERJURY THAT I pM E%EMPT FROM THE CONTRACTORS LI� G&f8CJ2/CefP01t W CENSEIAWFOR?HEFOI,LOWWGREASON(SEC.�p37.5BU5WES5ANDpROFE5510NSCODE�ANVCITYOR (n � COUNTYWHICNREQUIR65APERMI7TOCONSTRUCT,AUER,IM7ft4VE.DEMOUSN,ORREPA7RANYSTAVG � W TURE,PRpp TO 175 tSSUpNCE,AL50 REQUtRES THE ApPLICANT FOR Sl1CN PERMIT TO FIIE A SIONEb w Patio/Deck � STATEMENT THAT NE OR SHE IS LICENSED PUHSUANT TO THE PF10VI.SIONS OF TH�CONTRAC70R5 U� � GENS[UW(GMRPTEfl e{COMMENC7NG WtTH SECTI6N 7(Xtay oF ONISiON a O�TtiE 4USINE55 AND PRp� � POtl�SpO p FESSIpNSGODE)ORTMAiHEORSHEISEXEMP7THEREFROMANDTHEBASISFOqTHEALI.EGEDEXEMP� (� � iION.ANVVIOLAiIONOFSECTION7031.5&YANYAPPUCAN7FORAPFRMITSU8JFG75TMEAPPLICAMTTO Z R8-ROdf � R CIY7l PENRI.TY�hlpT,y.pRE TFtAN FtVE ttUNORE6 DOLiARS(f5oo),j�. � OI,ASqWNEROFTHEPROPERTV,OFMVEMPLOYEE5WITNWAGE5A57HEIRSOLECOMPENSATION, � GOtfitil9tCi81 Z WILL 00 THE WORK,AN[7 THE STRUCTURE 15 NOT�l+7Ero�Eo oR oFFERED FOR SAtE(SEC.�a<a,eUs�. _J � NESS AN6 pRaFESSIONS COOE:TH[CANTflAC7oRS LICENSE I.AW DOES NOT APPLY TO AN OWNER OF � �+ wrj >" PROPFRTV Wlq BUILDS f}R IMP%OVES THEREON,ANO WNO DOES SUCH WORK HIMSELF OR HERSELF 03 Ct THROUGH MS OR NERDWN EMPLOYEES,PftDYtDED THA7 S�'CN IMPftOVEME��TS ARE AOT ddTENi7ED OR m ... Q6FFER60fQR5AL[.IF,HOWEVER,7HEBl11LDINGORIMPRpVEMENTISSOLDWITHINONEVEAROFCOMPLf- �, 710N,THE OWNEH�BUIL�ER WII.L HAVE THE 6URDEN OF PqOVING THAT HE(7R SHE DID NOT BUILD OR � lliPfpVEFORTHEPURP65EOFSALE}. fJ I,AS OWNER Of THE PRQPERTV,AM EXCLUSNELV rONTRACTING WITH UCENSEO COM'RACTOpS a TO CONSTRUG7 THE PRpJECT(SEC.'70da.BU5INE5S AN6 PROFESSIDMS CODE:FNE CDNTRACTURS il� VBIUfltioli ADJ.AREA W CENSEIJtWOCESNOTAFAIYTOANt]WNERpEAPROFEflfVWH66UIlDSOPiMVqOYESTHEREdN,AN6 � Nh1000NTRACTSFORSUCHPRqJECTSWITHACONTRACI4R(S�LIGENSEOPlJRSUANTTOTHECONTRAG QUAN7ITY ,�DESCRIPTION� roas ucENSE uw>. FEE 4�C O I AM E%EMPT UNDER SEC, _B.8 PC.FOR THIS REASON J � Q S �....... U .. � OATE OWNEA � � °� � UCENSED CONTRAGTORS DECLARA710N � +.~rK W � I HEREBY AFFIRM UN�ER PENALTV OF PERJU%V THAT I AM I.ICENSED UNpEfl PROVISIONS OF CHApTEF � d 8(COMMENCINGWRHSECTIONJ000)OfDtY1S�oN30FTHEeU51NES5RNDPRO'rESStONSC06E,AN0 Z 'X MV IiGFNSE tS�N FULL iOViCE AND EFFECT m ta UCENSE CtASS_. LIC.NO. � -- ... .�..�.—_� � WOATE�_. „__. CON7ftAGTOR d � WORKERS'COMPENSATION DECLARRTION � Q � I HERE@VAFKIRM UNpER PENALTY OF PERJURY ONE OFTHE FOLLQWING�ECLARATIONS: V � Z � _.�IMAVEANOWILLMAINTAINACERTIFICATEOFCANSENTTOSELF�INSUREFORWOqKEFS' ¢ S Q CAMPENSATIOM.AS PROV@EO 8Y SECTloN a7000F THE LRBOR CODE,FOft TNE PEflfORMANCE U 4F THE W�FpC FOp WHICH THiS PERMiT(5 ISSUED. W d � W T_i HAVF.A4D Will MAiNTAIN W6ftKEFi5 COMPENSATIt7t3INSURANCE.AS REdUiREO 8Y SECTION � 3�ooOF THE LABOR CODE,FOR THE PERFORMANCE OF THE WtlRK FOR WHICHTHI5 PERMI'IS � n F,,�^�� I55UEb.MY W�RKEPS'COMPENSATION INSUf?ANC[CPRP1Eft ANfJ POtiCY NUMBEftARE CONSFRUCTION ,�� Q > CARRIER _,_ , ._,,,. pLAN REVIEW �� POIICYNUMgER � �� — a ��—� -- ELECTRIC � �ssc�cnoraNFmrr3TaecaaFtt�oc�n;EpE�i�su�navEraMnaeooaa.aas�sim7oatEss�. PLUMBiNG w Z' 1 CERTIFY 7Y1AT 4N THE PERFCAMANCE OF TNE WOAK FOP,WHICH THtS PERM!i 75 ISSUED,i MEGNANI{;AL CJ SHAtI N6T EMPIOY ANV PERSON IN hNV MANNER 50 AS TO BEGOME SU&IECT TO TNE ' (%) WORKERS'COAAPENSAT14N LAWS OF CALIFORNIA,AND AGREE TNAT IF I SHOUL�BECOME 1NSPECTION FEE r F SUH./EGT 70 THE WORKEft�CCMP�NSATIOY?RflYiSiONS GF SECTlON 97�76 pF THF t180p �_i, G_1 � CODE,�SHALL FORTHWITH COMP�Y WIIHTMqSE PROVIS0.lNS. ISSUANCE a -- O q DR7E:_, ,� APPLIGANF: SM�P W J WAANlNG:FAItURE TO<_ECVRE WORlCERS'COMPENSRTioN GOVfRAGE IS UHtAWFt7C,ANO SHALL 8F ��EHCiY PIC � SUBIECTANEMPLOVERTOCRIMiNALPENALTIESANpGVILFINESUPTOONEHUNDREDTHOU5ANC1 �NERGYPERMIT DOLLAR3(f io0,000),IN ADfJITION Tp THE GOS'qF GOMPENSATION,DAMAGES AS PROVIDED FaR�N � SECTK3N S7oaqF TNE LAeQR COQE,iNTtRE57,AN6 RT70ftN'eY'S FF.ES. RETENTION FEE: � GOtJS7RUCTIOtV�ENDiNG AGEtJCY PRE-AlT FEE: ,� � I HEREBYAFFIFM UhUER PENALTV OF P[RJUM TMA7"HERE IS A CpNSTRUCTIpN LENpING AGENCV �� FOR THE PEAF4RMANGE OF THE WQRK=0R WHICH TM�S AEHMIT i$I55l;£D{SEC.3097,pV G.}. "' " - � �� z w � � IENQEft'S NAME .....__.�.... ._.... . .. 1—� LF.NDER'SA�DRE55 �� I [�^ ['� r, � 7 1 W ICERTIFYiHATIHAVEPEPp7NISAPPLICATIONANDSTATETNAiTHF.ABQVEMFOqMATIQNISCORRFCT TOTAt FGE4'i � t; �J �^� �—� �� y p_ IAGftEE TO COMPLY W;Ttt A(,�CI'Y AND GC?uNtY OftD7NPNCkS AND STATE tAW5 RE�ATING Tq BNIbiNG u �' 1� � CONSTRUCTiO4,AND HEREUY AUTHORIZE REPRESENTATIVES OF THIS COUN7V TO ENTFR UpON THE Z a6bVE-MENTIONED PqOPERTY FOR INSPEGTION PURPOS[S. � /+� �� C6MMENTS_ „�,_,. J �fh ——_ � . . ._ �_�_. _,_— � PERMITTEE M1AME(PRINT) . .. ..—.. .. .........— . Q ._...... ___ � ...� � — _.._... ..... _.. � � SIGNATUREOFPERMITTEE OATE ' � � pECPT.h�q. PAID 8Y ;�...... � 1 _VALIDATION �T� � � WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOL ENROD—File Copy,GR,EEN—AppiicanYs Copy { r� u Fa �� ,; . ;�� . . r „ �`�� - �4 � � . . . . . . , 9/� ,�� _.. . . . . .. .... .. . .. � . . . ..� Y_-�Y'- 7 ,4� y . . . .. . .. .. .. . � ...... . .. . ... ... . ..... . .. _ , .. _ . .. . .. _ . . .: . ' .,,,�€ �a�� .... �.... .. �. . .. _ . .. .. .... .. �,r= w��i ,�,�a.cr.� 9'� ge'�t�- �.c-�� /�s2 P�-d�v i-y-t��..� _ _ _; _ � � ,:. � � � � � �� - . , � �� . ��, , _ � � � � � -� � � ��.,,��'� �; "��`��;� �'� _ �� _ _ , , a��3��'� �a� a��;�, � s ,:� � i 1 . '.,� _. _ ... . .. �- � ,�` r �§��r�`s ��._„� .. .. . .... . . . . .. .. . . . . .. . . . s � bi� ;' �, �. ,�. w f, �x � �- �: .... .. .. ._. .. . . ... . . .. . - fi'-,t„a,-�k ,�, ,�,� �� 3 .. . _ . . . . . _ — �� ; � "� i, � �: .. .. . .. .. ... .. . .. . i s��i �� ' � � +� ` "�. ' P t '�?�r�, � � ; " ; '�� _ �'- n _ _ �ya E� � �� .,; , ��z�d� � v _—.-�� , �mN��'.� �y .�r: _ _ �� _ _ — �_ — — JOBSITE ADDRESS-r APN LOT TACT OWNER ADDRESS CITY la^PWA E32*--ZIP TEL. APPLICANT TEL. CONTRACTOR ADDRESS CITY ZIP TEL. 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 REQUIRESA 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 ANYAPPLICANT 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 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.). 0 I AM EXEMPT UNDER SEC. B. &PC. FOR THIS REASON -'w oe 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 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'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER POLICY NUMBER (THIS SECTION NEED NOT BE COMPLETED OF THE PERMIT IS FOR ONE HUNDRED 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. DATE:APPLICANT. WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE SUBJECTAN 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 3709 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 LENDER'S ADDRESS 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 INSPECTION PURPOSES. PERMITTEE NAME(PRINT) SIGNATURE OF PERMITTEE DATE III 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 APPLICATION. PERMIT P/C I' DATE NUMBER # ISSUE jy!'7 TYPE OCC DATE(! L'-' CONST. GROUP ZONING SETBACKS FRONT RW ^ REAR ^ SIDE/SIDE STREET RW ^ SIDE ^ PROPOSED USE N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM Garage/Carport W Patio/Deck LLI Pool/Spa 0 Re-Roof Z 0 Commercial 1 j CO Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U U w W Z CE) J CL Q Z 0 LU CONSTRUCTION 1 2 0. r� PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE r SMIP p ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES 1 (; .� JU COMMENTS RECPT N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy