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Home My WebLink About17544 CTTY OF DIAMOND BAR �-. ' �y, � �` DEPARTMENT OF COIvIl�tUNITY&DEVELOPMENT SERVICES ��'rJ� i � � __ 21825 E.Copley Drive ` (909)860-3195 Fax(909)861-3117 PRESS `-.��^ BUILDING PERMIT APPLICATION —� �f,�' 1, FIRMLY o DDRIESS_�C S �,1 ��G(�� DATEICATION f ��f1� NUMBER� '� #/C 1 V m ISSUE IYPE OCC APN______ LOT__.______ TRACT__ DATE CONST. GROUP p OWNER __ � ADDRESS „�cG.�Y!/�� ZONING SETBACKS I Z CITY ZIP__ TEL. FRONT RW ❑ � APPLICANT TEL. REAR ❑ � SIDE/SIDE STREET RW ❑ z � CONTRACT R � � �c�--� SIDE ❑ � ADDRESS S.� L PROPOSED USE �� CC Cli� � CITY ZIP TEL.` k•6o a�r �---. � ARCHIENG/ �1 S�fv2 i 1-, • � �� iz DESIGNER NO.DWEL. NO. NO. `" a ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANAWATION � OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HEREBV AFFIRM LINDER PENALTV OF PEFJURY 7HAT I AM E%EMPT FROM THE CONTRACTORS LI- GafdJe/CafPOft W CENSELAWFORTHEFOLLOWINGREASON�SEC.]031.SBUSMESSAN�PROFESSIONSCODE:ANYCITVOR (J� U COUN7VWHICHRE�UIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,OFREPAIPANYSTFUC- W PdIl0/D9CK w TURE,PRIOR TO ITS ISSUANCE,AL50 REQUIRES THE APPLICANT FOfl SUCH PERMIT TO FlLE A SIGNED w � STATEMENT THAT ME OR SHE IS LICENSED PURSUANT TO THE PRO'✓ISIONS OF THE CONTRACTOR9 LI- � � GENSE LAW(GHAPTEfi 9(COMMENCING WITM SEG�'ION 1oaaJ Of DIVISION 3 OFTHE BUSME55 AND PRO- POOVSPB FESSIONSCODE)ORTNATHEORSHEISEXEMPTTHEREFFOMANDTHEBASISFORTHEHLLEGE�E%EMP- � � TION.ANYVIOLATIONOFSECTIDN7031.SB'/ANVAPPLICANTFORAPEFMITSUBJECTSTNEAPPLICANTTO Z Re-Roof A qVIL PENALTY OF NOT MORE THAN FIVE rIUNDREO DOLLARS(f500�.): � ❑I,ASOWNEHOFTHEPROPERTVORMYEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, ❑ CommBfClal Z WILL DO THE WORK,AND THE STRUCTURE IS NOT INTEN�E�OR OFFFRFD FOR SALF(SFC.]Oda,9U51- J NESS ANO PROFESSIONS CODE:THE CONTFACTORS LICENSE LAW DOES NOTAPGLY TO AN OWNER OF � PROPERTVWHOBUILDSORIMPROVESTHEREON,ANDWHODOESSUCHWORKHIMSELFORHERSELFOR � � THROUGH HIS OR HER OWN EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTSARE NOT INTENDEOOR m w OFFERE�FORSALE.IF,HOWEVER,THEBNIDINAORIMPfiOVEMENTIS50LDWITHINONEYEAROFCOMPLE- 0 TION,THE OWNEH-BUILDER WILL HAVE THE 9URDEN OF PROVING THAT HE Ofl SME DID NOT BUILD OR Z IMPROVEFOPTMEPURPOSEOFSALE). _ ❑I,ASOWNEROFTHFPROPERN,AMEXCLUSNELVGONTRACTINGWI�HLICENSEOGONTRACIOFS W � TO CANSTRUCT THE PROJECT(SEC.7D04,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- V81U8fi0f1 ADJ.AREA W CENSELAWDOESNOTAPPLYTOANOWNEROFAPROPERTYWHOBUILDSORIMPROVESTHEREON,AND � WHOCANTRACTSFORSUCHPRQIECTSWITHACANTRACTOR(5)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE Y TORSI.ICENSELAW.) � J Q ❑I AM E%EMPT UNDEFI SEC. B.8 P.C.FOR THIS REASON Q � U � ¢ DATE OWNER � Z --- C� w � LICENSED CONTRACTORS DECLARATION w � I HEREBYAFFIRA!UN�ER PF.NALTV OF PERJUFV THAT IAAA LICENSED UNDER PROVISIONS OFCHAPTER � I { d 9(COMMENCING WITH SECTION 1ooa�OF DIVISION 3 OF THE BUS:NE55 AND PROFESSIONS COOE,AND Z L�I w MV LICENSE IS IN FULL FOFCEAN�EFFECT. m � LICENSECL//�SyS�' � � LIC.N4 _�� 'G' � V DATE�/�7_�,7 CONTRACT0�7 _ �/ d W l a� WORKERS'GOMPENSATION DECLARATION � � a � U � I HEREBY AFFlRM UNDER PENALTV Of GERJURV ONE OFTHE FOLLOWING DECIARATIONS: Z Q � IMAVEANDWILLMAINTAINACEHfIFIGA�EDFCONSENTTOSELF�INSUFEPoRWORKERS' _ CAMPENSATION,A:i PROVIDEO BV SECTION 370a OF THE LABOR CO�E FOR THE PERFOPMANCE U ¢ OF THF WORK FOR WNICHTHIS PERMIT IS ISSUE�. � 0 w I HAVE AND WILLMAINTAIN WORKEflS'COMPENSATION INSURANCE,AS RE�UIRE�BV SECTION ry Q ]7000FTHELABORGODE,FORTHEPERFORMANGEOFTHEWORKFORWHICHTHISPERMITIS I � ISSUED.MY WORKERS'COMPENSATION INSURANCE CARRIE9 AN�POLICV NUMBER ARE: CONSTRUCTION � J j caaaiea _____. _ . PLAN REVIEW 0 POLICV NUMBER_ ELECTRIC � � Z — Q � (i}7ISSECTqNNEmNOTeEWMPLE�EDOFhiEPERMfTISWRONEHUNDREDDJl1ARS(510a�ORLESS). PLUMBING W Z I CERTIFY THAT IN'�HE PERFORMANCE OF THE WORK FOq WHICH THIS PERMIT IS ISSUED,I MECHANICAL (} SHALLNOTEMPLOYANYPERSONINANYMANNERSOAS70BECOMESl1BJECTTO E � WORKEFS'COMPENSATION LAWS OF CALIFORNIA.A��D AGREE THAT IF I SHOULnA OME INSPECTION FEE � SUBJECTTO THE WORKERS'COMPENSATION PRnVISIONSOF SECTION 3]OOOFT. LABOR � CO E,I S L FORTHW�TH COMPIV WITH THOSE PROVI51 NS ISSUANCE IJI. ��.� � / J / ./,j�/J�� 1 0 DATE:�_ APPLIGFNT. l_�� (�` /'GL'L. $MIP w � ENERGY P/C J WARNING:FAILURE TO SECVRE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AN�SHALLBE J LL SUBJECTANEMPLOVERTUCRIMINALPENALTIESANDCIV�LFWESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOLLARS�f I00,000),IN ADDITION TO THE COST OF COl.APENSATION,DAMAGES AS PROVI�FD FOR IN J SECTION]laBOf THL LABOR COOE.INTEREST,ANDATTORNEV'S FEES. RETENTION FEE: � d CONSTRUCTION LENDING AGENGV PRE-ALT FEE: O � I HFREAV AFFIRM 11NDER PENALTV OF PERJURV THATTHERE IS ACONSTRUCTION LEN�ING AGENCY FOR THE PERFORMANCE(]F iHF WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097.CIV.C.i. Z W � LENDER'SNAME F- LENDEF'SA�DFE55 (� I 7� � 1 CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTAL F EES A � U l 1 w IAGREETOCOMPLVWITHALLGTVANDCOl1NTVORDIN CESANDSTATEL4WSRELATINGTOBUILOING �•� ` � � CONSTRUCTION,ANDHEREBYAUTHORIZEREPRESENT ESOFTHISCOUNTVTOENTERUPONTHF ZABOVE-MENTIONED PFOPERTV FOR INSPECTION PUR � S. COMMENTS � �!G�_ ( � �r'•st'�� _ - � m PEH TTEENAM (PRINT) Q � G�� D.s'G�L'�.��-"'" !J (? �/ � SIG �TUP F MI EE �A� = REGPT.NO. PAID BY VALIDATION ~ WHITE—Depanment Copy,YELLOW—Finance Gopy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Appli anfs Copy d� 1 � � ��:. . . . . . . . _ �;��i�� . � > . �k��' �k,�, s�= . .. ._. . ... . . . . . .. . . _ . . .,,�, p . a _. _. ... .. . ,., i. - °' �a,��,�"'� ,.., . . „��.�,,�� - _ _ _ _ _ . _ _ ! ��"° �' _ �� r : �� ; �� '�� s.� w = ' .. E „ _ _ _ � p2 � u 9.� { li� yb U CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION fat PRESS FIRMLY I ADDR ESS �?C APN LOT TRACT OWNER ADDRESS S,L_ CITY ZIP TEL. APPLICANT TEL. CONTRACT R ADDRESS S L CITY 4 j4",ZIP TEL.aC7 i91 ARCH/ENG/ lk'Z- 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 CITYOR 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 W ITHIN 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. &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 LICENSE C DATEI /7 CONTRACTO 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($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 E WORKERS'COMPENSATION LAWS OF CALIFORNIA.AND AGREE THAT IF I SHOULDA OME SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OFf LABOR CO E,I S LL FORTHWITH COMPLY WITH THOSE PROVIS IONS 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 OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC. 3097,CIV.C.). LENDER'S NAME LENDER'S ADDRESS 1 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDIN CES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENT ES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PUR S. IGhA ! Y.SLR�'t/ PER TTEE NAM (PRINT) SIG TURE F MI EE DA U) cc) 2 0 ILL- 0 w 0 M cc 0 U 0 Z u) 0 d X w 0 (JI w UJ I) uJ W r7 J 0 w Z U) I- 0 ULj J J w W 0 Cr d W F- I APPLICATION PERMIT P/C �Jv DATE 1 0� NUMBER # ISSUE TYPE OCC DATE CONST GROUP ZONING SETBACKS FRONT RW^ REAR ^ SIDE/SIDE STREET RW^ SIDE ^ PROPOSED USE�� CCL CCU 64 L- N0. DWEL. N0. N0. UNITS STORIES BEDROOM S DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREAIVALUATION SFR/ADD/REM CO Garage/Carport w Patio/Deck L.I LL PooVSpa 0 Z Re-Root Commercial M Valuation ADJ.AREA QUANTITY DESCRIPTION FEE U I- U W J w m U Z W CONSTRUCTION PLAN REVIEW ELECTRIC_ PLUMBING MECHANICAL INSPECTION FEE ISSUANCE UL SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES COMMENTS RECPT N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applibant's Copy