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Home My WebLink About18144 ...�,_�. CITY 4F DIAMOND BAR (�� 1�'� DEPARTMENT C1F COMMUNITY&DEVEL4PMENT SERVICES � �� 21825 E.Copley Drive tso9�s�o-��9s�a�t9o9>sbl-31 i� PRESS `%v«� BUILDING PERMIT APPLICATION FIRMLY �� JOBSITE ( DATEICATION �'�� NUMBER rf�j,�Y !#lC G�v � ADDRESS��,�_L/�_ _ �i,___ �� __�L o — T' ISSUE TYPE OCC `� APN �OT TRAC7 _ DATE GONST. GROUP °C OWNER ' ��G�<�_ p � � � AQDRESS,.�,�� ' �, ZONlNG 5ETBACKS z CITY ��, �,,� i "' TEL. `a L � FRONT . RW f l � APPLtCANT TEL. ti � REAR C7_ z SIDE/SIDE STREET RW ❑ m CONTRACTOR_ _ SIdE O � ADpR�SS,.�.,�( , ��TEL.�—��,�J��wl `"'�'�� PROPQSEDIlSE �� lV�� fVc�CC'/"l�Gj�L�/ � GfTY w ARCWE G! � DESIGNER_,__ NO.dWEL. NO. NO. a AdDRESS UNITS STORIES BEDROQMS � G!N _ ZIP TE�._ � DESGRIPTION SQ.�T. FACTOR PSF ADJ.AREANRLUAT(ON cr3 � C7WNER�BUILpER DECLARATION SFRlA6[71REM O [� i HEREBY AFFtRM UNOER PEHALTv OF PER.A/Rv THpT i AM EXEMPT FaOM THE CONTAACTOFS LI- � G8fflJ8ICHf�70fI W GENSELAWFOqTliEFOlI(?WINGftEASON(SEC.1o8i.58U51N£SSAN�PROFESSIbN5C6DE:ANYCiTrOR ... fJ COUNTVWHICHREOUIRE�APERMITTOCON5TftUCT,PITEA,IMPRQVe.DEM�UgH2OqREPAIftANYSTflUG � {�yt10/DBGk Z TUPE,PRIOR Tq IT9 ISSU�4NCE,ALSO RE�UIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SiGNEO W 57ATEMENT THAT NE QR 3ME IS UCENSED PURSUANT TO THE PROVISiONS 4F THE CONTRAGTORS LI� "�� CENSE LAW(CHAP7'ER 9{COMMENGNG WITH SECTION t00o)QF D!VlSION 9 OF TNE BU51NE95 ANO PRO� � ��S(38 � FESSI!?NSCODE�ORTHATHEORSHEISEXEMPT7HEREFftOMANpTHEBASISFORTMEA�IEGEDEXEMP� {� � TION.ANYVIpLATiONOFSL-CTION703t,50vANVAPPLICAN7(ORAPERMITSV6JECi5THEAPPLICANTTO z R2-ROOf � ACIYiI PENALTY�F NOT MOitE THAN FIVE HUNDRED aOLLARS tFSW).}', � �I.ASOWNEROFTHI:PROPERTY,QflMYEMPLOYEESWfTHWAGESASTNtiRSOLECOMPFN5A710N, � Commercial � WILl00 THE WORK,AND 1'HE S7RUCiURE IS NOT INTENDED OH OFFEflEp FpR SAIE(SEC.�P4n,BUEI� J � NESS AND PROFESS�ONS CODE:TME CONTRACIORS LICENSE lAW DOES NOT ApPLv Tf7 AN 4WNER aF � PftOFERTYWH06UilD50RRdPROVESTHEREOti,ANDWitOD6ESSl1CiiWORKNiMSELFORHERSELFOR = _ [[ THROUGH H19 OR MEROWIJ EMPLOYEES.PROVtDEp TNAT$UCN IMPROVEMENTSARE NOT WTENDEDOfl � � OFFEREOFORSPLE.IF,HOV/EVER,7FiE8UI�DINCaORIMPROVEMEN715501DWIiHINONEYEAROFCqMPLE� � TION,THE OWNER�BUILOER WILL HAVE THE BUROEN OF pqpViNG THAT HE 6R Sf1E DID NOi 9UILD OR IMPHOVEFOHTNEPUftPO5EOFSALE). ❑I,AS OWNEfl OF THE PFbPEpTY,AM EXClUS1YEl.Y CONTRACTING WITH LICEMSED CAN'RACTORS Q 70 CONSTRUCi THE PROJL-CT(SEC.�oa4,BUSINESS AND PROF65510N5 CObE:THE CONTRACTQRS L'�� VdittdYlOfi ADJ.AREA�_ W CENSE UW DbES NOTA�PIY TOAN OWNER bF F PROPER7Y WHO BU�LDS OR IA7PROVES THEpEON,AND � WHOCANTRAC75FqR$UCHPAO.lEC7SWiTHRCONTRACTOR(5}tIGENSEDPUR5l7ANiTOTNECONTRAC- (aUANTITY DESCRIPTION FEE Y TORS I.ICENSE LAW.). Q ❑t AM EXEMPT UNDEA SEG.__,,,__... .8 P.G.F4R TH15 flEASON Q „_,. '�i ,L'��.- � � � OATE � _ OWNER ~ __ � ... d � LII,ENSED CONTRACT Au DECLA TION � ¢ CC i HEREBY AFFIftM UNGER FENACl`Y OF PERJURY THA7 i AM LIC"eN5ED UNDER PROVISIONS OF CNAATER � � 'r".r L - �y/J'" � 9(CDMMENCINGWITHuECTIQN70W)bFD1Y1510N30FTHE8U51NES�ANDFFOFE55!ONSC40E,AND -��„ fV�+. !X MY410ENSEIGINFULIFORCEANDEFGECT � � ,J �-=�;�/�- Q LICENSECtASS_�__ LIC.NO. . � V DATE _ CONTHAGTOR,,,. ... .—..—., �- �� —�� i W tt�i WORKERS'COMPENSATION OECLAflATION —� ¢ � tFiEftESYAFfiflMUNDERPENAITYfJFPEAJLIRV4NEOFTNEFOLLOWINGDECLARATIONS: � � z ¢ � IHAVEANDWIL4MAll4TAiNACEfl71FlCATEOFCONSENTTOSElF�lNSUREFORWORKERS' _ CpMPENSATIOM11,AaPflOYIDE08YSECTIONa7a04FTHE�A80RCO�E,FOHTHE?ERFOAMANCE C� `� OFTHE WORK FOR N�HICN THIS PERMIi IS 155UED. � � __I MAVE AND WIII.MAINTAMI W6flKERS'CAMPENSATI6N iNSURANCE,AS REOUIRED BY SECTION y.y Q 370a OF THE LA80R t:ODE,F4R THE PEAfOflMANGE OF THE WORIC F4R WHICHTHiS PERMI715 � "�'�"� � ISSUcD.MY WtlRKER9'COMPENSATION INSURANC:CARRIER AND POIIGY NUMBEftAfl6: CONSTRUGTION _. _._ ��• j cnaaieA_.Y_ —. . PLAN FEVIEW ,� ..;[� "'� � _,..._ Zaoucv ruuMeee�� .. EI.EC.TRIC _.,_,.._. ¢ d (i}iISSECiK7NNE�NCr7gEC!_MAPLETEDOFiHEaEF%4TiSFORONENUKKtE000LI.AA$�SI00)ORLESS) PLUMBiNG .._. — � I CERTIFV THAT IN THf:PERFQRMANCE OF THE WOftK F�R Wh4lCH THIS PEFMIT IS ISSUED,I MECHRNIGAL �' _.�..__ . ._ � SHAlLN4TEMPLOYANYPEft50NIN 1NV MANNEflSOAST06ECOMESUBJECTiOTHE tNSPECTtON FEE Uj WQRKERS'i.OMPEHS4TION 4AW5 CSF CAI.IFORNiA.ANa ACiiEE iHAT�F I SNOULD GECOME � � SU&JECT TO THE WQF4KEft5'fAMPENSATION PRctVIS�NS OF SECi10N a7�60F THE LABOR fS$UANCE ..,. �� GODE,I SI1ALL FORTHWITH COMPL�WITHT405E PRaV15InN5. a SMtP p DATE: ,_.._ APPI�CANT: _._. ..,� .�..�.— �' — . '_ _ J ENERGY P!G . .—....._ J WARNING:FAILUF4E T4 SECUHE WOftKEAS'C4MPEN5ATION GOVEftAGE 15 UNI�WFVI.,AND SNALL BE � SU9JECTANEMPLOYERTOCHIMINALPENALT�ESANOCIVILFINESUPTOONEHLINDflEQTMOUSAND ENERGYPERMIT _,,, QOLLARS(5�W,000j,IN A�D(T10N TO T4E COST OF CQMpENSATION,DAMAGES AS PROVIUE�FOR IN � � SECTION 37090F THE tA86R t^.ObE,INTERESi,AND ATTOflNEY'S FEES. RETENTION FEE: __.,, .__,.�r~— d CONSTRUG710N l.ENDING AGENCY PFfiE-ALT FEE: T, .,.`. _.— � i HEREBY AFFlPM UNDEH PENFlLTV OF PEFJUPV THAT THERE IS A CONSTRUCTION LENDING PGENGY _,__,,, FORTME PERFQRMANCfi O'r TI1E WORK FOR WHIf,H THIS GERMil is t$SVED{9EC.369T,GV.G.). Z W � LFNOER'SNAME ._..`.._. —.—_._._ —_ . .:.... F— LENDER'SADDRESS_,.._.__. ...—. ...—. --— . � ICERT�FVTtiATiMAVEHEAD7YiI5APPLICATIONANDSTA7ETHATTHEABOVEMFORMAfIONISCARqEGi. TUTALFE�S �� '•..�..�C�� W IAGftEE TU G4M?lY WITH Att�=RV AND COUNTY ORbtNANCES ANU STATC LAWS REIATiNG TO BNLDMC n' CONSTflUCTION.ANLiHEREBYAUTHOFI7EREpFESENTATIV6SOFThftSCOUNTYT4ENTERUPONTHE - � A(3DVEMENTIONED PROPERTY FOR INSPECTION PJflPOSEG. CDMMENTS�, �� '_ __.....—�._._. _-F^"'— � J � ._.. ..—.__.—__.. � � _-... — _'_ � PERMITTEE NAME(PRlNT) _ — �- — Q � y _ _..._ ._—. .. ——T.._ _ - .._. .... SIGNATVRE OF PERMITiEE OATE }'�7' � RECP7.NrJ. i� PAiDBY _,,, ' VALIDATION � WNITE—Qepanment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD-- ile Copy,GREEN—ApplicanPs Copy ';�� '�_. ' � �t r �y� : a�i � ;-�x� � �';�� d� � �'�" � w�'., .� �°, "� �u.r.,'"_��_ �r.�� a � �s�',»�� o� 9;'�'r�� 1��;' � _ �� f,��`'"��"�,y' ��" � _ _ �. _ � � a,h � r , � � , ° � �� ;�� ya�. �� , � a�_ , -, , �ba ;:.r �`�f � �'' ��s��'� • _ _ _ _ e g �� 5�� b�� . . ... . . . .. . .. .. .. .. . .. . �..�4�^Y ,if `��d`"k k i�§ P�u�-'��€��, �'''�F�i�. = ' a��°�� . s s ,� .. . .... _. . ... . . . .. .. .. _ . .. ...... _.. _ .. . .... . �� ' r �-�`.s,� �d°' � _ _ , �. i � i+. � i t ; �`&r = � _ 6 -�5 ��a"�''3'�u��- ��rr�y� .�.° ,. . F. � s a :�;,,. � _., ^. t• � , a ., _ ., ... _.. . ...... . .... . . ... . . . .. .... .. .. ... . . . . .... . ... .... .. . .... .. .... . . .. ... . > � �. _ . , . .. ... . .. ... ..... .. . . .. . . ...... ..... .. . ... ... .. ... .. _. . . .. . .... . .. . . `� � r' - �� CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION JOBSITE j ADDRESS APN LOT TRACT OWNER I<Lw ADDRESS CITY TEL L APPLICANT TEL.CT oil, CONTRACTOR ADDRESS J 1( 1 CITY W 7TEL.J . "0 1 E ! "�'I Zap a- 17 V vu I ARCH/E 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 BYANYAPPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($500).): U 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 CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJI=CT(SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE LAW DOES NOTAPPLY TOAN 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.). U T AM EXEMPT UNDER SEC. . &P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACT RS DECLA TION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM 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($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. CONSTRUCTION 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. 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 APPLICATION PERMIT//iYr P/C i DATE NUMBER/# �'- ISSUE TYPE OCC DATE CONST.GROUP ZONING SETBACKS FRONT RW^ REAR^ SIDE/SIDE STREET RW^ SIDE^ PROPOSED USE/�Jj_�� ' �/ N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM W Garage/Carport W Patio/Deck LL Pool/Spa 0 Re-Roof Z 0 Commercial 15 co Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U ol: H U w W Z r L/NA:: I Z W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES COMMENTS�,---�--""- 7 RECPT NO. i PAID BY?VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy