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Home My WebLink About15511 �� CITY OF DIAMOND BAR / �� DEPARTMENT OF COMMUNITY 8c DEVELOPMENT SERVICES w 21660 E.Copley Drive Suite 190 (909)8643195 Fax(909)8613117 % . �,, � �:?/ PRESS ��^�� BUII..DING PERMIT APPLICATION � -j�,�` FIRMLY o DDRIESS� ? � l /� `r� F Gf DATE CATION �Q v NUMBER�'�`�� Mf C � APN I.OT TRACT � D TEE a CONST. GROUP p OWNER C: o ADDRESS '��'f ' sg, ZONING SETBACKS � CITY ��i��i� � ZI TEL (� O D FRONT NW ❑ APPLICANT _ TEL. REAR ❑ � SIDFJSIQE STREET RW ❑ CONTRACTOR efys i-�u SIDE ❑ p� ADDRES�S �� CITY i�/ !� � ZIP / lc9 TE z' 6ZZ�' PROPOSED USE � AHCWENG/ � DESIGNER NO.DWEL. NO. NO. ADDRESS UN ITS STORI ES BEDROOMS � CITY ZIP TEL. � y DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADD/REM O I HEREBY AFFIRM UNDEk PENALTV OF PERtt1RV THA7 1 AM EXEMPT FROM THE CANTMC70R5 LI- GaragelCafport W CEHSEUWWRTHEFOLLOWINORFASON�SEC.1a3t.58USINESSANDPROFE5510NSCODE:ANVCI7VOR (n C� COUNTVNhiICHIiEWIHE5�7ERAlITTOCONSTRUCT.ALTER,MPHOYE,DEMOLISH,ORHEVAIRANYSTRUC- W Pa�10/�BCk Z 7URE,PFIDR TO ITS ISSUANCE,ALSO RE�UIRES THE APPLICANT FOR Sl1CH PERMIT TO FILE A SIGNED W ST�TEMEM THAT HE OR SHE IS LICENSED VURSUAN7 TO THE PROVISIONS OF THE CONTRACTORS LI- w � CENSE LAW(CHAPTEP Y(COMMENCINO MATH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AN�PRO- � POOUSPH FESSpNSCODE�OqTHATHEOR5HE15EXEMPTh1EflEFROMNIDTHEBA515FORTHEALLEGEDEXEMP- � TION.ANYVKKATqNOFSECTION7031.5BVlWVAPPLICAMFORAPEFMITSUBJECT57HEAPPUCANTTO Z Re-Roof � A qVll VENALT'OF NOT MORE TIIW FNE HUNDflED OOLLARS(5500).): � ❑I,ASOMRIEROFTH[PROPERTY,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, � CORIR10fCi8I MIILL 00 THE WORK,AND'HE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SECJD/!,BUSI- J � NESS AND PROFESSION5(:WE:THE CON7MCTOHS LICENSE UW DOES NOT APPLY TO AN OWNER OF = PROPERTY ViF10 BUILDS Op IMPROVES TiEFEON.AND NMO DOES SUCH WORK HIMSELF OR HERSELF OR Q THROUGHHISORHERONMEMPLOYEES,VROVIDE�THATSUCNIMPRWEMENTSARENOTINTEN�E�OR m � OFFEREDGORSALEIG,VIOWEVERTMEBUILDINGORIMVpOVEMENTISSOLDWITNINONEVEAROFCOMVLE- Z TqN,THE OWNER-BUILDEH WILL HAVE TNE BUROEN OF PROVING THAT HE OR SHE DID NOT BUILD OR � IMPiqVE wRTHE PURPoSE oF SI�LE�. w ❑I,ASOWHEROFTFIEPflOPERTY,MIEXCLUSIVELYWNTMCTINGWIh1UCENSED�NTRACTOfl3 [[ TO CqISTflUCT 7NE PRO.IEGT(5EC.70/4,BUSINE55 PND PROFESSIONS GO�E:THE GpNTRAGTORS LI� V81U8IIOf1 ADJ.AREA W CENSELAWDOESNOTAPPIVTOMIONTlEROF1IPROPEHTYWHOBUILDSOHIMPROVESTHEREON,MlO � 'MiOCONTMCTSFORSUCHPRQIECTSWl7}1AIX7NiPACTOR(5)LICENSEDPURSUANTTOTHECONTMG QUANTITV DESCRIPTION FEE � TORS LICENSE LAW.). J O ❑IAM E%EMPT LINOER SEC. 8.d P.C.FOR THIS REASON Q U -7 3 ..---- OC ' OJ''2'v .4 DATE _ OWNEfi U ,r�� W �° � � LICENSED CONTRACTORS DECLARATION W . .Y � �. �. � I HEREBY AFFIRM UNDER PENALTY OF PE0.IURV THAT I AM IICENSEO UNDER PROVISIONS OF CHAPTER (� Y�COMMENCINCiWITHSECilON7000�OFDIVISION30FTHE8U5WE5SANDVROFESSIONSCODE,AND Z / �X� MY UCENSE IS IN FULL iCEAND EFFECT. m ...7 a��„-`�� a� �I (�Q � /6"l ,� � UCENSE CUSS �� LIQ NO. � � . r7 �r ,-� J w~ OATE CONTRACTO 1� d ,t' — -- S �,yssY iC'- �' � � W'ORKERS'COMPENSATION DECLARATION Q / #f ' ! . O = U � I HEREBV AFFINIA 11NDER PENALTY OF GE0.IURY ONE OFTHF FOLLOWING DFCLARATIONS� v� Q - �GJjf,s , �� _IHAVEANDWILLNAINTAINACERTIFIC�TEOFCQN5ENTTOSELF�INSUREFORWORKER3' _ 1 COMPENSATIOIJ,AS PrIOVIDED BY SECTION 3�00 OF THE UBOFi CODE,FOH TME PER W RMANCE U I u' �� I ' O� UF THE WORK FOft WHICH THIS CERMIT IS ISSUED. � �. �l W I MAVE�ND WILL MAIMAIN WORKERS'GbMPENSATION INSUqANCE,AS REQUIRED BV SECTION Q 9�00 OF THE U90R CODE,FOR THE PEflFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS /'� ISSUED.MV WDHK�{.5'WMPENSl1TKKJ INSURANCE CARRI 0 PO'JCY NUMBER RRE'. CONSTRUCTION ��(��,5 jCARRIER_r.�i��S��_ �C.[�v� PLAN FiEVIEW I I z vaicrNUMeEa__ ELECTRIC � �, Q (nusSEci�NEa�rq7eEo�ErEooFn+ErEar.�t�s:oaoniE�000ueasl5�ooloa�Ess). PLUMBING � W ICERTIFYTMATINTHEPERfORMANCEOFT1iEWORKFORWHIGMTH15PERMITI5155UED,l MECHANICAL I Z I (,'j SHALL NOT EMPLOV ANY PERSON IN PNY MANNER 50 AS TO BEGOME SUBJECT TO THE � 1MDRKERS'COMPF:NSFTIONUWSOFCALIFORNIA,ANDAGREETHATIFISHOUL�BECOME INSPECTIONFEE S SU&IECTTOTHFWORKERS'CAMPENSATIONPROVISIONSOFSECTION97000FTHELABOR � � C(bE.ISHALLFO'iTHWRHCOMPLVWITHT EPHOVISIONS. , ISSUANCE ��j ' p DRTE: _ APPUCAN7: �/+�JL�Y �J 0(�� SMIP ��i s� ' {�,��",��F1 J WARNING:FAILURE I'O SECURE WORKERS'COMPENSRTION CAVERAGE IS UNUWFl1L,AND SHALL BE ENERGY P/C � � � � �y SU&IECT AN EMPLOVER TJ CRIMINAL PENALTIES ANO CIVIL FMES UP TO ONE HUNDRED THOUSAND ENERGY PERMIT � ��-'" DOLL.ARS(f10a,0a0),IN A�DITION TO THE COST OF COMPENSATqN.DAMAGES AS PROVIDED FOR M - � SECTqN 37060F 7HE IABOR CODE,INTEREST,ANDATTORNEY'S iEES. RETENTION FEE: E�� ,� - t•� � GONSTRUGTION LENDING AGENCY PRE-ALT FEE: O Q I HEREBV AFFIRM UNDEP PENALTY OF PERJUflV THAT THERE IS A CONSiRUCTION LENDING AGENCY a- FOR THE PERFORMANCE DF THE WORK FOR WHICH THIS PEFMR IS ISSUED(SEC.3097,CIV.C.�. W � LENDER'S NAME H IENDER'SADDRESS_ w I CER7IFY THAT I HAVE READ THIS APPLICATION AN�STATE THAT THE ABOYE INFOFMATION IS CORFECT. TOTAL FEES � I AGREE TO COMPLV W17H PLL CITV AN�COUNTV ORDINANCES AND STATE UWS REUTING TO BUILDING � CONSTRUCTION.ANDHEFEBYAl7rHORIZEREPRESENTATIVE50FTHI5COUNTVTOENTEFUPONTHE Z ABOVE�MENTIONEO PROPERTV FOR INSPECTION PURPOSES. COMMENTS � —��1�.�� J s�rp;�1,ZD.c/ m P . ITTEE (PRINT) � Q � � 5 N/1TURE PERMITTE DATE ^ = RECPLNO. PAIDBY C�' VALIDATION ~ WHITE-0epartment Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENRO ile Copy,GREEN—Applicant's Copy _, 4 � .... ��P.. �t. . . ,� . �,�,„4��«�=�* �`: a � ��.. �,�� _ .� . ,..,,��.r�.°rs �� *` ��r��•.��r t:� ,� � 3F��;+�"�:�G .°� s.' �..:�.`. �� n � r �r�' �� . �� .. .. . . � �� .�� ` :5 �� r, �.. l,, �; _ _ . .,4� -.. .<��.,.�b . . � . . . . . . . � i Z�18�° � . _ _ _ __ _ _ _ . _ _ _ � �� _ �� , ,�. 9�._,, � ,�� ..d � . . .. .. _. . �, .sa�. .. . _ .. ... . . . .... ... . _. . ..._. ... .. .. .... . . .. . ._ . ... . . .. ... . . .... .. .. .. .. . .. . . .... . .._.. .. . . . .. _.... . . . .. � ..._ . .. .._. .. ... . _.. .. .... ... ... .. _.... ........ ...... .... ... . ..... ..... ... . .. .. . ':, . .,�'..., x .; k ,".;" .. ... . .... . . . .... .. .. ... . ... ... ... ... ... . .. . . . .. .... . . . . ... . ' ��'C`�, 0. .... ... .. . ...... .. .. . . ... . . .. . . . . .. . .. .. . � r�F� �� . �. � . �`- A�`�' t�a�* � '^�,' `� :.ww.�k�i "� . `��"'�.�o-V ._. . ... ... . .. _.. .. _.. ...... .. . ._.. . ._.. . ... ._ . : �� ; P, ".', �� r�, "' .. � � � �,'k � .• .. .... ........ .. . .. ._ ... ... . ._ ... . ... .. . ... .. .. ._ ..... ... . .. _ .. . .�. � y�• :-,;a ':. � a..e"'�+�'3�w y vrv=::��,1 .., . , ; . .... .. ... ... ... .. .. .. : y,� � � ' r y t, �' __ . . .. .. .... ... .. _. .... .... .... . ... . ._... ... . . . �+.�v i .5,. u : �. .. ....... ...... _ _.. .... � i ° �� ;, ' � '� �*�k�G .qF�'`�a as: 5�' ,' '�"..a��a a,�F a,� �'.. ... ... _. . ... .. . . . . . . . .. .. . CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION � j PRESS FIRMLY JOBSITE?r ADDRESS F Gf APN LOT TRACT OWNER L ADDRESS'�lf sg, CITY,6t.EJL-ZI TEL_0 t APPLICANT TEL. CONTRACTOR ADDRESS CITY i.-� I ZIP/.4 TEL 2'62z" ARCWENG/ 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 PERMITTO 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-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 YEAROF 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 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.A 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 10E AND EFFECT. QQQ le e4zjjr--.7 LICENSE CUSS LIC. N0. C NTRACT 0 DATE OR W'ORKERS'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 WOR'COMPENSATION INSURANCE CARRI D POLICY NUMBER ARE: CARRIER POLICY NUMBER (THIS SECTION NEW> 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 THO E PROVISIONS. "/L�Y,JV/ P ICANT DATE: AP L 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 3706 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. P ITTEE(PRINT) S NATURE PERMITTE DATE APPLICATION 3o V PER T/��%P/C / NUMBER # DATE ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ^ REAR ^ SIDE/SIDE STREET RW ^ SIDE ^ PROPOSED USE N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION S0. FT. FACTOR PSF ADJ.AREANALUATION SFR/ADD/REM Garage/Carport W Patio/Deck U_ PooVSpa 0 Re-Roo( Z 0 Commercial Valuation ADJ.AREA QUANTITY DESCRIPTION FEE .Z U - W 0 Z -7 At/I 13 �S�� , J 1 .. . 47 5 V'isY AC= � ID a . r� IciFS cj 0 = r iL 1 u CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL -- INSPECTION FEE ISSUANC E i SMIP + 3{,��( ENERGY P/C ENERGY PERMIT - - " RETENTION FEE: .'„a."•-+ ---t PRE-ALT FEE: TOTAL FEES COMMENTS RECPT N0. PAID BY C' VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy �M�