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Home My WebLink About17741 �.�c��r�-�--1; CITY OF DIAMOND BAR ��-^�... _ � I?EPARTMENT OF COMMUNITY b�I7EVELOPMENT SERV]CES I ,� 21825 E.C;opley Drive (909)860-3195 Fax(969}861-3117 PRESS �.�9ti>" s�xL�iNc P��zT Ar��.leA�rta�v FIRMLY � JOBSITE APPLICATION PERMIT 1,,, P/C � � � ADDRESS- ----��"_"b�� — DATE__ C�- NUMBEP�_�, _ #t -'�� o� —- ISSUE TYPE OCC APN��_ LOT T ACT _� DATE. C4NST.__ GRdUP p OWNER YYIf:� N AdDRESS �-eR1}� fn.�.vt�"s.J Y�+ ZONING SETBACKS z CITY�J�,p_v►�_�—�ZIP_�+ L�'�og� ',��,.�� FRONT � _ RW_ C7_� � APPLICANT /�p .�p TEL. Ii REAR !1 ^ � --t"� ��-1t�• -_,-- --- SiUE181DE STREET RW []_ 2 � CON7RACTqR I,�_��'_t.� ,�ti}C, , SIDE � , �",_,_ AE}DRESS "��_�„S�7,� _��- PROP05ED USE_ �� J � Q CITY Wa4y1,�` Z!P GF.�'4�4TEL��-�',�- � ARCH/ENG/ J�� V� —- z pEStGNER�• �• hi'�Ai'N��y._.-_ NO.DWEL. NQ. NO. 4 ADpRESS �J 0'Y�-- GLY�+�`Q_ �✓ � �� f�-¢ UNITS STORIES BEt?ROOMS-- � C(TY j�,_,(�y�j[ ZIP TEL. t . � � -- DESCRIPTIQN SQ.FT. FACT4R PSF ADJ.AREANALUATtON p� QWNER-BUILDER UECLARATION SFR/ADD/REM ^ � i HERE�Y AFFIRM VNDEF PENALTV OF P'cRJURY iHAT I AM E%c'MPT FPfJM THE CONTfiACTORS LI� GyfaJB/C8fP01t L,U CENSELAWFORTHEFOLLOWINGREASON(SEC.7C31.5BUSINES5AN�PROFESSION5CODF�.ANVCITVOF (f� � � CQUNTYNMIGMREQUIReSAFERMITTGCQNSTftUCT,AITER,IMAft6VE.6EMDI.t$H2ORREPAIRANYSTRt7C� W Patio/Deck � y� TUqE,PRIOfl TO ITS�SSUANCE,ALSp REQUIRES TME APPLICANT FOP SUCH PERM�T TO FILE A SIGNED ✓'"�� STATEMENT THAi HE OR SHE IS LIC�N5E0 PURSUANT Lq THE PROVISlON50F TwE CONTPACTORe U� � .� GENSE lAW ICHAPTER 9(C�AMENCN�IG WITN SECTION'l0667 OF OIVISION 3 QF THE BUSINfi55 AND PR6- POOIISpB KES51f7NSCA0E10RTHA7HEOPSHEISEXEMPTTHEREF1-10MANpTHEBASISFORTHEALI.EGE�E%EMP� � Q T1�N.ANY VIQLATIQN O�SECTIpN?o31S BY ANY 4PFLICANT FOftAPERMIT SUBJEGiS TNE AFP�ICAN7 TO Z RB-ROOf � ACNILPENALTV06NOTMOqETHANFiVEHUNDFEDDOLlARS(S5Wj.): Q ❑I,ASOWNEflOFTNEPR6PERTYORMYEMPLOVEESK'IfHWAGESASTNEIFSQLECUMPEN5ATION. � Commercial -`v WiLL p0 THE WQRK,AND TME STftUC?VftE!S Y07 lNFENDED bfl OFFEREO FOA SAIE{bEC.704d.BUSi� J NESS AND PROFESSIONS COD'e:TME CONTRACTORS UCENSE LAW DOES NOTAPPI.Y TO AN O'NNER OF � PROPERTYWHOBVILDSORIMGROVES7HEREON,AN�'NMO�OESSUCHWORKHIMSELFORHERSELF0-1 � (� THROt1GH HtS Ofl N�R OWN EMP�4YEES.AROYIDED THAT SUCti iMPFOVEMENTSARE ROT INTEN[SED4R m � OFFEREDFORSPLE.IF,HbWEVER,TNEBUILDINGORIMPapVEMENTI550LDWITHINONEVEAROFCpMPLE� �, TION,THE OWNER�BUILDER WILL HAVE THE BURaEN oF nROVING i4AT!iE Oft SHE D!D NQ7 BUILD Oft � IMPROVEFQR7HEPUPPiJSEOFSaLE}. �, W ❑I.AS6WNEROFTNEPROPEfiTY,AMEXC�'JSIVE'�YCONiFACTINOWITHLIGENSEDCONTRAGTOqS [� TQ CONSTPUCT TNE PPOJECT{SEC.70Aa,BUSlNESS RND PROfES510N5 GOLIE THE CANiRAC70ftS L�� V3IU3Ii0(i ��• AD,I.AREA W CENSELAWDOESNOTAPF'IYTpANOWNERpFAPROPERTVWHOBUILUSOflIAAPRC7VE5TNEREON,ANp — - - - � WHOCON7RACT5FpF5UGHPROJECTSWI'HACONTRAG10H�5)GICENSEDPURSUAN7TOTHECONTPAC- QUANTITY QESGRIPTIQN FEE � TORS UCENuE LRW.). i � IJ I AM E%EMPi'VNOEH SFC. 8.R PC,FOR THIS REASON J � _.._.. __ Q U �'S .�_ .� ___. __..__ .—...—..... - � � DATE _.T_ OWNEP._...._..... F-" "�' � - _. — U � W _'....... � UCENSED GQNTRACTORS DECLARATION � '�C --- - � I HEREBV AFFIRM UNDER PENALTV OF PERJUH�THA�I AM IICEN°ED UNDER PFOVISIO�S OF CHAVTER � ~ � 3({:4MMENCMlG W:T}S SEGi'MON 7RW)4F OIY�S�ON�OF 7NE BUSINESS AND PAOFESS�F15 C;(tDE,AND Z X Mv LICENSE IS IN FULL FOHCE AND EFFECT - '-�� iJCENSE CLASS_�_.�y�• ��LIC.NO._�� .�. — , -��.�....._. ._ � � pATE �'ZL�"'_�_ Ow7_- ..._ CONFFAuTOft,,,��_�_,r,��' � ' '-�� W a d��1 WGRKERS'COMPENSATft7N QECLARATION � G � I HERE9v AFFIRM UNDER PENALTY OF PERJJRV ONE aF THE FaIL�WING DEC4ARATioNS: z L� IHAVEANOWILLMAiNTAINACERTIFlCATEOFCON9ENT'fOSELF-INSU%EFORWOFKERS' $ COMP�NSAT�ON.ASPqOVi0ED6Y5EGTiGN3iaoOFTHEIABOHCQ6E.�ORTNEGERFORMANCE C} � OFTHE WO%K FOFi WMIf.H TMIS NEHMIT IS ISSU[D, � � � „�_7 HAVE AND WILL MAINTAIN WORKFRS'C6tAPENSATioN iNSURhNCE,M,ftEdU�RED 8Y SEGiION "rs.0 3]OOOF THE LABOR COpE.FOR THE PERFORMANC[OFTNE WClRK FOR WHIGM THIS PERMII IS t1p`j �" � ISSUED.MYWOAKERS'COMPENSA7110iJiNSUftAYCECAftft1ERANDF'cJtICYNUM6E�ARE�. CONSTRUCTIQi� _ I'�I`+. __ � cnaRieR�__�'�17."'e�_- PLAN REVIEW ld'1..�3 ,,,,, ._ � aoucrNurneER ._�C�.Q_..� ' � ELECTRIC , _ ,,, Q � � � (PriISSECiKNJNE�tVJTBEQ�MRETEDOFhKPEHMiTiSK�ONEHUN3RCDOJt.tAR51$it10}QRLESS). PLUMBING __ ,,,,,, . W MEL'HANICAL � Z 1 CERTIFY TNAt M TriE PGRFOflMANCE OF TNE WOHK FbR WHICH i Hi5 PERMIT IS ISSU�p,i . _....�- ...__-_ (� SHA'_LNOiCMPLOYANYPERSONINANYMANNE%SUASTOBECOMESUBJECTTOfHE INSPECTIONFEE � WORKERS'COMPENSATION LAWS C1F(;ALIfORN1A,AND AGREE THAT IF I SHOl1LD BECOME ......_ .. ...-...�_ � SUBJEGT'fGTHEWt}HKEFiS'COAAPENSATIONPROVISIOHSO�SECiIO�'3l{�60FTHEtABOft ,1 � CODE,I SHA4.L FORTHWIiH COMPLY WITH THOSE PROVISIONS. �SSUANCE _ .. ____,,,,,_ �'Y�' Q J t .......�. �> p DATE' r1(t.r�� APPLICANT: ��_�x,�,� SMIF __ . . _ , „ "�..._ W �.'r_........�.___ -�_. J WAN9MIG_FAl�URE TO SECURE WOf3KEftS CC3MPENSATiOM CaVEftAGE i5 UNIAWFUi.,AN4 SHAt�BE ENERGY P}C __...._. ___ ,�_ J W SUBJECTAN EMPLOVERiO CqIMINAL PENALTIES AND CNIL.FINES UP TOONE HUNDRED THOUSAND ENERGY PERMIT OOLLARS(f1 W.o00),IN ADOITION TO THE COS70F COMPENSATION,DAMAGES AS PHOVIDEJ FOR IN — J SECTION 37G8 Of THE 1A60R CODE,INTERESi.AND ATTOAF7FY'S FEES. RETENTION FEE: � ^ _�_�`^d � --' ___ � GONSTRUCTION�ENDING AGENGY PRE-ALT FEE: _ ,,,...�_.. .._ ____ � I HEREEIV AFFIflM UNDEP PENAL.TV UF VERJURY TIIAT'THERE IS A CON5TRl1CTIUN LEN�ING AGEN(:V FQR ThiE REfti�RidANCE VF THt WOiiK F6R WHI£H THIS PEAA}IT IS ISSUEO(SEC.3097.CIY.G.}- ` � � �� Z W —. ._ ....-_.__ S iCNDEft'ShAME--�...�..-_'.._,.__......."'--_....._�....._... .._.�_' ?� _ _. ._ ... �...... _� IAGftEf.TO�COMPi.YWiTHAlIGifYANUCQ .�_—... ...... �....-_..._'_...-. � IC[RTiFYTHATIHAVEREAD�HISAP�UCA�IUNANDSTATETHATTHEABOVEMFGRMAT��ON15COqHECT� TUTALFEES �a�� '�� t7/7. ��' � VVTY dHDitdANG�S ANO STAi"E tAWS REIATING Tf3 e�Uii bING ti � CONSTNUCTIfJN,AND HEREBYAUTHORIZE FEPRESENTATNES OF THIS COUNiY TO ENTER IJGON THE � FBOYE-MEN7'IONED PROPEftTY FOft INSPECTION PUFPOSES. COMMENTS � � ...__...__ �. .._._ ..�. J � — a� -�a---=�� ___ —. __—_--__— � PERMITTEE NAME�PRINT) `� � � /�� ---_-�t. � . . . ..... _.._� � �� [ tj� � ....___ c!) ..—.___.__. ....� ..._ ,__ ._..1--�-__ _ —_ ..��...�. !'��'} � SIGNATURE OF PEpMITT " �ATE �'J'�� ftECPT NO. PAIp BY "�/G.SC��VRLIOATION�.�,_..... ~ WHITE-Deoar(ment Copy,YELLOW-Finance Gopy,PINK-A5Sessnr Copy,GOLDENFOD-File Copy,GREEN-ApplicanCs Copy �� ` ��a� �: ��-� � ; � �,, , .:` �i a it ,.� � ',� � � i��,..��e=°�.m ��,. .a"iti�' .:`�S.�,S �,�;`..��r.- F � � . . i.. .��-a� , � . �'��'��a��g � .,�,,, 5°�7��r ��3 ,:s<<,i. ��'��',., i�r...,,��::'t.�'�m ��..".��n' ,� �� rr,vys �,+�.p,�-i�t�-�/tlr'��- .�'r.�-- _ _ _ _ ,� � � � �� - - , , �_ � rv��.4. ��a��.m�� .��.��,� _ _ �_ _ _ _ � �., ��,g k�„� � a �"��°�a ��R�� _.. ,�� ' � � _ _. .. . . . .. _ _.. _. .. .. . ... _ ... �.`+�v��'�:��g P �iP �_ .. . .. . .. .... ... ... ... .. �p � � � _ _ '� � . � �� 'U��ig�i�� -;t�k �� . ��k� a^t��$ � ��'i ... .... .. . .. . .. . .. .. . ... _. ... . . .. ... -. ;. „�, m...� i '�t��'�d� �� , ��' �� g � _ _ � � ��a '� �� ^�a'�� a T �� _.� t� ,� �r�� '�� `� . �� a��4` �� $i i .�r'�"!�"4 I - .. _ . ._. ... _. .. .. .... ... ._ . . . .. . .. . �� b� p�7�� ;w ��`��1�� . .: r� '��"�=' . ys��i.bx.�'a�-:Y "�,�r. s5.r�=, ..,,�....�n.� ...... ... . .... ... .._.. . .. .. . . . .. . ..... . .... . . ... .. ... .. . _ . . .. CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION PRESS FIRMLY JOBSITE fu ADDRESS- APN LOT TF�ACT OWNER Yrl{j r� Nr ADDRESS-V C41A"4 YI-, CITY_qzlkpv$A ZIP_- L�- APPLICANT__r2 pfiq TEL. CONTRACTOR'sl AF It f- ADDRESS CITY 4--ZIP r1VTE DESIGNER/�� DESIGNER�•QY�- ADDRESS 0 Yom-QYCMn�A ��p CITY [ZIP TEL.�'L Y 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 BUSINESSAND PROFESSIONS CODE: ANYCITY 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).): C I,AS OWNEROFfHE PROPERTY. OR MY EMPLOYEES WITH WAGESAS 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 COMPILE 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 PROJECT(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.) LI I AM EXEMPT UNDER SEC. B. &PC. 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 CLASS LIC N0.v/ DATE 3- �L p x CONTRACTOR WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: -1 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'LI U,L I (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.I DATE: ?APPLICANT: P-0 N6 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 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 I SPECTION PURPOSES N PERMITTEE NAME(PRINT) SIGNATURE OF PERMITT DATE APPLICATION PERMIT P/C DATE�--NUMBS it ISSUE TYPE OCC DATE CONST.GROUP ZONING SETBACKS FRONT RW^ REAR r SIDE/SIDE STREET RW[_] SIDE PROPOSED USE 11.41!0 C4,M„Z 0(201 1. N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREANALUATION SFR/ADD/REM U) Garage/Carport W Patio/Deck SAO IL Pool/Spa 0 Re-Roof Commercial Z) M Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U w CJ z m a Q Z 2 U W CONSTRUCTION PLAN REVIEW Ia'� . 3 ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP tV v ENERGY P/C ENERGY PERMIT RETENTION FEE:/A•�_ PRE-ALT FEE: TOTAL FEES gyp .Y3 I"77�" COMMENTS., R CPT NO AI . P E D BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy