The URL can be used to link to this page

Home My WebLink About17988 y., CITY OF I7IAMOND BAR ; - �"��`'` DEPARTMENT OF COMMUNITY&DEVELC7PMENT SERVICES ! i� 21$25 E.Copley Drive (944}8b0-3195 FaC(909}$61-3 t 17 PRESS '��`%.»�i BUILDING PETtMTT APPLICATION FIRMLY � DDRIESS�� `*.� _� APPIiCAT14N PERMtT Q{" P/C DATE_�� NUMBER�I b� # o� �y ISSUE TYPE OCG � APN LOT_,.�_�RACT r T 7�_ DATE _CONSI GROUF p OWNER ��Ctis.� i�-_._1 t,l'4_i� L-�"'�- " ADDRESS l' 4 ZONING SETBAGKS � CITY"�� A�G- ZIP QG�L� TEL��S�L� �'LIG!3`I�1 �RONT , RW ❑ APPLICANT TEL. REAR ❑ o ---- SIDE/SiDE STREET RW O ro C4NTRACTOF_��.�,_� �"►�� t.- SIpE �._. Q � AdDRESS ` '�- �,�-- PROPOSED USE �� C�✓ +C- 1a� "' Q GITY ��.ti1_�,��7 I�'1�.�_ ZIA. t 77�i TEL'�U�'�/1�.7i� oARCHtENGf iz DESIGNER — NO.DWEL. NO. NO. c� ADDRESS UNITS_ STORIES 6EDR40MS � CITY _ ZIP TEL. `n - DESCRIPTION 5Q.FT. FACTOR PSF AQJ.AREAlVRlUATidN cA � OWNER-BUILDER DECLARATION SFWADDIREM O d 1 HEftEBY AFFIRM UNDEfl PENAl7'Y OF PERJUflY TNAT i AM EXEbiPT`rROM THE CON?RAC.TORS LI� GefB J9/Cdf{lOR W GENSELRWFORTHEFOLI.OWING0.EASON(SEC.�oa1s6U3WE5SANDPAOFE551GN5G4DEANYCITXOR (fy C.3 COUNTVWHICHREOUIftESApERMR7000N5TRUCT,ALiEP,IMPPqVE,�EMOLISH,OFREP0.1qANVSTRUG .jJ,f PetiOlDeCk '�- TURE,PRIOR TO iTS iSSVANCE,ALSO REOUIRES THE APPL�CANi FOR SUCH PERMtT TO FlLE A SIGNED W W STA7EMENT THAT HE OR SME!S LICENSEII PUftSUAMi TO TNE PROVISIONS OF THE CONTRACTORS Li� � CENSE LAW(CHAPTER 9(COMbtENCIN6 WIiH SEC?ION 7W0)QF pIVI510N 3 oF TNE BUSINE55 AND PflO� u" PooUSpa OFESSiONSCOOE)OflTMpTHEORSHEISE%EMPT7HEREFROMAN�THEBASISFORTHEALLEGEpEXEMP- (� � T14N.AMYVtQIATtOMOF5ECT70N7031.bBYANYAPPLICANTFORA�ERAA�TS�BJECTSTHEAPPI�CANT70 Z qe-Roof � ACIVILPENAI.TYOFNOTMORETNANFIVEHUNDREDDOLLARS{f5co).}� a ❑I,ASOWNEROFTHEPROPERTV.ORMVEMPLOYEFSWIfHWAGESASTMEIfl50LECOMPENSATION, � �ommerciai � Wii4 W THE WQRK,ANO THE STRUCTURE IS NOT INTEND[U OR OFFEflED FGH SALE;SEC.�Oa4,BUSI- J NE55 ANQ PRflfESSiDNS CODE.TtlE CONTRACTORS IiCENSE�AW pOES NDT APPLV TO AN OWNER 6F � PROPERTVWl108UILDSOPIMPROVESTHERE�N,ANDWNODOESSUGHW4RKHIMSEIFORHEA5E�F4R = „ CC THqOUGH HIS OR HER OWN EMPLOYEES,PROVIDED'HAT SUCH IMPROVEMENTS ARE NOT IMENOED OA m W pFFEREOFORSALE.iF,NOWEVER,T}iEBUiLDiNGpFIMPftOYEMENT15SOLDWI7HINONFVEApOFCOMPLE � TION.TNE OWNER-8U11.OGR WiLL HAVE THE BUFDEN 4f PflOV1NG TNAT HE OR SHE Dib NOT BV�LD 6R �� Z IMPPOVE FOq THE PURPOSE OF 5Pl.E]. � ❑I,ASOWNEROFTHEPROPEfiTY.AMEXClUSNELYCONTRACTINGWITHUCENSEDCONTRACTORS � TO CANSTRUC7 TNe+'Ft0.7ECT(SEC.7p44,BUSiNESS AND PROFESSIONS CODE THE CONTRACiORS LI- ValUBIlOf1 ADJ.AREA W CENSEL4WOOESNUTMPLYTOANQWNEROFAPftQPERTYWHOBUIEDSu^fttMPROVESTHEftEON,AND �- -�� , � WHOCANTflACTSFORSUCHPFOJEC7SWITHACONTRnGTOf7{S)LICENSE�PUR5UANTTOTHECONTflAG QUANTITY DESCRIPT�ON FEE x TORS UCENSE tAW.). � � a O�PM E%EMPT UN�EF SEC.� _9.&P_C.FOR TkiS R6ASON Q 3r _ — U �j � CC f� ' � PATE OWNER F ._._.._— (� W a llCENSED C6NTAACTORS DECIARATION W � IHEflE9YAFFIRMUNDERPENALTVOFPER1URviNATIAMLICENSEDUNbEftAftOYiSI(7NSOFCh1APTEf{ �. p„, S(COMMENCING W11H SECTION 7000)OF DIVISION 3 6F THE BUSINESSAND PROFESSIONS CODE.AND z �C MY UCEF7SE IS IN FUl.1 FORCE AND EFFEC?. m W ,�+ )/'�� +J �J' _ � LlCENSE CLASS ��G�"pj�_(,.,,__,_t1C.NO._,��4�^' � ... V pATE______�Z��L.Q/1 t�. CONTRACTOR__.. � �� l � n. W f � WORKERS'COMPENSATI6N DECLARATION ¢ � {HEFlEBYAFFIRMUNDERPENALTYOfPERJUfi`fONE(�FTHEFOt�4WtNGDECIARATiONS- U tfl QZ O _I HAVE AND WILL MAIN I'AIN A CER7IFICATE OF CONSENT TO SELF�INSURE FOR W09KER5' $ COM9ENSATION,AS FROVtDED BV SECTIDN 3700 OF THE 1A80fl COpE.�OR THF.PE%FORMANCE U ¢ pF TH6 WOflK FOR WHICN iMS PERMiT IS tSSUED. � 0 w _I HAVE ANO W�LL MAINTAIN WORKEftS'COMPENSATION INSUflAhCE.AS RE4UIREU BY SEC?!ON Q 3]0o OF TME LA90H C4DE,FQR THE PERFORMANCF OF THF WORK FOq WHICN THIS PERMiT IS v— - ` tSSUEU.MV WORKER�'COMP SATION INSLIRANCE C RIER AND POLICY NUMBER qRE: CONSTRUCTION } '�Z"c'.+1.�,_��'l.. _� ._ PLAN REVIEW v CARqIER_� � �� ZPoucv NUntBER_��'rZ{L''�l��Z L%I '�7 (fe7! ._ ELECTRIC .- �.._._... ,�"��`--� '"'- - ¢ (MISSECTIONNEEDNOTBEOJMREfE09F1HEPEMNI'ISF-0flCNEHUNDREC�IXYL4R5tS1W}ORlESu} PLUMBING — p —_ W i CERiiFv THAT IN THE PERFORMANCE OF iliF YJORK FOq WHiCH THIS PERMIT IS IS<UED,I MECMANICAL � �. (f SHAU N4T EhIPl.OY ANY PEftSON IN ANY MANNER SO AS TO @ECOME SUBJECT Tq iHE (/} WORKERS'COMPENSA710Nl.AWSOFCALIFORNIA.ANDAGREETNATtF15NOUL�BECQME INSPECTIONFEE __,,, SUBJECT TOTHF WORKERS'COMVFNSATION PROVISIONS OF SEGTI4N 3700 OF THE IABOR . � CODE,t 6HA�L FORT3iWiTN COMPLY WI iH THQSE PR6VISIONS. ISSUANCE �.,, � „_. -.-,. �� 4��— � SMIP � DATE:_ _ APPUCANT ,__.._ .—. .' . w ENERGY%C J WAW�lMG:fA�LURE TO SECURE WOFNERS'COIAPENSATION COVEFAQE 15 UNLAWFUL,AND SHALL BE —` "'� LL 9U8.iEGT AN EMPl6YER TO CRIMiNA�PENAtTiES aN0 CIVit FINES I1P TO UNE HUNORED THDUSANO �NERGY PEFIMIT .�.,,. DqLlARS(ii W.�7.�N ADDITIOM TO THE cAST�F GOMPF:NSATION,DAMAGES AS PROYIDED FOR IN � SECTION 3)oe OF THE LABOH COpE,INTEFiEST,AN�ARORNEV'S FEES. {{ET�N-�'(dN FEE: _ „_, . _...._. d CONSTRUCTiON LENDING AGENCY pRE-AL7 FEE: � �..._._. O � INEREBVAFFIflMUNDEftPFNALTYOFPERJl1RYTNATTHEP,EISkCONSTftU[:IIONi.ENRfNGAGeNCY FORTHF".PERFORMANCFOFTHEWORNFORW-VICHTHISPERM�TI5155UEo(SEC.309),CIVCJ. � -- � 2 --. W � LENOER'S NAMc_. __....�—.-- .. - _. (-_ �ENDEft'SADORESS�.._.._�_,�_ ._-..._.. —...—..--.. /� r i�s r\ W I CERTIFY THAT I HAVE NEAD THISAPPLICATlONANO S7ATE ThfATTMEA80YE}NF9RMATION PS CORREGT. TQTtt�FECS �� ,l �l � i AGREE TO COMPLY WITH Al.l[;ITv AND COUNTv ORDINANCES ANU STATE LAwS RELATING Tf7 BUILDING � CONSTRllCTK}N.AND HEREBV AUTHOP2E RCPHESENTAT��VES OF TH�S CqVN7V TO EN7ER UPON THE ZABaVE-MEN716NEfP�OPERTYFORlNSPEC?K1N?uRPo5E5. COMMENTS .. Q } " . � � �.� ��'_� l--i cl F� �__ __ — m PERMIRFENAME R�M} /� . .. � cn t�{1.�..� f� �L+ L�� J _. SIGNATU F RMITTE`c ��T Z RECPL�b- �� PAID BY� __VALIDATION___�._.. ~ WNITE-DepaAment Gopy,YELLOW-Finance Copy,PlNK-Assessor Copy,GOLDENROD--File Copy,�REEN-AppiicanPs Copy � .r� � �� __� G ��E � � � � ' ��'� ..`. ,�a�.��%� ��d �� ,� ' � nw�� . ��. �; a�'�, e . �� L`� � .. : .. � . ._ .. . .. ..... .. . ,` � : ��. . .. . .... . ... ..... . . . . .. . .. .. . .. ... _. . ...'' . �,�,d..,;��..�;�s-�" t�.._. . ... . .. .. . . ;. ... . .. .. ... . .. . . .. . . .. a��.Y�,,.�`�� ""�.a gyq��- ... . . ... . .... .. ��r;-��i�`7� �� 9r .. .. .. . . .. .. .. . . . .. .. ... - - �r��, � " ��. �� 7 . . . . . . . . .. . . ... .. � ��; �" �y �`� � � �� y� .. . . . . . .._. .... . }��,�,��J.�'��'"�� ",�T �:� '� .... . .. _ _. . ... . .. _ .. : i��a&��,�-ryry�,„��s 3f: ��d�.'�$��y��R �� . . .. . .. . . . �� `�'S �'4! e- .. . .. . . .. .. . . � � � I . . .. . - �p i ��:°��" P �ya 4�-� . . .. ... _. . �,�`-k'��"sn��` ��r5�� s<< ..._ . .. _ . ... . .. _ _.. � ,f'-�R,�m h ��ti�a�i ��+a^'u.g5� q�.T .... . . _.... . � �- - � �.� � ��"�ik+'��`�� S�u.+. � . ... .. ry � �W ��i�d��e`�ra.e N 4,�� 2E _ , , _ , _ � � .Q _ JOBSITE n Q 0 ADDRESS-"1 APN LOT'2-7 TRACT 4/79-- i C- N.-��j000 V" �r�� -- OWNER ADDRESS CITY I 4R C ZIP C L TEL31 APPLICANT TEL. CONTRACTOR 13 Yr C� ADDRESS CITY Mi&t- %W05,ZIP5il 3 TEL Z/0-YQ.3d1 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 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 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 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 70W)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORCE AND EFFECT. f ZZ" 0 LICENSE CLASS 49f LIC. N0. 1 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 WORKER'COMP SATION INSURANCE CARRIER AND POLICY NUMBER ARE CARRIER'QJ i/ POLICY NUMBER L (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 SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($1 W.0(30),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.CJ. 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 RINT)f d SIGNATU F RM... DAT 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 7 9�IF P/C DATE 0 NUMBER# ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ^ REAR ^ SIDE/SIDE STREET RW ^ SIDE ^ PROPOSED USE I N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION SFRJADD/REM U) Garage/Carport W Patio/Deck LL- Pool/Spa Z Re-Roof Commercial Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U P / u � w 0 Z on a U Z U W CONSTRUCTION PLAN REVIEW ELECTRIC Q PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEE S COMMENTS RECPT. N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy