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Home My WebLink About17101 (33) J�� CITY OF DIAMnND�AR f � ! I7EPARTMENT QF CC?MMI3NITY&DEVEL4PMENT SERVICES EXPI RED .� 21825 E.Copley Lhive (909)$60-3195 Fax(909}8b1•3111 PRESS �"��»°' BUILDtAIG PERMIT APPLICATION MAY D� 2003 FIRMLY �� .IOBSlTE ^� , � +�� APPLICAT� ��j_ j`� PERMIT r'"� P/C n ADDRESS G_��,�.� t'Y.�T�:�.— �I L'�l (�"�.' , DATE—,.3__;".-�"-�—NUMSER t_ !�� # � � /�� " ISSUE TYPE OCC APN_. LOT_ TRACT_,__ pATE CONST. GROUP p OWNER � t�'"l .T__.._�— �_ — --- p AdC7RESS_ __ ZONING SETBACKS FRONT RW (1 � CITY ZIP TEL. — — � APPLICANT ' TEL._ i REAR �� _. — -- SlUEiSIIIE STREET_ RW [:i � � C�RESS �s(�g r,.�Z!P" Ct%�CTEL,�rJ�� PROPOSED USE "", � . "'- m CONTRACTCIR C� *�t t l'_. ,�.+-i� ARCH/ENG! � - _� a DESIGNER - w --__ -- NO.DWEL. NO. NO. ci ADDRESS cn — UNITS__ STORIES 8EDROqMS_� � ClTY � ZIP__� 7EL. cn DESCRIPTION S4.FT. FACTOR PSF ADJ.AREANALUATIGIN � OWNER-BUILDER DECLARATIQN � SFRlADD/REM �] i HEREBv AFFItYAt VNDER Fl[NALTV OF pERJUflY THAT I AM EXEMPi FpOM TFVE CONiRA�70R5 LI� G8f398/C3fp01'I W CENSELAWFORTNEFOLIOWINf3REA50N(SEC.]03'.5BUSINES5ANDPROFESSIONSCO�E:ANVCITVQp ((� C.a COUuttWHiCHREOVtRE5APEfiMiTTQCONSiAUGT,AITER.�iPROVE.DEMOIiSH,ORREPAiRaRY5iRi7C. W Pa1ioIDECk TURE,PHIOR 70 ITS iSSUANCE,ALSO REQUIRES THE APP�ICANT fOF SUCH PERI.AIT 70 FILE A SIGNED n��,r 5TATEMENT THAT HE OR 5HE IS LICENSED PURSUANT TO THE pqOVlSlOnls OF TkE CONTRACTORS Ll� � -""' r�, CENSE lAW(CtlAPTER 4(COMMENCING WITN SFCTlQN zcrop)OF OIVISFt7N s Ot'THE 6US�NESS ANO PRO� Po0USP0 � FESSIONSCAUEjORTHATNEONSHEISF%EMPTTHEREFGOMANDTHE9ASI5FORTHEALtECEDExEMV'� (� U TI�N.ANYVIOLATION�FSECTIONT03L56YANYAPPLICANTfOftAPEftMITSUBJEGTSTMEAoaucntt770 Z fte-Roof � ACtYILPENALII'OFNOTMORETHANF7VEHUNORCbDOLLARS(;Sooj.); ...... � ❑I,ASOWNEflOFTHEPROPERTVORMYEMPLOYEE5Vr'ITHWAGESASTNEIRSOLECUMPEN5ATIDN. � GOmR18fGt01 W1LL DO THE WQRK,AlFD THE STRUCTUftE IS 40F INTENDEU Q(i OFFERED FOft SAtE tSEG 7�44,E3USi� J � NESS ANO PROFESSiONS CODE:THE GOYTRACI ONS LICENSE LAW 0C7ES N07 APPLY TO AN O'NNER pF � PROP[RTY WNO 2UILD5 UR IM PROVE5 7MERcON,AND WNU DOES SUCH WOFK HIMSF.LF OR HERSELF Oh � THfiIX,M'H ttiS OR HER OWN EMP�OYcF.S,PROVIDED THAT SllCH IMaROVEA3ENTSARE NOt IMENDEOOti m ' � fSfFERE�FORSALE.IF,HOWEVER,THEBUILDWGORIMPR6VEMENTISSOLDWITHINONEVEAROFC4MPLF� , �„ TION,THE OWNER�BUILDEfl WILI.HAVE THc BUR�EN fJF FlROVING T4AT HE UA SHE DID Nl?T F3UILD Oft -y �MAft4VE F6R THE PUFiPOSE OF SAIE). `T W �71,ASnWNEROFTNEPRf7pERTV,AMEXCLU3NELVCONTRACTINOWITNUGEN5EDCONTNAGTOFS ' (`[ TD CONSTRUCT"NF PROJECT(SEG')ods,BUS�NESS AN�J?ROfE5510N5 CODE'.THE GQNiRAGTQRS�i� Valu2tioti �- �� AQJ.AFEA W CENSE LAW[�ES tJOTAPPLV TOAN OWNER OF A PROPEflTV WHO BVILUS tiH IMPRQYES THEREON AN6 —"—" - I � WNOCONTRACTSFpRSUCHPRS7JECiu"WITHACONTaACTOR(S)LICENSEDPl:RSUANTTOTHECQNTFAC� QUANTITY pE CRIPTION FEE � T�RS IICENSE LAW}. ( � :]I AM E%EMPT UN�ER SFC._�„ __.. _,_�q A PG FOF THIS FEASON Q �'� �` � `' Q � V . � ' .—�� -- —_—— _ � Q � ►i.;s� T ? bATE �`_ _. OWYEft..__„_ .......—_ _._�__ � /• . i � �_....._ � W � • � IJCENSEp CONTRACTQRS DECLARATION� W at Cl_ I HEREBVAFFIRM UNDER PENAl7Y OF PERJURY TMAT I AM I IGENiED UND[R FROVISIQNS OF CHAP7FR � �.,, r �^'� d 4(GflMMENCiNG WiTN SECTiGN T0a?)Of 01Vi310N 30F 7NE BJSlNESS AN�PRQFESSIJNS Ct�OE,AN0 Z ti t� YG MVIICENSE lu IN FULL FPRCEANf)tFFFCT. - W ' �� .- +�r�-�� j + � ItCENSE CLASS_ L�.. �� _....._ LIG.NO.__. � t � .. � _ � "'�. � « �� +� .,..,.. — .. � , r� . . / �' � •� U DATE�...., -.? .._C�l�� CCNTRACT4fi....�j�i.�_. '�C`( � .J � \`•• W � WORKERS'COMPENSATION DECLARATIflN Q � � ' �_.y h . � INERE@VAfFIRMUNUERPENALiYOFPeRJURVONEOFTNEFO'_4.C]WINGDECLPRATbNS: Z � -�� j Gy/ Q rv � IHAVEAN�WILLA�AINTAINACERTIFICATEOFCONSCNTTqSELF�INSUqEFO%WO%KERS' _ 6 'CQMPENSATtON.AS PROVIDED 6Y SECTiON 3Joo OP THE GA80R GY�E F4�TNE PEPF49MANCE U Q OFTHE WO(iN FOR WHICN THIS PERMIT IS ISSUED. � � ".IHAVEANDWILLMAM'TAINWORkERS'C�h7FF"NSAT19NMSURANS:E,ASREOI.'IREIIdYSECTiON •�\ '��i ��'1 . � 77001JF THE IABCJR�OCIE.FOq'fHE PERFORMANCE Of THE WpRN FbR'NHICH THIS PEHMIT IS Y Y i IS:UEE1.AdY WaP,KERS'COMPENSATIA^I INS NCE C�PPoER AND P4�iGY NUMBER ARE COMSTRI}CTIQN ¢ ,�f a+�a --..��ii � )(*� "— - y cnaqi6r3_',�__,�t��l��f'�b�' _ PLANREVIEW �� D 1 �- _....�,- - —' ... � F(ILiCY NUMBER_ t v''� � ,,,�� _ ELECTRIC _ _ ` �� ' Q a {niiSSK:riotaNE¢7Nor8Emds�.ErEoc�n�c`auTiswaauFN�r�oacooa.v�sr,s,ro�oaiess�. PLUMBiNG __, � � -- Z 1 C.ENTIFY THAT M THE PERFOftMANCG OF TNE WOftii F6a Wri1CH iH15 PEFiM1715 i$$UE6,i +�ECHANICAL ` .J�_, (�S SH4LLNOTEM�LOVANYPERSONINANYMANNE350A5106ECOMEiUBJECTTOTHE T �' � WORY4EFl5'COMPENSATION LAWS OF GAIIFUNNIA,AND AGREE THAi IF I SHOULD 9ECOMF INSPECTIDN FEE St77JECT TO THE WURKERS'COAiF'tttSATiON PRflVISiGN3 OF cECTION 3769 OF TNE tA80H ��/'� � CODE,I;iHALLFORTHWITHCOMPLVWITHTNO EPROVI510N5 �SSUANCE _,,,,` ^� �O�W �- jj ��, �� yy ......._ }'�_.._ p DATE:��,_ AAPLtCANT �,L��, SMIP � U —...—.._ ._ WWAANlNG:FAi�VRETO ECVRE WOP,KEftS'COMPENSATION GOYERAGE IS UN N'Ftl�,AN�SHAllBE ENERGY PIC � ,_ W SUBJECTANEMFLOVERTOCRIMINALPENALTIFSAN�CIVILFlNESUPTOONEHUNOREDTH6USAND ENERGVPERMIT � � C10LLARS�f10b,000j,INA�0ITIONTO'HCCOSTOFCQMPENiATION,DAMAGESASGR()VILtEpFORIN — _,�.....--. _ _.! SEGTi6Nsl08UFiNE�ABOftCO(YE,P+7FREST,ANDAi74ANEY5FFE5. RETENTIQNF�E: ��.�-� "!`-- OC --�.—...--- — - a CONSTRUCTION�ENDING AGENCY PRE-AlT FEE� a --- --- � I HEPE9VAFFIRM UVDER PEtvALTY OF p[R�U%Y THA}I-IEflF IS ACONST'F1UC110N Lc'N�ING AGENCv �_ _ _ � FpR 7HG�PEiFi?f1MhNCE OF THE WOfiK fOR W NIGH fHiH PERM,T IS ifi$`JED{SF..".-309T.CIV C.}_ - � W �_.... . ._ Z LENpEfi'S hAME � �'_....A_.�_......_ _.- ' 1 ... . F- IFNDEfl'SADUHESS -'— _ —.. —_ ..._-"...._-_ ._...-___�- . �—_ � TdTALFEES � � w I CEFTIFYTHAT I HAVE�i[AD THIS APPI.IGAfiON FND S1ATE INAT ThIE A60VE INFJRMATION 15 COF%ECT - � !AGftEE`O COMPIY WI'H A1�CITY At�b CAUNiY O}iDtNANf,ES AN-D S`A7�LAWS REI.AL7NG T081i1�piNG .. CONSTRUCTIqN,ANG HEREBY AUTHUHILE REPRESENTATIVES GF T}{IS COUNTV TO ENTER UPOM1 THE /�^� /� ZABOVE-MENTIONEO ROP[NIYFOPINSPECTIONPUR°OSE5 ��(� ( t / � — f 1 ' j C4MMEN 8 �'U t:�' lJ t �� `—..�._ .7•�d'�� l�._ a K � :�� . �i i/.� � IT �- �— �- _ __..—_ ,�_�_ —_—_ — � —_._._ � PERMI7'I'EENAMt(FRINT) �, • � � -� � ,. ` - —' ��......_^.�....._"_"' � - ._ �. ��v-t-�i:G � ��-�--��__._. � � � - Uj SIGNATUf�EOFPE OATE Z RECPTNO ____.,,,,,,__, D[!Y VAUUAT70N , .__ �' WHITE-De>artment Co YELLOW-Finance Co PINK--Assessoi Co GOLDENROL7--File Co GREEN-A licanfs Go F VY� �Y. PY, PY, PP PY �s ' 9- s -ro r r � r �u�� s��. .� ; i e:. � r a n �k � �� . � �� ,�' - �k� - � �� ", .� es�� b ��. _ - a" � � a�L F s� � � $ r � x, � � . .. .,. �.,� . . �.�a . . � . . , . _ ° _. .. .. x, . , �, , � .. �6s ,<.,�r''.��.Y.§,e"�� .€5�hr�. . ,�7.,, � .. .. .. . . .... . .. ._.. . ... .. ...._ ....... �s^,.r .�w^�'sm#�..��°�ea"^:,,"�C*,^�.�:�.��'�=m�.��aG.. ...... ...... .... ..... ,.. ' � . ��,`�r� � _. .... .._ _... . . ._ . .. . . ... . _.. ... _. Y�I� �'�r „� �$��y�� S � � `�'� '+:ti�u �= *��a ,�' �r�"�u��"� _ .. . . . .. .. .. . .. _. ._. -.. .. ... .. ;. -� yi r��'��I �:��ar��1g:��, , � �� a` � °: _ — ��`n?�'� ,�gs��w�� _ _ I a � a�;t 1 �,�-?� � �' � K � � �� H i �-�,�' �G� �� 4 � � �� . . " 4 t�t '��i�s J �„ ��n't# 1S �n ��i . .- .... . .. . _. . .. _ . . ... ._ ... .. ... � � R��,`-4a*��`3�F&'� ...... .. . . .... . . .. . .. . ... .. . ... . . . ... . .. �.. �� a .q F i�" '�i �E,�;��t��'' . - I �� '� `.. . �� H � �� ,;;��y�.�� .� . _ ... _. .... ... . . .. _. _ _. . . .. . . ._ . . ... .. ..... _ . . . ... . . .... .. .. . .. . _. r �� C�� i��"��``�*�� ,a� : yk i �m �, � ,. ��-� c ,� � ; .. _ �� ,,�� _ _ _ _ CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861.3117 BUILDING PERMIT APPLICATION EXPIRED MAY 0 9 2003 PRESS FIRMLY JOBSITE ��(7 ADDRESS G- APN LOT TRACT OWNER K 1 r-, ADDRESS CITY ZIP TEL. APPLICANT TEL. CONTRACTOR$iC ADDRESS„ CITY_t g fs ZIP"C TEL. 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 BUSIN ESS 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 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE A'PPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($500).): ^ I,AS OWNEROF THE 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,BUSK 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) C7 I AM EXEMPT UNDER SEC. 8. &P.0 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. x� e^'/ LICENSE CLASS� LIC N0. DATE NTR Cf CO A OR 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 INS ANC FC A RR IE R AND POLICY NUMBER ARE RI -^'� J I A7�/ I CARRIER �Y a 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 ISIO CODE.I SHALL FORTHWITH COMPLY WITH THO E PPROV Ns, s VI TE PP A DA A LIC NT_/-S_S WARNING: FAILURE T URE WORKERS'COMPENSATION COVERAGE IS UN WFUL,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 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. AGREE TO COMELY 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 ROPERTY FOR INSPECTION PURPOSES / PERMITTEE NAME(PRINT) i--.•- lE OF P1: -- SIGNATUF DATE APPL ICATIII PERMIT 4'1 Ibl P/CO- - NUMB DATE > # }'C ISSUE TYPE OCC DATE CONST GROUP ZONING SETBACKS FRONT RW i REAR II SIDE/SIDE STREET RW SIDE PROPOSED USE N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM CO Garage/Carport W Patio/Deck LL Pool/Spa Z Re-Roof Commercial M Lr Valuation ADJ.AREA QUANTITY DE CRIPTIONN FEE W tC w Z V U Q }y 2 U w CONSTRUCTION PLAN REVIEW D ELECTRIC PLUMBING SID U,A MECHANICAL INSPECTION FEE ISSUANCE��p•� SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES A COMMEN 0-4-V..v T 1 RECPT. NO D BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy