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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
r
PRESS
FIRMLY
JOBSITE
ADDRESS_2888 CRYSTAL RIDGE ROAD
APN LOTParcel BTRACT 47850
OWNER Diamond Bar West, LLC
ADDRESS 3480 Torrance Blvd. Suite 300
CITY Torrance ZIP 90503 TEL. 3IQ-540-399
APPLICANT 3Chard 1.(I TEL.game
CONTRACTOR.JCC.o,s trI_ion
ADDRESS same as Owner
CITY ZIP- TEL.J
ARCH/ENG/
DESIGNER R. Gould&Assoc.
ADDRESS-same as owner
CITY ZIP TEL.
OWNER-BUILDER DECLARATION
I HEREBY AFFIRM TINDER 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 FEPAIR ANY STRUC.
TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
STATEMENT THAT HE OFT 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-
T".ANY VIOLATION OF SECTION 7031.5 AVANT APPLICANT FOIS A PERMIT SUBJECTS THE APPLICANT TO
A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($500)).
0 I,AS OWNER OF THE PROPERTY. OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION,
WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC 7044. BUSI-
NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF
PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR
OFFERED FOR SALE IF,HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE TEAR OF COMPLE-
TION.THE OWNER-BUILDER WILL HAVE THE BURDEN GF PROVING THAT HE OR SHE DID NOT BUILD OR
IMPROVE FOR THE PURPOSE OF SALE).
^ I.AS OWNER OF THE PROPERTY.AM EXCLUSIVELY CONTRACTlNG WITH LICENSED CONTRACTORS
TO CONSTRUCT THE PROJECT(SEC. 7044. BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LI-
CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON AND
WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(SI LICENSED PU RTI)ANT T0.THE CONTRAC-
TORS LICENSE LAW.).
CJ I AM EXEMPT UNDER SEC. B A i'C FOR THIS REASON
DATE_OWNER
LICENSED CONTRACTORS DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED TINDER PROVISION:; OF CHAPTER
9(COMMENCING WITH SECTION 7000)OF DIVISION 30F THE RUS:NESS AND PROFESSIONS CODE.AND
MY LICENSE IS IN FULL FORCE AND EFFECT.
LICENSE CLASS,B LIC NO
DATE - .CONTRA TOR JCC COns true i
WORKERS'COMPENSATION DF CLARA.TION
I HEREBY AFFIRM UNDER PENALTY OF PERIIJRY ONE OF TE Fn[OWING D A A:
I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT'J SFI1,1551.100 O;W I
COMPENSATION AS PROVIDED BY SECTION 3700 (,r HF ARC H C DF FOR 1. IF i�FH INCF_Y
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED
X
I HAVE AND WILL MAINTAIN WORKERS'COMPENSAI ION F-SI ANC A=. II,T"N
0
3700 OF THE LABOF CODE. FOR THE PERFORMANCE 0 HF WOR OH WHIC 1
ISSUED,MY WORKERS'COMPENSATION INSURANCE CARRIER ANC OI ICY NI'AH a AR
Com en
CARRIER Stat�
Oatio in .F.I�nd
0
POLICY NUMBER
(THWSECTlONNCEDt$OTBECOOFMI_ErFDOFTHEPERSI FORONFH RJoR.DCFALAYS 51 A:ORLES'S)
I CERTIFY THAT IN THE PERFORMANCE OF THE WOSK FOR WHICH THIS PERMIT IS LED.I
SHALL NOT EMPLOY ANY PERSON IN ANY MANNER �OAS TO BECOUF SUBJECT TO I HE:
WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHO11.D BECOME
SUBJECT TO THE WORKERS'COMPENSA ON OF SF IN 3.00 CF I.IO OR
CODE.I SHALL FORTHWITH COMPLY WITH THOSF P OJI ON4.
DATE:APPLICANT
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAC.0 IS UNLAWFUL AND SHALL BE
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS(5100.0001,IN ADDI"'ION TO THE COST OF COMPRN�,ATION,DAMAf:FS AS PROVIDE] FOR IN
SECTION 3708 OF THE LABOFI CODE,INTEREST AND ATTORNEY"i FEES
CONSTPIJCTION LENDING AGENCY
I HEREBYAFFIRM UNDER PENALTY OF PERJURY THAT THER-IS A CONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PP RMIT I�: ISSUED(SEC. 3097.CIV.C
LENDER'S NAME
LENDER'S ADDRESS
I CERTIFY THAT I HAVE READ"HIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT
AGREE TO COMPLY WITH ALL CITY ANTI COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
ABO-MENTIONED PROPERTY FOR INSPECTION PURPOSES
P MITTFEA,NAME P WT EE DATE
APPLICATION PERMIT I P/C\
DATE NUMBER
ISSUE TYPE OCC
DATE CONST. GROUP
ZONING SETBACKS
FRONT RW
REAR
SIDE/SIDE STREET RW LI
SIDE
PROPOSED USE New single family
residence
with attached gZT ge
N0. DWEL. N0. N0.
UNITS 1 STORIES 2 BEDROOMS 5
DESCRIPTION SQ. FT. FACTOR PSF AD AREAIVALUATION
SFR/ADD/REM 6731 U L
Garage/Carport 1270 \, a
LU Patio/Deck Bal 199 '
S'
.1
U- Pool/Spa
Z Re-Roof
Commercial
5 Porch 138 _
�
Valuation ADJ.AREA
QUANTITY DESCRIPTION FEE
J
L
i
L
W
Z
1
J -
- JUN 0 W
1
J
T
Q L
z = Y..
LUI
CONSTRUCTION
PLAN REVIEW
II ELECTRIC
PLUMBING
MECHANICAL !�t r^
INSPECTION FEE _
T
ISSUANCE �T
SMIP �
r
ENERGY P/C
ENERGY PERMIT
RETENTION FEE:
PRE-ALT FEE:
TOTAL FEE S 0
COMMENTS
RECPT N0._ PAID BY VALIDATION
WHITE-DA02rtnSRDt Cope,YELLOW-Finance Cooy,PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy
FLOOR. G�' ;' �T 1
FHA�'� , �
.�,�.. �1C�
CITY OF DIAMOND BAR
INSPECTION RECORD
DATE INSPECTt7R INSPECTlON QATE INSPECTpR
ti