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Home My WebLink About18389 �.. CITY OF DIAMOND BAR �i,� ' � � , � DEPARTMENT OF COMMUNTI'Y&I7BVELOPMENT SE � Y>>� ;� 21825 E.Copley Drive x (909)860-3195 Faat(904)861-3117 PRESS '%w��`� BUILDING PERMIT APPLICA'TIdN FIRM�Y � A4 RIESS��GI `� C-'I' �LJ�17f �'[r�,�/'�� DAPEICATION ��'tlnl NU BER_�� !C Q�.��- � �— ISSUE TYPE OCC APN �'JT�C� TRACT �� S� DATE � - CONST. GROUP p OWNER �/'.� c�.- � ADqRE5T�5�^�.��,, �h��/ �_(.�'j�� ss�f„� ZONING SETBACKS � CITY��1�!�j'"'__ Z#P�„j'�/.��TEI��.�"1G> .i'�S' FRONT RW ❑ APPLICANT � TEL. REAR � z SIDEtS1QE STREET RW ❑ Q GONTRACFOR� ,�f �� i,y,y� SIDE � _�!��C+/�� ADpRE5S � � CITY�-7 1�'v 21F�f/71�� TEL.�l.�'(a>G'i�F�?.Z� pROPCtSED USE � ARCHlENG/ -- z DESIGNER � ADDRESS `� NO.DWEL. NQ. NO. � CITY ZIP TEL. �N1TS STC}RiES BEpA00MS �? —' DESCRIPTIQN S�.FT. FACTOR PSF ADJ.AREANALUATtON � OWNER-BUILDER DECLARATION SfFUADDtREM "U I HERE6V AFFIPM UNDER PENALTV OF pERJI:flV THAT I AM EXEMPT FROM THE CON7RACT17R5 LI� G21"998/Cefp01'I tLi CENSEtAWFORTNEF��UWiNGREASON{SEC.703tSBUSiNESSANDPRQfESSK}NSfbDE:ANYCIFYQR (f� WU COUNTYWHICHRECtUIRESA7ERMITTOCANSTRUCT,AITER,IMPqOVE.DEMOU5H2ORREPAIRANYSTRUG W PdUO/D6CI( � 7URL,PFiIOR TO ITS ISSUANCE.AL50 qEOUIRES THE APpLICANT FOR SUCH PERMIT TO FILE A SIGNEO � i ,� STATEMENT THAT HE OR SHE IS I�CENSEO PVRSUANT TO P.iE Ppp1rySIONS OF THE CONTRACTbRS LI- � . .� CENSE LAW�CHAPTER 9�COMMENCINtl WITH SECTION�000)OF DIVISION 3 OF TH6 6USINESS AN�PRO. V' POOUSPB Q fE55k7N5COQE)ORTHATHEQRSHEISE%EMPTTHEREFROMANDFHEBASIufOATHEALLEGEDEXEMP�� U TiON,ANYVIOtATiONOFSF:CTipNJo37.58vpNYAPPIiCANTFOqAPERMiT5U9JECT5TyEpPPtiCANTTp Z Re-Roof A CIVIL PENALN OF NOT MORE THAN FNE HIINDRED D044AR5(x5oo�.): Q ('7i.ASOWHEftOiTNEPROPEfitt,ORMYElNF{.OYEESWITHWAGESASTNEift5GHECOMPEN5ATfON, 0 �ommerwial ,-s� WILL p0 7HE woAK,AND THE STRUCTURE IS NOT INTENO'eD OR OFFEFED FOR SALE i�EC.7odi,BUSi� J � NESS AND PqOFESSIONg CODE:THE CONTRACTORS�ICENSE LAW DOES NOT APPLY TO AN OWNER OF = PF�P�R7Y WHfl BUIIOS Ott IMRAOVES THEqEON,At,�WHO DOES SUCN WORK HIMSELF 6fl HERSELF OR � THROUGH NIS OR HEROWIJ EMPLOVEES,PROVIDEp THAT SUCH IMPFOVEM�NTSAqF NOT IMENbEDOR m "" Q QFFEREDFORSPLE.IF,HOWEYER,THE9VILDWGQRIMPROYEMFNTIS54LDWITHINONE`/EAROFGOMPLF� 2 TION,iME GWNER-BUILpEIi iMtt HAYE THE BUR�EN QF PROVING THAT HE OR SHE OID NOi 9UICD OR = IMPHOVE FORTME PUHPOSE OF SAIE). (y� CII.ASOWNEROF7NI_PRQPERTY.AMEXGLu51VELYCONTRAGTVNGW17NtiGEN5EDCQNTRACTORS � 70 CANSTRUCT THE PROJECT(SEC.JOad,9USMESS ANp PROfE55�ON5 CUDE:THE CONTPAG70R5�i� VflIU8i1Df1 ADJ.AREA W CENSEUWDOESNOTAPFLVi4ANOWNER4FAPROPERTVWNOBUILD50RIMPROVESTHEftEON,AND — � WNC�C6NfRACTSF4R5U{;HFRAIEGT5WtTHACON7RACTOR{S}(,��ENSEDPURSI3ANTTOTHEG4NTRAC- OUANTITY QESCRIPTION � TORS LICENSf LAW.�. FEE Q ❑tAM E%EMPT tFFOER SEC. ,._ p.8 P.C.FOR THIS REASQN Q � � U � oarE_ —owHeR_ � f � Z � _.. U . J.� � llCEN5E0 CONTRRCTORS DECLARATION W s �� ~a W � `....+iE 2 y' CY I HER£BY AFFiRM UNQER PENAI.TY OF PER1tiftY THAT i AM L�ENSE�UNDER pRQVi$pNS OF CHtPTFfl � y � B�COMMENCINGWITHSECTION]000)OFDIVISION80FTHEBUSINFS5ANDPROFESSIONSCODEAND Z - ,�GZ - �,�� MY LICENSE IS IN FULL F NCE AND ECfECT. m � IY�''�'S GS'�aA /i'�'7+e' f' �� p LICENSE CLASS�,�_��,_, LIC.NO._�„_ � �'1 Z / � U DATE ,_ CONTRACTOR��`� a � ..�� f!:!Z � N+ORKERS'COMPENSATION DECLARATIpN � �S �' O = a � yi J � � 1 HEREBYAFKiRM UNDEfl�'ENAITY OF PEH.lURY ONE OF TNE FCIIOWiNC DECIAflATI6N5: U J � Z � f �+f/�� / � ' � _i HAYE AM1�}Wilt AiAiNTAiN A CERTIFICATE dF CONSEHT T4 SEi.i-�NS�1RE FOR WOHKEft5 = � {� �J �� 4 COMOENSATION,NS 7pOVIDED BY SFCTION 310o OF THE LABOR CODE,FOR THE PERFORMANCE U OF THE WOqN FOR WHIGM THI5 PEitM1T IS ISSUEp. w � � s�'a �i'�/t.. �`c 1� � QW _I HAVE AND WIIL MAIN7AIN WQRKERS'GOMVENSATION INSURANGE,AS REOUIRED BV SECTION `��'�-'L- 3To00F TNE tA9C�fl CADE.FOR TH�PERfORidANCE 4F THE WOAX FQA WHICH THIS PERMiT IS ISSUED.MV WOqY.ERS'COMPENSATION INSURANCE CARRIER AND PCUCY NUMBERARE; CONSTRUCTION J -. ..__ j cARaiEA�-�.�f-�L� PL,Ay REVtEW z POLICVNUMB[R JZ`'I � 2.t1 ' _____ ELF_CTRIC q ..... _.__ ._ � RFIISSEC110NNEE�NOTBEOOMREt�DOFTHEPER,WT15FORONEHUND1iEDDCN.tARS(5100)ppLE&:r). PLIJMBING �� - --�--- � — Z I C6RTIFY TFIAT IM THE PERFORMANCE OF?HE WqRK FOR WHICHTNIS PERMIT IS ISSUEO,I MECHANICAI CJ SHAIL NOT EMPLOY AN�PER30N IN aNV MANNER SO AS TO fiF.COME SUBJECT TO THE � (J} WL}RKER5'COMPENSAi40N LAWS�t'CAtiFORN�A,AND AGAEE iHAT�F I SH6ULQ BECQME (N,cr,PEGTION FEE = SUBJEGT1'O THE VJORKERS'COMP�NSATION PRpVISIONS OF$ECTIqN 3]OOOFTHE LA80R t��__ C4DE,i SHqLL tC�fiTNWiTHCqMPLY WITH T OSE PROVI$INJS. ISSUANCE Q J p DATE: ,__ APP4ICANT: �IZ�Y"� I�f%"�Y"��/ff SMIP W --.. ____ ..— 'J WAflNING:FAIIURE TO SF;CUflE WORKERS'COMP6NSATION COVERAGE IS UNLAWFUL,AND SHAI..L 9E ENERGY P/C � _� � SUBJEGT AN EMPI.OYER't0 CftIMlNAI PENAlTIESANQ CIYLL FlNE6 UP TO ONE HUNDRED THOUSANO ENERGY PERMIT I OOLtAFS(5700,000).MAi)�ITIONTO THE CO5TQ��COMPENSATION,OAMAGES AS PROVIDED F�R W � SEC710N 3I08 OF THE LABOR CODE,WTEFEST,AND ATTORNEV'8 FEES. RETEM�ION FEE: v QCONSTRUCTION LEN�ING AGENCY PRE-ALT FEE: ___ _ i � i HER£BY A�FIRM UNDEP PENA�TY�F PER/UPY THAT Tt{ERE�S A C�NSTRUCTiON l6NDiNG AGENCY FORTHE PEflFORMANCE OFTME WOHK FOR WH��Gi THIu PERMIT IS I$SUED(SEC.808�,CIV.C.). "" �-'— � -- Z W j LENOER'SNAME .._^,.._ ......_ _...... � .. � � __ F- LENpER'SApDRESS � _ __. � _ w i GERTIFY iHAT I HAVE R=AD THIS APPLICATION ANO STATE TNATTHE AF30VE INFORMATI6N IS CbRRFC7. T11TAl. FE EL7 -9�[ � I AGFEE TU COMPLY WITM ALLCITY AND COUNTY ORDINANCES AND STATE I.A.WS RELATING TO 6UILDING {/r� � � CONSTftUCTiON,AND Mt.HEBYAUTHOftiZE REPRFSENTATNES OF THIS COUNTY TO ENTER UP�N THE z A60VE�MENTIONFO PRCVeftiY FOR INS>ECTION PURP05ES. COMMENTS /� __ .' � ,/��r'b,�� i..� �F-c ��[-X .... _ _ -__ _ � P£ftMiTfEEti {PRINtj � Q _. _.. �n tk..�•� C.+_ ,."�. Vy StGNATUREOFPERMiTt DATE � RECPT.NQ �� PAIp BY � VALIDATION_w„ WHITE-Department Copy,YFLLQW-Finance Copy.PINK-Assessor COpy,GOLOENROD-Fiie Copy,GREEN-AppiicanYs Copy �� Pa u; r ` � I r ��-'�-a „�E ' 'a-� �+ a �?�'-�`�,�' �*��'�,� ��;ew� ��-� �".� , ,�� ;. .. . i , , . , �� r�.,�,��' .,'��„e u��. .t �� ;c�:,� � .. .� . ,. _ , �, _ .� .» , . � � .. ��s'� ,r�—.�,. _ � _ �#��G��- �j''� ��"��, � .-, �:, �� _,� _ _ . � � , . 9 � �� . o� �a� : _��«. .� �_ _ � _ t , _ .� F ,� � �� ! � , �� a��,� _ �� : ��'�.�� '��"a"�,��; _ , � � � � G ��r�� ,�� . � ��.� ;. .�,�r ��;�a�� . , : �,�� _ _ _ _ �,� f � � � tifi t � ' �E � ��f ��' w� ��w�,�;, �ey '� , s �^� _ . � � �tir' � ...'. ��u�5 r .� , 3 v k2 ( ., , � �� . .. .. ... . ... . . .. ... . .. - . .. ... �, � .. .__ . . . . . . ..�, �� .�, �i��Y_tW�"..5" � '. s � ` sc � 1 t ( ' , .' ." "` '_�€ h 'I�.3,,'%"(�;"i _... .. .... . .... . ... .. .. ... . .... ... _ .._. . ... . ....... .... . . iBM CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SE 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION P PRESS FIRMLY -1 71 1 ADDRESS A APN LOT 0 TRACT OWNER .- ADDRESS H SI&'2.Vnt CITY�-ZIP 4 U TEL/J APPLICANT TEL. CONTRACTOR--_;I ADDRESS 04 J/V/ 14R/i/A CITYL7/w ZIP'//Zjkl TEL I(aG7�ls9 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 FORTHE FOLLOWING REASON(SEC. 7031.5 BUSINESS 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 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 CONTRACTING 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 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL F RCE AND EFFECT LICENSE CLASS�� LIC. N0. ^Z 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, NS 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 �'f: / POLICY NUMBER/2-7 6 Z.. (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 50 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 TTHOSEE PRROVISIONS. �/ DATE:_APPLICANT:/i oa�c/M r��JM 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. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS ACONSTRUCTION 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 INSPECTION PURPOSES. Yl l k/�v DQN PERMITTEE N"yy(PRINT)/J,,., SIGNATURE OF PERMIT! DATE APPLICATION (\, 'I� hnl PERMIT Rn Vl P/C DATE NUMBER# 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 SQ. FT. FACTOR PSF ADJ.AREANALUATION SFR/ADD/REM Garage/Carport L11 Patio/Deck 'R LL Pool/Spa V Z Re-Roof 0 Commercial D E Valuation ADJ.AREA QUANTITY DESCRIPTION FEE Q s -76 0 LU W t) d L=L- 14 vt !� m G�.. Irt-�-J 7 6S yy /0. 1 ls 0 ° y_ Qf Lv��,, = I o so u) , CONSTRUCTION 3 PLAN REVIEW ELECTRIC PLUMBING--- MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES 9,3(� COMMENTS RECPT. N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy