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Home My WebLink About18809 �.,p��t C(� � CITY OF DIAMOND BAR \ " `-'� �� ! DEPARTME�e'T OF COMMUNTfY�bEVELOPMENT SERVICES � ! I�� 21825 E.Copley Drive � (909)860-3195 Fax(909)861-3117 PRESS �' '�� BUILDINGPERMITAPPLIC�ATION FIRMLY � JOBSITE - f � � APPLICATION •-o PERMIT G�(� P/C o ADDRESS �'� �S L \ � — OATE G�'�NUMBER I 0 �+ p � =�', t ��. l ISSUE TYPE OCC APN LOT v �jRACT�/e.� DATE CONST. GROUP p OWNER �i��w �iv�Z� EJO.�., ( `•S� L.� C o ADDRESS ��`t`.'a C� � c�'�T�� t'1 t'� ZONING SETBACKS OCITY 'f�'f'��'/11��i�i ZIP��'S7EL�lt1.��3�%�I� FRONT Ryy � APPLICANT TEL._ REAR � z SIDE/SIDE STREET RW ❑_ Q CONTRACTOR_=� ti—�i "'L.Lr'_�1"l �- -- SIDE � ADDRESS +' : - � i•> � ' o CITY��ry � ZIP�1 7�1 S L `L lt`jr',`� g,t� PROPOSED USE w ARCH1ENGl --� � � � � l�� z DESIGNER � C-�--I {� � 4-....... — a ADDRESS�7S L` �y��Qp ,�[� �,�!�'� - NO.DWEL. NO. ryp. � CITY ZIP TFL. UNITS STORIES BEDFi00MS � - � D SCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER•BUILDER DECLARATION SFR/ADD/REM � O 0 I HEREBV AFFIRM UN�ER PENAIN OF GEFiJUPV THAT I AM E%EMPT FROM iHE CONTRACTOP$LI� W CENSELAWFORTHE�OLLOWMGREASON(SEC.7o3t.5BUS�NE55ANOF9VFESSIONSrODE'.ANYqTVOR � GaragelCarport U CAUNTYN7iICMREOI:IRESAPERMITTOCONSTRUCT,ALTER,IMPROVEDEMOLISM,DRREPAIRANYSTRUC- W Py[IOIOBCI( w TURE,DRIOH TO ITS ISSUANCE,AL50 REQUIqES THE APP�ICANT fOR SUCH 7ERMIT TO FILE A SICNFD W � ST�TEMENT THAT HE OR SHE IS:ICENSE�PURSUANT TO TNE PROVISIONS OF'HE CONTRACTORS LI� LL .� CENSE LAW(CHAPTEF e(COMMENCING WITN SECrION 7000�OF DIVISION 3(lF 7HE BUSINESS AN�PRO� POOVSPO 0 FESSIONSCODE)ORrHATH�ORSHEISEXEMPTTHF_qEFROMANOTHEeA515FORTHEALLE0E0E%EMP� (� U TION,0.NYVIOLATIONOi5EC110N7037.5BYANYAVPUf.AN�FORA7ERMIT5U9JEGlSfHEAPP�ICANTTO Z Re-Roof � � A pVIL PENALTY OF NDT MOR'=THAN FIVE HUNORED DOLURS�f5oo).��. Q ❑tASOWNEROFTHEPLIOPEFTV,ORMYEMPLOYEESWiTHWnGE5A5THEIWSOLECOMPEN54�tG�1, � CORIl710lC181 Z WILL DO THE WORK AND THE STRVCiUFlE IS NOT INTENDLD OR OFFEREU FOq SALF!SEC.70«,BUFI� J � NESS ANU PROfE5510NS CODE THE CONTRRCTORS IICENSE LAW 00'eS NO�APoiY TO AN OWNER OF PROPERTYNMOBVILOSORIM�FOVESTHEftEON,ANOWHODOE55uCHNiORK/+IMSELFORMFRSELFOR � � iHROUCHHISORHEROWNEIAPLOYEES,PROVIDE�h/ATSUCHIMPROVEMENTSARFNOTMTENOEDOR m Q OFfERE�FORSALE.IF.HOWEVER,TMEBUILDINGORIMPROVEMENTISSOLDwITH1uoNEVEAROFCOMPIE� Z TION,THE OWNEF:BUIL�ER WILL MAVE THE BURDEN OF PFOVING`HAT HE OR SHE DID NOT�UILD OR � IMPROVEFORTNEPURPOSEOFSALE). w ❑I.ASOWNEROFTHEPiiOVERTY.AMEXCLUSNfLYCC�NTRACTINGWITHIICENSEDCANTftACTUHS [[ TO CANSTRUCT THE PRQIECT(5EG JOl1,BUSINESS AND PROFESSIONS cooe:rne coNrHacrons u- Valuation ' ADJ.AREA W CENSEUIWDOESNOTAPPLV'fOANOWNEROFAPROPERTYWNOdUIID50RIMVROVESTHEREON,AND - � WFIOCONTRACTSFOqSUCHPRQIECTSWiTNACONTMCTOq(51!IGEtvS[OPUHSUANT70THECONTRAC- QUANTITY DESCRIPTION FEE Y TORS LICF.NSE LAW.). � OIAMEXEMPTVNDERSEC. _____B.dP.0 FORTNISREASON Q �� ,r',►l� � yY y�. (�,�� '�-� � v_ , � ,� --- --- ¢ Za'�- �. Z,.;t-- _j, �- �ATE OWNER F- � LICENSED CONTRACTORS DECLARATION � � t �L�'�� Q W� L� "1 �I U � I HERE9V AFFIRIU UNJER PENA�TY OF PERJURY LNAT 1 AM IIGENSED UNOER PROVISKNJS 6F CNAPTER � � d 9�COMMENCING WITH SECTIOnI loW)OF DiV151oN 3 UF THE BUSMESS AND PPOFESSiONS CODE,AND Z `X MV UCENSE IS W FUIL FORCE AND EFFECI. m � LICENSE CL4S5 �r��.,.5__ LIC.NO. ��I! L'�C- � �/ '�• J V �A7E Lr� � / D r CONTR/1CTOR� t�f'�i� `� \� n. W � WORICERS'COMPENSATION DECLARATION a � I HEAE@V qFFIRM UNDER PENAI.TV OF PERJURY ONE OF THE FOLLOWING DECLARATIONS. Z _ a Z _I HAVE AND WILL AAAINTAIN A CERTIFICATE OF CONSENT�O SELF-iNSURE F�R WORK[RS' _ ¢ CAMFENSAiION,AS PROVI�ED BV SEC710N 310D OF TNE LABOR CO�E,FOR TNE PERFORMANCE `U Q OF THE WORN FOR WHP�H TMIS PERMIT IS ISSUEO. � w �I HRVE AND WILL MAINT/UN WORKERS'COMPENSATIDN INSUFANC'c.AS REOl11RED BV SECTION Q 3700OF THE LAOOR COI)F.FOFTHE PERGOFMANCE OFTHE WORK F�A WH!GH THIS PENMII IS ISSIIED AIV WORKE{j5'iAM�NSATION INSURANCE�ARRIERAND POLICY NUMBERARE' CONSTRUCTION J �► — j caaa�ea -._)�r�� '� PLAN REVIEW 0 POLICV NUMBER_�,�1 �� 'Ye+�T �Z� --L-'_� __- ELECTRIC Z ,-.. Q � (iHISSECTIONNEmNOTElEO7MPLEfEDOF1HE7ERAYTISFOFONEHUNDRED�ILARS(E100)OqLE55�. PLUMBING _ Z I CER7IFV THAT M THE PEflFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL C� SHALL N07 EMPLOYANV'PEASON IN ANY MANNEF SOHS TO BECOME SUBJECT 70 THE (n WORKERS'COMPENSAT�ONLAWSO�CAL�FORNIA,ANDAGREETNATiFISHOULDOECtIME INS?ECTIONFEE _ � SVBJECT TO THE WORKLRS'COM7ENSATION PROVISIpNSOF SECTION 3]Ua OF THE LABOR - GOOE,I SHALL ORTHWITH GOMPLV WITH THOSE PROVI 5 ISSUANCE O ['� DATE: �� - 11PPLICANT � �� 7,��- SMIP _ . � WARNING�F�IIURE TOSECURF 1NORKERS'GOMPENS ION COVERAGE IS UNLAWFUI,AND SHALL BE ENERGY P/G . � SUOJECT AN EMPLOYEfi TO CflINIINAL PENALTIES A CIVIL FINES'JP TOONE HLINOREO 7H0'JSAND ENEFGV PERMIT } DOLLARS(Stoo,cwj,1N nWITiOh TOTHE COST OF COMPENSATION.DAMnf:FS AS PROVIDE�FOR iN -- .. � SEGiION 3)CB OF THE'_ABOR CODE,INTEREST.PNO ATTORNEY'S FEES. qETENTION FEE: � d GGNSTRUCTION LENDING AGENCY PREALT FEE: � O � I HEREBY qFF1qM UNpER PENAL'v OF VEf1JURY TNAT THEPE IS A CONSTaUCTION LEYDING AGENCY _ _ FORTHE PERFOqMANC[Of TIIE WOFK FOR WHIGH TNIS PERMIT IS ISSUE��SEC.309�,CIV C.�. Z W -_ j LENDEF'S NAME _ ____ _.. � F- LENDER'SA�DRESS y � !CERTIFY�NATIHAYEREADTNI�,APPLIGA�IUNAN�STATETHATTMEABOVEMFORMATIONiSCORRECT TOTAL FEES /--) //j� R� w I AGREE TO COMPLY WITM AL:CI-�y qN�GOUNTV ORDINANCES ANO STATE IAWS RFI ATIN.TO 9UILDING �,/ vJ�V a � CONSTRUCTION,ANO HERE9Y AI,THOFRE REPRESENTATIVES OF THIS COUNTV TO ENTER UPUN'NE Z /�80VE-MENTIGNF.DPRDPERTVfORINSPECTIONPURPO5E5- �� COMMENTS p +�r�-Y•� '�a � • ' �' �•� � �- � — ¢ PENMITTEE ME(PRINT) � � � �, gy_,��-� � (j.�i ,�L� ; `t �� , g � SI l�q�' F PE:HIAITTEE OATE = RECP?.NQ _ PAID BY VALIDATION� ~ . WHITE-De ar,ment Gc YELLOW-Fnance CoDY�P�NK-Assessor Co GOLDENROD-File Co GREEN-AppllcanCs Copy P PY, PY� PY. ��, �� _ ,. �' " r� A t>� =�mt,��37�s .,�,,`}r � �f "�'; :.�„�, � � ��+'�� r� ,. _ ;� .� �- � � � ;�� v,� �F� ��s��„ �� ! d . � . _ _ i . � � � � � 'ic-�?� � � . �; __ � s� �>�- f��`_`�� ;.��:. .� � :�� i ��,.� _ _ _ _ _ . _ _ __ _ ; � __ __ , � ,� �,��, � .�r�� __ _� � � , . . . , x _� .� �� _ _ _ _ 1� .,�.f:°��;�� . � � � _ � ��5, , , _ _ _ � . �� , , �� . � , . .v �� . �� p (i% dm CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION J PRESS JOBSITE r f i% APPLICATIO/9,H PERMIT P/C ADDRESS_")S L{\- DATE"-NUMBER J APN LOT RACT/r' ') # ISSUE TYPE OCC --j = , DATE CONST.GROUP OWNER it rl LIL-C ADDRESS-' r t i'I fA'(f- 1 %'j„ ZONING SETBACKS CITY-/Iii�d'/ZIP Sk_tSti3TEL_21 Z!�(V FRONT RW^ APPLICANT TEL REAR^ SIDE/SIDE STREET RW^ CONTRACTOR SIDE^ ADDRESS I,-�C4-1 f CITY 7 JIL ZIP 71 i L. L PROPOSED USE ARCH/ENG/7-> 1 Ly DESIGNER � { N S�4--•.- N0. DWEL. N0. N0. ADDRESSV• [_ CITY ZIP TEL. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION OWNER-BUILDER DECLARATION SFH/ADD/REM Ga ra I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI ort e/Car CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESSAND PROFESSIONS CODE.ANY CITY OR (n 9 P COUNTY WHICH REOUIRESA PERMITTO CONSTRUGT,ALTER,IMPROVE,DEMOLISH,OR REPAIRANY STRUC- W Patio/Deck TORE, 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 PROVI Iii IO FT S NS 0 LL HE CONTRACTORS LI- CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- 0 PooVSpa 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 Z Re-Root A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($500)). ^I.AS OWNER OF THE PROPERTY,OR MV EMPLOYEES WITH WAGES AS IHEIR SOLE COMPENSATION, 0 Commercial WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC 7044. BUSI- J NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF P PE RO RTY WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES PROVIDED THAT SUCH IMPROVEME S N NT ARE OT INTENDED OR OFFERED FOR SALE. IF. HOWEVER,THE BUILDING OR IMPROVEMENT IS SOLD W ITHIN 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). LI I AS OWNER OF THE PROPERTY AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS Valuation ADJ � AREA 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 ACONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- QUANTITY DESCRIPTION E TORS LICENSE LAW) FE U < Cc c,1 -I'w'y i_ I AM EXEMPT UNDER SI:C. B A P.C. FOR THIS REASON F ze Lam L4'Jam. Ct DATE OWNER W ,e 4 LICENSED CONTRACTORS DECLARATION LLI ,y I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT(AM LICENSED UNDER PROVISIONS OF CHAPTER z D 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MV LICENSE IS IN FULL FORCE AND EFFECT, ,g �p L/G 22 LICENSE CLASS LIC N0. L' DATE C J 3k4d ONTRACTOR S j WORKERS'COMPENSATION DECLARATION Q I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: U -I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT-,0 SELF-INSURE FOR WORKERS' COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE C) .J/OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, w 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'COMf�ENSATION INSURANCE CONSTRUCTION ARRIER AND POLICY NUMBER ARE' C CARRIER PLAN REVIEW POLICY NUMBER ELECTRIC (THISSECTION NEED NOT BE OOMPLETEDOF THE PERMIFT IS FOR ONE HUWREDDOLLARS(5100)OR LESS) PLUMBING I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I M ECHANICAL SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE INSPECTION FEE 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 ORTHWITH COMPLY WITH THOSE ISSUANCE PROVI9160 S. Q SMIP DATE APPLICANT: �-. -- WARNING FAILURE TO SECURE WORKERS'COMPEN ENERGY P/C_ ION COVERAGE IS UNLAWFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES ANO CIVIL FINES UP 10 ONE HUNDRED THOUSAND ENERGY PERMIT 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. RETENTION FEE: CONSTRUCTION LENDING AGENCY PRE-ALT FEE: 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'SADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT TOTAL FEES 5 0 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. COMMENTS /r PERMITTEE ME //' T) RII N ��P /A � 9 SI UR F PERMITTEE DATE RECPT N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy DIAMOND DA W