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Home My WebLink About17148 t 1,E.,,,�,. c1�oF D�arrD gAx � ; � � DEPARTMENT t3F'COM[M[.T2�TI"i'Y&DEVELQPMENT SERVICB3 �,� 21825 E.Copley Driva ,�-''� �'�� '1 . �' C9o�>s6o-��i�sFax�so9>s�i-��r� � � �� PRESS �'%��' BUILDIIVG PERMIT APPLICATION FIRMLY � JOBSITE APPLIGAT��NUMBER �' � #j� a ADDRESS�� P� �(d.,i4..� �� DATE � —' IS5UE TYPE OCC � APN LOT TRACT__ DATE CQNST. � GROUP p OWNER _ L�`�� _ a ADDR S z?i G�s�� ' t�"� t�?�_/�.��`��_ ZONING SETBACKS Z C1TY� ti ,�_i¢�, ZIP�J77�,s TEL. FRONT RW ❑ g APPLICANT i��l ("f�=^C.=�, n�4 _ �"�__' 7Q�-dy,p' REAR _ ,� z T SIDElSIDE STREET RW U Q CON7RACTOR�c?� Ayp�L`/c. �'y/�_ SIDE � � ADDRE ,S G'cr G"3C _..1 1_��r ur L� a C{TY �_�_�,1��i�__ ZfP�"��_ TEL d'/� " PROPOSED USE w ARCWENG/ ,.;�t y�—,f'�`�'7 `A- z DES�GNER � n - G� ` u+ NO.DWEL. p. ,,,,, a ADDRESS � cn UNITS _ STOR��' �4— ED O MS � G�TY ZIP TEL._ � DESCRIPTIC?N SQ.FT. FACTC7R PSF ADJ.AREANALUATION p� OWNER•BUIL6ER DEGLARATiON p SFR/ADdlREM t HEREflY AFFIRM tlNO'cH PENALiY OF PEflJUflY THAT 1 hM EXEMFT FROM THE C.4NTRACTQqS LI� �`ara je/Car(�({ W CENSELAWFORTHEFbLLOWINGREA50N(SEC.7031.SBU5ME53ANDPROFE6SipNSCWE:ANVGTVOR (� �..� COUNTVWHICHREOUIRESAPERMI7TpCONSTRUCT,A�TEH,IMPROVE,DEM4LI5H2OR(7EPA�RANVSTRUC. � TVPE,PRIOR TO iT5 iSSUANCE.ALS6 REOUIPES TNE AFPLICANi Fqft SUGN PERMVi TO FILE A SIGNED W Patio/peck .�,r STATEMEPiT THAT HE OR SHE I5 LICENSED Pt/RSUAM1T Tb 7NE PRCIV4SIQN5 OF 7HE GONTAACTORS Ll- .� CENSE LAW{GHAPTER 9{COMMENCING WITN SECTION 7000)OF DIVISION 8 OF THE 6U91NESS AND PRO� �'�' PooUSpa � FESSpNS CODE)Ofl THAT HE OR SHE IS EXEMG7 THEREFROM AND THE BASIS FOF THE ALLEGk�EXEMP� (� � TiON.ANVVIOUTipNpFSEC7iONTo3i.5&YANVAPPLiCAtJTFORARFRMiTSU3.lECTSTH£APPLiCAN(7U Z Re-Rovf � AGfVi�PENALTY OF NOT MflHE TNAN f1Yp HUN�RED DOUARS{55oR).j�. p �I.ASqWNEROFTHEPROPERTY,ORMVEMPLOYEE9WITNWAGESASTNEIR50LECOMPENSFTION, � Commercial Z WILL p0 TH6 WqRK,AND THE STAUCTURE IS NOT IMENOED OR OFFERE6 FOR SALE(SeC.'l044,BUSI- J � NESS ANp 7ROFESSIbN5 CODE:7HE CONTAAC70R5�IGENSE�AW DOES NbT APFtY TQ AN OWNER Of PROPERTYWHOBUILDSQRIMPqQVESTliEAEON,MlDW1#OPOESSUCMWORKHIMSLLFORH6RSELFOR a C.L THROUOII HIS OR HER OWN EMPLOVEES,PROVIDEp THqT SUCH IMPROVEMENTS AflE NOT INTENOEp OR � � OFFEREOFDRSALE.IF,HOWEVEP,THEBUILDWGORIMPROVEMENTISSQIOWiTHiNONEYEAROFCOMGLE- � FiqN,THE OWNER�BUILO[F{WI(,l NAVE THE 8UR0[N QF PRqYiNG T�fAT HE UR SHE OID NOT BUILU OR = IMPROVEWRTHEPUftPO5EOF5ALE). W 17 I.AS OWNER OF THE PROPERTY.AM EXCLUSIVELY CONTRACTWG 1MTH LICENSED CONTRAGiORS (r TO CQNSTRUCT iHE PHOJcCT(SEC.ioa4,BUS4NES5 AND PROFESS�OMS fADE:THE C4N7flAGTQRS LL Va�U221�li AQI.AREA WT CENSELAW06E5(+IOTAPPLYTOANOWNEftOFAPftOPERTVWHOBU1lDSORIMPfjpYESTHEREl7N,ANp —— � WNOCONTqACTSFORSUCHPpOJECTSWITMPCONTNnCTOR(5)LICEN5EpPURSUANTT07HECONTRAG OUANTITY DESCRIPTION � TORSLICENSEI_AW). FEE p ❑i AM EXGMPT UNDER SEC. _ @.6 P.C.FOR TNIS REASQN d C� i/,../ � U ZDATE __—.,� OWNER � '�—� LiCENSEp CONTRACTORS OECIARATiqN W ¢ CL 1 HERE9YAFFIRM UNOER PENAI.TY OF PERJURV TMAT I AM LICEMSED UNDEfI PROVISIONS OF CHAPTER [,L 9(COMMENCING WITN SEI:TION7000)OF DIVISIpN 30F THE BUSINE55 AND°POFESSIpNS COD€,AND z iX MV LICENSE IS�N FUIL FORCE AND EFFECT � � , '�fJ' G�f d�'J a�.i = LICENSE CLASS� _LIC.N4. V DATE G � =G7� GON7RACTOR ,�,� ALJC-� d . LLI � WOFKERS COMPENSATION DECLARATiON Q � i HEflEeY AF�IRM UNp£R PENAITY Of 9FRJUFiY ONE OF THE FOILOWlNG�EG4APATIDNS: V (/� Z � _,_IHAVEAN�WILLMAINTAINACERTIFICAT[OFCONSENTTQSELF.INSURErORWORKERS' 4 S CAMFENSATION,AS PROVIDEO @Y SECTION a�oo OF TNE LAHOR CopE.FOR TNE PERFOHMANCE C.) OFTHE WORK F6R WHiC!{THIS PER611T ISlSSVED. W � � W IHAYEAND WILIMAINTpIN WORKERS'COMPENSATIqN IN5JqANCE,AS REQUIREU BY SEGTIIXJ /� /� Q 370p OF TNE IA130R CpDE,FqR THE PFPFORMANCE OF T1,E WOHK FOR WHICH THIS PERMIT IS ��1 1 J ISSUED.MV WOFlK RS'COMPENSATION WSURANCE CARR�ER AN�PDtICV NUAIBFR ARE: CONSTRUGTIQN ! �.� j cr,aa«a_..__��A hC_.f DG7 t� PLAN REVIEW �'�''�� aour.v Nur�6EF L7 /I� GG�l `i!.Z...� ..— E�ECTRIC -I��.J� ¢ — d (iHl55EG'110NNEmN0T8E�MA4,EfFppGIHEPERMfTISWRIXJEViUJ7REDp�IlAR5�5100)4RLESS). PLUMBIN�a , W Z" I CFFiTIFY THAT IN THE PEflFORMANGE OF THE WORK FOfl WHICHTHIS PERtAiT�S ISSUED.i MECNANIGAL L'J SHAII N6T FiAGLOY ANY PERSON IN ANY MRNNER SOAS T4�'ECOME SUBJECT TQ THE �� ' � W(JRKERS'CONPENSA740NLAWSOFCAUFpRNln,ANUAGREEiHA71FISNOULDBECOME INSPECTIONFEE � SUOJECT70THEWORKERS'COMPEN5ATIONPROVISIONSOFSEGTIOIJ3l0apFTHELA80R ' S�y Q� ODE,I 9HALL I'ORTHWITH COMPLV THOSE PROVIS' +�;- ISSUANGE a �d�`�''!- ��1��.—� `�`� _ 2 � p DATE: RPPUGANT: �L� .L•' SM1P W ENERGY P!C �v�-1 ��-�u��-f . . J WARNING:FPIWRE70'."sECIJRE WORKEpS'COMPENSATION COVERAGE IS VNLAWFUL,ANO SHALL BE _! — � SUBJECTANEMPIOVEt�TOCR�MWALPENALiI£SANDCIVftFWESUPTOONENUNOREDTHOU$ANO ENERU'YPERMIT pOLi.AftS(t�0o,000},iN AODtTtON TO THE COSTOF COMPENSATION,ORMAGES AS PROYIDEO FpR IN ---� � SECt10N 3JON oF THE I ABOR COpE,INTEFEST,AN�ATTORNEY'S FEES. � ac ftETENTION FEE: 4 CONSTRUCT�ON�ENDING AGENCY PRE-ALT FEE � � i HEftEOY AFFIRM UNDI:R PENA{7'Y Of PfPJURY THAT THEHE 15 A CONSTRUCTION LENDING AGENCV KORTHE PEAFORMANCE OFTHE W(7RK FOR WHICH THIS PEFMI'I51$SUE6(SEC.909�,CN.C.). -'—' �� --- Z W � LENDER'S NAME ^ � I-_ LENDEflSADGRESS_ _, ,,.�,,,_� .,,, „_ � lCER�IFYTHA7IHAVEPEAOTH15AVPLICATIONANDSTAIETHATTMFA60YE1NFDiiMAiIOM1ISCORRECT. �OTA�FEES ( n� '�--{� � 1 AGRcE TO COMPLY WITH ALI.CITV AND COUNTY ORDINANCES AN�STATE LAWS FEIATING TO BUILDING �t L � CONSTRVCTION,AND NEqFBV AUTNORIZE REPRESENTATNES OF THIS GOVNTYTO ENTER UPUN TH£ 2 ABQVE�MENT�ONE➢PlOPLRTYFOqtHSPECT�ONPtiRPOSES, COMMENTS Q �'�-��.�_ �, _- _ _. � � __ �� r , _ _ - _ m RMITT�E N E"(�u�y}T,�) /� Cn L"L //! CC�'�-`+�C�G-f��C �~!7l_�/� .—. . . Vy SIGt+M1A7URE0�11TEE DATE T�—� '—'- ` F RECPT.NO._ PAlD BY ,,,, VALIDATIQN WHITE—Dapartment Gopy,VELLOW—Finance Copy,PINK—A55essor Copy,GOLpENROC1--Fiie Gopy,GREEN—ApplicanYs Copy �� F � „n_ � -.v .: � �r , _ ;, � �� e� i � � .�. ., � 3� �� a��, ,� . �, _. �. �.��,.�'r-. (�-Z,�-u1 �� r��zy-G� ,.� l(-tC�--�1 _ E , : � �;� . _ � � : _ _ �� ti�� _ � �� - , � _ � t�-��' �� r�s��,� _ i�'�P'�� a-w� a '�C,��rr''";�av�,.,� �� .. . . ... .... c �a ��ir � � , � ; �� ' . _ .� • - e��,�P _ ;�, � 1 ��t� _ _ � �� - � �,�.� � _y _ y ��.�„ `�o- � r�,- ".��v .. ..... _ ..... ....._ .. ... ,��. �` :� t+r � ,., , . : p v:� � E �j (J� . . . . . .. .... .. —. ._ . .. .. � _'�. k � �tF&!Y �PP�'� . . . ... . .. .. .. . ... ...... . ... .. `: �y� a : " ... � t�.., ��$ P = �y��s'P P� ._ .. .. . ... . .. .. .. ..... .... .. . . ��1�` ."l,h� �.. .... — . . ... ... . . � i � � ....... . _ —. e lQa �. r `3 �x��:�"'� " ..' .. . ... ... . .. . .. � ..... . . ..... ...... ...... .... . ...... . ... .. . .... .... .. . . .... ..... .. . .. ... �. CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION JOBSITE ADDRESS C S'ID APN LOT TRACT OWNER c ADDR S z?,C.OX P_c�2 R.A4 �3T CITYZIP gl_)de.2.TEL. APPLICANT 1R'/f-C<,1, .,7e'-Oy p 1555 fl 9 Belt-L/'/r. CONTRACTOR ADDRESt.5 Vi cnui L el) CITY t/f-ZIP/�TEL.A'/J- ARCH/ENG/Y%cJ''7 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 REQUIRES A PERMITTO 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).) ^ 1,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 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORCE AND EFFECT {s� LICENSE CLASS LIC. N0. DATE CONTRACTOR r 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. 1 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"' L-A"I G11 DO 1-) �^- cam'//'IJ G3G;k POLICY NUMBEF 0//-,' (THIS SECTION NEED NOT BE COMPLETED OF THE PERMIT IS FOR ONE HUNDRED DOLLARS($100)OR LESS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR C .SHALL FORTHWITH COMPLY THOSE PROVISIS]W$. 70�DE / / a I�Y��y DATE: (Y�-_Y APPLICANT: L�L7 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. 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 I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT I 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-MEN IONED PROPERTY FOR INSPECTION PURPOSES. T r P�g R"M""ITTEE N E T) V r S T SIGNATURE 0 PERMITTEE DATE ui CD 0 IJ UI w z 0 0 Cx: 0 2 0 W U w 0 U Cn LL 0 0 X W 0 U LU CJ3 U) W 4 fn LL] c.7 U) I-- 0 F APPLICATPERMIT"� P/C DATE R,�, NUMBER #_ ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ^ REAR ^ SIDE/SIDE STREET RW ^ SIDE ^ PROPOSED USE 4LF;A:xa C, n 4 N0. DWEL. 0. UNITS STOR ED MS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREANALUATION SFR/ADD/REM CI) Garage/Carport W Patio/Deck LL Pool/Spa V Z Re-Root Commercial co Valuation ADJ.AREA QUANTITY DESCRIPTION FEE a �- u v Cc W J W Z on a Z W �ft�� CONSTRUCTION PLAN REVIEW 0 JG ELECTRIC PLUMBING MECHANICAL INSPECTION FEE S'y 06 ISSUANCE , SMIP „L. L 'finnt SE ENERGY P/C r ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES COMMENTS RECPT. N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy