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Home My WebLink About18905 �� CITY OF DIAMOND BAR � DEPARTME'e'T OF COtvIIvfUNITY&bEVELOPMENT SERVICES 21825 E.Copley IJrire (909)860-3195 Fa�c(909)861-3117 PRESS -.�� BUILDING PERMIT APPLICATION FIRMLY o DDR�ESS��___ � � DATEICATIO� � uL� NUMBER /��C� i/� o ISSUE TYPE OCC r° APN LC�T TRACT DATE CONST. GROUP p O W NE—��A-f.�i lS�c L.1 C S�- '�'Tr'c.�H,(tL.� � p ADDRESS—._./_s��`�`� S��l1�MOtJ��l�r �-�p . ZONING SETBACKS Z CIT`(�l�'-"'�'�n0'_�'� ZIP��`� TEL._ FRONT RW ❑ � APPLICANT TEL__ REAR _ ❑ Z — SIDFJSICE STREET RW CJ _ m CONTRACT�F � �PM� !►<,r('J�-T��ii SIDE ❑ � ADDR/E�$S ,, — � J '— PROPOSED USE �� =V P"�T�`'l �C!1l Q �l � CITY��-`� Z{P t�0 TEL. `�O� � GclSccc,c � '4c�'�t, '�xT, oARCH/ENG/ (Qi)�!L'c �ecZ.� tio` � a�-�.�. z DESIGNER — NO.DWEL. NO. NO. � ADDRESS UN1TS STORIES BEDROOMS � CITY _ ZIP TFL._ � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECLARATION SFFUADD/REM O � I HEREBY AFFIRIA 11N0EFi PENALTV OF PERJURV THAT I AM F%EMPT FROM THE CONTRACTORS LI� G8fa98/CBfPOft W CENSEUWFOPTHEFOLLOWINGREASON(SEC]031.SBVSINESSANOFFOFESSIONSCODE'r1NVGITYOft (n ZCOUNTVWHICHNEOUIRESAPI:RMITTOCANSTRUCT,ALTER,IMPROVE,DEMOLISH,OflRE7A�RANYSiRL;C� W Patio/Deck w TURE,PRIOR TO ITS ISSUANCE,AL50 REOUIRES THE APPLIGANT FOR SUCH PEFiM1T TO FILE A SIGNE� W � STATEMENT TYAt Hc OR SNE IS LIGENSED PVftSUANT TO�HE PRO4ISIONS OF TH_�OtiTRACTOR$Li� � GENSE U�'d(GHAPTEfl e(COMMENGING WITM SECTION]OOC�OF DIV�SION 7 OF TNE BUSINE55 AND PRO� LL POOUSPB O FESSIONS G�DE)OR THRT ME Dp SHE IS EXEMPT TH�REFROM AND THE BASIS FOF THE ALLEGFD E%EMF� (� U SION.ANVVqlAT10NOf5ECTICN703�.5BVANYAPFLiCANiFORAPEFMITSliOJEC(SiHFAGPLICANTTO Z Re-Roof A CIVII PENALTV OF NOT MORf:THAN FIVE HUNDRED DGLURS(f5oo),I: Op1.ASOWNEROFTHEPFOPERTV,OR6IVEUVLD�EESWiTHWAGESAS7HF�fiSOLECOMPENSAT�CN, 0 CpmmelCl01 �� ,(,�� Z WILL DO THE WORK,AND THE STRUCTURE IS NDT IN'ENDCD OH OfFERED FOH SALE(SEG.7044,BU�•I� J NE55 AND PROFESSIONS COOE�.TH[CON�RACTORS LICENSE lAW DOES NO'APPLY TU qN UWNEF OF � PqOPERT�WHOBU�LO50RIMPROVESTHEREON,ANDWHODOE55UCHriOWN�1MSElFORHERSELFOR � � THFiOUGHHISORHEPOWNEM1APLOYEES,vROVIDEDTMA75uGMIMPHOVEMENTSARENOTINTENDEDOR m w OFFEREDFORSALE.IF,MOWEVER,TMEBUIL�INGORIMVPOVEMENTISSDLDWITHINONEVEAROFCOMFLE- 0 TtOn,TYE OWNEfi�EU'.LDER WILL MAYE THE BUR�E4 OF PROVINC`MAT HE OR SHE D�D FiOT Bt11��G OH Z IMPHOVEFORTHEPURPOSEOFSALE�. � ❑I,ASOWNEROFTHEPHOPERTVAMEXCLUSIVELYC(1NTRACtINGWiTHLICEN5E000NiRACTORS W [t TO CANSTRUCT TME GRWECT(SEC.7011.fi1151NE551ND PROFESSIONS CODE.THF COMRACTORS U- V01U8110f1 ADJ.AREA W CENSEUWDOESNOTAPPLV"OANOWNEROFNPROGERTVWNOdUI1.DSOHIMPROVESTIIE(iEON,ANO = WHOCANTRACTSFOqSUCHPqpJECTSWITkACONtqACTOR(SILIGENS[OPURSUANTTOTHECONTqAG (]Lf{NTITY DESCRIPTION FEE ~ TORS LICENSE LAW.). Y J � CII�MEXEMPTUNDERS�:C. 8.8PC.FORTMISFEASON Q � ' _ Q O�STL-�G�� LL DATE OWNER ____ U W � LIGENSED CONTRACTORS DECLARATION W � �-C-L��'� � Q � I HFRE9V AFFIRM UNDER PENALTV Of PERIURY THAT i A!A LICENSEO UNOEF FROV�SIONS OF CHAPTER � p. 9�COMMENCING WITH SECTION 1000)OF DIVISION 3 OF THE BVSINESSAN�PPOFESSIJNS GODE,IWD Z X MV UCENSE IS M fULL FOFCC.4N�EFFECT. m W '/F7 � LICENSE C SS " LIC.NO.�1�,��' � V DATE � �4 b 1.. CON7RACTOR__� 1��`� b�IS��J�JL \ d w � WORI<ERS'COMPENSATION DECIARATION Q N U � � 1 HEREBY AFFlRM UN7ER PENAITY OF PERJURY ONE OF THE FOILOWING DECUAATIONS�. Z Q � IHAVEAN�WILLMAWTAINACERTIFICATEOFCONSENTiOSELF�INSUREFORWORKEFS' _ COMPENSATION,AS PROVIDED BV SECTION 3]DOOF TNE LABOR CODE,FOR THE PERFORMANCE U Q OF THE WORK FOq WH'�CH THIS PERMIT IS ISSUED. � �I � — w I MAVE AND WILL MAINIqIN WORKERS'COMPENSATInN INSURANCE,A5 REOIIIRED BY SECTION Q 3]OOOF THE LABOR CODE,fOR THE PEPFORMANCE Df THC WOPK FOR WHIf,HTH15 PERMIT IS � O ISSUEC�.MY WORKERS'COMPENSATION INSUR,INCE CARRIER AND PO�ICV NUMBER AqE CONSTRUGTION �_�G_� _ J '¢ CARRIER PLAN REVIEW �y��/��_��_�� F�'y—�_ Z POLICY NUMBER_ — ELECTFiIC d � (1HissEc7x)NNcmNO1BE�.�.1PLE�EOOFTHEPER�M15(CFONEMR�ONED70LLARS(E1[o)OFLESSI. PLUMBING _ _ w MECHANICAI Z I CERTIF�THAT IN THE PERFORMANCE OF THE M�ORN FOR WHICN THIS PERMIT IS ISSUED,1 --- — (J SHALL NOT F�IAVLDV ANV PERSON IN ANV MANNER SO AS TO 9ECOME SUAJE(:T TO THE � Uj WORKERS'COMPENSATION UWS OF CALIFORNIA,AA�AGREE THA71f i SHOU�O 9ECOME INS?ECTION FEE ... SUBJECT TO THE WORN.ERS'COMPENSATION 7aOVl ONS OF SEG710N 31G0 OF THE LABOR � C DE.I SHALL FORTHW'ITM COMPLY WITM TM 5E VISONS. ISSUANCE .__ J_ Q � • �� p �ATE� � ��^ APPLICANT: SMIP _ — w ~�`- ENERGV P/C --� WqRNING�FAILURE TO SECURE WORKERS'COMP ATI N V� E IS UNLAWFUI,PND SMNLL BE ` J � SUBJECTANEMPLOVEHTOCFININALPENALTIESAND F TOONEHt/N�RE�THOUSPN� ENERGYPERMIT D011ARS(l�W.oaa`�,.INA�DITIOYTO'HEGOSTp�COMP B , MAGESASPROVI�EOFOftlN — J SECTION3]080FTHELABORGODE.INTEFiEST,NN�AiiOR� FE . RETENTIONFEE: � _ . w Ci�NSTRUCTION LENDING AGENCY pRE-ALT FEE: � — —_— � 1 HEREBYAFFiqM UNDE�l PErvAI.TY�F PERJURV THAT THEFiC I,`,ACONSTPUCTtON LENDING AGENCY _. _ _ _ d FOR TNE PEHFORMANCE OF THE WORI{FOR WHICH THIS PERMIT IS ISSUED(SEG.3091,GIV.C.). Z - W = LFNf]FH'S NAME _ -- � __ F— IENDER'SADORESS __ 1 � I CEATIFV THAT I HAVF REAO iNIS APGLICATION ANO STATE THAT THE ABO�E INFORMATiON IS CORRECT TOTAL FEES y{ �'� 7 7 � w I Af;FcE TO COMPLV WITH ALL CITV ANO COUNTV ORpINANCES AND STATE LAWS RE�ATING TO 9UILDING �� ( � � CONSTRUCTION,AND HEflEBV PUTHORIZE REPRESENTATNES OFTHIS COUNTV TO ENTER UPUN THE ZABOVE-MENTIONEOPROFE TYF RI P-CTIpNPURPOSES. COMMENTS _— o ,� ��__��I��aN1� J — � � ' m P EN E(P NT�� O� — ¢ �� G TtIH ERM EE D E RECPT NO. PAID BY VAIIDATiON _ — ~ WHITE—�epanment Copy,VELLOW—Finance Copy,PINK—Assessor Copy,GOlOENROD—File Copy.GREEN—Applicant's COpy .�� 4 f . . .. � �� 3 °a�� 4� "��' . �%�w �. .. . . . � ��. .� . � � < , � 11��t 9- �- � _ ; , , _ 1��`�'r �..� . ' 1-�--�.� A.R _ ' �� : �� _ _ � �" : _ .. � �. . � . � � . ,:,, ".� _ . _ �,:�� ,. � � �� _ _ _ _ __ ; _ _ _ _ __ _ __ ; _ ____ .___ ___ x _ _ __ _ < ��e� „ �. ,� � ��#} '`� � {�`'�� _ __ _ .. , -- — � �� , r��z, �� ,�` �+�r�� _ _ _ _ _ ; g� ' _ _ _ _ j , �,, .�a,.� _ _ _ �. _.. �� . ; �,� �,� , , �� , ;, _ _ �:� ,� _ _ �� .� __ _ . __ _ _ _ _ _ CITY OF DIAMOND BAR DEPARTME'aTT OF CONQvIUNI"I'Y&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION PRESS FIRMLY JOBSITE�� ADDRESS APN LOT TRACT IIr A-f.Il I?4, L1 C's�- 't'�r'c.�L�H� KL� OW NE� �i ADDRESS�� 7 5-�11iP'LOplv'��,� '��10, CITY�I��m/-p ��ZIp��TEL., APPLICANT TEL. CONTRACTQ .I �'M� !-��Z'('J�,Z' �a/I ADDRESS�1 ��ET�� 1 . CITY C�It�M (�,-�ZIp�?�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 FOLLOW ING 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� 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 PgOVISIONS OF THE CONTRACTORS LI- CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONSCODE)ORTHAT HE ORSHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION.ANV VIOLATION OF SECTION 7031.5 BV ANV APPLICANT FOR A PERMIT SUBJEC'(S THE APPLICANT TO A CIVIL PENALTY OF NOT MORE:THAN FIVE HUNDRED DOLLARS(f500). ): � 1,AS OWNER OF THE PROPERTY,OR MV EMPLOYEES W iTH WAGES AS 7 HEIR SOLE COMPENSATION, WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOH SALE(SEC. 70d4, BU'.'•I� 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 VEAROFCOMPLE- TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVING .'HAT HE OR SHE DID NOT BUILD OH IMPROVE FOR THE PURPOSE CIF SALE). ^ I,AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTlNG WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC. 700d, BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- CENSE UW DOES NOT APPLY"0 AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,ANO WHO CONTRACTS FOR SUCH PROJECTS W ITH A CONTgACTOR(SI LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). CJ I AM EXEMPT UNDER SI:C. 8. fl 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 PPOFESSiONS CODE,AND MV LICENSE IS IN FULL FORCE.4ND EFFECT. � �� LICENSE C SS LIC. N0._ A DATE� �-I � '1. CONTRACTOR f�� I'��,T� WORItERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLAgATIONS: I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT iOSEL�-INSURE FOR WORKERS' COMPENSATON,AS PROVIDED BV SECTION 37000E 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 37000E THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMI715 ISSUED. MV WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER J POLICY NUMBER (THIS SECTION NEm NOT BE NMPLEfED OF THE PEFpM IS FOF ONE HUNDRED DOLLARS(f100)OR LESS). 1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, 1 SHALL NOT EMPLOY ANY PERSON IN ANV 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 PROVI ONS OF SECTlON 3700 OF THE LABOR C DE.I SHALL FORTHWITH COMPLY WITH TH�SE VIS DNS. �f C DATE: '� ��^APPLICANT: WARNING: FAILURE TO SECURE WORKERS'COMP ATI N V EIS UNLAWFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRI NINAL PENALTIES AND F TO ONE HUNDRED THOUSAND DOLLARS(f 100,000),IN ADDITI04 TO THE COST OF CAMP MAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE.INTEREST,AND ATTOR FE CONSTRUCTlON LENDING AGENCY I HEREBY AFFIRM UNDER PENAI.N OF PERJURY THAT THERE IS A CONSTPUCTION LENDING AGENCY FOR THE PEH FORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC. 3097,CI V.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 CI7V AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION,AND HEREBY PUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPEgN FpR $PE n PU ES. � J\1 I/•'�-{' G TUR ERM EE DE 0 0 0 LL 0 z 0 0 z m 0 Q S F WHITE-Department Copy,YELI-OW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy .I