The URL can be used to link to this page

Home My WebLink About18900 � i' , �.� CITY OF DIAMOND BAR `,�_ � DEPARTMENT OF COMMUNTI'Y&DEVELOPMENT SER.ViCES � 21825 E.Copley Drive '� (909)860-3195 Fax(909)861-3117 PRESS '%�:� BUILDING PERMIT APPLICATION FIRMLY � JOBSITE APPLICATION � ZPERMIT P/C (X� o AODRESS �-Z��J -��Y G_F F F I< ��i DATE '� ��"'_7JUMBER �� # ��V � ISSUE TYPE OCC APN LOT TRAGT _. DATE � � �Z CONST. GROUP °C OWNER W�N KD O o ADDRESS �'1-�}L?, .�RY L{.��jL �. ZONING SETBACKS z CITY .��1/W n,'�-y� f�i1�i ZIP��+�iS TEL t�[74-c�'�r-G 2cn FRONT RW � _ o APPLICANT TEL.__ SIDE/SIDE STFiEET RW ❑ z Q CONTRACTOR_ SIDE r'_ _ � ADDRESS _ � CITY ZIP TEL. PROPOSED USE w ARCH/ENG/ — z DESIGNER h0�R1(;tJF_� G 1;U�)� - NO.DWEL. NO. NO. a ADDRESS C"/3-�- `(,�qj:lW�,�)Tri A'/�. UNITS � STORIES �__BEDROOMS 3 � CIIY t/��Gi�V C! ZIP�}� TFL.=��-� � v� DESCR�PTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADDlREM Z I O �MERE9Y AFFIRM 11NDER 7ENALTV OF PERJURY THAT I AA1 FXfMPT FROM TME CONTRAGTORS LI- G8f098/CBfpOf1 �W CENSEUWFOqTHEFOLLOWINGREA50N;SEC.]03t5AIJ51NES5AN�V50FE5SION5CpDE:ANYC�TYOR (f� Z COJNTVNMICHREOUIRESAPFRMITTOCDNSTRUCT,ALTER,IMoqpyE.DEMOLISH,ORREPAIRANv>TRUG W pBtiO�DBLk NRE.PPIOR TO ITS ISSIIANCE,ALSO REOUIRES THE RPPLICANT rOR SUGH PERMIT TO�ILE A SIGNED w STATEAIENT THAT NE OR SHE i5 LICENSE�PVRSUAIlT TO THE PROJISIONS OF THE CONTPACTORS L- W � CENSELAW(CHAPTER9(COMMENCINOWiTMSECTION]D0o)OF'JIYISION30FTHEBUSINESSANDPRO- LL" POOVSPB FESSIONSCODE)OflTHATHEOR5HEI5E%EMPTTMEpEFROMANOTMEBASISFORTHEALLEGEDEXEMV� � � TION.AY�VIOl4T10N OF SECTION 1011.5 3"ANY APVLIGAN"FOH A 7EPMIT SUBJEC(S 7H"e AFGIICANT TO Z Re-Rooi � ACIVi�PENALTYOiNOTMORETHANF'.VEHUNDREDDDLUPS�f500).)'. - �I,AS OWNER OF THE PROPERiY,OR MY EMVLOVEES WiTi WAGES A5 THEIP SOLE COMPENSATiON, Z � Commercial WILI�O iHE WORK,AND THE STfiUCTJRE IS NOT ihTENDFD OF OFFERED FOR SALE!SFC.]oes,BU�i� J � NESSAND PqOFESSIONS CODE:THE CONTRACTORS LICENSE LAW DO'eS NO'APF'_Y T�AN OWNER OF j PROPERTV WHO BUILDS OR IM GROVES THEREON,AND WHO OOES SUCH WOf7K HIMSEIF Oq HEFSELF ON � THROUGHHISORHEROWNEAIPLOVEE5,7ROVIOEDTMAT�UCHIMPROVEMENTSnRENOTINTENDE�Ofl m � QOFFFREDFORSALEIF,HOWEVER,TNEBUILDINGORIMPROVEMEN',ISSOIDWITHINONEYEAROFCOMPIE- Z T'qN.THF OWNER-BUIIDER WI'_L HAVE TME BUR�EN OF PROVI4G'H0.T HE�R SHE DIIJ NOT BUILD Ofl � IMPROVEFORTHLPURPOSEOFSALE). w OI,A�OWNEROFTHEPHOPEFTV,AMEXCLUSIVEI�CONiRACTINGWITHLICF.NSEDCONTFACT[]RS [L TO CONSTP.UCT THE oROJEGT fSEG.7c6a,BUSINESS AND PPOFESSIONS CODE:TIiE CONTRACTORS LI- VBIu3110f1 ADJ.AREA W CENSE UW DOES NOTAPPLYTOAN OWNER OF APROPERTV WHO dUn.DS aF IMPROVES THEREON,AND -- = WHOCONTFlACTSFORSUCHVPOJECTSWITMACONTRACTOR�SIIICENS[DPURSUANTTOTHECONTRAC- QUANTITV DESCRIPTION FEE ~ TORSLICENSEUW). Y J � ❑IAME%EMPTUNOEHSF_C. B.3PC.FORTHISREPSON Q � -- U LL 2 Ea — U Z W � UCENSED ONTRACTOf1S DECLARATION W Q I HEREBY FFFIRM UNDEH PENALTV Of PERJl1qV THAT I AM LICFNSED UNDEF PROViSIONS OF CHAPTEA � � 9�CDMM[NpNG WITH SECTION 7000)OF�IVISION 30F THE BUSINE55 AND PP.OFESSiJNS CODE.AND Z LX MV LICENSE IS M FULL FORCE AND EFFECT m � LICENSE GLA55 _ LIC.NO. _._ �j � J U DATE _ CONTRACTOR a W � WORKEFS'COMPENSATION DEGIAflATION Q � IHEREB�AFFIRMUNDcRFENALTVOF7ERJUPVONEOFTHEFOLLOWINGDECLARATIONS: Z � IHAVEANOWiLLMAINTaNACERTIFICATEOFCONSENTiOSELF�INSt1REFORWORKERS' 2 Z CAMPEh5AT10N,AS PROVIDED 6Y SECTION 3700 OF THE LABOR CODE.FOR THF OEPFORMANCE U Q OF THE WDqK FOR WHICH THIS PERMIT IS ISSUED. � � w I MAVEAND WILI.MAINTAIN WOFKER;'COMPENS/TION iNSURPNCE,AS REUUIHED BY SECTION // 1 1 Q 3)o00F TNE LABOR COOE,FOR THE PERFORMANCE OF THE WORN FOR WHICH TNIS PERMIT IS * N �SSVED.MVWOPKERS'GOMPENSATIONINSURANCECARR�,ERANDPOLICYNUMBERARE' CONSTRUCTION �U 1 l� __ � J j cnr�aiea� __ . PLAN f7EVIEW _,_ ZPOLICYNUMBER` -�-�- --- ELECTRIC _._ _ � (MISSECMNNEmNOTBECOMPLEfEDOFTI-IEPEPIMISFOFONEHUI�D4EDOOl1iKS�S1ao�ORLE55�. PLUMBING _ f � w I CERT�Fv 7HAT IN'HE PEPFOftMPNCE OF THE WO�K FOR JJHICH THiS PFPMITIS ISS�EO.1 MECHANICAL � Z ___- C}' SHPLL NOT EMPLOY ANV PERSON IN ANV MANNEa SOAS TO BECAME SUBJEf,TTO 7HE (n WOFKERS'COMGENSATION lAWS OF CALIFORNIA.AND/GREF TMAT IF I SHOl1LD BECOME INS?ECTION FEE _ �� = SU9JEC7 TD TnE WORNERS'COMPENSATION PROVi5lou5 OF SECTiON 3�ou OF Tr�E UBOR — CODE,I SNALL FORTHWITH CQMPLY WITH THOSE PROViSIGNS. ISSUANCE � SMIP p DA7E:_ APPLICANT. _ ��-}�}� — w ENERGY P!C � � J WARNING�.FAILURE TO SECURE WORKEflS'GOMPENSATION COVERAGE IS UNLAWFIIL,AND SHALL BE � SUdJEGTAN EMPLOVER TO CRIMINAL PENALTIESAND CIVIL FINES 11P TOONE HUN�RED THOVSAND ENERGV PERMIT OOLLARSff1000001,INA0DITIpNTOTHECOSTOFCOMFENSATIONOAMAGESASPROVI�E�FOfiIN � - — J SECTION 3709 OF THE LA90R COUE.INTEREST.AND ATTORNEV'S FEES. RETENTION FEE: _• Q — _ — d CONSTRUC'ION LENDING AGENCY PRE-ALT FEE: p �_ __ — � I HEFEdVAFFIqM UNOER PENALTV OF PERJURY THAT THERE IS ACONSTRII(:TION�ENDING AGENCV � FON fHE PERFORMANCE OFTHE WOFN FOR WHICH 1NI5 PEAMITIS ISSl1ED(SEC.309],CIV C). — Z � W _— _ _ S LENDER'SNAME . ___ _ � — _ F= LENDER'SAD�RESS _� ' Ip w TOTAL FEES s �Da� `�� 3�� 2„"f D ,5 � ICERiIFYrHATIHAVEREA�THISAPPLICATIONAN�STATETHA�THEA80VEWFORMAT10N15�(1RRECT � I AGR�E TO CCIMYI.Y WITF AL�CITY AND CO�NTY ORDINANCE$AND$TATE iAWS RELATING TO BL'iLDING � GONSiRUCI�ON,AND HEREBV AUTHORIZE FEPRESENTATNES OFTNIS CDUNTv To ENTER UPUN THE Z ABOVE�MENTIONE07ROPERTYFORINSPcCTIONPURPOSFS. COMMENTS _,_ � — � W IIV 1<0 _ _ m P ITTEE NAME(P INT) �/,h;,.w„�.�{�� o y - _ — - � S!G . OF PE�1.1if1 ` �---� = RECP?,10. _ PAIDBY _ VALIDATION _ WHITE—Devanment Copy,VELLOW—Finance Copy.PINK—Assessor Copy.GOLDENROD—File Copy,GREEN—Applicanfs Copy �a � ��x�� ,� . '�-�',","-� +'��?t-'"�' �' � ��e �` �+ ��-e`� ;,`��.`��:�' �<. � a � . a._ , ....... . . . .. . . *. ,, . .. . . , .. , . . . ,. � , }, , � �_� ---.� _ /�-3�d.� �i , �• _ . k �� . . , � ,��,� �;r _ _ r . . a .� , .,� : �t . _ , � �=�,��.� �. , ,� � . ��,.� _ _ �-�° . � _ ��° _ �,�� S �„� i.�� .��.��. . z�� , _ �� l-r �t�.�- �'� �� ld ��r�a�� '''��`��v �%°�°��_r�:�� '��l��f � �r�',�'��'' �' ��'�`,�' �..�'�- _ � �` _ __ __ _ _ t _ ____ _ _ _. _ _ _ __ _ � �� ,aAa�_ .�. o�� _ _ _ �� ._� ,�;, .. � ; .�r ,, , �a � _ - �. ,, � , _ . _ �a � ` :: ,. y� t �'4", .. .. . . . .. . . . . .. . . .. .. ... .. .._. _.,... ..._. .... . ._... ... .. i ��. t:. �r�� .. ..i � a � af ��" ��°'��" ... . .. ... .... ... .._. . .... .. ._ .. . . _. _ ._ ... ... . . ... .. ....... _. �. � .w�y �, E�=1�.. =...�a... ,.,..: .. . . . .. _ .__ _._.. ._. .. ..._ .. ..... .. . . ..__. .._.. ...._ ..... .,_. __ .. . . . . . .4 CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES E. Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION PRESS FIRMLY JOBSITE ADDRESS'LZ OJ iPY GF.FF I� Psi. APN LOT TRACT OWNER W/A)A 0 ADDRESS_-')Oj;)AY-AEEIIL R.D. 9fI n,&)JI I3AP•ZIP CII }6S TEL CICY7-&61 -G'IF_n APPLICANT TEL. CONTRACTOR ADDRESS CITY ZIP TEL. ARCN/ENG/ DESIGNER hOJ)kl(;,t)P_�G/;U()P ADDRESS S 1 S S YARIwn J'T H Ave, CITY I=AICf V 0 ZIP TEL. = I8�IE'- OWNER-BUILDER DECLARATION 1 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 PERMIT TO CONSTRUCT,ALTER,IMPROVE, DEMOLISH,OR REPAIRANY 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(5500)) U I,AS OWNER OF THE PROPERTY. OR MY EMPLOYEES WITH WAGES AS 1 HEIR SOLE COMPENSATION, WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC. 7044, BUFI. 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). U 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 TOAN OWNER OF A PROPERTY WHO RUII.DS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW). U T AM EXEMPT UNDER SEC._B. &P C. FOR THIS REASON ER LICENSED ONTRACTORS 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 LICENSE CLASS_LIC N0. 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,AS 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 15 ISSUED. MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE CARRIER POLICY NUMBER (THIS SECTION NEEDNOT 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 CODE,I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE:APPLICANT: 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. 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. wINAKO PITTEE NAME C OF PERM( APPLICATION PERMIT �I � , � 00 /C NUMB R 1 DATE rv # ISSUE TYPE OCC DATE I v-CONST. GROUP ZONING SETBACKS FRONT RW EI REAR 1_1 SIDE/SIDE STREET RW^ SIDE PROPOSED USE N0. DWEL. N0. N0. UNITS I STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREANALUATION SFR/ADD/REM 2 U) Garage/Carport W Patio/Deck PooVSpa Re-Roof 0 Commercial 5 Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J Q U w w z m J n. Q U Z Q 2 U w I �� CONSTRUCTION 11 PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE_ SMIP ENERGY P/C_ ENERGY PERMIT RETENTION FEE: PRE-ALT FEE:/ TOTAL FEES S P-f b 30 Z4,?5 COMMENTS RECPT. N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy 11