The URL can be used to link to this page

Home My WebLink About19041CITY OF DIAMOND BAR ` DEPARTMENT OF COMMUNHY & DEVELOPMENT SERVICES 21825 E. Copley Drive (909) 860.3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION r JOBSITE ADDRESS_ �-03 PrRi IZ,51- APN LOT TRACT OWNER VV I N I -CG ADDRESS 1-1103 'D%Y Cf -60Z 1-!I CITY I)iAMprUD r9d ZIP 10-63r G1" TEL.`1t_>�1- nf.61�0 APPLICANT w W TEL. c`1 D9 -gel _G `L 8 CONTRACTOR JA -f '5 c onJST)Z IJC-'-1 D AJ ADDRESS (tl f ATLAs�TIG- Ru CITY 1-On/C I)II ZIP C10k05' TEL. 562 y2S }f ARC WENG/ DESIGNERDJ)R1 G1-11�� f„f2t Ui) ADDRESS 5-1 -s �46(,MQ JTIA AL1F. #I CITY rNLI"r, ZIP 101& TELgIS-65-6-iG OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REOUIRE:', A PEflM1TT0 CONSTRUCT, ALTER, IMPROVE, DEMOLISH, OR REPAIR ANY STRUG 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 PROVISIONS OF THE CONTRACTORS LI- CENSE LAW (CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 30F 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 Ii500).): O I, AS OWNEROF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORN, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 701x, BUSI- NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS CR 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 K)IF, HOWEVER THE BUILDING OR IMPROVEMENT 15 SOLD WITHIN ONE YEAR OFCOMPLE- TN, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPCSE OF SALE). ❑ I, AS OWNER OF THE PROPERTY. AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 704, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE LAW DOES NOTAPPLYTOAN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S) LICENSED PURSUANTTO THE CONTRAC- TORS LICENSE LAW.). O I AM EXEMPT UNDER SEC. B. 6 P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISIONS OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT. ' t LICENSE CLASS j,L_ LIC. NO. n 1 Ci �" g �D 2 -- DATE I 2 '3 CONTRACTOR WORKERS' COMPENSATION DECLA ATI N I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATION& 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 WORN FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WILL MAINTAIN WORKERSCOMPENSATION INSURANCE, AS REQUIRED BY SECTION 3700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, MY WORMERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER POLICY NUMBER (MIS SECTION NEE) NOT BE COMPLETED OF THE PERMIT IS FOR ONE HUNDRED DOLLARS (5100) OR LESSA I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY P EPSON IN ANY MANNE R SO AS TO BECOM E SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF ISHOULD BECOME SUBJECTTO THE WORKERS' COMPENSATK)N PROVISIONS OF SECTION 37W OF THE LABOR CODE, 1 SHALL FORTHWITH PROVISO NS. COMPLY WITH THOSE PROVISNS. DATE: 1 APPLICANT: W 1/V I`d WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 15 UNLAWFUL, AND SHALL BE SUBJECT AN EMPLOYER 10 CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY 1 HEREBYAFFIPM UNDER PENALTY OF PERJURY THAT THERE IS ACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC.30B7, CIV. C.). LENDER'S NAME LENDER'SADDRESS 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. ti K PERMITTEE NAME RINTI SIGNATURE OF DATE !� 1 PRESS FIRMLY APPLICATION 2 �3 OL PERMIT ��i O�i+�,' P/C DATE NUMBS # _ ISSUE ^ TYPE OCC DATE L1jan, CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ __ SIDE/SIDE STREET RW ❑ _ SIDE U PROPOSED USE FF—l:'\O0FIPJ G, ( CUt K6m-r tsL 0 1J 31 VC I -F WII bc fP V N LnMNY,I'I 1-�_ SHI/y4 I F I�f7G NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carpon W Patio/Dock LL Pool/Spa 0 Z Re -Root 0 Commercial 5 m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE OUT`F_i> 2 P0OIL) E. �Ac ks U W J Z I P"IA/A66 Pt Fr" 00 a U_ Z 2 W n-^i� /� 55110 ONSTRUCTION ✓ J1 Y V PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: TOTAL FEES COMMENTS 9C00fV(; Wil -L. fi')✓. RECPT. NO. PAID BY 499 VALIDATION WHITE --Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD—File Copy, GREEN—Applicant's Copy 1, h. € v OF i.1, it A °€ ('11KIDAB , �� as =i a __ 3 ro fiN er $ i %—I CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21825 E. Copley Drive (909) 860.3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION --b F— RESS FIRMLY JOBSITE ADDRESS -2—"-- 37(LY Lr— I— R-- APN LOT TRACT OWNER —' —/ I—G ADDRESS 7-Z 10 S :D —Y GJ" " 12 tt -D CITY 7iAMprUp f7r'" ZIP - I !" TEL. "II?N1-8!nf.61;"-U APPLICANT w W — TEL. d' - G CONTRACTOR -TA'(N "O/x-15"f"!3C-'"1U ADDRESS"" ATLaauTIG- Ru -- CITY I-On3G f7r"1C"N ZIP " TEL. 562.- y21 - IS ARCWENG/ DESIGNER""R1G1-lf"" Gft"(JF"" ADDRESS "1-. " ' (A(:M10t7 TI -F A L1F • # I CITY " N G f N L" ZIP r'l i (o TEL. g 1"S - " S" - "2G OWNER -BUILDER DECLARATION I HEREBY AFFIRM UAIDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LI- CENSELAW FORTHE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE: ANV CI7V OR COUNTY WHICH REQUIRES°" A PERMITTO CONSTRUCT, ALTER, IMPROVE, DEMOLISH, OR REPAIR ANY STRUC- TURE, PRK)R TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT 70 THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW (CHAPTER a (IbMMENCING 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- 710N.ANY VIOLATION OF SECTION 7031.5 BV ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CNIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (5500).): 0 I, AS OWNER OF THE PROPERTY, OR MV EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 700x, 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 PROTECT (SEC. 7001, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY 70 AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S) LICENSED PURSUANT TOTHE CONTRAC- TORS LICENSE LAW.). ^ I AM EXEMPT UNDI.R SEC. B. 6 P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM UNDER I'ENALTV OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WITH SEC7KK3 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MV LICENSE IS IN FULL FORCE AND EFFECT. 'L LICENSE CLASS niG""" "DZ" LTC NO —2 C DATE CONTRACTOR WORKERS' COMPENSATION DECLA ATI N I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECURATK)N5: I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED BV SECTION 37000E THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. _ I HAVE AND WILL AMINTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BV SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MV WORN: ERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER POLICY NUMBER (THIS SECTION NE9) NOT BE—ARETED OF THE PERMT IS FOR ONE HI1ADRED OOIIARS (5100) OR LESS), I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANV PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF I SHOULD BECOME SU&IECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 37000E THE LABOR CODE, I SHALL FORTHWITH COMPLY WITH THOSE PROVISKKJS. WIN I-0 1— 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 OOLURS (5100,000), IN ADDITION TO THE COST OF COMPENSATKN, DAMAGES AS PROVIDED FOR IN SECTK)N 3705 OF THE LAEIOR CODE, INTEREST, AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY 1 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. 3087, CIV C.). LENDER'S NAME LENDER'S ADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATKKJ IS CORRECT. I AGREE TO COMPLY WITFI ALL CITY AND COUNTY ORDINANCES AND STATE UWS RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OFTHIS COUNTY TO ENTER UPON THE ABOVE-MENTKKJED PROF'ERTV FOR INSPECTION PURPOSES. INhQ PERMITTEE NAME RINT1 " " t 217 I c y SIGNATURE OF DATE WHITE -Department Copy, YELLOW -Finance Copy, PINK -Assessor Copy, GOLDENROD -File Copy, GREEN -Applicant's Copy