The URL can be used to link to this page

Home My WebLink About17856 �,` CITY OF DIAMOND BAR � DEPART'MENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 PRE$$ ' `'%.v�� BUILDING PERMIT APPLICATION FIRMLY � ��` � � �' APPLICATION`x �" ,�^'� PERMIT P/C `� �] / o ADDR'ESS'�'��_+_C�� ^" DATE �J��`-��UMBER 7� # � t7�" !.� � ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER � "' ADDR SS ZONING SETBACKS Z ��Ty r� o�+ P��STEL7D� g(QQ FRONT RW ❑ � APPLICANT � �+ T�'0��57R�/�f j REAR I� Z 7 —TT SIDE/SI�E STREET RW LJ Q CONTRACTOR� V r .�-� SIDE ❑ � ADDRESS PROPOSED USE � J�� CITY ZIP __ TEL. �w ARCH/ENG/ z DESIGNER NO.DWEL. NO. NO. � ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL._ � DESCRIPTION SQ.FT. ..FACTOR PSF ADJ.AREANALUATION � � OWNER-BUILDER DECLAAATION SFRIADD/REM O � I HEREBY AFFlRM UNDEft PENALTY OF PERJURY THAT i AM EXElAPT FROM TME GONTRACTORS LI- G9f8JB/CBfPOfI W CENSELAWFORTHEFOLLOWINGREASON(SEC.7031.SBUSINESSAN�PROFESSIONSCADE:ANVqTYOR (� U COUNTYVhiICHREOUIFESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC- W pgti0/DBCk Z TURE,PRIOR TO ITS ISSl1ANCE,AL50 REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w w STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO iHE PFOVISIONS OF THE CONTFACTORS LI- � CENSE LAW(CHRGTER 9(COMMENCING WITH SECTION]000)OF�IVISION 3 OF THE B1151NE5S AND PRO- LL' POOVSPa � FESSIONSCADE)ORTHATHEORSHEISEXEMPTTHEREFPOMANDTHEBASISFORTNEALLEGEDEXEMP� � TION.ANV VIOLATION Oi SECTION 7031.5 BV ANY APPLIC0.NT FOR A PERMIT SUBJECTS THE APPLICANT TO Z RB-ROOf � A GIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED�OILARS(f500�.): � ❑I,ASOWNEROFTHEPHOPEflTV,ORMYEMVLOYEESWITHWAGESASTHEiR50LECOMPENSATION, � COfIlIll8fC18I Z WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDEO OR OFFERED FOR SFLE�SEG.�044,BUSI- J NESS AND 7ROFESSIONS CADE:THE COM1TRACTORS LICENSE LAW DOES NOT APPLV TO nN OWNER OF � PROPERTVWHOBUILDSORIMPROVESTHEREON,ANDWHODOESSUCHWORKHIMSELFOFHERSELfOR m � THROl1GNHI50RHEROWNEMPLOYEES.7ROVI�EDTHATSUCHIMPROVEMENTSARENOTINTENDEDOR W OFFEREDFORSnLE.IF,HOWEVF.R,TNE8l11LDINGORIMPROVEMENTISSOIDWITHINONEVEARO�COMPLE- � TION,THE OWNER-BIIILDER WILL HAVE THE BUR�EN OF PqOVING THAT HE OR SHE DID NOT BUILD OR � IMPR�OR h1E PURPOSE OF SALE). I,AS OVJNER OF THE PROPERTV,AM EXCLUSNELV CONTFAC7ING W ITH LICENSED CONTRACTORS QTO GONSTflVGT THE PRQIECT(SEC.1046,BVSINESS AND PROF[SSIONS CODE:THE CONTRACTORS LI Valuation — ADJ.AREA W CENSEUWDOESNOTAPPLVTOANONTJEROFAPROPERTYWHOBUILDSORIMPROYESTHEREON,ANO � NAiOCONTRAGTSFORSUCHPROJEGTSWITHAGONTRAGTOR�S�LIGENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE Y TORS LICENSE LAW.). � ❑I AM E%EMPT UN�ER SEC. B.8 P.C.FOR THIS REASON U V � � , 5 d ZDATE OWNER_ W � rl//TG(!YL � LICENSED CONTRACTORS DECLARATIDN W U T S/ 6 � � I HEREBV AFFIRM UNDEP PENALTY OF PERJURV THAT I AM LICENSED UNDEF PROVISIONS OF GHAPTER � d, 9(COMMENCING WITH SECTION 7o00�OF DIVISION�OF THE BUSINESS AND PROFESSIONS CODE,AN� Z X AIV LICENSE IS IN FULL FORCE AND EFFECT m W �/ �/� `f � LICENSE CL455��_Qcs._ LIC.NO. / � � �/ J V DATE a � � �� Z GONTRACTOR /� a W � WORKERS'COMPENSATION�ECLAFATION Q � I HEFEBV AFFIRM UN�ER PENALTV OF PERJURV ONE OF THE FOLLOWING DECLARATIONS: � � Z O IHAVEANOWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFOFWORKERS' _ ¢ COMPENSATION,ASPFOVIDEOBVSEGTION3]OOOFTHELABORCODE,FORTHEPERFORMANCE IU OFTHE WOFK FOR WHICH THIS PERMI'IS ISSUED. � � w I HAVE AN�WILI MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOLIIRED BV SECTION '�/ Q 3�OOOFTHELABORCODE,FORTHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMITIS li� �J ISSUED.MY WORKERS'COMPENSATION INSURANGE GARftIER AN�POLICV NUMBEii ARE CONSTRUCTION rT1 j cARRiEa PLAN REVIEW � . , _-- O POUCYNUMeEa ELECTRIG � � �U Z Q �n-i�ssEcrior+NEmraTeEcorVs�E'EooFn+EaEw,nrriswaouENUNoaEooa_�ws(sim)oa�Ess�. PLUMBING � w I CEHTIFV THAT IN THE PERFORMANGE OF THE WORK FOft WHICH THIS PERMIT IS ISSUE�,I MECHANICAL � Z (,'} SHALL NOT EMPLOY ANV PERSON IN 1NY MANNEF 50 AS TO BEGOIAE SUBJEGT TO THE � WORKERS'COMPENSATIDN LAWS OF CALIFORNIA,ANC AGREE 7HAT IF I SHOULD BECOME INSPECTION FEE SUBJECT i0 THE WORNERS'COMPENSATION PROVISIONS OF SECTION 3]00 OF THE LA00R - � COD I SHALLFOHTHWITH COMGLY WITH GEPROVISIONS � ISSUANCE � SMIP � DATE'. � �'��PLICANT �N�/ V� w ENERGY P/C J WARNWG FAIIUFE TO SECIJRE WOftKERS'COMPENSATION COVERAGE IS JNLAWFVL,AND SHALL BE J SUBJECTAN EMPLOVERTO CRIMINAL PENALTIES AN�CIVI��_FINES JP TOONE HUN�REO THO',JSAN� � � ��- � DOLLARS(f��000),iN ADDITION TOTHE COSi OF COMPENSATION,DAMAGES AS PfiDVIDED FOR IN ENERGV PERMIT J SECTION 3]OB OF THE LABOR CODE,INTEREST.AN�ATTORNEY'S FEES. RETENTION FEE: � • d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � 1 HEREBV AFFIqM UNDER PENALTV OF P�RJURV THAT THERE IS ACONSTRUGTION LENOING AGENCY � FOP THE PERFORMANC[OF THE WORK FOR WHICH THIS PERMIT IS ISSUE�;SEC.309],GIV.c.). Z W S LENDER'S NAME � H IENDEF'SADDRESS_ {�\� � ICERTIFYTHATIHAVEREADTH'�SAPPLICATIONANDSTATETHFTTHEABOVEINFORMATIONISGORRECT. TOTAL FEES .�'� `-+ � W I AGREE TO COMPLV WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS fiELATING TO F3UIL(IING - � � CONSTRUCTION,ANOHEREBYAUTHOPIZEREPRESENTATNESOFTHISCOUNTYTOENTERU�ONTHE ��R�� /1 /J � j� ZABOVE�MENTIONED PROPERTV FOR IN57ECTION PURPOSES. � COMMENTS �^ Q �� /�O N � c.J r � ¢ PE EE AME(PRINTJ � — �-- � � � � � � SIG OFPEPMRTEE DATE � RECPT.NO. PAID BV VALIDATION _ ~ WHITE—Depariment Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLOENRO�File Copy,GREEN—ApplicanYs Copy �� ' — �� a�� .�w�� '�'�d� . �: "� a �`" , � ��.�;', �, ��w" �� J�z -�'�` Y� � � �'�� sI� l8� ��-� _ _ _ _ 8 � ��2 � _ , g��,� /p��-''�t _ _ _ . B�iy(�z ti��-y� _ ��`�L dl. � �f�� /�� ;�� , - �p�1. :�` , �? f 3 �� < , � n > � � �.� � (,-1}��fri., ��G>(�P��S '!'� � `�� _SF�C+�_ �_ f�Li'`��_ �� IJP'f � �� 3� Dc�[ �C brsC p�3� _-� _ _ ; _ _ _ . ,, , �a �a � ; � _ _ ��:�v �� ,�� , �'� � �r �� . ':��.� ��.e�� - � � - �� , ,; � ,�� _ _ `,. i �i� ��. .� , i i '�.. "�; � d$%�•k�y.� ��. �.� � .. .. . ... . ... .... ... . .. . . . ... . ... ... ... .. ... . ... ...... ra�� ri �� j �:. �s�r ��_�.',��,��`�,�w - . & F z_ ' ' ,.,q `A ��isi '' @ ` . .. ... ... .. ... ._.. . . .. .... . � n 'a . _ . ;5r . . . . . .... . ...... .. ... . ... . .. .� �5 i s, 2 rf( �xi .. , i 'sh2 �,. ... . .... ... . .... . .. ... ... . ... . ... .... . .. ...... . . .... .. .... . . .... ...... . . �-0�e= . • � J.� . � ,�.. i '- 1 � ��i q� _� .,: �� ._ ,.. ULl?IOJD MR JOBSITE/I ADDRESS APN LOT TRACT OWNER ADDR SS CITY r cow P/�STEL..9 f o APPLICANT r T�09 57R�/I CONTRACTOR u p-' ADDRESS CITY 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 FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE :ANY CITY OR COUNTY WHICH REQUIRESA PERMIT TO 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).): ^ I,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 THE PURPOSE OF SALE). IMPR OR I,AS ONER OF THE PROPERTY.AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS W 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 7 LICENSE CLASS LIC N0. DATE d t/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 IS ISSUED. MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER POLICY NUMBER (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 )COD I SHALL FORTHWITH COMPLY WITH ROVISIONS �� L PLICANT: / DATE. 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 J SECTION 3708 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES. J 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.). J LENDER'S NAME LENDER'S ADDRESS C I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. 'J 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-MENTIONED PROPERTY FOR INSPECTION PURPOSES. /SON v r PE EE AME(PRINT) rj SIG OFPERMITTEE DATE CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION PRESS FIRMLY APPLICATION/\PERMIT P/C f\'\ 7 #J c7� DATE UMBER ISSUE TYPE OCC DATE CONST GROUP ZONING SETBACKS FRONT RW^ REAR^ SIDE/SIDE STREET RW^ SIDE � ii PROPOSED USE\ N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. -FACTOR PSF ADJ.AREANALUATION SFR/ADD/REM Garage/Carport LU Patio/Deck LU IL Pool/Spa 0 Z Re-Roof Commercial Valuation ADJ.AREA QUANTITY DESCRIPTION FEE Q v b s U lirc�c.t w vT SiJ m J a J 0 Z 2 0 W J CONSTRUCTION PLAN REVIEW �� c kl ELECTRIC PLUMBING MECHANICAL INSPECTlON FEE_ ;fy 99 ISSUANCE 5 SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES �'R 33 COMMENTS RECPT. N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy, L5ULUtNHULt-I-Ile Copy, 1r+eeIN-. 6-Lqot k)W*L�-P S&-vmzv� Fcl�-sq-c%-c A-4 FLA-Wet