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Home My WebLink About18512 �,� ci�aF D�orrD B� � DEPARTMENT OF COMMUNPfY&DEVELOPMENT SERVICES � � 21825 E.Copley Drive (909)&60-3195 Fa�c(909)861-3117 PRESS ��*� BUILDING PERMIT APPLICATION FIRMLY � JOBSITE �� s' APPLICATION � �]P�ERMIT �P/C o ADDRESS� � �� DATE ''14UMBER � # � °r APN OT TRACT ISSUE TYPE OCC p OWNE��/✓ - - DATE CONST. GROUP o ADDRESS �� ZONING SETBACKS Z CITY ZIP 7EL. FRONT qyy � � APPLICANT TEL._ REAR � z SIDE/SIDE STREET RW ❑ Q CONTRACTOR �t�n /p � SIDE � ADDRESS%�/ � CITY � ZI TEL �� ` PROPOSED US 7 f, o ARC NG/ 0 7�� ` � z DESIGNER ' - w NO.DWEL. N . - � ADDRESS NO. � CITY ZIP TEL. UNITS STORIES BEDROOMS � � -- - � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION p SFR/ADO/REM 0 I HEREBV AfF'qM UNDER PENALTV OF PERJUflY THAT I AM EXEMPT FROM THE GONTRACTORS LI- G2f29B/C2fPOIT W CENSEUWFOR7HEFOLLOWINGREASON(SEG.�oai.5BUSINESSANDFROFESS�ONSrppE:ANYCITVOR (n U COUNTYWHICHREOIiIRESAPERMITTOCONSTRUC',AL�ER,IMPROVE.DEMOLISH,CPREPAIpANYSTRUC� W P2(i0/DeCk w TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES TNE APPIICANT FOR SUCH PERMIT TO FILE A SIGNED w � STATEMENT THAT HE OR SHE IS LICENSED PVRSUANT TO THE 7ROVISIONS OF THE CONTRACTORS LI- � � CENSE LAW(CHAPTER B(COMMENCING WITH SECTION]00�)OF DIVISION 3(1F TNE BUSINESS ANJ PRO- POOVSPB O FESSIONSCA�E)ORTHATHEOFSHEISE%EMPTTNcqEFROMAN07HE8ASI5FORTHEALLEGEDEXe'MF- � V TION.ANVVIOLATIONOFSECTION]0�1.SBVANVAPRLICAN�FORAPEHMITSU9JEG�5"IHFAPPLICANTTO Z Re-Roof � ACIVIL PENALTV OF NOT MORETHAN FNE HUNORED DOLURS�f500).)�. � ❑I,ASONMEROF�HEPROPERiY,ORMYEMPLOVEESW�THWAGE5A51MFIR50LECDMPEN�A'iON, 0 Commercial Z WILL DO TME WORK,AND THE STRUCTURE IS NOT I�END['J OH OFFERED FO�i SALE�SEC.70dA.BU�I- J � NE55 AND PROFESSIONS GODE:THE CONTRACTORS LICENSE LAW DOES NO'APPiV TO AN OWNER OF � VROPERTV WNO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK NIMSEIf OR HERSELF OR � THRIXIGH HIS OR HER OWN EMPLOYEES,PROVIDED TMAT SUCM IMPROVEMENTS ARE NOT INTENDED OR m Q OFFEREDFORSALE.IF.HOWEVER.THEBUILDINGORIMPROVEMEN'.ISSOL�WITHINONEVEAROFCOMPLE- Z TION.THE OWNER-6LlILDER WILL HAVE THE BUFDEN OF PROVING THAT HE OR SHE DIO NOT BUIID OH � IMPROVE FOR THE PUR705E OF SALE). w ❑I,ASONMEROFTHEPROPERTV,AME%CLUSIVELVCONTRACTINGWITHLICENSEDCONTRACTORS [L TO CONSTPUCT THE PROJECT(SEC.]001,dU51NES5 AND PROFESSIONS'CODE.THE CONTqACTORS LI� V81U3IIOf1 ADJ.AREA W CENSEUWOOESNOTAPP�YTOANOWNEROFAPROPERTYWHOdU11D50FIMPROVESTHEREON,AND F� - � WHOCONTRACTSFORSUCHPFOJECTSWITMACONTRAGTOq(5)I.IGEM1SEDPURSUANTIOTHECONTFAG � QUANTITV DESCFIPTION� FEE Y iOHS LICENSc LAW). � ❑I AM EXEMPT UNDER SFC. 8.8 PC.FOR THIS ReA50N Q � U iy., — CC — DATE OW4ER F- Z U O W � LICENSED CONTFACTORS DECLARATION w ¢ 2 I HEREBV AFFIRM UNDER PENALiV OF PERJURV THAT I AM LICENSED UNDEN PRO`/ISIONS OF CHAPTEF � � 9�GOMMENGINGWITHSEC110N�000)OFDIVISION30FTHEBUSINESSANDPPOFESSiJh5C0'JE,AND Z �X MV UCENSE IS M FULL FORCE AND EFFECT � LICENSECLASS �"3 y__ IIC.NO. � ��/�G. � � U DATE � � Z CONTRACT d -- W � WORKERS'COMPENSATION DECLARATION Q � I HEREBY AFFIRM UNDER PENAITV OF PERJURY ONE OF THE FOLLGWING DECLARATIONS: z Z _I MAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENTTO SELF-INSURE FOR WOANERS' a 2 Q CAMPENSATION,AS PROVIDED BY SECTION 310o OF THE LABOR CODE,FOR THE FERFORMANCE U Q OF ThE WORK FOR WHICH THIS FERMIT IS ISSUED. � W I HAVE AND WILL MAINTAIN WOPKERS'GOMPENSA710N INSl1RANCE,AS NFOUIRE�BV SECTION //ff ///...�� Q31o00FTHE LABOR�DF,FORTHE PERFORMANCE OF THF WORK FOF WHICH THIS PERMIT IS �,{� / ` ISSUED.MV WO Eii"C MPENSATION INSUR iICE CARRIER AVD POLICY NUMBERARE: CONSTFUCTION j V J �� ,,,,,,,�,� - j cnaaieR PLAN REVIEW oPOLICV NUMBER_^C�ft _. x/�� - 6+-�----- ELECTRIC � Q � � (TNISSECTICfJVEmNOTBECOIAFLEfE00FTNE7ERfMISFOFONEHUf�DRED0IX1A0.S({100)oFLESS). PLUMBING Z �CEfiTIfV THAT INTIIE PERFORMANCE OF THE WOflK FOR WHICH iH15 PERMIT IS ISSUED,I MECHANICAL C'3 SHALL NOT EMPLOY ANY PEPSON IN ANY MANNER SOAS TO BECOME SUBJEf,T TO TnE — � WORI(ERS'COMPEN54TION LAWS Of CALIFORNIA,ANJ AGREE TM/T IF I SHOUlO BEGOME INS?ECTION FEE � SUOJECT TO THE WOFKERS'COMPENSAtION PFOVISIONS OF SEGTION 370a OFTHE LAB09 �� COD,I SHALL FORTHWITH COMPLV WITHTHOSE PROVISIONS. —I 9� ISSUANGE O DATE L-�APPLICANT: ��_�— SMIP ` � � � � � ;•} �r -- — J WNRNING�.FNILUFE TO SEGURE WORNERS'COMPENSATION COVERAGE IS UNLAW�UL,AND SHALIeE ENERGY P/C � SUBJECTNfJEMPIOVERTOGRIMINALPENALTIESANDCIVILFME5UP100NEHUNDRE�THOU5AN0 ENERGYPERMIT } DOLLARS(f1ao,Doo),INAOD'�TIONTOTHECOSTOFCOM�ENSATION,DAMAGESASPROVIDEDFORIN � SECTION37o80FTHELABORCODE.INTERESTANDATTORNEv'SFEES. RETENTIONFEE: � � CONSTRUCTION LENDING AGENCY PRE-ALT FEE � O ___...._ __ � I HEREBYAFFiqM UNDER PENFLTV OF PERJURY TMAT TfiERE i5 A CONSTFUCTION LENDING AGENGY .. FOF TME PEFFORMANGE OF THE WOFK FOR WHICH THIS PEFMIT IS ISSUE�(SEL'.3a9],CIV.G.�. � ---— Z w = LENpEN'SNAME � � I F— LENDER'SA�DRESS _ _ ___.- ._.__ ..__. ... ._____ w TOTAL FEES � 9,'�v I CERTIFY THAT I MAVE READ TMIS APPLICATIdJ AND SThTE THAT THE ABOVE INFORMATION IS CORRECT � I AGREE TO COMPLY WITH AL�GITV AND GOUNTY ORDINFNGES ANO STATE LAWS RELATING TO E3UILDING � GONSTFUGTION,ANDHEFEtlYAU�MOHIZEREPRESENTATIVE50FTHI5COUNTVTOEMERUPUNTHE Z ABOVE-MEIrTIONED PROPERTV FOR INSPECTI04 PURPOSES. GOMMENTS � Ci✓/4�N G� .Sy (J� _ -- - m PERMITTEE NAME(PRINT Q C/� SIGN OFp ITTEE D/+TE = RECP?.NO. PAID BY VALIDATION ~ WHITE—Deoartment Copy,VELI.OW---Finance Copy,PINK—Assessor Copy,GOLDE RO�File Copy,GREEN—Applica Ps Copy .. __. .. ,a ;,�. , �k �ec��t�?.� '..�°` �' r � � .�'�. �°`�?, � '��``,e. a °�� /+ _ ` ' _ ��d� �� . � -� � ' : � ��- . � - � �� :�� . � _ - ,, . _ � _ _ �m�.� �,�,��r . � , � _ _ _- __ ,��n� ,� �a. �� W _ _ _ _ _ _ __. _ __ --. ___ _ _ _ _ _ __ _ � ; „�� w,�;��r _ �� r Py ... . . .. . _.. . .. .. .. .. _. __. �' g��#� I k e � � �;., ��,F.d'n . `�i r t . ..._ j,�,_. � , �� i � _ i.. I �� , k. _..._. .._. . "� :�:�,:�}; � .. . . .... . .. ..._. . .. .... . . .. .. . . ..... ... . . ... ... ...... ._._.. ��-. �. ;:��'(. : . .. . . .. . . . . ._.... ...._ .._.. ._... _. .. _ ... i �, _ , _ � '"` � ... . .. .. . ..... ... _. . ._. . . f`�� ... .. ..... . . .. . . .. . . ... .. ._.. Y a`�� ., . b ��: � .�. �u: #�'°�'�' � � � � , _ _ — -- — — 3� �� DIANOXD HART 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 1 APN OT TRACT OWNER// ADDRESS S�iart.a CITY ZIP TEL. APPLICANT TEL. CONTRACTOR WD/� ADDRESS 4117C 4F 1,4g. Oa A 4 CITY ZI IIVX4-TEL ARC NG/s 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 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 SUBJEC IS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($500)): 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. 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). U I,AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTlNG WITH LICENSED CONTRACTORS TO CONSTRUCTTHE PROJECT(SEC. 7044, BUSINESS AND PROFESSIONS CODE.THE CONTRACTORS LI. CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO aUl(.DS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT 10 THE CONTRAC- TORS LICENSE LAW). U T AM EXEMPT UNDER SEC. B.&PC . 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 MY LICENSE IS IN FULL FORCE AND EFFECT L-39 -,7,v LICENSE CLASS 'IC. N0. DATE C 2 CONTRACT 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. HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTlON 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS UR �ICE CARRIER AND POLICY NUMBER ARE ISSUED. MY WO ERS'C MPENSATIOON IINSS f CARRIER�"Y POLICY NUMBER -rCJ (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 SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE"'L-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 15100,000),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 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 INSPECTlON PURPOSES C�JPUV' PERMITTEE NAME(PRINT SIGN OFP ITTEE DATE cr 0 LL w z 0 IS 0 LL 0 a x W 0 I I-- w a CO CO CO LL LU w Z 0 CO ZD 0 J Cc ILL-1 0 CE d C DO m F- WHITE-Department Copy,YELLOW-Finance Copy, PIN PRESS FIRMLY APPLICATION ERMIT/C J! J DATE # '4 UMBER ISSUE TYPE OCC DATE CONST.GROUP ZONING SETBACKS FRONT RW REAR^ SIDE/SIDE STREET RW^ SIDE^ PROPOSED US N0. DWEL. N-N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM Garage/Carport W w Patio/Deck LL PooVSpa Z Re-Roof Commercial 5 Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J F- I- U J W 0 Z DO OL Q U Z Q 2 0 W 4 To CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES 1,-70 COMMENTS RECPT N0. PAID BY VALIDATION