The URL can be used to link to this page

Home My WebLink About17847 � . �` _ CITY OF DIAMOND BAR `�� " i ��"Q,1 �� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive � (909)860-3195 Fax(909)861-3ll7 �� PRESS -»� � BUILDING PERMIT APPLICATION FIRMLY o A�DDRIESS��J Z.('/? F'�' DATE CATION ^�Z NUMBER L[O 7'� #lC � ISSUE �j TYPE OCC APN L.OT TRACT DATE t7 'L. CONST. GROUP p OWNER _ Q�� `' --i p ADDR S�Q'L1 ' /�'r%ilG�__ _ ZONING SETBACKS z CITY P J TEL `�J j 7 /� FRONT RW ❑ o APPLICANT TEL. SIDE/SIDE STREET RW LJ z ¢ CONTRACTO � � � SIDE ❑ ADDRESS �C'� � o CITY (1.,ai,,u _ ZIP .r"5 TEL. ��IS�`�`7S`7� PROPOSED USE � S /1 ' { w ARCHIENG/ z DESIGNER ,� w NO.DWEL. NO /�:;.5�C7 �?�c NO. � a ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS � — �n DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION ¢ OWNER-BUILDER DECLARATION SFR/ADD/REM O � I HEREBY AFFIRM 11NDER PENALTV OF PERJURV THAT I AM EXEMPT FROI.1 THE CANTRACTORS LI- G8f8J9/CBfpOfl W CENSEUWFORiHEFOILOWINGREA50N�SEC.1031.58U5MES5ANDPFOFESSIONSCODE:ANVCITVOR (n U CAUNTVWNICHREOUIRESAPERMITTOCONSTRVCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANVSTRUC- w TURE,PRIOR TO ITS ISSUANCE,ALSO RE�UIflES THE APPLICANT FOR SUCH PERMIT TQ FILE A SIONED W Patio/Deck � STATEMENT THAT ME OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE GONTRAGTORS LI- � � CENSELAW�CHAPTER9(GOMMENGINGWITHSECTION]oaO)OFDIVISION90FTHEBUSINESSANDPRO- POOUSpO fE5510NSCO�E)ORTHATHEOfl5MEI5EXEMPTTMEHEFROMAN�TMEBA515FOFTHEAILEGEJE%EMP� (7 � TION.ANYVIOLATIONOFSECTION7031.5BYANVAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO Z R2-ROof A CIVIL PENALiV OF NOT MORE hIAN FNE HUNDRED DOLLARS(5500;.): ❑I.ASOWNEROFTHEPROPERTVORMYEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSA7IDN, � O Commercial Z WIL�DO THE WORK,AND 1HE STRUCTURE IS NOT INTENOED OR OFFERE�FOR SALE(SEC.�OdC,BU51- J � NESS AND PROFESSIONS GODE:THE CONTRACTOftS LICENSE lAW DOES NOT APPLY TO AN OWNER OF � — PFOPERTVWHOBUILDSORIMPROVESTHEREON,ANDWHODOESSUCHWOFKHIMSELf-ORHERSELFOR � THROUGHHISORHEROWNEMPLOVE[S,PROVIDE�THA75UCHIMPROV[MEN?SARENOTINTENDEDOR m O OFFEREDFORSALE.IF,HOWEVEfl,h7EBU1LDINGORIMPROVEMENTIS50lDWITHINONEYEAROFCOMPLE- Z TION,TME OWNEfl-BUILOER WILL MAVE THE BUPDcN OF PROVING THAT HE OR SHE OID NOT BUILD OR � IMPHOVEFORTHEPURPOSEOFSALE). W CI,ASOWNEROFTHfPROPER7Y,AMEXCLUSiVELYCONTRACTINGWITHLICENSEDCONTRACTORS � TO CONSTRUCT THE PROJECT(SEC.7DC4,BUSINESS AND PHOFESSIONS CO�E�.THE CONTRACTOPS LI- VelUet10f1 ADJ.AREA W CENSELAWDOESNOTAPPLYTOANOWNEROFAPROPERTYWHOBUILDSORIMPROVESTHEREON.AND � WHOCONTRACTSFORSUCHPR0.IECTSWITHACONTRACTOR(S)LICENSEDPURSUANT'OTHECONTRAC- QUANTITY D SCRIPTION FEE Y TORS LICENSE UW). Q J Q ❑I AM EXEMPT UNDEH SEC. B.8 P.C.FOR THIS REASON Q � U � � DATE OWNER � Z w � �ICENSED CONTRACTORS DECLARATION W ¢ � I HEREBY AFFIRM UNDEfi PENALTV OF PERJURV TI-AT IAM LICENSED UNDER PROVISIONS OFCHAPTER � d B(COMMENCING WITH SECTION]000)OF DNISION 3 OF THE BUSINESSAN�PROFFSSIONS CODE,AND Z X MV LICENSE IS IN FVLL FORCE AND EFFECT � LICENSECLAS ��1. LIC NO.�� j r J V OATE � 7 CONTRACTOR � W � WORKERS'COMPENSATION DECLARATION ¢ � 1 HEflEBV AFFIRM VNDEfi PENALTV OF PERJURY ONE OFTHE FOLLOWMG DECURATIONS: Z 0 IHAVEANDWILIMAINTAINACERTIFlCATEOFCONSENTTOSELF�INSUREFORWORKERS' _ Q COMPENSATION.ASPROVIDEDBVSECTION37000FTHELABORCOOE.FORTHEPERFOflMANCE W OF THE WORK FOR WHICHTHIS 7ERMIT IS ISSUED. 0 � W I HAVE AND WILI MAINTAIN WORKERS'GOMPENSFTION INSUftANCE,AS REOUIRED BV SEGTION ^� Q 37000F THE LABOR COOE,FOR THE PERFORMANCE OF THE WORK FOR WHICH iH15 PERMIT IS � � � / � ISSUED.MY WORKL=RS'COMPENSATION INSURANCE CARFIER AND POUCYNUMBER ARE' CONSTRUCTION b ¢ — � CARRIER_r I � pLAN REVIEW 0 POLICV NUMBER_ � ELECTRIC Z Q � (R1ISSECTIONNEmNOTBEWMPLEf�OFhiEPERMITISFORPVEHUNOREDDOLWLS(5100;OFLE55). PLUMBING W Z I CERTIFY THAT IN fHE PERFOPMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUE�.I MECHANICAL �} SHALLNOT FMPL(]YANV PFRSON IN ANV MANNER SO AS TO BECOME SUBJECT TOTHE ..f.l{_i _ _ _ � WORKERS'COMPENSATION lAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE SUBJECt TO THE WORNERS'COMPENSATION PROVISIONS OF SECTION 3100 OF THE L480R '� CODE,I S/y ALL FOFITHWITH COMPLY WITH T�Q PROVIS NS. � ISSUANCE L p DATE:___�Z ' APPLICANT /.�(�dCV'�C' S � SMIP .... � E-� J WARNING:FAILURE TO SECURE WORKERS' P�ON COVERAGE IS UNLAWFUL,AN�SHALL BE ENERGY P/C � SUBJECT AN EMVLOYERTO CRIMINAL PENALTIES ANO CIVIL FINES UG TOONE HUNDflED THOUSAND EfvERGY PERMIT DOLLARS�f�D0,000),IN ADDITION TO THE CQST OF COMPENSATION,DAMAGES AS PROVI�ED FOP IN —�-��---- J SECTION 3]OB OF THE LABOR CODE,INTEREST,AND ATfORNEY'S FEES. RETENTION FEE: � d CONSTRUCTIONLENDINGAGENCY PRE-ALTFEE: ' � .�U O � i NEREBV AFFIFM UNDER FENALTV OF PERJURY THAT THERE IS ACONSTRt1CTION�ENOING AGENCY FOHTHF PERFORMANCE OFTHE WORK FOF WHICHTHIS PERMIT IS ISSUED IS�C.a09],CIV C.). W S �_ENDER'S NAME � F'- LENDER'SADORESS � TOTAL FEES � � • S(� � I CERTIFV THAT I HAVE RE/��THIS APPLICATION AND STATE THATTHE ABOVE IM1FORMATION IS CORRECT w I AGREETO COMPLV WITHALLCITY AND COVNTV ORDINANCES AND STATE LAWS REIATING TO BUI�DING d � CONSTRUCTION,ANDHEREBVAUTHORIZEFEPRESENTATIVESOFTHISCOUNTVTOENTERUPONTHE Z ABOVE-MENTIONE�PROPI=flTY FOR INSPECTION PURPOSES. Q COMMENTS J � m PERMITTEE NAME(7RINT) Q Cl) = SIGNATURE OF PERMITTEI= DATE d y RECPT.NO. ��O / PAIDBY c � L VALIDATION ~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy.GOLDENRO�File Copy,GREEN—Applicant's Copy r i=�: p F - d �i a�i� ia w ,��.�s°, .,6 d�� :i �-i �'�� F a a�m�a��a ,,€ ��C�.�¢`° 1 . a... _., ., �s . . . . . . . .��ti� ��i'�, � �.�: .. ,. . . ,��/°'Z �'� �� . , ��. _ _ _ r �_�.» � �:� , � ��,a� _ _ _ _ � � � � �� ; _ � �� .�,fi��.�� 2 _ �€ � � "� ' �� ;N�� : a� - �-�R �� ..� � .� �� ,� „ .�: � _ . : __ f� � A � � �� n��M �� f� �. ti��.t�. � � � d�� 3 ��., ��;�� y .b> � . t � � r 4� Ik a ., � . '�� ,�. _a�.'�s�=�N . �' .. DIAMOND HARI 7 1 CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION I Y�Q� 11 u2 PRESS FIRMLY AJOBSITEDDRESS-1322 do zt, / APN LOT TRACT 5 . OWNER �1' ADDR S5an ' Ilicil<L CITY P J TEL 3 �7 k APPLICANT TEL. CONTRACTOR 1164Z6 4 ADDRESS oC CITY 40121,1UL ZIP 076 TEL-I).59%757/ 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 REQUIRES A PERMITTO 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 IMPROVE FOR THE PURPOSE OF SALE). ^ 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 TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(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 B(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORCE AND EFFECT 'y�� i . LIC N0. LICENSECLAS DATE z 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 T E Y POLICY NUMBER E- )7 3"1 E---- [7/ (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 CODE.I S ALL FOFITHWITH COMPLY WITH T PROVISIQNS. DATE:APPLICANT 06 ENSATION COVERAGE IS UNLAWFUL,AND SHALL BE WARNING: FAILURE TO SECURE WORKERS' P SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES. CONSTRUCTlON LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC. 3097,CIV C.). LENDER'S NAME LENDER'S ADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES PERMITTEE NAME(PRINT) SIGNATURE OF PERMITTEE DATE ui 00 0 LL W z 0 2 0 0 W U Z W 0 U C/) LL 0 Q 0 LU W 0 W CID C!) 0 c W W Z C/) to W LL d W I-- W a CD Z U) CO F APPLICATION PERMIT P/C DATE 4'-D Z NUMBER# ISSUE TYPE OCC DATE CONST.GROUP ZONING SETBACKS FRONT RW^ REAR^ SIDE/SIDE STREET RW^ SIDE^ PROPOSED USE U�,,,2j CV E' 5 74 CZ lz k��,6• c < N0. DWEL. NO ft-RZI C Fr N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM U3 Garage/Carport w Patio/Deck LL Pool/Spa 0 Re-Roof Z 0 Commercial 5 CO Valuation ADJ.AREA QUANTITY D SCRIPTION FEE J U W J W (0 DO a Z 2 U W J' 0 CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE G} ISSUANCE "} SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: OU I PRE-ALT FEE: TOTAL FEES COMMENTS 1L/D PAID BY C NO RE PT C VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy 1$t_�,