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_ 1� CITY OF DIAMOND BAR ��� ��' i
1 DEPARTMENT OF COMMLTNITY&DEVELOPMENT SERVICES
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�, CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
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CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21660 E.Copley Drive Suite 190
(909)860-3195 Faz(909)861-3117
BUILDING PERMIT APPLICATION
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CITY-��'-Y°�ZIP��TEL (�Z,� •I )Z°,?��L
APPLICANT �E' Vl� iZY TEL. -�
CONTRACTOR���t2SG/I �Q rJ5
ADDRESS�I�".2 A-[01�°t K.0 •E
CITY WC ZIP �TEL ZV� �iZ�
ARCWENG/
DESIGNER�.Q.�IZGFfI i�CTS-�'II�/4FZY
ADDRESS�af E fTZ./16c .411�rVGIE
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CITY�y,���,/L�, �_ZIP'•Q'TEL S�'Iti-�S.S�S�
OWNERBUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI-
CENSELAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE: ANV CITY OR
COUNTY WHICH REWIRESA PERMRTO CONSTRUCT,ALTER,IMPROVE. DEMOLISH,OR REPAIR ANY STRUC-
TURE. PRIOR TO ITS ISSUANCE,ALSO REQUIRES 7HE APPLICANT FOR SUCH PERMIT 70 FILE A SIGNED
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI-
CENSELAW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISK)N 3 OF THE BUSINESS AND PRO-
FESSgNS CODE)OR THAT IiE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP-
TKNI.ANY VKX.ATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO
A CML PENALTY OF NOT ANDRE THAN FIVE HUNDRED DOLURS(f50oJ.):
^ 1,AS OWNER OF THE PROPERTY,OR MV EMPLOYEES W ITH WAGES AS THEIR SOLE COMPENSATION
WILL DO THE WORK,AND 7HE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC. 7044, BUSI-
NESSAND PROFESSKNIS CXx1E:THE CONTRACTORS LICENSE UW DOES NOT APPLY TO AN OWNER OF
PROPERTY WHO BUILDS OFI 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,HOV/EVER THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE-
TION,THE OWNER-BUILDEI7 WILL HAVE 7HE BURDEN OF PROVING THA7 HE OR SHE DID NOT BUILD OR
IMPROVE FOR THE PURPOSE OF SALE).
^ I,AS OWNER OF THI: PFOPERTY,AM EXCLUSIVELY CONTRACTING WITH Li'^f NSED CONTRACTORS
TO CONSTRUCT THE PROJECT(SEC. 7044, BUSINESS AND PROFESSIONS COLE:THE CONTRACTORS LI-
CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES 7HEP =0N
AND
WHO CONTMCTS FOR SUCH PROJECTS WITH A CONT RACTOR(S)LICENSED PURSUANT TO THE CONTRAC�
TORS LICENSE LAW.).
^ I AM EXEMPT UNDER SEC. B. 8 P.C. FOR THIS FIcASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER
P(COMMENCING WITH SECrKN�'7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND
MY LICENSE IS IN FULL FOPCE AND EFFECT
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LICENSE CUSS'�� LIC
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DATE��Y--CONTRACTOR�r��C -
WORKERS'COMPENSATION DECLARAT
I HEREBY AFFIRM UNDER P'ENALN OF PERJURY ONF OF THE FOLL NG DECLARA I S:
I HAVE AND W'LL M/\INTAIN ACERTIFICATF OF G:NSEN OSELF-INSURE FOfI WOFIKERi'
COMPENSATION,A:. PROVIDED BY SECTION 3700 OF THE ORM
0 E WORK FOR WHICH THIS PERMIT IS ISSUED.
(HAVE AND WILL M/UNTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED SECTIO
' 3700 OF THE LABOR CODE,FOR?HE PERFORMANCE OF THE WORK FOR WHIC IS PERMI�f I
ISSUED. MV 0
RKE'.RS'COMPENS Tk7N 1 JRAN[C
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BIER AND POLICI'BER ARE'
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CARRIER Y�"�
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POLICY NUMBER
RHN SECnON NEEnIV07 BE CCNf"LErFD OFTHE F'EfInCT IS FOR ONE E.^DOI.LARS(f100j ORL).
1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH TH D,
SHALL NOT EMPLOI'ANV PERSON IN ANV MANNER 50 AS TO BECOME SUBJECT TO THE
WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF 1 SHOUID BECOME
SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 37000E THE IABOR
COD I S LL FORTHWITH COMPLY WIT I
DATE: APPLICANT: -
WARNING:AIWR TO SECURE WORKERS'C PENS ION COVERAGE IS UNLAWFUL,AND SHALL BE
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS(f 100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
SECTK)N 3708 OF 7HE LABOR CODE,INTEREST,AND ATTORNEYS FEES.
CONSTRUCTlON LENDING AGENCY
I HEREBY AFFIRM UNDER PI:NALN 0 ERJURV THA7 THERE IS A CONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OI=iHE WOR WHICH THIS PERMIT IS ISSUED(SEC. 3097,CI V.C.).
LENDER'S NAME "
S� — –
LENDER'S ADDRESS
I CERTIFY THAT 1 HAVE REN3 THIS APPLICATION AND STATE THAT THE ABOVE INFORMATK)N IS CORRECT.
I AGREE TO COMPLY WITH A.LL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
CONSTRUCTlON,AND HEREBY AUTHORRE REPRESENTATIVES OFfHIS COUNTY TO ENTER UPON THE
ABOVE-M
EN
TIONED PROPE9T
VF
OR INSPECTIO
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DI.1M111X0"IRR i
CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21660 E.Copley Drive Suite 190
(909)860-3195 Fax(909)861-3117
BUILDING PERMIT APPLICATION
JOBSITE
ADDRESS�6?IQ CZ/�A.WAy CT R 2t4
ADDRESS
APN LOT TRACT
OWNER TRAAAMQLL,GROW C0.
ADDRESS-i.862 �(-S_GdL-E AI/� . �s(J I TLc Z2�
CITY 1NDa5Tr=V CA ZIP-7 j TEL.'6269�/2•. BIZ
APPLICANT TEL.
CONTRACTOR s'.'r r
ADDRESS?IC e-1
CITY ZIP'4'-�7 TEL.�'1,'i = r�tjl
ARCH/ENG/
DESIGNER K�J I kJ At_Y-L•dr j m TS
ADDRESS Z'E.OL//tffAUL-
#305
Y
CITY abR-9 ZIP 9/507 TEL./A 7 g35
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 FIE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP-
TION.ANY VIOLATION OF SECTION 7031.5 BY ANYAPPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO
A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($500).):
^ 1.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 ODDE: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).
^ 1.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 PURSI/ANTTOTHE CONTRAC-
TORS LICENSE LAW.).
^ I AM EXEMPT UNDER SEC. B. &P.C. FOR THIS REASON
DATE C'e OWNER
LICENSED CONTRACTORS DECLARATION
I HEREBY AFFIRM UNDER PEI4ALTY 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
C,CONTRACTOR,s.._pJ,�•'
WORKERS'COMPENSATION 6tCLARATION
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,ASP ROVIDED 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,j".
POLICYNUMBERT... ,j..,C-t�(� • 1 "I,t: ,-
(HISSECTEN NEED NOT BE OSA'LETEDOF THE PERMIT tS FOR ONE HUNDRED DOLLARS($1 W)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(SIOSE PROVISIONS.
DATE:APPLICANT:/�Ce
WARNING: FAILURE TO SECURE WORKERS' PENSATION COVERAGE IS UNLAWFUL,AND SHALL BE
SUBJECT AN EMPLOYER TO CFIIMINAL PEN TIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS($100,000),IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3709 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.
1 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.
�N.
PERMITTEE NAME(PRINT) p 1
1 ATURE OF PERMI EE DATE
WHITE-Department Copy,YELLOW--Finance Copy,PIN
PRESS
FIRMLY
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ISSUE/n••, TYPE OCC
DATE V V CONST. GROUP
ZONING SETBACKS
FRONT RW ^
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SIDE/SIDE STREET RW ^
SIDE ^
PROPOSED USE T I FOIZ lIV LL.S FP-6'0 11 4 IST434
N0. DWEL. N0.
UNITS STORIES ate - BEDROOMS
DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREAIVALUATION
SFR/ADD/REM
U) Garage/Carport
LU Patio/Deck
L
LL Pool/Spa
Z Re-Root
Commercial
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Valuatio�j a �a o ADJ.AREA
QUANTITY DESCRIPTION FEE
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LU
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W
CONSTRUCTION
PLAN REVIEW
ELECTRIC _
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
SMIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE:
PRE- LT FEE:
rim3 1
IL,4-I 41'6 1
TOTAL FEES
COMMENTS
RECPT, N0. PAID BY VALIDATION