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Home My WebLink About17436 (10) f� CITY OF DIAMOND BAR I I w� DEPARTMENT OF COMMUNITY 8c DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Faac(909)861-3117 PRESS BUILDING PERMIT APPLICATION FIRMLY o DDRIESSQ�1 U'�� ' �^�L' lfL�I'�J� �� , DATE CATION JI�� ' NUMB R�� #/�� / � ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER p ADDRESS ZONING SETBACKS z CITY ZIP TEL. FRONT RW ❑ p APPLICANT _ TEL. SIDE/SIDE STREET RW ❑ z Q CONTRACTQR ` �,C C S (�'✓1 r� SIDE U � ADDRESS � 2:C ��Q " t PROPOSED USE � S'P�s� . L- � o CITY ��1.t,'y�_ ZIP�(f�2 TEL. '�t[.. �� C2i) ��C�� o ARCH/ENG/ z DESIGNER w NO.DW L ,� N . NO. a ADDRESS � CITY ZIP TEL. UNITS TORIES BEDROOMS cr� cn DESCRIPTIO S�.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECLARATION SFFl/AODlREM O � I HEREBY AiFIRM UNOER PENALTV OF PERJURV THAT 1 AM EXEMPT FpOM THE CANTRACTOqS LI- G8(390/CBfpOR W CENSELAWFORTHEFOLLOWINGREASON(SEC.7031.SBUSINESSAN�PROFESSIONSCOOEANYCITVOR (n U COUNTYWHICNREOUIRESP,PERMITTOCANSTRUGT,ALTEFi,IMPROVE,�EMOLISH,ORREPAIRPNYSTRUG w TURE,PRIOR TO ITS ISSUAIJCE.ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/DeCk 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 0F THE BUSINESS AND PR6 � POOUSpO FESSIONS CODE)DR THAT 4E OR SHE IS EXEMPT THEREFROM ANO THE BASIS FOR THE ALLEGE�E%EMP- � � TION.ANYVIOLATIONOFSECTION]031.SBVANVAPPLICAN7FORAPERMITSUBJECTSTHEACPLICANTTO Z Re-Roof ACNIL PENALTY OF NOT IM�RETHAN FNE HUNORED DOLtARS�f5a0�.�: ❑I,AS OWNER OF THE PROPERTV,OR MV EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, O � Commercial Z WILL DO THE WORN,AND THE STRUCTURE IS NOT IMENDE�OR OFFEREO FOq SALE(SEG.'/04C,BU51- J � NE55 ANO PROFESSIONS OJDE:THE CONTRACTOftS LICENSE LAW DOES NOT APPLV TO AN OWNER OF � .�'L��P-1� r �,�� PROPEflTYWH09UILD50RIMPROVESTHEflEON,ANDWHODOE55UCHWOFKHIMSELFORHEFSELFOR `T CC THROUGH HIS OR HER OWN EMPLOYEES,PflOVIDED THAT SVCH IMPROVEMENTS ARE NOT MTENDED OF m ' w OFFEREOFORSALE.IF,HOWEVER,THEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE � TpN,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING TNqT HE OR SHE DID NOT BUILD OR Z IMPROVE FOR THE PUR70SE OF SALE)_ �_ ❑I,ASONRJEROFTHEPROPERiV,AME%CLUSNELVCONTRACTINGWITHLICENSEDCONTRACTORS TO CONS7RUCT THE PROJE':CT(SEC.]044,9USINESS AND PPOFESSIONS CODE:THE CONTRACTORS LI- VdlllallOfl t � • `� ADJ.AREA = CENSEUWOOESNOTAPPI.VTOANOWNEROFAP90PERTVWHOBUILDSOFlIMPROVESTHEFEON,AND � WHOCONTRACTSFORSUCHPflOJECTSWITHACONTRACTOR(S)LICENSEDPURSUANTTOTHECANTflAC- QUANTITY DESCRIPTION FEE Y TOftS LICENSE LAW.). � ❑I AM EXEMPT UNDEFI SEC. B.8 P.C.FOR THIS REASON Q � U � � DATE OWNER U Z W � LICENSED CONTFIACTORS DECLARATION W ¢ � 1 HEREBV RfFIRM UNDER PENALTV OF PERJURY THAT I AM LIGENSED UNDER PPOVISIONS OF CMAPTER � � 9(COMMENCING WITH SEC110N]OCO)OF DIVISION 3 UF THE BUSINE55 AND PROFESSIONS CODE,AN� Z X MY LICENSE IS IN FULL FORCE AND EFFECT ) � LICENSE CLASS � � � LIC.NO. � J�'� ' � � V DATE � �� {� CONTftACTOR �'� l� � d w �� {- � WORKERS'COMPENSATION DECLARATION � � � Q � I HEREBVAFFIRM UNDEF PI:NALTY OF 7EfiJURY ONEOFTHE FOLLOWING DECLARATIONS: Z Q � IHAVEANDWILLAI/,INTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' _ QCOMPENSATION,F�PROVIDEDBYSECTION3]OOOFTHELABORCODE,FORTHE7ERFORMANCE `U OFTME WORK FOR WHICH THIS PERMIT IS ISSUED. � � w 1 HAVF.AND WIIL M/,INTAIN WORKERS'COMOFNSATION INSURANCE,AS REOUIRFO BV SECTI[�N Q 3]0o OF THE LPBOR CODE,FOR 7HE PERFORMANCE OF THE WORK FOR WHICHTNIS PEPMIT IS �7�� .�. ISSUEO.MY WOR ATIO NCE CAR ER AND POIICY NUMBERARE�. CONSTRUCTION � �L� � � CARRIER �• U .-�� 'Li�� PLAN REVIEW ZPOLICYNUMBER_ � �Z C ELECTRIC __ Q � (IHISSECTIONNEFPIWTBE/YIMPLEfEDOFTHEPFRMITISFORONEHUN]RED�OlLARS(51m)ORLESSj. PLUMBING W Z ICERTIFYTHATINiHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMITISISSUED,I MECHANICAL ('J SHALL NOT EMPLOI'ANY PERSON IN ANY MANNER 50 AS TO BEGOME SUBJEGT TO THE � WOHKEflS'COMPENSAfION LAWS OF CALIF RNIA,A AGREE THAT IF i SHOULO BECOME INSPECTION FEE = SUBJECTTOTHEWORKERS'COMPENSAT PROV ONSOFSE TION37000FTHElABOR CODE.I SHALL FORTHWITN COMPLV WIT HOSE P VISIONS. � ISSUANCE __._.._ _' 7� _ � OATE: �� -'r'` qppLICANT: SMIP WS V J WARNING:FAILURE TO SEGJRE WORKERS'COMPENSATION GOVERAGE IS UNLAWFUL,AND SHPLL BE ENERGY P/C � SU&IECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOLLARS(Sl D0,000�,IN AOOITION TO THE COST OF COMPENSATION,OAMAGES AS PROVIDED FOR IN � SECTION37080FTHELABCIRCO�E.INTER'eST.hNDATTORNEY'SFEES. RETENTIONFEE: aw. CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � O 3 � IHEREBYAFFIRMUNDERPLNALTYOFPERJURVTHATTHEREISACONSTRUCTIONLENDINGAGENCY � ��f FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.C.). Z w � j LENOER'S NAME � H LEN�ER'SAODRESS ,� TOTAL FEES `� J ,` � � I CERTIFV THAT I HAVE REA'J THIS APPLICATION AND STATE THAT THE ABOVE MFORMATION IS CORPECT. � I AGREE TO COMPLV WITH NLL CITV AND COUNTV ORDINANCES AND STATE LAWS RELRTING TO BUILDING � CONSTRUCTION,AND HERFBV AUTHORRE REPRESEN7ATNE5 OF THIS COUNTY TO ENTER UPON THE Z ABOVE-MENTIONED PROPERTY FOa INSPECTION PURPOSES. GOMMENTS � �\ �1 �11 S I�- �-�'`l � . --- QPERMITTEE NA (PRINT), � , � i �� SIGNATURE F PERMITTEE DATE = RECPT.NO. PAID BY VALIDATION ~ WHITE—De aAmen�Co YELLOW—Finance Co PINK—Assessor Co GOLDENRO�File Co GREEN—A lican s Co P PY� PY� PY. PY. PP PY L � �y ,y��i� _ i i�� e r , i �,�r • � !� - , i — � � 4� .�.s r r ��,.� .a rt�.,�.� ,1,��' ra��,��fi �4 `�� ' �r ( ��,. � �� , !i�.s�, „ �,(�'� ... .. �. . „E,a ,_ , . _ � . . JC,. .�seis_�,z��Zs ,., �a=d .. ... _ .... . ... ... . ... . . . .. ._ . . . . _. : vi m . . ._ . .... ... . ... . e ��-��°� .. �' " ;..� 3� �aet, � . . . .... .. . ..... ...... ._.. ...... . ... '. �. . . ._.. ...... _._. ...._. ....... ._�-�. . .... . ._.. _. ... ..._ ..._ ..._. _... ...; _ �� .. .. ... ... . . . ..... . ._.. . ..... ..... ._.. ... ... . .... . �,��k,�c�� vF��r e�p_ '��. a.�a i ai ' r ��a�r�� s _ i u m�. � ��,��gi �,� "�',�`�E e:a M - EP a�B a�`� ��(��y� �� r ui _ _ _ ;.9 Fr9.,�Elk�.�(3 USk �i� 'I b i i�� '�. .. a�� . �.` �� _ _ r ' � , m . _ _ _ `�" +°- r. ' '�'' .� i �" k ��" 7�r+. "...: . ._ .. ... ... .. . . . . ... . .. .... . .. ... . . .. . .. .. . .. . ... . .. 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 ADDRIESSQ�1 0, APN LOT TRACT OWNER ADDRESS CITY ZIP TEL. APPLICANT TEL. CONTRACTQR C 1 S bON,"N ADDRESS 1 2: (3(Q(-'- CITY ZIP'1°P TEL. ')/ct C"2i1 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 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 FE 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($500).): ^ I,AS OWNER OF THE PROPERTY,OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC. 7044,BUSI- NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE. IF,HOWEVER,THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE- TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). ^ I.AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTlNG WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC. 7044, BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). ^ I AM EXEMPT UNDEFI SEC. B. &P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORCE AND EFFECT. C WY' LICENSE CLASS LIC. N0. �P�� DATE CONTRACTOR -D 1 - 1{ WORKERS COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS NCE R AND POLICY NUMBER ARE: ISSUED. Y WO RI$E'ATION CARR ER S POLICY NUMBER 1 j-7 t c (THIS SECTION NEED I40T BE COMPLETED OF THE PERMIT IS FOR ONE HUNDRED DOLLARS(Elm)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 CALIF RNIA,A AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS'COMPENSAT N PROV ONS OF SE TION 37SS OF THE LABOR CODE,I SHALL FORTHWITH COMPLY WIT HOSE P VISIONS. I/O1 DATE: APPLICANT: WARNING: FAILURE TO SECJRE WORKERS'COMPENSATION COVERAGE 15 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 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 INSPECTION PURPOSES. I 1 S 11!f L PERMITTEE NA(PRINT) SIGNATURE F PERMITTEE DATE APPLICATION//_3e) PERMIT / ,p DATE N UMBER i/# 1 ISSUE TYPE OCC DATE CONST GROUP ZONING SETBACKS FRONT RW^ REAR^ SIDE/SIDE STREET RW^ SIDE � ,r PROPOSED USE S P�s L p N0. DW L,�A)V N N0. UNITS TORIES BEDROOMS DESCRIPTIO S0. FT. FACTOR PSF ADJ.AREAIVALUATION SFR/ADD/REM Garage/Carport W Patio/Deck LL Pool/Spa 0 Re-Root Z Commercial Valuation t 0 ADJ.AREA QUANTITY DESCRIPTION FEE J I- U w J UJ z z m a Q U Z S 0 w CONSTRUCTION t7 L PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP WJ V ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES COMMENTS RECPT. N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicants Copy