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Home My WebLink About18214 (11) i > f 1^ ,� � ci�oF n�orm anx �, �� S �t`'��\ -� DEPARTMENT OF COI�RvfiJNITY&DEVELOPMENT SERVICES � 21825 E.Copley Drive T (909)860-3195 Fax(909)861-3117 �}�,� � PRESS �%'��'.� BUILDING PERMIT APPLICATION " � ��{�' FIRMLY o DDRIESS_6-t � • �. �7O APPLICATION�� PERMIT �-� � P/C /^�_ J�D DATE I �� NUMBER # L G r� ISSUE TYPE OCC -- APN LOT TRACT_ DATE � ��" CONST. GROUP � OWNER O " ADDRESS ZONING SETBACKS OCITY ZIP TEL. FRONT RW ❑ APPLICANT TEL. REAR ❑ � SIDE/SIDE STREET RW LJ Q CONTRACTO " . � SIDE � – ❑ ADDRE r-'� � CITY ^ �ZIP lj��(,'iEL. PROPOSED USE � '�` i/i(/� � 0 ARCHlENG/ z DESIGNER — NO.DWEL. NO. NO. a ADDRESS UNITS STORIES �BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � O OWNER-BUILDER DECLARATION SFR/ADD/REM � I MEREBV AFFIRM UNDER FENALTV OF PERJURY THAT I AM F.XEMPT FROM THE CONTRACTOflS LI- G8f8JB/CBfPOR W CENSELAWFOHTNEFOLLOWINGREASON(SEC.]031.SBUSINESSANDPROFESSIONSCO�E:ANYqTVOR (n C.� COUNTVWHICHREOUIRESAPERMITTO(7JNSTRUGT,AL7ER,IMPROYE,�EMOLISH,ORREPAIflANYSTFUG W P8ti0/DBCk Z TUNE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w W 5TATEMENT TNAT HE OR SHE IS LICENSE�PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- � CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 30FTHE BUSINESS AND PRO- � POOUSPd O GESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGE�EXEMP- � V TION.ANY VIOLATION OF SECTION]0]1.S BY ANV APPLICANT FOR A PERAAIT SUBJECTS THE APPIJCANT T0 Z Re-Roof � ACIVILPENALTYOFNOTMORETHANFNEHUNDREODOLLARS(f500).)�. O ❑I,ASOWNEROFTHEPROPEFiTV,ORMVEMPIOVEESWITHWAGESASTHEIRSOLECAMPENSA710N, � CORIR18fC18I Z WILL DO THE WORK,AND THE STRUGTURE IS NOT INTENDED OR OFFERED FOF SALE�SEC.]044,BUSI- J NE55 AN�PROFESSIONS GODE:TME GONTRAGTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF N PROPERTVWHOBUILDSORIMPROVESTHEREON,ANOWHODOE55ucHWORKHIMSELFORHERSELFOR m � THROUGHHISORMEROWNEMPLOVEES,PROVIOEDTHATSUCHIMPROVEMENTSAFEhOTMTENDE�OR w OFFEREDFORSPLE.IF.HOWEVERTNEBUILDI4GOFIMPROVEAIENTISSOLDWITHINONEYEAflOFCOMP�E- � � TION,THE OWNER�8111LOER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OF Z IAIPROVE FOR TNE PURPOSE OF SALE). � ❑I,ASOWNEROFTHEPROPERTY,AMEXCWSIVELVCONTRACTINGWITHLICENSEDCONTRACTORS � TO CANSTRUCT THE PflQ1ECT(SEC.]ON,BJSINESS AND PROFESSIONS CODE THE CONTRACTORS LI- V8I118110f1 ADJ.AREA W GENSELAWDOESNOTAPPLYTOANONMEROFAPRDPERTVWHOBUILDSORIMPROVESTHEREON,AND � WMOGONTRACTSFOFSUGMPROJECTSWITHACONTFiACTOR(5)LICENSEDPURSUANTTOTHECONTHAG QUANTITY DESCRIPTION FEE TOfiS UCENSE LAW.). Y J � ❑1 AM EXEMPT UNOER SEC._ B.8 P.C.FOR THIS REASON Q � U � LL' DAiE _ OWNEfl U Z lyA � LICENSED CONTRACTORS DECLARATION w Q � I HEREBYAFFIRM UNOER PENALTV OF PERJUFV THAT IAM LICENSEO UNDER PROVISIONS OFCHAPTER � d 9(COMMENCING WITH SECTION 70D0�OF DIVISION 3 0F TME BUSINESS AN�PROFESSIONS GOOE,AND Z a' `X MV LICENSE IS IN FULL FORCE ANO EFFECT. (' M1�j�"'��1 � � LICENSE CLASS `w '� LIC.NO._�[_�� H =. , J U DATE L� �� , CONTRACTOR a W � WORKERS'COMPENSATION DECLARATION -� � a � I HEREBY AFFIRM UNDER PENA�TV OF PERJURV ONE OFTHE FOLLOWING DECLAFATIONS: U � Z � IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWORNEftS' 2 Z COMPENSATION,ASPROViDEDBVSEGTION3�000FT11ElA80RCO0E,FORTHEPERFORMANCE U ¢ OF THE WORK FOR WHICFi THIS PERMIT IS ISSUED. � 0 w �I HAVEAND WIIL MAINTAIN WORKERS'COMPENSATION INSLIRANGE,AS REOUIRED BV SECTION Q 370aOFTHELABORCOOE,FORTHEPERFORMANCEOFTHEWORNFORWHICHTHISPEPMITIS �� ••—� ISSUED.MY WOftKFA'G PENSATIIXJ I URFNCE CARRIER ANO PDLICY NUMBER ARE: CONSTRUCTION LL��. ¢ r- r 1 � CARRIER � !'li� PLANREVIEW �. ). "� z Poucv nun+eea �,J(t.�"" ELECTRIC ¢ Q iT1155ECT4NNEmNOTBECIJMPLEfEDOFTHEPFRMlTISFORCNEHUI�DRE�OIXLARS�510%ORLESS). PLUMBING W MECHANICAL Z I GERTIFYTHAT IN THE PEHFORMANCE OFTHE WORK FOR WHICH THIS PEFMIT IS ISSUED,I (,'} SHALL NOT EMPLOV ANY PEFSON IN+WY MANNER 50 AS TO BECOME SUBJECT TO THE � WORKERS'COMPENSATION LAWS OF GALIFORNIA,AN�AGREE THAT IF I SHOULD BECOME INSPECTION FEE ? SUBJECT TO THE WORKERS'COMPENSATION PROVISION OF SEGTION 31000F THE LABOR �` <<� CODE,I SHALL F RTHWITH COMPLV WITHTHOS PRO I'I S. � ISSUANCE C J T � n /� i p DATE'. � � �' -APPLICANT: � � I J SMIP �. W ENERGY P/C J WARNING�.FAILURE i0 SECURE WORKERS'GOMPEN A ION GOVEAAGE IS UNLAWFUL.AND SHHLL BE J - ___....._.__ � SU&IECTANEMPLOVERTDCRIMINALPENALTIESAN IVILFINESUPTOONEHUNOFEOTHOUSAN� ENERGVPERMIT DOLLARS(5700.000�.IN AODITION TO THE COST OF COMPENSATION.�AMAGES AS PFOVIDED FOR IN J SFCTION 3]De OFTHE LABOR COOE,INTEREST,ANI]ATTORNEY'S FEES. FlETENTION FEE'. � � d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � 1 HERE6VAFFIRM UNDER PENALTY OF PEfiJURV THATTHERE IS ACONSTRUCTION LENDING AGtNCY � FOR TH'c PERFORMANCE DF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3091,CIV.C.�. Z w � S LENDER'S IvAME � � F- LENDER'SADDRESS �� -�J w ICERTIFYTHATIHAUEFEADTHISAPPLICATIONAN�STATETNA��HcABOVEINFORMAT10NI5CORREGT. TOTAL FEES I �// " �' d IAGREETOCOMPLYWITHALI.GTVANOCOUNTYORDINANCESANDSTATEL4WSREUTINGTOBUILDING � CONSTRUCTION.AND HEREBYAUTHOR'�ZE REPRESeNTATIVES OFTHIS COUNTVTO ENTER UPON THE • Z AFOVEMENTIONEO PROPERTY FOR INSPECTION Pl1RPO5E5. COMMENTS Q I'. � , 4.7, 1 '� m GERAIITTEF NAME(oql � ^ (� _ (!� 4�� T1L�- � SIGNATUREOFPE I EE � DATE � e� 2 = RECPT.NQ �L ✓ PAID BY ✓�� VALIDATION ~ WHITE—De artment Co YELLOW—Finance Co PINK—Assessor Co GOLDENRO�File Co GREEN—A licanl's Co P PY� PY, PY. PY, PP PY f ` br a�� Ri.. � � y - �� ,�'n� _?r rr�'��"� � . �t'��'��o. ; � � � � mk mi � a"'�'°� .�.�'.� �,:�..., , i<i��a �E - a ._ .�� a�«�,� �.� �I�arr��'' I fc � u� ' ,..�.d.._� .-�,�a !�N G ., . . . . . .3 . _ . , F . . . . �m ��o�."1a Li ,. �Sa;a� . � . , . �. � ..�.. . � ',. ��. � �, � � �� _ - � �. � I�., .s A� . _�x, .,�.w� -- � _ _ _ _ _ �� i�I< ; � - �, n .. ._._ ... .. . ._.. .. . . . . .. . .... . ... . .. . . ��r��i"� x��a�1a�� ,��g� `• �. °�w i p � . . . . . ... . . ... .. ... _ . ��g��,� ��r .. �� '' �'�x '�� a�i . � F = - .... .. . . .. ... ... . . .... .. . .. .. .... _ . . _ . ,� � '�.r� �� i�; '�.. '�� a�F � �� ' _ _ ,�"�r'��= ,��"^��.�y��'�� i� � � �� _ :� �t� : a� .. _ .. . .. .. .. . . .... . . ... . .. ... . . . ... ... _.. . ... . ..... . ... . ... ... _�3�'y ��.t r s.�r ��° ry �'�� p u �.+r� � p .� _ � r �� w.�: "�� '� �� it�^�� ,��,_a��' , 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 121wo ADDRESS APN LOT TRACT OWNER ADDRESS CITY ZIP TEL. APPLICANT TEL. CIDNTRACT09 A( ADDRE r.' CITY ZIP'QTL I-EL. 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 APERMIT 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 30F 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 A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). 0 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 C1L, LIC. N0. LICENSE CLASS DATE L(21 D CONTRACTOR=_w I 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 WORK C PENSATION DURANCE CARRIER AND POLICY NUMBER ARE: CARRIER Jt r ci j' POLICY NUMBER E;6c-, (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 OF SECTION 3700 OF THE LABOR SUBJECT TO THE WORKERS'COMPENSATION PROVISI r CODE,I SHALL F RTHWITH COMPLY WITH THOS PRO S. DATE: �APPLICANT: r�� WARNING: FAILURE TO SECURE WORKERS'COMPEN A ION COVERAGE IS UNLAWFUL.AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AN IVIL 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. AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE CONSTRUCTION ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. )PERMITTEE NAME(PRI I ^ (,�t SIGNATUREOFPE I EE DATE vi CC 0 w 0 0 z W (_3 21- L5 0 U N U 0 d x w 0 U w a Cn U) In ci C W �� I APPLICATION PERMIT P/C R I .1 DATE NUMBE # 04 ISSUE TYPE OCC DATE CONST GROUP ZONING SETBACKS FRONT RW ^ REAR SIDE/SIDE STREET RW ^ SIDE ^ PROPOSED USE N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREANALUATION SFR/ADD/REM U) Garage/Carport LLI Patio/Deck L LL PooVSpa 0 Z Re-Roof Commercial Valuation IWO ADJ.AREA QUANTITY DESCRIPTION FEE J U cc F- W J W Z s m a Z W e" CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE G T SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: Z PRE-ALT FEE: TOTAL FEES / �17• COMMENTS RECPT. N0. bL/PAID BY/�� VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENF IUU-I-IIe(Dopy,GHEEN-Applicant'S copy