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Home My WebLink About14412 (8) � CITY OF DIAMOND BAR � DEPARTMENT OF COMMUNTTY&DEVELOP�NT SERVICES � 21660 E.Copley Lhive Suite 190 �� (909)86Q3195 Fax(909)8 PRESS �� BUII.DING PE APPLICATION FIRMLY � JOBSITE 1 , ��, ` T�ii ' �� . APPLICATION �.�- PERMIT ' (,�I� P/ o ADDRESS ' DATE II -S " � J NUMBER�_ �1 c� ISSUE TYPE OCC APN LOT CT � DATE CONST. GROUP p OWNER —��1 Cr � 4�.� ZONING SETBACKS Ip CDDRES� ' � f "r'�IP _:f��CTEL. ' FRONT RW ❑ � APPUCANT _—�— TEL. REAR ❑ � SIDEISIQE STREET RW O CONTRACTOR � '� L�� 'j� SIDE ❑ � ADDRESS�� ' Z� �� (� Li;�� t' ROPOSED USE � Jz��-�� cirv ' -� ziP "F � 4"C4�rE�.� �t�l- YI�-Z ��jt/��..I L�/�'l_�/L��— oARCHlENG/ �- <i .f � DESIGNEFi -�I�17� F `� " .- ! '1- ��= TC�>'� NO.DWEL. N . NO. ADDRESS �-�7�- /1 /3C--. � �'7J77-� L y �' e`s � , NITS STORIES BEDROOMS � CITY �� i � _ ZIP�G=TEL. 7��- 77y�=`� � DESCRIPTION SQ.FT. FACTOR PSF ADJ. REANALUA � OOWNER-BUILDER DECLARATION SFR/ADD/REM � ) Q I NEREBV AFFlRM UNDER PENALTV OF PE0.NRV THAT I AM EXEMP7 FROM THE CANTRACTORS LI- G8ffl99/CflfPOff W CENSEUWFORTHEFOLLbWINGREASON(SEC.703156USINESSAN�VROFESSIONSCODE:ANYCITVOR (f� U COUNTYWHIp1RC-0UIRES�CPEHMRTOCONSTRUCT,ALTER,INPqOVE,DEAAOLISH,ORREPAIRANVSTRUC- W P2t10/DBCk wNflE,PflKKi TO ITS ISSUANCE.ALSO RE�UIRES THE APPLICPNT fOR SUCH PERMIT TO FILE A SIGNE� w STATEMEM THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CANTRACTORS ll- C CENSE LAW�CHAPTER Y(COMMENdNO WRH SEGTION]000)OF DIVISION 3 OF THE BUSINE55 AND PRO- R POOUSPB V FESSIONSCOOE)OflT}VITHEORSHEISEXEMPTiT1EREFROMANDTMEBRSISFORiHEALLEGEDE%EMF� v V TKKJ.ANY VIOLATION OF SE�:CTION 7091.5 BY ANV APPUCANT FORA PEPMIT SU&IEGiS THE RPPLICANTTO Z Re-Root � A CML PENALTV OF NOT FN�flE TiAN FIVE HUNDRED DOLLARS�f500).): ^ ❑I,ASOWNEHOFTHEPROPERTY,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECAMPENSATION, � CommefCidl � VALL 00 THE WORK�ND 1HE STRUCTURE IS NOT IMENOEO OR OFFERED FOR SALE(SEC.7061,BUSI� J NESS IND PfpFESSIONS(X1DE:7NE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNEP OF � PROPERTYWFIOBVILDSOf11MPROVESTHEREON.ANDNMODOESSUCHWORKHIMSELFORHERSELFOR � Q T7ROUOII HIS OR HER ONfH EMPLOYEES,PROVIDED TNAT SUCN IMPROVEMENTS ARE NOT MTENDED OR m � OFFEREDWRSKEIFHOWEVER�IIEBUIlDN00RIMPROVEMEMIS50LDWITHINONEYEAROFCOMPIE- Z TpN,THE OWNER�BU�LDEN WILL MAVE TME BURDEN OF PqOYING THAT HE OR SHE OID NOT BUILD OR � IMPROVE FOfl THE PURPO;iE OF SALE). '� w ❑I,AS OWNEROf THC PROPERTY,AM EXCLUSNELY CANTRACTING WITH LICENSED GONTRACTORS ) [C TO CONSTRUCT THE PRQIECT(SEC.7014,&1SINE55 AND PROFESSIONS CODE:THE CONTRACTOflS LI- V81118IIOf1 C' /� � ADJ.AREA W CENSEUWDOESNOTAPF��Y70ANOWNEPUFAPROPERTYWHOBUILD5DNIMPqOVESTHEREON,AND � VAIOCONTRACTSFORSUCHPROJECTSWITHACON7RRCTOH(S�LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE � TORSLICENSELAW.). ❑INA E%EMPTUNDERSEC. B.8 P.C.FORTHIS REASON J Q 3 _ _ U ¢ � DATE OWNER U - 7r W FQ LICENSED CONTRACTORS DECLARATION W 2 I HEREBY ALFIFM UNDEFl PENALTY OF PE0.IURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �r L � Y(COMMENCINOWI7HSECTpN]000)OFDIVISfON3OFTNE9USINESSANDPROFESSIONSCODE,AND Z 1G MY UCENSE IS IN FVLL FORCEAND EFFECT. m M _ � LLl 7� I f C. t 0 LICENSE CLASS_�/ UC.NO. �C ��C' � : � '».� n�� ,na i" V DATE_�__�_7.L'T C' CONTRACTOR / ,�, iL��'!�_ _ a '� w � WORKERS'COMPENSATION DEGLARATION � 4 N I HEREBY AFFIRM UNDER CENALTV OF PERJURV ONE OFTHE FOLLOWING DECLAFATIONS: U � Z Q � IHAVEAND'MLLMAINiAINACEHTIFICATEOFCANSENl705ELF-INSUfiEFOHWOHKERS' _ � CONCFNS�TKKJ,AS PROVIDED BV SECTION 370o OF THE LABOFi CODE,FOR THE PEHFORMANCE IU OF THE WORK FOiI WMICM TNIS PERMR IS ISSUED. � � W �I HAYE ANO WILL NUINTNN WORKEPS'WMPENSATION INSUflANGE,AS REOl11RED BY SECTION % Q 37(qOFTHEUBORCOCE.FORTHEPERFORMANCEOFTMEWORKFORWHICHTHISPERMITIS � ��+l� 0 ISSUED.!AV NIORNEHS'COMPENSATKKJ INSURANCE CAFRIER AN�POLICY NUMBER ARE�. CONSTRUCTION �� L J � .. . . .7 i �� , 1 ¢ cuaaiEa_I LC-CC.� .. t . ' S � �_ � > PLANREVIEW ---- -.____-- ---------- > � ---------__— � va.icvNuusEa. - " ' ' ^ �7r -c-- ELECTRIC � Rra55[c�tcxar�H)noTBE�ns�eiIDOFn+eaEwxr�sFonor+E�aa�of�Doa�aas�slaa)oHLEss} PLUMBWG w I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL Z (,rJ SHALL NOT EMPl6Y ANV VEFSON IN ANV YANNER SOAS TO BECOME SUBJECT TO THE � WORI(ERS'COMPI:NSATION UWS OF CALIFOkN1A,AND AGREE THAT IF I SHOU'.�BEfAME INSPEGTION FEE S SU&IECT TO THE INpRKEHS'COMPENSATION PROVISIONS OF SECTION 9]OOOF THE LABOR CADE,I SHALL F09THWITH COMPLY WITH THOSE PROVISIONS. ISSUANCE o SMIP � p DATE: __. APPUCAN7: w ENERGY P/C � J WAFNINO:FAILURE TO SECURE WORKERS'COMPEN50.110N CAVERAGE IS 11NLAWFUL,AND SHALLBE � SU&IECTANEMPLOVERTOCRIMINAIPENAL71E5ANOCIVILFMESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOLLARS(1100,000�,IN ACDITON TO THE COST OF COMPENSATION,DAMAGES AS PFOVIDED FOR IN � SECTION 37a6 OF THE IAEIOR GODE,INTEREST,NNO ATTOflNEY'S FEES. FETENTION FEE: d CONSTRIJCTION LENDING AGENCY PRE-ALT FEE _.____. O � I HEFEBV AFFIRM UNDER PENALTV OF PEA�URV TNATTHERE IS ACONSTRUCTION LENDING AGENCV n- fOP THE PERFORMMlGE�F THE WOPN FOR WHICH THIS PERMIT IS ISSUED(SEC.309),CIV.C.). Z S / (�� /� � LENDER'S NAME 'JI�.^ �.. Y� ��J r7'/�T'_ f- LENDER'SA�OHESS� �j � II� �� t� �� ' �/ �/.�'/1 /�. � I CERTIFY THAT I HAVE READ THIS APGLICATION AND STATE THAT THE ABOVE INFORMATIDN IS CAPRECT TOTAL FE ES i I I� /� /, w I�GREE TO COMPLV WITFI ALL CIT'AND COUNTV ORDINANCES AND STATE L4WS REUTING TO BUILDING _. � � CONSTRUC ON,ANO HEREBV AUTFIORIZE REPRESENTRTNES OF THIS COVNTY TO ENTEk UPON THE / I � Z PBOVE�M IONED PROCERTV FOR INSP CTIO auaaosEs. COMMENTS L�� C 4J � J � m PEftMITT NT 1 ¢ /2--��-q`� ��- �' � � � SION E OF ER Tf: DATE = RECPT.NO. PAID BV � � n � VALID ON ~ WHITE—Department Copy.VELLOW—Finance Copy.PINK—Assessw Copy,GOLDENRO ile Copy,GREEN—Applicant Cop ��-�.��-��`��('L ��-�� p�'�-�� 3��` � '�� ;� � � �� u��P � � , ,�.�, � . u .� r , � �r,.,,m��.�m .� �.� . �.�-,�. ��, �� "��-0� � .�.._ ` ,' .'• �.,. y :J• .. _ ..Y � �� ' '� C�`�`�F..�'� t�� • � � �F � . .. . . . . . ... . .. .. IILIAOSII ILIR 1 JOBSITE 1 r�! -rte a7/ !I ADDRESS APN LOT CT OWNER III'C 't-1 ADDRES S, il-- =-' J CITY�Eli SZIP'1 CTE�. APPLICANT TE�. CONTRACTOR L t. M/ •7--'tLI2(„�/,., r ADDRESS CITY ZIP t-C4'TE�.'ylk' 1 ARCH/ENG/. ,T r ly" A {F � i Lf I 17 DESIGNER 171fii��-Lar� S ADDRESS-)2 C � CITY 4.I ZIP'/1LI�=TE�.-'7 W-7 1 OWNER-BUI�DER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LI- CENSE IAW FOR THE F0��0 WING REASON (SEC. 70315 BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT,A�TER,IMPROVE, DEMO�ISH.OR REPAIR ANY STRUG TURE, PRIOR TO ITS ISSUANCE.ALSO REQUIRES THE APP�ICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE IAW(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 A�LEGED EXEMP. TION.ANY VIOLATION OF SECTION 7031.5 BY ANY APP�ICANT FOR A PERMIT SUBJECTS THE APP�ICANT TO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DO�LARS($500).): 0 I,AS OWNER OF THE PROPERTY,OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WI�L DO THE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SA�E(SEC. 7044,BUSI. NESS AND PROFESSIONS CODE:THE CONTRACTORS�ICENSE�AW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUI�DS 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 BUI�DING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE- TION,THE OWNER-BUI�DER WIL�HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUI�D OR IMPROVE FOR THE PURPOSE OF SALE). ^I,AS OWNER OF THE PROPERTY,AM EXC�USIVE�Y CONTRACTING WITH �ICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC. 7044,BUSINESS AND PROFESSIONS CODE:THE CONTRP,CTORS LI- CENSE t_AW DOES NOTAPPLY TO AN OWNER OF A PROPERTY WHO BUII.DS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PRO)ECTS WITH A CONTRACTOR(S)LICENSED PURSUANI�i"0 THE CONTRAC. TORS UCENSE�AW.). ^ I AM EXEMPT UNDER SEC. B.&P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DEC�ARATION I HEREBY AFFIRM UNDER PENA�TY OF PER7URY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER Y(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY�ICENSE IS IN FUL�FORCE AND EFFECT. 3r t LTC. NO. LICENSE CLASS_ DATE Zr'< C'CONTRACTOR[L)�I WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENA�TY OF PER]URY ONE OF THE FO�LOWING DECLARP,TIONS: I HAVE AND WIL�MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE�ABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. 1 HAVE AND WI��MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION 3700 OF THE�ABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER(, �7,11 ?.&?it[i-5/1-2, L. Z �� ''1 c -2 POLICY NUMBER- [- � � (TH�S SECTION NEED NOT BE COMPLETED OF THE PERMIT IS FOR ONE FSN,ORED DCUARS($100)OR�ESS} I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHAL�NOT EMPLCIY 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(ABOR CODE,I SHAL�FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE: .APP�ICANT. WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERP,GE IS UN�AWFUL,AND SHAL�BE SUBJECT AN EMPLOYER TO CRIMINA�PENALTIES AND CIVI�FINES UP TO ONE HUNDRED THOUSAND DOL�P,RS($100,000),IN ACDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3705 OF THE LABOR CODE,INTEREST,AND Al�'ORNEY'S FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENA�TY OF PER]URY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE DF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC. 3097,CIV. C.). �! U7 r,{7 LENDER'S NAME � LENDER'SADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMP�Y WITH AL�CITY AND COUNTY ORDINANCES AND STATE LAWS RE�ATING TO BUILDING CONSTRUC ON,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-M TONED PROPERTY FOR INSP CTIO PURPOSES. ) l� Il PERMI'i"f NT J J 77 D SIGN E OF ER l"i': DATE r I CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVE�OPMENT SERVICES 21660 E.Copiey Drive Suite 190 (909)860-3195 Fax(909)8 APP�ICATION r PRESS FIRM�Y APPLICATION-�- PERMIT II-S DATE I NUMBER# ISSUE TYPE OCC DATE CONST.GROUP ZONING SETBACKS FRONT RW^ REAR ^ SIDEJSIDE STREET RW^ SIDE ^ ROPOSED USE tz� N0. DWE�. N N0. NITS STORIES BEDROOMS DESCRIPTION SQ. Ff. FACTOR PSF AD). REANA�UA SFR/ADD/REM ;7-AI 66) Garage/Carport W Patio/Deck LL Pool/Spa Z Re-Root Cl Commercial Ib Valuation C - ADJ.AREA QUANTITY DESCRIPTION FEE J W J W z M J 9 ] U Z Q 2 U W CONSTRUCTION PLAN REVIEW E E�ECTRIC P�UMBING MECHANICAL INSPECTION FEE ISSUANCE C SMIP -4 Alt 41 /- 14) ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTA�FEES COMMENTS �} i fvR'VI z, •C�+ V RECPT NO. PAID Y079,;4 12V VALID ON WHITE-Department Copy,YE�LOW-Finance Copy, PINK-Assessor Copy,GO�DENROD-tFileCopyy„GRREEEN-Appli�rsCOpy I(�b