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Home My WebLink About15971 (9) CITY OF DIAMOND BAR ExPIRED ---1�-- DEPARTMENT OF COMMUNITY�DEVELOPMENT SERVICES 21660 E.Copley Ihive Suite 190 MAY 0 91003 PRESS � �'��^�"w BUII.DIIVG PERMIT APPLICATION FIRMLY � JOBSITE APPLICATION C PERMIT � P/C o ADDRESSJ,��T� }��' ��-�� DATE i 1�� NUMBER�� # � ISSUE � TYPE OCC APN LOT TRACT DATE CONST. GROUP p OWNER �al�'� �'�� C�C�Ct�L C� o ADDRESS �' lc7CX'-� ZONING SETBACKS w CITY .LC� ! � ZI�171�14 TE FRONT RW ❑ � APPLICANT TEL. REAR ❑ SIDE/SIDE STREET RW ❑ � CONTRACTOR - _ SIDE ❑ � ADDRESS '- � � � j PROPOSED USE cirr M 1 I�t 1._C3�'�L� ZIP� TE Pu ARCHlENG/ z DESIGNER NO.DWEL. NO. NO. � ADDRESS " r"� UNITS STORIES BEDROOMS � arr E _ ziP� TE N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECLARATION SFR/ADD/REM O � I HEHEBV AFFlRM UNDER PENILTV OF PERNRV THAT I AM EXEMPT FROM THE CONTRACTORS LI- � Garege/Carporl �, W CENSEUWFOHTHEFOLLOWINGREASON�SEC.�031.58USINESSPNDPROFESSIONSCODE:ANVCITVOR U COUNTYNR71pIREWIRES�PERMITTOCONSTRUCT,ALTER,IMPROYE,UEMOUSH,ORREPAIRANVSTRUP W PaIlO(DBCk W7URE,PRIOR TO ITS ISSUANCE,AL50 REOUtRES THE APPLIGANT FOR SUCM PERMIT TO FILE A SIGNED W � STA7EMENT THAT HE OR SHE IS IICENSEO PURSUANT TO iME PROVISIONS OF THE CONTRACTORS ll- � CENSE UW(CMAFTER 9(COMMENqNO WITH SECTION 7000�OF DIVISION 9 OF THE BUSINESS AND PRO� � POOVSpa FESSIONS OO�E)ORTHAT HE OR SHE IS EXEMPT7}iEREFROAI AND THE 0AS15 FOR THEALLEGED E%EMP- (,r} 710N.ANVVIOIATIONOFSECTION�o31.5BYANVAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Root � ACiVIL PENALT'OF NOT�.IORE THAN FNE HUNDRE�OOLURS(f500�_)�. ^ ❑I,ASOVMEROF7HEPROPERTV,ORI.IVEMPIOVEESWITHWAGE5A5TNEIR50LECOMPENSATION, � COfi1fT10lC181 Z WILL DO TME WORK,AND THE STRUCTURE IS NOT INTENDED DR OFFERED FOR SALE(SEC.704�,BUSI. J NE55 AND PROFESSIONS COOE:THE CANTRACTORS IICENSE LAW DOES NOT APPLY TO AN ONRJER OF � PqOPEfi�YWFIOBUILOSORMAPROVESTMEflEON,ANDWFI0DOE55UCHWORKHIMSEIFORHERSELFOR m '� � THRpI(3HHISORHEROMMEMPLDYEES,PFOVIDEDTHATSUCMIMPROVEMENTSAFENOTINTENDEDOR i Q OFFEREDFORSALEIF,HOWEVERTHEBUILDINGORIMPROVEMENTISSOIDWITHINONEYEAROFfAMPLE- Z TION.THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING TH�T HE OP SME DID NOT BUIID OR � WPpOVE FOHTHE PURPOSE OF SALE�. ❑1,AS OMMEROF THE PFinPEHTY,M1 EXCLUSIVELY CONTRACTING WITH UCENSED CONIRACTORS � TO CONSTRUCT THE FRQIECT(SEC.10u,BUSINESS AND PROFESSIONS:AOE:THE CONTRACTORS LI- V2W21IOn ADJ.AREA W CENSELAWDOESNOTAPPLViOPNONMEROF�PROGEPTVWNOBUILDSORIMPROYESTHEREON.AND Z WF/OCONTMCTSFORSUCHPRQIECTSWITHACONTFACTOR�S)LICENSEDPURSUANTTOTHECONTMG QUANTITY DESCRIPTION FEE �- TORSLIGENSEIAW.). Y / O ❑IAMEXEMP7UNDERSEG._._ _. B.6P.C.FORTHISPEASON U ` , � . S 3 _ � GEE'T�.0 �.5 u' DATE_ ONMER _ U - II W C�`� � Pt-IC�NE N1�U�T � LICENSED CONTRACTOP.S DECLARATION w �j�:l. (TC-N�� 1 NEREBV AFFIRM UNDER PENALTY OF PEfUURV THFT I AA1 LICENSED UNDER PROVISIONS OF CHAPTER � d Y(COMMENCIlI(3 WITM SECTKKJ 7000�OF DIVISION 30F TNE BUSINE55 AND PROFESSIONS CAOE,AND Z MY LICENSE IS IN FULL FOFlCE AND FFFEGT. / /�,�� LICENSE CUSS.L�� LIC.NO. �R °f/.L� � J U DATE_'=��'C�L---- CONTRACTORM�C�S� �T�� a W � WOAKFRS'COMPENSATION DECLAFATION � � U N I HEREBY AFfIRM UNDER PENALTY OF PERIURY ONE OF THE FOLLOWING DECUFATKKJS: Z Q � I MAVE AND WILL MAMTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WOFlKEFS' 2 � CAMPENSATKKJ,ASPROVIDEDBVSECTION3'lo00FTHEl?BORCODE,FORTHEPERFORMANCF W - OF 7'ME WORK FOR WMICM TMIS PERMIT IS ISSUED. � O W �_I HAVF AND WILL MAINTAIN WORKERS'fAMPENSATION INSURANCE,A5 RE�UIRED BY SECTION Q 3Too OF TH[LABOR CODE,FOR THE PERFCRMANCE Of THE WORK FOR WHICH iH15 PERMIT IS ISSUED.MY WORKER$'COMPENSATION INSURANCE CAFRIER AND POLICY NUMB/E�fi ARE� CONSTRUCTION � CARRIEN�EPL}C�JI'_1��IJ7�.�1.�1T�'� G F-C_./� __ PLAN REVIEW -- ..'��,��_ t ZvoucrnuueeR_ - FLECTRIC . a ��-- 0 (Mss[crnNNFrflNo78EaMfiEtEooFn1EPER4n�tSwFONErxx�DREUoawis(blao)oa�Ess} PLUMBING __ W MEGHANICAL " ' '- ' . �� Z I CERTIFY THRT IN THE PERFOPMANCE OF THE WOFK FOR WHICH TH�S PERMIT IS ISSUECI,I L•} SFIALLNOTEMPIOYANYPER50NiNANVMANNERSOA5T08ECOMESUBJECTTOTHE INSPECTIONFEE `i I��S/ �1�;�� WOPKEAS'COMPENSATION IAWS OF GALIFORNIA AND AOREE THAT IF I SHOULO BE AME a ..�S;4\"��. SU&IECTTOT.`IEWORKERS'COMPENSRTION OVISIONSOFS CTION9l000F?HEUBOfl � � • = ISSUANCE r�f 137 r'},�xrr� �-^-+�� CODE,ISNALLFO{ATHWI'iHCOMP.Y'vVITHT SEP 51 S. � �� Fi'7''4��:S''`.b��i�_f� p DA7E: �""1�)1 APPLICAM: ��_ ...___ SMIP _ — J ENERGY P/C J WAFNING:fAILUflETOSECUREWOHKEH GOMFENSATIONCAVEPAGEISUNLAWFUL.ANDSHALIBE � SU&IECTMI EMPLOYEHTO CPIMINAL PENALTIES AND CIVII FINES VP TOONE HVNDRED TNOUSAND ENERGY PERMIT DOILARS(S10C.000).IN ADDITION TD THE COST OF COMPENSATION,DIIMAGES AS PROVI�E�FOR IN J SECTION 37oe OF THE LAdOR CO�E,INTEREST.AND ATTORNEY'S FEES. RETENTION FEE: � -_-___.__ _ w CONSTRUCTION LENDING AGENCY PRE-ALT FEE: a. � I HEREBY AFFIRM UNDEH PENALTY OF PERJURY THAT THERE IS A CONSTRVCTION LENDING AGENCV � FORTME PERFORMANCE OFTME WORK FOF WHIGH TMIS P�RMIT IS ISSUED(SEC.309],CN C.). Z W � LENDER'SNAME - H LENDER'SA�DHEgS_ � I CERTIFY iHAi I HAVE RGO THIS APPLICATION AND STATE THATTHE FBOVE MFORMATKKJ IS CARRECT. TOTAL FE ES � � � W I AGREE TO COMPLV WITH ALICITY AND COVNTY OFDINANCES AND STATE LAWS RELATING TO BUILDING � CANSTRUCTION,ANDMEREBYAUTFiORIZEREPFESENiATNE50FTHI5COUNTVTOENTERUPONTME Z PBOVE-MENTIONEDPRCPERTYFORINSPEC710NPURPOSES. COMMENTS O � . r � —� �y m PERMITTEE NAME RINT� ¢ `�Cn �' -_.'__ ... � SIGNATV �. ��G MIITEE � DATE RECPT NO. PAID BY VALIDATION H � WHITE--0epartment Copy,YELLOW--Finence Copy,PINK—Assessor Copy,GOLDENROD—File Copy.GREEN—Applicant'S Copy �,a#��$ re..�p" :�«��PL#+S�.�#�`"��.� A..�8-�s��a �� , ��,r��.�� "��:�n�� '� " �c`��,. �w m � , .`� k ^o-«stlg �vEt �� E ,. � �.� � � � �� i6 M �' � . �� s �; >`..-- t , . .. .. .. . .. .. . . . . . . . _ . ._... . . .. . , �„�- e_ . �, , [-j� 7 _'.a•_c . �. . . �. ...._� . __. .___ . . .� ........ . __ . � __ .._.._.. . .. . .. . . � . . 1 . ..:k .,_ . ..... , . _ . .. .._ ... ;.:, _ . 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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 DDRE A EESSZ 1 C ATE-WA i" (L, ntl Lc ADDR�7Z� APN LOT TRACT OWNER 7r1QaMHIJ1 GC,O1cC ADDRESS CITY L ! 1 ZIF4Z(L TE APPLICANT TEL. CONTRACTOR ADDRESS CITY MI'A L(it1AL ZIP TE" ARCH/ENG/ DESIGNER SPACE ADDRESS CITY U, 0 0 0 ZIP 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 REWIRES 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 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 ACIVIL 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 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORCE AND EFFECT. W N W LICENSE CLASS LIC. N0./II/�>r DATE I-�f-'CA L----CONTRACTORAILITf P FL lE C T 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 WORKEERRS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER KEY' POLICY NUMBER (THE SECTION NEED NOT BE COMPLETED OF THE PEFRAT IS FOR ONE((BORED 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„II SHALL FORTHWITH COMPLY WITH T DATE: I-�'yl -0 I APPLICANT: WARNING: FAILURE TO SECURE WORKERS COMPENSATION COVERAGE IS 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 ATTORNEYS 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 U) 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. I DATE EXPIRED MAY 0 9 2003 PRESS FIRMLY APPLICATION C�J}PERMIT P/C NUMBER# DATE 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.AREA/VALUATION SFR/ADD/REM U_ Garage/Carport W Patio/Deck L LL Pooi/Spa Z Re-Root Commercial In Valuation ADJ.AREA QUANTITY DESCRIPTION FEE 5 a 1 G C (-rA E W -70 �" Po-EON�-•IVU+T H 5 Tc LU E t 0 Z C3 J J Z 2 U W CONSTRUCTION_ PLAN REVIEW ELECTRIC PLUMBING MECHANICAL"� r r,. INSPECTlON FEE',.r"' 'T' ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: - PRE-ALT FEE: TOTAL FEES COMMENTS RECPT. N0. PAID BY VALIDATION �4407716 If j-rc-al El.tu4E. FI4j