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Home My WebLink About17707 (10) CITY OF DIAMOND BAR �x�', r�� ''�``� i DEPAR"TMENT OF COI�IIvIUNITY&DEVELOPIv�NT SERVICES �, 21825 E.Copley Drive (909)860-3195 Fa�c(909)861-3117 PRESS �<��° BUILDING PERMIT APPLICATION FIRMLY � JOBSITE /� G C%Ci �C1�� `��r � E! t� APPLICATION PERMIT P1C Q ADDRESS �zS� I ( I T o � _� DATE �� J UMBER��# OCC °r APN LOT TRACT D TEE �PE GROUP p OWNE� 't� �E'C L�/P�_[ L : CONST. o ADDRESS _ ZONING SETBACKS FRONT � PPLICANT ZIP TEL�/ � ,C,�J REAR Rw � 0 Z — SIDE/SIOE STREET Ry� � ¢ CONTRACTO - . I . SIDE � ADDRE S � " ��'�,/I---- � CITY � `3 ZIP�TEL. iC �j �G�C' PROPOSED USE 0 o ARCH/ENG/ — z DESIGNER � ADDRESS NO.DWEL. NO. NO. � UNITS STORIES BEDROOMS � CITY ZIP TEL. ' � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION p SFR/ADD/REM p I HEREBV AFFIRM UNDER PENALTY OF PFRJl1RY THAT I AM EXEMPT FROM THE CONTFACTORS LI- G8f8J0/CBfPOfI W CENSELAWFORTHEFOLLOWINGREASON�SEC.7031.SBUSINESSANDPROfES510NSCODE:ANVCITVOR (n U COUNTVWHICHREQUIRESAPEflMITTOCONSTFUCT,ALTER,IMPROVE,OEMOLISH,ORREPAIflANYSTRUG WTURE,PPIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICAN7 FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck � STATEMENT THAT HE OR SHE IS LICENSEO PURSUANT TO THE PROVISIONS OF 7HE CONTHACTORS LI- � CENSE UW(CHMTER 9(COMMENGING WITH SECTION 1000)OF�IVISION 3 OF THE BUSINESS AND PRO- LL' POOI/SP0 � FESSIONSGODE)ORTHATHEORSHEISE%EMPTTHEFiEFROMANDTHEBA515FORTHEALLEGEDEXEMP� (� U TION.ANYVIOLATIONOFSECTION7031.SBVANVAPPLICANTFOFAPERMITSUBJECTSTHEAPPIICANTTO z RB-ROOf � ACIVILPENALTVOFNOTMORETHANFIVEHUN�REDDOLLARS(SSOO�J: Q ❑I,ASOWNEROFTHEPROPERT/.ORMYEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, � Commercial Z WILL DO THE WORK,AND THE STRUCTupE IS NOT IhTENDED OR OFFERED FOR SALE(SEC.]oa4,BU51- J � NESSAND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF � PROFERTY NMO BUILDS OR IMPROVES iHEREON,AND WHO OOES SUCH WORK HIMSELF OR HERSELF OR w TNROUGH HIS OR HER OWN EMPLOVEES,PROVIOED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m Q OFFEREDFORSALE.IF,HOWEYER,THEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEPflOfGOMPLE- Z TION,THE OWNER-BVILDEfl WILL HAVE THE BUFDEN OF PROVING THAT HE OR SHE DIO NOT BUILD OR � IMPROVEFORTHEPUFPOSEOFSALE). w ❑I,ASOWNEROFTHEPROPEFTV.AME%ClU51VELVCONTRACTINGWI7HLICENSEDCONTRACTORS � TO CONSTRUCT THE PROJECT(SEC.7014,BUSINE55 AN�PROFESSIONS CADE:THE CONTRACTORS LI� V0luali0n ADJ.AREA W CENSELAWDOESNOTRPPLYTOANOWNEROFAPROPERTYWHOB�ILDSORIMPROVESTHEREON,AND WHO CANTRACiS FOR SUCH PROJECTS WITH A CONTfiAC70R(5�LICENSEO PURSUANT TO THE CONTRAC- � roRsuceNseuw�_ QUANTITY DESCRIPTION FEE Y 0 ❑1 AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q � U � DATE ONRJER F- Z U � LICENSED CONTRACTORS DEGLARATION W ¢ � I HEREBV AFFIRM UNDER PENAITV OF PERJIIRV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � • ' � � 9(COMMENCING WITH SECTION]ooa)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AN� Z � `X IAV LICENSE IS M FVLL FORCF AND EFFECT. m � LICENSE CLASS � ,_J�i LIC.ND. �� uC+ � � � � U DATE��C' G � CONTRACTOR I d W � WORKERS'COMPENSATION DECLARATION Q � I HEREBVAFFlRM VNDER PENALTY OF PERJURV ONE OF THE FOLLOWING DECLARATIONS: U � Z � _IHAVEANDWILLMAINTAINACERTIFICA7EOFCONSENTTOSELF-INSUREFORWORKERS' ¢ QCAMPENSATION.ASPROVIDEDBYSECTION31ooOFTHELABORCODE,FORTHEPERFORMANCE U OF THE WORN FOR WHICH THIS PERMIT IS ISSUED. W � � Qw IHFVEANDWILLMAINTAINWORKERSCOMPENSATIONINSURANCE,ASREQUIREDBVSECTION 37000F THE LABOR CODE,FORTHE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUE�.MY WORKERS'COMPENSATION INSURANCE CARRIER AND VOLICV NUMBERARE: CONSTRUCTION j cnaaiEq �_�_� F'y�i��-U / PLAN REVIEW Z POLICV NUMBER �fS I��VN( � r�I I(��l ELECTRIC Q —' � (iHISSEGipNNEmNOTBEWMRETE00FTF1EPERMITISWRONEHUl�ORED�OLIARS($100)ORLE55). PLUMBING W Z I CERTIFV THAT IN THE PERFORMANCE OF 7HE WORK FOR WFICHTHIS PERMIT IS ISSUED,I MECHANICAL CJ SHALL NOT EMPLOV ANV PFRSON IN ANV MANNER 50 AS i0 BECOME SUBJECT TO THE Uj WORNEFS'COMPENSATION LAWS OF CALIFORNIq ANJ AGREE THAT IF 1 SHOULD BECOME INSPECTION FEE ? SVBJECTTOTHEWORKERS'COMPENSATIONPROVISIONSOFSECTION3]o00FTHELA90Fi COD-I SHALL FOR�HWITH COMPLY WITH TH E PROVISJ�ONS. /� ISSUANCE � '/ J _._ p �ATE �.APPLICANT: �, ''--:>r�� ' �/J�.�+'� _ SMIP _.. W J WARNING�.FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS t1NLAWFUL,AND SHALLBE ENERGY P/C J � SU&IECTANEMPLOVERTOCRIMINALPENALTIESANDqVILFMESUPTOONEHUNDREDTHOUSAND ENERGVPERMIT } DOLLAFS(5100,000),IN ADDITION TO TH[COST OF COMPENSATION,DAMAOESAS PROVIDE�FOR IN J SECTION 9]OB OFTHE LABOR CODE,INtEREST,FNDATTORNEV'S FEES. OC RETENTION FEE: w O CONSTRUCTION I_EN�INGAGENCY PRE-ALT FEE�. � 1 HERE6V AFFIRM UNDEA PENALTY OF PERJURY THATTHER'c IS A CONSTPUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SLC.309],CIV.C.�. ---- Z W � LENDER'SNAIAE H LENDER'SADDRE55 w ICERTIFVTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATIONISCORRECT. TOTAL FEES Uj��C� � I AGREE TO COM�LY WITN ALL CITV AND COUNTV ORpINANCES AND S?ATE LAWS llELATING TO p'JIL�INO � � � CONSTRUCTION,AND HEREBY AUTHORRE R[PRESLNTATIVES OFTHIS COUNTVTO ENTERUPON THE Z ABWE-MENT NLD P70PERTY FOR INSPECTION PURPOSES. � � COMMENTS . -' C,l r1��-r� � �:� l/ � _- m __ ¢ PERMITTEENAME NT _ � ,L l-.�G-�]Z � SIGNATl1REOF�EF�.AITTEE DATE � � RECPT.NO. PAID BY VALIDATION WHITE—Department Copy.VELLOW—Finance Copy,PWK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy �F �y 1 P � 5 .� b �.. � _ ; �^9�79�'�^��e' �t '"�i� � � - . � r ,.. . _��. � � ,»a=,� c � _ , . , , ,_ � ,a� t, ,u�� , .., � � �. , _ � __ _ ' ° ��,� :r �� ;_ -, �. �� '�' _ ' � e ' �a � .,,� ,�� i�� „� �� a>�w'7`��u '. � �, ai � � ... .. . .. .. . . . . _ _.. ... . . ... ,y�� !, ,�� i� �as��x�a�-�� f •�'�^ s i� f 3�,,r) ... . .. ... .. . . .. . .. .... ._... _ . ..... _. .. { ' - ` ... ... . . . _ . ,..�� . ... . . .. .. ... . .. .._. ... ...._ ._ � - A A;t�w �� "r�`" �"'. _ .. ' _� �t S r i . . . . . . . . .... . ... ....... .. . . ''a !��:�:"��., a¢l� x ''�qe tsv:. . ... . � � . Mt �4 �4 ,3k; 'y r.a',c3 � �id . ... ...... _ .. .. .. . . . -� � . ,, �m.� .... . . .. . . .. . . .. . .. . - ... , t -1d 3 �, - � � ae_ � � s; � : �r f �+ �k.? a s'r � � .. . .. ... ... .. .... . .. . � , e'. ,. CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION JOBSITE C Iri �C1 23c L1� L ADDRESS 1 ADDRESS 1 � 1 II APN LOT TRACT OWNERID,j I'V/k'I- Ll/r ! L ADDRESS CITY ZIP TE APPLICANT TEL. CONTRACTOR ADDRE JMDI%a I CITY L- k fv40 II3 0 ZIP/C)I2T EL. X12' 1(t/)C 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 PERMITTO 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 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 TOAN 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 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. LICENSE CLASS 7 LIC. N0. DATEi G'-C 2 CONTRACTOR f4 1 1 WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: -1 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 WORKERS'COMPENSATI N INSURANCE CARRIER AND POLICY NUMBER ARE: 0 14AC ! F OC U CARRIER '} POLICY NUMBER A WAi C (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 SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR COD I SHALL FORTHWITH COMPLY WITH TH E PROVISIONS. DATE: �.APPLICANT 2, 1 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 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 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-MENT NED PROPERTY FOR INSPECTION PURPOSES. PERMITTEE NAME NT SIGNATURE OF OrERf.A ITTEE DATE WHITE-Department Copy,YELLOW-Finance Copy, PIN PRESS FIRMLY APPLICATION 40� �I PERMIT P/C DATE_ 10 UMBER I J6 1 # 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 Garage/Carport U) W Patio/Deck I LL PooVSpa Z Re-Roof 0 Commercial m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J UU cc: I- U w W Z j2hv r m d Q U 2 Q 2 U w CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES IAI) COMMENTS RECPT. N0. PAID BY VALIDATION