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Home My WebLink About16688 (10) � � ` � CITY OF DIAMOND BAR �`" � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fa�c(909)861-3117 PRE$$ '"�� BUILDING PERMIT APPLICATION FIRMLY � JOBSITE �1 t (� DATE CATION 4 ��'O� NUMBE� ��/ #/��'-�� o ADDRESS_ � m ISSUE TYPE OCC � APN LOT TRACT DATE CONST. GROUP p OWNER `n n p ADDRESS 11. ZONING SETBACKS oCITY 1 r ZIP TEL.�• 7 FRONT RW ❑ APPLICANT TEL.J"lC��-J-�.1LJ REAR ❑ � SIDElSIDE STREET RW Ll z ¢ CONTRAC�[OR e � SIDE ❑ � ADDRE 2 ` � CITY 'n ZIP TEL. PROPOSED USE r w ARCWENG/ w DESIGNER NO.DWEL. NO. NO. � ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-6UILDEP DECLARATION SFR/ADD/REM � Q I HEREBV AFFIRIA VNOER PENALTV OF PERJURV THAT�AM EXEAAPT FROM THE CANTRACTORS L6 G3f89@ICB�OfI W CENSELAWFORTHEFOLLOWINGREASON(SEC.J031.58USINESSANOPROFESSIONSCODE:ANVCINOR (n U CIXINTYWHICHREQUIRESAPERMITTOCONSiRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANVSTRUC� W patio/Deck w TURE,PRIOR TO ITS ISSUANCE,AL50 REQUIRES THE RPPLIGANT FOFi SUCH PERMIT TO FILE A SIGNED W STATEMENT THAT HE OR SME IS LICENSED PURSUANT TO THE PROVISIONS OF THE CANTRAGTORS LI� � CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � PooUSpa FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFRON�AND THE BASIS FOfl THE ALLEGED EXEMP- � TqN.ANYVIOLATIONOFSECTION7031.5BVANVAPPIICANTFOHAPERMITSUB:ECTSTHEAPPLICANTTO Z Re-Roat ACNIL PENALTV OF NOT MORE THAN FNE HUNDflEJ�OLLARS(f500)): ❑I,AS OWNER OF TNE PROPERN.OR MY EMGLOVEES W ITH WACES AS THEIR SOLE COMPENSATION, O � Commercial Z WILL DO THE WOflN,AND TNE STRUCTURE IS NOT INTEN�EO OR OFFEi7E�FO�SALE ISEC.]044,BUSI- J NESS AND PROFESSIONS CADE:THE CANTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF � PROPERTVWHOBUILDSORIMPROVESTHEREON,ANDWHODOESSUCHWORKHIMSELFORHERSELFOR � � THROVGHNISORHEROWNEMPLOVEES,PROVIDEDTHATSUCHIMPqOYEMENTSARENOTINTEN�EDOR m QOFFEREDFORSALE.IF,HOWEVER,7HEBUILDINGORIMPftOVEMENTi550LDWITWNONEVEAiiOFCOMPLE- Z TION,THE OWNEN-BUILDEF WILL HAVE THE 6URDEN OF PROVING THAT HE OF SHE�ID NOT BUILD OR � IMPHOVE FOR THE PURPOSE OF SALE). w OI.ASOWNEROFTHEPROPERTV,AME%CLUSIVELVCONTRACTINGWITHLICENSEDCONTflACTORS � TO CANSTRUCT THE PROJECT(SEC.7040.BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- VelUetlo ADJ.AREA W CENSEUWDOESNOTAPPLYTOANOWNEROFAPROPERTVWHOBUIL�SOPIMPFOVESTHEREON,AND � WHOCANTRACTSFORSUCHPRQIECTSWITHACONTRACTOR(S)LICENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION FEE Y TORS LICENSE LAW.). � J O ❑I AM E%EMPT UNDEfl SEC._ B.8 P.C.FOR THIS REASON Q � U � ¢ DATE OWNER � Z W � LICENSED CONTRACTORS DECLARATION W � 1 HEREBVAFFIqM UN�ER PENALTV OF PERJURV THAT I AA1 LICENSED UNDER PROVISIONS OF CHAPTER � d 9(COMMENCING WITH SECTION]o00)OF DIVISION 90F THE OUSINE55 AN�PROFESSIONS CODE,AND Z I `X MY LICENSE IS IN FU FOFCE AND EF� 1 m � LICENSE C SS UC.NO, � 1 H � � � � J U �ATE CONTRAC70R d � WORKERS'COMPENSATION DECLAFA SC 1� ¢ = U � IHEREBVAFFIRMUNDERPENALTVOFPERJURYONEOFTHEFOLLOWINGDECLARATIONS: Z Q � I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' _ CAMPENSATION,AS PROVIDE�BV SECTION 3]o00F THE LAAOR CODE.FOR THE PERFORMANCF. U Q OF THE WORK FOR WNICH THIS PERMIT IS ISSUED. � � w �I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANGE,AS HEQUIRED BY SECTION � •'7 / ` � Q37000FTHELABORCODE,FORIHEPERFORMANCEDFTHEWORKFOflWHICHTHISPERMITIS . L�`j _ ISSUED.MY R RS'C MPENSATI INSURANCEGAR IERANDPOLICYNUMBEflARE: CONSTRUCTION ' J -� �� _ . .__" _ D 11JS . _ -- -- � CARRIER_� rn PLANREVIEW J ' �� l � POLICV NUMBER ��Gn � EIECTRIC � Z —� 0 (i}iI55ECT10NNE�NOTBECCMPLEfEDOFTHEPEMMISFOFIXJEHUPDIiED[)OIJ.ARS�E1001�LE55�. PLUMBING � W Z I CERTIFY iHAT W THE PERFORMANCE OF THE WORK FOR WHICH iH15 PERMIT IS ISSUE�.I MECHANIGAL �} SHALL NOT EMPLOY ANV PERSON IN ANV MANNER 50 AS TO BECOME SUBJEC7 TO THE vj WORKERS'COMPENSATION LAWS OF CAI.IFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE ? SUBJECTTOTHE WORKERS'COMPENSATION PFlOYISIONS OF SECTION 3�0o OF THE UBOR GODE,I SHALL FORTHWITH COMPLY WITH THOSE PFOVISIONS. �SSUANCE � SMIP p DATE: APPLICANT: w ENERGY P/C J WARNING:FAIIURE TO SECURE WORNERS'C061PENSATION COVERAGE IS UNLAWFUL,AND SHALL BE J � SUBJECTANEMPLOYERTOCRIMINALPENALTIESANOCIVILF�NESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOLLARS(f100.000),IN ADDITION TD iHE COST OF COMPENSATION,DAMAGES AS PROVI�E�FOR IN J SEGTION 3]OB OF THE LABOR CODE,INTEREST HND ATTORNEYS FEES. RETENT�ON FEE: � � � CONSTRUCTION LENDING AGENCY � PRE-AlT FEE: O � I HEPEB�AFFIRM UNDER PENALTV OF PERIURV THAT THERE IS A CONSTRt1CTION LENDING AGENCV � FOR THE PERFORMANCE Of THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.309�,CIV C.). Z W 2 LENDER'S NAME � � F— LEN�EH'SNDOFESS , � ICERTIFVtHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEMFORMATIONISCORRECT. TOTAL FEES ' � w I AGR TO COMPLV WITH ALL GTY AND COUNTV ORDINANCES AN�STATE IAWS RELATING TO 3UIL�ING � CON CTION,AN�HEREBVAUTHORIZEFEPRESENTATIVESOFTHISCOVNTYTOEN'EflUPONTHE /^/ 1 .�I G '�� Z ABO - ENTIONED PRO INSPECTION PURPOSES. COMMENTS� �� C(/ � v v�� y �� J � m T`TE NAME(PRINT) ¢ �.��r�� I-D I g .-, -� �.r � , � - � SIGNATUREOFPER TTEE �ATE � = RECPT.N0. L' __. P DIA BY � � _ __VALIDATION__ ~ WHITE—Department Copy,YELLOW—Finance Copy.PINK—Assessor Copy.GOLDENROP—File Copy,GREEN—ApplicanYs Copy �ut E�` ft��" . i � a � 1 , � i �� ii � �, _ . ... . , . . '�'e��. . � ..-��'�. .��- . .... .... . . . . ._ .. .. .. .. .. .... . , g . .... ..... . . ... .. . � . . .. ,. � ° :�..r� � . .. �. � . .. .. ... .. . .. ... .... . . .. .. .. ... .. . .. ... .. .. .... .._.. .... .; � . -�. . . . . .. ... .. ... ... . ... . ..... .... . . . .. ... . . .. . . . ��'�t�� t;- .�s . _ � :�;�aa��6�'i �� '��w � � .. .. .. ... . . .. . .. . . .. ._. . ..... ... . . � °I�'� afi:�. 3:S��il��.�"`' '�w8�e, . �` ��s�� p � — — .� �d � � J � � � �� . �� F.as� _ _ __ -i �%N G8'�s��a�n,-�§�k� ' .. rn� �, r .. e�_ _�` � ' � . . . ._. ... ... . .. . . . . ._. ...... ._ .... .. _. . . . .. .. . i , ��'"�� . � m.�. , a,,,,R,a a-,� �'. .. . . . . . ... ... ... ... . . .._ ..... . .. .. ... . ...... ...... ..._ .._.. .... ... .. .. ... ._ . ...... 116s+T,.w JOBSITE ADDRESS L APN LOT TRACT OWNER �^ n ADDRESS ckey-N Cu h CITY\(ZIP TEL. APPLICANT TEL. CONTRACTOR c Lo�A e:0, K) ADDRE CITY n ZIP TEL. 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 REQUIRESA 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 I.J. 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 NOTAPPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S)LICENSED PURSUANTTOTHE 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 MV LICENSE IS IN FU FORCE AND EFfT. 1 LICENSE C SS_LIC. N0. DATE-CONTRACTOR IsC' WORKERS'COMPENSATION DECLARA 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. 1 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 AN D POLICY NUMBER ARE: AR TE ISSUED. MY RI RS'C MPENSATI AV,INSURANCE C RR � ) N •v CARRIER rnU POLICY NUMBER (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 CODE,I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE: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 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 AGR TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CON CTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABO-ENTIONED PRO INSPECTION PURPOSES. 717E NAME(PRINT) rc r a SIGNATURE OF PER TTEE DATE CC 0 w 0 w z 0 0 2 0 0 w 0 z w C') U3 U) Q 0 W U Z W 0 U 0 Z 07 LL 0 Q d X W 0 U w U) U) W 0 0 w N I- 0 w J W W CI- 0 Or- d W CC W CL (D Z 0 J Q3 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 APPLICATION PERMIT/„/_�/CC" 0 DATE NUMBE yc� la' # ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ^ REAR ^ SIDE/SIDE STREET L RW ^ 1 SIDE � PROPOSED USE 550 j � r- N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREANALUATION SFR/ADD/REM U) Garage/Carport EXP IREn w Patio/Deck LL Pool/Spa MAY Q 9 200 1 Z Re-Root . Commercial 5 "a Valuatio ADJ.AREA QUANTITY DESCRIPTION FEE J 5 U Q 0 w J W �� 00-Z tj Z 00 J a U Z Q U W CONSTRUCTION PLAN REVIEW ' - ELECTRIC PLUMBING $ MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES IP I C ' L COMMENTS AI / L'- / RECPT N0. LS' ' PAID BY li,/L VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy