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Home My WebLink About18840 � CITY OF DIAMOND BAR / ./ �, DEPARTME'�1T OF COMMLTNTCY&bEVELOPIv1ENT SERVICES � � 21825 E.Copley Drive '@v�� (909)860-3195 Fau(909)861-3119 PRESS M BUILDING PERMIT APPLICATION F LY Y JOBSITE i L APPLICATION f D � PERMIT p/C o ADDRESS_�3�1 � /G �4�L�ftv' Z.�CiJ+IJ �%f+�l DATE NUMBER � � OCC �' APN__ LOT TRACT ISSUE f ^ ' PE DATE 0 f� CONSL GROUP p OWNER _�l�'�i2�L+f S S//�7/17(JNj — — o AD�REj��f �- �i-�ftir C�ddt7wN (< <u� ZONING SETBA KS oCITY V �- ZIP��7EL. �-.ZE� 'J- FRONT RW L� p APPLICANT A..''Zt% TEL REAR �-� Z ---� SIDEISIDE STREET RW ❑ ¢ CONTRACTO��,�� 2'S� !�. _---y(�r-i-�+��+�—,�_ SIDE _ ___ � _ ADDRF�SS_S�•�_�+1_�((!w� ��svo<< rj'XGc. � aOS O PROPOSED USE L '� /N, � o CITY ('�...qC.�fi,�vT�.f� ZIP �J�--�k,- TEL.�b�l"SE�i-��+Zv � r� ��L � w ARCH/ENG/ ��'1� �.T ) Nh.4F'L z DESIGNER y'�'^'�/L � ADDRESS_ � UDITSWE�� / NO. NO. � � CITY _ ZIP_� TEL.__ � STORIES � BEDROOMS '� DESCRIP710N SQ.FT. FACTOR PSF ADJ.AREANALUATION OWNER-BUILDER DECLARATION p SFR/ADD/REM p I HEREBV AFF�.RM UNDER PENALTV OF VERJURV'HAT�AM E%EMPi FqOM iHE CANTRACTORS LI- Gef290/C9fpOK W CENSELAWFORTHEF�LIOWMGREASON(SEC7D71.SBUSINESSANDFqOFESSIGNSrODE�ANVCIT'OR (/� � COUNTYWHICHREQUIRESAPERMITTOCONSTRUCT,ALTER,IMPROVF.DEMOLISH.ORREPAIRANYSTRUC� W Patio/Deck w TURE,PRIOR TO ITS�SSUANCE.AL50 REOUIRES THE APPLICANT fOR SUCN PERMIT Tp FlLE A SIGNE� w � SiATEMENT THAT ME Oq SHE ii LICENSEO PURSVANT TO THE FROVISIONS Of iHt CONTqAC10RS U� � CENSE LAW�GHAPTER B(GOMNIENCING W�TH SECTION�000)OF DIViS10N 3 C�F THE BUSINESS AND PRO- � Pool/Spa O FESSIONSCOD"c)ORTHATMEORSNEISE%EMPTiNFREFROMAN�THEBASISFORTFIEALLEGEDEXEMF- � U TION.ANYYIOLATIONOFSECTI()N7031.50YANYA�PL1GqNiFOqqPERMITSUBJE:.fS'fNEAPPUGANTTO Z Re-Roof � ACIVI�PENALTVOFNOTMORETHANFIVEHUNDREDDOLUFS�S5o0�): � p �I.ASOWNEROFTHEPROPERIV.ORMYEMP�OYEESWiTHWAGE5A51HE;q50LECOMPl:NSAiipN. � Commercial Z WIL�DO THE WOqK,ANO THf,TRUCTJRE IS NOT IN'END[D OP OGFER"c�fOH SALE!SEC.7o4a,BU�'�� _„J � NESS AND VROFESSIONS CODF:THE CANTqACTi�RS L'�CENSF LAW DOES NO�APPLV TO AN DWNER OF PAOPERTVWNOBVILDSORIMGROVE57HEREG/1,ANDWHOf:0ES5l/CuWORKHIMSELFORHERSELfOR � CC THROUGH HIS OFl HER OWN EMPIOVEES,PROVIOED THAT SUCH IMPqOVEMENTS qRE NpT INTfNDED DR m Q OFFEREOFORSALE.IF,HOWEVERn1EBUILDINGORIMPROVEMENTISSOLDWITHINONEYE4ROFCOMPLE- I Z TION,THE OWNER-BUILDER Wi�_l HAVE TNc BUROEN OF GqOVIhG:HA7 HE OR SHE Di0 NO7 8Vi10 OR � IM7ROVE FOR TME PUHPOSE 0=SAIE). w C;I,ASOWNEflOFTHEPW7PEHTY.AMEXGWSNE'_YGC�NTqAGTiNG'NITHLICEYSEDCONTRACTURS I [t TO CANSTRUCT TME PROJECT(SEC.7066,6USINE55 AND PROFESSIVNS CODE:THF CONTRAGTOR5l.1- VaWBIIOn ADJ.AREA _ W CENSELAWDOESNOTAPPLYiOANOWNEROFAPROPER'YWHOdUIID50fiIMPPOVESTHEREON,AND � WHOCONTRACTSFQRSUCHPRQIECTSWITNACONTRACTOR�S)I.ICENSLDPURSUANT101HFGO4TRqC- QUANTITY DESCRIPTION FEE Y TOqSIICENSE LAW). __ Q01 AM E%CMPT i1NDER 5F C. __ 9.S PG FOq THIS REASON Q � U � Da7F _.___ OWNER .--. ..— ¢ Z -- U � IICENSED CONTRACTORS DECLARATION � Q W 2 11�ERE9v AFFIRM UNDFR PENALTV OF 7ERJUAY THA71 AM IICENSED UNDER PROV SIONS OF CHAP7Ea � d e(COMMENCIhG WITH SECTION)D00)OF OIVISION 30F THe BUSINESSAN�PPOfES5iON5 CODE,AND Z �X MV LICENSE IS IN FULL FORCE 4ND EFFECT. � � LICENSE CLASS��✓�^��___ LIC.NO. ��J� � U �ATE ��,—�^� �'.l _ CON'RACTOR. . � a I W � WORKERS'COMPENSATION DECIARATION Q — � 1 HEREBY AFFI4M V�DEF PENALiV OF PERJURY ONE OF THE f01_L�WING DECLARATIONS: U � Z 0 I f1AVE AND WILL MAIN'AIN qCERTIFIGATE OF GONSENT TO SEIF�INSUFE FOR WORKERS' _ Z CAMPENSATION,AS PqOVIOED BV SECTION 3700 nF�HE UBOR GpDE,FOF THE PEFFORMANCE U ¢ Of TH'c WORK FOR WFIICM TNIS PERMIi IS ISSUED. W � � w _i hAVE AND WI�L MAIN'"AIN WOflKERS'COMPENSAi ION INSURANCE,AS PEOUIRED BV SECTION O3]OC OF 7HE LABOR CDDE,FOR THE PERFORMANCE OF THG WORK FOR WHICH 7HI5 PFRMIT IS � ISSUED.MV WOfl ftS'COMPENSATION�ISURqVC qRRIER AND POLICV NUMBE9 AFE�. CONSTRUCT�QN j f:ARRIER ��Z T�''�� PLAN REVIEW , � Poucv NUMeEa {��'� ��'/ /� —— ELECTqIC ¢ p (?IISSECTIONNEmNOfBEOJMPLE7EDOFTHEPERMfT15FOFONEVN�pPED�OLLARS;510L)ORLFSS�. PLUMBING W — Z 1 CERTIFV THAT IN THE PERFpRMANCE OF iHE WORK FOR WHIGM THIS PEFMR I$ISSUED,I MECHANICAL C} SHALL NOi eMPLOV NVV 7ERSON IN ANY MANNER SOAS TO BECOME SU9JEC:T TO THE '�--�- �- � WORNERS'COMVENSATICNLAWSOFCALiFORNIA,ANDAGREETHATIFI5H0U'.UEECOME INS?ECTIONFEE ? SUBJECT TO THE WOFlNERS'COMPENSATION PROVISIONS OF SECTpN 37�OOF THE LABOfl — CODE,I SHALL FOflTHJJITHCOMPIV WIT OS ROVI NS I ISSUANCE � u.,,z --�,r- - �� p DATE:r � APPLIGANT: ______�� SMIP W J WAqNING�FAII UqE TO SECURE WORKERS'COMPENSATION GOVEFAGE IS UNLAWFUI,AN�SHq��BE ENERGY P/C J LL SUBJECTqNEMPLOVERTOCI;IIAINALPENALTIESAN�CIVILFINESU01'OONEHUNDREDTHOl1SAND ENERGVPERMIT �ILARS�S1GC.DCO).Iv ADDIT'AN TO THE COST DF CCMPENSATION.DAMAGES AS PflOVIDED FOR IN J SECTION3]OBOFTIIELABORCODE.I4TEf3EST,ANOATTORNEV'$FEES ` W RETENTION FEE: � O iANSTRUGTION LENDING AGENCY PRE-ALT FEE: _ � IH[qEBYA=�iRMUNDERPENA�TYOFGERJURYTHA7THEREISACONSTFUC'IONLENDINGAGENCY n- f-Oq'HE PEHFOqMANCF OF 1'HE WOPK FOR WHICH THIS PEFM�T IS ISSUEO($EC 3097,GN(:.) _ W � I EN�EH'S NAMt ____ -- _ f— IENOER'S AODfiE55 � �. . ._ w i�FPTIFYTHA7INAVEREADfHISAPPLICATIONANDSTATETHATTNEA80VtWFORMATipNiSGORREGT. TOTAL FEES � IAGREE TC COMPLY WITH ALI_CITV AND COU4TY ORDINANCESAN�STATE LAWS FELATING i0 HUIL�iNG / � CpJSTRUCTION.AND HERE9�AIITHORIZF qEPRESENTATIVES OF TFVIS COUNTY TO ENTER UPON iHE Z �Ip�VE�IUFJryONEDGROCER-IYCOC'NSPFCTIONPURPOSES. COMMENTS — Q \l \y J �j � ' � m PERM N P ) .'--.� — Q � `�� — cn `�� —�.(}--�-G'J------ � SI,NAiliqF DV PE%1MI'T�E DATE - � RECPT NQ PAID BV VALIDATION WHITE—Department CoDy.YELI.OW—Fnance Copy,PINK—Assessor Copy,GO DENR D--File Copy,GREFN—Applicant's Copy � � �� ; ��;�� t :. �� ,: � ,e � �� F - . � � �» , �� . w � � � � , � . � �_ � �� ,. �� _ � � : �Z�`'��-.�� / b �- � _ ,._ a.. : ��-l-a�-. ,�4 _� _ . _ _ __ _ _ � ��"��'� � � >. „iir� __ _— _ ': �.� _ � __ _ __ _ _ __ ; _ i . _ __ _ , i _ __ __. _ ; — -- — — --— � � __ _ ; . __ _ _ ? _ _. i r a .�, ,�..�, ., ' � � � ,. �y — _ __ -- �� Y� , �t�'�� rt �t „ � ; �e�.�..�k�� '��-� � .. .... . . . .. . _. .. ... ... .... ...... . .. �:. .,� . .._ . .. .... . . _... . _ .._. . ; �t .� ' �� .. .. .. ...... _.. ._ ..... . . .. . ... .. ... .. ... ... . .... . _. . ._... _.... ._. .._ ._.. . � r � . `� � � �.� � . ._. . .. ... . . . . . . ... . .. . .. ...... ... ' � � �� . .. . . .. . .. . . ... . . . .. .. .. . . . ....... .... .. ....... . ._. ._..... ...... �� .r" �. � v, ��.^�^, �� _ .... .. .._.. . . .. ... . . . .... ....... .... .. . ._.. . ..._ .. .._. ._ ... .__ . x �a. . JOBSITE/_ ADDRESS_��j �� 1�4�L1)� ��i.Ll+l�Z%�,�1 APN LOT TRACT OWNER�/+�I�'Z(L�Y.S �Si/�'1/Y�C�IVj E�'c-vN� �� ' LD'E w ADDRE�°'3�1��-G� 1 Q CITY ZIP� 7EL. --a(£� ',�- APPLICANT A °�+ci TEL � CONTRALTO Th2��-� '�^°C. ��+C ADDRF,�SS �(s A+�.CLU� CITY(��+ge.f(we� (. �'ZIP TEL.�G�/"�i-..Yb r7y 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.ANV CITY OH COUNTY WHICH REOUIRESAPERMITTO CONSTRUCT,ALTER,IMPROVE, DEMOUSH,OR REPAIRANV STRUC� TORE, PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR BHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI� CENSE LAW(CHAPTER B (COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THERE FROM AND THE BASIS FOR THE ALLEGED E%EMF- TION.ANV VIOLATION OF SECTION 7031.5 RV ANV APPLICANT FOR q PERMIT SUBJEGTS'fHE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(5500)): ' (�I,AS OWNER OF THE PROPERTY,OR MV EMPLOYEES W ITN WAGES AS 1 HEIR SOLE COMPENSATION, WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOH SALE !SEC. 7041, BUT NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES N0;APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO GOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR MER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE.IF HOW EVE R THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE- TION,THE OWNER-BUILDER WI'�_L HAVE THE BURDEN OF PROVING 'HA7 HE OR SHE DID NOT BUILD OH IMPROVE FOR THE PURPOSE 0= SALE). ^ I,AS OWNER OF THE PROPERTY AM EXCLUSIV ELV CONTRACTlNG WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC. 7064, BUSINESS AND PROFESSIUNS CODE:THE CONTgACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO dUII.DS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PFIOJECTS W ITN A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). CJ I AM EXEMPT UNDER SEC. i 8. 8 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 30F THE BUSINESS AND PROFESSIONS CODE,AND MV LICENSE IS IN FULL FOR AND EFFECT. CE {{{ S LICENSE CLASS LIC. N0. T �� 'i�� CONTRACTOR.__ DATE WORKERS'COMPENSATION DECLARATION I NEREBV AFFIRM UNDER PENP,LN OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MAIN'-AIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORKERS' COMPENSATION,AS PFOVIDED BV SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WFIICH THIS PERMIT IS ISSUED. I HAVE AND WILL MAIN"CAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION 37000E THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS RANC ARRIER AND POLICY NUMBER ARE: M PENSATIO S U ISSUED. MV WORf ERS N[J�1 yC �p \ / Y CARRIER �r I" ••�L T�� POLICY NUMBER t�V��- (i}iIS SECTlON NEED NOT BE Q7.APLEfED OF THE PERMIi IS FOF ONE HUNDRED DCILARS(5100)OR LESS) 1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY AIVV PERSON IN ANV MANNER SO AS TO BECOME SUBJECT TO THE WORKERS'COMPENSATION LAWS OF CALIFORNIA.AND AGREE THAT IF 1 SHOULD BECOME SUBJECT TO THE WOFIKERS'COMPENSATION PROVISIONS OF SECTION 37000E THE LABOfI SH ALL FORTHWITH COMPLY WIT OS ROVI N CODE,I f ) DATE:r V-�/��APPLICANT: ��'�� WARNING FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE SUBJECT qN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP 1'0 ONE HUNDRED THOUSAND DOLLARS(5100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3]OB OF THE LABOR CODE,INTEREST,AND ATTORNE V'S FEES. CONSTRUCTlON LENDING AGENCY I NEREBV AFFIRM UNDER PEN ALN OF PERJURY THAT THERE IS A CONSTFUCTION LENDING AGENCY FOR THE PERFORMANCE OF I"HE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC. 3097,CIV C.j. ENDER'S NAME I LENDER'S ADDRESS I CERTIFY THAT I HAVE READ THIS APPLIGATKNJ AND STATE THAT THE ABOVE INFORMATION IS CORRECT I AGREE TO COMPLY WITH ALI-CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION,AND HEREB{gUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE /�pQVE�MFJfIyONED PROPERTY FOR INSPECTION PURPOSES. \ 1 J �\\„ 1/ 1 PERM N P) I SIGNATURE OF PERMITTEE DATE Tri 0 0 Q 0 w I� w z 0 0 z m 2 0 Z 0 2 X W 0 U W r� Z Q W Q Z Q W Z H 0 I� w J J LI J Q W a 0 CL Z W 2 F-- W �� Z CITY OF DIAMOND BAR DEPARTMENT OF COMMUNTfY&bEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION WHITE-Department Gopy,YELLOW-Finance Copy,PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy PRESS FJ�R�ALY