The URL can be used to link to this page

Home My WebLink About18448 (11) �� CITY OF DIAMOND BAR �_`"' I I Y''�—l�� DEPARTME'�'T OF COMMUNI7'Y&DEVELOPMENT SERVICES 21825 E.Copley Drive �� 3 (909)860-3195 Fax(909)861-3117 pRE$$ �' `-�� BUILDING PERMIT APPLICATION FIRMLY o� JOBSITE ��r APPLICATION � c 1\ PERMIT ��Q P/C ADDRESS_�� _ DATE � ��,��UMBER � Il1 # � ISSUE TYPE OCC APN O'T T CT_ DATE CONST. GROUP p OWNER � �"'�Z.(� -- � ADDRESS �� ' !�' 6 ^ ZONING SETBACKS � FRONT qyy � z CI - � ZIP �/7 7EL.cf'f�Z-�� -3 � AP LI ANT TE REAR r�_ z SIDE/SIDE STREET RW ❑ Q CONTRACTOR , ✓ SIDE ❑ ADD S � o CI ��_ ZIP�2_ty�j TEL. � PROPOSED USE o ARCH/ENG/ z DESIGNER w - NO.DWEL. NO. � NO. a ADDRESS � CITY ZIP TFL. UNITS STORIES BEDROOMS cn -- — N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION p SFWADD/REM � I HEREBV AFFIRM UNDER PENA�TV OF PERJURYTHAT I AM FXEMPT FROM THE CONTRPCT(Ni5 LI- G8/8J8�C8f(JOfI W CENSEUWFORTHEFOLLOWINCREASON(SEC.7031.5BUSINESSANDFAOFESSIDNSfODE:ANVCITYOR (n U GOUNTVWHICHREOUIRESAPERMITTOCONSTAUCT,AI.TER,IMPROVE.DEMOLISH,ORHEPAIRANVSTPUC- W TURE.PRIOR TO ITS ISSUANCE„LL50 iiEOUIFES THE APPLICAIvT FOR SUCH PERMIT TO FllE A SIGNED w PatiO/DBGk � STATEMENT THAT HE OR SHE IS UCENSED PURSUANT TO THE PROVISIONS OF THE CON7RACTORS LI- � � CENSE LAW(CHAPTER e(COMMENCING WiTry SECrION 7000)OF DIVISION 3(�F THE BUSINESSAN�PRO- POOVSpB � FESSIONSCADE�ORTHATHEOqSHEISEXEMPTTHFREFROMANDTMEeASISFOFTHEALIEGEDEXEMV� (� V TION_ANVVIOLATIONOFSECTION7031.SBYANVAPPLICAMFORAPERMITSJBJECfS"fHFAPPLICANiTO Z Re-Roof A CIVIL PENALTV OF NOT MORF THAN FIVE HUNDREO OOLLARS(f500))�. Q ❑I,ASOVMEROFTHEPROPERN,OflMVEMPLOY[[SW�THWAGESAS7HEIRSOLECOMPENSATiO�`l, � COffIRI0fC18I Z WILL DO THE WORK,AND THE STRUCTURE IS NOT INTEND[D OR OfFERED FOH SALE(SEC.7oa4,BUSI� J � NESS AND PROFESSIONS CODE:THE CONTRACTORS lIGE45E LAW DOcS NO�APPLY TO AN OWNER OF � — FROFERTVYRqBUILDSDflIMPROVESTHEREON,AN�WMODOESStICHWOflNHIMSELFORHERSELFOR wTHROUGNHISORHEROWNEMPLOYEES,PROVIDEDTMATSUCHIMPROVEMENTSARENOTINTENDEDOR m � OFFEREDFORSALE.IF,HOWEVER,TiEBUILDINGORIMPROVEMENT,IS50LDWRMINONEYEAFOFCOMttE- Z TION,THE OWNER-BUILOER WILL MAVE THE BURDEN OF 7RDVING'HAT HE OR SHE DID NOT BUIL�OH � IMPROVEFORiHEPURPOSEOFSALE). w CI,ASONTJEROFTHEPROPERTV.AME%CLUSIVELVCONTRACIINGWITHLICENSEDCONTRACTORS � TO CANSTRVCT THE PROJECT(SEC.]0«,BUSINE55 AN�PROFESSIONS CODE:THF CONTRACTORS LI� VaIUO�lOf1 � ADJ.AREA W CENSELAWOOESNOTAPP�YTOANOWNEROFAPROPERTYWMOdUII.�50�tIMPROVE5TIEREON,AND � WHOCONTRACTSFORSUCHPROJECTSWITHACONTRACTOR(S�1.IGENSEDPUqSUANTTOTHECONTqAC- QUANTITY DESCRIPTION Y Toas ucEnse uw.� FEE QL:i I1M E%EMPT UNDER SEC. __ B.d P.C.FOR THIS PEASON Q ?� U W -- � — DATE OWNER �- Z -- — U ' � LICENSED CONTRACTORS DECLARATION w ¢ 2 I HEREBYAFFIRM UNDER PENALTV OF PEFJURY THAT IAM LICENSED UNDER PROViSIONS OF GHAPTER � d 9(COMMENCINGWIT4SECTIOPI'/o00)OFOIVISION30FTHEBUSINE55/NDPPOfE55�iON5GO0E,AND Z X MY LICENSE�S IN FUIL FORCE ANO EFFEGT. W / /� (Y] Q LICENSECLASS_�__��_ LIC.NO l9' ��/�,/ � � V DATE `i'-��_�� CON7RACT0 ,`��]�„'u d W J 'T 9 ., � WORKERS'COMPENSATION DECLARATION Q � I HEREBYAFFIRM 11NDER PENALTV OF PERJl1RY ONEOFTHE FOLLOWING DECLARATIONS: z � _IHAVEANOWILLMAMTAINACERTIFICATEOFCqNSENTTOSE�F�INSUREFOPWORNERS' a 2 CAMPENSATION,AS PROVIDED BV SECTION]]oo OF THE U60R COOE,FOR THE PEFFORMANCE U OF THE WORK FOR WHIGMTMIS PERMIT IS ISSUED. w � � w IHAVEAN�WILLMAINTAINWORNERS'COMPENSAiIONINSURANCE.A5PE0UIREDBVSECTIINJ Q3]OOOF THE LABOR CODF,FOR THE PERFORMANCE OF'HE WORK FOR WHICH THIS PERMIT IS �_i-n � f O ISSU��.MV WORKERS'COMVENSATION INSURANCE CARRIER AND POLICV NUMBER ARE' CONSTRUCTION �_ v j c�qRiER PLAN REVIEW zPOLICY NUMBER_ -- ELECTRIC Q � (!}iISSECTqNNEmNOTBEOJMPLETEDOFT/ffPEi4MISPoFIXJE1d1PDREDDOLLARS(E100)ORLESS). PLUMBING Z I CERTIFV THnT IN THE PERFORMANCE OF THE WOFK FOR WHICH THIS GERAIIT IS ISSllEO.I MECHANICAL C} SHALL NOT EMPLOV ANV PERSON IN ANV MANNER 50 AS TO BECOME SUBJECT TO TH[ � WORKEPS'COMPENSAf10N LAWS OF CAUFORNIA,AND NGREETHAT l I SHO LDBEO��ME INS:�ECTION FEE _ � SUBJECT TOTHE WORKERS'COMPEN�FTION OVISIONS OF SECT 310 F THE BOR � COpE.15HALLFORTMWiTHCOMPLVWIIH CP DVISIONS. ISSUANCE Q p DATE- � APPLICANT SMIP Q J WARNING:FAILURE TO SECURE WOflKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C � SUBJECTAN EMPLOVER TO CRiMINAL PENALTIES PNO GVIL FlNES UP TOONE HUNDRED THOUSAND ENEFGY PERMIT OOLlARS(S1oa,0U0),IN ADDITION TO THE COSTCF COMPENSATION,DAMAGES AS PROVIDEJ FOR Ifi J SECTION 3"/08 OF THE I.ABOR CODE,INTEREST,AND ATTOfiNEV'S FEES. �{n p� RETENTION FEE: V V � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � p _—... ____— � I HEREBY AFFIRM UN�ER PENAITV OF PERJURV THAT THERE IS A CONSTRUCTION LENDING FGENGV � FOR THE PERFOfiMANCE OF TFIE WOFK FOR WM�CH iN15 PERMIT IS ISSUED(SEC.3091,CIV.G.�. —�� -- Z W S LEN�C(i'S N0.ME i � I F- LENDER'SAODRE55 w� �/ � ICERTIFVTHATIHAV[READTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATIONISCORRECT. TOTAL FEES ��]� � � I AGREE TO COMPIY WITH ALL CITV AND COUNTY ORDINANCES AND STATE L4WS RELATING 70 9UIL�ING �J � � CONSTRUCTION,NND MEREBV AVTMORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE Z ABOVE-MENTIONED PROFERTV FOR INSPE TION PUiiPO5E5. COMMENTS � J � - m PE N EIPRINII / •.. Q `� .—�j cn �-- -- � G TL�RE OF ERMITTEE DATE = RECP?.NO. PAID BY VALIDATION ~ WHITE—DepaAment Copy,VELI.OW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy va� : _ �,. y ��. . , , �;: � � ,� �� -�� e� � �� , � . � P� �� _ , (��dI�O� /�d�"'" _ __ „��.�,�f � , , , ,.,, __ _ _ �� + _ _ _ _ __ _ __ _ __ _ _ _ _: _ __ __ : J� + �2. :. �1�"T . ... . . . . .... .. ....... _.._.. �.... . _._._ .._.. y�l' � �}�M�'+. � � . ... . . . x � ,ig�"� .e ` �� • �7 � � "� ,�.. ,i�,':.'�' ��..� '. ' . . .. . . .. . . _ .. .. . . _.._ ..._.. . . .. Q" �,.' . .. . . �— �.. �� . ..... ..... . ��. ' ' ,k " ��' .... . .. . . . ... ... ... . ... .. .. .. ... .. _. �;�:,yb � .. r r '�t Yi��P� . . ..... . —.— �.�"'. .�- ' " . ... . . . . ... ... ._. _.. .._ _.. _. :. �:., ��t � ....... ^>'s,a9�$ :t. � �� . ... ... _. ,. '��., �. s '� ,. '; ._ . � -� . .... .... .. . .. .. .... ... ._. ... ... ... T},„ ��'� ._. '^E Y ` ` �r�.,. n " �e .. _.. .. .. � ��'.'�, _ CITY OF DIAMOND BAR DEPARTME'VT OF COIvINIUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION JOBSITE II� ADDRESS_ �� APN 0'T T CT- OWNER� .i+�r,� ADDRESS�t!�'6 CI�-c ZIP�/� 7ELCf��•��-3 APPLI ANT TE CONTRACTOR ADDR S� CI-��_ZIp��-yy^'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- CENSELAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE: ANV CITY OR COUNTY WHICH REOUIRESA PERMIT TO CONSTRUCT,ALTER,IMPROVE. DEMOLISH,OR REPAIR ANV 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- CENSELAW(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.ANV VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJEC fS'f HF APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(f500(): - ^ I,AS OWNER OF THE PROPERTY,OR MV EMPLOYEES W iTH WAGES AS 1 HEIR SOLE COMPENSATION, WILL DO THE WORK,AND THE STRUCTURE IS N07 INTENDED OR OFFERED FOH SALE(SEC. 7044, BUSI� NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES N0� APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORN 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 'HAT HE OR SHE DID NOT BUILD OH IMPROVE FOR THE PURPOSE OF SALE). C I,AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCTTHE PROJECT(SEC. 70a<, BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI� CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY W HO aUI1.DS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS W ITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). ^ i AM EXEMPT UNDER SEC. B. 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 3 OF THE BUSINESS AND PPOFESSiONS CODE,AND MY LICENSE IS IN FULL FORCE AND EFFECT. //�7 LICENSE CLASS_�_��_LIC. N0.f9'Z�/ DATE ' '-�� CONTRACTO I WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINTAIN ACERTIFICATE OF CONSENT TO SELF�INSURE FOR WORKERS' COMPENSATION,AS PROVIDED BV 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 BV SECTION 37000E THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MV WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER POLICY NUMBER_ (THIS SECTION NEm NOT BE OOMPLETED OF THE PERMfT IS FOR ONE Id1NDRED DOLLARS(f100)OR LESS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I SHALL NOT EMPLOY ANV PERSON IN ANV MANNER SO AS TO BECOME SUBJEf,T TO THE WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT I I SHO LD BEC ME SUBJECT TO THE WORKERS'COMPENSATION OVISIONS OF SECT 370 F THE BOR CODE.I SHALL FORTHWITH COMPLY WITH EP OVISIONS. T �- IS DA E: 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(f 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 PEN ALN 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.I. 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(:IN AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OFfHIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPE TION PURPOSES. i PE N E(PRINT)' -C� _�S� G TORE OF ERMITTEE DATE WHITE-Department Copy,YELL-OW-Finance Copy,PIN PRESS FIRMLY APPLICATION_�C� 1\1 PERMIT� P/C DATE J V�IUM BER # ISSUE TYPE OCC DATE CONST GROUP ZONING SETBACKS FRONT Ryy^ REAR^ SIDE/SIDE STREET RW^ SIDE�� PROPOSED USE N0. DWEL. N0. �N0. UNITS STORIES BEDROOMS� DESCRIPTION S0. FT FACTOR PSF ADJ.AREANALUATION SFR/ADD/REM � Garage/Carport W Patio/Deck LI- PooUSpa Z Re-Roof 0 Commercial m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J Q u H U w w C7 Z m a Q U Z Q 2 U w CONSTRUCTION '��Q PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INS?ECTION FEE ISSUANCE SMIP Q ENERGY P/C ENERGY PERMIT_ RETENTION FEE: PRE-ALT FEE: TOTAL FEES 1�0 S� COMMENTS RECPT. N0. PAID BY VALIDATION