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Home My WebLink About19053 �.,,,� CITY OF DIAMOND BAR � ; DEPARTME�'T OF COMMUNTCY Bt bEVELOPMENT SERVICES , T,� � 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 PRESS ��° BUILDING PERMIT APPLICATION FIRMLY o� JOBSITE (. �� y�� APPLICATION � ^ C� '\^ pERM1T '�"(�� p/C ADDRESS_ � � ��'� DATE d�v u d'NUMBERI�.�..�_ � m ISSUE T'�PE OCC APN T ACT DATE CONST. GROUP p OWNER p ADDR S . ZONING SETBACKS OCITY TEL FRONT qyy �,� p APPLICANT Tim Nock� TEL.�L��+ REAR � z — — SIDE/SIDE STREET Ryy � — a CONTRACTOR_NOCIC PIllIItb1R''�– SIDE _ � ADDRESS 11Fi12 Knott St afl/ � crrv Garden rove ziP 9284hE�. 714895124 PROPOSED USE o ARCWENG/ _ z DESIGNER a ADDRESS - NO.DWEL. NO. NO. � CITY ZIP TEL. � STORIES BEDROOMS cn -- - � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION O SFR/ADD/REM � I NEREBV AFFlRM UN�ER PENALTY OF PEHJUFV THAT I AM E%EMPT FqOM THE GONTRACTORS LI- (�`afflQO/CdfP01'I W CENSEUWFORTHEFOLLOWIIJGREASON(SEC.1031.58USINESSAN'JF90fES510N5GO�EANYGTYOR (n zCOUNTVWHIGHRE�VIRESNPERMITTOGONSTFUGT,ALTER,IMORCtVE,DEMOLISH.CRREPAIRANVi'RUC- W Patio/Deck W TVRE,PPIOF TO ITS ISSUANCf:,ALSD FEOUIRES THE APPLICAM FOR SUCH PERMIT TO FILE A SIGNED w � STATEMENT 7HAT NE OF SHE'�5 LICENSE�PUFSUANT TO THE PROVISIONS OF THE CONiRAC704iS LI- � CENSE LAW�CHAP7ER 9(COMIAENCING W'�TH SECTION 1000)OF DIVISION 3(�F THE BUSMESS AND PRO- � POoUSpe � FESSIONSCA�E)ORTHATHEORSHEISEXEMPTTHFqFfROMANDTHEBA5I5FORTHEALIEGEDE%EMP- (� V TION.ANVVIOLATIONOFSECTION1031.58YANVAGP',.ICAN�FORAPERMITSJ&IEG�S"MEAPPLICFNTTO Z Re-Roof � ACIVILPENALTVOFNOTMORETHANFIVEHUNDRFDDO�URS�S5o0�.)�. � � � ❑I.ASOWNEROFTHEPROPERTV,ORMVEMPLOVEESWiTHWqGESA5IHEIRSOLECOMPENSATiON, � Commercial Z WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED ON OFFERED FpR SALE(SEG 70<4,BUEI� J � NE55 AND PflOFE5510N5 CODI=:THE GON'RACTORS LIGENSE LAW DOeS NO�APPLV TO AN OWNER OF � — PROPERTVWHOBUIL�SORIMPROVESTMEREON,ANDWHODOESSUCHWORKHIMSELFOPHERSELFOR Q THROUGHHISORHEFOWNENVLOVEES,PROVIDEDTMATSUCHIMPROVEMENTSAqENOTINTENDEDOR � O OFFERE�FORSPLE.IF,HOWEVE:R,THEBNIDINGORIMPROVEMENTISSOL�WITHINONEYEAROFCOMPIE- Z TION,THE OWNEF�BUILOER WILL HAVE THE BURDEN OF PPOVING'HAT HE OR SHE OIO NOT BUILD OR � IMPROVEFOR7HEPURPOSEOFSALE�. w fII,ASO4MEROFTHEPROGERTY,AMEXCLUSIVELVCONTRACTWGW:THLICENSEDCONTRACTORS � TO CANSTRUCT 7HE PROJECT(SEC.]046,BUSINESS AND PROFESSION5 CODE:THF CONTRACTORS LI� V81U221011 � ADJ.AREA W CENSEUWDOESNOTAPPlV10ANOWNEROFAPqOPERTVWHOdVII�50NIMPROVESTHEREON,AND -- = WHOCONTRACTSFORSUCHPFlOJECTSWITHACONTqACTOR(SII�CENS[DPURSUANTTOTHECONTRqF QUANTITY DESCRIPTION FEE ~ TORSLICENSEUW.). Y � ❑1 AM EXEMPT UNDER SEC. _ 8.8 P.C.FOR THIS REASON Q � U � OATE _ OWNEP. '— ¢ Z -- U � LICEIVSED CONTRACTORS DECLARATION w Q � I HEREBVAFFIRM UNDEFi PENAI_TV OF PERJURY THAT I AM LICENSED UN�ER PROVi510N50F CMAP'EH 7 7 d 9(COMMENCINGWITHSECTION]o00�OFDIVI510N30FTHEBU51NE55RN�FF?OFESSiONSCODE,AN� Z 1 Dishwasher C/� �y.�0 'X MV LICENSE IS IN FULL FORCE NND EFFECT. � UCENSEC ss- C36 LIC.NO. 7�7775 � U DATE—��=�� CONTRACTO(i__ NOCK d —' W � WORICERS'COMPENSATION DEC�ARATION Q � I HEREBV AFFIRM UNDER PENALTV OF PERJURY ONEOf?HE FOLLOWING DECLARATIONS: V VJ Z Z __IMAVEAN�WILLMAINTAINACERTIfICATEOFCONSENTTOSELF-INSIIPEFOFWOPKERS' a 2 Q COMPENSATION,AS PqOVID[D BY SECT�ON 3]0o OF THE LABOR CODE.FOF TME PERFORMANCE U OF THE WOFK FOR WHICM iH15 PERMIT IS ISSUED. W � v � w n 1 NAVE AND WILL MAINTAIN WOflKERS'COMPENSATIbN INSURANCE,AS RF�l11RE�BY SECTION Q3�00 OF THE LABOR COI]E,FOR THE PERFOFMANCE OF THF WORK FOR WHICH THIS GEFMI'IS ISSUED.MV WORKERS'COMPENSATIO�INS RAN CA/gq'�EyR��/N D�PA/LICY NU/M—BERARE:,/ CONSTRUCTION j c^RqiER '�'�� `�I� �vr � PLAN REVIEW Z aoucvHUMeEa ``��'1 1 9�RRhR� s �+v ELECTRIC ¢ � (iHI55ECilONNEmNOTI3E�f+iPLEfEDGF7HEPEFilMISFOFIXJEHUNDREDDOLLARS(E1oo)oRLESS) P�UMBING .S W — Z I CERTIFV THAT IN THE PERFORMANCE Of THE WORK FOR WHICH THIS PERMIT IS ISSUED,1 MECHANICAL C� SHALL NGT EMPLOV AN`/PERSON IN ANV MANNER SOAS TO BECOME SUfiJEfT TO THE -' �� — (n WORKERS'COMPENSATION�AWS OF CALIFORNIA,AND AGPEE THAT IF I SMOULD BECOME INS?ECTION FEE � SUBJECTTO THE WORI(ERS'GOMPENSATION PROVISIONS OF SECIION 3]OOOF THE LABOR � �E�, I HAL FOflTHWITHCOMPLYWI'HTHOSEPROVISIONS. ISSUANGE ZS.00 Q __ p DATE.� APPLICANT�. TZIIL NOCk SMIP _ W -- J WARNINGFAILURETOSECUREWORKERS'COMPENSATIONGOVERAGEISUNLAWFUL,ANOSHALLBE ENERGVP/C J � SUBJECTNNEMPLOVERTOCFIININALPENALTIESANOCIVILFMESUPi00NEHUN�REOTHOl1SAND ENERGVPERMIT } OOLLAFS(ftoo,oao�,IN ADDITIOIV TO 7HE COST OF COMPENSATION,DAMAGES AS PROVIDE�FOR IN J SECTION 37090F THE LABOfl CO�E,INTEREST,AND ATTORNEV'S FEES. t.oa w RETENTION FEE . O CONSTRUCTION LENDINGAGENCY PRE-ALT FEE ___ _ � 1 NEREBV AFFIqM UNDER PENNITY OF PERJURV THAT THERE IS ACONSTF'UGTION LENOING AGENCY � FOR THE PERFORMANGE OF THL WOFK FOF WHICM TMIS PERMIT IS ISSUEp(SEG.309],CIV.C.). Z W � LENOEfi'S NAMC __ — F— LENDER'SADDPESS � . _ ____.... — wI CERTIFY THAT I HAVE RERD TH��.S APPLICATION AND STATE THAT THE ABOYE INFORAIATION IS CORqEGT TOTAL FE ES V 7.S O � I AGREE TO COMPLV WITH ALL CITY ANO COIINTV ORDINANGES AND SiATE LAWS RELATING TO BUILDING � CONSTRUCTION,AND HEREBV AUiHOR2E REPRESENTATNES OF THIS GOUNTY TO EN�ER UPUN THE �� Q�✓ �/�/(,�L`w ' Z ABOVE-MENTIONEO PROPERTY FOF INSPEGTION PURPOSES. COMMENTS 7 �� V�1. f�C�C,��. _ � - m - ¢ PE 7 A Yy IN / �I �n'7 / _'__ — G!J V (�•'`! � SiGNAT�.�flFOFPFRMITTEE DATE — � RECP?.NQ _ PAID BY VALIDATION WHITE—DepaAment Copy,YE�LOW—Finence Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanCs Copy � ��< y_, y, ;,� ��„� , ,. � � M „ ».� � e;� „ . � , � : . � . �� s � � �� . . _ _ _ _ _ . _ _ _ _ ; ��4� ; _ ��a�� _ __ . ._ . _ _ _ � � � � �� _ � __ _ __ __ _ . _ _ , _ _ . . _ . _ __ _ _ _ ; __ . ___ __ . . � _ _ __ _ _ _ __ __ __ _ ;�a � , �� . � ��,� a� ��n�� t#� _ _ ,» �'+ a.". g��E.« � �,:i °e.° .�� „r ��,i . .. .... . . . ..__ ...._. .._.. ...... .. ._.. _. ... __.. ..' ti: �. , } i 7 � � „ ... . ... ..... . ...._. .... .. .. .... . . .... . ..... .. .._. ._... ...... .._. . ...... � �. ' � 9 �� '�� . �1. �� _ _ _ _ _ , .�,�.,�„� �' �� _ � , .� � ; .. � ;�� _ _ _ _ _ � x�. � ��`' .. . .� . . . �. CITY OF DIAMOND BAR DEPARTME'VT OF COMMUNTCY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION �� I �1 ADDR ESS uV 1�1��C+ C.I APN T ACT_ OWNER ADDR 3 CITY�TEL. APPLICANT Tim Nock TEL. 314 CONTRACTORNOCk Pl.umbin ADDRESS 11612 Knott St afl/ aTY Garden rove zIP 9284hEL. 714895124 ARCN/EKG/ 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 REQUIRES APERMIT TO CONSTRUCT,ALTER,IMPROVE, DEMOLISH,CR REPAIR ANV STRUC- TURE,PRK)R TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE'�5 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.ANV VIOLATION OF SECTION 7031.5 BY ANV APPLICANT FOR A PERMIT SUBJEC TS'fHF APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLARS IfS00). )�. ^ I.AS OWNER OF 7HE PROPERTY,OR MY EMPLOYEES W iTH WAGES AS THEIR SOLE COMPENSATION WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OH OFFERED FOR SALE(SEC. 7044,BUSK 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 WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EM PLOVEES, 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 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 UW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO B'JII �5 OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PFIOJECTS W ITH A CONTRACTOR(SI LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). ^ 1 AM EXEMPT UNDER SEC. 8. 8 P.C. FOR THIS REASON DATE OWNEP. LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENAI_N OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH SECTION 70001 OF DIVISION 30F THE BUSINESS AND PPOFESSIONS CODE,AND MV LICENSE IS IN FULL FORCE/WD EFFECT. LICENSE ss. C:36 LIC. N0. 707775 DATE�r-�)(,�(/CONTRACTOR__NO CK WORMCERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATKJNS: - I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' COMPENSATION,AS PROVIDED BY SECTION 37000E THE LAROR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. X I NAVE 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. MV WORK ;OMPE TIO: INSI�RAN N SA Af�IER ADD Pj� C UMBER ARE: +T O CARRIERTl �lY/�AV'/�!�f(/JiUv1J(r- POLICY NUMBER �FTrl 1 9�RRhR_'�Q (THIS SECTION NEm NOT IBE LT]MFLETED OFTHE PERMIT IS FOF ONE HUNDRED DOLLARS(f100)OR LESS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, 1 SHALL NOT EMPLOY AN�/PERSON IN ANV 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 37000E THE LABOR E,I](Q��((��H-A-L FORTHWITH COMPLY WITH THOSE PROVISIONS. T k im NOC DATE: APPLICANTS. WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,ANO 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 1 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 TH'.S APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT I AGREE TO COMPLY WITH ALL CITY ANO COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTlON,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPiJN THE ABOVE-MENT I 0 N E D PRO PERT Y FOR INSPECTION PURPOSES. w A � VA �/ Y . � �� PE-AI ��IN/ �I � n�7 o(,.,' (� SIGNATI�RE OF PERMITTEE DATE WHITE-Department Copy,YELLOW-Finance Copy, PIN PRESS FIRMLY