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Home My WebLink About18596 � CITY OF DIAMOND BAR � � DEPARTME'�'T OF COIvIIvIUNTfY&DEVELOPMENT SERVICES � 21825 E.Copley Drive (909)&60-3195 Fax(9(19)861-3117 � PRESS � :��1w BUILDING PERMIT APPLICATION . FIRMLY L o� JOBSITE APPLICATION . PERMI � p/C ADDRESS_� _ DATE r �Z NUMBER � C T�'PE OCC �-° APN LOT_ TRACT DATE � G I^ CONST. GROUP p OWNER _��M\�� ` �' o ADDRESS_ `'�� ZONING SETBACKS FRONT z CITY ZIP TE . � RW !� � APPLICANT TEL.__ REAR � QSIDE/SIDE STREET Ryy � Q CONTRACTOR SIDE L — AODRE � CITY ZIP T�� PROPOSED USE � L oARCH/ENG/ �'��" z DESIGNER_ w I NO.DWEL. ryp, � ADDRESS_ UNITS NO. � CITY ZIP__ TFL.__. —_� STORIES _�_gEDROOMS � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREA/VALUATION p� OWNER-BUILDER DECLARATION p SF WADD/REM �' � I HEREBV AFfIRM UNDER PENALTY OF PERJURY'HAT I AM F%EMPT FROM THE CONiRACTORS LI� G2f2Q8/CBfpOR ' W CENSELAWFORTHEFOLLOWINGREASON(SEC.]031.58VSINESSANOFROFESSIONSCODE:ANVCITYOR (n i, Z GOUNTYWHICMREOUIRESAPERMITrpcpNSTRUCT.ALTEF,iM�ROVEDEMOLISH,CRREPAIRANVSiqUG W Pdt10/DBCk I W TURE,PFIOR TO ITS ISSUANCE,RLSO REOUIRES THE APPLICANT FOR SUCH PERMI7 TO FllE A SIGNE� W I � STATEMENT THAT ME OR SHE IS LICENSED Pl1RSUAN7 TO THE PROVISIONS OF THE CONTRAC70R5 Li- CENSE LAW(CHAPTER 9(COMMENCING W�TM SECrION 7000)OF�IVISION 3(�F THE At15INE55 ANO Pa0- LL Po01/Sp3 I O FESSIONSCODE)ORTHATHEORSHEISExFMPTTHFq�FROMANDTHEBASISFORTHEALLEGEDEXEMY- � � TION.ANVVIOLA710NOFSECTION7031.SBYANYAPPLICPN;FOqAPEHMITSi19JEGT5fNEAPPLICANTTO Z Re-Root A CIVIL PENALTV OF NOT MORE THAN FNE HUNDRE�DOLLARS(SSooj): QL71,ASOWNEROFTHEPROPERiYOFMVEMGLOYEESWiTNWAGE5T5TMFIRSO�ECOMPENSAiiON, ❑ Commercial �, Z WILL W THE WORK,AN�THE STRVCTURE IS NOT IN i ENO[D OR OFFERED FOH SFLE!SEG.]046,BU�.I� J '. � NESS ANO PqOFE5510N5 GODE:TME GONTRACTORS LIGENSE UW JOcS NO�APPLY TO AN OWNER OF j PROPEFiTY WMO BUILDS OR IM VROVES THEREON,AND WHO DOES SUCM WORK HIMSELF OR HERSELF OR I w TMROUGHHISOFlHEROWNEMPIOVEES,PROVIDEDTHATfUCHIMGROVEMENiSARENOTINTENDE�OR m � OFFERE�FORSALE.IF,HOWEVERTNEBUILDINGORIMPROVEMENTISSOLDWIiHINONEYEAROFCOMPLE- Z TqN,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVING:HAT HE OR SHE DIO h0T BUI�D OH � IMPROVE FOR THE Pl1PPO5E OF SALE). W ❑I,ASOWNEROFTHEPROPERTVAMEXCWSIVLLYCCINTRACTINGWIfHLICENSEDCONTRACTORS [t TO CANSTRUCT THE PROJECT(SEC.]Oba,BUSINE55 AND PRO�EF,SIONS CODE:THE CONTRACTORS l.l� V31U3110f1 � ADJ-AREA W CENSE LAW�OES NOTAPPLY TOAN OWNER OF A PqOPERTY WMO dU11DS ON IMPROVESTHEREON.AND — - - WHO CONTRACTS FOR SUCH PRQIECTS WITF ACONTRACTOR�S)LIGEM1SED PURSUANT'i0 THE CONTRRC� �" roRs uceNse uw.�. �UANTIN DESCRIPTION FEE Y � ❑I AM EXEMFT JN�ER SFC. B.8 PC.FOR THIS REASON Q � U � � DATC OWNeR � � � . - — -_..—__ U � LICENSED CONTRACTORS DECLARATION w ¢ � I I�IEREBYAFFIRM UNDER PENALTY OF GERJURY TNFT I AM LIGENSED UNGER PROVISIONS CF GHAV I EH � d 9(COMMENCING WITM SECTION�U00)OF DIVISION 3 OF THE BUSINE55 FN�PP.OFESS:ONS CODE,AN� Z `X MV LICENSE IS IN FULL FOHCt AND EFFECT. m � � LICENSE CLASS C �.IC.NO. ��/ � ~ DATE�,_f��M��_ CONTRACTO� 6_ U W � WORKERS'COMPENSATION DECLARATION a � U � I HEqEBVAFFIRM L'NDER PENALTY OF PERJURY ONEOF THE FO�LOWING DECLARATIONS: z � I HAVE AND WILL MAINTAIN A CERTIGICATE OF CDNSENTTO SELF��NSURE FOR WORK[RS' ¢ Z = Q iCAMPENSATION,AS PPOVIDED BY SECTION 3lCo fJF THE LABOR CODE,FOR THE PERFORMANCE U l OF TME WORK FOR WHICH iHIS PEHMIT IS ISSUtO. W � v � w I MAVE AND WILL MAINTAIN WORKFRS'COMPENSATI(lN iNSURANCE.AS REOUIRE�BV SECTIDN /� Q3]0o OF THE LPBOR CODE,FOR THE PERFORb1ANCE OF THE WOFK FOR WHICHTHIS PERMIT IS / ISSUED.MY WORP' S'C�7PENSAT i�,$UAANC RIEF AND POIICY NUMBERARE: CONSTRUCTION J _ j c^RRiER_ � . PLANREVIEW �� Zaoucv HUMeca —__-___ ELECTRIC Q - � (iHl$SECiKNJNEmNOTBECL�MPLEfEDOFTNEPERAAIiIS�OFONEHUI�DRFDI](1LtA0.S(5tIX1)ORLE55). PLUMBING W Z �CERTIFV THAT IN TNE('ERFORMANCE OF TItE WORK FOR WHICH THIS PEflMIT IS ISSUED.I MECHANICAL C'} S!IALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BEGOME SUBJE�T TO THE �-�--- Uj WORKERS'COMPENShilONL0.W50FGALIFORNIA.ANDAGREETHATIF15HOULDBt(:OME INS?ECTIONFEE � SVBJECTTO?MEWORHERS'GOMPENSAiIONPqOVI5lON50F5ECTION3]OOOFTHELABOR � . - � CODE,I SNALL FORTHW'ITH COMPLY WITN THOSE PROVISIONS. ISSUANCE � ' p �ATE: APPLICANT: _ __ SMIP _ . � T W - - J WARNING:FAI�UflE70 SEGURE WORKERS'COMPENSATION CO'✓ERAGE IS UNLAWFUL,AN�SHqLL9E ENERGY P/C J � SUBJEGTANEMP�OVCRTOGRIMINALPENALilESAN�CIVILFINESI.PIOONEHUNDREOTHOUSAND ENERGYPF.RMIT UOLLAFS(510�.0001.IN ADDITION TO THE COST OF COMPENSATION.DAMAG'e5 AS PROVIDED FOR IN J SECT'.ON37080FTNELABORCDDE,INTEFEST,AN�ATTORNEV'S�EES. � �� w RETENTION FEE: _ _ O CONSTRUCTION LENDING AGENCY PqE-ALT FEE : ._ ¢ IHER'cBYAFFIRMUNDERPENALTVOFPEa..UFYTHATTHEHtISq(;UN.�iNl1C`IONLENDINGAGENC;V � FOR THE�EHFOFMANCE OF TME WfJFK FUH WHICH 1HI5 PERMI�IS ISSUEG(SEC.3091,CIV.C.). - Z W � LFM1DCH'S M1AME_ ______ _ _ H LENDER'SADDRESS � TOTAL FEES f Z .�� I CERTIfY THAT I N�VE READ THISAPVLICATION AND STATE THAT TME ABOVE INFOaMHTIDN IS GURREI;� w I AGREE TO GOMPLY WITM ALL CITY ANO COl1NTV ORDINANCES FNp SiATE L4W5 HELAiING TG SUILDING � CONSTqUCTION,AND MEREBV qU1HOHILE HEPRESENTATIVeS OFTHIS COUNTV TO ENTER UPi>N THE � ABOVE-MENT f OPERTYGOR�{6f�e TIO URPOSES. � � COMMENTS _ _._ J �j � _ m PE TTEE NAME(GR /� Q 9�A J - � � �":.L�'_"'-_——. __ '.-_"'.-_ - _.__'"" __-"--_ _ _'__ Uj SI(;NATI iRF(1F P�i TTEE DFTF � RECP?.NQ _ PAID BY VALI�ATION WHITE-Departmenl Copq,YELLOW-Fnance Copy,PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-AppliCanl's Gopy . ...., .� ,,� m .��, c��'�°� �,?as k , ,��-� �i�.�fi . n�� , ,... � i � r � . s �... � n t �,}." : .:� '� � . " ;�` , .. . ...... ;. ,�'�0:�4.,.., n a . , . ,:�� ' .. _ . .. . . ... . ...�. ._.. ... .. . ... . ... ... ,�>;�. .. ,,,... . .._ _.. ... . . � �ei�� yr ��.. .. ... .. . . .. ... .. �r' ... .. .. .... ... .. .. .._.. ........ _..... _. ... .. .. '�.. . .. .... ._. .__.. _... . . .... . . ...... �: . _.. ..._.. ......_._.. .. _. .e ._._. __.... .. ..._._ ..._ . ..... ....i .... ._..._ ..._. ._.... .... .. ..... .. .._.� , ��.��.y� Q,; . �. . . -� t � _ __ �� ,� � � �� ; �� , ��,,�� . y; ��,��: � , � _ _ � � � �� • ,., _•' _ ,,.�' d t, � , � � � , _ � . �'� �- ' _ _ _ r� } ; z-� � � � �� g� _ _ . _ _ _ � � ��,� ,� �� _ __ _ _ DIAl10XD DART U9 CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION JOBSITE ADDRESS APN n LOT_TRACT OWNER ADDRESS- CITY ZIP TE i APPLICANT TEL. CONTRACTOR ji6M ADDRE CITY ZIP T ARCH/WG/ 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 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 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 SUBJEC IS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(SSW)) : L71,AS OWN ER 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 ANO 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- TON.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 SUII.OS 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. &PC. 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 LIC. N0.I DATE CONTRACTOR WORKERS'COMPENSATION DECLARATION 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' MPENSATION.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 SECTlON 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED. MY WORT S'C PENSAT 5{y1RANCc rePBIER AND POLICY NUMBER ARE 7 11 �I� NN CARRIER_ 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 SU8JECT 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 15 UNLAWFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100.0001. 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 WOFK FOR WHICH THIS PERMIT IS ISSIJED(SEC. 3097,CIV C) LENDER'S NAME LENDER'S ADDRESS CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT AGREE TO COMPLY WITHAL L CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENT OPERTY FOR y{6f�E TIO URPOSES. PE TTEE NAME(PR SIGNATURFOFPiTT E DATE E WHITE-Department Copy,YELLOW-Finance Copy, PIN PRESS FIRMLY DATEICATION z NRMI P/C DATE r NUMBER# 1(/ ISSUE e;- TYPE OCC DATE V I^� CONST-GROUP ZONING SETBACKS FRONT RW^ REAR SIDE/SIDE STREET RW^ SIDE C PROPOSED USE Vat N0,DWEL. N0. N0. UNITS STORIES _ BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM U) Garage/Carport W Patio/Deck LL Pool/Spa 0 Z Re-Root Commercial M Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J 0 I- U W W ED DO CL Q U Z 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 I Z t COMMENTS RECPT. Na PAID BY VALIDATION