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Home My WebLink About18597 (11) �� CITY OF DIAMOND BAR � DEPARTIvCE'VT OF COIvIIviUNI"I'Y&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)&60-3195 Fax(909)861-3117 � PRE$$ ''%�� BUILDING PERMIT APPLICATION -� FIRMLY } JOBSITE �I� �1 � � APPLICATION PERMIT P/C o ADDRESS � (v DATE ' � i�Z NUMBER # o � ISSUE C� �� "� ONST. GROUP `r APN LOT T,,fl,�ArCT DATE t p OWNER _�1��71� Of'[Ik��_— " ADDRESS � ZDNING SETBACKS � FRONT RW �,� Z CITY , ZIP TE I � o APPLICANT TE ._ __ I S DE S{DE STREET _ RW ❑_ z ¢ CONTRACTO � SIDE Ll � ADD r PROPOSED USE -"V � CI , ZIP TEL �y;��}{f w ARCH/ENG/ '"'- '� - Z DESIGNER_� f - w — -- NO.DWEL. NO. NO. a ADDRESS_ UNITS STORIES C BEDROOMS � CITY ZIP TFL — � --- -- cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-B W LDER OECLARATION SFR/A00/FEM O I HEPEBV AFF!qM UNDER PENALTV OF PERJURV THAT I AM F.XEMFT FROUI iHE CONTRACTOqS LI- G2fd90/COfpOK �W CENSEUWFORTHEFOLLOWINGREASON(5EC1a3i.58lISWE55ANOFROFESS�ONSrpDE:ANVCITYOH (n ZCOUNTYWMICNREOUTAESAPERM17TOCONSiRUCT,ALTER,IM°RCtVL,DEMOLISH,GFREPAIRANYiiFUC- W patio/Deck W TURE.PflIOR TO ITS ISSUANCE,ALSO qE0U1PE5 THE A�PLICAM1T FUR SUCH PEFNIT TO FIIE A SIGNED � STATEMEN7 7HAT HE OF SHE IS IICENSED PURSUM/T TO TME PROVISION��F TNE�ONTP.ACTORS LI- � CENSE LAW�C4APTER 9(COMMENGING WiTF1 SEGTION]o00)l)F OIVi510N 3(1F THE 9USINESS AND PRO� � POOL'Spa FESSIONSCODEjORTHATHEORSHEiSEXEMPTTH�REFqOMANOTHE8A515FORTHEALLEGFOFXfMV� � � TION.�NYVIQLA'IONOFSEGTION103159YANYAP?'�:CAN�FnRAPERMiTS�9JECi5fN%APG'��CAVTTO Z Re-Rool � A CIVIL VENALTV OF NO7 MOPE THAN FIVE HUNDHED DO�LAR.S(f500))�. ' � JI.HSOWNEROFTHEPflOPERfY,ORMYEMGLOVFFSW��THW4GESASTNF:950LECOMPENSATiON. � COff1T0fCial Z WIIL DO THE WCRR,AND THE STRUCTURE i5 NOT IN�ENCf�OH OfFERED�OH SALE!SEC.lo6a,BU.`�I� J � NESS AND PROFESSIONS CODE TNE CONTRACTORS�ICENSE LAW GOcS NO�APPLY i0 AN OWNEH OF ? PROPERTV NM110 AUILDS OR lu CROVES TNER�ON,AND JMO OOES SUCN WORK NIMSEIF OP HEHSELF OR Q THR(XIGHHISORNERDWNEMPLOVEES.�POVIDEnTMATfVCH'�MPROVEMENTSAHENOTINTENDEDOR � w OFFEREDFORSALE.IF,HOWEVER,THEBUILUINGORIMPROVEMEN�ISSOLOWITHINONEYEAROFCOMPLE- ZTION.THE OWNER�BVILDER WI1 MAVE TME 9UPOEN OF V'ROVING'HA1 HE OR SNE Dlp hOT dU'iiD OR � IMPROVE FOR THE PUPPOSE OF SALE). w ❑I,ASOWNEROFTHEPROPEFTV.AMEXCLUSIVE'_VCC1NiRACTINGWIiHLICENSEOCONTRACTORS - ¢ TO GONSTPUGT TNE PROJECT(SEC.7000,Bl15INE55 AND PRUFESSIONS CODE.7HF CONTqACTOPS I I- V21U8110f1 ADJ.AREA W GENSE UW DOES NOTAPPLV TOAN OWNER OF h PFOPFRTV WHO dUII.DS OF IMPROVES THEREON,AND — � WHOCONTRACTSFORSUCHPROJECTSWITHACONTRACTOR(s11.ICEh�CD�11R5UANTTOTHECONTqAC- QUANTITY DESCRiPTION FEE Y TORS LICENSE UW). _ , � f I I AM EXEIAPT UNDER SFC. 8.8 PC.FOR THIS REASON Q � _ U -- — -- � � onre owriEa_ F-' Z - --— — ----- c� O W � LVCENSED CONTRACTORS DECLARATION w � I MEFEBV AFFIRM UNDER PENALTY OF PERJIIRY'HAT I�1J LICENSED�JNDER PRo`/iSIONS OF CMAPTEiI � d 9;COMMENCING WiTH SEC710N]om)OF DiVI510N?OF THE BVSINESS AND PPOFESS:ONS CODE.AND Z X MV LICENSE IS M FULL FORC N FFECT. /� ` � LIGENSE CLASS__\� tf 11✓_ LIC.NO _/,f_{'��_�,�/ j ~ —�_t�_ � �uyal- � U DA7E GOMRACTO n- W � WOflKERS'COMPENSATION DECLARATION a � � I HE9EBY AGFIFM 11NDEN PENnLTY OF PERJURY ONE OF THE FOLIOWING DECLARATION$'. Z I � IH EAN�WILLMAINTAINACERTIFICATEOFCONSENTiOSELF-INSURF�ORWORKEFS' a Z Q MPENSATION,AS PROVIDED BY SECTION 3100 nF THE LABOR CDDE,FORTHE PERFORMANCE U OF THE WONK FOR WHICH TNIS PERMIT IS ISSUED. W O � w IHAV[ANDWILLMAINiAINWORKERS'GOMPENSATInNIN$URANCE,ASREOUIpEDBVSECTION Q 310o OF THE�ABUH CO�E,FOR THE PcRFJRMANCE OF TH[WORK FOR WHICH�NIS PERMIT IS �1 ISSUED.MV WORK CO I�IRANC�.A�RIER AND POLICv NUMfiER APE' CONSTRUCTION V J �� J j CnaRiER .. ---��[—=L .—. . PLANREVIEW ._ 0 VOLICY NUM9ER_�_ ��. � Z �----- ELF.CTRIC ¢ � (I}iISSECT70NNEmNDt6ELi,'�MRETEDOFTMEPEfWl�ISFOFIXJEHl1rARED�JLIARS(5170�ORLE55). PLUMBING , _. W Z I(;tHTiFv THqT IN THE P_RFOFMAVCE OF THE WORK FOR WHIf.H rHiS PEHIAIT IS ISSUEG,I MECHANICAL (f SHALL NOT EMPLOY AMV FERSON IN ANY MANNFR 50 AS TD BECOME Sl1B.Er,7 TO THE � WORKER$'COMPENSP�ION IAWS(1G CALIFORNI4.ANC AGFEE TNAT IF i SI10'�LD BECOME INS?ECTION FEE _ _. � SU6JEC1 TO THE WORKERS'COAApENSATION PROVISIONS OF SEC-10N 3]Do�F THE IABOR � CCOE,1 SNALL FOfiTHWITM COMPLY WiTH THOSE PROVISIONS. �SSUANCE __ � SMIP p DATE. APPLICANT'. _.__ _ — . ��----- J WARNING:FAIIURE lOSEGURE WORKERS'COMPENSATION COVERAGE IS UNIAWFUL.AND SHAIL BE ENERGV P/C . __ � SUBJECTAN EMPIOYFR TO CFIMINAL PENALTIES AND CIVIL FINES UP 100NE HUNDRE�TMOUSAND ENERGY PERMIT } OOLLARC(S1ro.M0�,INAODITIONTOTNECOSTO�COMFEN5AT10N,0AMAGE5A5PROVICEDFORIN � -- � .- J SECTION3]OBOFTHELABOiiGODE.�NTERESTqNDATTOFNEY'SFEE�. RETENTIONFEE: � _. 2 GONSTRUCTION LFNDING AGENCY PRE-ALT FEE: � O ` Q I HERE9VAFFIRM UNDEF GFNALTV Oc pERJURv`HAT TNEHE�S A CON.`.�TFiL�(:LION 1EN01NG AGENCY d FOR THE PFHFORMANCF nF THE WOFK FOR WHICN THIS PERMIT i5 I5.`,UE�(SEC J09),CiV C.). '-- Z w � LENDER'SNAME. _. _ - _ F_ LENDER'SAODRE55 � T07AL FEES �,�. �U � I GEfiTIFY THAT I HAVE READ THIS APPLICATIONANO ST4TE THAT THE ABOVF INFpR1AATION IS CpqRECT. w I AGREE TO COMPLY WITH ALL CITV AND COUNTV ORDINANCES AND STATE UWS RLLAT�NG TO BUiLDING d � CONSTRUCiION.4Nn NFRE6V AUT ZE HEPRESENTATNES OFT�{I COUNTV TO ENTEP UPJN THE � ABOVE- NiinNEO GROPE9T�INSPECTION C'UPPOSES. !— o COMMENTS J � __ — .. ._.--" _ - _ m PER E NAM (P 1'� ,1N 1 __—_— � .�— C��•.2 i ir� - — � SIGNAT�.iREOF� Ii�EE �----�� DFTE ------ - - � - _ � ! R[CPT VrJ. PAIDBY VALIDATION ~ WHITE-Department Cc VELI.OW-Finance Co PINK-Assessor Co .GOLDENFO�File Co GREEN-A Wicanfs Co PV. PY. PY. PY. P PY Wt.'. 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" �. ��a� 1. .. � � rt. . . . .... ... .. .. .. . .... .... ._. ._ ... . ... . W.� � �� .� .... ... ... .. .. . ... . . . .. .. .. . ._. .. ,.. . .. ... ... . . ��.. M1,, , ;;, m., � ��.. , � r` �" �w` ' . .. .. .. . . . . ...... . ... CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION fi, PRESS ix 7A A I/3� FIRMLY JOBSITE lv ADDRESS VV APN LOT TRACT M OWNER QA7^' ADDRESS- CITY ZIP TE r APPLICANT TE CONTRACTO(!' ADD r ,S kA, CI 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 REOUIRESA 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 SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($500)), ^ I,AS OWN ER OF THE PROPER TY,OR MY EMPLOYEES WITH WAGES AS T HEIR SOLE COMPENSATION, WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC. 7044,BU" (- 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 CONSTRUCTTHE PROJECT(SEC. 7044. BUSINESS AND PROFESSIONS CODE.THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO SUII.DS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW) CJ 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 FOR.0 N FFECT � LICENSE CLASS_.tf If,LIC NO DATE_CONTRACTOR WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I H E 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 SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORK C I095,L�LSURANC RIER AND POLICY NUMBER ARE' CARRIER - POLICY NUMBER 1 7n (THIS SECTION NEED NOT BE OCMPLE TED OF THE PERMJT 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 10 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 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION,AND HEREBY AUT ZE REPRESENTATIVES OF THI COUNTY TO ENTER UPON THE ABOVE-NTIONED PROPERTINSPECTION PURPOSES. PER E NAM (P T) SIGNATURE OF ITT E DATE APPLICATION OZ PERMIT P/C 2 NUMBER # DATE A ISSUE V V TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ^ REAR ^ SIDE/SIDE STREET RW ^ SIDE ^ / PROPOSED USE"V N0. DWEL. N0. N0. UNITS STORIES C BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA(VALUATION SFR/ADD/REM U) Garage/Carport W Patio/Deck LL Pool/Spa Z Re-Roof Commercial Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U S I- U w LU CD Z m a 0 Z 2 0 w CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP II ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES COMMENTS RECPT N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy