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Home My WebLink About18600 (11) �� CI7Y QF DIAMOND BAR � i, DEPARTME'�1T OF COtvIlvtUNTCY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)&60-3195 Fax(909)861-3117 � � PRES$ BUILDING PERMIT APPLICATION �..- �� FIRMLY � JOBSITE iO p\ (� r ' .`�. APPLICATI� ` �� PERMIT �` f✓`� P/C o A�DRESS1 v N _�__ ��^�V -� DATE � NUMBER �ilA> # � ISSUE � 1�� TYPE OCC APN LOT TR CT_ a' � �� __ DATE I CONST. GROUP p OWNER I�1� LL ADDRESS �— ZONING SETBACKS Z CITY ZIP 7E . FRONT RW ❑ p REAR ❑ o APPLICANT . TEL.__,__ SIDE/SIDE STREET RW ❑ z a CONTRACTOF� SIDE ❑ p� ADDR S 6 � CI ZIP 4' TEL (�b/ PROPOSED USE �w ARCH/ENG/ z DESIGNER_ — NO.DWEL. . NO. � ADDRESS_ UNITS � STORIES _�BEDROOMS � CIIY ZIP__ TFL.__ _ T— � OESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFfllADD/REM O p �i HEREBV AFFIRM UNDER PENALTV OF PERJUi7Y THAT I AM E%EMPT FROM THE CONTRACTORS LI- � Garege/Carport � W CENSEUWFORTHEFOLLOWWGREASON(SEC.7071.SBUSINESSANDPROFESSIONSCpDE�.ANVCITVOR U COl1NTYWHICHREOUIRESADERMITTOCONSTRUCT,ALTER.IMPFOVEDEMOLISH.CaREPAIRANYSTRUC- W Pd110(DBCk WTURE,FRIOR TO ITS ISSUANCE,ALSO REIXIIRES THE APPLICANT FC1R 5'JCN PERMIT TO FILF A SIGNF� W � STATEMENT TNAT HE OR SHE IS LICENSEO GURSUANT TO THE FROVISIONS OF TNE CONTRACTORS ll- � CENSE UW(CNAP7ER 9(COMMENCING WITH SECTION 100a�OF�IVISION 3 C�F TME BUSINE55 AND PRO- � POOVSPB FESSIONSCODc)OflTHATHEORSHEISEXEMFTTH�REFROMAN�THEBA515FDR'HE�LLEGEDE%EMV- � � TION.ANYVIOLATIONOFSECTION]031.SBVAN'fAPP�ICAVTFORAVERM1iSU9JEG"5lHfAPPLICANTTO Z R0-RD01 .. L � � ACIVIL PENALTY OF NOT MORE iHAN FIVE HUNDREO DOLLARS(55a0)): � , � ❑I,ASOWNEROFTHEPROPERTV,ORMYEMP�OYEESWiT�iWAGE5A5lHEIP50LECOMPENSATiON, 0 CommerCial Z WILL DO THE WORK,ANO THE STRIJCTURE IS NOT INTENDED OH O�FERED FOH SALE;SEC.704a,BU�I� J . NE55 ANO PROFESSIONS CODE THE CONTRACTORS L��CENSE lAW GOES NO"APPiY TO qN OWNER OF � PROPERTV WHO BUILDS OR IMGROVES THEREGN,AND WHO�OES SUCH WORK HIMSELF OR HERSELFOR � � THROUC+H HIS OF NER OWN EMPLOVEES,PROVIDED THAT cUCH IMGROVEMENTSARE NOT INTENDED OR m QOFFEREDFORSPLEIF,HOWEVER,THEBVIIDMGORIMP90VEMENTISSOLDWITHIM1ONEVEAROfCOMPLE- Z TION,THE OWNER-BUILDER WILL HAVE THE BUR�EN OF PROVING:riAT HE OR SHE DIO NOT BUILD OH � IMPROVE FOR THE PURPOSE OF SALE). w :�I.RSOWNEROFTHEPROPERTY,AMEXCWSIVELVGONTRAGTINGWIfHLICENSEDLONTRACTORS � TO CANSTHUCT THE PROJECT(SEC.]066,BUSINESS AN'J PROFESSIONS COOE�.THF CONTRFCTORS LI- V8IU0IIOf1 ADJ.AREA W CENSEUWDOESNOTAPPLVTOANOWNEROFAPROPERTVWMOdUII.D50RIMPROVESTHEREON,AN� -- -- = WHOCANTRACTS�ORSUCHPROJECTSWITHACONTRAC70R�5)LICEM1SEDPURSUANTTOTHECONTRAC- � QUANTIN DESCRIPTION FEE I ~ TORSUCENSELAW.). _ Y � � CJ 1 AA1 E%EMpT JN�ER SFC. B A P f FOR THIS REASON Q � U —____ __ ._---------------- [C � DATE OVr'NER � Z -- --- -- U w � LICENSED CONTRACTORS DECLARATION w CC IHEREBYAFFIRMIINDEFPENALTYOFPERJURY'HA7IAMUCENSEDUNOERPROV�SIONSOFCHAPTEF � d 9(COMMENC,NG WITM SECTION 70001 0F DIVISION 3 0F THE BU51NE55 AND PPOFESS�i�NS COOE,ANO Z X AAY LICENSE IS IN FUIL FOR�C.,E�D EFFFC.T `�; W L-�''1 C ��"1�9�S m � LICENSE CLASS_ LIC.Np. �y,16� j V DATE__.��_ CONTRACTOR IWIA/6b� d ---�� I W � WORKERS'COMPENSATION DECLARATION —� � ¢ � I HEFEBV AFFIRM UNDER GENALTV OF PERJUF'I ONE OF THE FOILOWING DECLARATIONS: � (/J ¢ � IFFFyyy11�444E FND WILL MAINTAINA GERTIFICATE OF CONSENT iOSELF-�NSURE FOR WORKERS' _ �PENSATION,ASPROVIOEDBVSECTION9�ooOFTHELA80RCODE,FORTHEPERFORMANCE (� Q OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED. � � I HAVE ANCI WILL MAINTAIN WORKERS'COMPENSATION IM1SUFlANCE,AS RF.QUIRED BV SECTION Q 3]W OF TFIE LABOR CODE.FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT I� 4 T\ 0 ISSUED.M�WORKER5 COMPENSATIO INSUFA E CARFIER AND POLICY NUMBER ARE' CONSTRUCTION �]� �V j caaqiEa_ � N ._ PLAN REVIEW _ _____ . Z voucrNUMeEa - —— ELECTRIC ¢ �rr�issEcrarrNEmr+oro[ca.RE'EooFniEa�w.�risror,auE'uwaEooaisns(siool��Ess�. PLUMBING � W MECHANICAL Z I CERTIFY iHAT M THE PERFORMANCE OF THE WOFK FON WHICH fHIS PERMIT IS ISSUEO.I _ C} SHAL�NOTEMPLOYANYPERSONINANYMANNERSOAST09ECOMESUB.,Ef,TTOTHF � WORNERS'COMPENSATION LAWS OF CALIFOflNIA,AN�AGREE TNAT IF 1 SHOULD BECOME INS?ECTION FEE SUBJE�T TO THE WORKFRS'COMPENSA710N PROVISIONS OF SECTION 37C0 OF?H�LABOR �� ~ CODE.ISFIALLFORTHWITHCOMPLYW��THTHOSEPROVISIONS. ISSUANCE � . . ..._.___ . � SMIP �U p DATE'.__ APPLIGANT. — W ENERGV P,'C J WARNING�.FAIIURE TO ScCURE WORKERS'COb1PEN5ATION COVERAGE IS JNLAWFUI,AND SHA�L BE — J � SUBJECTAN EMPLOVER TO CqIAIINAL PENALTIES AN�CNIL FINES UP TOONE HUNDRED THOUSANO ENERGY PERMIT r DO�LARS(f100.000J,IN AOOITION TOTHE COST OF COMPENSATInN.�PMAGES AS PR�VIDED FOR IN _�-- SECTION J�000�THL LABOR CODE,INTEREST,AND ATTOPNEV•S FEES. RETENTION FEE: � d GONSTRUCTION LENDING AGENCY PREALT FEE: � O � I HERE6Y AFFIRM!JNDER PENALTV OF PEFJURV THA7 iHERE IS A CCNSTPUC!"ION LENDING AGENCY d FnR THE PFRFORMANCE OFTHE WOFK FOR WHICH TNIS PERMIT IS'�SvllE�^.ISEC.30B1.CIV.C.�. Z W _— � LENDEN'SNAME_ . _________-- -- H LLNDE(i'SADDRESS._ ___,_ .___— � TOTAL FEES • � � I CERTIFY iHAT I HAVE READ TNIS APP'�_IGATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT � I AGREE TO COMPLY W1TH AILCITY AND COUNTV ORDINANGES AND STATE LAWS RELATING T09UILDING � CONSTRUCTON,ANDHEREBVAUTMORIZEREPRESENTATNESOFTHISCOUNTYT ENTERUPUNTHE Z A60VE-ME TI PROGERTVFORIN. OSES. GOMMENTS � � -- J � — +� m PER ENAME(PR.NT ` ��r�(� ¢ J � - -- - cn '` SIGNATUryEOFPF MI E 0/+1E = y� � RECPT NO. PAID BY VALIDATION ~ HITE—De artment Co YELI.OW—Finance Co PINK—Assessor Co GOLDENROD—File Co GREEN—A IicanYs Co p Py. PY� PY, PY. PP PY . � � � � �� . . � � , � � �y, � �� ror �,� ��a� �,� � .� ♦ �. t e _ . � � � , _ � . _ .. ._ .. ,�w -, " ��. ..... . . _.. . ....,. .. . �... ... _ . . ....... �� _��. �-. , . ... ... �... .� . .... . .. . . .... .. .... ... . � � ; ,.^..�� . ..._ ... . .. . ....._ _._ ...... ....... _ ......_.... ___.. .._. . .... "� �' ... . .. . . . . . .. ... . .... ... ....... .. ._._ .._..._ .__. .."'__. _... ........ .... . . .. .. 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CONTRACTOR S6 ADDRFA 11 CI ZIP TEL64 RIP'L.W 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 PERMITTO CONSTRUCT,ALTER. IMPROVE. DEMOLISH,OR REPAIRANY 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 THERE FROM AND THE BASIS FOR THE ALLEGED EXEMP- TION.ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SU9JEC[S THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(SSW)): ^ I,ASOWNEROFTHE PROPERTY,OR MY EMPLOYEES WITH WAGESAS THEIR SOLE COMPENSATION, WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC 7044, BUST. 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). [3 1.AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTING WI R H LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC. 7044, BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO AUII.OS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW). LJ I AM EXEMPT UNDER SEC. B. &P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM LINDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PPOFESS;ON'S CODE,AND MY LICENSE IS IN FULL FORCE D EFFECT. ��'J/�; 5 C W, LICENSE CLASS LIC NO DATE Q,_CONTRACTOR I WWa3 WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS MAINTAIN A CERTIFICATE CONSENT TO SELF INSURE FOR WORKERS' I NAVE AND WILL S A S PROOVIDED BV SECTI TION N 3 37000E THE L LABOR OR CODE CODE, FORR THE PERFORMANCE /�_MPENSATION 0 / OF THE WORK FR 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 15 ISSUED. MY WORKERS'COMPENSATIO INSURA E CARRIER AND POLICY NUMBER ARE: 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 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 TO ONE HUNDRED THOUSAND DOLLARS(5100,000),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 THATTHERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WOFK 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 AUTHORIZE REPRESENTATIVES OF THIS COUNTY T ENTER UPON THE ABOVE-ME TI PROPERTY FOR INS ORES. PEfI E NAME(PRINT SIGNATURE OF PE MI E DATE Q 0 in W U Z W 0 U 0 C') Z 0 d US CO 0 U CO v] UJ 0 W Q J Z Q W Z U) 0 In CO J LL CO CO d 0 Ir d W H- CO CO C1 0 GD m PRESS FIRMLY APPLICATIc ERMIT�„f�/\P/C Oz PERMIT' G_P/C 2 If DATEINUMBER 0 TYPE OCC ISSUE e DATE CONST.GROUP ZONING SETBACKS FRONT RW^ REAR^ SIDE/SIDE STREET RW^ SIDE^ PROPOSED USE 7 A5 -Nki.-I DIE N0. DWEL. NO UNITS/STORIES . BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM U) Garage/Carport W Patio/Deck W LL PooVSpa Z Re-Roof 0 Commercial 5 Valuation AAD ADJ.AREA QUANTITY DESCRIPTION FEE J U F U W J W Z Do 0 C 2 0 W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL_ INSPECTION FEE ISSUANCE SMIP �� ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES C) COMMENTS RECPT N0. PAID BY VALIDATION HITS-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy. GREEN-Applicant's Copy