The URL can be used to link to this page

Home My WebLink About18601 �,� CITY OF DIAMOND BAR � DFPARTIVTENT OF COMMUNI"fY&DEVELOPMENT SERVICES � ��w 21825 E.Cop►ey Drive (909)860-3195 Fax(909)861-3117 - � PRESS � \%»x BUILDING PERMIT APPLICATION ' ��f (;�� FIRMLY } JOBSITE J C f�� , (' APPLICATI PERMIT � P!C Q ADDRESS 1 O�J��_� �� o �-- DATE � NUMBER # °r APN LOT—_ ��T�R�ACT DATE U v Z CONST. GROUP p OWNER �IMhrfUt-9'W l."VrIK-S t�A p ADDRESS_ ZONING SETBACKS z CITY ZIP_ 7E � � FRONT RW f] � APPLICANT TEL.____ REAR � zSIDE/SIDE STREET RW U __ ¢ CONTRACTO SIDE � ADDR S 1 - � O — PROPOSED USE CITY ZIP TEL.( �D t � ARCH/ENG/ L z DESIGNER_ c. w — ---- -- -- NO.DWEL. NO. � NO. i n. ADDRESS__ � CITY ZIP TEL. UNITS STORIES BEDROOMS cr� -- --- � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HEREBY AFF'.RM UNDEfl PENALiY OF PERJURY THAT I AM FXEMP7 FHOM fHE�NTRACTORS LI GaregelCarpon W GENSEUWFORiHEFOLLOWINGFEA50N(SEC.70]1.SBUSINESSANDFFOFESSIONSCODE:ANVCITVOR (n U COUNTYN?11CHREQUIRESAPERMITTOCONSiRUCT,ALTER,IMUROVE�EMOLISH,CRflEPAIRANV;7RUC� w TURE,PRIOR TO ITS ISSUANCE.ALSO RE�UIFES THE APPIICAN'FOR SUCH PERMIT TO FlLE A SiGNEO w Pd110/D@Ck STATEMENT THAT NE OR SHE IS LICENSEO PIIRSLIANT TO TNF GROVISIONS OF THE CONTRACTORS LI� � CENSE LAW(CHAPTEfi 9(COMMENCING WITF.SECTION]000)OF DIVISION 3 C�F THE BUSINESS AND PRO- � POOUSPB O FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHcqEFAOMANDTHEBA515FORTHEALLEGEDEXEMF- � U TION.ANVVIOLATIONOFSECTION]031.SBVANYAGFLICAN'FORAPEFMITii19JEClSfHfAPPLICANTTO Z Re-Roof � � ACIVIL PENALTY OF NOT MOFE THAN FNE HUNDREO DOLtARS�5500))�. � Z ❑I,ASOWNEROFiHEPROPERiY,ORMVEMP�OVEESW�THWAGE5FJIHFIR50LECUMVENSA�iON, � Commercial Wlll DO THE WOL1K,AN�THE STHUG�UHE IS NOi INi ENO[�7 ON OF=ERED FOH SALE;SEC.704a,BU�'- J � NESS AND 7ROFESSIONS CODE'.7HE CONTRACTORS LICENS"c�AW DOcS NO'FPP�V TO Ati DWNER OF � PROPERTV NMO BUILDS OR IMPROVES 7HEREON,AND WHO DOc'S SUCM WORK HIMSELF OR HERSELF DR �� THROUCaHHISORHEROWNEMPIOVEES,PROV10EDTHATPUCHIMPFOVEMENTSARENOTINTENDFDOR CO ' w OFFEREDFORSALE.IF,HOWEVER,hIE6lJILDINGO(iIMPROVEMENTI.SSOLDWITHINONEYEAROFCOMPLE- I � TION.THE OWNER-BUILDER WILL HAVE THE BI:R�EN OF PROVING:HAT HE OR SHE DIO NOT BUID OR Z IMPROVE FOR TME PUHPOSE OF SALE). _ ❑I,ASOWNENOFTHEPROPERTV,AME%CLUSIV[LVCONTRACTINGWITHLICENSEDCONTRACTOftS W -- � TO CON57RVCT THE PRQIECT(SEC.]oa6,BUSINESS AND PROFESSIUNS CODE:THE GONTqAGTORS LI- V21U8110f1 � ADJ.AFIEA W CENSEUWDOESNOTAPP�YTOFNOWNEROFPPROPERTYWMOdUII.D50FIMPROVESTHEFEON,AND � WHOCONTRACTSFORSUCHPROJEGTSWITMAGONTRACTOR(S1:.ICEhS[DPUFSUANTIOTHECONTRAC- QUANTITV � DESCRIPTION FEE Y TORS LICENSE LAW). _ � ❑I AM EXEMPT UNDER SFC. _. B.8 P G FOR THIS PEASON Q � U LL - -._- _. CL - DATE UWNEH f Z U O W � LICENSED CONTRACTORS DECLARATION w ¢ � I HEREBYAFFlRM UNDEH PENALiV OF PEFJUFV THAT I AM IICFNSED JNDEH PRO'✓ISIONS OF CHAPTE� � d 9(COMMENCING W�7H SECTION 7000)OF�IVISION 30F THE BUSINESS AND PP.OFESS��ONS CODE,AND Z X MV LICENSE IS HJ FULL FORC/E�AND EFF'eCT. �/ � LICENSE C SS C�`� C LIC.NO. 1� I � � ~ DATE�_��_ CONTRAGTOR f� d C� - W � WORKERS'COMPENSATION DECLARATION Q � I HEREBV AFFlRM UN�ER PENALTV OF FERJURY ONE OF THE FOLLGWING DECLARATIONS� Z _ ¢ ZIHqyEANDWILLMAINTAINACERTIFICA7EOFCONSENTTOSELF-INSUREFORWORKERS' _ d MPENSATION,AS PROVIDED BY SECTION 310o nF THE LABOR CODE,FON TME PEqFOfiMANCE U OF TNE WORK FOR WHICH THIS PERMIT IS ISSUED. W OI HAVE AND WILL MAINTAIN WORKERS COMPENSAi ION INSURANCE,AS REOUIRE�BV SECTION � Q �]Oo OF THE LA�OR CODE,FORTHE PEFFORMANCE OF THC WORK FOR WHICH THIS PERMIT IS ISSUEO.MV WORI RS'COMPENSATI� NSURANCE CFFRIER AND POLIC�NUMBERARE' CONSTRUCTION Q -_ - > cnaaiEa_ `1 � � . ____ PLAN REVIEW � POLICV NUMBER_1_ l / -_ _- ELECTI�IC Z -�� 4 - � (MISSE�TIONNEmNOTBEllkAPLEfEGCFTHEPEPMfiISFOFONEHUWREDOCllAqS(E100jORLESS� PLUMBING W Z I GERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WMICH THIS PERMIT IS ISSUED,1 MECHANICAL (.'J SMALL NOT EMPLUY ANY PERSON IN ANY MANN�_N SOAS 10 9FGOME Sl16JE�T TO TH`e � -�� WORNERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INS�ECTION FEE __ � SUBJECTTOTHEWORKEflS'COM7ENSATIONPROVi510N50F5ECT�ON3�ooOFTHELABOR �- � - � CODE.ISHALLFORTHWITNCOMPLYWITHTHOSEPROVISIONS. ISSUANCE __ � p DATE�._"___ APPLICANT�. __ SMIP /� W � J WARNING FAILUFE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SMALIBE ENERGY P/C _ � SUBJEGTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFINESUPIOONEHUNDREDTHOUSAND ENERGYPERMIT DOLLARS(f100.0001,IN A�DITION TO THE COST Of COMPENSATION.DAMAGES AS PROVIDED FOR IN J SECTION 3�OE OF THF I ABOR CnpF.INTEaFST ANO ATT(]RNEV'S FFES. RETENTION FEE: �� - � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � �� O � IHEftE6VAFFIRMUNDERPENALTVOFPEaJURYTHATTHEREISAf_ONSTFUC?IONLEN�INGAGENCY � FOR THc PEHFORMANGE OF TNE WOFM FOq WHICH THIS PERMIT IS ISSJEU�SEC.]09i,CN.C.). - — Z W _ �EM1DEH'SNAME _ _ - ——___—_ F- t.FN�FR'SAD�RFSS � TOTAL FEES ( � � � I(;EMTIIY THA�I MAVE HEAD THISAPPLICATION ANO STATE THAT THE A60VE INFOaMATION IS CORRECT w I AGREE TO COMPIY WITH ALL CITV ANO COUNTV OR�INANCES AND STATE L4WS HELATING TG BUILDING d � CONSTRUCTION,AND HEREBV AUTNORIZE REPRESENTATNES OF THIS COUNTV TO cNTER UPJN THE Z ABOV-MENTIONED PROPERTV FOR INSPECTION PURPOSES. COMMENTS � - � _- __ ____'._-'__-_ _" m PERMI AME(P ' ¢ �,cr Z -- - _. � _ _-- -- � - - - -- - ------ - ----- Uj SIGNATIiREGF EF�. T7Ei=. I 'JAT = RECP?.40. PAID BY VALIDATION ~ WHITE-Department Copy,YELLOW-Finance Copy,PWK-Assessor Copy,GOLDENFOD--File Copy,GREEN-Applican�'s Copy � _ .,.� � � o _ _ � � �� . ��_ �� m:� ��°�. � � � �,�� . � �� . � » � m,. A� � _ � ; 3 �_ __ � < _ _ �y.,� �., . �.. �,� _ ��e��,� �� _ _ _ ____ _ _ __ : __ _ ; � _ __ _ _ , ___ . _ _. _ _ __ _, � �� . ,,;� � �� ,��b ;t �t ,, # _ �� _: � — — __ _ � � y, � ,, . �� „ i � � o ii � �i r d �il! �° �i=��j�'''��' � , _ , __ _ _ '�' �� _. ._ h � CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION ADDRIESS I c o feu iv� APN LOT TRACT OWNER 1M/trf2�A�1 Y'\VA ADDRESS- CITY ZIP TE APPLICANT TEL. CONTRACTO ADDR 1 co?-N 6 CITY 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 REQUIRES A PERMIT TO CONSTRUCT,ALTER,IMPROVE. DEMOLISH,OR REPAIR ANY S TRUC TURF, 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($5W)) ^ LAS OWNER OFfHE 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. BUSI- 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 CONSTRUCT THE PROJECT(SEC. 7044, BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- CENSE LAW DOES NOTAPPLY TO AN OWNER OF A PROPERTY WHO BUILDS 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&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 PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORC AND EFFECT E� / � r LICENSE C SS C 3 I �ft C LIC NO� F e „^',^'7 DATE 1 Mal fl�r7 W 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 SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED MY WOR RS'COMPENSATI NSURANCE 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($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 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 AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOV-MENTIONED PROPERTY FOR INSPECTION PURPOSES. FERMI AME(P SIGNAT,HE OF ER IEE T7 . DA WHITE-Department Copy,YELLOW-Finance Copy, PIN /k nla(j PRESS FIRMLY APPL' PERMIT P/C DATE NUMBER ISSUE yti, TYPE OCC DATE V CONST GROUP ZONING SETBACKS FRONT RW L I REAR SIDE/SIDE STREET RW 0 SIDE ^ PROPOSED USE 6DIt N0. DWEL. Na N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREANALUATION SFR/ADD/REM Garage/Carport U) W Patio/Deck LL Pool/Spa Z Re-Roof Commercial D Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U Cr F- U w W (5 Z a Q U Z 2 CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INS?ECTlON FEE ISSUANCE • SMIP • ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES (L COMMENTS RECPT N0. PAID BY 1 VALIDATION