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Home My WebLink About18602 (11) �.� CITY OF DIAMOND BAR �_�� DEPARTME'r'T OF CO[vIIv[UNTfY&�bEVELOPMENT SERVICES � 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 - PRES$ �� BUILDING PERMIT APPLICATION �;- - � ° , � �_ FIRMLY o� JOBSITE '` APPLICATIO ADDRESS�V � �� f1� �_� DATE �Z PERMIT I.�h'��p/C NUMBER U�W °r APN Y,_ LOT TRACT DATE � V��. ONST. OCC p OWNER U�4�PA(L(L/TI ('y�� GROUP o ADDRESS ZONING SETBACKS z CITY ZIP 7E - FRONT qyy �; o APPLICANT TEL_ REAR � Q - SIDE/SIDE STREET qyy � Q CONTRACTO SIDE � ADDR S � � C�TY ZIP � TEL � PROPOSED USE $ � // �� oARCH/ENG/ � .s z DESIGNER � ADDRESS_ -- NO.DWEL. Np. % NO. '/ � CITY ZIP__ TEL._ UNITS STORIES � _ BEDROOMS �V U' DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION O SFW'ADD/REM � I HEREBV AFFIRM UNDER PENA�TV OF PERJIIRV THAT I AM EXEMPT FROM T�E CONTqACTOqS LI- G8f8J9/CBfPOR W CENSEUWFORTHEFOLLOWINGREASON(SEC.]031.SBUSINESSANDFqOFE5510N5CODE:ANVGITYOR (n U CIXINTVWNICHREOUIRESAPEflMITTOCONSTRUGT,ALTER,IMoqpyE.DEMOUSM.CRqEPAIRANVSTRUC� pyli0/DBCk w TURE.PRIOR TO ITS ISSUANGE.RL50 RE�UIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w � STATEMENT iHAT HE OR SHE IS LICENSE�VURSUANT TO THE PROVISIONS OF THE CONiflACTORS LI- � CENSE LAW(CHAP7ER 9(CAMMENCING WITH SECTION]000)OF�IVISION 3(�F THE BUSMESS AND PRO- LL PDOUSP3 0 FESSIONSCODE)ORTHATHEORSHEISE%EMPTTH<_REFROMANDTHEBASISFORTHEALLEGEDExEU�- (!� V TION.ANYVIOLA710NOfSECTiDN7031.5BYANV4PPLICAN'FnRAPERAAITSJ&lEC(S'MFA7PLICANTTO Z Re-Roof r A CIVILPENALTV OF NOTMOFE THAN FIVE HUNDRED DOLL4RS(f5o0)��. � � ❑I,ASOWNEROFTHEPROPERTVGRMYEMPLOYEESWITHWAGESASIHEIRSOLECOMPENSATiON, O Commercial Z WILL DO THE WORK,AN�THE STRUCTURE i5 NOT INTEND[D OR OFFERED FOH SALE(SEC.I04a,BUFI� J � NE55 PN�PROFESSIONS COOE:THE CONTRACTORS LIGENSE lAW DO'c5 NO�AVPiY TO AN OWNER CF = — PROPERTYWHOBUILDSORIMGROVESTHEREON,ANDWHO�OESSUCHWOFKHIMSELFORHEflSEIFOR � THROUGM HIS OF HER OWN EMPLOVEES.PROVIDEC]TMAT SUCH�MPROVEMENTSARE NOT INTENDE�OR m w OFFEAEOFORSALE.IF,HOWEVER,THEBUI�DINGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLF- � TION.THE OWNEP�BUILDER WILL HAVE 7HE BURDEN OF PqOVING'HA7 HE OR SHE DID NOT BUILO OR Z IMPROVE FOR THE PUflPOSE OF SALE). _ ❑I.ASOWNEROFTHEPROPERTV.AMEXCLUSIVELYCONTRACTINGWITHLICENSE�CONTRACTOqS W � TO CANSTRl1CT THE PROJECT(SEC.]044,BUSINESS AND PROFESSIONS CODE:THF CONTRqCTORS LI- VflIUd110f1 ADJ.AREA W CENSE UW DOES NOTAFPLV TOAN OWNER OFA PROPERTY WHO dUll DS Oq IMPPOVESTHEFlEON,AND — � WMOCONTRACTSFORSUCHPROJECTSWITHACONTftACTOR�S)LICENiEDPURSUANiTOTHEGONTRqG- QUANTITY DESCRIPTION TORS LICENSE LAW.). FEE Y — � "1 I AM E%=MPT UNOER$EG. J Q _ B.8 P.C.FOR THIS PEASON � U � DATE OWNER —�— H � LICENSED CONTRACTORS DECLARATION w Q � I HEREBVAfFIRM UNDER PENALTY OF FERJURY THAT I AM LICENSED JNOER PROJISIONS OF CHAPTEN � � d 9(COMMENCING WITH SECTION 1000)OF DNISION 3 OFTHE BUSINE55 AAD PPOFESSiJNS CODE,AND Z `X MV LICENSE IS W FULL FpqC AND EFFECT. G In r m � LICENSECLASS LIC.ND. � � ✓`�'• � � ~ DATE C S��'� J U �, F�.� CONTRACTOR_ � d W � WORKERS'COMPENSATION DECLARATION Q � I HEREBV AFFIRM UNUEH PENALTV OF PERJURV ONE OF THE FOLLOWING DECIARATIONS�. V � Z � _... I HAVE AN�WILL MAMTAIN A CERTIFICATE OF CONSENTTO SELF-INSURE FOR WORKERS' ¢ Z = Q CAMPENSATION,AS PROVIDED BV SECTION�loo nF THE LpBOR CODE,FOR THE PERFORMANCE U /OF TNE WORK FOR WHICH THIS PEPMIT IS ISSUcO. � � V I HqVE AND WILL MAINTAIN WORKERS'COMPENSPTION INSURANCE,AS PF(]UIRED BV SECTION � ✓`�� O3700 0F THE LABOR CODE,FORTHE PERFORMANCE OF THE WORK FOR WHICH iHIS PERMIT 15 J ISSUED.MV WORKER�� ENSA11 INSURANCE CARRIERAND POLICY NUMBERARE' CONSTRUCTION j caaaiea_ Q �� -q/� PLAN REVIEW Z POLICV NUMBER_i_�_��^t'�,(i ___ ELECTRIC �� Q p (iHISSECTqNNEmNOTBEO�MRE7EDOFTHEPERMfTISfOFONEHUPDREDDOLIARS(Etao)OpLESS). PLUMBING W Z i CE{�TIFV THAT INTHE PERFORMANCE OF THE WOFK FOR WHICH THIS PERMIT IS ISSLIED,1 MECHANICAI. C} SHAL�NOT EMPLOV ANV PERSON IN ANV MANN[R 50 AS TO BECOME SUBJE�T TO THE -��— (/j WORNERS'COMPLNSATION LAWS OF CALIFORNIA AND AGREE TMAT IF I SHOULD BECOME '� INS�ECTION FEE � SUBJECT TO THc'WORKERS'COM>ENSAT'.ON PROVISIONS OF SECTION 3�OOOF THE LABOR ' �� CODE.I SHAiL FORTHWI�H COMPLV WITH THOSE PROVI510N5. ISSUANGE � l — p DATE. APPLICANT�. SMIP U W J WARNING:FAILURE TO S[CURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHqLLBE ENEFiGY P/C J � SU0.IECTANEMPLOVERTOCRIMINALPENALTIESANDCIV'�IFINESUPTOONEHUN�PEDTHOUSAND ENERGVPERMIT } DOLLAftS(floo,o0o),INADDITIONTOTHECOSTOFGOMPENSAiIDN,DAMAGFSASPROVIDEDFORIN . J SEGTION 3]oeOF THE LABOR CODE,INTEREST,ANDA'TORNEY'S FEES. w RETENTION FEE: O CONSTRUCTION LENDING AGENCY PREALT FEE: : � I HEREBYA�FIfiM UNDER PENALTV OF PERJJRV�-1AT THERE IS AGONSTFUCTION LENDING AGENCY d FOl1 THE PERFORMANCE OF THE WOFK FOR WHICH THIS PERMIT IS ISSUE�(SEC.3091,CIV.G 1. — Z W j LENDEH'SNAME_ _ _ - � � LENDEF'SAUUHESS - � TOTAL FEES ( ` /) T � I CERTIFV THAT i HAVE REA�TMIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS GORRECT 1 ��,C� l 0 w �AGREE TO COMPLY WITHALL CITY UNTv OFDINANGES AND STATE LAWS FELAiING TU BUILLIING � .L V V d � CONSTRUCTION,ANDHEREBY HORIZE EPRESENTATIVESOFT ��pUN1YlOENiERU�UNTHE Z ABOVE-MENTIONEDPROPE FORINSPE TIONPUHVOS 5. � GOMMENTS __ J � m PER EE NAME(P T) �� Q � �2� � SIGNATUqEO ��q ITTEE OArE � � —�---- - � � RECPT.NO. __ PAID BY VALIDATION WHITE—Depariment Copy,VELLOW—Finance Copy,PINK—Assessor Copy,GOLDENRO�File Gopy,GREEN—AppGcanfS Copy �� , ,�: ;,_ � � �.,;� ,��,� ., �. ; � � r � e - _ _ _ __ P,� � � .� _ _ _ _ ; _ __ ...___ . __. . a t _ _ _ < _ ._ __ ._. _; _ __ ____ ____._.. _. _ € . _ _____ _ �� , �, ��',,�' .� _ _.. __ _ �;�. „ ,, x �� , �� .� �� n��.. � � _ _ . _ _ , , ,� �� $ _ _ _ _ _ , .ti�d 4 '' 1t,',. � _ �_ � , . » t: _ . _ _ �n ;{ , ; ��,'�a � , � � _ _ _ _ _ _ _ �� t �� .��hrr� �� . . ... . ._.. ..._... . . ._. . ...... .. . .. ... .. .. ..... .._.. . _._. ..._. ._.... .. _ . . CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION ADDRIESS [Wou APN LOT TRACT OWNER(Z9�y ADDRESS CITY ZIP TE APPLICANT TEL. CONTRACTOR ADDR S CITY ZIP TEL.T! 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 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 SUBJECIS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($500) L. ^ I,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 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 OWNERBUILDER 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 NOT APPLY TO AN OWNER OF A PROPERTY WHO 5011 DS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). Ti I AM EXEMPT UNDER SEC. B. 8 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 PPOFESSIONS CODE,AND MY LICENSE IS IN FULL FORC AND EFFECT. r G 7(�� bl5 V V LICENSE CLASS LIC N0. yl DATE C ST� .i CONTRACTOR IA IJ 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' OMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE. FOR THE PERFORMANCE /COF THE WORK FOR WHICH THIS PERMIT IS ISSUED. / V 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 WORKERS_Qp ENS AT I INSURANCE CARRIER AND POLICY NUMBER ARE I 5 d 1(•) CARRIER _p I 0 L POLICY NUMBER� '1 11 "I Gi (THIS SECTION NEED NOT BE COMPETED 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($100,000),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 ACONSTRUCTION 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 THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL CITY UNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTlON.AND HEREBY HORIZE EPRESENTATIVES OFf COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPE FOR INSPE TION PURPOS S. PER EE NAME(P T) I,' � 7 i V SIG tIREO R ITTEE DATE WHITE-Department Copy,YELLOW-Finance Copy, PIN PRESS FIRMLY TIO APPLICA PERMIT�V P/C DATE NUMBER W# ISSUE TYPE OCC C DATE V CONST GROUP ZONING SETBACKS FRONT RW^ REAR^ SIDE/SIDE STREET RW^ SIDE^ PROPOSED USE O1 F1,643 N0. DWEL. N0. � N0. UNITS STORIES � BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM Garage/Carport W Patio/Deck LL Poot/Spa 0 Re-Roof Z Commercial m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE U U W J W (} Z d -J Z 2 U W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP 42 ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: - TOTAL FEES COMMENTS RECPT N0. PAID BY VALIDATION