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Home My WebLink About18603 �,` CITY OF DIAMOND BAR � DEPARTMENT OF COIvIlvIUNTCY&bEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Faac(909)8613117 PRESS BUILDING PERMIT APPLICATION �� C'-i'?C FIRMIY o� JOBSITE p APPLICAT Q PERMIT J� p/� ADDRESS� � � rtiNGS � DATE I �OZ NUMBER l:' # `r APN_ LOT R CT DATE � G n TMPE OCC `��` , /�� —��--- L CONST. GROUP p OWNER �M lu—�� lar1 o ADDRESS ZONING SETBACKS oCITY ZIP 7E � FRONT Ry� � p APPLICANT TEL._ REAR �, a SIDE/SIDE STREET RW f7 aa CONTRACTO SIDE n ADDRE S � CITY ZIP - TE PROPOSED USE "U w ARCWENG/ �� r/` — z DESIGNER �� ADDRESS — NO.DWEL. � NO. NO. � CITY ZIP TFL._ UNITS_�__ STORIES � _ BEDflOOMS � DESCRIPTION SO.FT. FACTOR PSF ADJ.AREANALUATION � OWNEfl-BUILDER�ECLARATION O SFRlADD/REM I NEREBV AFFIRM UNDER PENA�TV OF P[PJURV THAT i AM EXEMPT FROM THE CONTRACTOqS LI- G8f8 B/C8 OfI W CENSEUWFORTHEFOLLOWINGREASON(SEC.]031.SBUSINESSANDFqOFE5510N5CO0E:ANVCiTVOR (n 9 � 2 COUNiYWHiCHREOUIRESAPERMITTOCONSTRUCT,A�TER,IMPROVE.DEMOLISH,GRFEPAIRANYiTRUC- W PytiO/DBCk w TURE,PPIOR TO ITS ISSUANCE,AL50 REOUIRES THE APPLICANT FOR SUCH PERMIT TO FlLE R SIGNED w � STATEMENT TNqT ME OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- � CENSE LAW(CMAPTER 9(COMMENCING WiTH SECr�Ofr 7000)OF DIVISION�(1F T4iE PUSINE55 AND PRo- � POOVSpe � FESSIONSfADE)ORTHATHEORSHEISE%EMPTTHEqEFROMANDTMEBASISFORTHEALIEGEDE%EMF- (� V TION.ANVVIOLATIONOFSECTIDN]OAI.SBYANVAPPLICAN�fORAPERMITSU9JECT5'fHFAPPLICANTTO Z Re-Roof o � A CML PENALTV OF NOT MORE THAN FNE HUNDRED DOILARS(f500)): � 0 C]I,ASOWNEROFTHEPROPERiV,OqMVEMPLOVEESWiTHWAGESASTMEIRSOLECOMPENSATiON, � CORfIT12fCldl Z WILL DO THE WORK,AN�THE STRUCiUftE IS NOT IN7END[D OR OFFERED FOH SALE;SEG.70d6,BU�I� J � NESS AND PROFESSIONS CODE:THE CONTRFGTORS LICENSE LAW DOeS NO'APPLY TO AN OWNER OF PROPERTYWMOBUILDSORIMPROVESTHEREON,ANDWHODOESSUCHWORNHIMSELFOFHERSELFOR � Q THROUGHMISORHEROWNEMPLOVEES,PROVIDEDTHATSUCHIMPROVEMENISARENOTINTENDEDOF LO � OFFERE�FORSALE.IF,HOWEVERTMEBUILDWCORIMPROVEMENTISSOLDW17HINONEVEAROFCOMPLE- Z TION,THE OWNER-BUILDER WILL HAYE iHE BURDEN OF PROVING'HA7 HE OR SHE DIO NOT BUILD oR � IMPROVE FOR THE PURPOSEOF SALE). W �I.AS O WNER OF THE 7ROPERTV.AM E%CWSNELV CONTRACTING'NITN LICENSED CONTRAClORS [[ TO CANSTRUCT TNE PROJECT(SEC.]oa6,BUSINESS AN'J PROFESSIONS CODE:THE CONTRACTORS LI- V8IU0IlOf1 ADJ.AREA W CENSELAWDOESNOTAPPLVTOANOWNEflOFAPROPERTYWHOdUl1.�5OpIMPPOYESTMEREON,AND - � WHOCONTRACTSFORSUCHPRQIECTSWITHACONTRACTOR(5)LICENSED�UqSUANTTOTHEGONTRAC- OUANTITY� DESCRIPTION FEE Y TORS LICENSE LAW�. _ O ❑I AM EXEMPT UNDEfl SEC. __ B.S PC.FOR TMIS REASON Q � U � DATE _ OWNEF "— � � LICENSED CONTRACTORS DECLARATION � Q w � I MERFBV AFFIRM UNDEH PENALTY OF PERJURV THAT I AM LICENSED UNDER PROVi510N50F GHFPiEF � d 9�COMMENCING WITH SECTION]000)OF DIVISION J OF TME BUSINE55 AND PP.OFESSIONS CODE.ANG z O MV LICENSE IS IN FUL�OLC N EFFECT � � � � .�}�i m r LICENSE CLA�S 1�Y L��C.NO. � V DATE _ CONTRACTOR � d W � WORKERS'COMPENSATION DECLARATION Q � I NERE6vAFFlRM UNDEF PENALTV OF PERJURY ONE OF THE FOLIOWING DECLARATIONS�. U (/� Z Z �IAVE AND WILL MAINTAIN A CERTIFlCATE OF CONSENT TO SELF-INSURE FOR WORKERS' ¢ 2 ¢ �COAIPENSATION,AS PROVIDED BV SECTION 3�0o OF iHE LABOR CODE,FORTHE PERFORMANCE U � OF THE WORK FOR WHICH TMIS PERMIT IS ISSUED. W 0 V � W I HAVE AND WILL MAINTAIN WORKERS'COMPENSPTION INSl1RANCE,AS RF_�UIRED BV SECTION Q3]OOOF 7NE LABOR CO[]E.FORTHE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS � J ISSUED.IAY WO ERS'COMPE�ION INSUflANCE CARPoER AND POLICY NUMBERARE' CONSTRUCTION � ¢ T��0��g PLAN REVIEW � CAPR'�ER �.. Z POUCVNUMBER 1� F�i�l"'V � -- ELECTRIC Q p (i}iISSECiqNNEmNOTBECI7MP�EfEDOF1}IEPEFUNTISFOFONEHLMDRE�OIXIA0.S(510o)ORLESS). PLUMBING W Z I CERTIFVTHAT INTHE PERFORMANCE OF THE WORK FOA WHICH THIS PERMIT IS ISSUED,I � MECHANICAL C} SHALLNO7EMPLOVANVPERSONINANY MANNEFSOASTOBECOMESU&IECTTOTME � �-'� (/J WORNERS'COMFENSATION LAWS OF GALIfORNIA,qN�FGREE THAT IF I SHOULL18tGOME I INS�ECTION FEE � Sl1BJECT TO TME WORNERS'GOM�ENSATION PqOVI510N5 OF SECTION 37000F THE LABOR � � � GO[lE.ISMALLFORTHWITHCOMPLVWITHTHOSEPflOVISIONS. ISSUANCE � � p DATE. APPLICANT�. SMIP W J WARNING:FAILUflE TO SECUflE WDRKERS'GOMPENSATION COYERAGE IS UNLAWFUL,ANU SHALL 6E ENERGY P/C J � SU&IECTANEMPLOVERTOGRIMINALPENALTIESANDCIV:LFINE5UP100NEHUNDFIEDTMOUSAND ENERGYPERMIT � DOLLAfts(S�Oo,OW),IN AO�ITION To THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN J SECTION 3]o80F THE LABOR COOE.INTEREST,ANDA`TORNEY'S FEES. � - w RETENTION FEE: o CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � � I HEREBY AFFIRM UN�ER PENALTV OF PERJJRY THATTHERE IS A GONJTRUCTION LtN�ING AGENCY n- FOR THE PERFORMANCE OF THE WOFK FOq WHICM THIS PERMIT IS ISSUE�(StG.309],CIV.C.). Z W j LEN'JEH'SNAME_ _____ s F— LENDER'SAD�RESS � � ' —__- ._- � �� i CERTIFV THAT�i HAV[fi[AO TIIIS APPLICATtON AND STATE THAT THE h80VE INFORMATION IS GORflECT TOTAL FEES w �qGREE TO COMPLY WITH ALL CITY AND COUNT�ORDINANCES AND STATE LAWS FELAiIN(i I08UILDING � � CONSTRUCTION,AN�MEREBY AUTHORIZE FEPRESENTATIVES OF iH15 GOUNTV TO ENTER U�UN THE Z NBOVE-M NTIONE�PROPERTVFORINSPECTIONGURPOSES. GOMMENTS � J � I m PtRMIiiE A E INT) `� ¢ L /'+ �, , . � SIGNATUqE� RMITiFE �� - - --- "'-- J__�_�_ S RECPT.NQ ___ PAID BV �+ ) 1 VALIDATION �N WHITE—Department Copy,YELI.OW—Finance Copy,PINK—Assessor Copy,GOLDENRO�File Gopy,GREEN—ApplicanYs Copy �� _. ,,��„ �«. �� n-. " � � �� . �``�u. � �� ° � . _ _ _. _ ,,�,� u, . _ _ _ �.�n � �� ,� ; _ _ __ � _ ___ . .-- . __ _ _ ; _ _ _ _ __ _ _ _ ; _ _ ___ _ ._ _: _ . ___ _ __._ _� ___ . . _ � ___ _ _; _ ___ _ �, ... , "�`,�� "`'�d' j �� } _ _ � '�'� �s��_� � �s�,� .�,..��t,��,'� � �, , __ _ ; ,.,; � �. �,; _. _ . �, �� _ � „ . ,�s._ � i ,�t� __ _ _ ,� �� , '� , �� , _ _ _ �� } � �q�:_ �. �_.�...�....�.�...„ DIAMOND MAR i CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION 2C�� PRESS FIRMLY JOBSITE ADDRESS APN_LOT OWNER Q M_�C P2-o4 40A- ADDRESS CITY ZIP TE j APPLICANT TEL. CONTRACTO ADDR S CITY ZIP TE If-1 �WA 97 ARCH/ENG/ 1 , 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 BUSINESSAND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REQUIRESA 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 THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP. TION.ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SURJEC VS VHF APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($5w)). C]I,AS OWNER OF THE PROPERTY,OR MY EMPLOYEES W OTH WAGES AS 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 WORN 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. &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 PPOEESSOONS CODE.AND MY LICENSE IS IN FULL ORC N EFFECT R L LICENSE CLASS v f4 LIC N0. DATE CONTRACTOR WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: AVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF INSURE FOR WORKERS' COMPENSATION,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 WO ERS'COMPEN,ION INSURANCE CARRIER AND POLICY NUMBER ARE tJt) CARRIER AVE {�_.7 POLICY NUMBER��I/,_r_I (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(9100,000),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 LENDERS ADDRESS :CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT 1 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 ABOVE-NTIONED PROPERTY FOR INSPECTION PURPOSES. PERMITTE A E INT) SIGNATURE RMITTEE DATE APPLICAT(} PERMIT P/C 0- NUMBER # DATE.V ISSUE n TEID£ 2 TYPE OCC D CONST. GROUP A ZONING SETBACKS FRONT RW REAR ^ SIDE/SIDE STREET RW ^ SIDE C PROPOSED USE r-u4c N0. DWEL. 17 N0. N0. UNITS ! STORIES I BEDROOMS DESCRIPTION S0. FT. FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM U) Garage/Carport W Patio/Deck LL Pool/Spa Z Re-Roof 2500 Commercial ED Valuation ADJ.AREA QUANTITY DESCRIPTION FEE -J U U W LU C7 z m D Q 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 COMMENTS RECPT N0. - PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy