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Home My WebLink About17085 �. CITY OF DIAMOND BAR .-=�"'° DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES ,'�,��; 21825 E.Copley Drive (909)860-3195 Fax(909)861-311'7 � PRESS BUILDING PERMIT APPLICATION FI R M LY � JOBSITE ¢ ADDRESS Zp�� `�'� �� aPPLICATION �/Z,/o PERMIT I-', j P/C :rI � p DATE NUMBER tt � ISSUE �,� O TYPE OCC APN L.OT TRACT______ DATE CONST. GROUP p OWNER �p � �!'�'C- p ADDRESS ZONING SETBACKS z CITY ZIP�� TEL� FRONT Ryy � � APPLICANT TE�- REAR � z SIDE/SIDE STREET RW ❑ QCONTRACTOR I� �6�1I QN� SIDE U o CDDRES_S ti �� ZIP TEL. �p/ PROPOSED USE �c'7AeP. o =1E�t-i-�—'-� o ARCHIENG/ �.r��og'-o�LK z DESIGNER w NO.DWEL. NO. NO. � ADDRESS UNITS STORIES BEDROOMS � CITY _ ZIP TEL. � cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUIIDER DECLARATION SFR/ADD/REM O � I HEPFBV AFFIFM UN[)ER PENALTV OF PERJURY THAT I AM E%EMPT FRDA1 TNE CONTFACTORS LI- Gdf2(JQ/CBfPOfI W CENSELAWFORTHEFOLLOWINGREASON�SEC.7031.SBUSWESSANDPROFESSIONSCO�E:ANVCITYOR (n U COUNTYWHICHREOUIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,OEAAOLISH,ORREPAIRANYSTRUC- w 7URE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUGH PERMIT TO FILE A SIGNED W Patio/Deck � STATEMENT TMqT HE OR SHE IS LICENSE�PURSUANT TO THE PROVISIONS OF THE CONTRAGTOFS LI- � � CENSE UW(CHAPTEF9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AN�PRO- POOUSPB � FESSIONSCODE)OR7HATHEORSHEISEXEMPTTHEREfROMAN�iHE8A515FONTHEALLEGEDEXEMP� (� V TION.ANVVIOLATIONOFSECTION7031.SBYANYAPPLICANTFORAPERMITSU&IECiSTHEAPPLICANTTO Z Re-Roof � A CIVIL PENALTV OF NOT MOflE THAN FIVE HUNDRED DOLUPS�f5ao).): O ❑I,ASOKRJEflOFTHEPROPERTV,ORMYEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, � Commercial . Z WILI DO THE WORK,ANO THE STRUCTURE IS NOT INTENDED OR OF=EREO FOP SALE(SEC.]064,BUEI- J ' � NESS AND PflOFE5510N5 CODE:THE CONTRACTORS LICENSL LAW OOES NOT APPLY TO AN OWNER OF j �j / PROPERNWHOBUIIDSORIMPROVESTHEREON,ANDWHO�0ES5UCHWORKHIMSELFORHERSELFOR O�l� ', Q 7HflOUGHHI50RHEfiOWNEMPIOVEES,FROVIDEDTHATSUCHIMPROVEMENTSHRENOTINTENDEDOR m � Q OFFEREOFORSALE.IF,HOWEVER,7HEBUILDINGORIMPROVEMENTISSOLDWITFINONEYEAROFCOMPLE- Z TION,THE OWNEREUILDEH WILL HAVE-fHE E3UROEN OF PROVING THAT HE OR SHE D'.D NOT BUILD OR � IMPROVEFOqTFiEPURPO5EOF5ALE). w ❑I,ASOWNEROFTHE7ROVERTY,AME%CWSNELYCONTRACTINGWITHLICENSEDCONTRACTOFS � TO CANSTRUCT THE PROJfCT(SEC.7044.BUS�NE55 AND PROFESSIONS CODE:THE CONTRACTORS ll- VelUetion 3 D�Z�U ADJ.AREA W CENSEUWDOESNOTAPPLYTOANOWNEROFAPROFERTVWHOBl11�DSORIM7FOVE5THEREON,MID � YAiDCANTRACTSFORSUCHPROJECiSWITHACONTRACTOR(5)IICENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION FEE Y TORS LICENSE LAW.). O ❑1 AM EXEMPT UN�ER SEC. B.8 P.C.FOR THIS REASON Q �( � U � � OATE OWNER U Z W � LICENSED CONTRACTORS DECLARATION W ¢ � I HEREBY AFFIRM UNDER Pi_NALTV OF PERJURV THAT 1 AM IICENSED UN�ER PROVISIONS OF CHAPTER d e(COMMENCING WITH SECTION]000)OF DIVISION J OFTHE 6USINE%AND PROFESSIONS CODE,AND Z I �G MV LICENSE IS M PJLL PoRCE AN�EFfECT. W (1] � �ICENSE CLASS LIC.NO. � F, J V DATE CONTfiACTOR d w �I � WORKEFiS'COMPENSATION DECLARATION Q I � IHEREBYAFFIRMUNDERPENALTVOFPERJUflYONEO�THEFOLLOWINGDECIARATIONS', Z Z IHAVEANDWILLMAINTAINACER7IFICATEOFCANSENTTOSELF-INSUREFORWORKERS' _ ¢ CAMGENSATION,AS PROVIDEO BV SECTION 3�no OF THE LABOR CODE,FOR THE PERFORMANCE U Q OFTHE WORN FOR WHICH iHIS PERMIT IS ISSUED. � W _I HPVE AND WILL MAINTAIN WORKERS'COMPENSAiION INSURANCE,A5 RE�UIRE�BV SECTION Q 3700 OF THE LABOF CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS �C /y� ISSUE�.MY WORKERS'CAMPENSAiION INSIJRANCE CARRIER AN�POL ICY NUMBERARP CONSTRIJCTION ] 'lJ�� J � � j cnaaiEa PLAN REVIEW y_ � POLICY Nl1MBER_ Z ELECTRIC Q � (IHISSEC�70NNEmNOTBECOMREfEDOFTHEPERMfTIS�ORIXJEHUl�DREDDOl1ARS�EIW�ORLE55J. PLUMBING _ Z I CERTIFY THAT IN THE PERFOPMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,1 MECHANICAL L7 SHALL NOT EMVLOY ANV PERSON IN ANV MANNER SO AS TO BECOME SUBJECT TO THE -� � WORKERS'COMPENSATION LAWS OF CALIFORNIA,AM1D AGREE THAT IF I SHOULD BECOME INSPECTION FEE SUBJECTTOTNEWORKERS'COMP'cNSATIONPROVISIONSOF5ECT10N3]OOOF IABOR �- � GODE.IS ALLFOFTHWITMCOMPLYWITHTMOSEPROVISION -�"°'�� ISSUANCE � • p DATE � 2 J1/ APPLICANL ._�_..-. __� SMIP • J WARNING:FAIWRETO SECURE WOFKEFS'COMPENSATION COVERAGE IS UNLAWFVL,AND SHA:LBE ENERGY P!C � LL SUBJECTAN EMPLOV[R TO CRIMINA�PLNAI.TI[SAN�CIVIL FlNES UP TOONE HUN�RED THOUSAND ENEFGY PERMIT DOLLARS(f 100,000�,IN ADOITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN � SEGTION310BOFiHEU1BOiiGO�E,MTEREST,ANDATTOFNEY5FEE5. RETENTIONFEE: O OCONSTFIUCTION LENDING AGENCY PRE-ALT FEE: � INEREBVAFFIRMI:NDERPENALTVOFPERJURVTHATTHEREISACONSTRUCTION�EN0INGAGCNCY FOR THE PERFOflMANCE OF THE WORK FOFi WHICH THIS PCAMIT IS ISSU[0(SLC.J�9],CN.C.), Z W -— ? LENDER'S NAME � F- IEN�ER'SA�DRE55 TOTAL FEES („( o 0 � � I CERTIFY THAT I HAVE READ THIS APPIICATION ANO STATE TNAT THE ABOVE INFORMATION IS CARPECT. „/ w IAGflEE TO COMPLY WITH hLL CI'V AND COUNTV OFIDINANCESANO STATE L4W5 RELATING TO BUILOING +� O I �� CONSTRUCTION,AND HEREBY AUTHOPIZE REPRESENTATNES OF THIS COUN7Y TO ENTER UPON THE L � ABOVE-MENTIONE�GROPERTY FOR INSPEGTION PURPOSES. T � Z COMMENTS � /��6�t/AG� ✓� O\- - m PERMITTEE NAME ' � ¢ f� _.___ �/�7�0 _ v' � —c_ G-��._, . — � SIGNATUREOFPERMITTEE DATE = RECPL��Q PAID BY �Z� I VALIDATION ~ WHITE—De artment Co VELLOW—Finance Co PWK—Assessor Co GOLDENRO File Co GREEN—A licanfs Co P PY. PY, PY. DY. 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F `�h."�' .. ... . . . . .. .. ... ��. u° CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION PRESS FIRMLY ADDRIESS-2-pi-x7 APN L.OT_TRACT OWNER AVZ. 14140,41 I; -Af SS CITY ZIP TEL.( APPLICANT AI ey4/7--TE CONTRACTOR L)/6 ^I/'/- ADDRESS CITY1�}-ZIP TEL.Apr ARCH/ENG/C�goS'-o ELK 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 SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($500).): ^ I,AS OWNEROFfHE 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 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 NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). ^ 1 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 FORCE AND EFFECT. LICENSE CLASS LIC. N0. DATE 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' 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 WORKERS'COMPENSATION INSURANCE 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 SECTlON 3700 OF LABOR CODE. 15 ALL FORTHWITH COMPLY WITH THOSE PROVISION ZJ DATE: APPLICANT: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE 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 I 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 HERE BY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES 04W / PERMITTEE NAME'/ 7 O SIGNATURE OF PERMITTEE DATE APPLI CATION/2-7 I-1085 /C I DATE NUMBER # ISSUE rr TYPE OCC D ATE CONST GROUP ZONING SETBACKS FRONT RW^ REAR^ SIDE/SIDE STREET RW^ SIDE^ PROPOSED USE N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREAIVALUATION SFR/ADD/REM co Garage/Carport W Patio/Deck L LL Pool/Spa 0 Re-Roof Z Commercial 16 n/ CI D Valuation 30-�d ADJ.AREA QUANTITY DESCRIPTION FEE Q U W W 0 Z J Z Q U W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE00 SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES 1„(0 0 W I rl I PVUfj(5 0 r\/i/ COMMENTS RECPT N0. (q 7_14 PAID BY L.� 1 VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy