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Home My WebLink About17352 (10) ��` r.ITY OF DIAMUND BAR. � ' DEPAKTMENT OF COMMUNITY&DEVELOPMENT SERVICES �f I �I1 I� jr' � 21825 E.Copley Drive � �909>s6o-3�9s FaX�909>a6�-3 i i� PRESS ��%�w; BUILDING PERMIT APPLICATION FIRMLY o AODDR'ESS�Q�8.`� � % '�� DATE CATION _ rG c NU e R � "'-�/C � ' i �35 fl�_y � D TEE � 5 '�i I T�'PE OCC APN L.OT TRACT_ p OWNER 6D - CONST. � GROUP Q�_� o ADDRE S �� ZONING SETBACKS z CITY ZIP ��,�EL:/ f FRONT RW C: � APPLI ANT TEL, REAR �� - ¢ '_�____ SIDE/SIDE STREET RW ❑ ¢ CONTRACTOR SIDE �� _ ADDRESS � CITY ZIP TEL. O PROPOSED USE �'� " � _ w ARCHIENG! �'�n ��'� ' �� '�� z DESIGNER� S Q w � 1� , NO.DWEL NO. NO. a ADDRESS � CITY ZIP TF UNITS_ STORIES � BEDROOMS �, �-t�— �'�G �3�` —' Z cn '" DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARArION � SFR/ADD/FEM p I HEREBV AFFIRM UNUER PENALiV OF PERJURV THAT�.AM EXEMPT FROM TNF C,ONTRACTON51.1� Gdld B/Gd Ofi W CENSEUWFOR7HEFOLLOWINGPFAS(:ViFE(:'/031.SBUSRJESSANOFROFESSIOM1SCODEANYCITVOR (n 9 � U COl1N7VWHICNRE�UIRESAPERMITTOCONSTRUCT,ALtER,II.IPROVE,DE410LIW,ORREPAIRANVSTRUC� w TURE.PRIOR TO ITS ISSUANCE ALSO RF.GUIR'e5 THE APi'�_.ICANT�OFI SUCk'PERMIi TO FlLE A SIGNED w Pa1i0/�BCk � STATEMENT THAT HE OF 511E IS LIC[NSED PUFSUANi TO THE Pq0'✓ISIONS OF THE CONTFACTORS�I� � .� CENSE LAW(CHAPiER 9(COMMENCING WITH SECTION]�oo)OF DIVISION 3 OF THE BUSINESS ANU f'HO� P001/SP2 � FESSIONSCADE)OFTHATHEORSHEISE%EMPTTHEREFROMANDTHEBASISFUNIHEALLEGEDE%E1AP- � U TION.ANYVIOLATIONOFSECTION]031.SBYANVAPPLIGAN"FOFIAPERMITSUgJEi;"SiMEAPPLiCANTTO Z Re-Roof � A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED�OLIAFS(ESOLj.,`: ❑I,ASOWNEROFTHEPROPEATV.ORMVF.MPLOVEE:iWITHWTGESASTHEIR50LECOMPENSATION, � CommerCiLl O� Z WILL DO THE WORK,ANO THE STRUCTUflE IS NOT INTcN1�ED OR OFFfRFi)FCIR SALE(SEC.]cad,BUSI� J � NESS AND PROFESSIONS[()[)E-THE CONiRA(:TOPS LICENSC LAW C�OES NOT APPLY TO AN OWNER OF j PROPERTV WHO BUILDSOF',INCROVESTNEREON,AN�WHO C10ES SUCN 1VORK HIMSELF ORHERSELFGfI wTHROUGM HIS OR HER OW�I EMP�OVEES,PROVIDED THAT SUCN IMPROVEMENTSARE NOT INl EN�E�OR m Q OFFERE�FORSALE.IF,H04l�EVER,7MEBUIL0INGORiMFIlOVEMENTISSOLDWITHINONEVEAROfCOMPL.E- Z TION,THE OWNER��UILDEFl WILL HAVE THE BUFDEN OF�ROV:NG THAT H'e OR SHE DID NOT BU�_D OR � IlAPROVEFORTHEPUPPOS�EOFSALE�. W f]I,ASOWNEROFTHEPROPERTV,AMExGWSIVE_YCONiHPCTINGWITHLICENSEJGONTRAC'OFS �. ¢ TO CONS(HUCi THE PflOJFCT(SEC.70a4,BUSINESS/ND PROFFSSIONS CO�['.THE CONTRACTORS L- V81U8ti0n __� ADJ.AREA W CENSELAWDOESNOTAPPLYTOANOWNE36FAPROPERTYWY09UILDSOFlIMPROVESTHEREON,A�D � � WHOCONTRACTSFORSUC-IPqOJECTSWITI-AGONTRACI"OF(�)LICEVSE��URSUANTTOTHECONTi7AG- QUANTITY DESCRIPTION FEE Y TORS LICENSE LAW). � I_IIAMEXEMPTUNDERSFC. ,______ 8.8P.0 fOfiTfIISREASON Q � U LL —— _ ___ � �ATE _ OK'NER F Z -- U p — W LICENSED CONTRACTORS DEGLARATION � � w I HEREBY AFFlRM LNDER PLNALTY Of PERJURY THAT I AM�ICENSED UN�FP PROVISIONS OF CHAP'ER < d 9(COMMENCING WITH SEf:lION�000J OF DIVISIUN 3 OFT'.-IE BUSINE55 AND PaOFES510f�dS CODE,AN� Z � J �X A!V LICEhSE IS W Fl1LL FOFCE AND Er'FECT m � LICENSE CLASS � _ _ LIC.NO. _ �1't � ~ DATE � 1 � U ��— _._ ______ CONTRACTOR._._ 1 d W � WORKEflS'COMPENSATION nECLARATiON Q � � 1 HEREBV AFFIRM UN�ER P'�,=NALTV OF PERJURV O�E OF'HE FOLLOWING DCC�ARATIONS: Z • ��V mr�. �„� '� O._,` � IMAVEPNDWILLMNIN7AIYACEHIIFICATEOFGONSENTTOSELF�INSUREFORWORKEFS' a I �� I ' .� '� Z COMPENSATION,AS PROVIDED BV SECTION 370o OF'HE�ABOR CODE.FOR THE PERFORMANCE U � Q OFTNE WORK FOR WHIC.H THIS PERIAIT IS ISSUEfI. W � � W I HAVE AND WIL�MAINTAIN WOFKEFS'COMPENSAT�.OV INSUFUNCE,AS REOUIFEO BV SFCTIDN Q3]CO UF 7Ht�ABOF GOOE,FOR THE PERFOFMANCe OF THE WORK FOR WFICH THIS PERMIT IS �� ISSUE�.lAYWORKERS'COMPENSATIONINSl1RANCECARaIERANDPOLCVNUMBEFARE CONSTRUCTION J j cnaaiEa __ PLAN FEVIEW �S \ Z aoucv NUMaEa_ �I �� i ___,�Q j.>___ __ - ELECTRIC I �d�-� Q.�fJ Q l l—'� `,y 0 (iHISSECTIClJNEmIVOTBEQ�ARTEDOFhiEPERhUTISFORIXJEHUPAHEDDOLIARS(51W��RLESS,. PLUMBING y lrv 1 �9 w [1 �� 1 �-�l� ..S u Z I CEFTIF\'THAT IN THE PERFORMANCE OF THE WG9K FOR WHICH THIS PEHMIT IS ISSUED.I MECHANICAL v (.�J SHALL NOT EMPLOI'ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE </] WORKERS'COMPENSATIO�I AW5 OF CAf IF(Ii�NIA,fAD Af,qEE THAT IF I SHOU�D BECOME INS:�FCTION FEE = SUBJECTTO iHE WORKERS'COMP'cNSATION PROVISIONS OF SECTION 3] OF THE L4BOR CODE,:SHALL.'OR�HWITMCOMPLVWITHTHOSEI'ROVISIONS = ISSUANCE p DATE: _,__ APPLIGANT�. - _ SMIP _ r�L')C.. J WARNING:FAILURETOSECJREWORKERS'CO�N VERAGEISIJNLAWFUI,ANDSNALLPE ENERGYP/G _ _ _ � �UHJECTAN FMPI.nYER TO CRIMINAL PENALTIES AND CIVII NES UP TO ONE Hl1NOR=0 THOUSAND ENERGY PERMIT } DOLLARS(S1DO,000�,INADDITIONTOTNECOSTOFCOMPENSATICN,DAMAGESASPROV10EDFORIN -�---- _ J SECTION3'030Fh1[LA30(iCODC,INT[fiC.`,T,ANDATT041NEV'SFEES. p� RETENTION FEE: OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: �K,�L � I HEREBV AFF10.M 11NDER PLNALTV OF PERJURY TIIAT THEFE IS ACONSTRUCTiON L[NOING AGENCV ' FOR THE PE�iFORMANCE n%iHE WORK FOR WHICH THIS PePMIT IS ISSUEC:(SEC.3J9�,CIV.C.). � — Z W 2 LENOEfi'SNAMF �� '- --.- . _--_—_"____._.___--.—_ F— LENOER'SADDRESS � W� --- - ----- ---- - 4 �� !(�?�.�}� ICERTIFYTHATIHAVFRFAIJiHISPPPIICATInNAVfISTATf-.IHAifHEABOVEI4FORlAATIONISCORRECT TOTAL FEES J � I AGREE Tfi CONPLY'NITN ALL CITV ANp CCUNiV OaDINANCES AND STATE L4'NS HELATING TO BUILDING N I /� � CONSTRUCTION,AN�HEaFBV AUTHORI7.E REPRESEHT�TIVES OF THIS COUNTY T�ENTER UPOIJ'HE � z ABOVE MENTIONED PROPEFTV FOR INSf'ECTION!'Uf�.f'OSCS. COMMENTS � _�� 1 _. - --�t ;,,,e. ----- -- — — m P[RMITTEF NAME(Pft � + �� Q1 — ___ __-.._.— � • f _ _"__ '— _...__.�__'"'_.--_ ._. � SIG E OF PE ITTEF � DAT[ - -�- _ � RECFT NO_ PAI�BV VALIDATION ~ WHITE—Depa.rtment Copy.YELI.OW—Finance Copy,PIMK—Assessor Copy,GOLDENRO6—File Copy.GREEN--ApplicanYs Copy i�a �I�� r�" h.d cS ��„�� m.� ��'Jg�t�t�q � � "�3"�� 1� . ., = U u� , . .. . . . . . . � , '.�. .t��,.�.,- .-,�t� w.�a�i�� , , ' . . . ._. . ..... _ ... �. /l'_; .. .. ... .. ... .. �� ..... ......_ . ..... ... ... ..... . . , ; > � � . � � . . .�� . � � ... �' --- .... . . .. _.. ._. ..�� .... ..�. �... .. ,�- . . . .. .. . . :: .. . ..�.:.�� ._.. . . ... . , . �. � � _ . . _. . .. ;�� O� � .. .-- -� J ........... ;1. , , _ �" � _ _ _ �� _ _ ... .. .... . .. .. .. .. .. .. .. . ... ........ - !_ i � Ty��W9%6 4 �i .... _ . . . . � .... . �.� ,s �,�^��..ave ��`Ma��G°��''+a,.� .� S°"_..... _. ... .... . .. .�, � .. .... . . .... .... . . . .... . . .... . .... . . ... .. ... ... ..... . ... .... ..... . .... .... .. ...�.. . ...... ...... . ..... ... .. ..��.. . ... . . . ...... ..... .... . .. ...�' r ��. � � _ - ... .. .. .... .... . ..... .. .. . .. .. . .... ... ... .... .... .... . � _�� rg;;�5 t` �a�:�°�,��'�i�i� � pi� �'�..„'� �,, � .�% ��g�2`�- .. .. . . �('�'� ��'��'Jig 3��8� � y(� . . . .. . . . . ... . . .. _ ��`��.t��,�� 8��' �� . . ... . . .. ... .._. . _ ... .... .. .. . ._ , � 9� � ,g,3 q w�9'""�:�y�,��A I!�� ,�iii ._. — -- � �. . � �+ ",. ��`� w �"�� _ = i�, �� s�"� �'� ��'��`�@�L�� ,�"�_ �'�m �,� �'a��s� �r , ' __ :",,: i a: ai �Y,�k � a..€-, -.. _ . .. ... .... .. . . .._. ... .. .... ... ' c '-i �;g E� ��°� 4ao ..... ,, si. ;,F�.�� .. .. ... .. .. ._.. ..... .. ...... ..... ..... . .. . .. .... . ._.. ,. � 91 3 � n �� w 5. � p f a�..:.' .� . ie�. t�+ .ta�s��' .k�.� .._. ._... _._. . .._. _.. ... . ... ... .. . .... .. .... .. ....... OI CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION JOBSITE ADDRESS APN LOT TRACT OWNER !A cA� ADDRE S 1 �=j 2A P1 CITY ZIP J TEL. APPLI ANT TEL. CONTRACTOR 1 ADDRESS CITY ZIP TEL 0 ARCH/ENG/ DESIGNER S ILI-A> ILL&P 1 (211'. ADDRESS hite CITY ZIP 10 TE 2 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 APPTJCANT 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 AP PLICANT FOR A PERMIT SUBJECT 5 THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($500); 0 I,AS OWNER 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 BUILDSOP: IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INT ENDED OR OFFERED FOR SALE. IF. HOWEVER,THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COM PL.E- TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE) L7 I,AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTING 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 PROPERTYWHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW). I_I I AM EXEMPT UNDER SEC. B. &P.0 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 NO A V 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- :1 -a-E34 f- b5 t- (THIS SECTION NEED NOT BE 03MRETED OF THE PERMIT IS FOR ONE HUNDRED DOLLARS($100)OR LESS) IC RTIFY 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 37 OF THE LABOR CODE,I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS DATE.APPLICANT WARNING: FAILURE TO SECJRE WORKERS'CO NSATION VERAGE IS UNLAWFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL NES 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 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 ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES PERMITTEE NAC" + 2 SIG r ff-Tff DATE WHITE-Department Copy,YELLOW-Finance Copy, PIN APPLICATION PERMIT I"'�'552J P/C c01 DATE G NUMBER I �"� + TYPE OCC ISSUE I �:I CONS-N GROUP DATE ZONING SETBACKS FRONT RW L; REAR SIDE/SIDE STREET RW^ SIDE I-� PROPOSED USE /9 Th// L fF-1,(_RAJ�-�t N0. DWEL. N0. N0. UNITS STORIES _ BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREANALUATION SFR/ADD/REM C� Garage/Carport W Patio/Deck L LL Pool/Spa CD Re-Roof Z Commercial Valuation ADJ.AREA QUANTITY DESCRIPTION FEE Q U U W W z is, DO a Q a V(t-fr-t. 1 f'0_�� W .pl CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING �� . CV 0 MECHANICAL /! INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES COMMENTS RECPT N0. PAID BY VALIDATION