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Home My WebLink About19054 �` CITY OF DIAMOND BAR �� I � ,� � l � DFPARTNIENT OF COMM fY& LOP ERVICES �� T, 21825 E.Copley Drive �l�� (909)&60-3195 Fax(969)861-3117 � pRE$$ ��~ BUILDING PERMIT APPLICATI FIRM Y } JOBSITE �,��7''�� , ��4f.r' APPLICATION r�' ��PERMIT 1qv� p/C' �' •-}" ¢ o ADDRESS�u iu��_„7VS7�"}/1C_�� e�� DATE_ ��✓ iJUMBER Y / y ,, � ISSUE � �TYPE OCC � APN LOT TRACT__,__ DATE_____ ONSL GROUP p OWNER �� /�,��}tA o ADDRESS " � {' .''�;�j� ZONING SETBACKS Z CITY ��,r ZIP ' EL.��I �/ –' FRONT RW C o APPLICANT �'�Y'iP�� j�, TEL. 4f REAR � �,r SIDE/SIDE STREET RW U ¢ ADDTRSS CR T�V�XI a�c lA �S'cT3��– s�RCC ' SIDE—' Cl � CITY�GI��` ' ZIP ��TEL7 1C, PROPOSED USE S /�C 4!- �y,l I oARCH/ENG/ . - z DESIGNER '� ' w ., NO.DWEL. NO. NO. a ADDRESS cn ,.y UNITS STORIES BEDROOMS � CITY (1 ZIP ��TFL� � DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BWLDER[�ECLARATION SFPo'ADD/P�EM O p I HEREBV AFFIRM UNDER PENA�TV OF VEHJURY THAT I AM EXEMPT FROM THE CONTRACTOqS LI� GBfd OICd OfI W CENSELAWFORiNEFOLLOWMCREA50N(SEC.�a3i.5BUSMESSAND�qOFESSIONSr,ODE:ANVrITYOR (n 9 � U COUNTVWHICHREOUIRESAPERMITTOCONSTRUCT,ALTER.IM�RCIVE.OEMOLISMCRREPAIRANYS'RUf.- WTURE.PRIOR TO ITS ISSUANCf.ALSD REdUIRES THE APPL ICANT FnR SUCH PERMIT TO FILF A S13NED w Patio/Deck � STATEMENT iHAT HE Oi7 SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CON7RACTORS LI- LL � CENSE LAW�CHAPiER 9(COMMENCING W'�TN SECTION)000)OF DIVISION 3(�F THE BUSINESS AND PRO- PDOUSpB Q FESSIONSCO�E)ORiHATHEORSNEISE%EMPTT4��EFROMANDTHEBASISFORTHEALIEGFDEXEMP- � V TION.ANVVIOLATIONOFSECTION1031.SBYANYAPP'�ICANi r'ORAPERM�TSU9JECf5-iHFAPPLIGANTTO Z Re-Roof � ACIVIL PENALTV OF NOT MORE THAN FNE HUNDRED DOLlARS(SSaa��. � O ❑I.ASOWNEROFTHEPROPERlY,OHMVEMPLOVEESWITHWAGESAS7HF'�FSOLECOMPENSATiON, ❑ CORIrt1CfCl01 Z WILL DO THE WORK,AND THE STRUCTUFE IS NOT INTEIJCED OH OFFEFED�OH SAIE!iEC.70a4,BU!'I� J � NESS AN�PROFESSIONS COD,=:THE CONTRACTORS LICENSE LAW DO'r.S NO�APP��V TO AI.OWNER OF PROPERTVWHOBUILDSORIMVROVESTH[REOM1,ANDWHODOESSUCHWORKHIMSFI.FORHERSE�FOR � CL THROUGH HIS OF NEROWN EMPLOVEES,PROVIpE[1 THAT FUCH IMPROV-MENTSARE NOT INTENDEDOR m QOFFERE�FORSALEIF,HOWEVER,THEBUILDINGORIMPROVEMEN?��SSOLDWITMINONEVEAROFCOMP�E- i Z 710N,THE OWNEF�BUILDER WILL HAVE THE BURDEN OF Fi70VING:HAT HE Oq SHE 010 NOT BUILD OH � IMPROVE FOR iHE PURPOSE CF SALE). w ❑I,ASOWNEROFTHEPROPERTY,AME%CLUSIVELVCC�NTRAGTINGWI'iHLICENSE�GONTRACTORS [t TO CANSTRUCT THE Pfl0.1ECT(SEG.]�a6,B1151NE55 AND PROFESSIONS CODE�.THE'GONTRACTORS ll- V2I1J0f1011 ADJ.AREA W GENSELAWDOESNOTAPPIYIOANOWNEHOFAPqOPERTVWHOdU11.D5ONIMPROVESTNEREON,AN� � � WHOGONTRAGTSFOFSUGHP{iOJECTSWITHACANTRACTOR(S)I.ICEhSCDPURSUANiTpTHECONTRAC- I pUANTITV DESCRIPTION FEE Y TORS LICENSE LAW). Q ❑I AM EXEMPT UNDER SFC. 8.fl P.C.FOR THIS REASON Q � U � � — DAiE __ OWNER F� Z —- U � LICENSED CONTRACTORS UECLARATION w � Q Q I HEREBY AFFIPM UNDER PENALTY OF PERJURY THAT I AM LICENSED i�NDER PROVi510N5 OFCHAPTER � d 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESSAND PPOFFSSi�)NS CO�E,AND z `X MV LICENSE IS M FULL FORCE AND FFFFCT /� /� � UGENSE GLA55�_ _ UC.M1O. _,_ � •1�' �-� • � . � ~ DATE CONTRACTOF_^ ` . a (� — . W � WORKERS'COMPENSATION DEGLARATION a � I HFRFPV AFFIRM UN�ER PENA.TV OF PERJURY ONEOF TNE FOLLOWING OECLARATIONS: Z� � IHAVEANDWIL�MAINTAINqGERTIFICP.7EOFCONSENTTOSELF-INSUREFORWORKERS' ¢ Z coMPENSATION,AS PPOVIDED BY SECTION 3700nF THE LABOR CODE,FOR TNE PERGORMANCE � Q OF THE WORK�OR WH'�CH TNIS PERMI'IS ISSUED. W � � w i HAVE AND WILL MAINTAIN WORKEiS'COMP[NSATION INSURANCE,AS RF.OIIIRED BY SECTION Q 31Go OF THE_ABOfl CCDE,FOR THE PERFORMPNGE OF THE WORK FOF WMICH THIS PERMIT IS �� 1/� ISSUED.M1'WOFKEHS'GOMVENSATION INSURANCE CARRIEP AND POLICY�UMBER AflE' CONSTRUCTION �� . ./,� jCARRIER ____._.. _________ PLAN REVIEW `� 1 ' 7 '... ZaoucrNurnaEa_ — ELECTRIC � � ¢ �` Q (iFiI55ECT70NNEmNOTBECUMPLEiEDOFTI{EP[RMf�1`.fGFONENUI�DRED70i1AR5(EtW)OFLE55�. PLUMBING _ �.v O `�' _ a � Z �CERTIFv THAT IN THE�ERFORMANCE OF THE WOFK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL � C'} SHALL 40T EMPLOY ANV PERSON IN ANV MANNER SO AS TO BECCME SUBJEf.T TO THE [/J WORKERS'COMPENSA'ION LAWS OF CALIFORNIA.AND AGREE THAT IF I SHOULD BECOME INS?ECTION FEE = SUBJECTTO TNE WORY,ERS'COA4GENSATION PROVI$Il)NS F SEf.TI a F THE IABOR — �� CODE SHALL ORTHViITHCOMP�V WITNT P O 1 5. � ISSUANCE � p �ATE: / � d �7PPlIGANT: _ 4' � y� SMIP __ � w ENERGY P/C � WARNIN 'FAIL'JRE TO SECURE WORKERS'COMPENSATI�N.COVE AGE IS U K'FUL.AND SHALL BE — _. __ � SUBJECTAN EMPLOVER TO CR�MINAL PENAL7IES AND CIVIt F IP ln ON_HIINDRED THOUSANO ENERGY PERM17 � } �OliAR5�S11Nf.(IOO�,INA��ITIONTOTHECOSTOFCONPENSATIONDAMAGESASVROVIDEDFORIN �--�� -- _ �J SECTION 3)OB OF THE LABOR CODE.INTEREST,AVD ATTt�RNE'Y'S FEES. RETENTION FEE: O d CONSTRUCTIDN LENDWG AGENCY PRE-ALT FEE: - O -. Q I NEREBY AFFIRM UNDER PeNA_TV OF PERJUFY'HAT THEHE IS ACDN.iTHLC?ION t FN(IINC A,FNC� � FORTHEPEPFORMANCEOFTF WOFNFORWHICHTHISPFRMITISISSIIFG(SEC.309],CIVC.). ' Z w __r�ti/�� — � LENDEH'S 4AM'" . ___ __ __ — H LENOER'SAD'JfiC55 � TOTAL FEES �� ¢ ICERTIFYTHATIHAV�qEADTF'.ISAPPLICA710NANDSTATETHATTHEABOVEINFORVAATION'SCORRFCT w I AGREE TO CONPLV WITH ALL(;ITV AN�COl1NTV nR�INANf.ESAN�STATE LAWS HELATING TO 9UILDING d � ('nNSTRIICTION,ANO HEREBY,IU7HOFI2E REPRESENTATIVES OF THIS CO�NTV T'J ENTER UPUN i HE Z ABOVE�MENiIONED PROFERTV FOR INSPECTION P'JRPDS[5. COMMENTS � �T ' a.5� �v, uL.,��'�� — m PERMITT� NAME P TI �., ' '� + , � SI[iNFlt -NE MIT�_ --'__'_._��_.v.—_ __� __ __ ._ ..� = RECPT.NO� PAID BV LIDATION � WHITE—Department Copy,YELI.OW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN— pplicanfs Copy _ �� r�� 3�� ,� "�', � _;„� ��~ ` � ��' �� ^� � � � �� + � � x'..: � � �` . � _ , _ , ,.. . � � r. '�� .� ,��. _ � � �� _ � ..... �` - - - �....:. . � � �� .. . ,� _ _ . _ 5 . �. � __ ; h �, �-7�� , . - _ �► �?�'�-- �:�-�3_�-,�- _ _ _ 1 � � -d� �- : - _ _(o-L '� �- � (l� ' � t3 . � � , . �,� � �, � , .. _ � :�� * �� ,� a � _ � _ __ _ �, �� ,�� e~ :� �� - , — ,��`�� _ — �. _ i, . , �� t �x , _ _ _ _. ; . . � . , . �_ � — _ _ _ _ _ , ��n , . � � � u , �� _ _ _ � � , �k"• s „ E� �� :�� _ _ _ _ _ �.��£� „ ��r, r�a, � �e, ��' _ .. _ _ _. __ _ _. CITY OF DIAMOND BAR DEPARTMENT OF COMM 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATI JOBSITE I"t-e ADDRESSA4iu ' l ler n D e 9 i APN LOT TRACT_,_ ;;tL OWNER j 1 .T-J,Al"A ADDRESS c ct CITY A_I_-__'� ZIP'71 15�7 EL. )yyrs"1 APPLICANT c'�I W I£-i I TEL.9t X CONTRACTOR ADD SS'. -1111-a4c CITY LI � 'ZIP Cia l TEL7 ARCH/ENG/ DESIGNER 47' ADDRESS CITY 0(j y ZIP V&,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 BUSIN ESS AND P90FESSIONS 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 SUBJEC IS THE APPLICANT TO ACIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($500)). ^ I,AS OWN ER OF THE PROPERTY,OR MY EMPLOYEES WITH WAG ES AS IHE: 9 SOLE COMPENSATION, WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE)SEC. 7044,BUT. 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 DOE5 NOT APPLY TO AN OWNER OF A PROPERTY WHO dUII.DS 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 PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORCE AND EFFECT J LICENSE CLASS LIC N0.-,_• 10- 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 WH'GH THIS PERMIT IS ISSUED I HAVE AND WILL MAINTAIN WORKERSCOMPENSATION 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 F SEC 0 FT E LABOR T ORTHVIITH COMPLY WITH T P 0 1 S. CODE SSHAALL d / I P' D T A E. APPLICANT: WARNIN FAILURE TO SECURE WORKERS'COMPENSATI COVE AGE IS U WFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL F PTO ON 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 TF- "WORK FOR WHICH THIS PERMIT IS ISSUED(SEC 3097,CIV C.). // LENDER'S NAME I/Y LENDER'S ADDRESS I CERTIFY THAT I HAVE READ TI-IS 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 AOVEE. MENTIONED PROPERTY FOR INSPECTION PURPOSES. cam! ,A�,S 1 (,•(",�'L., � (JGr PERMIT TE NAME T) 7i- SIGNATI P MITT D WHITE-Department Copy,YELLOW-Finance Copy, PIN ��I eleel�lec Plu,�h, PRESS FI RM APPLICATION/PERMIT P/C� I DATE / 1JUMBER ISSUE W 5-1 TYPE OCC DATE ONST GROUP ZONING SETBACKS FRONT RW^ REAR^ SIDE/SIDE STREET RW^ SIDE EI PROPOSED USE S +�! C!�I N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/P.EM U) Garage/Carport W Patio/Deck t I Pool/Spa 0 Z Re-Roof Commercial Valuation ADJ.AREA I QUANTITY DESCRIPTION FEE J U W W 0 Z m a Z 2 LIJ W t"- CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES INU V COMMENTS < n RECPT NO PAI D F BY LIDATION