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HomeMy WebLinkAbout17575 � _____ r/"'�`._ _ ��` D PARTMENT OF COMMUNTI'Y&DEVELOPIvfENT S CES `�'�+--� , ' t� ��'r�\ 21825 E.Copley Drive �"'i (909)860-3195 Fax(909)861-3117 �_ ' � Ya i� PRESS �`'�9� BUILDING PERMIT APPLICATION �� �`��� • FIRMLY � JDBSITE �� ,/ APPLICATION RMI � - o ADDRESS����� �OLA(rN S�J�1'�✓�S D/� • DATE ✓ �` �� BER # � ISSUE TYPE OCC r APN LOT TRACT DATE CONST. GROUP p OWNER � � lJ S� �LZ' " ADDRESS � Y . ZONING SETBACKS OCITY �L BN ZIP TEL�b � FRONT RW ❑ APPLICANT TEL. REAR ❑ � SIDEISIDE STREET RW ❑ z Q CONTRACTOR O� UO1VS"r- SIDE ❑ � ADDRESS aCr,d: S_ S.�fI j� �`�' PROPOSEDUSE � 7'O 4 L 4 � �LD � CITY���/dj_'�� ZIP ' TEL 6� s , � w ARCH/ENG/ �z DESIGNER NO.DWEL. d ADDRESS UNITS TORIES B ROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF A J.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O � I HEREBY AFFlRM UNDER PENALTV OF PERJURY THAT I AM E%EMPT FFOM THE CONTRACTORS LI- G2fa9B/CBfPOR W CENSEL0.WFORTHEFOLLOWINGREASON(SEG7031.SBUSINESSAN�PROFESSIONSCOOE:ANYCITYOfl (f� U COUNTYWMICHRE�UIRESAPERMITTOCONSTRUG',AL7ER,IMPROYE,DEMOLISH,ORREPAIRANYSTRUC- W Pdi10/DBCk Z TURE,PRIOR TO ITS ISSUANCE,ALSO HEOUIRES THE APPLICANT FOR SUGH PEFMIT TO FILE A SIGNEO w STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PFOVISIONS OF THE CONTRACTORS LI� w � CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 1000)OF DIVISION 3 OF THE B1ISINESS AND PRO- � POOUSPB FESSIONSCO�E)ORTHATFIEORSHEISE%EMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP- (�J � TION.ANYVIOL4TIONOFSECTION7031.5BVANYAPPLICANTFORAPERMITSUBIECTSTHEAPPL'�.CANTTO Z Re-Roof � ACIVILPENALTV OF NOT MONE THAN FIVE HUNDRED DOLURS(f5oo).): O ❑I,ASOWNEflOFTHEPROPERT',ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, � Commercial Z WILL DO THE WORK,ANO THE STRUCTURE IS NOT INTENDED OR OFFERE�fOR SALE(SEC.]o4a,BU51- J � NE55 ANO PROFESSIONS GODE:THE CONTRACTORS LIGENSE LAW DOES NO7 FPPLV TO AN OWNER OF � PROVERTVWHOBUILDSOFIMPROVESTHEREON,ANOWHOOOESSUCHWORKHIMSELFOFHERSELFOR m I Q THROUGM HIS OF HER OWN EMPLOVEES,PROYIDED THAT StJCH IMPFOVEMENTS ARE NOT INTENDED OR � OFFEREDFORSALE.IF,HOWEVER,THEBUILDINGOPIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE 4 Z TIIXJ.THE OWNEREUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR � IMPHOVEFOFTHEPURPOSEOFSALE)_ w ❑I,RSOYMEROFTHEPROPERTV.AMEXCLUSIVELVCONTRACTINGWITHLICENSE�CONTRACTORS � TO CONSTRUCT THE PROJECT(SEC.]040,BUSINESS AND PROFESSIONS CODE:THE CONTRACTOPS LI- V8IU8lI0f1 ADJ.AREA � '� W CENSE LAW DOES NOTAPPLV TOAN OWNER OF APROPERTY WHO BUILDS OR IMPROVESTHEREON,AND � YA-IOCONTRACTSFORSUCHPROJECTSWITF�ACONTPACTOR(5)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY D SCRIPTION FEE Y TORS UCENSE LAW.). � ❑I AM EXEMPT UNDER SEC. 9.8 PG.FOR fHlS HEASON J � ¢ � U ti � DATE OWNER F Z w � LICENSED CONTRACTORS DECLARATION w � IHEREBVAFFIRMUNDERPENALTYOFPERJURYTHATIAMLICENSEDUNDER?ROVISIONSOFCHAPTEA � d 9(COMMENCING WITH SECTION]000)Of OIVISION 3 OF THE BUSINE55 HNO PROFESSIONS CODE,AND Z X MY UCENSE IS IN FULL FOFCE RND EFFECT. ` � IICENSECLASS V LIC.NO. �/���^///l���J��_�v � U DATE f'�/��1 CONTFIACTOR�r/�O (��� d W � � � WORKERS'COMPENSATION DECLARATION Q -') � I HEREBYAFFIRM UNDER PENALTV OF PERJURV ONE OF THE FOLLOWING�ECLAF/TIONS: U [� Q 0 IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSl1flEFORWORKERS' 2 COMPENSATION,AS PHOVIDEO BV SECTION 9']oa OF THE LABOR CODE,FOR THE PERFORMANCE U a OF THE WOflK FOR WHICH TMIS PERMIT IS ISSUED. � � w .�I HAVEAN�WILLMqINTAIN WORKERS'COMPENSAiION INSUqANCE,AS REQUIRED BY SECTION ------ Q 3�0o OF THE LABOR CO�E,FOH THE PERFORMANCE OF THE WORK FDfl WHICH THIS PERMIT 15 ' � ISSUED.MV WORKE.RyS',C(OrMPENSATION INSURANCE CARFIER AND POLICV NUMBER ARE: CONSTRUCTION � CARRIER SC/d'I G IA:�N} P(/� .. PLAN FiEVIEW � POUCY NUMBER_ �S��J�J AS/Y l�I I ELECTR�C Z Q � (fHISSECl10NNE�NDTBECOrAPLEfmOFhIEPERMfiISFORIXJEHUt�DREDDOLlAAS(5100)ORLESS). PLUMBING w I CERTIFV THAT IN THE PERFORMANCE OF THE WORN FOR WHICN THIS PERMIT IS ISSUE�,I MECHANICAL Z (,� SHALLNOTEMPLOYANVP[RSON�,NANVMANNERSOASTOBECOMESUB.,'ECTTOTNE N WORKERS'COMPENSATIONIAWSOFCAIIFORNIA,ANDAGREETHATIFISHOULDBECOME INSPECTIONFEE j SUBJECTTOTMEWORKERS'COMPENSATIONPROVISIONSOFSECTION3]�OOFTHELABOR I'� � fADE,I SHALL FOflTHWITH COMPLV WITH THoSE PROVI5lON5. �SSUANCE �.J 4�, � ��/Q �. SMIP p DATE:� [(� ✓_y APPLICANT w ENERGY P/C J WARNING:FAIWHETOSECUREWOqKEF15'COMPENSAT�O ERAGEISUNIAWFUL,ANOSHALLBE J � SUBJEGTANEMPLOVERTOCRIMINHLPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOVSAND ENEFGYPERMIT OOLLARS(f100,000),IN ADI7ITION TO THE GOST OF GDMPE45ATION,DAMAGES AS PROVIDED FOR IN - -- J SECTION 3]OB OF 7HE UBOR CODE.INTEREST,AND A7TORNEYS FEES. RETENTION FEE: Q � CONSTRUCTION LENDING AGENCV PRE-ALT FEE: � I HEREBV AFFIRM UNDER CENALTY OF Pc'RJURV THAT THERE IS ACONSTRUCTION LENDING AGENCV d FOR THE PERFORMANCE OF THE WORK FOR WHICHTHIS PERMIT IS ISSUED;SEC.309�,CIV.C.). Z W � LENDER'SNAME F– LENDEf7SADDRESS � ICERTIFVTHATIHAYEPEAOTHISAPPLICATIONAN�STATETHATTHEABOVEINFORMATIONISCORRECT. TOTAL FEES W IAGREETOCOMP�VWITHALLCITYAN�COUNTYORDINANCESAN�STATELAWSREI.ATING70BUILDING d � CONSTRVCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE Z ABOVE-MENTIDNED PqOPERTY FOR INSPECTION PURPOSES. COMMENTS � J � m PERMITTEENAME(PRINT) Q Cn — _ __–...._.. _ • � SIGNATUREOFPERMITTEE DATE = FECPT.NO. PAID BY VALIDATION ~ WHITE—Department Copy,YELLOW—Finance Copy.PINK—Assessor Copy,GOLDENROD—File Copy.GREEN—ApplicanPs Copy �S � � �.�, � � �i,U���,�;� a a��r.� , . .. . . , _ - . , . ���.`P ���?a�+'�nm�.��.;. ��a . �� , .t� . 7 . .. .. . _. .. .... . .. .. . � ��Z,. �:�'�7"4 .....,. , . . . . 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' � � 6 `a, w � � � a �'�o'02 i��t QLepY_r Z� (7' _��-'c�`Z ` , �_ _ M'°; "' y��l.-a2 CAn� 5�.�,13 .�R�tP o K � , , .���'�� _ _ .� � s � ,9�x°�� ; � 7 �.�� : ` ° ���/Z ..���rTi� �`, " �i�•c'�- !j�)ci� �'ecri� dl� � _ _ : , : v e .. � � x �'���, �°. r . JOBSITE/C p ADDRESS-- i-c�OLA(rN JPP�S DA APN LOT TRACT OWNER b LI ADDRESS r CITY A*-6A/,ZIP TEL(E>'- APPLICANT TEL. CONTRACTOR„4Z U61V Sr- ADDRESS_r,dr. .J IC"ArW-WiIM L-'2'. CITY ZIP TEL 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 REQUIRESA 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 BYANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($500).): ^ 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 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.). ^ I 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. EF 77"/„16 V LIC. N0. LICENSE CLASS DATE I-z-D.1-CONTRACTOR^ 0 [T- 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 574- L W/P � ,JI lfz/ Ifll J POLICYNUMBER �� (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. 11 ANT DATE:APPLIC :,._ WARNING: FAILURE TO SECURE WORKERS'COMPENSATIOF'C6VERAGE 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 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. 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 NAME(PRINT) ) SIGNATURE OF PERMIT-TEE DATE Cn 0 0 w z 0 0 m 0 w 0 w a C� cc 0 1.1 U W 0 U U) �L fr 0 tL 0 Er wW 0 U w U3 0 Z UJ W J W M C.'3 0 W w d J m C! N I CITY OF DIAMOND BAR nFPARTMFNT()F COMMUNITY&DEVELOPMENTS CES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION + irk a PRESS FIRMLY APPLICATION V RMI DATE BER # ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ^ REAR ^ SIDE/SIDE STREET RW ^ SIDE ^ PROPOSED USE 1 L 0 I3LA S' R&gjll N0. DWEL. UNITS TORIES B ROOMS DESCRIPTION SQ. FT. FACTOR PSF A J.AREANALUATION SFR/ADD/REM W Garage/Carport w Patio/Deck LL PooVSpa 0 Z Re-Roof 0 Commercial Valuation ADJ.AREA QUANTITY D SCRIPTION FEE F- 0 J W Z E8 D 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 1)00 RECPT N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy ----�� ��4�5-o�C r'16�-sreGc,E.�t�Res� ��,v�tc�,c;�� �tR,��a�tts�ti S--S '7����-'C1�-- �-E-tzc.�a�co't- P�-r�- � �f '� � �i�l ���� '{-5•aL�I.0 S_�i 57A��'�f 70��cam-�L' '7'��-z 5146 c-��'��, ��0-02��P�Y r�C�"> �I"D'CF'U��Y �t-'co2