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Home My WebLink About17576 (10) CITY OF DIAMOND BAR f - ��` DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES J I ! 21825 E.Copley Drive I � (909)860-3195 Fax(909)861-3117 PRESS � ��^� BUILDINGPERMITAPPLICATION FfRMLY � JOBSITE �y b; o DATE CATION " NU B p r�� #�C `�j_ ¢ ADDRESS��r.r��0 5' ,Y ,5' � b � � J �y � APN LOT TRACT �SSUE _ _rl TYPE C p OWNER DATE � ONST. GROUP p ADDRESS�I "- ZONING SETBACKS z CITY �'��p�� ZIP TE g FRONT RW n p PLICANT EL.6 REAR � Z SIDE/SIDE STFiEET Ryy � a CONTRACTOR_ SIDE � � ADDRESS � ��TY ZIP TEL. PROPOSED USE 2 "3TaC'( ►�TA�L�oF�i c� g tq I Lpl�l E9' w ARCH/ENG/ ` w�?H su 4-r�g��,�Rk�� z DESIGNER � �� a ADDRESS NO.DWEL. Np, N� UNITS STORIES � CITY ZIP TEL BEDROOMS � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION O SFR/ADD/REM I HEREBY AFFIRM UNDEF PENALTY OF GERJURV THAT I AM EXEMPT FPOM THE CONTRACTORS LI- GH18 8/Cd Off �W CENSELAWFORTHEFOLLOWINGREASON�SEC.7031.SBUSINESSANDPROFESSIONSCADE:ANYCITVOq (n 9 � U CWNTVWHICHRE�UIRESAPERMITTOCONSTRUCT,ALTER,INVROVE.DEMOLISH,ORREPAIfiANVSTRUC- pyti0/DeCk w TURE.PflIOR TO ITS ISSUANCE.AL50 REQl11RES THE AGP�ICANi FOR SVCH PERMIT TO FlLE A SIGNED W � STATEMENT 7HAT HE OR SNE IS LICENSED PURSUANT TO THE PROYISIONS OF THE CONTRACTOFS LI� � CENSE LAW(CHA77ER 9(COMMENCWG WITH SECTION]oao)OF DIVISION 3 OF TME BUSINE55 AND PRO- � POOUSPB O FESSIONSCODE)ORTHATHEORSHEISE%EMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP� � V TION.ANVVIOLATIONOFSEC710N7091.5BVANYAPPUGANTFORqPERMITSVBJECTS�HEAPPLICANTTO Z Re-Roof � A CIVIL PENAL7Y OF NOT MORE TMAN FIVE HUNDRED DOLLARS(5500).): � ❑I,ASON7JEROFTHEPROPERTV,ORMYEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, � COmmefCiel �O ��.OT1 � Z WILL DO THE WORK,AN�THE STRUCTURE IS NOT INTEN�ED OR OFFERED FOR SALE(SFC.7Cdd,BUSI- J I 1 � NESS M!D PROFESSIONS CODE:THE CONTqACTORS LICENSE LAW�OES NOT AGPLv TO AN OWNER O: f�� 6'��` PROPERTY WHO BUILDS OR IMFqOVESTHEFEON,AND WHO DOES SUCH WORK HIAASELFORHERSELFOp � ��'�-" �y Q 7HROUGMHISORHEROWNEMPLOVEES,PROVIDEDTHATSVCHIMPROVEMENTSARENOTINTENOE�OR m OOFFEREOFORSALEIF,HOWEVER17iEBUILDINGORIAIPROVEMENTISSOLDWITHINONEYEAROFCOMPLE- Z TION,THE OWNER�BUILDER WIIL HAVE THE BUFDEN OF PROVINO THAT HE OR SHE�ID NOT BUI�D OR � IMPqOVEFORTHEPURPOSEOFSALE). �y,� ❑I,ASOWNEROFTHEPROPERTY,AMEXGLUSNELYGONTPACTWGWITHLIGENSEDCONTfiACTORS ' Q TO CANSTRUCT THE PR0.IECT(SEC.�o4a,BUSINESS ANO PROFESSIDNS CODE:THE CONTRACTORS U- .�,( a O �fj� � ADJ.AREA W CENSEIAWDOESNOTRPPLYTOANOWNEROFAPROPEFTVWHOBUILDSORIMPROVESTHEREON,AND � WHOCANTRACTSFOFSUCHPRQIECTSWITHACANTRAC70R(S�LICENSEDPURSUANTTOTHECONTFAC- QUANTITY DESCRIPTION Y roRs ucervsE�aw.�. FEE Q ❑I AM E%EMPT UNOER SEC. 8.8 P.C.FOR THIS REASON J I �i U � DATE OWNER � U � LICENSED CONTRACTORS DECLARATION � ¢ w � IHEREBYAFFlHMUNOERPENALTYOFPERJURVTHATIAMUCENSEDUNDERPROVISIONSOFCHAPTER � d 9(COMMENCMGWRHSECTION70C0)OFDIVISION30FTHEBUSINESSANDPROFESSIONSCODE,AND Z �X MY LICENSE IS IN FULL FORCE AND EFFECT � LICENSECLA55_ L7 LIC.NO. �/ �✓� m � � U DATE_��__�-OZ� CONTRACTOR�/��j�C/�_ d ` W ✓ ...,_ � WORKERS'COMPENSATION DECLARATION Q � I HEREBYAFFIRM IIN�ER PFNALTY OF PERJURV ONE OFTHE FOLLOWING DECtARATIONS: U � Z � _IHAVEANDWILLMAINTAINACERTIFICATEOFGONSENTTOSELF-INSUREFOqWOHKEFS = QGOMPENSAiION,ASPROVIDEDBYSEGTION37000FTHELABORCODE,FORTHEPERFORMANCE U OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. W � � w _.;(�IHAVEANDWILLMAWTAINWORKERS'COMPENSATIONINSURANCE,ASREQUIREDBYSEGTION � Q � 3]0o OFTHE LABOR CODE,FORTHE PERFORMANGE OF THE WORK FOR WHICH THIS FEFMIT IS �� , ' � •��r l� ISSI/ED.MY WORKEFS'COMPENfSATION IN�rSUR,A'N`CE/CAFRIER AND POLICY NUMBERARE: CONSTRUCTION �� U j c^RRiER��TG ricyv� .__ PLAN REVIEW � POLICV NUMBER_ ��'�I Q � Q , � ��T� ELECTRIC . _ � (iHiS5ECl10NNEmNOTBEOJMPLETEDOFTHEPERMRISFORONEHUNDFiEDD01.LAR5($100)ORLESS). PLUMBING w , _ Z I CERTIFV THAT INTME PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL � C'} SHqLL NOT EMPLOY ANV PERSON IM1 ANY MRNNEF SOAS TO BECOME SUBJECT TO THE (/� WORKEftS'COMPENSATIONLAWSOFCAUFORNIA,ANDAGREETHATIFISHOULOBECOME INSPECTIONFEE ? SU6JECTT07HEWORKERS'COMPENSATIONPROVISIONSOFSECTION370aOFTHFLABOR �•� ., CADE,I SHALL FORTHWITH COMPLV WITH THOSE PRO IONS. ISSUANCE 0 p DATE:�_/. s�;-v�__ qppLICqNT: SMIP W � WARNING:FqILUflE TO SECUflE WORKERS'COMPEN qAGE IS UNLAWFUL,ANO SHALL BE ENERGY P/C J �^] �^�- � SU&IECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAN� ENERGYPERMIT ?y�� ] � , 'T DOLLAFiS(S I OD,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PPOVIDED FOR IN J SECTION 3708 OF THE UBO�COC1E,INTEREST,AND ATTORNEV'S FEES. � w FETENTION FEE: � CONSTflUGT10N LENDING AGENCY PRE-ALT FEE: � 1 HEREBV AFFIRM UN�ER PENALTY OF PERJURV THAT THERE IS A CONSTPUCTIpry LENDING AGENCV n- FOR THE VERFOR4AANCE OF THE WORK FOR WHICH THIS PEflM1T IS ISe"UED�SEC.309],CN.C.). W ` � LENDER'S NFME _ , %- H LENDER'SAD�RF55__ �� ICER7IFYTHATIHAVEREAOTHISAPPJCATIDNANDSTATETHA7THEABOVEINFOflMATIONISCORRECT. TOTAL FEES `� � J l-�1 � IAGREETOCOMPLVWITHALLCITYANDCOUNTYORDINANCESANDSTATElAWSRELATINGTOBl11l�ING J \ � CONS7RUCTION,ANDHEREPVAUTHORREREPRESENTA7IVESOFTHISCOUNTYTOENTERUVONTHE J Z FBOVE-MENTIONEDPROFERTYFORINS�ECTIONPURPOSFS. 0 COMMENTS J � m PERMI7"fEE NAME(PRINT) Q � _ Uj SIGNATVREOFPEFMITTEE DATE � � F RECPT.N0. PAID BV VALIDATION WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy 4, #� �.m� - S `.�.�n n. sdV�C��Aaa w. st�F �. . � � . .�" • ' . .. .. _. .. .. ..,... ,: y„ b/�l�z � �� _ �� ,, � �� . r�;;..3�� ss�.� s-c�� C� _ / � � -- �2 w�otl�I.a�C.rr�� >.�/�� --�. ., � �� _ , � � �,e ��- � iF�aR- s+#kt'��_oK �s�:�t� _ _ . _ _ __ �•3-�2 sau'- P�.1-1E N(uuua cF SECcu� Ptt�c2 iwYu.S 4u- +d� - _ _ /'p -��'= 6� /110 `,P�f Pl��'��s/G _02 �ir/Giiv�� ,�°ic'� ��,1�-��'�' �,� _ _ _ _ _�� .�� _ -�� .� �� -�� _ — �� d .� � �„�� -; _ �� .. , _ m � e ;� �� _ � ,N, �� , k '� =�}i� ^��r. . . . .. . . ..... .. ` ..._.. � I.f ... . . _ .. .. . ... ... .._. � �. �" �'. . . .,�»�t�,� �.�.... . t i � �� „f�L.�— h —� _<,,� "�'" �",'� � . .,, , s �a , 5 r2� ?�� ,,' � � ' � - -�-,,�_ ,� _ ..�,_. _:_. ..�...�_______ � 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 JOBSITE�y/-b, ADDRESS Zc j.> qD Sf A s ypu a APN LOT TRACT_ OWNER ADDRESStI CITY JSr{p�(ZIP T-7 T-If E4 PLICANT EL. CONTRACTOR_ ADDRESS CITY ZIP TEL. ARCH/ENG/ DESIGNER S'& ADDRESS V�j CITY Air 4,ZIP slal 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 PERMITTO 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 LF 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).): ^ 1,AS OWNEROFTHE 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 OFA 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. ge 7 LICENSE CLASS L7 LIC. N0. // DATE/ 1 OZ�CONTRACTOR D E I�S� 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.57-�76 J aVi 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 SECTION 3700 OF THE LABOR CODE.I SHALL FORTHWITH COMPLY WITH THOSE PRO IONS. DATE:APPLICANT: WARNING: FAILURE TO SECURE WORKERS'COMPEN RAGE IS UNLAWFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. CONSTRUCTlON LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC. 3097,CIV C.). LENDER'S NAME LENDER'S ADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. 1 AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION.AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. PERMITTEE NAME(PRINT) SIGNATURE OF PERMITTEE DATE APPLICATION j„PERMIT�� P/C �- DATE(0 V NUMBER f# 7 ISSUE TYPE C DATE r ONST. GROUP ZONING SETBACKS FRONT RW^ REAR^ SIDE/SIDE STREET RW^ SIDE^ PROPOSED USE 2_ST°�7 g-TAIL/opFIC&_g ulLpl*-I- wI7H saQTEk�i FAft�?r N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREANALUATION SFR/ADD/REM co Garage/Carport W Patio/Deck LL Pool/Spa 0 Re-Roof Z Commercial Q.Oa V /o r m SArBI�$+' 6,9, y a o7sP ADJ.AREA QUANTITY DESCRIPTION FEE J tr U W UL! (.� z -J Z U W IILAlA IV CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING 00 MECHANICAL C x) INSPECTION FEE ISSUANCE SMIP ENERGY P/C 60 ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES 5') 4S COMMENTS RECPT. N0. PAID BY JC�VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy 49/oz(2�I 4enR SHtkr�i ok S�JI Sri 3-(t SOL2-P,.'eT NStU k cF%icMb Fw"2 U*"0- le" 6,;t/1/0 i%PF_'f AXON- 1,69 o,f&'GeNrEPAIC,