The URL can be used to link to this page

Home My WebLink About18299 i � �� CITY OF DIAMOND BAR � � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES _,:� 21825 E.Copley Drive (909)860-3195 Fax(909)861-31 L'l PRESS ��• BUILDING PERMIT APPLICATION FIRMLY o DDR'ESS_��4V� �Q�'`/��`-[ �' /�^''� ATECATION �_ PERMIT Q� �' p(C NUMBER J # �� ,.� W APN LOT TRACT D TEE JO C� � TMPE OCC ¢ �� CONST. GROUP p OWNER _Co"W/C•/Y IY��%��L— p ADDRESS �..�VY1�-- ZONING SETBACKS z C��1' ZIP ._ TEL. FRONT RW ❑ p APPLICANT _ _ TEL. REAR � z SIDE/SI�E STREET qyy � a CONTRACTOR ��I �d�' //t� • SIDE � ¢ ADDRESS__� ' O ' � CITY lNl7L^,��-� ZIP 9� TEL. Z'(� /�' PROPOSED USE o ARCH/ENG/ z DESIGNER a ADDRESS NO.DWEL. NO. NO. � CITY ZIP___ TEL._ UNITS STORIES BEDROOMS � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION p SFR/ADD/flEM Q I HEREBV AFFIRM UNDER PENALTV O'F PE(iJl1RY iHAT I AM EXEMPT FROAA THE CONTRACTORS l.l- G8f8J8/CBfpOfl W CENSEIAWFORTHEFOLLOWINGREA50N SEC.'l031.5BUSWESSANDPROFESSIONSCADE�.ANVCITVOR ((� ZCOUNTYWHICHRE�UIRE51\7ERIAITTOCANSTRUCT,ALTER,IMPqOVE,�EMOLISH,OflflEPAiHANYSTFUG W Patio/Deck W TURE,PRIOR TO ITS ISSVANCE,ALSO REOUIRES 7HE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w � STATEMEN'THAT HE OR SHE IS LICENSE�PVRSUANT TO THE PROVISIONS OF TME CONTRPCTORS L,- � CENSE UW(CHAPTER e(Q�MMENCING WITH SEC710N]000)OF�IVISION 3 OF THE BUSINESS AND Pft0- � POOUSPB Q FESSIONSCODE)ORTMA7HEOFSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALIEGEDEXEMP- (� U TION.ANYVIOLATIONOFSECTION7031.58YANYAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO Z Re-Roof � ACIVILPENALTYOFNOTMORETHANFIVEHUNDREDDOLLAqS(S5a0)J: Q ❑I,ASOWNEROFTHEPROPERTY,ORMYEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATIOn, � Commerciai Z WILL DO THE WORK,ANO THE STRUCTURE IS NOT INTENDED OR OFFER'cD FOR SALE(SEC.7044,BU51- J � NESS AND PROFESSIONS CODE:7HE CONTRACTORS LICENSE LAW DOF.S NOT APPLV TO AN OWNER OF ? PROPERTV WHO BUILDS OR IM PROVES iHEREON,AND WHO OOES SUCH WORK HIMSELF OP HERSELF OR w THROUGHHISORHEROWNEMPLOVEES,PROVI�EDTHATSUCHIMPROVEMENTSARENOTINTENDE�OR m Q OFFEREDFORSALEIF,HOWEVER,THEBUILDINGORIMPPOVEMENTISSOLDWITHINONEVEAROFCOMPLE- Z TION,THE OWNER�BUILDEFI WILL HAVE THE BURDEN oF PROVING THAT HE OR SHE�ID NOT BUILD DR � IMPROVE FOR THE PURPOSE OF SALE). �y,� �I,AS OWNEROFTHE PROPERTV AM EXCLUSIVELVCONTRACTING WI7H LICENSED CONTRACTORS � TO CONSTRUCT THE PHQIECT(SEC.7oa6,BUSINE55 AND PROFESSIONS CODE'THE CDNTRACTORS LI- V31UatiOn • ADJ.AREA W CENSELAWDOESNOTAPPLYTOANOWNEROFAPROPERTVWHOBUILDSORIMPROVESTHEREON,AND = WHOCONTRACiSFORSUCNPROJECTSWITHACONTqqCTOR(5)LICENSEDPUFSUANTTOTHECONTRAG QUANTITY D SCAIPTION FEE ~ TORS LICENSE LAW.). Y Q �I AM E%EMPT UNDEfl SEC. _8.8 P.C.FOR THIS RtA50N Q � U � DATE ONMER ¢ � LICENSED CONTRACTORS DECLARATION w Q � I HEREBVAFFIRM UN�ER PF'NALTV OF PERJURV THAT 1 AAI LICENSED UNDER PROVISIONS OF CHAP7ER � d 9(COMMENCING WITH SEC7'ION 7000)OF DNISION 3 0F THE BUSINESS AND PROFESSIONS CODE,AND Z `X MY LICENSE IS M FULL FORCE AND EFFECT m � LICENSE CLASS__C'� ��C.No. �P Y'YY G�J �+ � V DATE__��U�- CONTRACTOR �'�� d�2- !/ d W � WORKERS'COMPENSATION DECLARATION Q = U � I HEflEBV AFFIRM UNDER PENALTY OF PERJURV ONE OFTHE FOLIOWING DECURAilONS: � Z 0 _I MAVE AND WILL MAINTAIN A CERTIFlCATE OF CONSENT TO SE�F-INSURE FOR WORKERS' ¢ Z = ¢ COMPENSATION.ASPflOVIDEDBVSEC710N3]OOOFTHELABORCODE,FORTHEFERFORMANCE U OFTHE WORK FOR'�NHICN THIS PERMI115ISSUEO. W � � � _IMAVEANDWILLMAINTAINWORKERS'c;OMPENSATIONINSURANCE,ASRE�UIREDBYSECTION � 37000FTHE LABOR CODE,FORTHE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ��l/� ` O ISSUED.MY WORKEq��}o'7MPpEN�SATION T�INSURANCE CARRIER AN�POLICv NUMBEFARE CONSTRUCTION . `, � j caaaiEa �'�'/� T�f/�� PLAN REVIEW � Z POLICVNUMBEA__�G� � !JL �d�/O ELECTRIC � ¢ � (lF71SSECTIONNEm�pTBE0.�MPLEfEDOFTHEPEFhVTISFOHIXJ_HUNDf7EDD011AR5�E700�ORLESS). PLUMBING W Z I CERTIFVTHAT INTHE PERFORMANCE OFTHE WORK FOF WHICN THIS PERMIT IS ISSUED,I MECHANICA� C,�J SHALL NOT EMPLOVANY PERSON IN ANY MANNER SOAS TO BECOME SUBJECT TOTHE [,/� WDRKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULO BECOMG INSPECTION FEE SUBJECTTOTHEWORKERS'COMPENSATIONPROVISIONSOFS[CTION9l000fTHEUBOP + ---- � COD ISHAL}FORTtIWITHCOMPLVWITHTHOSCPROVI510N5. ��}- ISSUANCE O y7Jd'�' � �,yC(� . p DATE�. L "� _ qPpLICANT� ��_"�� '" — SMIP � l.�__ J WARNING�FAIWRE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AN�SHALL�E ENERGY P/C J � SUBJECTANEMPIOVERTO�RIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOLURS�SI W,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGESAS PROVIDED FOR IN J SECTION 9]OBOF THE LABON GO�E,INTEREST,ANOATTORNEY'S FEES. \ ' -..�� w RETENTION FEE: V _. � CONSTRUCTION�ENDING AGENCV PRE-ALT FEE: _ � I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS ACONSTRUCTION LENDING AGENCV FOR THE VERFORI.IANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUE�(SEC.309],CIV C.j. -- -�-'-�- Z W j IFNDER'SNAME � H LENDER'SADDflE55 wI CEPTIFYTNAT I HAVE REA�THIS APP�ICATION AND STATE THATTHEABOVE INFORMATION IS CORRECT TOTAL FEES 5 � IAGREET0006APLVWITHAI.LCITYANDCOl1NTVOR�INANCESANDSTATELAWSRELATINGTO6UILDING � / � CONSTRVCTION,ANDHEREFIVAUTHOfi12CREPPESENTATIVESOFTHISCOUNTViOENTEFUPONTHE "� ��+\�`-� Z ABOVE-MENTIONE�PROPEF�,TVFOflINSPECTIONPURPOSES. COMMENTS � _�vm�G� d%�rL,e'�,c� __ � � __ m PERMITTEENA RINT) � __��r 2 2 ts 2 � � SIGNAT REOFPERIAITTEE � � p-E � ' � RECPT.NO. s �✓ PAID BY VALIDATION WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy � r�,�� aF,�:;a � k � �ff ak� � . ��iL _ � . � : . 9�' �� .� . t , a . . . : , . .a,t �vPoe�.�� "kG. .. � . . .. . .� .. . ...� . . .. ...� .. /��[ V/..��'i� �I�v� �� • � ; ... . ... /�' ... . . . . . . .... ... ��M./ .. .rl ....��. ._.`� . 1�1�G�- � I , , �� w . �• ,....��: �4 .=er`' .� ...._ . . .. .. . ... .. ',. . . ,. . . ....... ... . .... . . ... . ... . . _.. _.. . »p �F , � d 9 r WI ;'_�fiii . o"- . ... . . . . .... .. � � o-'_ � �, i .. ... .. .. .. .... .... . _.. ._ . .._ . t< �� + t �t r-� 13 ��.` . x'ib � z�al �r , �IE �,t� `'�. . ..._ .._. .. ._. ._. .._.. I � _ _ �.._ a ,. a �., . ... .. ... . ... . . ... �. � ,. a ° � t r : ... ._. . j � . . i = "§ � ' .. ._ .. .... . .... .. .._.. .. �-..� a ` 3 ... .. . � ,�`s..� �e�� '"'"' _.. .... �. . , . ... .. . ... ... . . . . 3. <'� ., . . ... . _.. _. �� yi_ .. _ . ... �. , _ i �� u r°•iu:��. . .... ... . . ... ... . . .... . ...... .. .... � � „ t .i� 5 ,- i , . .._ . . ... . .. . . .. . .. . . .. � . ,. �� E ��,. �� .: ' �� . ... . •�... .9t�°i . �.,�;= _ .... — .. . . ... . . — .. . ..... .. . _.. __ ._.. .._ ._ . .__ . 6 DIAMOND BAR i 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-(0 . ADDRESS ..anc-- CITY ZIP TEL. APPLICANT TEL. CONTRACTOR 6 a toe f/tIF ADDRESS-F(' 130 CITY LIVV^�-M ZIP V17/-r 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 BUSINESSAND 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 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(5500).): ^ 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.BUILDEFI 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 A CONTRACTOR(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 LICENSE CLASS LIC N0. IP Y'YY �?J �rs DATE�U CONTRACTOR,Sc�p d�2- r� 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 WORKE, MMPE�NSATION INSURR�ANNCCE CARRIER AND POLICY NUMBER ARE: CARRIER"/'• ' ! ' ^' 7��-.i�� // POLICY NUMBER{s7_(L 0 .�f (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 COD 7yI SSHHAALLL,FORTHWITH COMPLY WITH THOSE PROVISION DATE S u,P�p :APPLICANT WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. CONSTRUCTlON LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC. 3097,CIV C.). LENDER'S NAME LENDER'S ADDRESS CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPEFTY FOR INSPECTION PURPOSES. PERMITTEE NA RINT) /rtI 2;Z45 z NATURE OF PERMITTEE ATE WHITE-Department Copy,YELLOW-Finance Copy, PIN PRESS FIRMLY APE CATION_ PERMIT p/C�j C$ N UMBER ISSUE O TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ^ REAR F 1 SIDE/SIDE STREET RW ^ SIDE EI PROPOSED USE N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM Garage/Carport W Patio/Deck U Pool/Spa 0 Z Re-Roof Commercial Valuation ADJ.AREA QUANTITY D SCRIPTION FEE J U I- U w W DO CL Q U Z U w CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES 2i\5v COMMENTS -------------- RECPT. N 0./PAID BY i VALIDATION