The URL can be used to link to this page

Home My WebLink About18363 (11) i,ITY OF DIAMOND BAR �-N�� •� � � �,�/�� J(''� DEPARTNiENT OF COMMUM"I'Y&bEVELOPMENT SERVICES N�, �"''' / -• S � ..; � 21825 E.Copley Drive � � � �� (909)&60-3195 Faac(909)861-3117 PRESS � �� BUILDING PERMIT APPLICATION FIRMLY n APPLICATION n PERMIT � p/C, o DDRESS�� I �� • DATE �� NUMBER �� tY °T APN LOT TRACT ISSUE TYPE OCC p OWNER DATE V� CONST. GROUP o ADDRESS ZONING SETBACKS z CITY ZIP 7EL. FRONT RW n o APPLICANT TEL._ REAR _ n z - SIDE/SIDE STREET Ryy � Q CONTRACTOR C I � /'I � i SIDE -� ADD SS ` I � CIT� p�+� ZIP� TEL. PROPOSED USE w ARCH/E G�� i f�j p�, � � �` z DESIGNER �d �f'�t�0 � a ADDRESS '--- NO.DWEL. NO. Np. cn UNITS STORIES BEDROOMS � CITY ZIP__ TFL._ _ � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION p SFRfADD/REM p I HEREBY AFFIRM UNDER GENALTY OF PERJURV THAT I AM F.%EMPT FROM iME coNrancroqs u- GaragelCarport W CENSELAWFORTHEPoLLOWIWGREASON(SEG]031.5BUSINESSANDFAOFESSIONSCOUE�.ANYCITYOR (n � GOUNTVWHIGHREQUIRESAPERMITTOGONSTRUCT,AI�ER,IMPROVe.DEMOLISH,CRREPAiRANVSiRUC� W Pd1i0/DBCk w TURE,PfilOfl TO ITS ISSUANCf,ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FIIE A SIGNED W � STATEMENT THAT HE OR SHE IS LICENSED GURSUA�IT TO THE pqOVI51DN5 OF THE CONiRACTOFS LI- � CENSE LAW(CHAPTER 9(COMidENCING W�TH SECTION]000)OF DIVISION 3�F THE AUSME55 AND 7Ro- LL PooUSp2 O FESSIONSCO�E�ORTHATHEORSHEISFXFMPTTM�REFROMANDTHEBASISFORTHFALLEGEDEXEMP� � U TION.ANVVIOLATIONOFSECTION]031.SBYANYAGP'.ICAN'FORAPEPMITSJ9JE(:IS-(M;.A!'{'LICAYTTO Z Re-Roof A CIVIL PENAITV OF NOT MORF THAN FIVE HUNDPEO�OLLARS(SSoo)). Q ❑I,ASOWNERO�THEPROpER�Y,ORMYEMP�0YEE5Wr7HWAGESASTHEI9SOLECOMaEN5hTi0�, � COffIT2fCi31 Z WILL DO THE WORK,ANO TNE STRUCTURE IS NOT IN�ENO[D OF OFFEREO FOH SALE!SEG.7044,BU��.I� _J � NESS AND PROFESSIONS GODL-:THE CONTRAGT[)RS LIGENSE LAW GOES NO"A7P��V TO Alv OWNER OF ? - PROPERTVWFpBUILO50RIMPROVESTHEREON,ANDWHODOESSUCN'NORNH'MSELFORHERSE�FOi7 wTHROUGHHISOFHEROWNENIPLOVEES,PROVIOEOTHATSUCHIMPPOVEMENTSARENOTINTEN�EDOR m � OFFEREDiORSALE.IF,HOWEVLR,h1E8UILDMGOiiIMPROVEMEM1'ISSOtDWITHINONEYEA90FIX7MPLE- � TION,THE OWNER-BUILDER WILI HAVE THE BURDEN OF PFOVING:HAT HE OR SHE�IO NOT 9UIL0 OH � IMPROVE FOR THE GURPOSE OF SALE). w C:I,ASOWNEROF7HEPROPERTV,AMEXC�USNLLYCC1NrRACTINGWITHLICENSEDCONTRACTORS -- � TO CANSTRUCT iHE PR0.IECT(SEC.�o4d,BUSINE55 AND PRO�ESSIONS fODE:THF CONTPACTORS LI- V81U3I10f1 � ADJ.AREA W CENSELAWDOESNOTAPPLV70ANOWNEROrqPROPERTYWHOdUII.D50HIM�ROVESTHEREON,AND — WHO CONTRACTS FOR SUCH PROJECTS W ITH A CONTRACTOq�S)..ICENSCD PURSUANT TO THE CON'RAF � Toasucer+seuw.�. ' QUANTITY DESCRIPTION FEE Y — � L I NM EXEMPT UNDER SEC- ____, B.8 P.C.FORTHIS REASON Q � U LL - -- [L - DAiE OWNEP, F- Z -- _ _-_ __ U � LICENSED CONTRACTORS UECLARATION w I Q 2 1 FtEREBV AFFIRM UNJER PENALTY OF PERJURV 7MAT IAM LIGENSED UNDER PRGVISIONS OF CHAN�EF � �j/ d 9(COMMENdNG WITH SECTIOM ZuoO)Of DIVISiON:i OF TME BUSINESSAND PP.OFESS�iJIJS GODE,AND z y"/ � MV LIGENS�IS IN FULL FOM(:E ANp sEFFECT �� UCENSE CLASS� �'�/ � �IC.J�'O. � y wDATE_____�" _ CDNTFACTOR /� d ` � � U �{�-� `�.� � WORI<ERS'COMPENSATION OECLARATION Q /'� �� , (O � I HEREBV AFFIRM UNDER PENA�.TV OF PERJURY ONEOF THE FOLLOWING�ECLARATIONS: Z Z __I HAVE AND WILL MAINiAIN A CERTIFICA7E OF CONSENT i0 SELF�INSUPE FOq WOF�(ERS' ¢ 2 � ¢ CAMPENSATION.AS PROVIDED BY SECI'ION�100rJ�T11E LADOR CODE,FOR TFIE PERFpRMANCE U , OF TI+.E WORK FOR WHIGH THIS PERMI'IS ISSUE�. w � � w I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE.AS flEOl11FE�AY SFCTION 1--- - O3]�0 OF THE LABOR CO�E,FOR THF PFPFORMANCE OF THE WORN FO W H THIS PERMIT IS ISSUED.MV WOFKER9'�/AGE ION IN511 E CARRIER AND P ICY�BER ARE: CONSTRUCTION J j cnaaiea__� --.L'!l� PLANREVIEW � ZPOLICY NUMBER_ _ __— ELECTRIC � Q � (iHiS5ECT10NN"emNO7BEIX,WIPLETEDOFTHEPEi7MISFCFONEHUAORE�JOLLARS(E1N)oHtFSS� PWMBING W Z I CERTIFV THAT IN THE PFRFORMANCE O�THE WORH FOR WHICF THIS PERMIT IS ISSUEO,1 MECHANICAL � SHALL NOT FMPLOY ANV PERSON IN ANV MANNER 50 AS TO BECOME SUBJE�T TO TME � WORKERS'COMPENSAI"ION LAWS OF CALIFORNIA,AND FGREE TMAT IF i SHOULD BECOME INS�ECTION FEE � SUBJEGT TO THE WORM:ERS'GOMPENSATION PROVISIONS OF SEC�ION 3;OOOF THE LA80R � — -' GOJ,I SH ORTHN'ITH COMPLY WITH T OSE PROVISIONS. ISSUANCE � J� p OATE�� Y APPLICANT: � SMIP � � Jw � ENERGY P/C WAFNING:FAI�URE TO SECURE YlORKERS'COMPENSATION COVERAGE IS UNLAWFUL.AND (/LL BE - � SUBJEGTNN EMPLOVER TO CR MINAI PENALTIESAND CIVIL FINES UP l0 UNE HUNDFED T SNNO ENERGY PEFlMIT Y OOLLARS(f1W.Doo�.INq��ITIUN10IHtCOS�OFGOMPENSATION,OAMAGESASPROVI FORIN J SECTION3]OBOFTHELABORC�DE,INTEREST,ANDAI'CRNEV'SFEES. o� RETENTION FEE: w -- O CONSTRUCTION LENDING AGENCY PRE-ALT FEE � _ � I HEFEBV AFFiFlM UNDER PENAI_TV OF PERJUR�'HAT THERE IS ACONSTR�JCTiUN LEN�ING AGEN(;Y � FOR'HE PEHFOqMANCE OF iHE WOF.1(FOF WYICN THIS P�RMIT IS ISSUEC(SEC.]D91,GIV G.). - — W � LENDEH'S NAM=_____ ___________ F- LENDERSAD�Rf55 _ __"_ _-_..._.... . .___ � - w1 CERTIFY TIIAT I HAVE READ THIS APPLtCATION AYD StATE TMAT THE ABOVE INFORMATION IS GORRECT TOTAL FE ES � I AGREE TO COMPLY WITH ALL(:ITY AND COUNTY OqDINANCESAND STATE U1W5 FELATiNG TV SUILUING • � CONSTRUCTIDN,AND NEREBV i\UTMORIZE FIEPRESENTqTIVES(JF IMIS GOUNTV TO ENTER U�UN THE Z nBOVE�MENiIONt�PROPERTV FOR INSPECTICN PURPOSES. COMMENTS � ___�' r rn r�U�l�,sm� — . — � _ m PERMITTE \AM'(PRINT) �a _��,� �� ---- � � SIf.NAT i .nF P_RU11'E� _- DAT'e �_-— ---- �I — � RECPT.N2 PAI�BY VALIDATION WHITE partmen[Copy,VELI.OW--Finance Cooy.PINK-Assessor Copy,GOLDENR �File Copy,GR N-A licanfs Copy . a , � . . ��,��„ '� u �� .«� � � � �r� �� ; " = �.,� � � � �� o e� � > ,. * . ° ��g ,� � �. � � - � m;�� _�� lll�-�� _ _ . :�.� .; �,; . , _ _ _ _ �� v � �w� � �_ _ (�/�j�L�"L _ �,� F l.^Qi � �L i-�n.�� (} i� `J�J'"� JU s.`� � _. �� • ��:_ � '.> 1 _ . . _�_ _ __ . . --- � �irf� �'�.rv►,r� � �--- ' �� _ __ _ . _ _ _ __ _ _ : — — --- —_ _ , __. _ _ ; '� 9�� I�yFlk 3'0.i`�� - . .. . . . .. . . . . .. ... ' ��I _ __ ."__ . .__. � 1� � k fi y} �� n ,. t S 6� II „ ..... _.. .. ... ... � �� , �,� __ _ �� 1 f'. .�.�� . . .. .... . .. .. .. .... . . . . .... �i 4 , �� , at'-� '. ' - i�,' � - Ip� .. ... . . .. ..... _.... ...._ . .___ � i ,i�s ..1�. ... . . . . . . . ._. ... , � '.� � � .,��. �� ... .. . . CITY OF DIAMOND BAR zAv DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES n�,_[U,I 21825 E C I Dri op ey ve (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION JOBSITE'° ADDRESS'214-W 2 APN LOT TRACT OWNER ADDRESS CITY ZIP TEL._ APPLICANT TEL. CONTRACTOR< /) h Jolla i ADD SS � I CIT ZIP_ TEL.I / DESIGNER G 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 REQUIRES A PERMIT TO CONSTRUCT.ALTER,IMPROVE. DEMOLISH,CR REPAIR ANY STRUC. TUBE,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 S09JEC IS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($5,x)) : - ^ I,AS OWN ER 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,BUTT 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). L: I.AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTlNG WITH LICENSED CONTRACTORS TO CONSTRUCTTHE PROJECT(SEC. 7044, BUSINESS AND PROFESSIONS CODE.THE CONTRACTORS LI- CENSE LAW DOES NOTAPPLY 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). G I AM EXEMPT UNDER SFC- B 8 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 PP.OFE5503NS CODE,AND MY LICENSE IS IN FULL FORCE AND E FECT/I LICENSE CLASS i LIC. N0. DATE 7 CONTRACTOR -Y� 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 FO WHCCH THIS PERMIT IS ISSUED. MY WORKER390MPE�NJ�T ION INSU E CARRIER AND P ICYNUMBER ARE, CARRIER POLICY NUMBER (THIS SECTION NEED NOT BE OOMPLETED OF THE PERMIT IS FOR ONE HUNDRED DOLLARS(5100)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 WORMERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR 0001,I SH ORTHWITH COMPLY WITH Y DOE PROVISIONS. /F DATE 4 APPLICANT: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 115 UNLAWFUL,AND LL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP 10 ONE HUNDRED T SAND DOLLARS 15100,D05). IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVI 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 U ON THE J ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. 3 'rnl&I�m PERMITTE 0 M PRINT) //-r2- SIGNAT RM IT'EE DATE I WHITE-ipartmeTt Copy,YELLOW-Finance Copy, PIN PRESS FI RM APPLICATION v"J PERMIT P/C DATE NUMBER W fY JW ISSUE ,r TYPE OCC DATE v v CONST. GROUP ZONING SETBACKS FRONT RW F] REAR F1 SIDE/SIDE STREET RW ^ SIDE ^ PROPOSED USE N0. DWEL. N0. N0. UNITS STORIES - BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREANALUATION SFR/ADD/REM Garage/Carpor U) t W Patio/Deck U Pool/Spa 0 Z Re-Roof Commercial Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U ICE H- U W W C7 • ,•/ Z ct J ff :Ilk I C) 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 RECPT N0. 1 PAID BY VALIDATION