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Home My WebLink About18444 -�.f \ �` CITY OF DIAMOND BAR �� E�v � � � DEPARTMENT OF COIviIviUNTfY&DEVELOPMENT SERVICES � 21825 E.Copley Drive -'" (909)860.3195 Fax(909)861-3117 � PRESS `-'-..:� BUILDING PERMIT APPLICATION FIR LY � JOBSITE „� ^ � /+ .�a/„�,n ! APPLICATION � PERMIT � P/C o ADDRESS_�«� � C7 '��v � DATE NUMBER # o ISSUE NPE CC °r APN LOT TRACT___ �_ DATE CONST. GROUP °C OWNER O p ADDRESS ZONING SETBACKS z CITY ZIP 7EL. FRONT RW �� APPLICAN7 TEL. REAR ❑ o SIDFJSIDE STREET RW ❑ mCONTRACTO C SIDE ❑ ADDRESS_�, �L.e�- PROPOSED USE o CITY � alL �"L1�11�a- IP�.� TEL. � �r� w ARCH/ENG/ z DESIGNER — NO.DWEL. NO. NO. a ADDRE55 UtJITS STOAIES BEDROOMS � CITY _ ZIP�_ TFL_ � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION cn � OWNER-BUILDER�ECLARATION SFR(ADDIREM O � I HEPEBV AFFIRM VNDEP PENALTV OF PEFJURY THAT I AM EXEMPT FROM THE CONiRAG70R5 LI- � Garege/Carport W CENSEUWFORTHEFOLLOWINGREASON(SEC.]03�.50VSINESSANOFROFE5510NSCpDE-.ANVCITVOP. U COVNTVWHICHREOUTAESAPERMITTOCONSTRULT,AITEF,IMPROVt.�EMULISH,CRREPAIRANViiRUC� W Patio/Deck Z TURE,PRIOR TO ITS ISSUANGI:,AL50 fiEOUIRES THE APPLICANT fOR SUCH PERMIT TO FlLE A SIGNED w W STAT£MENT TMAT HE OA SME�S LICENSED PURSUANT TC THE 7ROVISIONS OF TiE CON':FACTOaS ti� � CENSE LAW(CHA7TER e(COMMENGNG WiTN SECTION�OOOi OF�IVISION 3�F THE 9USINESS AND PRO- � PooUSpe O FESSIONSCADEIORTHATHEORSHEISEXEMPTTN�REFROMANDTHEBASiSFORTHEALlEGEOE%EMV- U TION.ANYVIOLATIONOFSECTION1031_SBVANYAGPLIC<N�FORAPERMITSU9JFCi5'fH=APPLICAVTTO Z Re-Roo1 � A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDREO OOLLARS ff5oo�)�. Q O n�,pSO4/NEROFTHEPROPER�Y,ORIAYEMPLOVEESW�iTHWAGE5AS1HE1RS�lECOMPENSATiON, COn1TBfCi81 Z WIL�DO THE WORK,AND THE STRVCTURE IS NOT INTENDED ON OFFEqED FOH SALE(iEC.7U44,BU`��- J � NESS ANO PHOF�SSIONS CODL:THE CONTRACTORS LICENSE LAW OOES NO�AFPLv TO AN OWNEF OF = PAOPERTYWFIOBIJILO50RIMPftOVESiHEREON,ANOWHO0UES5l.'CH'NORKH'.MSELFOflHEftSE'�_FCF m � THqOUGM HIS OR HEROWN EMPLO7EES,PROVIDED TMAT�UGH IMPROVEMENTSARE NOT INTENDED OR w OFFEREDFORSPLE.IF,HOWEVI:q,THEBUIl01NCOfiIMPROVEMENTiS50LDWITHINONEYEAROFCOMGLE- � T10N,THE OWNER�BUI�CER VI'�lL MAVE'ME BUPDEN OF PROVING'HA7 HE OR SHe 01�NOT 3UtLD OR z IMPROYE FOR iME PURPOSE OF SALE). _ ❑I,ASOWNEROFTHEPFOPERTY.AME%CLUSNELYCCINTRACTINGWITHLICENSEOCONTRACTORS W � TO CONSTRUCT THE PROJECT(SEC.IOGI.BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- V21U3I1011 _ _.___P.DJ.AREA W CFNSEUWDOESNOTAPGLVIOANOWNEROFAPROPER7V1NHOdVII-0SOFIMPROVE'�THEFEON,AND = 4MOCONTRACTSFORSVCHORQIECTSWITNACONTRACTOR(��LICEM1SEDPURSVANTTOTHECONTqAG- OUANTITY DESCR4PTION FEE , ~ TORSIICENSEUW.j. Y J � �:I AM EXEMPT UNDEF SEG B.8 PC.FOR THIS REASON � �i -' � � OATE OWNER . __'_�__ ~ U Z w � LICEtJSED CONTRACTORS DECLARATION W Q � 1 HEFEBV AFFIRM INDER PENALT'Y Of PEflJUFiY'HAT I AM LICENSED JNDER PROYi510N5 GF CHAPTEH � p, 9(COMMENCING WI7N SECTIOM]oo0j OF DiVISqN 30F TME BUSINE55 FND PPOFESSiONS CODE.AND Z X MV IICENSE IS IN FULL FORCE NND fFFEGT. m W f � LICENSE CL4SS �/��1�� _ LIC.NO. �f/� !�___ � ('� J V OATE__��JL CONTRACTOR� _ d W ` � WORICERS'COMPENSATIONDECLARATION U �JC� WG � � I HEftEBY AFFIRM UNOER PENAI_TV OF GERJURY ONE OF THE FOLLOWING DECIAqATiONS: • � � Z 4 � IHAVEANDWILIMAWTAINACERTIFICATEOFCONSENTT�SELF;NSUFEFORWORKERS' _ � Z COMPENSATION.AS GROVIDEO BY SECTION 3100 fJF THE�ABOR CODE,FOR THE PERFORMANCE `U ¢ OF THE WORK FOF WHICH THIS PERMIT IS ISSUED. � � W I HAVE AND WILLMAINTAIN WORKERS'COMPENSATION WSUFANCE,AS REOUIRED BVSECTION Q `3�00 OF THE LABOR CO�'lE.FOR THE PERFORMANCE OF THC WORK FOR WhICH 7NI5 VERMI?IS ISSl1FD AAY WORKE 5'COMPENSATION INSURANCE CARRIEA AND POLICY NLJMBERARE CONSTRUCTION — � CARRIER �_�� ;,p�� PLAN REVIEW _._ � coucv NUMeEa�"�� -- FLECTRIC __ z ¢ (iNISSECiIONNEmN073ECOMPLE�'EDOFTHEPEWMISFOHCNEHUNDREDDCl1ARS(Et001�LE55). PLUMBING . � � w MECHANiCAL Z I CERiIFv THAT IN THE PERFOPI.AANCE Of THE'MORK FOR WHICH THIS PERMI7 L ISSUED,I (} SHALI NOT EMVLOV AN'/PERSON IN ANV MANNER SOAS TO BECOME Sl16JE�T TO THE INS?ECTION FEE � WORKERS'COMPENSATION LAWS Of CAUFOR�IP,AND AGPEE'HAT IF I S�+OUIO BECOME -- SUBJCCT TO THE WOHIfEPS'COMPENSATION PROVISIONS OF SEGTION 3]00 OF THE LABUH �_ � GODE.ISHALLFOFTHWITHCOMPLYWITHTMOSEPqOVI510N5. ISSUANCE _ __` � ` SMIP — � p DATE:��S.:��' APPUCANT: �� - J ( ENERGV P/C J WARNING�.FAILVPFTOSECVREWOFlKERS'COMPENSATIONCOVER�GEISUNLAWFULANDSHPLLBE � SUBJECTANEMFLOVERTOCLiIININALPENALTIESANOCIVILFMESUPTOONEHUNDRE�THOUSAND ENERGYPERMIT DOlLAftS(SICOOC9),IN AODITiOIV TO THE COST OF CCMPENSAT'ON,DAMIIGES AS PflOY'AEC FOR IN T� J SEGTION 31UE OF THE LABOR CI)11E,INTEREST,ANOATTORNE�'S FEES_ RETENTION FEE: — . � 2 w CONSTRUCTION�ENDING AGENCY PRE-ALT FEE: d _ __ — O � IHEFEEYAFFIRMUN�En�CNAITYOFFERJURYTHATTNERE�SACONSTFUCTIONLENOWGAGENCY � FOR THE PER�ORMANCE DF THL-WORK FOR WMICM TMIS PERMiT IS ISSUED(SEC 309I,GIV.G.). Z — W S LEN�JER'SNAME __ . I � H LENDEP'SAJJnt.SS___ --- -- /� _ r✓ry� � TOTALFEES Yl , � I CFRTIFv iHAT I MAVE FE40 THIS hPPI�CATION 4HD STATE 1h1AT THE A80`lE INFORMAT�ON IS COFFEGT. 'j�%�j� n y w I AGREE TO COMf'LV WITH ALL CITY 4ND COUNTY OFDINANCES AND STATE LAWS fiELATING TO BUIL�ING r � V � CONSTRUCTION.AND HEREBY AUTHORIZE REPRESENTATiVES OFTHIS COUNTV TO ENTEH UPUN THE Zq80VE-MF�TIONE�PROPEFTY FOR INSPE�T�ON PURPOSES. GOMMENTS_ _ _ . � — � � _. — .... � m PEFMITTEE NAM PRINT) . � - t,�.. � ..-�- ��-- -- � SIG RE OF PE I OATE RECPT.YQ PAID BV VALIDATION 2 — ~ WHITE—DepartmeM Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOIOENROD—File Copy,GREEN— ppli nPs Copy r:� ; r .�� d- . � .�a � ��_ � �� _ _ _ _ . _ f�1�-1,�- /�� . ��. �,��_�rR�� _ ' � __ . __.__ �-i:3t� �'`C I��'t � 5�..t��e�( �_ _ _._ _ _ _ _ _ _ _ _._ _. ___.__ . _ __ _ ; . _. _.. _ ,_ __ i _ __ .. __ _ _ : __ ; _ _ . ___ __ ��' �� ,, � .,_ r ; _ __ � . �� .��' ��' F ,�,R ��-�k P _ __ _ ia .. �� , � , t, 3.� _ �� _ _ _ �x�� ; � � �� . _ _. �, , � � �G �. �. — �.�. �, � � �� __ _ ��.�. ,a.� . , �y4 � _ _ _ � �w x�� 0 ao Cr O w 0 w 0 0 z m Cr 0 0 w 0 w CIO, GD cr 0 ci w U Z W 0 U I- 0 Z Y) 0 n- >< W 0 U Ljj CA) N ci w ci ci ci Z CD U) t O li W -J LL J Cr EO 0 CC d W F- -.5 cc W R- CI 03 m Gr) Tn IIL%MOXD IIXR 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 ADDRESS CITY ZIP TEL._ APPLICANT TEL. CONTRACTO ADDRESS; CITY Ail IPg TEL.-t^ 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 REQUIRES APE RMIT 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($5w)): C I,AS OWNER OF THE PROPERTY. OR MY EMPLOYEES WITH WAGES AS 1 HEIR 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). C 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 NOT APPLY TO AN OWNER OF A PROPERTY WHO BUII.DS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW). C 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 LICENSE CLASS Gi G lit. LIC. N0,IIf� DATE Iy'��7L 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 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 CARRIER POLICY NUMBER�Z THIS SECTION NEED NOT SE 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 SECTlON 3700 OF THE LABOR CODE.I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS DATE: ��62 APPLICANT. WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVE GE 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 THIS 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 I 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. APPLICATION k Bf PERMIT DATE 14 NUMBER ISSUE TYPE DATE CONST. ZONING SETBACKS FRONT REAR SIDE/SIDE STREET SIDE PROPOSED USE N0. DWEL. UNITS DESCRIPTION SFR/ADD/REM Garage/Carport Patio/Deck Pool/Spa Re-Roof Commercial J U FI R P/C CC GROUP RW^ RW^ N0. N0. STORIES BEDROOMS SQ. Ff. FACTOR PSF Valuation ADJ.AREA QUANTITY H U w W CD Z Ia D a a U Z U W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTlON FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES DESCRIPTION ADJ.AREAIVALUATION FEE PTWGt (L�f YI��_,� COMMENTS WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-ppli nt's Copy ISSUED MY WORKS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE RECPT N0. PAID BY VALIDATION