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Home My WebLink About18755 CITY OF DIAMOND BAR '/��- - ��`` DEPARTMENT OF COIvDviUNTfY&bEVELOPMENT SERVICES }� I Z 1823 E.Copley Drive ( '� (909)860-3195 Fax(9Q9)861-3117 PRESS � ��M BUILDING PERMIT APPLICATION FIRMLY y JOBSITE ��►�� ,�'_L�� ' � ,/�`.,�I�. � APPLICATION ,\ � NUMBER�� #/C �• o ADDRESS_ «7 __ ��,_ DATE U TYPE OCC °r° APN LOT TRACT D TEE CONST. GROUP p OWNER � o ADDRESS ZONING SETBACKS � C��' ZIP 7EL._ FRONT Ryy � o APPLICANT TEL. REAR �� z — SIDFJSIDE STREET RW ❑ a CONTRACTO e.ti • _ SIDE � ADDRE �; — � C�N �. ZIP TEL. — ] PROPOSED USE w ARCWENG/ fl �' z DESIGNER a ADDRESS — - NO.DWEL. NO. NO. � CITY ZIP_._ TFL._ UNITS STORIES BEDRDOMS '� DESCRIPTION SQ.FT FACTOR PSF ADJ.AREA/VALUATION � OWNER-BUILDER DECLARATION p SFR/ADD/REM Q I HEREBY AFFIRM UNDER PENILLTY OF PENURY iHAT I AM F.XEMPT FROM THE CONTRACTORS LI� G3fa e/Ca OR W CENSELAWFORTMEFOILOWIWGHEA50N(SEC.7031.SBUSINESSANDPFOFESSION5�'ADE:ANVCITYOR (n 9 � U cOUN7VWHICHREOUtRESAPERMITTOCONSTRUCT,AISER,IMORC�VE.DEMOLI.SM.ORiiEFn�aANv,7aUc. P81i0/DBCk w TURE,PRIOR TO ITS ISSUANC[.AL50 REQUIflES THE APPLICANT F�R SUCN PERMIT TO FILE A SiGNED W � STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIDN$OF THE CONiRACTOqS ll� � CENSE LAW�CHAPTER B(COAIMENCING WITH SECrION]000�OF D'V�SbN 3(�F THE BUSMESS hND PRO- � POOUSPO O FESSIONSCADE)ORTHATHEOPSHEISE%EMPTTH�REfROMANDTHEBASISFORTHEALIEGEDE%EMP� � V TION.ANVVIOLATIONOFSECTIDNl031.5BYANVAVPLICAN�FORAPERMITSJ9JEG�5"fH�qpp�ICqV77p Z Re-Roof � A CIVIL PENALTY OF NOT MORE THAN FIVE MUNDREO DO�URS(5500�.)�. � Q ❑I,ASOWNEROFTHEPROPERTY,ORMVcMPLOYEESWiTHWqGE5A5lHEIRSOLECOMPENSATiON, ❑ COffIfTiE1Cl01 Z WILL DO THE WORK,AND THE STFUCTUFE IS NOT IMENL�[D ON OFFEFED FOH SALE!SEC.7044.BUEI- J � NE55 AN�PROFESSION$CODI=:THE CONTRACTOFS IICENSE LAW DO'eS NO'APPiV TO AN OWNER OF � DROPERTV WHO BUILDS OR IMPROVESTHEREON,ANO WHO DOES SUCH WORK HIMSELF oR HERSELFOR Q THROUGH HIS OR HEROWN EMPLOVEES.PROVI�ED THAT FUCH IMGROVEMENTSARE NOT INTENDEDOR m QOFFEREDFORSPLE.IF,HOWEVLR,THEBIIILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE- Z TION.TNE OWNEp�BUIL�ER WILL HAVE 7HE BUFDEN OF PqOVING:HAT HE OR SHE�I�NOT BUILD OH � IIAPROVE FOR THE PURPOSE OF SALE). w ❑I,ASOWNEROFTHEPPOPERTY,AMEXCLUSNELVCONTMCTINGWfMLICENSE�CONTRAGTORS _ D . � TO CONSTRUC7 THE PRQIECT(SEC.]Ja6,BUSINE55 ANO PqUFE551UNS GODE:THE CONTRACTORS ll- V81118fIDf1 ADJ,AREA W CENSELAWDOESNOTAPPLY70ANOWNEROFAPROPEHiYWHOdUII.D50HIMPROVESTHEREON,AND — I = YMOCANTRAGTSFORSUGHPROJECTSWITHACONTRACTOR(S�IICENSCDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE ~ TORS LICENSE LAW.�. Y � G I AM EXEMPT UNOER SFC. _ B.fl PC.FOR THIS REASON Q � U LL' DATE OWNER __"__�� '— � Z U � LICENSED CONTRACTORS DECLARATION W Q � I HEREBY AfFIqM UNDER PENN_TV OF PERJURY'HAT I AM LICENSED UNDER PROViS1ON5 OF CHAPTER � p_ B(COMMENCING WITN SECTIOM 7000)OF DIVISION 3 0F THE BUSINESSAND PPOf-ESSioNS CODE.ANO Z �X MY LICENSE IS W FULL FOPCE I\ND EFFECT. m � UGENSE CL4S5_��--�-r _ LIG.NO. �L • � U DATE__.�,�___�;:�-r:)_�2pNTRACTOR_ __ � � W � WORI(ERS'COMPENSATION DEGLARATION Q � I HEREBV AFFIflM LINDER PENA�_TV OF PERJURv ONEOF THE FOLLOW WG DEC�ARATIONS: V C� Z � �HAVE AND WILL MAINTAIN ACERTIFICATE OF CONSENT TO SELF�INSURE FOF WOHKERS' ¢ Z = Q COMGEnSATION,AS PqOVIOEo BY SECTION 37ooOF TME LABOR CODE,FOR THE PERFOFMANCE U OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. W � � w �1 HAVE AND WILL MAINTAIN WORKERS'COMPENSAi iON INSURANCE,AS REOUIRED BV SECTION Q310o OF THE LABOR CODE,FOfi THE PERFORMAkCe OF THE WORK FOR WHIGH THIS PERMI7 IS i55'JED.Mv WORKERS'COM 5 7ION INSURANCE CAqRIER ANO POLI� NUMBER AFiE' CONSTRUCTION / J j CARqIER `� ___� PLAN REVIEW �1, Zaoucr NUMeEa_ ELECTRIC �+�_— Q �/�L-__ � �issEc�ar�NEmrareE�rna�ErEooFn�E�w.uriswr;ow[HuroAE�oauqs�siro�oq�Ess�. P!UM81NG __ w Z I CERTIFY THAT IN THE PERFpqMANGE OF THE'NOflK FOR WHICH iH15 PERMIT IS ISSUEO,1 MECHANICAL C� SHA�L NOT EMPLOY ANY PEfl50N IN ANY MANNER SO AS TO BECOME SUBJEf.T TO TNE (/� WORKERS'COMVENSATION lAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INS?ECTION FFF ? SUBJECTTO THE WORNERS'COMPENSATION PROVISIONS OF SFC?ION 3�0o OF THE � CODF.I S ALL FORTHNITH COMPLV WITH THqBE 7ROVISIONS ISSUANCE � � p �ATE: � ' "'- L�PF'LICANT: �'� SMIP ._ d _ . �� "J WARNING FAILURE TO SECURE WORKERS'COMPENSATION CAVERAGE IS UNLAWFUL,AND SHALLBE ENERGY P/G J � SUBJECTANEMPLOV'eRTOCRIUINALPENALTIESANOCIVILFWE5l1PTOONEH'.INOREDTHOUSANO ENERGYPERMIT OOLLAR$(f100.000),IN ADDITIOY TO THE COST[Jf COMPENSATION,DAMAGES AS PROVIDED FOR IN J SECTION3)080FTHElABORC�JDE.INTEREST,ANpATTORNEV'SFEES. � RETENTION FEE w O CONSTRUCTION LENDING AGENCY PRE-ALT FEE: _ � IHEPEBVAFFIRMUNDERPEhM1AI.TVOFPERJl1RYTHATTHEREISACONSTRl1C"IONlFNf11NGAGENCY FOR THE PFHFOPMANGE OF'HE WOFK FOR WHICH 7HIS PERMIT IS ISSIIF[1(SEC.3091,CIV C.). ._ Z W � LENDcH'SNAAAE_ _ _ � I— LENDcR'SAD�FESS � � TOTAL FEES � U�y I Q, � I CERTIFV THAT I HAVE READ THIS APP�ICATIONANO STATE THAT THE A60VE WFOaMATION IS f;ORRECT w 1 AGFcE 70 COMPLY WITH ALL CITV ANO COUNTV OR�INANCFS AND STaTE LAWS REIATING TG AUI�D�NG � � � CONSTRUCTION.AND HEREBV ALITHORI2E REPRESENTATIVES OFTHIS COUNTV TO ENTER I�PON THE Z ABOVE-MENTIONFfI PROGERTV FOR INSPECTION PURPOSES. � COMMENTS � �a �'7 ��__ � �� ` m PERMITTFENAME(GqINT � � �i�c � ��__.' ._ _— � S'�GNFTIiqEOFPERM'�7TE�� - � RECPT NO. I PAID BY VALIDATION WHITE—�epariment Gopy,YELLOW—Rnance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—ApplicanPs Copy � �.�� , a,�� _ "�� _ �� ° ��'- �'x � � �� . � : 4 # . - . . ,,.. �. _ /��'��1—. �9• �� . _ _ 1�i/�� _ — � _ ��. � . �� _ __ .. ___ _. _ _ _ ____. _ _ _ _ . _ _ ; _ _ _ _ ._ a _ _ . _ __ _ _ _ _ � s . �� w �.r� ��.�� , � E _ _ .__. � � �` �, �� :�� . __ .., � i�'�,�� P = �s�i " � ,�;�1 4y��Z,{1 1�11 �. ., .: , Fl , o� . ... . .. . . . ... .. . . . ..... ... ._ ._..._.. . � _.... __... __ ; t: , ��` ' ' ' . ....... .. ._.. . ...... .. . .. , , �.. .�,: � . .. ._. .. _.... . ... ._ __.. .._. .. .._. ._.. .... . . ! t�� i - �n; { } �;R, �."; �. . ... . . .. . . .. .. . . . .... _ ... . _.. ..... b<,� �. , .. .... . . . .. . .. . .. . . .. .. .. ... .. ._ .. .._. .. . � .. r� k � �.�..'` Y � �� .... _. ...... ......... . . . .. .. .. .... ..... .._._ .. .... ... .. . ... .. ��.� . �. . ,. __ _.,,....___.„,,. _ �, 0 0 Q Iir d X W 0 F (_3 W U) Cn uJ W J d W Z 0 U) 0 W J J E- J Cr W CL 0 CI Q W 2 W U) 00 C/) I CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION ADDRIESS-a)• APN LOT TRACT OWNER ADDRESS CITY ZIP TEL. APPLICANT TEL. CONTRACTO 1_ ADORE CITY ZIP_TEL. ARCH/ENG/fl 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(SSW)): ^ 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.). G 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 B(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. DATE�ONTRACTOR 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' COPENSATION.AS PROVIDED BY SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMANCE .1M HE WORK FOR WHICH THIS PERMIT IS ISSUED 1 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'COM S TIONINSURANCE CARRIER AND POLI JV NUMBER ARE CARRIER�"QL POLICY NUMBER 117 �,-3' (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 CODE,I S ALL FORTHWITH COMPLY WITH THQBE PROVISIONS DATE: "LAAPLICANT: {Jr•W--7 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 -L 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. 1"1 t, PERMITTEE NAME(PRIN SIGNATURE OF PERMITTEE��' DATE APPLICATION PERMIT IJ V-P/C_5 DATE NUMBER ISSUE TYPE OCC DATE CONST.GROUP ZONING SETBACKS FRONT REAR SIDE/SIDE STREET SIDE PROPOSED USE N0. DWEL. UNITS DESCRIPTION SFR/ADD/REM Garage/Carport Patio/Deck PooVSpa Re-Roof Commercial RW^ RW^ N0. N0. STORIES BEDROOMS SQ. Ff. FACTOR PSF ADJ.AREANALUATION Valuation ty"OO,z_yp ADJ AREA QUANTITY Q Z 0 W ii CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTlON FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE DESCRIPTION TOTAL FEES U'Y COMMENTS WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy FEE Sb 3� yo IV PRESS FIRMLY