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Home My WebLink About18778 s� '�-I' s�� CITY OF DIAMOND BAR i�i� � � DEPARTME'�iT OF CONIlVILJNI"I'Y&bEVELOPMENT SERVICES I �w 21825 E.Copley Drive (909)860-3195 Fa�c(909)861-3117 E$$ "'%.�� BUILDING PERMIT APPLICATION FIRMLY ¢ ADDRIESS��) ��'L-Y�f�itN S !L!NC5 D� b I?) APPLICATION , � �/��pERMIT i�� p/C U�� o DATE v NUMBER 1 � � � LOl" TRACT DA EE � � �� CONST. GROUP p �R S R'�� n,L .LN�I2q'�V GC =— p ADDRESS ��3CfS vts12A IZa+9"b ZONING SETBACKS Z CITY WFS'C�.A'e-N� VL(�IP 913/�37EL.�-�/-�3'1 FRONT RJV _ ❑ � APPUCAN�'`�`� a-�YJ� TEL �� REAR _ _ � z SIDE/SIDE STREET R✓V_ ❑ Q CONTRACTOR � � _ SIDE L — ADDRES — � CITY . ZI � TEL. PROPOSED USE �_ � ARCH/EN / � �✓ — iz DESIGNER �" - -- NO.DWEL. NO. NO. = CDDRESS i�IP �X ' UNITS STORIES __BEDROOMS y -1TI� � �L -.l'A/_�� DESCRIPTION SQ.FT. FACTOFI PSF ADJ.AREANALUATION � ��WNER-BUILDER DECLARATION tl ��Y SFR/ADD/REM O p I MEREBV AFFIRM UNDEfl FENALTV OF PERJURY iHAi I AM E%EMPT FROIA THE CONTRACTOqS LI- G8la90/C0fF101I W CENSELAWFDRTHEFOLLOWIMGREASON�SEC.'031.56USINESSANOFFOFESSIONSCODE'.ANVCITYOR (n CJ COUNTVWHICMREQUIRESAPEHMITTOCONSTRI:CT,ALTER,IM�ROVE.DEMOLISN.CRREPAIRANYiTRUC- w TURE PPIOR TO IT5ISSUPNCE.ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FlLE A SIGNED W Patio�Deck STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE 7ROVISION$OF THE CONTRACTORS LI- � CENSE LAW(CHAPTER 9(COMAIENCING WITH SECTION 1J00)OF DIVISION 3 OF THE BUSINESS AN�PRO- � POOUSPB O FESSIONSCADE)ORTHATHEORSHEISEXEMPTTHAEFROMANDiHEBA515FOPTHEALLEGEDEXEMP- � U TION.ANVVIOLATIONOFSECTION7091.5BYANYAPPLICANTFOR>PERMITSU9JECr5fHEAPPLICANTTO Z Re-Roof � � A CIVIL PENALTV OF NOT MOflE THAN F'VE HUNDRED DOlLAFS�f500�)'. ' i O '71.ASOWNEROFTHEPROPERiY,ORMYEMPiOVEESWITHWAGESA57NEiR50LECOMFENSATiON, 0 CORIRIB/Cid1 I Z WILL DO 7HE WOqK,AND THE STRUCTJRE�S NOT INTENDFD OP OFFERED FOH SALE(SEC.704a,BU�I- J � NESS AND PFOFESSIONS CODE:THE CONTRACTORS L'�CENSE lAW DOeS NO�APPLV TO AN OWNER OF '�� PROPEFTVNMOBUILDSORIMPROVESTHEREGN,ANDWHO�OESSUCHWORKHIMSELFORHEPSELFoa � � THROUGH HIS OR HER OWN EMPIOYEES,PROVIDED TNAT FUCH IMPROVEMENTSARE NOT INTENDEn OR m QOFFERE�FORSALEIF,HOWEVEF.hiEBUILDINGORIMPROVEMENTIS50LOWITHtNONEVEAROfCOMPLE- Z TION,THE OWNER-BUILDER WII1 HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUII.D OR � IMPROVE FOR THE PVRPOSE 01-SALE�. W ❑I,ASOWNEROFTHEPROPEflTVAMEXCLU5IYELYCCINTRACiINGWITHI.IGENSEDCONTRAGTORS � TO CANSTRUGT TME PRQIECT(SEG.]064,OUSINE55 AND PROFESSIONS COOE:TNE CONTRACTOHS L.I- V2II18�1Of1 �' ADJ.AREA W GENSELAW�OESNOTRPPLVTOqNOY/NEROFAPROPERTVWHOd'JII.f750FIMPFYJVESTHEFEON,AND F WMOCANTRAGTSFOFSUCHPP�QIECTSWITHACONTRACTOR(SII.ILENS[�PURSUANTTOTHECONTFAC- QUANTITY DESCRIPTION Y TORS LICENSE LAW.). _ FEE QU T AM EXEMPT UNDER SFC. _ e.A P.C.FOR THIS REASON Q � U — � --- ----- -- ¢ — DATE OWNER H � — Z — U � UCEIVSED CONTRACTORS DECLARATION W — ¢ � I HEFEOYAFFlRM UNDER PENAI.Tv OF VERJURY THAT I AM LICENSED�NDER PROJiSION50F CHAPTER � � 9(COMMENCING WITH SECTION 7000)OF DNISION 3 OFTHE 9USINESS AhD P�OFESSIONS CODE.AND Z X MV UCENSE IS iN FU FORCE RND EFFECT. I_ — � ,LIGENSE GLASS� __ LIG.Nn. I Z�)��.�,�_�� ` �� j U DATE CONTRACTOR F±-'�/ _LV C ��b r � — W � WORKERS'COMPENSATION OECLARATION Q — �— � I HEREBVAFFIRM UNDER PFNAITY OF GERJl1FY ONE OF THE FOL�OWING DECLARATIONS: Z Z IHAVEANDWILLMAINTAINACERTIFICATEOFCONSEN7iD5ELF-INSURE%ORWORKERS' ¢ _ Q COMPENSATION,AS VROVIDE�9V SECTION 37ao OF THE LABOfl CODE,FOR THE PERFORMANCE U _ OF THE WOFK FOF WHICH TMIS PERMIT IS ISSUEO. w � � W i HAVE AND WILL MAINTi11N WORKERS'COMPENSATN]N INSURANCE.AS REQUIRE�BV SECTION Q3'/00 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOF WHICHTHIS PERMI'IS �^)(�'�Q ISSVED.MV WORKERS'COMPENSATIOR INSURANCE�ARRIEH AND POLIGY NUM9Eq nae CONSTRUCTION /.a.,! j cnaaiEa`]'rl�.t-(� Li.K�'�'�� ,��j • �„�Y'1G- _ PLAN REVIEW Z PoucrNumaEa��ID,��{ ��L/ __— ELECTRIC ¢ — Q (INISSECiIONNEmN0T3EQ:MPLEfEDOFTHEPERMITISfORONEHVPDRE�DOLLAAS(510D)OqLE55J. PLUMBING _ Z 1 CERTIFv TMAT IN THE PERFORMANI;E OF THE WORK FOR WHIGM IHIS PERMIT IS ISSUED,I MECHANICA� C}' SHALL NOT EMPLOY ANf PERSON IN ANV MANNER SO AS TO BECOME SVBJECT TO THE � WORKERS'COMPENSAIION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOU�D BECOME INS�EGTION FEE _____ � SUBJECTTOTHEWORNERS'COMPENS ION O ISiONSOF CTION370oOFTHELA80R � � CO�E,I SHALL FORTHN'ITH COMPLV W �T 5 P OVI ONS� f ISSUANCE ___ _ 10 O � , � DATE: « 1� L APPLICANT: F SMIP -- �� O __ � 3 J WARNING FAILURE TO SECURE WORKEfiS'COMPENSATION CAVERAGE IS UNLAWFUL, SHA BE ENERGY P/C _ _ � SUBJECTANEMPLOVEflTOCRISiINALPENALTIESAN�GVILFINESUPTOONEH'JNDRE�THOUS ENERGYPERMIT } DOLLARS�f100 D00).14 AD[]ITIOY TO THE COST t]f COMPENSATION,DAMAGES AS PROVIDED FOR IN - __—_ Z O (((f////// J SECTION31o80FTHELABORC'JDE,INTEREST,ANDATTORNEv'SFEES. RETENTIONFEE: Jyf � /// d CONSTRUCTION LENDING AGENCY PR6AlT FFF� �� p — -- � I HEflEBVAFFIRM U4DER PENAI.TV DF PERJURY THAT THERE IS ACONSTHUC'ION LENDING AGENCY _ FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PEPMIT IS ISSUED(SEC.JOW.CIV.C.�. W _ � LENDEN'SNAME _ — 1— IENDER'SADDRESS � TOTAL FEES ,�4 ,O� �� , l � I GERTIFV THAT I HAVE READ THIS APPLICATIONANO STATE THAT THE ABOVE INFORMATION IS CORRECT w I AGREE TO COMPLV WITH ALL CITY ANO COUNTV OR�INA4CES ANO STATE L4WS REUTING TO BUILDING d � CONSTRUCTION.AND HEREBY/�UTHORIZE REPRESENTATNES OFTHIS COUNTV TO ENTER UPUN THF Z ABOVE-MENTIONEO PROPERTV FOR INSPECTION PURPOSFS. . � t � CO MENTS � � U,1 iCN �:.=C 'Y�.-A�� rCU✓✓' Z.G �'Z - � ¢ All ANE(GRINT� r� ____ — — �„ � �`y{� ` � . �t: ►0 �'�v � 51 NRTl1qE OF PERMITTEE �ATE — - _ - REGPT NO. PAID BY VALIDATION ~ WHITE—Depanment Copy,YELLOW—Finance Copy,PWK—Assessor GODY.GOLDENFOD—File Gopy,GREEN—Applicant's Copy 2-3Ce • o d . ,�n� a , . �� ,� ��_ ��. .. =m� � � � � �t; � , ., � �� ,� . . . /� �02 f? � , _ �. , � . _ �� , _ �' �"- _ _ �' _ _ , _ __ _ �� __ _ _ . _ _ _ _ _ __ _ _ : _ _ , __ ._ _ _ f _ . _ , r _ __ _ _ . _ ; , �� " � �� _. _ . . _ � �� m�� . �� . �� '�� ,�, �� _ _ . _ �{,� �j� . �. � �� , , _ _ __ _ i �'i . , , �,:��e, � � � �, , . _ _ _ _ _ _. { �' � .�:. �� ( �- �.�. _ _ _ _ _ . _ _ _ a., ,� � _ ��',� _ _ _ _. _ ULl?IIISD D,1R i CITY OF DIAMOND BAR DEPARTNIE'VT OF COIvINILJNI"IY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION ADDRIESS��c'LX��IN S rurv�,s��b�, F L01"TRACT R S R'fl_� F�n�So-�2�y G� ADDRESS�13�nU2A IZa+4'b CITY W�'R.A'e-N�VL(aZIP 9 i�,/p 3TEL. �-�/-�3'1 APPLICAN�" �� LZ-�+TEL. h� CONTRACTOR d ADDRES CITY�ZI TEL. ARCH/EN/ DESIGNER r ADDRESS 6 CITY�IP�'r� �,/L OWNER-BUILDER DECLARATION„Q�j�'7�-�� 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: ANV CITY OR COUNTY WHICH REQUIRESA PERMIT TO CONSTRUCT,ALTER,IMPROVE. DEMOLISH,CR REPAIRANY 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 ]000)OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONSCODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION.ANV VIOLATION OF SECTI(7N 7031.5 BY ANYAPPLICANT FOR A PERMIT SUBJEC(S THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(5500)). ^ 1,AS OWNER OF THE PROPERTY,OR MV EMPLOYEES W ITH WAGES AS 1HEIR SOLE COMPENSATION, WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOH SALE(SEC. 7046,BUSI- NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOS APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMP ROVES 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 W ITHIN ONE YEAR OF COMPLE- TKNJ,THE OWNER-BUILDER WII1 HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE 01= SALE). ^ I,AS OWNER OF THE PROPERTY,AM E%CLUSIVELY CONTRACTlNG W ITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC. 7064, 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 PP�OJECTS W ITH A CONTRACTOR(SI LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). U T AM EXEMPT UNDER SEC._B. 8 P.C. FOR THIS REASON DATE OWNER LICEIVSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENAL N OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSi(7N5 CODE,AND MV LICENSE IS IN FU FORCE AND EFFECT. Ir'� LICENSE CLASS� LIC N i � ' �� n. DATE CONTRACTORLV � ��b s WORhCERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT i05ELF-INSURE FOR WORKERS' COMPENSATION,AS PROVIDED BV 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 REOUIR ED BY SECTlON 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSVED. MV WORKERS'COMP EN S ATION INSURANCE �ARRIER AND POLICY NUMBE�ARE' / ��i"'S� ��, n,r'h II: k�\JI.N CARRIER,]�t.[� E �y f 1 POLICY NUMBER�',�,��I (J��L/•_ (FHIS SECTKKJ NEED NOT 3E C1:MPLETED OF THE PERMIT IS fOF ONE HUNDRED DCILAAS(5100)OR LESS). 1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS;SSUED,I SHALL NOT EMPLOY AN'f PERSON IN ANV MANNER SO AS TO BECOME SVBJECT TO THE WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS'COMPENS ION 0��((ISIONS OF CTION 37000E THE LABOR CODE,I SHALL FORTHWITH COMPLY W T S PROVI ONS t r �//� DATE: «Sv i/APPLICANT: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,.AI SHA BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUS DOLLARS(5100,000),IN ADDITIOY TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3]08 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. CONSTRUCTlON LENDING AGENCY I HEREBY AFFIRM UNDER PENAL N OF PERJURY THAT THERE IS A CONSTHLICTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC. 3097,CI V.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 LOWS RELATING TO BUILDING CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE M ENTIONED P ROPERTY FOR INS PEC TION PURPOSES AH MI [i(JAME(PRINT)�� r t0� V I•' SI NATUq E OF PERMITTEE DATE WHITE-DepaAment Copy,YELL-OW-Finance Copy, PIN �.-3C.e•O1 �d .