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Home My WebLink About19057 CITY OF DIAMOND BAR �`` DEPARTMENT OF COMMUNTI'Y&DEVELOPMENT SERVICES I 21825 E.Copley Drrve (909)860-3195 Fax(909)861-3117 PRESS "<�� BUILDING PERMIT APPLICATION FIRMLY y JOBSITE L�� S ��(��E'°'� S��Z/�// , APPLICATIONC� (L +�L/ PERMIT P/C �.� � � o ADDRESS_ �� DATE I NUMBER # T° APN LOT TR�y T � ISSUE TYPE OCC p OWNER _ {`'�f/'YI� /�- �✓v DATE CONST. GROUP o ADDRESS _ ZONING SETBACKS z CITY ZIP TEL FRONT RW L7 � APPLICANT TEL. REAR � z SIDE/SIDE STREET RW ❑ ¢ CONTRACTOR �pE I��i, �I� � �TI SIDE � ADDRESS � CITY l%'/` ��i ZIP / T��-'�r-]z%7i1 S�� PROPOSED USE o ARCH/ENG/ w DESIGNER NO.DWEL. NO. NO. � ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADD/REM � O � I HEREBV AFFIRA/UNDER CENALTV OF PERJl1RV THAT I AM EXEMPT FROM THE CDNTRACTORS LI- Gdfd96/C3fpOfl W CENSELAWFORTHEFOLLOWINGReASON(SEC.7031.SBVSINESSANDPROFESSIONSCODE:ANYCITYOR (f� U CDUNTVWHICHREOUIFESAPERMITTOCONSTRUC7,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUG w TURE,PRIOR TO ITS ISSUANCE,AL50 REOUIRES THE APPLICANT FOR SUGM PERMIT TO FlLE A SIGNED W Patio/Dack � STA7EMENT THAT HE OF SHE IS LICENSED PUFSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- � � CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 7aao)OF D�VISION 3 OF THE BUSINESS AND PRO- POOUSpd � FESSIONSCODE�OR7HATHEORSHEISE%EMPTTHEREFROMAN�THEBASISFORTHEALLEGE�EXEMP- � U TION.ANYVIOUTIIXJOFSECTION7031.SBYANVAPPLICANTFORAPERMITSl1&IECTSTHEAPP�ICANTTO Z R0-ROOf A CIVIL PENALN OF NOT NOFE THAN FIVE Hl1N�RED DOLLARS�f50o).): /�� ❑I,ASOWNEROF7HEPROPERN,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMP[NSATION, Q y�Fj�,{ (� Z WILL DO THE WORN,AN�THE STRUCTURE IS NOT INT[NDE�OR OFFEREO FOR SALE(SEC.1069,BUSI- J COfI1fI1BfC131 .l � NESS AND PROFESSIONS CODE:THE CONTRACTOftS LICENSE lAW DOES NOT APPLV TO AN OWNER OF � — PROPERTVWHOBUILDSORIMPROVESiHEflEON,ANOWHO�0E55UGHWORKHIMSELFORHERSElI-OR � THHOUGH 1715 OR HER OWN EMPLOYEES,7ROVIDED THAT SUCH IMPHOVEMENTS FRE NOT INTEN�ED OR m 0 OFFEREDFORSALEIF,HOWEVER,THEBUIIDINGOFiIMPROVEMENTISSOLDWITMNONEYEAPOFCOMPLE- � TqN,THE OWNER-BUIL�ER WILL HAVE THE BURDEN OF PROVING THAT HE Ofl SHE DID NOT BUILD Ofl � INPROVE FOF 7HE PURPOSE OF SALE). w ❑I,ASOWNEROFTHEPROPERTV.AMEXCWSNELYCONTRACTINGWITHIICENSEDCONTRACTORS . � � TO CANSTRUCT THE PRQIECT(SEC.]064.BUSME55 AND PROFESSIONS CODE:iHE CONTRACTORS LI- VBIl1dfI0f1 � ADJ.AREA W CENSEUWOOESNOTAPPLVTOANOWNEROFAPROPERTVWHOBUILDSORIMPf10VESTHEREON,AND � WHOCONTRACTSFORSUCHPRQIECTSWITHACONTRACTOq�S�LICENSEDPURSUANTTOTHECONTqAG QUANTITY DESCRIPTION FEE Y TORSLICENSEUW). O ❑I AM EXEMPT UNDER SEG. B.6 P.C.FOH THIS REASON Q � � T�./ ,�/_� �,/'� � ¢ � DATE OWNER U � ��`��.1 � LICENSED CONTRACTORS DECLARATION w Q � I HEREBYAFFIRM UNDER PENALTY OF PERJURY THAT 1 AM LICENSED UNDER PROVISIO�S OF CHAPTER - 1 /'r1z� .�l � d 9(COMMENCING WITH SECTION]000)OF DIVISION 3 OFTHE BUSINE55 AND PROFESSIONS CODE,AND Z ��'�`� � � `X MY LICENSE IS M FULL FORCE AND EFFEGT /� -�f m � LICENSE CLASS C�� LIC.NO. C��'��`� � U DATE �'f/d �Cl�� CON7RAC70R d W � WORKEAS'COMPENSATION DECLAFATION a � I HEREBYAFFIRM UNDER PENALTV OF PERJURV ONE OF THE FOLIOWING DECLARATIONS: Z Z I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENTTO SELF-INSURE FOR WORKERS' a 2 a COMPENSATION,AS PROVIDED BY SECTION�100 0F T11E 1A00R CODE,FOR THE PERFORMANCE U Q OF iHE WORN FOfi WHIGH THIS PERMIT IS ISSUED. � QW I HAVEAND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE.AS REQUIRED BV SECTION 3]Oa OF THE LA80R CODE.FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 � ISSUED.MY WORKERS'COr}M�PENSATION INSURANCE CARRIERAND POLICY NUMBERAflE: CONSTRUCTION � ''�� L � CARRIER iJ,�"/G �� PLAN REVIEW � ZaoucvNUMeEn ��'Z, �'"' '-��`L`�� ELECTRIC � Q 0 (iHISSEClICfJNEmNOT8EWIAPLEfEDOFT}EPEFlhNTISWRIXJEHUNDREDDIXIARS�S100�ORLESS). PLUMBING W Z I CERTIFV THAT M THL PERfOFlMANCE OF THE WORK FOft WHICH THIS PERMIT IS ISSUE�,1 MECHANICAL (� SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SOAS TO BECOME SUBJEGT TO THE � WOFKEftS'GOMPENSATION LAWS OF GAUFORNIA,ANU AGREE THAT If I SHOUI�BEGOME INSPECTION FEE SUBJECTTO THE WOflKERS'COMPENSAfION PHOVISIONS OF SEGTION 370a OFTHE LABOR � CODE,ISHALLFORTHWITHCOMPLVWI'HTHOSEPROVISIONS ISSUANCE � - � /o-� �.�j/,��7''�ra�C �-� SMiP p DATE: T� ! . APPLICANT: � J WARNING FAILURETO SEGVRE WOFKERS'COMPEIiSATION CDVERAGE I5 UNLAWFUL,ANO SHALLBE ENERGY P/C � SUBJEGTFNEMPLOVERTOCRIMINALPENALTIESANOCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOLLARS(ftoo,oCo),IN ADDITION TO THE COST OF COMPENSATI04,DAMAGES AS PROVI�EO FOR W � J SECTION37080FTHELABORCODE,INTEREST,ANDATTORNEV'SFEES. ¢ RETENTION FEE: _ OCONSTRUCTION LENDING AGENCY PRE-ALT FEE _ ._ � IMEREBVAFFIRMUN�EfiPENALTVOFPEFJURVTHATTHEREISACONSINUGIIONItNOINGAGENCY FOR THE PERFORMANCE UF THE WOHK FOH WMICH THIS PEFMIT IS ISSUED(SEC.3097,CIV C.). Z W j LENDER'SNAME _ � F— LENDER'SA�DRESS � TOTAL FEES �J�-�',�� . �� I CERTIFV THAT 1 HAVE READ THISAPPLIGATION ANO STATE THAT THEABOVE INFORMATION IS COFREGT W I AGREE TO COMPLv WI�H ALL CITY ANO COUNTY ORCINANCES AND STA7E LAWS RELATING TO BUILDING � CONSTRUCTION,ANDHEREBVAUTHCRIZEREPRESENTATNESOFTHISCOUNTYTOENTERUPONTH= � A30VE-MENTIONED PROPEFTV FOR INSPECTION PURPOSES. Z GOMMENTS o �,�j` c. - - � l'�'�'�>G9L�� m PERMITTEENAME(PRINT) � _-�/�U' 7�r�o2 N SIGNATURE OF PERMITTEE DATC = RECP2 NO. PAID BY VALIDATION ~ WHITE—De artment Co YELLOW—Finance Co PINK—Assessor Co GOLDENRO�File Co GREEN—A licant's Co P PY. PY. PY, PY� PP PY �`�a�r�' � ' i� �.' , ` ^i r s � � ��.�`i �°°y ��a� r ( � - � �i� o �b��5 . E,, s� R��'� *�e5a�' � s�� ,n . �.�� . . .. . .. _ . . . . .. . - . . .. ��'��7,`�,t E �'�> �s�,n�`a� . '... . .. .. . .. .. .. . .. .... .. . . ..... ...... , , � � �... .. _ .... .__. .... . �. - �. r� ;�' ._ � � r:s.,. f ,_ � ,� 6�r,S� ; � � . ... .... _ . .. . _. _. .. . ... .. . _. ... ... . _. .._. . . .. .... . . ... . _... �. e9 �,�o , ,; - ,.�� . .r , , �,r�.a; r �� r .... . . . . ,, .._.. —. . ��i� � � d �� a r ... .. ... ... .. .. . ... _ ... ... ... . .. . ...... _... .. , _,.,` i r��f�ry'�� r. ' '' :.Nf��p , 'f�� re, ...,, . ... . .. . .. _.. .. .... . . ..... ... .. . . _.. .......... .. . .... ... .... 8 8 , 1 ?��.�i,�:"� " � � . . .. . . ..... . .. . . ...... . .. . ,�. « s . .. . .. .. . ... ... . . . ... . E CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION JOBSITE L Q ADDRESS_/__7 W APN LOT TR T OWNER{'�frn :/'y ADDRESS CITY ZIP TEL. APPLICANT TEL. CONTRACTOR OP�/�� I ADDRESS CITY-5 CITY I/7 4c ZIP/TEL.64) '161 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 FORTHE FOLLOWING REASON(SEC. 7031.5 BUSINESS AND PROFESSIONS CODE:ANY CITY OR COUNTY WHICH REQUIRES A 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($500).): ^ 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 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 /^' C/ 2 LICENSE CLASS T7 mil LIC. N0. (o DATE//0/G-Z 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 ISSUED. MY WORKERS' OMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: C CARRIER iJ /'ZY tJ/6 POLICY NUMBER --760// T (THIS SECTION NEED NOT BE COMPLETED OF THE PERMIT 15 FOR ONE HUNDRED DOLLARS($100)OR LESS). IC E RTIFY 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 CODE,I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS C/0'Z- DATE 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 PROPERTY FOR INSPECTION PURPOSES. PERMITTEE NAME(PRINT) SIGNATURE OF PERMITTEE DATE CO 0 0 In w z 0 DO 0 Q 0 M w U W 0 U 0 LL 2 X W U w N Cn w z: CJ �"•) F 0 ww J I1 W 0 w W w W a CO WHITE-Department Copy,YELLOW-Finance Copy, PIN PRESS FIRMLY APPLICATIONC�L PERMIT p/C n I I I, DATE II NUMBER# ISSUE TYPE OCC DATE CONST.GROUP ZONING SETBACKS FRONT RW^ REAR^ SIDE/SIDE STREET RW EI SIDE EI PROPOSED USE N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREANALUATION SFR/ADD/REM Garage/Carport W Patio/Deck LL Pool/Spa 0 Re-Roof Z Commercial Valuation ADJ.AREA QUANTITY DESCRIPTION FEE ji CC U LU W Z 1 iris x a Q U Z Q W CONSTRUCTION r' � • 1 U I/.Yn PLAN REVIEW(((JJJjjj (� ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES [05,&D COMMENTS weQ01 RECPT. N0.15-L I I)PAID BY VALIDATION