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Home My WebLink About18785 �� CITY OF DIAMOND BAR �+ � �W�� DEPARTME'�'T OF COIvIlvIUNITY&bEVELOPMENT SERVICES �`� �Ra�� 21825 E.Copley Drive (409)&60-3195 Fax(909)861-3117 PRESS � BUILDING PERMIT APPLICATION FI LY JOBSITE ^� � APPLICATION � ( (�PERMIT /C o ADDRESS�0 �,��_�t{�� :Q�1 wP�� DATE � NUMBER k _ � ISSUE .n TYPE OCC APN^___. LOT TRACT DATE "�"CONST. _ GROUP __ ¢ OWNER 1'N +/1 � • � � p ADDRESS '��L� ` ZONING SETBACKS QCITY�A�i•�l.u,� A ' IP 'TEL�7 � FRONT RW ❑ _ APPLICANT __ TEL. REAR ❑ Z -- SIDE/SIDE STREET RW ❑ _ ¢ CONTRACTOF L�Oi�' ��1,-�L G- � SIDE ❑ Q ADDRES5'�_��_ � � � --- PROPOSED USE � CITY �O"�y/�C.[,Z��. Z1P��jTELl� �w ARCH/ENG/ �� — �z DESIGNER — NO.DWEL. NO. NO. a ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER OECLRRATION SFRIADD/REM � O � 1 HEPE6Y AFFIRA/UNDEP PENALTV OF PERJURV THAT I AM F.%EMPT FROM THE CONTRACTORS LI Garage/Ca�port W CENSEUWFORTHEFOIIOWINGREASON(SEC.TC3t56USINE55AND?90FESSIONSCODE:ANVCITYOR (n U COUNTVWHICHREOUIRESAPERMITTOGONSTFUCT,ALTER,IMOPpyE.�EA/()USH.CRREPAIRANVSiftUC- W Patio/Deck w7URE,PRIOR TO ITS ISSUANCF.,RLSO REQUIRES THE ACPLICANT FOR SUCH VERMIT TO FlLE R SIGNED w � STATEMENT TMAT HE Ofl SME'iS LiCeNScD PURSUANi TO THE PROVISION:OF THE CONTRACTORS LI� I � CENSE LAW(GHAPTER 9�COMMENCING W�TN$FCT�oN toCo�OF DIVf$ION]OF THE BU51NE55 AND PRO- LL POOVSpB � FESSIONSl:OOE)ORTHATHEORSHEISE%FMVTTHcqEfROMnNDTnEBA51SFORTYEALLEGEDE%EMN- (� U TION.ANVVIOLATIONOFSECTION]OJ1.5BYANYAPPLICPN'FORAPERMRSUBJE(:fS�HEAPPLICANTTO Z Re-Rool � ACIVILVENAITYOFNOTMORETMANFNEHUNDREODOLLAR5�35W�.��. - Q ❑I.ASOWNFROFTHE7RhP�RTY,OfiMYEMPIOYEE5WIT4WAGE5AS1V/ElPSOLEC�MPENSAT�ON, � (�Off1RIBfC19I Z WILL DO THE WORK,ANO THE STRUCTJRE IS NOT INTEN�ED OF OFFEREO FOH SALE(SEC.70da,BU�'- ,_I NESSAND VPOFFSSIONS CODE:THE CONTRAG�ORS LICENSE LAW DOcS NO'APF�V TO AN OWNER OF � VROGERTYN°iOBUILD30RIMPR�VESTHEREON,ANDWHODOE55l1CHWORKHIMSFLFORHERSELFOR � � TNROUGH HIS OR HEfl OWN EMP�OVEES,PROVIDED THAT°VCH IMPPOVEMENTS RRE HO?IN?EN�ED OR m w OFFEREDFORSALE.IF,HOWEVER,THEBUILDINGORIMPPOVFMENTISSOLOWRHINONEYEAROFCOMPIE- 0 TION,TME OWNEH-BUILDER WIt1 HpVE THE BUR�EN OF PPOVING�MA7 HE OR SNE OID NOT BUI�D OR Z IMPROVE FOP fME PURPOSE Of SALE). � LI,ASOWNEROFTHEPR6PERTV.AMEXCLUSIVEIVCONTRACTINGWIrHUCEN5E000NTRACTORS ¢ TO CANSTRUCT TME PRQIECi jSEC.]oaa,BUSINE55 AND PROFESSIUNS cJDE:THE CON7RAC70R5 t I- ' W CENSEUWDJESNOTAP�LVTOANOWNEROFAPROPERTYWMOdUII.D50RIMPROVESTHEREON,AND Valualion _ ADJ.AREA _ � WHOCONTRACTSFORSUCHPADJECTSWITHACONTRAGIOH�SI��CEkS�DPUFSUpNTTO'HFCbtJTRAG QUANTITY DESCRIPTION FEE TORS LIGENSE LAW�. Y J � U T AM EX[MPT UNDER SEG. B.S P.C.FOP THIS REASON Q � — _ — _ U � � DATE _ , oWNER . '_' U W � LICENSED CONTFACTORS DECLARATION w ¢ � IHEREBVAi"F�RAIUNDEPPENAl1YOFPERJURVTNATI�MLICENSEDUNDERPNOV3�ONSOFCHAPTEA � d 9(COMMENCING WITH SECTION i00J)OF DIVISIIXJ 9 O�TH_BUSINESSAN�PP(]FESSIONS COOE,AN� Z �X AIYLICENSEISINNLLFORGEAMDEFfEL'i � o „� v ) �y y_.7 r'-� � — � LICENSE C�LAS/$+� ✓ _ LIC.NO. �,L � _ J U DATE__.L/_2��__ CONT T _ d W 'l � WOFiKE=RS'COMPENSATION DECLARATION�� Q = U � 1 HEAEBV A�FIflM UNDER PENALTY OF PERJURY ONE OF THE FOL IOWING DECLARATIONS. � Z Q �� I HAVE AND WILL MAINTAIN A CERTIFICA7E OF CONSENT TO 3ELF�INSURE FGR W09KERS' _ CAMPENSATION,AS PR04'IDED BV SECTION 3l0o OF THE LPBOR CODE,FOfl THE PERFORMANCE U 4 OF THE WORK FOR WHIqI TNIS PERMIT I5 155UED. � � W MAVE ANO WiLI MAINTAIN WORKERS'CAMPENSP.TIOlI INSURANCE,AS PEOUlREDBY SEGTION Q 3�Oa OF 7HE LABOR COOE.fOR THE PERFORMANCE OF THE WORK FOR WHiCH THIS PERMIT IS ISSUED.MY WORNERS'COMPENSATION INSURANCE CAFRIER ANO POLICY NUMBER ARE' CONSTRUCTION � CARFIER ��:t` ��J n�� __ . PLAN REVIEW __ _ _ Z �o�icrNUMeEa___�(�� 'C� � � ��. ._--- ELECTRIC . _ ¢ p �rri�ssecrarvr+EmnoraE�ErEoan+EaEw.rrisroFCNEM�ot�Eooxwis6+oma��rss). PLUMBWG _ /-�_ W MECHANICAL V_ Z I CERTIFY THAT IN THE PEFlFORMANCE OF THE WORK FOR WHICH iHIS PERMIT IS ISSUED.I - (� SMALLNOT EMG�CY ANV PERSON IN ANV MPNNER SOAS i0 BECOM BJEf.T TO THE � WORKENS'COMPENSATI01!1AW50i CALIFOR'JIA.ANO AGREE TM if lD BECOFAE INS?ECTION FEE SUBJECT TO THE WORKEHS'GOMPENS PROVISIONS F S T 3] F THE LABOR TT � CODE.ISHALL HTHWITMCpAPIY M RO ISSUANCE �� _ � SMIP p DATCI� � . AP - - W � ENERGY P/C J WARNING�FAIW E TO SECURE WORKEflS'COMVENSAiION COVERAGE IS UNUWFUI.�NO SNALL BE - J LL SUPJECTANEMPLOVERTOCRIMINALPENA�TIESANOCIVILFWESUPTOONEHUNORFDTHOUSAN� ENERGVPERMIT DOLLpRS(S'�0,000).iN ADDITiON TI)THE GOST OF GOMPcNSAiION,DAMACES AS PROVIDED FOR IN - J SECTION3]oBOFTHELABORCODE,WTEFEST,IWDAT�ORNFY'SFFES. RETENTIONFEE: . CC d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: _ . _ O Q 1.1EREHYAFFIRMUNOERPENA'.TY��FPERJUFYTHATTHEHEIS�CONSTRUC�IONLENDINGACENCY _ _ n- FORTHEPERWRMANCEOFTHEN^JFKFORWHICHTHISVERM111SISSUE�ISEC.3091.CIVC). Z . _ - W S LENDEN'St�AME _ � F- LENOER'SADORE55_ .- I /\ ¢ I CEFiTIFV TNAT I HAVE READ TH�S AI'FIICATION 4N�STATE TMAT TME ABDVE INFOqMAT10N IS CORRECT. TOTAL FEES l//� - /� w I AGREF Tn COMPLV WITH ALL dTV AND COUNTY OflDINANGES ANO$TATE LAWS PELATINC TO RUILDING 'C � �/ � CONSTRUCTION.ANDNEPEBYAUiHORIZEREPRESENTATNE50FTNISCOUNTVTOENTERUPONTHE ZABOVE-MENTIONLDPROVERTVFOflINSPECT10NPliRPOSE$. COMMENTS _. _ -. --+ ��..�P�✓ /'�(J �i � - m PE NA 1 � --- - �h �r� L' _ ERMIYT OAl' RECPT NO. PAID BY VALI�ATION_ WHITE—Department Copy,YEII.OW—Finance Copy.PINK—Assessor Copy,GOLDE f70D—Fila Gopy,GRE N—ApplicanYs Copy � ��,, , ;.��,�>s H �,E,�,� ��,:�� .� �` � � � . �� , ��. ` ��:. �. . � � ! _ _ � ��' r/y� �� :.,, �, �, �' �/ �-�- � � � � _ - r :, , !'fJ�•,��-�o� -�-�%,�" �'-�'�fi/,��r;�/�G��.�'',l" �'%�� p _ . _ __ . � _ __. , .,� dt�'�� G't� `� 'd tl. �CEf�d'./z� ��_1c1� � � �� .��'/,�t��f __''�-� � ��t�� f�4 �d�--,�5"'`�.2, �� ,/� �/�G/i¢,� ��'-� _ ___-ldrt� {�/' D _ l� �,��! �f�� _ _ __ __ _ ; _ _ __ _ . _ . __ _ . _� . ; _ . __.__. ___ ___ � _ _ _ _ __ _ , _ _ _ _ _ _ __ � ' a � �t�sf '��'`" "� � ° i � � _ — — _ __ , � < � �� r�, �t�� , � �,��, �� y��e u � � $ "... � b . . ... .. . .. .. .... . .. . . .. ... . . . ft x . i�� . .. .. . . .. . . ..... .. . ... . . ... ..... ... .._ ........ ..... ...... .._.... ... .... y .. �� ` �� i � . � . �A . �..�..� u� ��.. ... . . . . . .. . . . . . . ... . ...... ..... ... ...... .... . ......� . ... ... . 7 � � � il � . .... . .. . .. .... .. . . .. .. . .. . . ... . ...... .... ..... ...... ..... . ...... .. r i � �� . { . ... �Y�£' a��, .� "w ......... ... .. ........... . ... ... . .. ... .. ... ...... ...... ...... ... .. . .... .. '*ag iY�Nt.� . �� 1111110,T0 HM 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 2 ADDRESS- 1J5 APN LOT TRACT OWNER/'iy ADDRESS P CITY La-tr'Ao ALIA7IP TEL6?7 APPLICANT TEL. CONTRACTOR"'Z PLG 2 G- ADDRESSZL2 0 CITY�ZIP d2 TELI 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 REQUIRESA 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 CR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION.ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJEC TS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(1500)): ^ 1.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). D I,AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTING 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) 0 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 'y(5 LICENSE CLAS (�/LIC. N0. DATE- �� CONT T 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 f OF THE WORK FOR WHICH THIS PERMIT IS ISSUED /^' J }( _IHAVE 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'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER-•Q-ice I ti POLICY NUMBER (THIS SECTION NEED NOT BE COMPLETED OF THE PSWAT IS FOR ONE HUNDRED DOLLARS($100)OR LESS) I CERTIFY THAT IN THE PEFFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOM BJECT TO THE WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE TH IF ULD BECOME SUBJECT TO THE WORKERS COMPENS PROVISIONS F T 37 F THE LABOR CODE. I SHALL RTHWITH COMPLY H RO N . DATED APP WARNING: FAILU E 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 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. PE NA ERMITT- DAI WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GRE N-Applicant's Copy PRESS FIRMLY APPLICATION( (--PERMIT C DATE tt NUMBER ISSUE .n TYPE OCC DATE " �'CONST GROUP ZONING SETBACKS FRONT RW REAR [] SIDE/SIDE STREET RW ^ SIDE � PROPOSED USE N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREANALUATION SFR/ADD/REM CO Garage/Carport W Patio/Deck LLI LL Pool/Spa 0 Re-Roof Z Commercial Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U X F- U W Z Ib i t Z 2 U LA 1. w CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING _ MECHANICAL INSPECTION FEE _ ISSUANCE SMIP ENERGY P/C _ ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: - TOTAL FEES 8 So COMMENTS RECPT NO PAID BY VALIDATION e ;4 0/1 1-7 s loaf��'! t2f /Y