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Home My WebLink About18910 CITY OF DIAMOND BAR �'�`` DFPARTMENT OF CONIlviUNTfY&bEVELOPMENT SERVICES � �1 W � 21825 E.Copley Drive (909)&60-3195 Fax(9t19)861-3117 PRESS ' "-��^ BUILDING PERMIT APPLICATION FIRMLY a� JOBSITE �2'7'�� '^ APPLICATION � � �j ��UMBER ��J ��P '#/C �• �r ADDRESS �� DATE o� ISSUE TYPE OCC APN LOT TRACT � DATE CONST. GROUP p OWNER � � ' v C �[�F'� L p ADDRESS �'� L ' k.,-� �2�V'{ fh y�) ZONING SETBACKS Z CITY �J 1 r-S:'y11�.'� ' 11L�[1� 7EL�ZC�3�1�G� '=;,"� FRONT RW f 1 _ o APPLICANT i+K C_ C? l� ELz �" � REAR ❑ _ Z �L � I � SIDE/SIDE STFiEET RW ❑ Q CONTRACTOR��,�e�✓- 1.:?l�vl[�:�, � c �� SIDE ❑ _ ADDRESS � PROPOSED USE � � CITY ZIP TEL. � � w ARCH/ENG/ — z DESIGNER — a ADDRESS — NO.DWEL. NO. NO. UN ITS STORI ES BEDROOMS � CITY ZIP__ TEL. cn v� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECLARATION SFR/ADD/REM O I MEREBY AFF'.qM VNDER PENALTY OF PERJUFY'HAT I AM E%EMPT FROM THE CONTRACTORS LI- G9f8J2/CBfPOfI �W CENSEUWFOHTHEFOLLOWINGPEASON(SEC.]OS758USMESSANOFROFESSIONSCOOE:ANYGITYDR (n U COUNTVWHICHFE�UIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE.DEMOL'SM,CRREPAIRANYSTRUC- W P3�10/DBCk TURE.PRIOR TO ITS ISSUANCE.ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO�ILE A SIGNED w STATEAAENT THAT HF OR SHE I:�LICENSED Pt1R5l1ANT TO THE PFOVISIONS OF THE CONTRACTORS ll- W � CENSE LAW(CHAPTER 9(CAMNIENCING WITM SECTION 1000)O:�IVISION 3 C1F THE BUSINE55 AND PRO. � POOUSPB FESSIONSCODE)OPTHATFIEORSHEISEXEMPTTHFRFFFOMANDTHEBASISFOFTHEALLEGEDEXEMV- � � TION.ANV VIOLATION OF SECTI(NJ 7031.5 BV ANV APPLICAN'fOR A PERMIT SUBJEG�S'!HE MPLICANTTO Z Re-Roof ACIVIL PENALTY OF NOT MOFE THAN FNE HUNDRED DOLLARS(5500)��. 0 ❑I,ASOWNEflOFTHEPROPERTY,ORMVEMPLOVEESWiTHWAGE5A5lHEIR50LEGOMPENSATiUN, 0 COfi1RIBfC18I Z WILL DO THE WORN,AND THE STFUCTURE IS NOT INTENDL'J ON OFFEFEO FOH SALE;SEG.7044,9U�1- J � NESSAND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NO'APPiV TO AN OWNER OF � PR07ERTV WNO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF ON � THROUGHHISORHEROWNEMPLOVEES,PROVIOEDTHATSUCMIMPROVEMENTSARENOTINTENDEDOR m W OFFEREDFORSALEIF,HOWEVER,THE9UIL�MGORIMPROVEMENTISSOLDWRHINONEYEAROFCOMPLE- � TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING�HAT HE OR SHE DIO NOT BUILD OR Z IMPROVE FOR THE PURPOSE 01=SALE). = CI,ASOWNEROFTHEPROPERNAMEXCLUSIVELVCONTRACTINGWI�HLICENSEDCONTRACTORS W Q TO GONSTRUGT THE PRQIECT(SEG.]040,BUSINESS MID PRVfE551UN3 CODE:THE CONTRACTORS LI- V81UB[IOl1 � ADJ.AFIEA W CENSELAW�OESNOTAPPLYTOqNOWNEROFAPROPEflTYWHOdVIID50FIMPROVESTHEREON,AND - = WHOGONTRACTSFOPSUCHPROJECTSWITMAGONTRAGTOq(5)IIGEhSCDPURSUANTTOTMECONTRAG QUANTITY DESCRIPTION FEE ~ TORS LICENSE LAW). Y � 1 7 I AM EXEMPT UNDER SFC. B.8 PC.FOR THIS REASON Q � U � — --- OC DAiE OWNER �" Z — -- -- U w � LICEIJSED CONTFACTORS DECLARATION W CC I HEREBV AFFlRM UNDEF PENAI.TV OF VERJURY THqT I AM LIGENSED UNOER PNOVISIONS OF GMAPTER � � 9(COMMENCWGWITHSECTION7oo0)OFDIVISION�OFTHEBUSINESSA/:D7aO�E5SIONSCODE,AND Z �X MY LICENSE IS W FULL FORCE/�ND EFfECT m � LICENSE GLA55 _.___ LIC.NO. j � J V �ATE _ GONTRACTOR__ � W � WORf<ERS'COMPENSATION�ECLARATION -� ¢ � I HEREBV AFFIRM IJNDER GENALTV OF PERJLIRY ONE OF THE FOLLOWING DECLARATIONS: Z Q 0 I MAVE PND WILL MAINT�qIN ACEflTIFlCATE OF ONSENT T03ELF�'�NSURE FOR WORKERS' _ � COMPENSATION,/5 PROVI�ED 9Y SEGTIOfY 3 OOnF TME LRBOR COOE.FOR THE PEFFORMANGE 'U 4 OFTHE WOflK FOR WHiCH THIS PERMIT IS ISS ED. � � w I HAVE AND WILL MAINTAIN WORKERS'COMPE SATION INSURANCE,AS REOUIRED EV SECTION Q 3)0o OF THE LABOR CODE FOR THE PER�OR ANCE OF THC WORK FOF WHICH TIIIS PEFMIT IS � ISSUEC.MY WORKERS'COMPENSATION LYSU ANCE CARaIER ANO POLiGY NUMBER ARE' CONSTRUCTION J — j cARPoER __ PLAN REVIEW ,,.,�J � _ ____ ZaoucvNUMaea_ ELECTRIC i/'� � ¢ ��ssEcrardN�mrao7eEa:�nc�ErEooF aEa.vriswForrEHuwaEooawas�sim)on�Essl. PLUMBING � — w Z I GERTIFV TMAT IN THE PERFORMFNCE OF TME WORK FOR WHICF THIS PERMIT IS ISSUED.I MECHANICAL (� SHALL NOT EMPLOY ANV PERSON IN ANY MANNEH 50 HS TO BECOME SUBJEf.T TO THE �/] WORKERS'COMPENSATION lAWS OF CALIFORNIA.AND AGREE THAT IF I SHOULD BECOME INS?ECTION FEE _ = SUBJECTTO TME WORM:ERS'COMPENSATION 7ROVISIONS OF SECTION 37000FTHE IABOF - — CODE,I SHALI FORTHN�ITH COM7LV WITH THOSE PROVISIONS. ISSUANCE � SMIP / p DATE. APPLICANT: - — J WAfiNING:FAIWRE TO SECUFE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHAllBE ENERGY P/C _ � SUBJECI AN EMPLOYER TO CRIMINAL PENALTIESAND CIVIL FINES UP 1'O DNE HUNDRED THOUSANO ENERGY PERMIT �OLLARS�S1 o0.00a�.IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDE�FOP IN -- J SFCTION 3108 OF THE LABOP CODF,INTEPEST.AND ATTORNEY'S FEES. RETENTION FEE: ^_ � d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O Q INEREBYAFFIRMUNOERPENALTVOFPERJI:RVTHATTHEREISACANSTRUCTION�ENDINGAGENCY � FOq THE GEH WRMANCE OFTHE WOFN FOR WHICH THIS PERMR IS ISSUED(SEC.309],pV C.�. �� — Z W -- � LENGEN'S NAME — 1— LEN�ER'SADDRESS � TaTALFEES � � ICERTIFYTHATIHAVEREA 11SAPPlIGATIONA S7ATETHATTMEABOVEINFORMATIONISCORRECT w IAGREETOCOMPlYW1T LL�'ITVAN�COUNT RDINANCESA IAWSRELATINGT09UIL'JING d / CON CT��ON.AN EBV 4UT RI2E RE S NT TNIS COjJj�TY TO ENTER,UP}�N TrHfE / � � A E�MENTION P TV�SPE OSES L%�Y V�' /J�- `i GOMMENTS � F� ! � ��'..: C ` � ;�;�. I�Ct-!} ' - - � �; `' _ �. _ — ¢ P ITTEE NAIAE(GRINTJ � + _ `„ k'L:--v1�tv�_E: �L��\�� --- �I- __C'_.� ✓ � �I�NqTI�HE OF PERM`TEE DATC ' �/ = FECPT.NO. _ PAID BY VALIDATION ~ WHI?E—DeFartment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,G DENRO ile Copy,GREEN—Applicant's Copy ..., . � � r�d� �:�5^,':.�s ,,.-, r�.. _ . . �o „ a.r .. „.�i s � 5 ��— � �,, f., � � � yg�x � _�� ! _ � � F . _ , e �� , �� ur15�v t. ��" . _ ;�. �,.�� .��,,,,,�� F ,- � . W � . � _. _ ' ; ___ _ _ _ _ __ _ _ _ _ ; __ ___ _ _ _ _ __ ; _ — ;�'��'��a��"'� � ,;�� - �� _ _ �� . , ��.��,� � �� y � , � t ,� �.�t� � �� — _ _ , ;: .; „ ;, _ _ . , � � m:� � �r i �. � � � _ _ � _ �:� : _ , �� . ,. � #�,�� ` _ _ __ �m � __ _ _ , Qif��> JOBSITE�2'7'�� p� ADDRESS_� 1-/ APN LOT TRACT_ OWNER+ �� r C.LrIC> t' �L ADDRESS 3,y s,t k., ��f 1 f"L�i. CITY I) 1 r-S :'�il�%.'II (/I�[ 1�TEL�ZC� �� "t APPLICANT�i-7a :ti\i +tiL�C_ �?� 12, >EL� � �� I CONTRACTORS'�,�e-/- 1.:fiW� [,( �,-, �c a ADDRESS CITY ZIP TEL C 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 UW FOR THE FOLLOW ING REASON(SEC. 7031.5 BUSINESS AND PROFESSIONS CODE: ANV CITY OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT ALTER,IMPROVE, DEMOLISH,CR REPAIR ANY STRUC- TURE,PRK)R TO ITS ISSUANCE.ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE I:i 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- FESSIONSCODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION.ANV VIOLATION OF SECTI(NJ 7031.5 BY ANY APPLICANT fOR A PERMIT SUBJEC t5'f HE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS IS500). ): ^ I,AS OWNER OF THE PRCIPERN,OR MV EMPLOYEES W ITH WAGES AS 1HEIR SOLE COMPENSATION, WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OH OFFERED FOH SALE !SEC. 7044, BUSI- NESSAND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NO'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,HOW EVER,THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE- TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING SHAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE Of SALE). C I,AS OWNER OF THE PROPERTY.AM EXCLUSIV ELV CONTRACTING W I FH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC. 7064, BUSINESS AND PRUFESSIUNS CODE:THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO dUII.DS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS W ITH A CONTRACTOR(S11 ICEN SED PURSUANT TO THE CONTRAC- TORS LICENSE LAW). ]I AM EXEMPT UNDER SEC. B. 8 PC. FOR THIS REASON DATE OWNER_ LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENAI-N OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 30F THE BUSINESS AND PPOFESSiONS CODE,AND MY LICENSE IS IN FULL FORCE AND EFFECT. LICENSE CLASS LIC. N0. DATE CONTRACTOR_ WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENAI TY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINT,41N ACERTIFICATE OF ONSENT TO SELF�INSURE FOR WORKERS' COMPENSATION,AS PROVIDED BV SECTION 3 00 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISS ED. I HAVE AND WILL MAINT,41N WORKERS'COMPE SATION INSURANCE,AS REQUIRED BV SECTION 37000E THE LABOR CODE,FOR THE PERFOR ANCE OF TH[WORK FOR WHICH THIS PERMIT IS ISSVED. MV WORKERS'COMPENSATION INSU ANCE CARRIER ANO POLICY NUMBER ARE: CARRIER POLICY NUMBER (THIS SECTION NEED NOT BE Ct�MPLETED OF TH PERMfT IS FOF ONE HUFDRED DOLIA0.5IS100)OR LESS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANV PERSON IN ANV MANNER 50 AS TO BECOME SUBJEf,T TO THE WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORMERS'COMPENSATION PROVISIONS OF SECTION 37000E THE IABOR CODE,I SHALL FORTHN�ITH COMPLY WITH THOSE PROVISIONS. DATE:APPLICANT: WARNING: FAILURE TO SECURE WORKERS'COMPENSATKN COVERAGE IS UNLAWFUL,AND SHALL 8E SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP 1'0 ONE HUNDRED THOUSAND DOLLARS(5100,000),IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3700 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES. CONSTRUCTlON LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERDU RV THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC. 3097,CIV C.). L E'NDEN'S NAME LENDE R'S ADDRESS I CERTIFY THAT I HAVE AEA 115 APPLICATION A STATE THAT THE ABOVE INFORMATION IS CORRECT I AGREE TO COMPLY WIT LL CITY AND COUNT RDINANCES A LAWS RELATING TO BUILDING CON CTION.AN EBV 4UT RI2E RE S NT THIS COjJj�N TO ENTER UP NTH A E�MENTION TY SPE OSES(�� j'i r �r- �� 4r �q ....\"/. P ITTEE NAM PR INT) E( I U �� . - � �NAT N 0 PE RMITT - - D a 0 w 0 0 w z 0 0 z m 2 0 0 0 W U Z W U H Z W Z 0 Q d X W H U w N Z Q W Q J D Z Q W Z C�3 C/0 F W J J W } J W 0 Q d Z W S F-- W d Z m Q C!) f-- CITY OF DIAMOND BAR DEPARTME!�.rI.OF CONIIvit7NITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION PRESS FIRMLY WHITE-Department Copy,YELLOW-Finance Copy,PINK-Assessor Copy,GCILDENROD�File Copy,GREEN-Applicant's Copy