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Home My WebLink About19080 � CITY OF DIAMOND BAR �� '`` DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES ,. � � � ��1 �y 2I825 E.CopleyDrive �. � (909)860-3195 Fax(909)861-3117 PRESS � ��:� BUILDING PERMIT APPLICATION FIRMLY � JOBSITE / APPLICATION ' PERMIT P/C r c o ADDRESS_23`,�GG [�DIrIP.!'I Sprrr►�s Dr. DATE_ 5 � Q� NUMBER # Qo2'` �0 � ISSUE /, TYPE OCC APN LOT� TRACT�,��7 DATE r � CONST. GROUP °C OWNER SUM �_Q2 O " ADDRESS 2396�(� ��O I�O� r �. ZONING SETBACKS z CITY �D IQYVIeYrL 8er_ ZIP TEL S09 5I3]'2'�lflZ FRONT RW ❑ � APPLICANT _�S'�1Y1 I�.C2. TEL �f REAR ❑ � SIDElSIDE STREET RW ❑ z Q CONTRACTOR_ SIDE ❑ � ADDRESS PROPOSED USE lJ � � CITY ZIP TEL. �w ARCH/ENG/ z DESIGNER�s' , s NO.DWEL. NO. NO. a ADDRESS p.l�. (�?j UNITS STORIES BEDROOMS � CITY ��l1Yla �� ZIP��7?„�TEL.67I� 331-3er2 � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNEfl-BUILDER DECLAFlATION SFR/ADD/REM O � I HEREBV AFFIflM UNOEF PENALTY OF PEWURV THAT I AM EXEMPT FROM THE CONTRACTORS LI� GdfBQ@/CBfpOfl W CENSEUIWFORTHEFOLLOWINGREASON(SEG]031.SBUSINESSANOPROFESSIONSCODE:ANYQTYOR (n U CAUNTVWHICHREOUIRES4.PERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISM,ORREPAIRANYSTRUC� W Patio/Deck TURE,PRIOF TO ITS ISSUAIJCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w STATEMENT THAT HE OR SHE IS LICENSED PUflSUANT TO THE PFOVISIONS OF THE CONTRACTOFS LI� w � CENSE LAW(CHAPTER B(C(JMMENCING WITH SECTION�OoO)DF DIVISION 30F THE BUSINESS AND PRO- � PooUSpa � FESSIONSCODE)ORTHATHEORSHFISFXEMPTTHEREFROMANDTHEBASISFORiHFALLEGEDEXEMP- � � TION.ANVVIOLATIONOFSE��TION7o31.58VANVAPPLICANTFORAPERMITSUB_�ECiSTHEAPPIICANTTO Z R0-ROOf ACIVII PENALTV OF NOT MOFETHAN FNE HUNDRE�DOLLARS�f5oo).�: ❑I,AS OWN ER OF THE PROPERT',OF MY EMPLOV EES WITH WAG[5 AS THEIR SOLE COMPENSATION, Z � Gommercial WILL DO THE WORN,AND THE STRUCTURE IS NOT IMENDE�OR OFFEREO f-0ri SALE jSEC.]064,BUSI- J � NE55 AND PROFESSIONS OJDE:THE CONTRACTOftS LICENSE LAW DOES NOT APPLV TO AN OWNER OG � PROPERTV WHO BUILDS OR IMPROVES THEREON,AND WHO OOES SUGH WORK MIMSELF OF HERSELF OR � THROUGHHISORHEROWNEMPLOYEES,PROVI�E�THATSUCHIMPROVEMENTSARENOTINiEN�EDOR m � OFFEREDFORSALEIF,HOWEVER,THEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPIE- Z TION.THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR � IAIPPOVE FOR THE PURPOSE OF SALE). w ❑I,ASOKTIEROFTHEPROPERTV,AME%CWSNELVCONTRACTINGWITHLICENSEDCANTflACTORS � TO CONSTRUCT THE PROJf:CT(SEC.]Odd,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- V81U0�IOf1 ADJ.AREA W CENSELAW�OESNOTAPPI_YTOANOWNEROFAPROP[RTVWHOBUILDSORIMPROVESTHEREON,AND � WHOCONTRAC7SFORSUCHPROJECTSWITHACONTRACTOR(S)LICENSEDPUflSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE I Y TORSLICENSELAW.�. � 7 I AM E%EMPT UNDEFl SEC. B.8 P.C.FOR THIS REASON � � - 7 � LL i' ER 7 . �. U . W � LICENSED CONTRACTORS DECLARATION W ¢ � 1 NEREBV AFFIRM UNDER PI:NA�TY OF PERJURY THAT I AM LIGENSED'JNDER PROVISIONS OF GHAPTER � � 9(COMMENCINGWITHSEGI"ION]000)OFUIVISION90FTHE6USINESSANOPFOFESSIONSGODE,AND Z `X MV IICENSE IS IN FULL FOflCE AND EFFECT m � LICENSE CLASS LIC.NO. j � J U �ATE CONTRACTOR a W � WORKERS'COMPENSATION DECLARATION —� Q = U � 1 HEREBV AFFlRM UNDER PI=NALTV OF PERJURV ONE OF THE FOLLOWING DECLARATIONS: Z Q � I HAVE AND WILL M/�INTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' _ CAMPENSATION,A::PROYIDEO BY SECTION 31000F THE U80R CODE,FOR THE VERFORMANCE U Q OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. � � w 1 HAVE AND WILL MIUNTAIN WOFKFRS'COMPENSATION INSURANCE,AS REOl11RED 6V SECTION r Q 3]OOOF THE LABOiI CODE,FOR THE PEFFORMANCE OF THE WORK FOR WHICHTHIS PERMIT IS ��. I ISSUE�.MY WORKERS'COMPENSATION WSUFANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION t J j CA�RIER PLAN REVIEW _ L �_a Z POUCV NUMBER_ ELECTRIC ¢ O (iHISSECiYJNNE�N0T8ECGYA%.EfEDOFT1EPEf7AARlSFORONF.HUNDRED00LLAR5(5100)ORLE55� PLUMBING w MECHANICAL Z I CERTIFV THAT IN l HE PERFORMANCE OF THE WORK FOfi WHICH THIS PERMIT IS ISSUEO,I ('} SHALL NOT EMPLOV ANY PEFSON IN ANV MANNER 50 AS TO BECOME SUBJEGT TO THE � WORKERS'COMPE!VSATION LAWS UF CALIFORNIA,qNpAGREE THAT IF I SHOULD BECOME INSPECTION FEE F SUBJECT TOTHE N'ORKERS'COMPENSATION PROVISIONS OF SECTION 37000F THE LA60R � CODE.I SHALL FOPTHWITH COMPLV WITH THOSE PROVISIONS. ISSUANGE � � SMIP _�� p DATE: _ APPLICAM: -- - � J WAqNING:fA1WHETOSECUREWORKEflS'GOMPENSATIONGOVERAGEISVNLAWFUL,ANDSHALL6E ENERGYP/C � SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUN�RE�THOUSANU ENERGY PERMIT � DOLUIRS(f 1 W.00a�,IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROYI�ED FOR IN J SECTION3Io80FTHELABORCODE.INTERESTANDATTORNEY'SFEES. RETENTIONFEE: ' / � a CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O � I HEREBV AFFIRM UNDER PENALTYOF PERJURY THAT THERE IS ACONSTRUCTIDN LENDING AGENGY d FORTHEPERFORMANCECFTHEWORKFORK'HICHTHISPERMITISISSUED(SEC.309],CIVC.�. �--�--- Z W � LENDER'S NAME _ 1— LENDER'S A�DRE55 � ICERTIFVTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATIONISCOFREGT TOTAL FEES `�//6/bL � CONSTRU�TION,PAND HER�aBVAIUTHORIZE�REPR SEN ATIVES OF T�HISACD NTYSTO ENTER U ON T DING Pp o� � ��.{y�� ABOVE- ENTIOM1EO PROPF_RTY FOR INSPECTION PUaPOSES. Z GOMMENTS � Qn � Ll� �W m PER AIu1E(PFINTI / ¢ ` ', `�--�-._�...... �.�ll� �'G'y � ONAiN�REOFPERMITTEF � DATE AECPT.NO. PAID BY VALIDATION WHITE—DepaAment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanPs Copy I I � r �'�? e k�.` ` p " t� r, � _ ��, i ��{ �F h=" ¢ y �ai�� s '� �'��,��`�� . . ,- . _ �. . . n ..' . ��. _ .,.tir . _. . . , _ � '.: — � � . ., � rp , � .,� , �� , . ,.. : . �� " . , .. . . � . v, , . . . . . . 3�. .i . � � , =��.,�.��, �. {J�� _ � / 1'�3-+D� � �1` ��e3 •� _ �.��.� �r� _ ��-�� .�� , .._:- : � . - . _ . . ... ... , ..�- . � .. .. �� /—�i".��'�/�-�'lr .. .. ... .. .. ... ..... .�.. ._ .... ..... . .... .. Z1�Ld�� 2.�. 21z�� Q-� - �u�3 R.c� . _ _ _ _ � � �d� r. . �rt .. . , _� . ...�s e�a.� _ � _ _ __ __ �'� ,� , : — � ,�.— _ _ _ ° .�� = s � � , ,�a�� !, a= , � �, , � _ _ _ .i F . � � .,, _ � . ' � �� . � � �.:n"�i F,_ .. . . � . . .. .... .. . . .. . ... . .... .... . .. .. . . . . :, ., . . . _±.. .....s,:�,:..,.s w..�t.,';,.. . . .. .. ... ... . .. ... . ... ... , .._ ..._ .._.. ..._... . . �. > i . � � s , , , � ,',. . . .. ... . ... .. . ..... ... .. . . .. .... ... .. ....... ...... ...... ..... . ..... . ...... .... �_ �� CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION F PRESS FIRMLY JOBSITE ADDRESS_2V(,okleA SP>S Dr. APN LOT TRACT ZA 12-7 OWNER Sun Lee ADDRESS 23961 60 WPM r Dr. CITY D iAmetrd Aar ZIP TEL. S09 137-,2#p2 APPLICANT .hS'Un kte-TEL. CONTRACTOR ADDRESS CITY ZIP TEL. ARCH/ENG/ DESIGNER&€S ADDRESS Ike)421 CITY rjliia ;C�ZIP 91723 TEL.62 332-3b17 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 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 FIE 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($SOS(.(: ^ I,AS OWN ER 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). ^ 1.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 UNDEFI SEC. B. &P.0 FOR THIS REASON ER 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 LICENSE CLASS LIC. N0. DATE 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,COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE CARRIER POLICY NUMBER_ (THIS SECTION NEED NOT BE COMPLETED OF THE PERMIT IS FOR ONE HUNDRED DOLLARS($100)OR LESSF 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 LABOR CODE,I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. 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 CF 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-ENTIONED PROPERTY FOR INSPECTION PURPOSES. Lt 1 W PER AME(PRINT)i.2111 III E OF PERMITTEE DATE r) 00 cc 0 LL w 0 0 IS 0 Cr 0 w W U W 0 U 0 C/D d X W 0 I- F- U w U U W Lu W UD, C7 0 U w J J L4 W W 0 d W I W Q_ CD J APPLICATION j/ 0 2 PERMIT /C Q 2- 5 7 0 DATE NUMBER 0 ISSUE 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 U) Garage/Carport w Patio/Deck LL Pool/Spa Z Re-Roof Commercial Ib A 0;- Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U cc: U w J w C7 Z m D J a- U Z z 0 w CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES S�/b�aL p1Do t 3 17D COMMENTS 61 on 14 Ile- t7N A RECPT. N0. PAID BY VALIDATION WHITE-Depaiment Copy,YELLOW-Finance Copy,PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy r