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Home My WebLink About18529 ��_ CITY QF DIAMOND BAR � DEPARTME'�T OF COIvIMUNTi1'&DEVELOPIv1ENT SERVICES 21825 E.Copley Drive ' '� (909)860-3195 Fax(909)861-3117 �, ,. � PRESS �',M'� BUILDING PERMIT APPLICATION -� � �� . FIRMLY � JOBSITE �' O ' �L�a A�� J,,.L �� APPUCA I p_.�^, PERMIT C, �f P/C o ADDRESS__ �V_ n�� DATE 'T7z1L NUMBER ?� # � ISSUE � �\'i TYPE OCC APN-�-- LOT TRACT r __ DATE_ �i�CONST. GROUP p OWNFR ( ��.��1Z�1{J L��i �' �.K o ADDRESS I ZONING SETBACKS Z CI7Y ZIP TEL � FRONT RW ❑ � APPLICANT TEL._ REAR ❑ o - SIDEISID[STREET RW (�i z ¢ CONTRACT SIDE O ___ ¢ ADDRE r f PROPOSED USE � C�Ty ZIP '' TE .- �w ARCWENG/ z DESIGNER -- NO.PWEL NO. NO. a ADDRESS UNITS STORIES �BEDRDOMS � � CITY ZIP__ TFL._ � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � � OWNER-BUILDER OECLARATION SFRlADD/FEM O � I HEREBV AFFIRM UNDE�PENALTV OF PERJVRY THAT I AM EkEMPT fROM iHE CONTRACTORS LI� � Garage/Carport W CENSEUWFORTHEFOLLOW�NGREASON(SEG.'l031.50USINESSPN0�90FESSIONS�'AOE�.AN��iTYC�? zCOVNTVWHICHREOUIRESAPERMITTOGONSTRUGT,Al7ER,IMNROVE.DEMOlISFi,CRflEPAIRANV:iRUC- W pa�i0/DBCk w TURE,PRIOR TO ITS ISSUANGE,AlSD REOUIRES THE APPLICANT FC]R SUCH PEftMIT TO FILE A SIGNE� w � STAlEMENT THAT HE OF SME IS'uCENSED PLIFS�MI'TC TNE>RCVIS�ONS OF iHE CONTPACTORS LI- � CENSE LAW(CHAPiER B(COMMENCING WiTH SECTION 7000)QF DIVi510N 3(1F THE Bl/SINE55 AND PRO- LL POOUSFI2 O FESSIONSCA�E!ORTHATHEORSHEISE%EMPTTHFqFFROMANDTHEBASISFORTHEALLEGEDEXEMF- � V TION.ANYVIOLATIONOFSECTION1031.5B�ANYAPPLICAN;FOFAPEHM�T2J9JEGTSfHFAPPIICANTTO z Re-Roof � A CIVIL PENALTV OF NOTMORE THAN FNE HUNORE�DO�LARS(S5o0�.)�. O ❑I,ASOWNE0.0FTHEPflOPERfV,CFMVEMFlO`/[ESWiTHWqGESA57HE�fi50LECOMPENSATitN, Q COrt1R1BtCial Z WILL DO THE WORK,AND THE STRV�TVflE IS NOT IN'ENDE�DH OFFEFEU FOH SAIE!iEG.70Ed,BU"�I- J � NE55 AND�flOFFS510N5 CODE'.THE GONTFHCTUFS LI(:ENSE lAW GOeS NO'"APPiV i0 AN OWNER OF ? PROPER'Y WHO BUILOS OR IMi'ROVES THEP.EOk,AND JtiO DQES SUCN WORK H'�,MSELF OF HEASE'_F OR � TNROUGM MIS ON HER DNM EMPLOVEES,GROVIDEDTHAT EUCH IMPflOVcMENTSARE NOT INTENDE�OR m w OFFEREDFONSALE.IF,HOWEVER,THEBUILOINGORIMPFOVEMEN?iS50LDWITH�NONEVEAROFCouo�E- � TION,THE OWNER�BUILDER WILL MAVE THE BURDEN OF PRDVING'HAT HE OR SHE OI�NOT aUILD oR Z IMPROVEFORTMEPURFOSEOFSALE). /'� � [1IA50WNERO�THEPFOPEFTV.AMEXCLUSNELVGONiRACTINGWITH�ICEN5E000NTRACTORS — W [= TO CANSTRUCT THE PRQIECT(SEC.]ON,BUSIN[SS AND PROFESS�ONS CODE.THE CONTRAGTORS LI� V21U811Df1 _ ADJ.AREA_ W CENSELAW DOESNOTAPPLVTOAN OWNEROFAPROPERTYWNOdUII.D50RIMPROVESTMEREON,AND ` � WHOCONTRAG75fOR5UCHPROJECTSWITHACONTRACIOR(S1110Eh5EDPURSVANTIOTME�ONTRAG OUANTITY DESCRIPTION FEE TORS LICE��SE LAW.). Y J � '�,1 AM E%EMFT UNGER SEC. B.8 PC.FOR�HIS REASON Q O -- U � '— S LL DATE OWNER '_.— --- U Z W � LICENSED CONTRACTORS DECLARATION J ¢ W � 1 4fREBY AFfIRM UNDER GENAITV OF PERJURv THAT 14M UGENSED UNOER PROYi510NS(lF CHAPTER � � 9(COMMENCING WITM SEGTION)OODI�F DNISION 3 OF THE BVSINE55 AN�PP.OF�SSiONS CODE,ANb Z W MY UGENSE IS IN FVL FO D EFFECt m �� C �� ..._�.� � � LICENS LA S LIC.NO. I`1yi�J, N/Y__L- _ U pq7��_ _ CONTRAC70R��Y JC n- W a� WORKERS'COMPENSATION DECLARATION Q � U � FRRM UNDcR?ENALTV OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: � Z Q � I HAVE AND WI�L MAINT4IN A CFRTIFICATE OF CONSENT�O SELF-NSUFE I'OR WORKERS' _ Q �ENSATION.AS FROVIDED BY SECTION 3]Co Of THE LABOR CODE.FOR TME PERFOFMANCE W THE WORK fOR WHIGM THIS PEAMIT 151SSUEU. rL � w I HAVE AND WILL MAINTAIN WORKERS'COMPENSATInN iNSIIRANCE,AS REOUIRED BV SECTION � Q 3]0�OF THE LABOP CODE.FOR THE PEFFORMANCE OF THE WORK FOR WFICH TNIS f ERMI?IS — f� ISSUED.MY WORKE 'COMPEHS/.TI ' SURANCE GARRIER AND POLICY NUMBERARE'. CONSTRUCTION � � �� j cnaaieA PLAN REVIEW _ � POLICV NUMBER -- ELECTRIC Q � (iHISSECTICNNEmN�TBEO�AARE�EDOFT},'EPEFUMISFOyONEHUf.OHF�IXJIIARS(f100!oRLEsS). PLUMBING w MECHANICAI Z I CERT!F�THAT IN THL PERFORMANCE O�THE WORK fOR WHICH THlS PERMIT IS iSSUED,1 —� �} SHALL NOT EMPLOY ANV PERSON IN ANV MANNER 50 AS TO BECOME SUBJE(:T i0 TME �j WORKERS'COMPENSATtON 1AW50F CPIIFOF�IP,AND AGREE TMAT IF 1 SHOtiLO HEG0IAE INS��ECTION FEE _ _ , . — � SUBJECTTO THE WORKERS'COMPENSATION PROVISIONS Of SECTION 3]OO OF THE LABOR ISSUANCE E'� � CO�E,I SHALL FORTHWITH COMPL�W�TH THOSE PROVIS�ONS. -- �•�— O SMIP � �7 f`' p DATE'.__ APPLICANT w ENERGV P/C —. J WARNING.FAIIURE TO SECURE WORKERS'COMPENSA7ION GDVEflPGE IS UNLAWFUL,AND SNALLBE J SU6JEGTNNEMVLOVEflTOCRIMINALPENALTIESANOCiVILFMESUVTOONEHUNDRE0TH04SAND � OOlLAR5�1100D00),INA�D'�TIO4TOTH[COSTJFCCM7ENSATIO`l,DAMAGESASPROYI�E�FORIN ENERGYPERMIT — J SECTION37o80FTMELABOflCODEINTEFEST,ANOATTORNE�'SFEES. RETENTIONFEE: _ �.' L �� - � w CONSTRUCTION LENDING AGENCV PRE-ALT FEE — � O Q i HEREBY piFIRM UNDER PENAITY OF PEflJUPv TNFT THERE�5 A(;UNSI F.U��110N LENpING AGENCV � FOR THE PER=ORMANGE DF TME WiJFK FOR WHICH TMIS PERM�T IS ISSUEG(SEG.3091,CIV.C.j. W S LENDEN'S NAME_ _ --- .... � F_- LENDEP'SA�DRF.SS ----.� -----� � � TOTAL FEES � -�.L ` � � 1 CEH'IFY��1RT I HAVE READ TN�S A�P�ICAT�.ON AN�STATE�HAT TME ABOYE INFORMATION IS GJRFtCi. 4 �1 �_ w I AGREE TO COMPIY WITH ALI CITY NND GUUNTV ORDINHNCES FND STATE LAWS HELAiING'O BUIL�ING � � GONSTRUCTION,AND NcREBV AUTMORIZE REPRESEN fAiIVES OF THIS COUNTV TO ENTEP UPi)N THE � ABOVE-MFNIVDNEDPqOPERiVFOPiNSPECTIONPURGOSES. Z �� COMMENTS __ ._ . � J - � -.--- m PEGIMIiT N R T� � , � ,2�--- � -- -----F�,�-� siC:NAi��'nF VER�EE DATF _ � �� RECPT NO. __ � � �� PAID BY � _VAUDATION x ~ WHITE—Department Copy.YELI.OW—Finance Copy.PINK—Assessor Copy,�GOLDENRO�File Gopy.GREEN—AppliCanPs Copy ��. a�� ;�� ,� �� `�� , . �� '� ,"��s� �� _ _, _ _ __ _ _ _ _ ��.�°�' :�`""�� ,� ,.�.�� , _ __ _— — _ � _ _ _ , _ . __ . .. _ _ _ _ � _ _ __ . _: __ ___. __ . . ; � ,�,. , 9 ._.. . _. .. � �� +�� $,�� &��`q�y,uyj�J�,�� , _ � � (�pf , �� A �� '��°t �: T *�,` .' k ._ .. . . . . . . .. . ._ ..... .... .. _ . ... ..... . _.... �s'�e '' �' �I ° r ��J . ... . . . ... ... . . .. . .. . . . ... ..... .. ...... .... .. ...... ..... , �� I s' �. c , � . .. . ... .. ... . ..... ... . ��i � a u,' 4; ,. �,.� � , . .. .. . .. . .... .. .. .. .. . . . . . ... ... .... .. ._... ..... . .... ,v q,��i. r k �v:''" .. ... ... . ... . .. .. .. . . . . . . . . ..... ...... ... ........ ... . . � ... . ..... . .. � DIAMOND BAR i Cri °co Ix 0 LU W z 0 M 0 Ap CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION 5 0 G��,��e ADDRIESS �� APN LOT TRACT OWNER ADDRESS I CITY ZIP TEL APPLICANT TEL. CONTRACT ADORE CITY ZIP 2 TE. 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 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 B (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 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 NO 7 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 W ITHIN 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 B'UIIDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)IICEN SED PURSUANT 10 THE CONTRAC- TORS LICENSE LAW) I I I AM EXEMPT UNDER SEC.__B.&PC. 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 FVLL FO f1D EFFECT LICENSE LAS(�-,T�JI C LIC NO JC !L/ Z�• DAT 1-1 CONTRACTOR WORKERS'COMPENSATION DECLARATION FFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT,0 SELF-INSURE FOR WORKERS E RI AS PROVIDED BY SECTlON 3700 Of THE LABOR CODE. FOR THE PERFORMANCE 0 K THE WOR 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 WORKE CTSUR�E CARRIER AND POLICY NUMBER ARE CARRIER POLICY NUMBER r (THIS SECTION NEED NOT BE COMPLETED OF THE PERMIT IS FOR ONE HLMORED DOLLARS(5100)OR LESS). 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 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. P-.I- N R T) SIGNATU ' F PERM EE DATE 0 LU W C� W 0 1- 0 C/) LL 0 W d X 0 1- U W a CO 0 W Q 0 0 w Z 0 0 0 w � LL CIE d 0 Q L_ w F- M LU C, J CO CO On CJ3 I- F- PRESS FIRMLY APPLICA I- PERMIT C: C P/C DATE NUMBER I # ISSUE TYPE OCIC DATEitIONST .GROUP ZONING SETBACKS FRONT RW n REAR 1 ^ L SIDE/SIDE STREET RW^ SIDE PROPOSED USE N0. DWEL. N .. N0. UNITS STORIES BEDROOMS_ DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM C� Garage/Carport Patio/Deck LL Pool/Spa 0 Z Re-Roof Commercial CO Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U 0 W w 0 z m 09 IL Q Z 2 0 W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP L ENERGY P/C a t ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES I�I I 1 COMMENTS RECPT N0. PAID BY VALIDATION