The URL can be used to link to this page

Home My WebLink About18530 � CITY OF DIAMOND BAR � DEPARTME'VT OF COMMLINI7Y&bEVELOPMENT SERVICES 21825 E.Copley Chive '� (909)860-3195 F�(909)861-3117 -� �• , � PRESS � �:�� BUILDING PERMIT APPLICATION ��, % .FIRMLY ¢ JOBSITE �}1y � j_ � APPLICAT O PERMIT �+-�� p/C o ADDRESS_- �J r �� DATE � NUMBER � J J g ( �� ,J ,�J TYPE OCC °� APN �OT T AC DA EE j �CONST. p OWNER _� N/�A�(Z(Z�I�I (��#^Tf(} A , GROUP p ADDRESS � ZONING SETBACKS Z CITY ZIP 7EL 't FRONT qyy � o APPLICANT TELC_ REAR r) z SIDFJSIQE STREET RW ❑ ¢ CONTRACT R '� SIpE � ADDRESS � CITY 3 ZIP TEL � PROPOSED USE .� w ARCH/ENG/ r�'/� � z DESIGNER_t�fn - w — ---- NO.DWEL. NO. Np, � ADDRESS �n UNITS STORIES � gEDROOMS � CITY ZIP__ TFL.__ T � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION p SFFL'ADD/REM � I HEREBV AFFIRM UNDER PENALTY OF GERJUPV THAT I AM EXEMP7 FROM�HE CONTRACTORS LI- Gaf890/CBfPOII W GENSEUWFORiMEFOLLOWINGREP50N(SEG.7037.56USINESSAN�FROFESSIONSCODE:ANYCITYOR (f� U CWN7YWHICHRE�UIRESAPERMITT0004STRUCT,ALTER,IMoppVE.DEMOLISHCRREPAIRANV;'RUC� w TURE,PRIOR TO ITS ISSUANCE,.4L50 REOUIRES THE A7PLICANT FOR SUCH PERMIT TO�I�E A SIGNEO w PBIIClDBCK � STATEMENT THAT HE OR SHE IS LICENSEO Pl1RSUANT TO THE PROVISIONS OF THF CONiPACTORS LI- I � CENSE LAW(CHAPTER 9(COMIAENCMG WITM SECTION)000)OF DNISION 3(�F TNF BUSMESS AND PRO- � POOUSPB � O FESSIONSCADE)ORTHATHEORSHEISE%EMPTTNFPEFROMANDTHEBASISFORTHEALLECEDEXEMP� � U TION.ANYVIOLA710NOFSECTION7031.SBYANVAPPLICRN�FORAPEFMITSJ9JEC�S'MfAPPUCANTTO Z Re-Roof ACIVIL PENALTV OF NOT MORE THAN FIVE HUhDRED DOLlAR5135W1)'. � ❑I,ASONTIEROFTHEPROPER�Y.ORMYEMPLOYEESWITHWFGESASIHEIRSOLECOMPENSATiDN, � COmlflerCial Z WILL DO TME WORK,AND iME STRUCTUFE IS NOT INTEN[!ED ON OFFERED:OH SALE(SEC.7o4a,BU�I� _J � NE55 AND PROFESSIONS CODE:THE CAN'RACTORS LICENSE LAW DOES NO�APPLV TO AN OWNER OF PROPERTVWHOBUILOSORIMVROVESTHEREON,ANDWHODOESSUCHWORKHIMSELFORHERSELFOR � � THROUGH NIS OR HER OWN EMPLOVEES,PROVIDED TNAT SUCH IMPROVEMENTSARF NOT INTEN�ED OR m QOFFEREDFORSALE.IF,HOWEVER,THEBUILOI!�GORIMPROVEAAENTISSOLDWITHINONEVEAROFCOMPLE- Z TION,THE OWNER�BUILDER WILL HAVE THE BVRDEN OF PROVING'.HAT HE OR SHE OI�J NOT BUILD OH = IMPROVE FOq THE PURPOSE OF SALE�. w C:I,ASOWNEROFTHEPROPERiV,AMEXCWSIVELVCONTRRCTINGWIfHLICENSEDCONTRAGTORS � � TO CONSTRUCT THE PROJECT(SEC.)Oa4,BUSINE55 AND PROFESSIONS CODE:THE GONTFACTORS LI- V2IU3IIOfi �_ 1i � �� qDJ.AREA W CENSELAWDOESNOTAYPLYTOANOWNEROF�PFiOPERTVWMOd'✓II.DSOFIMPROVESTHEHEON,AND WHO CANTRACTS FOR SUCH PROJECTS WITM A GONTRACTOR(S�I.IGENSE�PUFSVANT l0 THE CINJTRAC- ~ TORSUGENSELAW.). OUANTITY DESCRIPTION FEE Y — � CJ I AM EXEMPT UNDER SFC. _______ _ B.d P G FOR THIS REASON a �7 U � DA'E OWNEF F- Z U � LICENSED CONTRACTORS DECLARATION w ¢ CC I MEREBVAFfIRM UNDER PENALTY OF PERJURY`HAT I AM IICENSE�UNDER PROVISIONS OFCHAPTER � d 9(COMMENQNG WITM SECTION)OOO)OF DIVISION 3 OF THE BUSME55 AND PPAFESS�iONS CODE,AND Z XO MY LICENSE IS W FUL�RCE A EFFEC�T.� �� ' � W � LICENSE CLASS , �IC.No. � V �ATE�,F..� __ GON7RACTOR a W � WORKERS'COMPENSATION DECLARATION Q � I HER AFFIRM UNDER PENALTV OF PERJURV ONEOF THE FOLLOWING OECLARATIDNS: Z � IHAVEANDWILLMAINTAINACERTIFlCA7EOFCqNSENTiOSELf-1NSUREFORVIORKERS' a Z = ¢ CqMPENSATION,AS PROVIDED BY SEGTION 3looOF THE LABOfl CODE,FOP THE PERFORMANCE U FTME WGRK FOR WHICH TMIS PERMIT IS ISSUED. w � � w I HAV�AND WII L MAINTAIN WORKERS'COMPENSATIO�I INSUPANCE,AS RF_pUIRED BY SECTION /� QQ 3)0o OF THE LABOR CODE,FOR THE PER�ORMANCE OF THE WORK FOR WHICHTHIS PERMIT IS 1,�� (-�` ISSUEO.MV WOR N N INSU NCE CARRIER AND POLIGV NUMBER ARE' CONSTRUCTION � �1 J j caaaieq_ . PLANREVIEW � POIICV NUMBER � -- ELECTRIC � Q � (iHISSECTIONNEmNOTAE(YY.IRE7EDOFTHEPERAAITISFOFONENUnORE�'�OUARS(E1C0)OFLESS�. PLUMBING W Z I CERTIFv THAT IN THE�ERFORMhNCE OF TME WORK FOR WHICH THIS PERMIT IS ISSUE�.1 MECHANICAL �} SMALL NOT EMPLOV ANY PERSON IN AfvV MANNER SO AS TO BECOME SUBJE(:T TO THE �-� (/� WORKERS'GOMPENSATION LAWS OF CAUFORNIA,AfvD AGREE THAi IF�SHOULD BECOME INS:�ECTION FEE St18JECTTO THE WORKERS'COMPENSATION PaOVI510NS OF SECTION 3�00 OF THE IABOR � CODE,I SHALL FORTHWITH COMGLV WITH THOSE PROVISIONS. ISSUANCE _ � �� p DATE:. APPIICANT SMIP �� `�y W - J WAflNING:FAILURE TO SECUNE WOHKERS'COMPENSATION GOVERAGE IS UNLAWFUL,AND SHALL BE ENERGV P/C J � SU6JECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDFEDTHOUSAN� ENERGYPERMIT r DOLLARS(f 100 000),IN ADOITION TO THE COST OF COMPENSATION,�AMAGES AS PROVIOED FOR IN _._ J SECTION3]OBOFTHE�ABORCODE.WTEREST.ANDATTOFNEV'SFEES. i :,� 2 RETENTION FEE: OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: � � 1 HEREBv AFFIP,M UN�EH PENALTV OF PERJUR'/THAT THEFE IS ACONSTHUCTION IEN�ING AGENCV n- FUN-'Ht VFHFORMANGE OF THE WOFK FOR WHICH TNIS PERMIT IS ISSUEC(SEC.3D9],C�V.C.). " W = LENDEN'SNAME � - -_" — F-- LEN�ER'SADDRE55 ` � I CERTIFV THAT I HAVE flEAD THIS APPLIGATIONAND STATE THAT THE ABOVE INFORMAI ION IS CORqECT TOTAL FEES ' r\�..' \, ��1 I AGREE TO COMPIY WITH ALL CI7V AN�COUNTV ORDINANGESAND STATE LAWS NELATING TO 9UI�DING �j � GONSTFUCTION,AND HEREBV AUTHOflIZc REPRESENTATIVES OF THIS COUNTV TO ENTER UPJN THE Z ABOVE�MENTIONE�PROPERTV FOR INSPECTION PURPOSES. GOMMENTS � � � _..... _..__ _ �_ __ /'� PERMITTEE NAME P 1 � :.�-t Q O� Q � - � SiGN4TliaF O ENMITTEF DAT� � RECPT.'�O. _ PAIDBY _ _ VALIDATION � WHITE-Department Copy,YELI.OW-Finance Copy,PINK-Assessor Copy,GOLDENflOD-File Gopy,GREEN-ApplicanYs Gopy � ti ,. � .� �4�s�� ca s�� m�� ,�q ... ..� h. r .. x ;. � t"� ... � �"?a �,� a�� " �' �... � . „ , : �; , � � � . . . .. <. . . . . <,st�ia ., ^�'�"u�.� . . . . ..._. . � .. ' .. .. ... , ..,;'r ,.- .��. . . .... .. . '.,. ��.��-�� _ _ �� ,� ��,� � � - - _ � _ __ _ _ __ _ . _ _ . _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ __ � _ _ __ "'.°.a�# ��'�'``c�"' �'p�'1��'ah �� iy�`, ��. . .. . .... . _. . ... .. ��1k �g�� '��f1��} I .i . .... ... . . _ ..... _ ..._ ."__ ....,. _.. _ . �� q s' x �� i rt.� , . .... __. ... ... .. __ , ��, �y�. ' j . �-� � .. . . . . . .. ... . ... .. . .. . . _ ... ... ..... . ... . � �"� �,� °'� �� z, w � _ _ �� -n,?'� � �� .�.4 �; : �.. , � �a„ _ _ .�� ,� _ _ � ; ,� _ � �, �� ,�� W CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION PRESS JOBSITE APPLICAT 0 PERMIT P/C ADDRESS-°f DATE NUMB ER ISSUE/� (� �'}TYPE OCC APN DATE(I Ij LOTT Ai3 Cj ) CONST �C}' OWNER . GROUP ADDRESS ZONING SETBACKS CITY ZIP TEL. FRONT RW APPLICANT TEL. REAR SIDE/SIDE STREET RW CONTRACT R M1 S*T��4C ^ SIDE CITY ITY,ZIP TEL PROPOSED USE ARCH/ENG/ DESIGNER Vfn t N0. DWEL. N0. N0. ADDRESS- CITY UNITS STORIES BEDROOMS ZIP TEL. DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREANALUATION OWNER-BUILDER DECLARATION SFR/ADD/REM Gara I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- e/Car ort CENSE LAW FOR THE FOLLOWING REASON (SEC 7031.5 BUSINESS AND PROFESSIONS CODE:ANY CITY OR U) 9 p COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT,ALTER,IMPROVE,DEMOLISH,OR REPAIR ANY STRUC W 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 C W Patio/Deck N 0 TRACTORS LI- CENSE LAW LL I T CHAPTER � 9(COMMENCING W TH SEC (D Pool/Spa ION 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 Z Re-Roof A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($500))' UI.AS OWN ER OF THE PROPERTY,OR MY EMPLOYEES WITH WAGESAS T HEIR SOLE COMPENSATION, 0 Commercial WILL DO THE WORK.AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC. 7044,BUSI. J 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 OFCOMPLE- TION THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OH IMPROVE FOR THE PURPOSE OF SALE). 0 I.AS OWNER OF THE PROPERTY AM EXCLUSIVELY CONTRACTlNG WITH LICENSED CONTRACTORS V I TO CONSTRUCTTHE PROJECT(SEC,7044, BUSINESS AND PROFESSIONS CODE.THE CONTRACTORS LI- i t" L a uat CENSE LAW DOES NOT APPLY TOAN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND 00 L ADJ.AREA J� WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S)I ICENSED PURSUANT TO THE CONTRAC- QUANTITY DESCRIPTION TORS LICENSE LAW). FEE [1 I AM EXEMPT UNDER SEC.A. &P.C. FOR THIS REASON J Q U DATE OWNER 0 LICENSED CONTRACTORS DECLARATION W J I HEREBYAFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 0 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FUL RCE A EFFECT. LICENSE CLASS LIC. N0. DATE L CONTRACTOR d WORKERS U COMPENSATION DECLARATION I HER AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS Z HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' 2 COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE 0 THE WORK FOR WHICH THIS PERMIT IS ISSUED LLI HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTlON 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WOR N INSU NCE CARRIER AND POLICY NUMBER ARE CONSTRUCTION 1\11 CARRIER PLAN REVIEW POLICY NUMBER � ELECTRIC 157714,11 6- (THS SECTION NEEDNOT BE COMPLEfEDOF THE PEWBIT IS FOR ONE HUNDRED DOU.ARS($100)OR LESS). PLUMBING I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I MECHANICAL 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 INSPECTION FEE SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR J L CODE,I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS ISSUANCE DATE:.APPLICANT SMIP WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND ENERGY PERMIT 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 RETENTION FEE: L--� CONSTRUCTION LENDING AGENCY PRE-ALT FEE: I HEREBY AFFIRM CINDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR W IC THIS P H H ERMIT 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 TOTAL FEES 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. COMMENTS PERMITTEE NAME P) •..� �QO r SIGNATURE 0 ERMITTEE DATE RECPT N0. PAID BY VALIDATION CO CO 0 W z 0 Cr 0 0 W 0 W CO cn cc: 0 W C-) W 0 C> I- 0 C/J LL Z 0 !cc d YC 0 I- U W Z W Q ci W G7 0 n W J Cr W 0 CC d W F- MID W CL 031 i cr) DIAMOND BAR i WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy