The URL can be used to link to this page

Home My WebLink About18531 (11) � CITY OF DIAMOND BAR � DEPARTMENT OF COMMUNI"fY&bEVELOPMENT SERVICES 21825 E.Copley Drive '�` (909)R60-3195 Fax(909)861-3117 PRESS ��:�� BUILDING PERMIT APPLICATION �. FIRMLY �'� y JOBSITE f! � �I y� APPLICATIO PERMI � �` �P/C o ADDRESS_- N� ��'��I r +Vs OATE NUMBER � �� g � ISSUE � TYPE OCC APN LOT TRACT � DATE :• � � CONST. GROUP p OWNER `�� !'� r�� o ADDRESS_ ZONING SETBACKS Z CITY ZIP TEL. FRONT qyy �� APPLICANT TEL � " f REAR � z �_ SIDE/SIDE STREET Ryy U Q CONTRACTO SIDE -� ADDRESS � O C�Ty Z�P •�• TE PROPOSED USE 0 w ARCH/ENG/ � z DESIGNER_� w -- NO.DWEL. NO. � ADDRESS UNITS N� � CITY ZIP__ TEL.__ STORIES � BEDROOMS � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFWADD/REM O p I HEREBV AFFIftM UNDER PENALTY OF PERJURV THAT I AM F.%EMPT FROM THE CONTFAGTORS LI- G8f8JB/C2fPOR W CENSEUWFORTHEFOLLOWWGREASON(SEC.1031.SBUSINESSANJFROFESSIDNSCpDE:ANYCI7YOR (n U COVNTVWHIGHFEOUIRESAPERMITTOCONSTRUCT,ALTER,IM�POVE,DEMOLISH,CRREPAIRANYi'RUC- w TURE,PRIOR TO ITS ISSUANCE,/L50 RE�UIRES THE APPUCANT FOR SUCH PERMIT TO FlLE A SIGNED w Pd�iO/DBCk � STATEMENT THAT HE OR SHE IS LICENSED PUFSUANT TO THE PROVISIONS OF THE CONiFACTOf75 LI- � CENSE LAW(CHAPTER 9�CAMMENGNG WITH SECrION�000)OF�IVISION 3(?F T�1E BUSMESS AND PRO- LL PooUSpa 0 FESSIONSCODE)ORTHATHEORSHEISEXEMPTTNFREFROMAN�THEBASISFORTHEALLEGEDE%EMV- (� V TION.ANYVIOLATIONOFSECTIDN]031.SBVANVAPPLICAN'FORAPERMITSU9JEC�5"MeAPPLICANTTO Z Re-Roof ACIVIL PENALT'OF NOT MORE 7HAN FIVE HUIvDRED DOLL4R5�S5o0�.�: � ❑I,ASOWNEROFTHEPROPER�VORMYEMPI.OVEESWiTHWAGE5A5lHEIRSO�ECOMPENSATiON, O Commercial Z WILL DO THE WORK,AND THE STRUCTUflE IS NOT IN i ENDED OH OFFEFED FpH SALE(SEG.]oaa,BU��I- J � NESS AND PROFESSIONS CODE:7HE GONTRAGTORS LICENSE LAW DOeS NO�FPPiY TO AN OWNER Of ? PROPERTY WHO BUIL�S OR IM PPOVES 1 HEFcON,AN�WHO DOES SUCH WORK HIMSELF Oft HEi15ELF OR Q 7HROUGH MIS OH MEF OWN EMP�OYEES,PROVIDED TMAT SUCH IMPROVEMENTSARE NOT�NTENDE�OR C� p OFFEREDFORSPLE.IF,HOWEVER,THEBUILDI4GORIMPROVEMENTISSOLDWIiNINONEYEAROFCOMPLE- Z TION,THE OWNER�BUILDEfl WILL HAVE THE BURDEN OF PROVING'HAT HE OR SHE Il10 NOT BUILD OH � IMPROVE FOR THE PUHPOSE OF SALE�. j . w ❑I.ASOWNEROFTNEPROPERTY,AMEXCLUSIVELVCONTRACTINGWI�HLICENSEDCONTRACTORS Q TO CANSTRUCT TME oqQ1ECT(SEC.]a6<,OUSINESS AND PROFESSIONS CODE:THF CONTRACTORS LI� V81U2�1Df1 � ADJ.AREA W CENSE UW DOES NOTAPPLV TOAN OWNER OF A FqOPERTY WHO d'JII.DS OH IMPROVESTMEREON,AND --- FWHOCANTRACTSFORSUCHPRQIECTSWITHACONTRACTOR(3)LICENSEDPUPSUANTTOTMECON7RAG- I �UANTITY DESCRIPTION Y TORS UCENSE LAW.). FEE QL I 1 AM EXEMVT UN�ER SFC. __ B.8 P.C.FOR THIS REASON Q � U � DA'E OWNER � Z __ U � LICENSED CONTRACTORS DECLARATION W Q � I HEREBY AFFIRM IINDEH PENALTV OF PERJURY�HAT I AM LICENSED UNDER PROV�SIONS OF CHAPTER � d 9(COMMENCiNGWiTHSECTION'/0oo)OFOiVI510N30FTHEBU51NE55ANDPPOf-ESSiONSGO(JE,AN� Z `X MY LIGENSE IS IN FULL FORC D EFFF„�T. �, m � LICENSE C�,p�S LIC.Nn. � �' _�q - � U OA7E *-T��R _ CONTRACTOR d W � WORKERS'COMPENSATION DECLAFATION a � I NEREBV AFFIRM UNOER PENALTV OF PEFJURV ONE OF THE FOLLOWING DECLARATIONS: z '�, � _IHAV 4NpWILLMAINTAINACERTIfICATEOFCONSENTiOSELF-INSUREFORVlORKERS' _ PENSATION,AS PROYIDED BV SECTION 3�OOOF THE LABOR CODE,FOR THE PERFOPMANGE U Q F THE WORK FOR WHiCM THIS PERMIT IS ISSUED. � W I HAVE AND WILL MAINTAIN WOflKERS'COMGENSATION INSUPANCE.AS RFOUIREO PV SECTION ~ ,3� QQ 3lou OF TNE LABOR CODE,FO{i THE PER:ORMANCE OF THE WORK FOR WHICHTHIS PERMIT IS ` ISSUEC.MV WORKER' P S ANCE flRIER AND POLICY NUMBEP ARE�. CONSTRUCTION �1 Q ] cARRiER_ ///-�t�r��..��fff�--�� PLAN REVIEW ZPOLICVNUMBER �� F +�/I� — ELECTRIC � Q 0 (MISSECT1cXJNEmNOTBENAAPLEfEDOF7HEPEFi.4TISFOFONEHUhORWD011ARS(EtOoIOFlESS�. PLUMBING W Z I CERTIFv 1'HAT IN THE°ERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I MECHANICAL G} SMALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJEfT 70 THE -- Uj WORKERS'COMPENSA?ION LAWS OF CALIFORNIA,AhD AGflEE THAT IF i SHOVLD BECOME INS?ECTION FEE � SUBJECTTOTHEWORKERS'GOMPENSATIONPaOVI510N50F5ECTION3i000FTHELABOH �{�.��-\..',` - � GODE,I SHALL FORTHWITH COM7LV WITH THOSE PROVISIONS. ISSUANCE . � X� p L]ATE' APPLICANT� SMIP _ ��, W — J WARNING�.FAILURE TO SECURE WORKEFS'COMPENSATION COVERFGE IS UNLAWFUL,AND SMHLL BE ENERGY P/C � SUBJECTANEMPLOYERTOCRIMINFIPENALTIESANDGIVILFINESUPTOONEHUNOREDTMOUSANU ENERGVPERMIT OOLLAFS(5100 000),IN A�OITION TO THE COST OF GOMPENSATION,OAMAGES AS PROVIDED FOR IN J SECTION 37oe OF THE LABOR CODE,MTEREST,ANDATTORNEYS FEES. ¢ RETENT�ON FEE: OCONSTRUCTION LENDING AGENCY PRE-ALT FEE . _ � l_ u � I HEREBYqFFIqM UNDER PENALTV OF PERJUR�THAT THERE IS ACONSTFl1CTION 1EN01NG AGENGY � FOR�'ME PERFORMANGE OF TME WOF;N FOR W41GH THIS GERMIT IS ISSUEC(SEC.3�9],G'�V.C.). -- W = LENDEH'S NAME � - __- _ - F- LENDER'SADDRESS � TOTAL FEES ` -��.�+ C� "1 � I C[fiTI�Y THAT I 11AVE READ THIS APPLICATIONAVD STATE THAT TMEABOVE INFORMATION IS GOPFEGT w I AGREE TO COMPLY WITM ALL CITYAND COUNTY ORDINANGESAND STATE lAWS RELATING TO 9UILDING �� CANSTRVCTION,qND HEREBYAI;iMORIZE REPRESENTFTIVES OF TMIS GOUNTV TJ ENTEH UPUN iHE ' Z NBOVE TIONEO PROPERT � R I TION PUFPOSES. COMMENTS � -_. J � -__.__ m PEHMI�iEENAME�PRI Q VJ Uj SIGN4TliaFOFP H ITTFE ----_- DATE �--�---� --' = RECPT. YO. _ � PAID BY �f4� VALIDATION � ~ WHITE-Department Copy,VELLOW-Finance Copy,PWK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applican�'s Copy u _ �� ,. - �q.,��`,��;F1'�+w� �ro � .y ,�� a��*�:,��^,a. . � ; g » < ,�_ � � �a�. �,�x � � ' � � � !i �� .4 �. � �;�� ': _ ,..� � .�wp � F �� , i _ _ _ _ , __ ; �� • � ,� �� _ ��` �� '�`�+ . a � �� , . � ��,�; �. � ` ' �— �� s _ _ _ _ _ �.� :, ,, ' ^ � ljt� .. . . . . . . .... ...... . ._... .... .. .._. . .. ; _ �, � � ' , s*�" "�n �� : t _ _ � , �, � "WIT �N CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&bEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION JOBSITE� ! ��'('1�� fVs ADDRESS--N �/' APN LOT TRACT p ,�e OWNER�� (,U JV�_�i !'�rl� ADDRESS_ CITY ZIP TEL. APPLICANT TEL --+��- CONTRACTO ADDRESS CITY ZIP'��TE ARCH/ENG/ DESIGNER_1\!IA-Y' ADDRESS T CITY ZIP_TEL._ OWNER-BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM E%EMPT FROM THE CONTRACTORS LL CENSELAW FOR THE FOLLOWING 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,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 ]000)OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONSCODE)ORTHAT HE ORSHE IS E%EMPT THEREFROM ANO THE BASIS FOR THE ALLEGED E%EMP- TION.ANV VIOLATION OF SECTION 7031.5 BV ANY APPLICANT FOR A PERMIT SUBJEC f S'f HF APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(f500),I: ^ I,AS OWNER OF THE PROPERTY,OR MV EMPLOYEES W iTH WAGES AS 1 HEIR SOLE COMPENSATION, WILL DO THE WORK,AND THE STRUCTURE IS NOT IN i ENDED OR OFFERED FOH SALE(SEC. 70aa, BU"I- NESSAND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NO'APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO DOEB 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 'HAT HE OR SHE DID NOT BUILD OH IMPROVE FOR 7HE PURPOSE OF SALEI. ^ I,AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTING W I rH LICENSED CONTRACTORS TO CONSTRUCTTHE PROJECT(SEC. 706<,OUSINESS AND PROFESSIUNS CODE:THE CONTRACTORS LI� CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO d'JII.DS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS W ITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). C I 1 AM EXEMPT UNDER SEC._, B. 8 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 PPOFESSiONS CODE,AND MY LICENSE IS IN FULL FORC D EFF E,GT. �, LICENSE C S_LIC. N9. OATEj-CONTRACTOR WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAV AND WILL MAINTAIN ACERi1FICATE OF CONSENTTOSELF-INSURE FOR WORKERS' PENSATION,AS PROVIDED BV SECTION 37000E THE LABOR CODE, FOR THE PERFORMANCE F THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BV SECTION 37000E THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MV WORKER P SAT(QANCE C$PRIER AND POLICY NUMBER ARE: 1 CARRIER_ � ,NRX POLICY NUMBER��f+�I'I �- (fFitS SECnON NEED NOT BE NMPLETED OF THE PERMR IS FOR ONE HUNDRED DOIIARS(f1001 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 SUBJEf,T TO THE WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOVED BECOME SUBJECT 70 THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3]00 OF THE LABOR GODE,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(f 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 WOF:K FOR WHICH THIS PERMIT IS ISSIJEC(SEC. 309],CI V.C.). LENDER'S NAME LENDER'S ADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE IAWS RELATING TO BUILDING CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE TIONED PROPERT R I TION PURPOSES. PERMITTEE NAME IPRI SIGNATURE OF�R ITTEE T DA E WHITE-Department Copy,YELLOW-Finance Copy, PIN X��y PRESS FIRMLY � 's � P/C APPLICATIO PERMI � GATE NUMBER � �g ISSUE� TYPE OCC DATE� CONST. GROUP ZONING SETBACKS FRONT RW(� REAR � SIDE/SIDE STREET RW^ SIDE C7 PROPOSED USE N0. DWEL. N0. ! N0. UNITS STORIES I BEDROOMS DESCRIPTION S0. FT. FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM Garage/Carport W Patio/Deck � PooUSpa Z Re-Roof � Commercial m Valuation ADJ.AREA I pUANTITY DESCRIPTION FEE J Q U 2 F- W W Z fn a Q U Z Q W 1 CONSTRUCTION 1 I PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INS?ECTlON FEE ISSUANCE ,}" �� SMIP � �I ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: � I_�/ TOTAL FEES �. C. 1 �+I �� COMMENTS RECPT. N0.- � PAID BY � Y VALIDATION