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Home My WebLink About18532 (11) �,�,� CITY OF DIAMOND BAR � DEPARTME'�'T OF C01vIMiJNITY&bEVELOPMENT SERVICES � 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 � ( ` PRESS ��?�r�'w BUILDING PERMIT APPLICATION �j'x � .�L'l: ` FIRMLY } JOBSITE �y[ ,, } �' � APPLICAT � �"—_T��' � PERMIT "�r.� ` p/C o ADDRESS_✓�"� �V f��.,�� r DATE �� +jr'�p"�_ NUMBER ��.i`�_� ��# � ISSUE f�� t\ °� TYPE OCC p OWNER ��—�i D� �.f' DATE_�i �•v � �� CONST. GROUP o ADDRESS � ZONING SETBACKS Z CITY ZIP 7E FRONT qyy � � APPLICANT TE�.___ ' REAR �� z SIDE/SIDE STREET RW ❑ a CONTRACTOR � SIDE �-� ADDRE S N ,� � CITY ZIP T c PROPOSED USE 0 w ARCH/ENG/ � z DESIGNER_ � ADDRESS_ � -- NO.DWEL. NO. � NO. A� � CITY ZIP TEL. UNITS STORIES BEDROOMS '" cn — � DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER OECLARATION p SFFi�'ADD/REM p I HEREBV AFFIRM UNDER PENALTV OF PERJURY THAT I AM F.XEMPi FROM THE corvrancToqs u� GaregelCarport W CENSEIAWFORTHEFOLIOWINGREASON(SEC.]031.SBUSINESSANJFROFESSIONSCOOE:ANVCITYOR (f� U CWNTYWHIGHREWIqESAPERMITTOCONSTRUCT,ALTER,IM�pOVEDEMOLISH.CRREPAIRANYS'flUC� w TURE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPIICANT FOR SUCH PERMIT TO FILE A SIGNEO w P8�10/DBCK � STATEMENT THAT ME OR SHE IS LICENSED PURSUANT TO THE PROVISiONS OF THE CONiPACTORS LI- � CENSE LAW(CHAPTER 9(COMIAENCMG Wi7H SFCTION'!MO)OF DIVISION 3 C�F TNF BUSINE55 AND PRO- � POOUSPB O FESSIONSCAOE)ORTHATHEORSHEISE%ENPTTHEqEFROMANDTME8A515FORTHEALIECEDEXEMP- � U TION.ANYVIOLATIONOFSECTION]031.SBYANVAPP',.ICAN�fORAPEHMIT5U9JEG�5"MfAPPLICANTTO Z R2-R00} ACIVIL PENALTV OF NOT MORE 7HAN FIVE HUhDREO DO�URS�35001.)�. � ❑I,ASOWNEROFTHEPROPER�VORMYEMPLOYEESWITHWAGESASIHEIRSOLECOMPENSAiiON, O Commercial Z WILL DO THE WORK,AND TME STRUCTURE IS NOT INTENCEJ ON OFFERED�ON SALE IjEC.706C,BU�I� J � NESS AND PROFESSIONS CODE:THE CONTRACTOFS LICENSE LAW DO'eS NO�APPiV Tp AN OWNER OF � PROPERTY WHO BUILOS OR IMVROVES THER'cON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR Q THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTSARE NOT INTENDED OR m w OFFEREOFORSALE.IF.HOWEVER,THEBUII�INGORIMPROVEMEN?ISSOI�WITHINONEVEAROFCOMPLE- � TION.THE OWNER�9111L0ER WILL HAVE THE 6URDEN OF PROVING'HA7 HE OR SHE OIO NOT 3UILD OP Z IIAVqOVEFORTHEPURPOSEOFSALE�. � = CI,ASOWNEROFTHEPROPERTY,AMEXCWSNELVGONTRACTINGWIiHIICENSEDCONTRACTORS W — � TO CANSTqUCT THE PROJECT�SEC.]004,BUSINESS AND PROFESSIONS CODE:THE GON?qACTORS�I- VaIl18IlOf1 . ADJ.AREA W CENSEUWDOESNOTAPP�YTOANOWNEROFAPROPERTVWMOdVII.D50FIMPROVESTHERE(M,AN� WHO CONTftACTS FOR SUCM PROJECTS WITH A GONTRACTOR(S�I.IGENSLD PURSUANi 70 THE CON i RAG ~ TORSLICENSEUW.). OUANTITV DESCRIPTION FEE Y -- � fiIAMEXEMPTUNDERSFC._ __. _._. _ _ B.dPC.fORTHISREA50N Q � U � DA'E OWNER �� H Z U O W LICENSED CONTRACTORS DECLARATION � Q w Q I HEREBY AFFIRM UNDEF PENALTY OF PEFJUFY TMAT II1M LICENSED UNOER PPOVISIONS OFCHAPTER � a v(GOMMENC;NG WiTH SECTION 7o0a�OF DIVISION 3 0F iHE BU51NE5S AND PPOFESSiONS CODE,AND z `X MV LICENSE IS IN FULL FOPCE ND EFFECT. � m � LICENSE C�1SS � � �_ LI�.NO. � U �ATE�f r it� _ CON7RACTOR d W � WORKERS'COMP[NSATION DECLARATION Q � i HEREBYAFFIRM UNDER PENALTY OF PERJURV ONE OF THE FOLLOWING�ECIARpTIDNS: Z � _IH ANDWILLMAINTAINqCERTIFlCATEOFCANSENTiOSELF-INSUREFORWORKERS' _ QMPENSATION,NS PROVIDED BV SEGTION 3]ooOf THE LABOfl CODE,FOF THE PERFORMANGE U Q OF iME WORK FOR WHICH THIS PERMIT IS ISSUED. � I Qw I NAVE AND WIL�I�AAINTqIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BV SECTION � 3)o00F THE LABOR CODE,FOfi THE PER.'pRMANCE OF TH[WORK FOR WHICHTHIS PERMIT IS � \ ISSUEC.MY VJORKE ' OMFENSA710N, ANGE PoER AND POUGY NUMBER ARE: CONSTRUCTION �� J —. ._ j CARRIER_ PLAN REVIEW zPOLICV NUMBER� — ELECTRIC Q - � (iHISSECTI(7NNEmNOTBE0C7�1REfEDOFTNEPEfUNiISFOFONEHLMDREDD011ARS(Et[0)Oq�ESS�. PLUMBING W — Z I CERTIFV THAT IN THE°ERFORMANCE OF THE WORK FOR WMICN THIS FERMIT IS ISSUED.1 MECHANICAL �'} SHALL NOT EMPLDY qNY PERSON IN ANV MANNER 50 FS TO BECOME SUBJEt:T TO tHE � (/� WOFKERS'GOMFENSAi�ON lAWS OF CALIFORNIA,AhD AGREE THAT IF i SHOULD BECOME INS�ECTION FEE � SUBJECTTO THE WORKERS'COMPENSATION PaOVI510NS Of SECTION 3]�0 OF THE IABOR - CODE.I SHALL FORTHWITH COMPLV WITH THOSE PROVIS�ONS. ISSUANCE � p DATE�. APPIICANT: SMIP _ (r._. W J W/RNING:FAILURE TO SEGUflE WOfiKERS'COMPENSATION COVERAGE IS UNLAWFUL,AN�SHALL BE ENERGY P/C J — � SUBJeCTANEMPLOYEqTOGRIMINALPENALTIESANDCIVILFlNESUPTOONEHUNDREDTHOUSANO ENERGYPERMIT � DOLLARS(f 100.000�,IN ADOITION TO THE COSTOF COMPENSATION,OAMAGES AS PROVIDED FOR IN — J SECTION 370B OF THE LABOR CODE.MTEREST.AND ATTOfiNEV'S FEES. OC RETENTION FEE: OCONSTRUCTION LENDING AGENCY PRE-ALT FEE' � � � ( L' � I HEFEBV AFFIFM UN�EH VtNALIV OF PERJUR�TNAT THEFE IS ACONSTFUCTION LEN�ING AGENCV � FUH'HE YtHFOHMANCE OF TNE WOF'�h FOR WHICH THIS PERMIT IS ISSUEC(SEC.309],C'�V.G). -- W j LENDEN'S NAME_ � F— LENDER'SPDDAESS � TOTAL FEES ' � '� w I CERTIFV THAT I HAVE READ THIS APPLIGATIONA�YD STATE THAT THE FBOVE INFORMATKJN IS[:UHHtCi. � : � I AGFEE TO GOMVIY WITM ALL CITV HNp GOUNTY Ori[JINANCESAN�STATE LAWS RELATING TO 9UILDING � f� � ' � CUN57 HUCI ION,AND HEREBV AUTHORIZE REPRESENTATNES OF THIS COUNTV TO ENTER UPUN THE Z E�MENTIONE�PROPERTV FOR INSPECTION PURPOS S. � COMMENTS __ _ J � � PER ITTEE NA E(PFINT) Q/�r f� �� ¢ �^[l '____— � SiGNATIia P�HMITTE� — – Dl�Te –'-'"�--- – —'– -- = RECP?.NO. _ PAID BY -�' VALIDATION �-- WHITE—Department Copy,YELI.OW—Finance Copy,PINK—Assessor Copy,GOLDENRO�FileCopy,GREEN—AppliCanYs Copy � . .,, - -�� G,f i��OFy�y t:d:��- ':;#•� �i.�.+a,v# Y �'$.� „��-aa � , i � �� - �? `` � �r �'� � „,:�,�' '`� � � . .. �*., . . . .< . �,�. . �.�� 3 ... . .. . . .. . . . . ..... .... .. ... . . ... ... .... ... ..,t�q�+��.��e:a. ,�.�aa;c*�'n� -.�:�..,� ... ... ... .._. . . .". . .... '�w."�� q �� i.. I ... ... .... . ..... .. ... ..... .. _..._._ ..... ..... . . . .. . . .. ...... ._...... ..._. . ...... ..... . . ... ��, , .. ... ...._ ........ .. . .... ... ... . ..... .. � . ...... ........ ....._..._ . _.... ...... ......j ... .._... .......... ... .... . ..... .... ��. �. �� _ �. ,� � ��yt�� ,�� _ _ _ �E �+�S , , � �� a� � � ,�, ��P�. � � �; � � � ,p . � __ _ ��' � �� ,. �'a. '' . _ i , „ � ., , � �I � � . ; ,� r�,_ ' . . . . .. .. .. ... . . �°�" � � .�, .i ,�� _. . .. _. ... ��. �, �, . .._. ._. . _. . ... . . . . ... . . .._ , .� _�._. .. �. CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION JOBSITE ADDRESS X40 NV r�,� APN LOT TRACT AA�,'. OWNER�JN��1 i(J�It'f ADDRESS( CITY ZIP TE APPLICANT TEL. CONTRACTOR ADDRE I.IA I. 1 IU CITY ZIP T 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 REQUIRESA PERMIT TO CONSTRUCT,ALTER,IMPROVE. DEMOLISH,OR REPAIRANY 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 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 OWNEROFfHE PROPERTY,OR MY EMPLOYEES WITH WAGESAS 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 OFCOMPLE- TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). C I,AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCTTHE PROJECT(SEC. 7044, BUSINESS AND PROFESSIONS CODE.THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TOAN OWNER OF A PROPERTY WHO B'JII.DS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW). Li I AM EXEMPT UNDER SEC. B.A 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 PPOFESSIONS CODE,AND MY LICENSE IS IN FULL FORCE ND EFFECT. LICENSE CUSS Z G_LIC. N0./ DATEt,f) z CONTRACTOR WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS PENSATION,AS PROVIDED BY SECTION 3700 OE THE LABOR CODE. FOR THE PERFORMANCE HE WORK FOR WHICH THIS PERMIT IS ISSUED / H E 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 WORKS'OMPENSATION,ANCE BIER AND POLICY NUMBER ARE: CARRIER POLICY NUMBER (THIS SECTION NEED NOT BE OOMPLETED OF THE PERMR IS FOR ONE HUNDRED DOLLARS($100)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 WOFK 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 E.MENTIONED PROPERTY FOR INSPECTION PURPOS S. PER ITTEE NA E(PRINT) SIGNATLIR P6RM Tf 1 I E DATE PRESS FIRMLY APPLICATTTTTTTTOL�PERMIT P/C DATEI T I� N UMBER # ISSUE TYPE OCC f t\ DATEIttvJ ONST GROUP ZONING SETBACKS FRONT RW REAR r� SIDE/SIDE STREET RW^ SIDE PROPOSED USE N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM Garage/Carport U) w Patio/Deck LL Pool/Spa 0 Z Re-Roof Commercial Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U U W LU EQ Z m CL Q U Z S U N CONSTRUCTIO PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP Cr.... ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES COMMENTS RECPT. N0. - PAID BV-�'VALIDATION