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Home My WebLink About18533 � CITY OF DIAMOND BAR DEPARTIVIE'�iT OF COMMUNTI'Y&bEVELOPMENT SERVICES � 21825 E.Copley Drive "� (909)860-3195 Fax(909)861-3117 � PRESS �%_�� BUILDING PERMITAPPLICATION � FIRMLY } JOBSITE �['/� �� f�C � APPLICAT P PERMIT �,��=��P/C o ADDRESS ��-X�V(�� c� DATE NUMBER i �lJ J # � APN LOT RACT �SSUE ( ,-- _ �' TYPE OCC —�� y., DATE CONST. GROUP p OWNEq �j��) L, t�=,S . �� ADDRESS_ � ZONING SETBACKS Z CITY ZIP TEL_ FRONT RW ❑ p APPLICANT TEL.__ SIDE/SIDE STREET RW ❑ z Q CONTRACT SIDE ❑ � ADDRESS � I � � CITY ZIP TE . PROPOSED USE w ARCH/ENG! z DESIGNER_ � w �� — NO.DWEL. NO. r NO. � ADDRESS_ UNITS STORIES 4 BEDROOMS � CITY ZIP__ TFL.__ � cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION � SFR/ADD/REM p I HEREBY AFF�.RM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRPCTORS LI- Gef9JE/C2fPOR W CENSEUWFORTMEFOLLOWINGREASON(SEC.1071.50USINESSANDFROFESSIONSCODE:ANYGTYOR (n U COUNTVWHICHREDUIRESAPERMITTOCONSTRUCT.ALTER,IMPROVE.DEMOLISH,CRREPAIRANVSTqUC� wTURE,PRIOR TO ITS ISSUANCE.ALSO RE�UIRES THE APPLICAN'iOR SVCH PERMIT TO FiLE A SIGNED w PatiolOeck STATEMENT THAT HE OH SHE IS LICENSEO PURSUANT TO THE PR041SIONS OF THE CONTRACTORS LI- � CENSE LAW(CHAPTER 9(COMMENCINO WITH SECTION]000)OF DIYISION 3 C'FTHE BUSINESS AND PRO� � PooUSpa O FESSIONSCODE)ORTHATHEORSHEISE%EMPTTH�REFROMAN�JTHEBASISFORTMEALLEGEDE%EMF- � U TION.ANVVIOLATIONOFSECTION�031.SBVANYAPFIIGANiFORAPERMI�SUBJE�(S�IHFNPFLIGANTTO Z Re-Roaf � � ACIVIL PENALTY OF NOT MORE THAN FNE HI:NDRED DOLURS(f50D)J: � � ❑I,ASONMEROFTHEPROPERT',ORM�EMPLOYEESWITHWAGESASIHFIASOLECAMGENSATiON, O CommOfCidl Z WILL DO THE WORN.AND THE STRUCTURE IS NOT INTEM1D[�OH OFFERED FOH SALE(SEC.7004 BU�I� J � NESS AND PqOFE5510NS CODE�.THE CONTRACTORS LICENSE UW�OcS NO"APP�V Tn AN DWNER OF ? PqOPERTV WHO BUILDS OR IMGROVES THEREON,AND WHO OOES SUCN WORN HIMSELF OR HERSEIF OF Q TNROUCM HIS OR HER OWN EMPLOVEES,GROVIOE[/THA'3UCH IMPPOVEMENTS ARE NOT INTENDED OR m QOFFEREDPoRSALE.IF,HOWEVER,THEBUiLDINGORIMPROVEMENTIS50LDW17HINONEYEAROFCOMPLE� Z TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVING:HA7 HE OR SHE DiD NOT BUIL�OH � IMPROVE FOR THE PURPOSE OF SALE). ❑I.AS O WNER OF THE PROVEflTY NM EXGLUSIVELY CONTFAGTING W ITH LIGENSED CONTRAC�"URS Q TO CANSTRUCT TME PRQIECT(SEC.70ea,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI� V31110�1Of1 �' ADJ.AREA W CENSE UW OOES NOTAPPLV TD AN OMMER OF A PROPERTV WMO dUII.�S OR IMPiMJVES THEREON.ANO � NTIOCONTRACTSFORSUCHPROJECTSWITHACONTRACTOR(SIUCEhS[DPURSUANTTOTHECONTRAC- QUANTITY DESCFlIPTION FEE Y TORS LICENSE LAW). Q J O G I AM E%EMPT UNDER SFC. _ 8.8 PC.fOR THIS REASON Q � U --- ¢ � DATE oWNER __.__.. ._... . . U _-_.____.- -_--_ .. _..___. _-_- Z W � LICENSED GONTRACTORS DEGLARATION w ¢ � I HEREBV AFFIRM UNDER PENA�TV OF PERJURY'HAT 1 AM LICENSED UNOER PROVISIONS OF CHAP'EP � I d 9(COMMENCWGWITHSECTIONI000)OFDIVISIDN9OFTNEBUSINESSANDPn.OfESSl01.'SCO�JE,AN� Z X AAv LICENSE IS W FULL FORCE�ND EFFECT m W � �ICENSE CLASS � � _ .IC.NO. � ~ /j �f J w DATE �Y-.��. .tV_ _...____ CONTRACTOR � _� � d � i/ � WORKERS'COMPENSATION DEGLARATION Q � I H V AFFIPM UNDER PENALTV OF PERJURV ONE OF THE FOLLOWING DECLARATIONS�. Z 0 AND WILL MAINTAIN A GERTIFICATE OF GONSENTro SEIF-INSUPE FOR WOFKERS' _ Z -- MPENSATION,AS PROVIDED BY SECTION 3�OOOF THE LABOR CODE,FOR THE PERFORMANCE W QOF THE WORN FOR WHICH THIS PERMIT IS ISSUED. � w 1 HAV�ANp WILI.MAINTAIN WORNERS'COMPENSATiON INSURANCE.AS REQUIRED BV SECTION Q �1oa OF THE LA80ft CODE,FOR TME PERFORMANGE OF THE WORK FOR WHICH THIS PERMIT IS `( �� 0 ISSUEO.MY WORKERS' ENS 1 N.I�NGURAN CARRIER AND POLICV NUMBER ARE: CONSTRUCTION ��.�J�'� J L__' ' j cnaaiea_ -- . _ _.__..___.____. PLAN REVIEW ' z POLICV NUMBER -- ELECTRIC Q � �issEcn�xaNEmrarsEosna�Er[ooFniE�qurrisw�oniEHuroaEo�aLuis�sim�oa�Ess�. PLUMBING _ w I CEFTIFV TNAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL Z � SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJE�T TO iHE � WORKERS'COMPENSATION LAWS OF CALIFORNIA.AND AGREE THAT IF I SHOULD BECOME INS:'ECTION FEE � St1RJECTit]THF WORKFRS'COMGENSATION PRONSIONS OF SECTION 3100 OF TNE LABOR l CODE,-SHALL FORTNWITH COMPLI'WITH THOSE PROVISIONS. ISSLJANCE ��J�. � SMIP , � p DATE:_ APPLIGANT: -- ��V J WARNING:FAIIURE'�.TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SMALL BE ENEi7GY P/C � SUBJECTAN FMPLOVFR TO CFIMINAL PENALTIESAN�CIVIL FINES UP TO ONE HUNDRED THOUSAN� ENERGY PERMIT } �OLLARS�f��.�`I,INADDiTIONTOTHECOSTOFCOMPENSATION,[IAMACFSASPROVIpF�FORIN - SECTION 3]OB OF lNE LABOR CODE.-iNTEiiEST AND ATTORNEV'S FEES. RETENTION FEE: � -_. d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � I � (- �V O � I HEREBV AFFIRM UNDER PENALTY OF PERJUFY THAT THERE IS ACANSTFUCTION IENDING AGENCY n- FOR THE PERFORMANCE OF THE WOFK FOR WHICH THIS PERMIT IS ISSUEC ISEC.3091.CIV C.�. Z W - = LEN�ER'SNAME � - _. —' F- �ENDER'SADDRESS � TOTAL FEES � � �-� �f �"} � I CEFTIFY TMAT I HAVE REPD THIS APPLICATIOh AND STATE TMFT THEABOVE INFORMATION IS CURRECT w I AGftEE i0 COMPI.Y VJITH ALl CITY AND GOUN'V ORDINANCES AND STATE LAWS FELATING TO BI:ILDING � CONSTRUCTION.AND MEREBV AUTHORIZE REPR'cSENTATIVES OF THIS CDUNTY TO ENTER UPUN THE ZAP(1VE-MFNTIONF�PROPFRTY FOR I�ION Pl1FPOSES. � Q ,� � COMMENTS � m PE ITTEF N �PRINT `�,r'l ^/ ¢ �`d�{�- t�.�. --__'—_ - N � SIGM1NiURE PE MITT E 'JATE ' = P�ECPT.NO. __ PAID BY " j VALIDATION ~ WHITE-Departmert Copy,YELLOW-Finance Copy,PWK-Assessor Copy,G DENROD-File Copy,GREEN-Applica Ys Copy _ " '� ^v� � ,�tau � '=q �'.. � � ��wi � ; .��R s�" � g �,�x� ��_�� ' 7 " ,// �' �� «.� �, � ;�u., _ _ �., _ �� . �t ��.. _ _ _ _ _. _._ . _ _ __ __ __ _ _ __ � _ , _ _ �.. N� � �b b Pq��r B¢ .. ] � �'� ��'P�S^u ��#y�i'" 7. � .. . . . .. . .. . __. . ._ _... ._ ..... � ' � �� ;�� (li� l�d .. .. .. . . . .. . .. .._ .. . _ . _ . . ' �".�i- ... . . ...... . .. .. ��' b,� "E �: . ... .... ... _.... ...... .. ..... .... .. . . . . � �i. .' •ti�•••, � ' . .._,... ..... .. .... . .... .... . . ... . ... Bi t � y .. .. . . . . . . . .. .. � � s M1 r ' �� a � _ � � ��..� r�� F .. . ... ...... ... . . . _. __ ___. ". . ..... . . CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION PRESS Xi2t')�1 FIRMLY Oltf� ADDRESS APN LOT TRACT OWNER�I YNA�ZLZ��)L Y ='S . H ADDRESS_ CITY ZIP TEL._ APPLICANT TEL. CONTRACTT ADDRESS CITY ZIP 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 REOUIRESA 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 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 YHE APPLICANT TO ACIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($500)): - ^ I,AS OWNER OF THE PROPERTY,OR MY EMPLOYEES W OTH WAGES AS 1 HEIR 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). ^ 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 NOTAPPLY TO AN OWNER OF A PROPERTY WHO BIJII-DS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW). G 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 PPOFESS:ON'S CODE,AND MY LICENSE IS IN FULL FORCE,ND EFFECT. -7bq 4 c t LICENSE CLASS LIC NO DATE CONTRACTOR WORKERS'COMPENSATION DECLARATION I H V AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS. U#OfAND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' MPENSATION,AS PROVIDED BY SECTION 3750 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 ARRIER AND POLICY NUMBER ARE: ISSUED. MY WORKERS' ENS 1 RAN 0 CARRIER- POLICY NUMBER (THIS SECTION NEED NOT BE COMPLETED OF THE PERMIT 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(1100,000),IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 3709 OF THE LABOR CODE,INTEREST AND ATTORNEY'S FEES. CONSTRUCTlON LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS ACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WOFK FOR WHICH THIS PERMIT IS ISSIJED(SEC. 3097,CIV C.I. LENDER'S NAME LENDER'S ADDRESS I 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]IPC ION PURPOSES. PE ITTEEN (PRINT E PE MITT DATE SIGNATURE PE MITT E T E CO aT 0 LL 0 w 0 z m W 0 0 X LIJ 0 F- H-- U W C/J CIO 0 C) W 0 LU W Z CD 0 0 w IL Uj W IS d Z W ME Cr IULJ a CD LL] � Ce 202 APPLICAT PERMIT 3P/C DATE NUMBER # ISSUE TYPE OCC DATE CONST- GROUP ZONING SETBACKS FRONT RW^ REAR ^ SIDE/SIDE STREET RW^ SIDE ^ PROPOSED USE N0. DWEL N0. r� N0. jV UNITS STORIES 4 BEDROOMS DESCRIPTION SC. FT FACTOR PSF ADJ.AREAIVALUATION SFR/ADD/REM W Garage/Carport W Patio/Deck LL Pool/Spa Z Re-Roof Commercial Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U W J LU CD z m 0 U Z 2 LU CONSTRUCTION 1 (J �'J PLAN REVIEW _ ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: w L V TOTAL FEES COMMENTS RE PT N0. PAID BY VALIDATION WHITE-Department Copy. YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicaht's Copy