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Home My WebLink About18533 (11)0 Q O 0 w O 0 z ED w O 0 Lu 0 z Lu 13- U3 SQ Q O W U W U F- O .Z C17 Q W Z Lu Q W 1 -- CE rL L.L Z d X ll! O H' - U W C/J LuD Z Lu ¢ O J 0 z Lu W Z CIO O M W J O 2 d Z W S ME Er Lud LJ Z D m Q H CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21825 E. Copley Drive (909) 860-3195 Fax (909) 861-3117 PRESS BUILDING PERMIT APPLICATION'��" �- FIRMLY ADDRESS �J APN---�� LOT RACT _ OWNER �'— ADDRESS— CITY ZIP TEL. APPLICANT TEL. CONTRACTOR ADDRESS 6 1 CITY ZIP TE . ARCH/ENG/VIA- DESIGNER RCH/ENG!j }IA -DESIGNER _ ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFTM 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 TUBE, PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICAN' FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LL CENSE LAW (CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 CF THE BUSINESS AND PRO FE5SIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TIO ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJEL(S I HE APPLICANT TO ACIVIL PENALTY OF NOT MORE THAN FIVE HLNDRED DOLLARS ($500) ): D I, AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS 1 HEIR SOLE COMPENSATION. WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE ISEC. 7004 BUFIk NESS AND PROFESSIONS CODE. THE CONTRACTORS LICENSE LAW DOES NOT APPY 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 THAI HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). D I. AS O WNER OF THE PROPERTY AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRAC-ORS TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI CENSE LAW DOES NOTAPPLY TO AN OWNER OF A PROPERTY WHO d'JIIDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(SI LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW). U I AM EXEMPT UNDER SEC. ----S APC. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBYAFFIRM UNDER PENALTY OF PERJURY THAT 1 AM LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSION'S CODE. AND MY LICENSE IS IN FULL FORCE kND 41 EFFECT" LICENSE CLASS ..... ` _ LIC. NO. DATE �Y-. tV __. CONTRACTOR i/ WORKERS' COMPENSATION DECLARATION I H V AFFIRM UNDER PENALTY OF PERJURY ONE OF THE ED LLOWING DECLARATIONS. AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' MPENSATION, AS PROVIDED BY SECTION 3700 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 15 ISSUED. MY WORKERS' ENS 1 RAN CARRIER AND POLICY NUMBER ARE: CARRIER_ _ POLICY NUMBER (THIS SECT)ON NEED NOT BE COMPLETED OFT IE PERX4T 15 FOR ONE HUNDRED DOLLARS (SIM)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 SLIRJFCTTOTHF WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE, : SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE: APPLICANT: WARNING: FAILURE'. TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL BE SUBJECT AN FMPLOYF R TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($1 W,001), IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE. --INTEREST AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THATTHERE IS ACONSTRUCTION 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-MFNTIONFDD PROPFRTY FOR IPC ION PUAPOS F. r A PE TTEFN (PRINT SIGNATURE PE MITT E DATE f/J�' APPLICATP PERMIT �P/C DATE NUMBER # ISSUE -- TYPE OCC DATE (" CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR 1:1SIDE ❑ SIDE/SIDE STREET RW ❑ ❑ PROPOSED USE NO. DWEL. NO. j NO. UNITS STORIES 4 BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREAIVALUATION SFFVADD/REM U) Garage/Carport W PatiolDeck r� Pool/Spa V Z Re -Root -2500 OJ Commercial m Valuation _ ADJ.AREA QUANTITY DESCRIPTION FEE J Q U H- U W LU LU C7 Z DO 7171 ii Q U_ Z Q W CONSTRUCTION PLAN REVIEW _ ELECTRIC PLUMBING _ MECHANICAL INSPECTION FEE ISSUANCE �J SMIP ENERGY P/C ENERGY PERMIT T _ RETENTION FEE: _ PRE -ALT FEE: l- w TOTAL FEES COMMENTS RECPT NO.__ PAID BY rip ) VALIDATION WHITE—Departmert Copy, YELLOW—Finance Copy, PINK—Assessor Copy, G DENROD—File Copy, GREEN—Applica is Copy 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 01tf— 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 0TH 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 CONTRACTING 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. CONSTRUCTION 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 C13 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 DATE NUMBER # ISSUE TYPE OCC DATE CONST- GROUP ZONING SETBACKS FRONT RW ^ REAR ^ SIDE/SIDE STREET SIDE ^ PROPOSED USE NO. DWEL NO. jV 3P/C RW ^ r' NO. UNITS STORIES 4 BEDROOMS DESCRIPTION SC. FT SFR/ADD/REM W Garage/Carport W Patio/Deck LL Pool/Spa Z Re -Roof Commercial Valuation ADJ.AREA QUANTITY DESCRIPTION J U W J LU CD z m 0 U Z 2 FACTOR PSF LU CONSTRUCTION 1 ( 3 -3 ADJ. AREAIVALUATION FEE 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 NO. PAID BY VALIDATION WHITE -Department Copy. YELLOW -Finance Copy, PINK -Assessor Copy, GOLDENROD -File Copy, GREEN-Applicaht's Copy