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Home My WebLink About18534cli 0 O 0 w z O r� z DO CcO 0 W 0 w OD u3 cn Cr O C) W U Z Lu 0 O 2 ir W 0 Z Q It— ]e ]C Cc W Z O Q Q w X W 0 W 2 Z, Tn W M Z ¢ I W Q 0 J Z LU W Z C7 co O W J_ LU LU O Q CL Z W S H LLJ Cl - (2 C7 z O I111HOND DL111 i CITY OF DIAMOND BAR DFIDARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21825 E. Copley Drive (909) 860-3195 Fax (909) 861-3117 %.� BUILDING PERMIT APPLICAT JOBSITE _ ADDRESS AIGN LOTRACTT ADDRESS CITY ZIP TE APPLICANT TE . CONTRACT ADDRES CITY ZIP L. ARCH/ENG/ 1 DESIGNER ADDRESS CITY ZIP TEL, OWNER"BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS U CENSE LAW FOR THE FOLLOWING REASON ;SEC. 7031.5 BUSINESS AND P90PESSIONS CODE: ANY 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 :S LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS H CENSE LAW (CHAPTER 9(COMMENCING WITH SECTION 7W0) OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE GR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT TOP A PERMIT SUBJECTS "THF- APPLICANT TO A CIVILPENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (35001 )- L ] 1, AS OWNER OF THE PRIJPER TY OR MY EMPLOYEES WITH WAGES AS T 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 W ITHIN ONE YEAR OF COMPI F - TION, THE OWN ER BUILDER WILL HAVE THE BURDEN OF PROVING :HAT 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 U CENSE LAW DOES NOTAPPLY TOAN OWNER OF A PROPERTY WHO BUII. D5 OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S I. ICENSCD PURSUANT TO THE CONTRAC TORS LICENSE LAW). F I I AM EXEMPT UNDER SFC. B. d P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 30F THE BUSNESSANC PROFESSIONS CODE, AND MV LICENSE IS IN FULL FORD N FFECT, y LICENSE CLASS _ y�" LIC- NO. ��ff�� DATE-��'— CONTP,ACTOR 31_18VA 111IHAIA WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I VE AND WILL MAINTAIN A CERTIFICATE OF CONSENTTO SELF- INSURE FOR WORKERS' MPENSATION, AS IFIOVIDED BY SECTION 3700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. HAVE AND WILL MAIN -AIN 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 WOR RS MP ATI INSURA CARRIER AND POLICY NUMBER ARE: CARRIER POLICY NUMBER — _ (THIS SECTION NEED NOT EE COMPLETED OF THE PERMIT IS FOR ONE HUNDRED D LIARS $100) ORLESS) I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, SHALL NOT EMPLOY ANY PERSON IN ANY MANNER 50 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 SHA'�L FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE- APPLICANT: WARNING: FAILURE TO SECURE WORKERSCOMPENSALON COVERAGE S UNLAWFUL, AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP 10 ONE HUNDRED THOUSAND DOLLARS IS1 W.000). 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 THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF T -IE WOFK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3097, CIV. C.). LENDER'S NAME _ LENDER'SADDRESS CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION 15 CORRECT AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELAT ING TU BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY F R INSPECTION PURPOSES TAI_.; - PE T ENA INTI 51GNAT,Iq + PERM -- DAT WHITE—Department Copy, YELLOW—Finance Copy, PI ION / PRESS FIRMLY APPLICA PERMIT �. P/C DATE / NUMBER # ISSUE TYPE OCC DATET, 3� CONST. GROUP ZONING SETBACKS FRONT RW ❑ _ REAR ❑ SIDE/SIDE STREET RW ❑ _ SIDE ❑ PROPOSED USE Ai I KI NO. DWEL. N NO. UNITS STORIES ' BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA(VALUATION SFR/ADDlREM U) Garage/Carport W W Patio/Deck W POOUSpa Z Re -Roof IV Commercial m Valuation L'` Al QUANTITY DESCRIPTION FEE J Q U F- L) W W t� Z EE J Q U_ Z Q LU lJ CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE _ ISSUANCE SMIP V'' ENERGY P/C _— ENERGY PERMIT V RETENTION FEE. PRE -ALT FEE: TOTAL FEES It COMMENTS RECPT. NO. PAID BY VALIDATION NK—Assessor Copy. GOLDENROD—File Copy, GREEN—Applicant's Copy DIAMOND BAR i CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21825 E. Copley Drive (909) 860-3195 Fax (909) 861-31 17 BUILDING PERMIT APPLICATION PRESS FIRMLY ADDRESS'--. 1 ADDRESS 0 G I" —!Iv - AWN LOT TRACT OWNER _fA ADDRESS CITY ZIP TE APPLICANT TE CONTRACT will ADDRES I k) CITY ZIP 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 REQUIRES APERMIT TO CONSTRUCT, ALTER, IMPROVE. DEMOLISH, CR 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 (115W)) ^ 1, AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS T 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 NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S) I ICENSED PURSUANT TO THE CONTRAC TORS LICENSE LAW). LI I AM EXEMPT UNDER SF C. B & P.0 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 PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORC N FFECT, r dro LICENSE CLASS LIC NO. DATE _ CONTRACTOR ryj4 WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I—A VE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' —IOMPENSATION. 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 IS ISSUED. MY WOR ERS MP AT— INSURA CARRIER AND POLICY NUMBER ARE CARRIER POLICY NUMBER (THIS SECTION NEED NOI 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 SECURIE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP 10 ONE HUNDRED THOUSAND DOLLARS (S1 M,000), 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 THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF T -IE 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-MENTIONEDP f OPERTF R INSPECTION PURPOSES T PE 7 ENA INT) SIGNATIIq- PE KillTE DATE T/) a0 0 UL - L W 0 0 m a� 0 LU W 0 z W IQ_ rn U) co (n 0 UJ W U Z W 0 C-) 0 U) Cc W 0 Q W 0 LL Z 0 W X W 0 U W U) U.) CIO ci Z in W D Z Lu W Z C7 0 0 W J J Cr W d 0 12 d W S I- F - Er LU LU Q- (0 APPLICA PERMIT P/C DATE NUMBER # ISSUE 13 -^ TYPE OCC DATE T, )- CONST. GROUP ZONING SETBACKS FRONT RW ^ REAR ^ SIDE/SIDE STREET RW ^ SIDE ^ PROPOSED USE NO. DWEL. N NO. UNITS STORIES' BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREANALUATION SFR/ADD/REM U) Garage/Carport LU Patio/Deck W LL PooVSpa Z Re -Roof 0 Commercial Valuation ADJ.AREA QUANTITY DESCRIPTION FEE I- U W J W (7 Z E5 25 CL. Q U CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP —7 til' ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: - TOTAL FEES I COMMENTS RECPT NO. PAID BY Ilk VALIDATION WHITE -Department Copy, YELLOW -Finance Copy, PINK -Assessor Copy, GOLDENROD -File Copy, GREEN -Applicant's Copy