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Home My WebLink About18536 CITY OF DIAMOND BAR �� DEPARTMENT OF CO1vIIvIUNI'fY�DEVELOPMENT SERVICES �w �. 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 PRESS `":.:�' BUILDING PERMIT APPLI�ATION '�L � FIRMLY � JOBSITE � -�' APPLICATI PER IT � P/C o ADDRESS�� DATE NUMBER � ��' # r° __ DA EE ��--(�� TYPE OCC APN LOT_. T T '-�' q�_CONST. GROUP °C OWNER "' O `L ADDRE55 ZONING SETBACK$ � � FRONT � RW ❑ oCITY ZIP 7E . REAR ❑ _ p APPLICANT • TEL._ SIDElSIDE STREET RW O aCONTRACTO SIDE ❑ � ADDRE ` PROPOSED USE � � CITY F ZIP T . w ARCH/ENG/ •,�. z DESIGNER� — NO.DWEL. NO. /� a ADDRESS UNITS� STORIES �_BEDROOMS �i' � CITY ZIP TFL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � � OWNER-BUILDER DECLARATION SFFUADD/REM O � I HEREBY AFFIqM UNDER PENALTV OF FERJURV'HAT I AM F%EMPT FROM THE CANTRACTORS LI- G8f090/CdfPOfl W CENSELAWFORTHEFOLLOWINGREASON(SEC.�091.SBUSMESSANDPROFESSIONSf:O�E:AUYf,ITYOp (n U COUNTYWHICHREQUIFESAPERMITTOCONSTRUC',ALTER,IMORC�VE,�EMOI.ISH,CRREPAIRANVSTRUC. Z TURE,PRIOR TO ITS ISSUANCE.AL50 REOUIRES THE APVLICANT fOR SUCH PERMIT TO FLE A SIGNED w PatioiOeck W STATEMENT THAT ME OR SHE 1:3 LICENSED GURSUANT TO TNE PROVISIONS OF THE CONTRACTORS�:- I � CENSE LAW(CHAPTEfl 9(GOMMENGING WITV�SECTION�oo�)OF DIVISION 3 C`F THE BUSINESS AND PRO- � PooUSpa i O FESSIONSCODE)ORTHATNEORSMEISEXEMPTTHGREfqOMAN7THEBASISFOATHEAIIEGEDE%EMY- (3 U TION.ANVVIOLATIONOFSECTION7031.58YANYAPPLICAN�FORAGEHMITSu9JEC�5fHFAPGLICANTTO Z qe-Roat � A CIVIL PENALTY OF NOT MORE THAN FNE HUNDREO DO�URS(S5oo))'. � ❑I,ASOWNEROFTHEPROPERTV,OF�IVF�IPLOVEESWITHWAGESASTHEIRSOLECOM7ENSAT�ON, ❑ COmmBrCiel Z WILL DO THE WORK,AND THE STRUCTUHE IS NOT INTEND[D OF OFFER'e�FOH SALE(SEC ladd,911�1� J NESS ANO PROFESSIONS CODE:THE CDNTRACTORS LICENSE LAW GOES NO�AVPLV TO AN OWNER OF � PflOPEflTVWr10BU1LD50RIMPROVESTHEREGN,ANOWHO�0ES5UCHWORKHINSELFORHERSELFOR � � THROUGM HIS OR HER OWN EMPIOYEES,PROYIDED ThAT 9UCH IMPROVEMENT$ARE NOT MTENDED OR m W OFFERE�FORSILLEIF,HOWEVER,iHEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE- � TION,THE OWNER-BUILDEfl WII1 HAVE THE BUH�EN OF PROVING'HAT HE OR SHE DIO fJOT BVILD OH Z IMPROVEFORTHEPUFPOSEOFSAIE). = 71.ASOWNEROFTHEPROPERTY.AMEXCLJSIVELVCONTRACTINGWIiHLICENSEDCONTRACTORS w To CONSTRUCT THE PROJECT(SEC.7044.BUSINESS AN'J PROFESSIONS CODE�.THE CONTRACTORS LI- p� Valuation �"' ADJ.AREA W CENSE UW DOES NOTAP7Lv T7AN OWNER OF A PROFERTY WHO dUII.DS OR IMPPOVES THEREON,AND = WHOCONTRACTSF045UCHPFtOJECTSWITNACONTRACTOR�S111CFhi[DPURSUANTTOTHECONTRAC� QUANTITY DESCRIPTION FEE � TORS IICENSE UW). Y � � f;I AM EXEMPT UNDER SFC. B.8 P.C.FOR THIS REASON U � _— � "'— ¢ LL OATE _ OWNER U — W � LICENSED CONTRACTORS DECLARATION i j ¢ Q I HEFEBV AFFIRM UNDER PENA��TV OF PERJURY THAT IAM LICENSED iJNDER PROV�SIONS OF CHAPTER V. d 9(COMMENCING WITH SECTIOM]000)OF DIV15iON 30F TNE BUSWE55 AND Pf?OfESSiONS CODE.AVD Z XO MV LICENSE IS IN FU�O�C��N EFFECT. �� m r LICENSE LIC NC. _ � U DATE �� ' � Y Ii CON7RACTOR � � W � WORkERS'COMPENSATION DECLARATION J � a � U � I HEREBY AFFIRM UNDEP PENALTV OF PERJVRY ONE GFTHE FOLLOWING DECIARATIONS: Z Q � 1 HAVE AND WILLMAINIAINACERTIFICATE OF CONSENT'O SELF�INSURE FOR WORKEFS' _ �PENSATIdJ,AS vF�,OVIDE�BV SECTION 3]b0 nF THE LABOR CODE,FOR THE PERFORMP.NCE U Q Tu,E WOFiK FOR WHICH THIS PERMIT IS ISSUED. � � w 1 HAVE AND WILL MAIMAIN WOFKERS'GOMPENSATION INSURANCE,AS RFQUIRED BV SECTION .. l ` � Q 9]ooOF THE LABOR COOE,FOft THE PERFORMANCE OF THE WORK FOF WMICH IHIS PEPMII IS l �—) iSSUED.MVWORKFR' P N EC ERANDPOLICYNUMBERARE: CONSTRUCTION f �t�J ' j CARRIcq � U PLAN REVIEW _ �' 0 voucrNUMaEa_ -- ELECTRIC _ ¢ Q (iHI55ECTqNNEFUNDIBEQ7MREfEDOFTHEPEMUi�SFOFqJEHUI�DFE�00l1AR+(b100�ORLE55�. PLUMBING _ w I CERTIFv THAT IN THE PERFORMANCE OFTHE WOiiN FOR WHICH THIS PERMIT IS ISSUED,i MECHANICAL Z — �} SHALLNOT EMPLOV ANV PERSON INAVV MANNER SOA510 BECOME SLBJECT TO THE Uj WORKERS'COMPENSATION LAWS OF CALIFORNIA,A4D AGREE TFIAT IF I SHOl1L0 6ECOME INS?ECTION FEE � SUBJECT i0 THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3]Do OG THE LA80R \ � � GODE.ISHALLFORTHINITHCOMPLYWITHTHOSEPFOVISIONS. ISSUANCE r7'� . •`� p �ATE: APPLICANT: SMIP ��(.�� w ENERGY P/C J WARNING:fAILURE'O SECUR'�=WORKERS'COMPENSATION COVERAGE IS UNLAWFIIL,AND SHALL BE —"— J � SUBJECTANEMPLOYERTOCGIIMINALPENALT'�ESANDCIVILFINESUP100NEHUNDREDTHOUSAND ENEFGYPERMIT DOLLARS(f100.000),IN ADDITIDN TO THE COST OF COMPENSATION,DAMAGES AS PROVI�ED FOR 1U J SECTION 37080F THE IAdOH I:OpE,INTEFEST,ANDATTORNEY'S FEES. RETENTION FEE: —�� Q � CONSTRUCTION LENDING AGENCY PRF-ALT FEE � Oi ____ —.__ � I HEREBV AFFiRM UNOEtt PCN�GLTV OF PERJURV THAT THERE IS ACONS'FUfTION LENDING A(:ENf:V � _ � iOP THE PEHFORMAhCE OF THC WOFK FOR WHICH TNIS?ERMIT IS ISSUED(SEC.309],CI'J C.�. Z W 2 LENDEN'SNAMF __ _—...._— - � F-- LENDEP'SADDRESS__ �'` O\, wI CER7IFV THAT I NAVE READ 1H15 APGLICATIONANO STATE THAT THE AAOVE INFORMATION IS CORRECT TOTAL FEES � `�� `\.�� \ � I AGREE TO COMPL\'WITH ALl CITV ANO COUNTV OR�INANCES AND STATE LAWS RELATINC TO AUIL�ING �y� � CONSTRUCTION,AND HEREBY AUTI10Fi2E REPRESENTATNES OFTNIS COUNTV T ENTER LPUN TH= zA80VE-ME TIONEDFROPERTYFOR T'� NPURPOSES. COMMENTS __.. .-___. — Q _ — J — � m PtH EEN RINTj ,�,I , r1 �\ ___ — -- � 'y� ./ /f� � (/J _�/�i V � �._"'r=-- —_ � SICNATIiRf O� RMITTEE DATE � _ � . NECP?.NO. _ PAID BV VALIDATION ~ WHITE—Depatlment CoGy,YEL:.OW—Finance Copy,PINK—Assessor Copy,GOLDENRO�File Gopy,GREEN—ApplicanYs Copy � m � , , ��e,��,�:�,��. ^:;� w z�� 3�� . � �"�� s�..� �. ��, � � � . � . � � . ��r�, .. �e :.�: . �� 1 . � _ _ _ _ _ _ _ _ _ ��,�. , ,�� , �,, __ __ _ � �"•�,�" ��' '�• , , _ ____ __ ' _ . __ _ _ __ i _ . __ _ ! _ _ ; _ _ __ __ ; _ ; _ _ . ._A � ,.�..,�, �� r.,� , � ��. s �� ; _ _ _ �` � �a�{ �� — . ��m� _ _ _ " _ _ � ;�q „_�, . � � � , _ �_�' .,,. I . _ _ m��. UI�1)II-�D D,Ifti CITY OF DIAMOND BAR DEPARTMENT OF COI�M�IUNTfY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-311'7 BUILDING PERMIT APPLICATION f�4� PRESS FIRMLY JOBSITE�� ,�, ,' ��; RE SI ADD S APN LOT T T_ OWNER ADDRESSi CITY ZIP 7E � APPLICANT TEL. CONTRALTO L L' ADDRE CITY ZIP T j�; �� 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 LI- CENSELAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE: ANV CITY OR COUNTY WHICH REQUIRES A PEFiM1T TO CONSTRUCT,ALTER,IMPROVE. DEMOLISH,CR REPAIR ANV STRUC� TUBE. 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 IAW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONSCODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BAST S FOR THE ALLEGED E%EMF- TION.ANV VIOLATION OF SECTION 7031.5 BY ANV APPLICAN T FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLURS(5500)): - ^ I,AS OWNER OF THE PROPERTY,OR MV EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOH SALE(SEC. 7044, BUT NESS ANO PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES N0.APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMP ROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EM PLOVEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE. IF,HOWEVE R,THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE- TION,THE OWNER-BUILDER WII1 HAVE THE BURDEN OF PROVING 'HAT HE OR SHE DID NOT BUILD OH IMPROVE FOR THE PURPOSE OF SALE). ^ 1,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 UW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO dUII.DS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PFIOJECTS WITH A CONTRACTOR(SI LICENSED PURSUANT TO THE CONTRAC� TORS LICENSE LAW). f I I AM EXEMPT UNDER SEC._B.S 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 30F THE BUSINESS AND PF.OFESSiONS CODE.AND MV LICENSE IS IN FU ORC^4N EFFECT. J � �j _LIC. NC>. LICENSE li CONTRACTORS. DATE'� � WORI'(ERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJVRV ONE OF THE FOLLOWING DECLARATIONS: 1 HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' CgIPPENSATION,AS PFOVIDED BV SECTION 37000E THE LABOR CODE, FOR THE PERFORMANCE /q�THE WORK FOR WHICH THIS PERMIT IS ISSUED. �� ,L/ 1 HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION r 37000E THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKER' P 9Cy1N rE-C IER AND POLICY NUMBER ARE: CARRIER 4 V U POLICY NUMBER- (THIS SECTION NEm NOT BE CLY.APLETED OF THE PERMfT IS FOR ONE HUNDRED DOLLARS(81001 OR LESS). 1 I I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANV PERSON IN ANV MANNER SO AS TO BECOME SUBJECT TO THE j WORKERS'COMPENSP,TION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LA80R �CODE. I SHALL FORTH\NITH COMPLY WITH THOSE PROVISIONS. 1 r DATE APPLICANT: 1 �WARNING: FAILURE TO SECUR'.E WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE 1 SUBJECT AN EMPLOYER TO CFIIMINAL 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 1 SECTION 37080E THE LABOR I:ODE. 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 ISSUED(SEC. 3097,CIV C.). J 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 GIN AND COUNTY ORDINANCES AND STATE UWS RELATING TO BUILDING AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY T ENTER UPON THE CONSTRUCTION 3 ABOVE-ME TIONED PROPERTY FOR TI N PURPOSES. J 7 D PER EEN RINT)�,/+� C (0./ U�T L� DATE 0 SIGNATURE 0� RMITTEE C� WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor copy, LiuLUtrvrtuu-rile L,opy,oneerv-.