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Home My WebLink About18535 (11) �� CITY OF DIAMOND BAR � � DEPARTME';aiT OF COMMUNITI'&DEVELOPMENT SERVICES �. 21825 E.Copley Drive " (909)860-3195 Fax(909)86i-3117 � { PRESS '%»� BUILDING PERMIT APPLICATION � �- FIRMLY JOBSITE / C�,�, � APPUC 1 PERMIT � -/^l P/C � ADDRESS� `v � i�^ DATE � NUMBER ��''�3� � ik � ISSUE . � �, i I � TYPE OCC APN LOT TRACT DATE � V CONST. GROUP p OWNER " ADDRESS ZONING SETBACKS z CITY ZIP 7EL. � FRONT RW ❑ � APPUCANT TEL._ REAR ;_� � SIDE/SIDE STREET RW ❑ z ¢ CONTRACTO SIDE ❑ � ADDR S PROPOSED USE ' n� � � CITY ZIP TE . �w ARCH/ENG/ �j�jL � z DESIGNER_ ►v J� � ADDRESS_ NO.DWEL. NO. NO. UNITS STORIES ___t�___BEOROOMS � CITY ZIP__ TFL._ � DESCRIPTION SQ.FL FACTOR PSF ADJ.AREANAWATION OOWNER-BUILDER DECLARATION SFR/ADD/REM I HERE9V AFFIRM UNDER PENAL?V OF PEFJURV THAT I AM E%EMPT FROM THE CON7RACTOFS LI- Gefe(J8/CerpOA �W CENSEL4WFORTHEFOLLOWINGREASON�SEC.?031.SRUSINESSANOVAOFESSIONSCOOE�.ANVCITYOR (f� U COUNTVWHICHREOUIRESAPERMITTOCONSTRUCT,ALTER,IMoqpVE.DEMOUSH,CRREPAIRANVSTRUG W pytIO�DOCk Z TURE,PRIOR TO ITS ISSUANCE,ALSO flEOUIRES THE APPLICANT FOR SUCN PERMIT TO�ILE A SIGNED w w STATEMENT THAT HE OR SHE IS LICENSE�PVRSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- � CENSE LAW(CHAPTER 9(GOMMENCING WIThI SECTION l�oo)OF�1VISION 3 C`F THE BUSINESS AND PRO- � PooUSpa � FESSIONS(:OOE)ORTMATMEOfl5HEI5E%EMPTTHFREFROMAN�THEBASISFORTHEALLEGEDE%FMY- � � TION.ANYVIOLATIONOFSECTION7071.SBYANYAPPLICANifORAPEFMITSU9JE(:f51HFAPPLIGANTTO Z Re-Roof � ACIVILPENALTVOFNOTMORETHANFIVEHUNDRE�DOLURS�S500).��. - 0 -71.ASOWNEROFTHEPROPERiV.ORMYEMPLOVcESWiTH'NAGESASIHEIRSOLECOMPENSAT�ON, ❑ CommefCidl Z WILI DO THE WORK,ANO THE STRIICTIIFE IS NOT IN'END[�OH OFFEREO FOH SALE!SEC.70C<.BU''I- J NESS ANO PROFFSSIONS CODE:THE CONTRACTORS LICENSE LAW GO'eS NO`APPLV t0 AN OWNER OF � PROPERTYWHOBUILDSORIMGROVESTMEREON,ANDWHODOESSUCHWORKHIMSELFORHERSELFOR � � THROUGH HIS OR HER OWN EMPLOVEES,PROVI�ED THAT£UCH IMPROVEMENTSARE NOT MTENDEDOR m QOFFEREOFORSALE.IF,HOWEVERTIIEBUIL�MaOFIMPROVEMEN'ISSOLDWITHINONEVEAROFCOMP�E Z TION,TME OWNER-BUILDER WILL HAYE THE BURDEN Of PROYING'MAT HE OR SHE DID NOT BUILD OH � IMPflOVE FOR THE PURPOSE OF SALE). - w ❑I,RSOWNEROFTHEPROPERTY.AMEXCWSNELYGCINTRFGTINGWIIHLICENSE�coNTFiAciOHS � TO CONSTRUCT iHE PRQIECT(SEC.7a66,BUSINE55 AND PROFESSIONS CODE:THE CONTRACTORS I.I� V81118�1Df1 ADJ.AREA W CENSEUWDOESNOTAPPLYTOANOWNEROFAPROPERTYWMOdUI1.050%IMPROVESTHEREON,AND F WFIOCONTRACTSFORSUCHPROJECTSWITHACONTRACTOR(S11.ICEN;[DPUPSUANTTOTHECONTftAC- QUANTITV DESCRIPTION FEE Y TORS IICENSE LAW). � J O f]I AM E%EMPT UN�ER SFC. __ B.8 P.C.FOR THIS REASON Q � _ U � � OA',F OWNER r Z V W � LICENSED GONTRAGTOFS DECLARATION �j ¢ � 1 HEREBV AFFIRM IINDER flENALTV OF PERJLIRV THAT I AM LICENSED�N�ER PROVISIONS OF CHAPTER � d 9(COMMENCING WITH SECTION l000)OF DNi510N 3 OF THE BUSINESSANO Pf?OFESS�ONS CODE,AVD Z X MV LICENSE IS IN G'UL�FORCE AND EFFECT ^ /. — p �-- f � ��J (/� � � �ICENSE C SS { I.LIC.NQ�{(��!__�___ .... � U DATE�L�� CONTRACTOR . d W 0��[ WORKERS'COMPENSATION DECIAHATION -� Q Uj U — � I HEREBV AFFlRM UN]ER PENALTV OF PERJURV ONE OF THE FO�LOWING DECLARATIONS: Z Q � I VEANUWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSl1FEFORWORNEH5 = Z MPENSATION.AS PflOVIDEO BV SECTION 970o fJF THE LABOR CODE,FOR THE PERFORMANCE U ¢ OF THE WORK FOR WHICH THIS PEHMIT IS ISSUED. � � W I HFVE AND WILL MAINTAIN WORKERS'GOMPENSATION INSURFNCE,AS REQUIRED BV SECTION //�- Q 3700 OF THE LABOR CODE,FOR THE PERFOFMANGE OF 1 HE WORK FOR WMIGM THIS PERMIT IS �I � .'�V � ISSUED.MYWORNE COh NSATIO RANCECA ERANDPOLICVNUMBERARE: CONSTRUCTION � a Q ] cnaaiEa._ _ PLAN FEVIEW Z POLICV NIIMBER ..�._ � —__— ELECTRIC Q � (iH155ECTIONNEmNOTBECL'�MPLEfEDOFT1EPEfWlI'ISFOFqJENVFDREDDOLLAfU^(E100!OR_E55). PLUMBING w MECHANICAL Z I CERTIFV iHA'IN THE PERFORMANCE OF THE WOFK fOF WHICM THIS PERMIT IS ISSUE�,I (,�} SHALL NO f FMP:OY ANV PERSON IN ANV MANNER 50 AS TO BECOME SUBJE�T TO THE � WORKERS'COMVENSATIONLAWSOFCALIFORNIA.ANDAGRFFTHATIFISHOULD6ECOME INS.'�EGTIONFEE _ ___ , F SUBJECTTOTHEWORKERS'COMPENSATIONGROVISIO�SOFSECTION3�OOOFTHEUBOP � CODE,I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. ISSUANCE __ �.� � SMIP , Le� I, p DATE: APPLICANT'. w ENERGY P/C —� WARNING:FAILURE TO SECUFE WORKERS'C.OMPFNSATION COVERAGE IS UNLAWFUL.AND$HALL BE '-- J � SUBJECT AN EMPLOVERTO CFIMINAL PENALTIES AN�CIVIL FINES IJP IOONE Hl1N�REC1 THOI1SANp ENERGY PERMIT DOlLAf1S�f100.000),IN AD�ITION TOTHE COST OF COMPENSATION,DAMAGESAS PROVIOEO FOP IN — J SECTIOlJ 3�OeOF iHE LABOR CODE.INTEREST,AND AiTORNEV'S FEES. RETENTION FEE: I � L� � — �'. � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: _ i 0 — � 1 HEREBV AFFIqM UNDEF GENALTV OF PERJURV THAT THFRF IS ACONSTFl1CTION LFNDING AGENCY , � FOR THE PERFOqMANCE OFTaE WOFK FOR WHICH THIS PERMIT IS ISSIiF�i ISFC.30B],CIV.C.). Z w � ? �ENIlFNSNAMe__ ... ._— _ � F_ LENDER�SADC9E55 /� w I CERTIFV THAT I HAVF_REA�TNIS APPLICATION AND STATE THPT THE ABOVE INFORMATION IS CORRECT TOTAL FEES � ��\`�Y`4� '� � I AGREE TO COMPLV WITN ALLCITY AND COUNTV ORDINANCES AND STA'E LAWS PELATING TO AUILDING �� il � CONSTRVCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF TNIS COUNTV TO ENTER UPON THE z ABOVE-MENTIpNEDPROPERTYFORINSP ONPURPOSES. COMMENTS Q — _ J � ��!�/111 m PEflMITT NAME(PF T) �- --- _— ¢ —_ — � � �� SIGNATIIqE OF� MITTEE VATE y = RECPT.NQ _ t PAID BY '�'WALIDATION — ~ WHITE—Department Copy,vEU.OW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Gopy,GREEN—ApplicanPs Copy _ �_� �� sk� � � �k � � s� -> '� : m ,. , . ° ;' �' �� ' � :�" � ` �,a^�� ' � 4 � � � � _ � 4 .. . > . � ,� , �� . �.��, a.��, � �°`��' �� -, , � ,�. �.�,, ,�. _ �� __ _ _ _ _ _ c _ _ " ___ ; __ _ _ _._ ._ i _ : _ _ �r i� �y'�N"`'�,_ �a.�� ,� ��Y q�� Q��t s x' . ... . .. .. .. . .. ... .. . ... ._. .... . . . ..___ ..... . ._. ... ��s � �'�J� �.� , i:� i: .� �„ffiF o�.�.. 91 � ��. F . . . . . . . . . . .. . . .. . ...._ '. i, , ° w�, u•''j V':� _ . . .. . . ... . ... _.. ... _._ . ...... ._. . _ ._. .... _ �'f �� } �. � i � , .. . . .. f . , w . .� : .. ...... _.... ... ._. . . _. _.._. . F�'� 'p � ,, . �, N. �r�• Iry � �, � . _ . . . . .... .. . . .. . ... _._ ._... _.... .. ... . .. . n� �"i ° . . x,. � ` i ��4:' . . ... ... .. . . . .. . . ._ .... .... . .... . � � a ' ��"�. ... . . . .... ...... ... .. . . . . ... .. ._ ._. . . . . ... ... . ��.,. DIAMOND IIAR CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION PRESS FIRMLY JOBSITE/'I (WI ADDRESS ! 40 +�n APN LOT TRACT OWNER ADDRESS CITY ZIP TEL. APPLICANT TEL. CONTRACTO ADDR S Ki� CITY I%f W�d-M 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 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 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,ASOWNEROFfHE 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 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 3UII.DS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW) . U T 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 PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORCE AND EFFECT^ LICENSE C SS C LIC. N0. Dot DATE CONTRACTOR WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: AND WILL MAINTAIN A CERTIFICATE OF CONSENT i0 SELFINSURE FOR WORKERS' ENSATIONAS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE / E WORK FR WHICH THIS PERMIT IS ISSUED AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION �HA 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED MY WORKS COh NSATIO RANGE CA ER AND POLICY NUMBER ARE CARRIER_ POLICY NUMBER (THIS SECTION NEED NOT BE OYAPLETED 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($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 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 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 INSP ON PURPOSES PERMITT NAME(PR T) SIGNATURE OF MITTEE DATE 11 } 0 aD Cr 0 LL 0 w 0 0 Cr 0 IS 0 W U W 0 U 0 Z 0 d X W 0 I- U W cn CI) W LU W rn F 0 W J J LL LU W R- CD cc: d W I w W T CD APPLIC 1 PERMIT --°C P/C DATE NUMBER # ISSUE TYPE OCC DATE V CONST GROUP ZONING SETBACKS FRONT RW^ REAR SIDE/SIDE STREET RW^ SIDE ^ PROPOSED USE of C N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM CI) Garage/Carport LL Patio/Deck LLI LL Pool/Spa 0 Z Re-Root Commercial Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J Q L) 0 W J w z Z m a Q - U Z Q 2 W IIV CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE t---�-J SMIP L J ENERGY P/C ENERGY PERMIT RETENTION FEE: i L PRE-ALT FEE: TOTAL FEES COMMENTS RECPT. N0.t PAID BY 44�� WALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy