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Home My WebLink About18537 (11) f� CITY OF DIAMOND BAR DEPARTME'�'T OF COMMUNI7'Y&DEVELOPMENT SERVICES 21825 E.Copley[hive �.� (- (909)860-3195 Fax(909)861-3117 PRESS �"��^ BUILDING PERMIT APPLICATION ��/�' ` I y JOBSITE �_ �/� U F• � FIRMLY 4 ADDRESS��J/ .'�� S � APPLICATI PERMIT ' (,f �'�� ' p/C o OATE NUMBER � � � APN-�- LO'T TRACT ISSUE (`� � � -1 TYPE OCC p OWNF_R (Ik�� G'�r �� DATE ' "� �zoNST. GROUP p ADDRESS ZONING SETBACKS FRONT z CITY ZIP 7E .. �� RW ❑ � APPLICANT TEL._ REAR � — zSIDE/SIDE STREET Ryy �_ — a CONTRACTOR SIDE r`� ADDRE /� � CITY ZIP TE . PROPOSED USE � V ,�' 0 w ARCH/ENG/ +n, z DESIGNER�� w -- NO.DWEL. � ADDRESS UNITS NO. � CITY ZIP TEL.__ STORIES I BEDROOMS� � DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION p SFRlADD/REM � I NEREBV AFFIqM UNDER PENALTY OF PERJURV THAT I AM EXEMPT FROM THE coNTancToqs u- Garage/Carport W CENSEUWFORTHEFOLLOWWGREASON(SEC.1031.5BUSMESSANDFROFESSIONSCDOE:ANYGI7VOF (n , Z COUNiVWHiCHREOUIRESFPERMITTOCqNSTRUGT,ALTER,IM�ROVE.DEMOLISH,CRFEPAIFANYi?RUC- W Patio/Oeck , W TURE,PRIOR TO ITS ISSUANCE:,r1L50 REQUIRES TME AP7LICANT FOR SUCN PERMIT TO FlLE A SIGNED w � STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PPOVISIONS OF THE CONTRACTORS LI- � CENSE LAW(CHA7TER 9(COMMENCING WITH SECr�ON 7000)OF DIVISION 3�F THE AUSINESS AND PRO- LL POOUSpe O FESSIONS CODE)ORTHAT HE ORSHE IS ENEMGTTHFqFGROM ANO THE BASIS FOR THEALLEGED E%EMV- � V TION.ANYVIOLATIONOFSECTIDN]o31.5BYAN�APPLIC4N'FORAPfRMITSJ9JECf5MFAPPLICAHTTO Z Re-Roof �,I� r A CNIL PENALTV OF NOT MORE THAN FIVE HUNDRFO DOLLARS(f5aa�)�. � � ❑I,ASOWNEROFTHEPROPER'VORMYEMPLOVEESWiTHWAGE5AS7HFIRSOLEGOMPENSATiON, O Commercial Z WILL DO THE WORK,AND THE iTRUCTURE IS NOT IN i ENDED OF OFFERED FOH SNLE;SEG.]�4J,6U�.1� J � NE55 AN�PROFESSIONS CODI::THE CONTRAGTORS LIGENSE UW GOES NO�APPLY TO AN OWNER OF = — FROPEflTYWMOBUILD50RIMPRWESTHEREON,ANO'NHODOESSUCHWOFKHIMSELFOFHERSELFOR wTMROUGM HIS OR HER OWN EMPLOYEES.PROVIDED THAT£UCH iMPROVEMENTSAaE NOT INTENDEDOR m � OFFERE�FORSPLE.IF,HOWEVER.THEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPIF- � TION,THE OWNEF-BUILDER WILL HAVE THE BURDEN OF PROV�NG'HAl HE OR SNE DID fvOT BUILD oH � IMPROVEFORTHEPURPOSEOFSALE). � w f'I,AS OWNEROFTHE PiL7PERTV AA1 EXCLUSNELV CONTRACTING WITH LICENSED CONTRACTORS — Q TO CANSTRUCT iHE PRQIECT(SEC.]0/0,BUSINESS AND PROFESSION�CODE:LHE CONTqACTORS LI� V81U2�1Df1 ADJ.AREA W CENSELAWDOESNOTAPPLYTOANOWNEROFAPROPER'YWMOdUII.D50RIMPROVESTHEREON,qND — WHOCONTRACTS FOR SUCN PFlOJECTS WITH ACONTRACTOR(S1lICEM1SCD PUqSUANTTOTHE GONTRAF ~ TORSLICENSELAW.). QUANTITY DESCRIPTION FEE Y QLJ 1 AM EXEMPT UN�ER SFC. _ B.8 a C.FOR THIS REASON Q � U � �ATE OWNER H z U � LICENSED CONTRACTORS DECLARATION W � Q � I HEHEBV AFFIFM UNDEfi PENA�.TY OF PEFJURV THr1T I AM LICENSED UN�ER PflOVi510N5 CF GHAPTER � � 9(COMMENCING WITH SECTIO�7000)OF DIVISION 30F TME BUSINESS ANO Vf?OFESSn7N5 CODE,AND Z `X MYLICENSE IS IN FUL�FOFGE AN�EFFECI. /' -- � LICENSE CLASS �, G !IC.NO. V { ' � � H � U DATE� _ CONTRACTOR � d � W � WORi:ERS'COMPENSATION DECLARATION Q � I HEREBVAFFlqM UNDER PENAI.TY OF PERJURY ONEOF THE FOLLOWING DECLARATIONS: V � Z Z I AVEANDWILLAAAWTi11NACERTIFICATEOFCONSENTTOSELF-iNSUREFOFWORKERS' a 2 Q MPENSATION,AS PROVIDED BV SECTION J]0o OF TNE LABOR CODE,FOR TNE PERfOqMANCE U OF THE WORK FOR WH��M THIS PEFMIT IS ISSUED. � � W �NAVE AND WILL MAINTl11N WORKERS'COM�ENSATION INSURANCE.AS FEOIlIREO BV SFCTION Q3100 OF THE LABOR COIJF,FOR THE PFRFORMANCE OF THE WORN FOR WHICH iH15 PERMI?IS �'� {\ ISSUED.MY WORKE 'CO TIO' RANCE CAR0.IER AND POLICY NUMBEFARE. CONSTRUCTION __t_� _ •��/ J — j c^RqiER PLAN REVIEW � POLICV NUMBER� � ELECTRIC Q � (iHISSECTIONNEmNOTBEIXMAPLEfEDOFTHEPEWMIS�OHOfJEHU1�OftED00l1Ni5(SiW)OqLESS). PLUMBINCi _ W — Z I CfRTIFV THAT IN THE PERFORMANCE OF THE WOFK FOR WHICH THIS PERMIT IS ISSLIED,1 MECHANICAL C,�} SHALL NGT EMPLOV AN'/PERSON IN ANY MANNER SOAS TO BECOME SUBJE(:T TO THE --' - � WORKERS'COMPENSATION LAWS OF CA�IFOfl�iA,AND AGREE THAT IF 1 SHOt;LD BECOME INS"ECTION FEE ? SUBJECTTO THE WORI(ERS'GOMPENSATION PROVISIONS OF SEGTIOIV 3loa OF THE IABOH — �� , v� — COOE I SHALI FOR�MWITM COMPLY W�THTHOSE PROVISONS. ISSUANCE 0 � . — p DATE: APPLICANT SMIP l j W — 'J WARNING FAILURE TO SECVRE WORKERS'COMPENSATION COVERAGE IS UNIAWFIIL,AND SHALLBE ENERGY P!C J � SUBJECTANEMPLOYEfl70GFIMINALPENALTIESANOCNILFINESUPI'OONEHUNDFEDTMOUSAND ENERGYPERMIT DOLLARS(Sloo,oCa�,IN ADDITIOIV TO THE GOST OF GOMPENSAilOY,�AMAGES AS PFOVIDED FOR IN J SECTION 3]OB OF THE LABOR CI)DE.INTEREST,AN�ATTORNEV'S FEES. 1 cc RETENTION FEE , �,� � OCONSTRUCTION LENDIN6 AGENCY PRE-ALT FEE � _ . _ � � I HEREBV AFFIqM UNOER PENNITV OF PERJURV THATTHEPE IS ACONSiF.JCiiON LeNDING AGEN(:V n- FOF THE PEH�ORMANCE OF THI:WORK FOq WMICH THIS PERM;T IS ISSUE��SEC.3091,CIV.C.). . Z W ? LCNDCil'SNAME _ _ _ - s F- LENOER'SADDPESS � TOTAL FEES ` ��, �'�1 � I CERTIFV THAT I MAVE fiCAO TH S APPLICATION/NO SThTE THAT THE ABOYE INFORMqTION IS CORRECT w I AGflEE TO COMPLY WITH ALL CITV AND COUNTY ORDINANCES AI�'D STATE LAWS RELATING TO 9UIlDING � � CONSTRUCTION,AND HEfiEBY AUTHORRE REPRESENTATNES OFTHIS GOVNTY TO ENiEH UPON TH. Z ABOVc�ME1VTIONED GqOPERTV FOR INSP ' N VURPOSES. COMMENTS � � � _.. _ —'_ J � — — m P ITTEENAME M1l) Q t nT --- —_ �" + ��r_V�j , � SIGNATURE F ERMITTEE f ATE � — � ` RECPT NO. __ \,� PAID BY _ VALIDATION WHI E—Depariment Copy,VELLOW—Finance Copy,PWK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy ..� •�� tlit �` �."!W,��'+ '.4ia� ��s�:�* "`„� �, . �`��.�" �_� � � � � � � �'� � �. . . a a�r � ��. �'i� � r� . "��+�r�a. � . ��a ,� �- - : � � � � � � �. � � �� , _ �� -��,� _ _ _ _ � �. P" C4 n...:' ��vw: e' . . .. .. ..... _... .. 4; �� x�,�ll� k Y t "��'.�` t �g Y G��i. ��i &'.�'� +c,� . j .. .. .. . . ...... . _... _. ... . . . x°�..�'� ��. „�. I�� .. ._ . . ... _... . ... '. ., ; , .... ._ ... ..._... ��»_ � ri . . .. . ... .. . .. ._ . . . . _.. - � 1: =�,�fi 4, ; , .: , � . ,u _ �� (� , _ _ �'�� „ . _ � � ,� �n f , �� .��, �' , �� . ��Po � � _ __ . _� ,� _ ADDRIESS��S(/ APN LOT TRACT OWNER(Ik U�A� 'r�t'M� r4Q- ADDRESS CITY ZIP TE..� APPLICANT TEL. CONTRACTOR ADDRE 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 REQUIRESA PERMIT 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 THEALLEGED EXEMP- TION.ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT.SUBJEC IS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($5w)) ^ I,AS OWNER OF THE PROPERTY. OR MY EMPLOYEES W TH WAGES AS IHEIR SOLE COMPENSATION. WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC. 7044 BIfTI- 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). C 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 3UT.DS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PFIOJECTS WITH A CONTRACTOR(S) 1.ICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW). EI I AM EXEMPT UNDER SEC._B. &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 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORCE AND EFFECT LICENSE C LASS G LIC N0. �V �r -} [)ATE;F-07 CONTRACTOR WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: IyIAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF INSURE FOR WORKERS' /-n_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 IS ISSUED MY WORKS'CO TIO RANCE CARRIER AND POLICY NUMBER ARE CARRIER POLICY NUMBER (THIS SECTION NEED NOT 13E CO IPLETED OF THE PERMIT IS FOR ONE HUMORED DOLLARS(5100)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(5100,000),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 A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC 3097,CIV C.) LENDER'S NAME LENDER'S ADDRESS 1 CERTIFY THAT I HAVE READ TH S APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT I 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 N PURPOSES.AA P ITTEE NAME NT) J�t SIGNATURE ERMITTEE ATE CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION WH-11-E-Department Copy,YELIOW-Finance Copy,PIN PRESS FIRMLY APPLICATI PERMIT P/C DATE NUMBER 11 # S TYPE OCC DATE NST. GROUP ZONING SETBACKS FRONT RW^ REAR^ SIDE/SIDE STREET RW^ SIDE � ��t PROPOSED USE(V b' N0. DWEL. N0. 7 UNITS STORIES I BEDROOMS_ DESCRIPTION S0. FT. FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM CI) Garage/Carport LLI Patio/Deck L LL PooVSpa Z Re-Roof Commercial Ib Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J H W LU m IL Q U Z 2 W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES � L/, COMMENTS \ RECPT N0. ,D PAID BY VALIDATION