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Home My WebLink About18538 �,� CITY OF DIAMOND BAR � DFPARTME�'T OF COMMiJNPfY&DEVELOPMENT SERVICES 21825 E.Copley Drive T (909)&60-3195 Fatc(909)861-3117 � PR ESS � �+� BUILDING PERMIT APPLICATION (�,,�, FIRMLY JOBSITE � ��__� i ��}} APPLICAT PERMIT �P/C o ADDRESS� �_ ' '�� ' - DATE NUMBER '�✓ ) � � APN LOT TRA,��T —� � DATE I � �� '� CONST. GROUP p OWNER �jy_YV�,J�(��I�(JiU �m�,��— p ADDRESS y ZONING SETBACKS Z CITY ZIP 7E � 1 FRONT qyy U � APPLICANT TEL._ REAR r� ¢ SIDE/SIDE STREET RW �� _ Q CONTRACTO _ SIDE _ ADDRE � � ✓ �p � CITY ZIP TEI�.��I�� PROPOSED US lJ � w ARCH/ENG! /� � 7 �- zDESIGNER /"�� NO.DWEL. � ADDRESS � UNITS STORIES � B DROOMS � CITY ZIP__ TFL-- — � DESCRIPTION SO.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION p SFR/ADD/REM Q I MEflEBV AFFIRM UNDER PENALTV OF PEFJURV THAT i AM E%EMPi FROM THE CONTRACTOqS LI- G8fd9B�C0fP0lI W GENSEUWFORTHEFOLLOWINGREASON(SEG.1031.58U5ME55ANDFqOFES510N5CODE:ANYC1iYOF (n U COUNTYWHICHREQUIRESAPERMIT'OCONSTRUCT,AITER,IMPPCIVE,DEMOUSH,GRREPAIFANVi?RUC- W TURE,PRIOR TO ITS ISSUANCF.AlSO REOUIRES iHE APPLICANT fOR SUCH PERMIT TO FILE A SIGNFD w PetlO/DBCk rL STATEMENT TNAT HE OR SHE IS LICENSE�PURSUAflT TO THE PPOVISIONS OF THE CONTRACTORS LI- .� CENSE LAW(CHAPTER 9(COMMENGMG WITH SFCTION]000)OF�IVISION 3 ClF T4E BUSINESS ANO PRO- � POOUSP2 O FESSIONSCqDE)OHTHATHEGRSHEISE%EMPTTHEREFROMAND7HEBASISFORTHEAL�EGEDEXEMP- � U TION.ANVVIOLATIONOFSECTIDN7031.SBYAN�APPLICAN'FORAPERMRSJ9JECf5"fHFAPPLICANTTO Z Re-Roof A CNIL PENALTV OF NOT MORE THAN FlVE HUNORED�OLIAflS(f500j.)�. Z~ ❑I,ASOWNEflOFTHEPROPERTYORMYEMPLOVEESWITHWAGE5A57HEIR50LECOMPENSATiON, � CORlffl�lCi31 WILL DO TME WORK,AND THE',iTRUCTURE IS NOT IN i ENOL�OP OFFERED FOH SALE(SEC.7044,BUFI- _f � NESS AN�PROFESSIONS CODI::THE CONTRACTORS LICENSE UW DOcS NO,-APFLY TO AN OWNER OF � PROPERTV WHO BUILDS OR IMi'ROVESTHER'cON,AND WHO DOES Sl1CH WORK HIMSELF Oq HERSELFOR Q THROUGHMISORHEROWNEMPLOYEES,GROVIDEOTMATSUCHIMPROVEMENTSARENOT��.NTENDEOOR C� QOFFEREDFORSPLE.IF.HOWEVE:R,THEBUIL�INGORIMPROVEMEMI.SSOL7WRHINONEVEAROFCOMPLE� Z TION,THE OWNE(i-BUILDER WILL HAVE THE BURDEN OF PROVING�HAT HE OR SHE 010 NOT BUILD OR � IMPROVEFORTHEPURPOSEOFSALE). �y,� ❑I.ASOYMEROFTHEPROPERTV.AME%CLUSNELYCCINTRFCTINGW'THLICENSEDCONTRACTORS � TO CANSTRUCT THE PROJECT(SEC.]O6a,BUSINESS AND PROFESSIONS fODE:TME CON"RAGTOqS LI� V8IU8�IDf1 _ � ADJ.AREA W CENSELAWDOESNOTAPP�YTOANOWNEROFAPROPERTVWHOd'JII.fJ50FIMPROVE57HEHEON,ANO - � WHOCANTRAGTSFORSUCHPFIOJEGTSWITHACONTRACTOR(SII.IGENJ'CDPUHSUANTIOTHECONTRAG QUANTITV DESCRIPTION FEE Y TORS LICENSE LAW). � CiIAME%EMPTUN�ERSFC. _._.. .._ __ 8.8PC.FORTHISREASON Q � U � — CL — DATE OWNER F' Z — _—_—__ U � LICENSED CONTRACTORS DECLARATION W Q � I HEREBY FFFIRM UNDEH PENAI TY OF PERJURY THAT I AM IIGENSED UN�EF PROV1510N5 OF CHAPTER � d 9(COMMENCING WITH SECTIO�7000)OF DIVISpN 3 OF THE BUSINE55 AND PPOFESS�i�NS CODE,ANO z `X MY LICENSE IS M FULL FOPCE A EFFECT. m � LICENSE C V LIC.NO. V � ' V �ATE O F GONTRAGTOR � W � WORKERS'COMPENSATION DECIAFiATION Q {I � I HEREBYAFFIRM UNDER r�ENAI_TY OF PEi3JURV ONE OF THE FOLLOWING DECIARATIONS: Z I � —)IMAVE.4NDWILLMAINT,4INACEHTIFICATEOFCONSENTiOSE��-INSUREFORWOflKERS' ¢ � Z = Q �COMPENSATION,AS FRJVIDED BV SEGTION 3]OOnF THE LABOfl CODE.FOfl TME PERFORMANCE U �., Q OF TME WOHK iOF WMICH THIS PERMIT IS ISSUED. � w I HAVE ANn WII L I�AAINT4IN WORKERS'COMPENSATION INSURANCE,AS RFOUIRED 8V SECTION ^� Q3]0o OF TME LABOR CODE,FOF THE PEF�ORMANCE OF THE WORK FOR WHICHTHIS PERMIT IS - , J i55UEC.MY WORKE 'COMPENSA I. ANCE A AND POUGY NUMBEF ARE: CONSTFIUCTION + J — _�� j cnAaiea , I /� PLAN REVIEW ZroucvNUMeea '�` ___ ELECTRIC Q — � (1}iISSECTIONNEEDNOTAE00MRFTEDOFTNEPER/M15FOFONEHIMDRED�OLLARS(51W)ORLESS�. PLUMBING W Z I CERTIFV THAT IN iHE PERFORMANCE Of THE WORK FOR WHICN THIS PERMIT IS ISSUED.1 MECHANICAL ('J SHALL NOT EMP�OY ANY PERSON IN ANY MANNER 50 HS TO BECOME SUBJEf,T TO TME - [/) WORKERS'COMPENSAI ION LAWS OF GALIFORNIA,ANLJ qGREE iNAf IF�SHOVLD 6EGOME INS.'�ECTION FEE � SUBJEGT TO THE WORM:ERS'COMPENSATION PROVISIONS OF SECTION 3]OOOF THE IABOR -- �_��{ - CODE.I SHALL FORTHN'ITH COMPLY WITN THOSE PROVISIONS. ISSUANCE �,J. ) `��/ � SMIP — p OA7E:_ APPIICANT: __ ,�,,l.v_ W J WAPNING:iAI�URE TO SEGURE WORKERS'COMPENSATION COVtHAGE IS UNLAWFUI,AND SHALL BE ENERGY P/C __ � SUBJEGTANEMPLOVERTOCRIMINALPENALTIESANOCIVILFlNESUP100NEHUNDREDTHOUSANO ENERGYPERMIT } OOLLARS(S1Do.o0o1,INAD0ITIONTOTHECOSTOFCOMPENSAtION,OAMAGESASPROVIDEDFOPIN _ ..._ J SECTION3I080FTHELABORCJDE.MTEREST.ANDATTORNEV'SFEES. � �g p� RETENTION FEE: f� 1, � d G�NSTRUCTION LENDING AGENCY PRE-AlT FEE: - � p _— Q I HENEEivAFFiHM UN�EF PENAI_TV OF PEFJUF�THAT THERE IS ACONSTPUCTION LEN�INC.AGENC;� � VOH'ME PEHFORMANCE OF THE WOP,N FOR WHICH THIS PERMIT IS ISSUEC(SEC.30W,CIV C.). — W S LENDEH'SNAME � —""_ _ .— — -- F— LENDER'SADDRE55 � � ��j � I� � IGEFTIFYTHATIMAVEREADTHISHPPLIGATIONFNDSTATETMATTMEABOVEINFORMATIONiSGORRt(;I. TOTAL FEES �' � w I AGREE TO GOMPLY WITM ALL(:ITY nND COUNTY ORDINANCESANO STFTE LAWS RELATING TO BUILOING 1 Q_ � CONSTRUGTION,ANDHEREBVNt;THORIZEREPRESENTATNE50FTHI5COUNTVT�ENTERUPUNTHE Z AeOVE� ONED PROPERTv FOR IN CTION PURPOSES. � . GOMMENTS ___ J � m PERMITT M1AME(PR � ��(�y Q (//{`��// —_' � SIGNAT�iREOFVER ITTFE DATE `� — = RECPT NO. _ PAID BY VALIDATION__ . _��_ ~ WHITE—De atlment Co VELLOW—Finance Co PINK—Assesso�Co GOLDENROD—File Copy,GFEEN—Applicant's Copy P PY. PY, PY• ., . . . � �.,'.�2 ' °;�.'�'i�,.xr��,a�."!v wn�'�s � �' � r _, '��w � .. .. � . . _��. . . . . .�,,_ � ..� . A� � � � �� - .. � . . . � ��'" ''��NE � P�.�.g �,�^"'.a� � � � �� V��iJi� � . . ,. . . . . . . _. .. .. .. _. ��. 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' ,�+` . l _ ��, i .. .... ... .. ... . . .. .. ... .... .. . . .� r �S 5n I ��„ _..�� * ..... . .. . �. .._. _.. . . . ... .. .. . _. ; CITY OF DIAMOND BAR DFPARTME�IT OF COIvIIvIUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION JOBSITE/�„ � ADDRESS w� � APN LOT TRA T_ OWNER Cj„_��(��(JflJ a� ADDRESS CITY ZIP TE APPLICANT TEL. CONTRALTO ADORE _ ^'-/ CITY ZIP TE� ARCH/ENG/ DESIGNER ADDRESS CITY ZIP_TFL._ OWNER-BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM E%EMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE: ANV CITY OF COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT,ALTER,IMPROVE,DEMOLISH,OR REPAIR ANV 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 C'gDE)OR THAT HE OR SHE IS E%EMPT THERE FROM AND 7HE BASIS FOR THE ALLEGED E%EMP- TION.ANV VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT.SUBJEC f S'f HF APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(5500).). u I,AS OWNER OF THE PROPERtt,OR MV EMPLOYEES WITH WAGES AS 7HEIP SOLE COMPENSATION, WILL DO THE WORK,AND THE STRUCTURE IS NOT IN i ENDED OR OFFERED FOH SALE;SEC. 7044, BUSI- NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE UW 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 NAVE 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 E%CLUSIV ELV CONTRACTlNG Wii H 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 a'JII.DS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PFIOJECTS W ITH A CONTRACTOR(SI I.ICENSCD PURSUANT TO THE CONTRAC- TORS LICENSE LAW). Ci I AM E%EMPT UNDER SEC. B. 8 PC. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENAI TY OF PE RJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PPOFESSIONS CODE,AND MY LICENSE IS IN FULL FORCE A EFFECT. f /� �� LICENSE C� LIC. N0.V DATE 4r CONTRACTOR WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: 1 HAVE AND WILL MAINT,41N ACERTIFICATE OF CONSENTTO SELF-INSURE FOR WORKERS' COMPENSATION,AS PROVIDED BV 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 BV SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MV WORKE'COMPENSA ly$yq CE ARp�i AND POLICY NUMBER ARE: I ) CARRIER T \^'/ I POLICY NUMBER (i}il5 SECTION NEm NOT BE ODMPLETED OF THE PERMIT IS FOF(N9E HIMDRED DDLI.4RS(fl W)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 1 SHOULD BECOME SUBJECT TO THE WORMERS'COMPENSATION PROVISIONS OF SECTION 37000E THE LABOR CODE.I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE: -APPLICANT: WARNING: FAIWRE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP 10 ONE HUNDRED THOUSAND DOLLARS(5100,000),IN ADDITION TO THE COST OF COMPENSATION DAMAGES AS PROVIDED FOP IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. CONSTRUCTlON LENDING AGENCY I HEREBY AFFIRM UNDER PENAI N OF PERJURY THAT THERE IS ACONSTR'JCTION LENDING AG ENCV FOR THE PEH FORMANCE OF THE WOP,K FOR WHICH THIS PERMIT IS ISSIJED(SEC. 3091,CIV C.). 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 CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION,AND HERERV AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE ONED PROPERTY FOR IN CTION PURPOSES. PERMITT NAME(PR I SIGNATURE OF VER ITTEE AT D E WHITE-Department Copy,YELLOW-Finance Copy, PIN �r�G�a �r�off, �. PRESS FIRMLY