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Home My WebLink About18537 (11) �,� CITY OF DIAMOND BAR , �, DEPARTIviENT OF COMMUNTIZ'&DEVELOPIv�NT SERVICES T y � 21825 E.Coptey Drive (909)860-3195 Fax(909)561-3117 , PRESS ��?��» BUILDING PERMIT APPLICATION I FIRMLY 'n JOBSITE � Q ,,,. APPLICA PERMIT � � P/C � AODRESS_ ��J _�� DATE ' NUMBER � tl � — ISSUE TYPE OCC APN LCT TRAC � DATE ° w ,� CQNST. GROUP °C OWNER �� OO ADDRESS_ ZONING SETBACKS Z CITY _ 21P 7E . ` FRONT RW ❑ -- � APPLICANT TEL._____ REAR ❑ _ Z SIDE'S{DE STREET RW_ rl _ � CONTFlACTO SI�E ❑ _ � ADDRE S PROPOSED USE � CITY ZI� TEl/ '' _-tlst_1. w ARCH/ENG! �— ��l�� ; z DESIGNER --- NO.DWEL. . N . a ADDRESS UNITS STORIES _�___ BEDROOMS � CITY ZIP_._ TEL__ � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � Q OWNER-BUILAER OECLARATION SFR/A�CIREM O � I HEAEBV AFF!qM UNDEA FENALTV OF PERJUqV THAT I AM[%EMPT�ROM THE CONTRAGTORS LI Garage/Carport W CENSFL4WFOR7NEFOLLOWINGREASON(SEC.1031.'CVSINESSANDPROFESSIGNS�pDE'.ANVC�TYOR (f� U COVNTVWHICHRE�UIRESAPERMITTOCONSTRVCT,ALTER,IMPROVE,�EAAO�JSH,GFiREPAIRANVSiPUC� W Patio/Deck Z TURE,PRIOR TO ITS ISSUANGI=.AL50 REoI,'IFES THE APPLIGANT FOR SUCH PENMIT TO FI�E A SIGNED w w STATEMENT�MAT XE Oft SME IS UGENSEU PVASUAtlT TO TNE PROV',SIONS OF THE CONTRACTORS L1- � GENSE LAW(CHAPTEF 9�COMMENCING WiTH SECr�pN 1000j OF DIYISION 3 C�F TNE BUSINE55 AN[!Pa0- V' POOUSp3 � FESSIONSCODEIORTHATHEORSHEISE%EMr'TTHFREFPOMANDTHEBASiSFCRiHEALLEGE�E%EMP- � V TION.AhVVIOLATIONOFSECTION7031.5BYAM1YAPF�IGAN'Ff1RAPF.RMITSJ9JECf5-fH'r.APPLICANTTO Z Re-Roo1 _ F A qYIL PENALTV OF NOT MORE THAN FIVF HUNDRED�OLWFS(S50a�)�. � O n�.qSO4MEROFTHEVROPERiV.OR1AVFMGLOYEESW�THWAGESASTkiE'�RSOLECOM�ENSATiO�V, � COTTBtCi81 Z WILL DO TNE WORK,AND THF STRVCTURE IS NOT INTENDED OH OFFERED FON SALE�SEG.]u44,BUSI- J NESS AND PROFESSIONS CADk":THL CONfRACTORS LICENSE LAW DOcS NO�AVPLY TO AN OWNER OF � PROPERTyYh/00VIlOSORIMPFOVESTHEftEON,ANOWHO00ES5VGH'ryORKH'.MSELFOPHEASE'.FOR m � THROUGHHISORMEROWNEMPLOVEES,GROVIDEDTHAT�UCHIMPROVEMENTSARENpTINTF.NDEDOR I W OFFEREDFORSaLE.IF,MOWEVF.R,THEBUILOMGORIMPROVEMEN'ISSOLDW��THINONE�EAaOFCOMPLE � TtON.THc OWNEk�6Ut'��ER W''LL MAVE'ME BURDEN OF Fi'iDVING"HAi HE OR SH[DI�NOT 6�1'�lD OR Z IMPHOVE FOR TME PURPOSE aF SALE). � � ❑I.AS OWNEROF THE PR07ERTY AM EXClUSNEIY CC1N'FIACTING W;TH LICENSED CONTRACTORS W [[ TO CONSTRUCT THE PRQIECT(SEC]oaa BIISINESS AND PROFESSICMJS CODE.TFIE CONTRACTOaS LI- V81t18110f1 ADJ.AREA W CENSELAWDOESNOTAPGLVIOANOWNEROFAVROVERTVWHOdUII.DSfJRIMPROVESTHEfiEON,AND = WHOCONTRACTSFORSUCHOpOJECTSWITNACANTPACTOR(EILICEM1;CDPURSUpNT'OTHECON'FAG QUANTITV DESCRIPTION FEE ~ TORS LICENSE LAW�. — Y J � G 1 AM EXEMPTUNOER SFG 0.fl PC.FOqTH15 REASON U � —_— �— � � DATF __ _ nWNER ____' � W � LICENSED CONTRACTORS DECLARATION W Q � I HEREBV I.FFIRM UNDEA PENAI TV OF PERJUFv THAT I AM LICENSED JNDER PROYiSIONS OF GMAPTER � d 9�COMMENCING WITH GECTIOh 7000�OF D�VISION 3 OF THE BUSINE55 NND PPOFESSiJNS CODE,AND Z _ `X MV UCENSE IS IN FULI FORC-Ary�py�FFECT. m � LICENSE C SS � r 1,��L`� LIC.NO. � IT J V DATE V � _ CONTRACTOR d W � WORKERS COMPENSATION OECLARATION Q — � U � IHEREBYAFFIRMUNDEFPENAITYOFPERJVRYONEOF�HEFOLLOWINGDECIAqAT10N$'. Z Q � I M E AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE�OR WOFKERS' _ �PENSATION.AS GROVIDED BV SECTION 3]oD f]F THE IABOR CODE,FOR THE PERFORMANCE U Q F THE WORK FOR WMI�H THIS PERMI7 IS ISSUED. � 0 w I MAVE AN�WILL MAINTI\IN WORKERS'COMPENSATiON INSURANCE,AS REOUIRED BY SECTION � Q3'OOOF THE LABOR CODE,FORTHE PERFORMANCE OF THE WORK FOR WHICFI THIS PERMIT IS 1 � _ ISSUE�.MY WORK '� SATIO�..(�RANCE�RIEP AND POLICV NUMB[RAPE: CONSTRUCTION _. � �'s � C4RWER �/ � PLAN flEVIEW ____ _ ZaoucvNurasEa, � --- ELECTRIC _ ¢ 0 (THiSSt�TIONYEmNO'fBECOf�APLEfE00FTHEPERMfTISFOFONEHUI�DREDD0.LA{iS(Ef00)ORLE.55} PLUMBING _ . w MECHANICAL Z I CERTIF�THAT MTHF FERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSU[D,I -- — (} SHALL N()T EM�LOV AN��PEFiSON IN ANV MANNER SOAS TO BECOM[SUCJEfT TO THE � WORKERS'COMPENSATION LAW50�CAUfORNIA,qNJ AGFEE THAT IF i SMOUlO OECOME INS:�ECTION FEE _,_ r � SUBJECT TO THE WORKERS'COMPENSATION PROYISiONS OF SECTION 3�UC�OF TME LAdOR ISSUANCE , E'- � CODE,I SHALL FORTHW TM GOMPLY WITM THOSE PRGVISIONS. - � SMIP . ��+�-� p DATE__ __.. 4PPLICANT _ _ ' — w ENERGV P!C '--� WARNING�FAI�URETOSECUREWORKEFS'COM{'ENSATIONCOVEFAGEISUNIAWFUL,ANDSHAILBE J LL SUBJECTANEMPLOVEfiTOC1711AINALPENALTIESANDGIVILFINESUPi00NEHUNDREDTHOUSANU ENERGYPERMIT _ . — OOLUf\5(S�00.000),IN AODIT1011'O'HE COST OF GOMPENSA?'.ON,DAM0.GE5 PS�HOVIOEO FOfl IN � - —' J SECTION])OB OF THE LABOR CC)DE,IN7tNt5i,ANDATiORNEY'S FEES. `' � � RETENTION FEE: . f � �� '— w CONSTRUCTION LENDING AGENCY II pRE-ALT FEE�. d —_ O � i HE0.E8Y AFFIFM 11NDER PENALTY pf GE�JURY THAT THERE�S ACONSTF.UC?IONLENOfNG AGFNGY _ d FOP THE PEHFORMANGE OF iH1=WORK FOR WHICH THIS�ERMIT��S ISSUE��SEG.309],GI'✓C.�. Z W = LEN�EN'SNAME _` __--�—� � F- LEN�ER'SADOFE55 -- -- I ¢ I CEaTIFV tNAT i HAVE FEAO THIS APPLICATION AN�STATE ih1AT THE ABOVE INFpqMATIJN i5 f.l]RREGT. TOTAL FEES L�`�� l� w I AG�EE TO COMP�V WITH ALL CITV AI:D CO�NTv ORDINNNCES AND STATE LAWS HELAiING T0 9UILOING � CONSTRUCTION.AND�IEREBY AJTHOaIZE REPRESENTATNES�F THIS COUNTV TO ENTER UVUN THE ZA60VE-ME�TIONEDGROPERTY'-OR�t� EGTIOfiPlRPOSES. GOMMENTS � �J __ � . _' _-- m PEFM E E(PRi � ¢ —___-- — —_ (/) _ "'_'—" __ � . ^ ..._-_ � sicNan�ae o=a`E Min . ,� °ATE � RECPT NO. f � PAID BY � '" VALIDATIO� _ — — ~ WHITE—Department Copy.YELLOW—Flnancc Copy.PINK—Assessor Copy,GOLOENRO�File Copy,GREEN—Applicant's GOpy � � ��i� � ��a �,a �� _ � : r. R � _ � k , vf � n _ � g . � . �. �B � w �� ` � �� .,a.,. � �°��,�.,��eh��,� ,��°� � � �� ; � / :� ��G/ � `� ��/� _ , , f ' _ _ � „��.. �;;;� ,, _ a r�� " �� _ _. � �:�b}x�. _ _. __ _ '; _ __ _ _ �. � � �,,., �., ,,,�.� _ . _ _. _ �,� � � � � , � P,� € ,�,��. . . . � � . =y t �'Q� , : .,. _ . . . . . .. .. ... _ .. ._. ..._.. .... .. _.. _.. . .-.- . �� °i }f.a �s�Y ..� ; . ... ..._.. . ..... ....... ... � � : �. �, e��" ... . . . . . . . . . .. - ." ". _ £4e i _ s, 1 ., f. . , ; �� _ _ �� _ � �� ,�; �4; : . , �� _ _ _ _ � 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 F ADDRESS- APN LOT TRACT OWNER ADDRESS CITY ZIP TE, APPLICANT TEL. CONTRALTO ADDRE S CITY ZIP TEtj I""It 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,OR REPAIR ANY STRUC. TURF, 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 THERE FROM AND THE BASIS FOR THE ALLEGED EXEMP- TION.ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SURJEC TS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($5W)) ^ I,AS OWNER OFTHE PROPERTY,OR MY EMPLOYEES WITH WAGES AS IHEIR 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 CONSTRUCTTHE PROJECT(SEC. 7044, BUSINESS AND PROFESSIONS CODE.THE CONTRACTORS LI- CENSE LAW DOES NOTAPPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S11.ICENSED PURSUANT 10 THE CONTRAC- TORS LICENSE LAW). C I AM EXEMPT UNDER SEC. B.&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 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORC A FFECT r G 7A V LICENSE C SS LIC N0, DATE CONTRACTOR WORKERS'COMPENSATION DECLARATION I HEREBYAFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS I H E AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF.INSURE FOR WORKERS' MPENSATION.AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE F THE WORK FOR WHICH THIS PERMIT IS ISSUED. -VI 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 WORK SATIO F RANCE C,�4RRIER AND POLICY NUMBER ARE �rI(J �1/�II CARRIER � POLICY NUMBER � •_.(II�J'--�0 (THIS SECTION NEED NOT 13E 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 AN" PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS'COMPENSATION LAWS OF CALIFORNIA,ANO AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE,I SHALL FORTHW TH 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 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 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 AJTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE MENTIONED PROPERTY FOR IPA ECTION PURPOSES. PERM E E(PRI SIGNAiUREOF PE MITT i DATE APPLICA PERMIT+ P/C DATE J NUMBER ISSUE TYPE OCC w DATE° CONST GROUP ZONING SETBACKS FRONT RW^ REAR F 1 SIDE/SIDE STREET RW^ SIDE^ PROPOSED USE III)n N0. DWEL. N UNITS 4 STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION 4 SFR/ADD/REM W Garage/Carport W Patio/Deck t LL PooVSpa 0 Re-Root Z Commercial m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U U w W Z EQ IL Q U z Q 2 U W 15C� J s- CONSTRUCTION .� PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES COMMENTS RECPT. N05PAID BY TI)VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy 7