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Home My WebLink About18541 (11) � l '. CITY OF DIAMOND BAR � ��'(C`�.' \ ��` DEPARTME'�T'T OF COMMUNI"fY&bEVELOPMENT SERVICES I 21825 E.Copley Drive (909)860-3195 Fa�c(909)861-31 l7 PRESS `-�� BUILDING PERMIT APPLICATION FIRMLY � J08SITE � � � APPLICATI PERMIT � P/C o ADDRESS� � DATE NUMBER_ ��Z�� # °r APN LOT TRACT DATE 1 � �' L_t�ONST. GROUP °C OWNER �� _�_�- O p ADDRESS ZONING SETBACKS Z CITY ZIP 7E . �' FRONT q�n/ _ � APPLICANT TEL._ REAR r zSIDE/SIDE STREET RW C Q CONTRACT SIDE � ADDRESS � CITY ZIP TE^/�� PROPOSED USE � oARCH/ENG/ LL`^7v� z DESIGNER_ w -- NO.DWEL. NO. a ADDRESS - N� .Q.. � CITY ZIP TEL. UNITS STORIES F BEDROOMS �� cn -- - � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION � SFWADD/P.EM Q I HEREBV AF�IRM UNDEF PENA�TV OF PEfiJURV T71AT I AM F%EMPT FROM THE CONTRACTORS LI- G8f8JB/C2IpOfI W CENSEUWFORTHEFOIIOWINGREA50N(SEC.�031.5BUSINESSANDVAOFESSIONSCODEANYCITVOR (n U GOUNTYWHICMREOUIRESFVEFMITTOCONSTRUCT,pLTER,IMaROVE.DEMOLISH,CRREPAIRANViTRUC� w TUflE.PRIOR TO ITS ISSUANCE,ALSO RE�UIRES THE APPLICANT FOR SUCH PERMI(TO FlLE A SIGNED w PeliO/DBCk � STATEMENT THAT HE OR SHE IS LICENSeD PURSUA�lT TO THE PFOVISIONS OF THE CON'RAC7oR5 LI� � CENSE LAW(CMA7TER 9(COMMENCMG WITH SECTION 7000)OF�IVISION 3(1F THE BUSINESS AN�Pq0- LL POOI/Sp8 O FESSIONSCODE�ORTHATHEDRSNEISEXEMPTTHER�FROMANDTMEBASISFORTHEALLEGEDE%EMV- (� V TION.ANVVIOLATIONOFSECTION]031.SBYANVAPPLICAN,-FORAPEPMITSU9JEG(SfHFAPPLIGANTTO Z Re-Roof 5(�� A CIVIL PENALTV OF NOT MORE THAN FlVE HUNDRED DOLURS(35o0j): � ❑I.ASOWNEROFTHEPROPERiV,ORMVEMPLOYEESWiTHWqGE5ASIMEIR50LECOMPENSATiON, O Commercial Z WILL DO THE WORK,NN�THE STRUCTURE IS NOT IN i END[D OR OFFERED FOH SPLE(SEC.]Odb.BU�I� J � NE55 AND FROFESSIONS CO�E:TME GONTRACTORS LICENSE LAW GOcS NO�A7PLY TO AN OWUEF OF ? PROPEFTY WHO BUILDS OR IM VROVES TMEREON,AND WHO DOES SUCH WORK HIMSELF OR HEHSELF OR Q THROUGH HIS OR HER OWN EMPLOYEES.PROVIDED THAT SUCH iMPROVEMENTSARE NOT INTENDEDOR m � OFFERE�FOqSALE.IF,MOWEVER,THEBUILDINGOPIMPROVEMEN'ISSOLDWITMINONEYEAROFCOMPIf- Z TION.THE OWNER�BUILDER WILL MAVE THE BURDEN OF GROV�NG�HA1 NE OR SHE DIO hOT BUILD OH � IMPROVEFORTNEPURPoSEOFSALE). W C I,ASOWNEflOF THE VROPERTV AM EXCLUSIVELYC(�NTRACTING WI'�H LICENSE�CONTRACTORS � TO CONSTRUCT iHE PFOJECT(SEC.)oaC,BUSINESS AND PROFESSIUNS CODE:THF CONTRACTORS ll- ValUBIlOf1 � AOJ.AREA W CENSEUWDOESNOTAPPIYTOANONRJEROFAFROPERTVWNOdUII.fJ50FIMVROVESTHEREON,AND -- F WI-IOCONTi1ACT5FORSUCHPROJECTSWITMACONTRAGTOR(S11.ILEhSEDPURSUANTTOTHECONTRNG OUANTITY DESCRIPTION FEE Y TORS LIGENSE LAW). Q ❑I AM EXEMPT UN�ER SFC. B.8 P.C.FOR THIS FEASON Q � U � � DATE OWNER 1- � Z — -- U � LICENSED CONTRACTORS DECLARATION w ¢ � I HEREBVAFFlRM UNDER PENA�TV Of PERJUR�'MAT I NM LIGENSED UNDER PROVISIONS OFGHAP7EH � d 9(GOMMENCWGWITHSEGTION]o00�OFDiVI510N3(/FTMEBUSINESSFNDPF?OFESSiONSCODE,AND Z `X MV LIGENSE IS IN FULI FORC AND EFFECT /J � � I � LICENSE C SS � - �G _ LIC.NO. / ^ � ~ DATE CONTFACTO � d C.J w � WORKERS'COMPENSATION DECLARATION Q � IHEREBVAFFIRMUNDEF?ENALTVOFPERJUR�ONEOFTHEFOLLOWINGDECLARATIONS�. z ZI HAVc'AND WILL MAINTAIN ACERTIFICATE OF CONSENT i0 SELF�INSURE FOR WORKERS' ¢ Q $%CMPENSATION,AS PROVIDED BY SECTION 3]oa OF THE IABOR CODE,FOR THE PERFORMANGE U �OFTNE WORK FOR WH'�CH THIS PEfiMIT IS ISSUED. W � ;� � F �L HAV�AND K'ILL MAINTA�N WORKERS'COMPENSATION INSUPANCE,AS RFOLIIRED BV SECTIDN ,"�. . Q310a OF THE LABOk CODE,FOR THE PER:ORMANCE OF THE WORK FOR WHICH THIS VERMIT IS � ISSUEO.MVWO 'C M NSATI SUFAN CARRIERAN�POLICVNUMBERARE�. CONSTRUCTION d � ,�� J j cARPiER__ _ PLAN REVIEW o �oucvNUMeca � — - ELECTRIC ¢ � (�FIISSECTKXJNEmNOTBE00MPLETEDOFTHEPERAYTISFOFONEHUI�OREDDOLlARS(E1Lo�04it.F55� PLUMBING W Z 1 CEFITIFV THAT IN iHE°ERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I MECHANICAL C3 SFIALL NGT EMPLOV ANV PEii50N IN ANV MANNER 50 AS TO BECOME SUBJE�TTOIHE � WORKERS'COMPENSNTION LAWS OF CAIIFOFNIA,AhD AGREE THAT IF i SHOULD BEGOME INS�ECTIOi'J FEE j SUBJECTTO THE WORKEFS'COMPENSAiION PqOVI510N5 OF SEGTION 3i00 OF iME LA80R -- �-- - CODE.I SHALL FORIHWRH COMPLV WiTHTNOSE PROVI510N5. ISSUANCE _ __ ��._� `.��.., � p []ATE: APPLICANT: SMIP _ � li W J WAFNING�.FAILURE TO SECURE WORKERS'GOMPENSATION COVERAGE IS UNLAWFUL,AN�SHALL BE ENERGY P1C . . � SUBJEGTANEMP�OYERTOGRIMINALPENALTIESNN�CIVIlFlNESUPIOONEHUNDRED7HOU5AN0 ENERGYPERMIT DOLLARS(3100 000�,IN A�f]ITION TO THE GOST OF COMPENSATION,�AMAGES AS PROVIDED FOP IN J SECTION3]OBOFT4ELABOftCODE,MTEREST,ANDAT�'ORNEV'SFEES. ¢ RETENTION FEE: �� i%J OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: _ � � � IHEREBVAFFIRMUNDERPENALTVOFPEFJUR�THATTHEREISACON.)TF'JCTIONLEN�INGAGENG� � � FOR'ME PERFORMANGE OF THE WOFN FOii WHICN THIS PERMIT IS ISSUEC(StC.]09],C'�V.C.). - Z W � LENDEH'SNqME _ F- LENDER'SADDRESS � —__--- - _ ___— — TOTAL FEES � �l_�, �� ICERTI:VTNATIHAVEREADTHISAPPLICATIONHNDSTATETHATTMEABOVEINFORMATIONiSGORRECT w I AGREE TO COMPLV WITH ALL CITY ANO GOUNTV ORDINANGESAN�STPTE UWS PELATING TO ESUILDING � GONSTRUCTION,ANDMEREBVAU1HOflIZ �PRESEN�AINESOFIHISGOUNTVT�ENTERUPUNTHE Z AtlOVE�ME E�PROPEftTVFOR CTONPURPOSES. GOMMENTS � — __'__.__ J � _ m PERMITTEE M1AM Q � � oX ,��------ vj SiGN4TLi:iEO�PEN EE �PTE _ � • RECPT.NO. � � �"'` PAID BY " VALIDATION ~ WHITE-De aAment Co YELI.OW--Finance Co PINK-Assessor Co GOLDENROP-File Co GFEEN-A lican['s Co P PY, PR PY� PY. PP PY � ' ��1� �,< a �� e: �� , �,. < . �. . �� , ,—_ � .�'€�� _ ��_`� '' �. � � � . . ; � a �, �� A # ��m � - � ,��.� � . � � r , ��`�,. .. �� . � .,r� . ,,�„� ,. _ _ a�� i��m,.,. � � � ��$ �� " _ �� _ . _ _ . 1 a 4 •,w �a� .. _ _ _ � i < _ __. ��r� � � s� e� '� :�� +r � i �_ ra �. . .. . .. . �: �.,.��, . . . . . . .... . . .... __.. ..__ _..._ }�4 - ' ., ��i, � '� ' . .._.. �^�, " � - _. . . .._ ......._. . ..... . �.� , ., �I�`irc ' . ... . ... . . .. ... . . ... .. .. . �.,� .al. t � � � .. . ....... a A ; �,.' � "� . . ��.� ... .. . . . . . .. . ._.. .. ..... ....._ ._.. I �" w . ... . . .. _.._ ....... ...... ... , ,. .. . .. ... ._ .. . . _. . ;g �.� r . .... ... . . ... ... .. . ... � x ,� � . .. . .. ... ... ... . ... . ... . . .. . . y.R . "c,.' .. . ��, ,� ��_�` ,�.: � r� � _ _ DIAMOND BA1R CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION JOBSITE C ADDRESS( APN LOT TRACT OWNER �y��.k ADDRESS CITY ZIP TE APPLICANT TEL CONTRACT ADDRESS CITY ZIP" TEL/ r 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,OR REPAIR ANY STRUC. TORE. 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(5500)) ^ 1,AS OWNER OF THE PROPERTY,OR MY EMPLOYEES WITH WAGES AS 1HEIR 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 THAI HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). C I,AS OWNER OF THE PROPERTY AM EXCLUSIVELY CONTRACTlNG W!TH 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 B'JII OS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW) . ^ I AM EXEMPT UNDER SEC. B&PC FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM LINDER 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 F ORC AND EFFECT FO 5 C LICENSE LIC N0. V DATE CONTRACTO WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM LINDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS I HAVE 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 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 WO'C M NSATI SURAN'CARRIER AND POLICY NUMBER ARE CARRIER POLICY NUMBER' (THIS SECTION NEED NOT BE COMPLETED OF THE PERMIT IS FOR ONE HUI'DRED 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 15 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 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 PERFOR MANGE OF THE WOFK FOR WHICH THIS PERMIT IS ISSIJED(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 AUTHORIZ PRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-ME ED PROPERTY FOR ECT ON PURPOSES. PERMI TTEE NAM//��((55 ��r SIGNATURE OAPEH EE DATE WHITE-Department Copy,YELLOW-Finance Copy, PIN PRESS FIRMLY APPLICATI PERMIT I -&I P/C DATE NUMBER 1 }# ISSUE TYPE OCC DATE CONST GROUP ZONING SETBACKS FRONT RW REAR SIDE/SIDE STREET RW^ SIDE^ PROPOSED USE N0. DWEL. N0. ! N0. UNITS STORIES F BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM Garage/Carport U) w Patio/Deck PooVSpa Z Re-Roof SL"V Commercial D m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U H U w w (3 Z LD 0 Z 2 Lij 1 :3& CONSTRUCTION I PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP-t' ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE TOTAL FEES COMMENTS RECPT. N0. PAID BY"VALIDATION