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Home My WebLink About18542 �� CITY OF DIAMOND BAR � �� DEPART]v1ENT OF COMMUNTIY&bEVELOPMENT SERVICES 21825 E.Copley Drive '� (909)&60-3195 Fax(909)86i-3117 J - ' PRESS �-�.� w BUILDING PERMIT APPLICATION � (, FIRMLY � JOBSITE �/►„�� 1 e/=5�� uy � DATEICATI NUMB R d�'�i��/C Q ADORESS_tx� PJ � o ISSUE y^ TYPE OCC °O APN LOT��;�,�T,R,�A1C�T, ��('�' DATE � ' � ` �� "� CONST. GROUP p OWNER '�{�,LI� `Lf�'-�—i 1-I� ADDRESS ZONING SETBACKS Z CITY ZIP T ' '� FRONT RW fl REAR 17 o APPUCANT T�— SIDE/SIDE STREET RW ❑ _ m CONTRACT SIDE ❑ � ADDRE I�A Y� tl'�"�LJ'S ��. B o CITY �� ZIP�_ TE��r._�„f/i, PROPOSED USE 4 w ARCH 1/�J' "l<�'✓ C`f1U-r � z DESIGNER��/T'L __- _ _ w —T--�— NO.DWEL. NO. NO. � � a ADDRESS_ UNITS STORIES � BEDROOMS � CITY ZIP_._ TEL.__ � DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION cn � 1>WNER-BUILDER DECLARATION SFR/ADD/REM O p I MERE9V AFFIRM UNDER PENALTV OF FERJURY'HAT I AM E%EMPT FFOM THE CONTRACTORS LI- G3f3g0/CflfpOlt W CENSEUWFORTHEFOLLOWINGREASON(SEC.]0915BUSMESSANDPROFESSIONSCO�E:ANYCITYDR (n ZCOUNTVWHICHREOUIRESAPERMITTOCONSTFUCT,AITER,IMPROVE�EMOLISH,CPREPAIPANVSiqU(:- LLf PatiolDeck w TURE.PRIOR TO ITS ISSUANCE,ALSO REOL114iES THE APPIICAM FOR SUCH PERMIT TO FLE A SIGNED w � STATEMENT THAT HE Oii SHE li LICENSED PURSUANT TO THE PilOVISIONS OF THE CONTRACTORS LI- .� CENSE LAW(GHAPTER 9(COMMENCING WITM SECTION]000)OF DIVISION 3 CF THE BUSINESS AND PRO� � POOUSPB O FESSIONSCODE)OfliHATHEOF5HE15E%EMPTTM�REFROMANJTHEBASiSFORTHEALLEGEDEXEMM- � U TION.ANVVIOLATIONOFSECTION7031.SBVANYAPVUGFNiFORAPEHMIT5u9JEG�5fHFAPPLIGANTTO Z Re-Roai vTTJ I � ACIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLURS�SSaD))'. , � ❑I,ASOWNEFOFTHEPROPERTY.ORMVEMPLOYEESWITHWAGESASiHEIRSOLECOMPENSAT�ON, � COmmBfCial Z WILL'JO THE WORK,AND TNE STRUCTURE IS NOT INTENO[D OP OFFERED FOH SALE!SEC.7044.BU�I� J NESS AND PPOFESSIONS CODF::THE CONTRACTOFS L�CENSE LAW GO'eS NO'AVPLY T:]AN OWNFR OF � PROPERTVWHOBUILDSORIMPROVESTNEREGN,ANDNMOOOESSUCHWORKNIMSELFORHERSELFOR � � THROUOM HIS OR HER OWN EMPIOVEES,PROYIDE�TMAT£VCH IMPROVEMENTS AqE NOT WTENDED OR m W OFFEREDFORSALE.IF,HOWEVERTHEBUILDINOORIMP90VEMEN`ISSOLDWITHII:ONEVEAROfCOMPLE- � TION,TME OWNER-BUILDER W111 MAVE THE BVRDEN OF PROVING:HA7 HE OR SHE DIO NOT BUILD OH Z IMPROVE FOR THE Pl1RPO5E OF SALE). � = 71.ASOWNEROFTHEPROPERN,AMEXCWSNELVGCINTRACTINGWIiHLIGENSE�CONTRACTORS W [L TO CANSTRUCT THE PRQIECT(SEC.7046,BUSINESS AN'J PROFESSIONS CODF:THF CONTRACTORS LI- V81U2f1Of1 ADJ.AREA W CENSE LAW DOES NOTAPPLVT�AN OWNER OF A PROPERTY WHO dUII.DS OR IMPPOVES THEREON,AND F WNOCONTRACTSFORSUCHPFIOJECTSWITHACONTRACTOR�SILICENS[DPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION FEE TORS LICENSE lAW). Y J � ❑I AM EXEMPT 11NDER SEC. B.8 P.C.FOR THIS REASON Q � -- � � � OATE _ OWNER U � LIGENSED GONTRACTORS DECLARATION W Q 2 I HEREBV AFFIRM UNDER PENA_TV OF PERJl1RV THAT IAM LICENSED tJNDER PRGVISIONS OF CHAPTEF �r d 9(COMMENCING WITH SECTION]000)OF DIVISION 30F THE BUSINESSAND PPOFESS�iONS CODE,AVD z X MY UCENSE IS M FUIL FORCE AND EFf ECT /^/'�C� 5 m � LICENSE CLAS Cl�) C �IC.NC. .�{S�_SLJ 1 �! � � 7 J V DATE �/ CON7RACTOR�j�f . a W [� WORISERS'COMPENSATION DEGLARATION Q = U � I HEREBY AFFIRM UNDER PENALTV OF PERJURV ONE OFTHE FOLIOWMG DECLAFATIONS: � Z Q 0 IHAVEAN�WILLMAINIAINACEFTIFICATEOFCONSENT-05ELF�INSUilEFORWOFKERS' _ �OMPENSATION.AS GFOVIDEO BV SECTION 3700 nF TNE IABOR CO�E,FOF THE PERFORMANCE CJ Q �OFTHEWORKFOfiWHICHTHISVERMITISI55UED. � � Z / w 1L�HAVE NND WIILMAINIAIN WORKERS'COMPENSATION INSUPANCE,AS RF.QUIRED BV SECTION O ]7000F THE LABOFi GOOE,FOft THE PEFFORMANCE OF THE WORN FOR'NHIGM TMIS PERM'�T IS f ISSUED.MY WORKERS'COMPENSATI N INSURANCE CARRIER AND POLICV NUMBER AFE CONSTRUCTION I �. i ��.� � �J � PLAN REVIEW CARRIER__� — �. � POLICY NUMBER__ � —_ ELECTRIC ¢ (iH155ECT1JNNEmNOlBECbMPLErEDOFTHEPERMITISFOFONEI-�UI�DRC�D�LLJ375(E10010flLES5). PLUMBING _ 0 w MECHANICAL Z I CERTIFV THAT M THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I — (,�} SMAl1.NOT EMPLOVANV PERSON IN ANY MANNER 50 AS TO BECOME SUBJE�T TOTHE INS�EGTION FEE WORKERS'COMPENSlTION LAWS OF CALIFORNIA.ANO AGREE THAT IF I SHOUID BECOME j SUBJECTTOTHEWORKEFS'COAAPENSATIONPROVISIONSOFSfCTION3]OOOFTHELABOR ` , � CODE,I SMA'�L FORTH141TH COMPLV WITH THOSE PROVISIONS. ISSUANCE � 1�"�+ 0 SMIP ��',� - p DATE: APPLIGANT: - — w ENEFGY P/C J WARNING�.FAILURE TO SECURI=WnRKERS'COMPENSATION COVERAGE IS U4lAWFUL,AND SHALL 8E — J LL SUBJECT AN EMPLOVERTO CFiIMINAL PENALTIES ANO GVIL FWES L1P TO ONE HUNDflEDTNOUSANJ ENERGY PERMIT DOLlARS�f•�00.000).IN ADDITION T0T4E COST OF COMPENSATION,DAMAGES AS FROVI�ED FOR IN -'-- J SEGTION 3�08OF TI-�E LABOF I:ODE.INTEFES',AIvDATTORNE�'S FEES. RETENTION FEE: �� L�� Q � CONSTRUCTION LENDING AGENCY PRE-ALT FEE � O � I HEREBV AFFIqM UNDER PENALTV OF PFRJ'JRV TNAT THEPE I$ACONSTFUCTION LENOING AGENCV ______.__ � FOR THE PERFORl.IANCE OF THE WOF;K FOR WMICH TH�S PERIAIT IS ISSUEC(SEC.309].CIV.C.1. Z W ? LENDEN'SNAME ___. — _ � F- LENDER'SADDRESS __ w ICERTIFVTHATINAVFREADTHISAPPLI N�STATETHATTHEABOVEWFORMATIONISCORRECT TOTAL FEES � '_I�J� C� l/I � I AGREE TO COAIPLV WITH ALL CITV COl1NT ORDINANCES AND STATE IAWS REiATING TO 9UILDING � LT � CONSTRUCTION,AND HEREBV A ORRE REP ESENTATNES OF THIS COLINTV TO ENTEP UPUN THE ZABOVE-M TqNEDP T ORI TIONGURPOSE-S , GOMMENTS _ 0 �i,�(�!w —.__ � _ �N� m PERMI E NAME(PRINT� ___._— ¢ � 6 ��'.G�- � _ � SIGNATUREOFPEP IR E _ �ATE 7 L� _ � RECPT NQ _ �-� PAID BY VALIDATION _ ~ WHITE—Depariment Gopy,YELLOW—Finance Copy,PINK—Asseswr Copy,GOLDENROD—File Copy,GREEN—Applicanfs Copy . � � . . . .. .°{ ... y .:�� 5 .., . ,,.. � .. . . .. `� r , �, . 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Cf '�z.��'�i _ � � _ �� _ ��,�r . � , __ __ ��:z � � � _ _ __ _ _ . _ _._ i _ ; _ _ _ _ ._ ; _ _ _. _ ___ ; __ . _ ; _ �_ -- � _ _._ _ ; �,o ��E�� , ,, _ � � ��,,� � t'��,�� - � §. �ax � � �{�s � t��'�. ,�7.,, '` � ` � — r Vii „�. �,� :, . ........ ._. . _. . . ... .. . .. . ... ... ..... . ... ... _... ..... . ........ . � �� .i ..��, .:,�' . . .. . . . . ... ..... . . .. .... . . ._.. �r . � � .. . . . .. .. . . . _.... _... . .__ ... _. .. � y� U�� . ... .. . .. . .. . . .. ... . . .. .... . .. ..... ..... .... . .. _. ... ..... ... . � � a, `,�. „.;,. .. ��`� �`. . .... .. .. . . . .. . ._. ...... .. .... ... . . .. _... ._... . ._. ._.. . ..... ..... ... ... � CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)&60-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION iL'. I.�� PRESS FIRMLY , �J e��u� JOBSITE ADDRESS_L APN LOT TRACT OWNER� (� � �Q� ADDRESS CITY ZIP 7�� ', APPLICANT T CONTRACT W ADDRE�=�� (^' ZIP�TEIC�j CITY� C ��7� �I7�T =NG/ ARCHh//��!!'I DESIGNER�T� - - ADDRESS CITY ZIP ._TEL._ OWNER-BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM E%EMPT FROM THE CONTRACTORS LI- CENSE IAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE:ANV CITY OR COUNTY WHICH REOUIRESA PERMIT TO CONSTRUCT,ALTER,IMPROVE DEMOLISH,CR 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 CODE)OR THAT HE OR SHE IS E%EMPT THERE FROM AND THE BASIS FOR THE ALLEGED EXEMP- TION.ANY VIOLATION OF SECTION 7031.5 BY AN Y APPLICANT FOR A PERMIT.SUBJEC(S THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(SS00)): ' ^ I,AS OWNER OF THE PROPER TY,OR MV EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK,AND THE STRUCTURE IS NOT IN i ENOLD OR OFFERED FOH SALE;SEC. 7044, BUT NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DO'eS N0.APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMP ROVES 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 V EAR OF COMPLE- TION,THE OWNER-BUILDER WII1 HAVE THE BURDEN OF PROVING �.HAT 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 NOT APPLY TO AN OWNER OF A PROPERTY WHO dUII.DS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PFIOJECTS W ITH A CONTRACTOR(SI LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW). I AM EXEMPT UNDER SEC._B. 8 P.C. FOR THIS REASON DATE OWNER_ LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENA_N OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 91COMMENCING WITH SECTION 7000)OF DIVISION 30F THE BUSINESS AND PPOFESSIONS CODE,AND FORCE AND EFFECT MY LICENSE IS IN FU L L ( c LICENSE CLAS "' I i �� .tt�lll��.T // �p yly ONTRAC 1 C DATE �� =r- WORISERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER 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 BV SECTION 3700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WILL MAINZ AIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BV SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS'COMPENSATI N INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER POLICY NUMBER (THIS SECTION NEm N01 8E COMPLETED OF THE PERMn IS FOR ONE HUPORED DOLLARS(5100)OR LESS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANV PERSON IN ANY MANNER 50 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 FORTH141TH COMPLY WITH THOSE PROVISIONS. DATE:APPLICANT: WARNING: FAILURE TO SECURI=WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL 8E SUBJECT AN EMPLOYER TO CFIIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS(5100.000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN I SECTION 3708 OF THE LABOR I;ODE.INTEREST,AND ATTORNEY'S FEES. I <:ONSTRUCTION LENDING AGENCY i 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS ACONSTFUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC. 3097,CI V.C.). LENDER'S NAME - LENDER'S ADDRESS I CERTIFY THAT I HAVE READ THIS APPLI ND STATE THAT THE ABOVE INFORMATION IS CORRECT I AGREE TO COMPLY WITH ALL CITY COUNT ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION,AND HEREBY A ORIZE REP ESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-M TIONED P T OR I TIOfJ PURPOSES 1 V v' PERMI E NAME(PRINT) b� .GN n SIGNATURE OF PER ITT E DATE 0 0 ao 0 w 0 w z 0 z w 0 0 W � Z W a rn cn 0 W U Z W U F- 0 Z W Z W Q W 2 ]C 2 LL Z 0 Q 2 CL X W 0 U w (n D Q D Q 0 J Q Z Q W Z C:3 2 Z W 2 1-- W d D m Q ( WHITE-DepaAment Copy,YELLOW-Finance Copy, PINK-Assessor Gopy,GULUtNHUU-rne Gopy,c;Httrv-Appucancs copy