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Home My WebLink About18543 �` CITY OF DIAMOND BAR � � DEPARTMENT OF COIvIIvfUNI'fY'&DEVELOPMENT SERVICES � T, 21825 E.Copley Drive (909)860-3195 Fa�c(909)861-3117 � 4 PRESS � �� BUILDING PERMIT APPLICATION !� � . FIRMLY o ADDRIESS i'�V Iv� �Nc7VY i�YS Y DATEICATIOI� "� PERMIT '�,�� P/C —t— �� NUMBER �' p � ISSUE �'� TYPE OCC APN LOT T ACT DATE � ' 3"�=�,1`_CONST. GROUP p OWNER �,j.��]Q��j �(,�'�' o ADDRESS_ G ZONING SETBACKS z CITY ZIP 7E � FFONT RW ❑ � APPLICANT TEL___ REAR �-� z — SIDE/SIQE STREET RW ❑ QCONTRACT SIDE � — ADDRES o � � PROPOSED USE �� CITY � ZIP TEL� lC� � ARCH/ENG/ /� z DESIGNER ��`C w — ND.DWEL. NO. a ADDRESS NO. �/ � CITY ZIP TFL. UNITS STORIES �gEDROOMS !`� cn -- -- � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION p SFWADD/REM � I HEREBV AFFlRM UNDEfl PENALTY OF PERJURV THAT I AM EXEMPT fROM THE GONTRACTORS LI- G8f0Q0/CBfPOfI W CENSELAWFORTHEFOLLOWINGREASON(SEC.]031.SBVSINESSANDF90fE5510NSfODE:ANYCITYOR (f� V CWNTVWHICHREOUIRESAPERMITTOGONSTRUCT,ALTER.IMPRCIVE.�EMOLISH,CRREVA�qpNVSTRUC- w TURE,PRIOq TO ITS ISSUANCE,AL50 RE�UIqES THE APPLICANT FOR SUCH PERMIT TO�I�E A SIGNED w Pat10/DBCk � STRTEMENT TMAT HE OF SHE IS LICENSEO PURSUMIT TO THE PqOVIS10NS OF THE CONTRACTORS LI- � CENSE LAW rCHAPTER 9(COMMENCING WITH SECTION 7000�OF DIVISION 3�F THE BUSINE55 AN�PR(]- LL' POOUSp2 Q FESSIONSCODE�ORTNATHEORSHEISEXEMPTTHEREFROMANOTHEPASISFORTHEnLLEGEDE1cEMP- (� U TION.ANVVIOLATIONOFSECTION]031.SBVANYAVPLICAN'FORAPERMITS�9JEC�SMFAPPLICAN?TO Z Re-Roo1 � A qVIL PENALTV OF NOT MORF TNAN FIVE HUNORED DOLLARS�f5o0J.): � Q ❑I,ASOWNEROFTHEPROPERTY,ORMVEMGLOV[ESWiTHy.'qGESASTHEIR50LECOMPENSAT�ON, 0 COff1lf1EfC12I Z WILL DO THE WORK,AND TNE STflUCTURE IS NOT INTEND[D OH OfFERED FOH SALE(SEG.]oaa,BU51� J � NE55 AND GROFESSIONS GODE:THE GONTRAGTORS LICENSE LAW DOeS NO�APPiY Tp AN OWNER OF — PROPERivNMOBUILO50RIMPROVESTHEREON,ANDWHODOESSUCHWORKHIMSELFORHERSELFOR � wTHROUGHHISORHEROWNEMPLOYEES,VROVIDEDTHAT�UCMIMPROVEMENTSA{iENOTINTENDE00R m 0 OFFEREDFORSPLE.IF,HOWEVER,THEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE- z TION,THE OWNER�BUILDER WILL HAVE THE BUROEN OF PROVING'.HA7 HE OR SHE DIO NOT BUILO OH � IMVROVEFORTHEPURPOSEOFSALE�. �� w r11,ASOWNEROFTHEPROCEHTV,AMEXCLUSIVELVCONTRACTINGWITNLICENSEDCONTRACTORS � TO CONSTRUCT THE PROJECT(SEC.]Oad,BUSINESS AND PROFESSIUNS CODE:THE CONTRACTORS LI� V31U2IIOf1 ADJ.AREA W CENSEUWDOESNOTAPPLVTOANOWNEROFAVRO?ERTVW1-0d'JII.f;50RIMPROVESTHEREON,AND --- � WHObJNTRACTSFORSUCHPRQIECTSWITNACONTRACTOR(S)IICENSEDPURSUANT70THECONTRAC- QUANTITY DESCRIPTION Y TORSLICENSELAW.). FEE � ❑I AM EXEMPT UN�ER SEG. __ B.8 P.C.FOR THIS FEASON Q � U LL DA7E OWNER ¢ Z — U � LICENSED CONTRACTORS DECLARATION w ¢ � IHEREBYAFFiRMUNDE(iPENALTVOFPERJURYTHATIAMLICENSEDUNDERPROVi5lON50FGHAPTER � d 9(COMMENCINO WITH SECTION 1000)OF DIVISION 3 OF TME BUS'�NE55AND PPAFESSiONS GOOE,AND Z `X MY LIGENSE i51N iL/LL'FOPG 0 EFFECT. � � LICENSE CLASS ✓ {�'_ LIC.Nq. � � � h I, r � � V DATE_��..t � _ CON7RACTOR�y�_,�� { � d W � WORKERS'COMPENSATION DECIARATION Q � 1 HERE6v AFFlRM UNDER PENALTY OF PERJI.'RY ONE OF THE FOLLOWING DECIARATIONS: z � IHAVEANOWIILMAINTAINACERTIFICATEOFCONSENTiOSELF�INSUREFORWORKERS' _ Z PENSATION,AS PROVIDED BV SECTIDN 9]00 nF THE LABOR CODE,FOR THE PERFORMANCE U QOFTHE WORK FOR WHIGN THIS VERMIT IS ISSUED. � w I HAVE ANO WIIL MAINTAIN WORKERS'COMPENSATION INSURANCE.AS R=OUIRED BY SECTION �.` � O3700 OF THE LABOR CODE.FOR THE PERFOPMANCE OF THC WORK FOR WHICH THIS PEpMIT IS ,,.� ISSUED.MV WORKER ' OMGENSATI SUi3A CE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION ` J c t — j cARRiER_ rv PLANREVIEW � ZPOLICV NUTABER � 41�� C� ___ ELECTRIC � Q _ p (iHISSECTIONNEmNOTBENMPLE�EDOFTHEPE{qN7ISFOFONEHUNDRED00l!AAS(St00)ORLESS). PLUMBING W Z I CERTIFV THAT IN THE PEPFORMANCE OF TNE WORK FOR WHICH THI$PFFMIT ISlSSUE�,I MECHANICAL C7 SHALL NOT EMP�OV ANV PERSON IN ANV MANNER SOAS TO BECOME SUBJE�TTO THE Uj WORKERS'COMPENSATIONLAWSOFCALIFORNIA,ANDAGREETHATIFISHOULDBECOME INSi�ECTIONFEE � SUBJECT TO THE WORKEflS'COMPENSN'ION PFOVISIONS OF SEGTION 310o OF THE LABOR C�- GODE,I SFALLFORTHWITHCOMVLV WITM THOSE PROVISIONS. ISSUANCE aI'- �� p DATE'. APPLICANT�. SMIP _ . � (,� , W J WARNING:FAILURF.TO SECURE WORKERS'COMPENSATION COVEFAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C J -- _ � SVBJECTAN EMPLOYEfl TO CRIMINAL PENALTIES AND dVIL FlNES UP IOONE HUNDflED THOVSAN� ENERGY PERMIT OOLlARS(Sl 00,001�,IN ADDITION TO THE GOST OF GOMPENSAiION,OAMAGES AS PROVI�ED FOR IN J SECTION31080F1}IELABOflCODE.INTEREST.ANDATTORNEV'SFEES. ��. OC RETENTION FEE: OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: Q I HEREBV AFFIRM UNDER PENALTV OF PERJURY THAT THERE IS A CANSTFUCTION LENDING AGENCY � FOR THE PEFFORMANCE OF TME WORK FOR WHICH THIS PERMIT IS ISSIJED(SEG.309�,CIV.G.). �—-�---- W j LENpER'S NAME_ � 1— LENCER'SADDRESS wICERTIFVTHATIHAVEREA�THISAPPIICATIONPNDSTATETHATTHEABOVEINFORMATiONISCORRECT TOTAL FEES 1 �,�"� �`^- � I AGREE TO COMPLY WITH A�L CITV AND COUNTV ORDINANCESANp STATE LAWS 9E�ATING TO BUILDING P � CONSTRUCTION,AN�HEREBY AUTMORIZE REPRESENTATIVES OF THIS GOUNTY TO ENTEF UPUN THE Z ABOVE�MENTIONED GROPERTY FOR IN TION PURPOSES. COMMENTS � -. . J � — — - —"_ � PERMIT NAME / Q {� ___—_ � � � ( l� � SIGNATI/FE OF PF I FF DATE � �� t � RECPL NO. _ PAID BY VALIDATION WHITE—Department Copy,YELLOW—Firance Copy,PINK—Assessor Copy,GOLDENROD—File Gopy,GREEN—Applican�'s Copy f � d � , _. _ 4 ��:��a �� . � � � • � � � , -;,� ��=k - �� e��a. ,� � �� o , � . _ , _ _ _ _ _ _ ;��_ � � _ , _ _ _ _ _ _ _ _ __ , _ _.._ __. _ _ _._ , _ __ _. _ _ z .�'�rc!y,k & ;�if y.n'r-.we?' ,+u , �� a5��4r 9� 4 : ... . .. . . . . .. . .. ._.. ... . � �}� { .N:y{ $ �,�._ .. . . . ... . . . .. . . _ . .. .. _.... ...... ._.__. _.... .... . l `... =�1i�y .:14'. ...,. .. . . ..... .. ..... ... . .. . ... . . . . ... . .. ... . . .. . .... ; � �� . .. . .. . . . . .. . . .. . ..... � _ ._ _ .—. -�. +'` r :' . ... . .. .... ...... ...... ..... ...... ........ �. � _<! , ,�:i ; ... ..... ..... . .. . ... . .... . ... .. . . ...... . ... .. .. . ..... .._... . . . ._ ... ..... .._... - � �. �. � � 0141.111IIIXD B41Ri IO CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION �7 o i(e L5(ADDRESS So ANCDDRES_-fiY APN LOT TRACT OWNER r A ft� 1 Ot ADDRESS_ CITY ZIP TE APPLICANT TEL. CONTRACT ADDRES CITY ZIP TEL ARCH/ENG/&lA 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- 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 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($500)): ^ I,AS OWNER OF THE PROPERTY. OR MY EMPLOYEES WITH WAGES AS THEIR 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 CONSTRUCT THE PROJECT(SEC. 7044, BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI" CENSE LAW DOES NOT APPLY TOAN OWNER OF A PROPERTY WHO 3'JII.D5 OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S)I ICENSED PURSUANT 10 THE CONTRAC- TORS LICENSE LAW). ^ 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 FUULLLL F�ORC D EFFEtCT..� r 5 LICENSE CLASS/LIC. N0. 1/ r DATE aS5 AA 11 Ob f;� CONTRACTOR C {I WORKERS'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 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 WORKE'OMPENSATI SURA CARRIER AND POLICY NUMBER ARE CARRIER Ptv7 POLICY NUMBER 41 (THIS SECTION NEED NOT BE COMPLETED OF THE PERMIT IS FOR ONE HUNDRED DOLLARS(0100)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 10 ONE HUNDRED THOUSAND DOLLARS(0100,000),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 AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR IN TION PURPOSES luew PERMI NAME W Z 11 1 02 1L SIGNATI IRE OF PE I EE DATE WHITE-Department Copy,YELLOW-Finance Copy, PIN IJ1,11�.(X PRESS FIRMLY APPLICATIO PERMIT Q,r-,� P/C D y2 1 DATE = NUMBER�1 # ISSUE TYPE OCC � DATE 3 OO =,1 CONST GROUP ZONING SETBACKS FRONT RW^ REAR^ SIDE/SIDE STREET RW^ SIDE^ PROPOSED USE N0. DWEL. N0. N0. UNITS 7 STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREANALUATION SFR/ADD/REM U) Garage/Carport W Patio/Deck LL PooVSpa 0 Z Re-Roof Commercial In Valuation D-211 1-ADJ.AREA QUANTITY DESCRIPTION FEE J U CC U w UJ 0 Z m d U Z 2 W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INS?ECTlON FEE ISSUANCE dl SMIP L L' ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES COMMENTS RECPT N0./t! PAID BY VALIDATION