The URL can be used to link to this page

Home My WebLink About18586 (11) �� CITY OF DIAMOND BAR DFPARTMENT OF COMM[INTI'Y&bEVELOPMENT SERVICES � 21825 E.Copley Drive '" (909)860-3195 Fax(909)861-3117 PRESS ' "%+�^ W BUILDINGPERMITAPPLICATION , FIRMLY . QJOBSITE � � r/�n�,��u� �/1 APPUCA,� N /� PE MIT P/C Q ADDRESS_ 1.�Y�W�� V DATE . "y�� NUMBER� # o ISSUE � C a �r� TYPE OCC `r APN LOT' TRACT .�j,, DATE � J� CONST. GROUP p OWNER =4�L1/,��) i-{'� , — o ADDRESS �� ZONING SETBACKS Z CITY ZIP TE � ]' l FRONT RW ❑ � APPUCANT TEL._ REAR ❑ Z SIDE/SIDE STREET RW ❑ Q CONTRACTOg_ P �� L� SIDE �� _ ADDRE f.JL — D p PROPOSED USE �'� C CITY ` ZIP /.`��_�,_,[� TEL.j��31'�,�� w ARCH/ENG/ 'fRlti'"[ \ F z DESIGNER w - NO.DWEL. NO. NO. � ADDRESS � CITY ZIP TFL. UNITS STORIES �_BEDROOMS cn - cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECLARATION SFR/ADD/REM O � I HEREBV AFFIRM UNDER�ENALTV OF PERJURY-HAT I AM E%EMPT FFOM THE CANTFACTORS LI- G8f0 JB/CBfpOfl W GENSELAWFORTHEFOLLOWINGREASON(SEC.7071.SBUSMESSANDPFOFESSIONSCO�E:ANYGTYOR (n C.� COUNTYWHICHREQUIRESA?ERMITTOCONSiRUC',ALTER,IMoqOVE.DEMOLISM,CRHEPAIRANYSTRUC- w TURE,PRIOR TO ITS ISSUANCE AL50 RE�UIpES TME AP7LICANT FOR SUCH PEHMIT TO FILE A SIGNED w P2tiO1DBCk STATEMENT THAT HE OR SHE IS LICENSE�Pl1RSl1ANT TO THE PROVISIONS OF TNE CONTRACTORS LI- � CENSE LAW(CHAPTER 9(COMA�ENCWG WITH SECTION]000)OF DIVISIOh 3 C�F THE BUSINESS AND PRO- � PooUSpa O FESSpNSCODE)ORTHATHE095HEISEXEMPTTHcqEFROMANDTHEBASISFORTHEALLEGEDEXEMP- � U TION.ANYVIOLATIONOFSECTION7031.SBYANYAPPLICAN'FOFAPERMITSU9JEC�5'fHFAPPLICANTTO Z Re-Roof � A CIVIL PENALTV OF NOT MOflE THAN FIVE NUNDRE�DOLLARS(SSOD)�: � O ❑I,ASOWNEROFTHEPROPERTY,ORMYEMP�OVEESWITMWAGESAJIMF.IR50LE(7JMPENSAfiON, � Commercial WIL�DO THE N/ORK,AND THE:'�TRUCTURE IS NOT INi ENDE�OH OFFERE�FOH SALE!SEC.70ad,BUSI- J � NESSAND PROFESSIONS CADE:THE CANTRACTORS LICENSE LAW DOe'S NO�APPiV TO AN OWNER OF � PROPERTY WHO BUILOS OR IMPROVES THEREON,AND WHO OOES SUCH WOiiK HIMSELF OR HERSELF OR 2 TNROUGH HIS OR HER OYM EMPLOVEES.PROVIDED TMAT SUCH IMPROVEMENTS AFE NOT INTENDED oR C� Q OFFEREOFORSALE.IF.HOWEVERTMEBUILOINGORIMPROVEMEN?ISSOLDWITMINONEYEAROFCOMPLE� Z TION,THE OWNER-BUILDER WII.L HAVE THE BUR�EN OF PROVING�HAT HE OR SHE OID NOT BUILD OR � IMPROVE FOR THE PURPOSE Of SALE�. W ❑I.ASOWNEROFTHEPROPEFTY,AMEXCLUSNELVCONTRACTINGWITHLICENSEDCANTRACTORS � TO CONSTRUCT THE PRQIECT iSEC.]006,BUSINESS AND PROFESSIUN5 CODE:THE GONTRAGTORS LI- V31U0I1Of1 � ADJ.AREA W CENSEUWDOESNOTAPPLYTORNOWNEROFPPROPERTVWHOdU11D50RIMPROVESTHEREON,AND -- — — � WHOCONTRPGi5FOfl5UGHPPOJEGTSWITNAGONTRAGTOR(5)LIGENJEDPURSUANTIOTHEGONTFAC- QUANTITY DESCRIPTION� FEE Y TORS LICENSE UW). � ❑I AM E%EMPT UNDER SFi�. B.6 P.C.FOR?HIS REASON Q � U � � �PTE _ OWNEP _ __ U � Z W � LICENSED CONTFACTORS DECLARATION W ¢ � I HEREBVAFFIRM UNDER PENAlT1 OF PERJURV THAT I AM LICENSED UNDEii PROVISIONSOF CHAPTER � d, 9(COMMENCING WITH SECTION 7oa0)OF DIV�SION 3 OFTHE BUSINESS AND PPOFESS�ONS CODE,AND Z ._ X MY LICENSE IS IN FVLL FORCE PND EFFECT. �7 � LICENSE C 55 � %_ LIC.NO. / � � � � T J U DATE�� CONTRACTO��1_ � n- W � WORh;ERS'COMPENSATION DECLARATION Q tf� U � I HEREBV AFFIRM UNDER PENAITV OF PERJURY ONE OF THE FOLLOWING DEC�ARATIONS'. Z _ Q 0 I NAVE AND WILL MAINTpIN A CERTIFlCATE OF CONSENT TO SELF-INSURE FOR WORK[RS' $ Z 49MPENSATION.AS PROVIDED BV SEG'ION 3'!0o OF T11E LABOR CODE.FOR TME VERFORMANCE U ¢ ��OF THE WOFN FOR WHICH THIS PERMIT IS ISSUED. � O w I HAVE ANp WI�L MAINTAIN WORKERS'COMPENSATIC�N INSURANCE.AS REOUIRED BV SECTION Q 3100 OF TNE LABOR COIJE.FOR THE PERFOFMANCE OF THE WORK FOR WHICHTNIS PERMIT IS � + ISSVE�.MV WO ERS'COMPENSATI INSURA CE CARRIEP AND POLICY NL'MBEftARE: CONSTRUCTION �✓ J - j cnaaiea - PLAN REVIEW o PoucrNUMeea� ELECTRIG � Z Q � (iHISSE(:110NNEmfJ0T3E(%)MREfEDOFTHEPERANrISFOFpJEM11�DREDIXILIARS(E107)DRLE551. PLUMBING W Z I CERTIFv THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT!S ISSUEO,I MECHANICAL �' SHALL NOT EMPLOY AN'I PERSON IN ANV MANNER 50 AS TO BEGOME SUBJEf.T TO TME N WORKEHS'COMVENSA710N LAWS UF CPLIFORNIA,ANCJ AGREE THAT IF I SHOVLO dECOME INS?ECTION FEE � $UBJECTTO THE WORNERS'COMPENSATION PROVISIONS OF SECTION 37000F THE IABOR �� GODE.I SHALL FORTHW ITH COMPLV WI7H THOSE PROVISIONS. ISSUANCE � ��p DATE�._ APPLICANT SMIP ___ _ J WAHNIN(i:FAILURE TO SE(:UNE WORKERS'COMPENSATION GOVERAGE IS UNLAWFUL,AN�SHALLBE ENERGV P/C _ � SUBJECTANEMPLOVERTOCRININALPENALTIESANDCIVILFINESUPIOONEHIJNCRE�THOUSAND ENERGVPERMIT } DOLLARS(f 100.00�),�N ADDITIOY TO THE COST O�COMPENSATION,DAMAGES AS PROVIDED FOR IN � __ J SEGTION3]oeOFTHELABORCODE.INTEREST.AN�ATTOFNEV'SFEES. FjETENTIONFEE: � — a CONSTRUCTION LENDING AGENCY PREALT FEE � O � I HtHEFiV A4FIHM UNUEH VtNA�.iY OF PtHJURY THqT THEHE I5 AGONSTFUGTION LEN�ING AGENC:Y �- FOR THE PERFORMANGE O�THE WORK FOR WHICM THIS PERMIi IS ISSUE[J�StC.3�91,CIV.C.�. � �� -�- - ��- �� Z W - j LENpEN'SNAME _ � F- LENDER'SAD�RE55 � TOTALFEES � ICERTIFYTHATIHAVEREADTHISAPPLIGNTIONFNDSTATETMATTHEABOVEINFORMATIONISGORREGT w I A(iFEE TO COMVLY WRH ALL(�ITY AND GOUNTY ORDINANGESANO STATE L4W5 HELATING TU 9UILDING d � CONSTRUCTION,AND HEREBV NUTHORIZE REGRESENTATIVES OF THIS COUNTV T�ENTER UPON THE z AB �MENTIONE�PROPERTV FO TION PURPOSES. GOMMENTS � — � � _. . . _-—__.. ------__..-- m � E NA (PRINT) �/�,�.}�+��Jy�) (/��{ Cn `• _ V ��r'V S.� —_—_—"_ -- � SIGNATIiq. PERMITTEE OATE = RECPT NO. PAID BY VALIDATION ~ WHITE—De arlment Co YELI.OW—Fmence Co PINK—Assessor Co GOLDENRO�File Co GAEEN—A licanl's Co P PY. PY. PY. PY. PP PY , _ � �,�� e d. . . .� � �, � �� ,�� "��, , � � � �°�� r � ��e. .� * � . � . : _��., . • . g � � : � F�.�N �m ��,,,., ,:,,� , � � � � � _ _ _ _ _ _ _ _ ___. __ _ , _ _ __ _ _ _ ._, ��;� ,v , � , `�.�� _ r � � �� „, y�„��, _ _ _. ,M' �� i a��' �� . � � �, „�,�,� __ _ __ � �,`� � _ ��,,_ �a� _ _ ��' �„�, i _ _ ��'� ' � 3= ,. �e.,, . .. . . .... ..__ ._. . . . ... .. ... . ._. ... ._... .. ._... . . . ULIJIII�U U,1Ri CITY OF DIAMOND BAR DEPARTME?VT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION ��X n � �t�� PRESS FIRMLY JOBSITE�i,C, {^' ADDRESS ' �� U� APN LOT'TRACT OWNER%41M�)��+0'v Q�� ADDRESS CITY ZIP TE��'� APPLICANT TEL. CONTRACTOg P it� ADDREfJv, CITY ZIP_(� TEL.f2� ARCH/ENG/\T��" DESIGNER ADDRESS CITY ZIP TEL. OWNER-BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSELAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE: ANV CITY OR COUNTY WHICH REQUIRESA PERMIT TO CONSTRUCT,ALTER,IM PgpyE. DEMOLISH,CR REPAIR ANV STRUC- TURE,PRIOR TO ITS ISSUANCE ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PVRSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONSCODE)OR THAT HE 09 SHE IS EXEMPT THERE FROM AND THE BASIS FOR THE ALLEGED EXEMP- TION.ANV VK)LATION OF SECTION 7031.5 BV ANY APPLICANT FOR A PERMIT SUBJEC t5'f HF APPLICANT TO A CIVIL PENALTY OF NOT MOPE THAN FIVE HUNDRED DOLLARS(f500)I: ^ I,AS OWNER OF THE PROPERTY,OR MV EMPLOYEES W iTH WAGES A51 HEIR SOLE COMPENSATION, WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOH SALE !SEC.Todd, BUSI- NESSAND 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 W ITHIN ONE YEAR OF COMPLE� TION,THE OWNER-BUILDER WILL 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 iSEC. 7066,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY W HO dUI1.D5 OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS W ITH A CONTRACTOR(S)L ICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). CJ I AM EXEMPT UNDER SEC._B. a 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 PPOFESSIONS CODE,AND MV LICENSE IS IN FVLL FORCE PND EFFECT.T/� �j LICENSE C SS ��,�LIC. N0./ �� rY -7� DATE-�'1�� LL.�CONTRACTOf��I- WORMERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENAL N OF PERJURY ONE OF THE FOLLOWING DECLARATIONS'. I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TOSELF-INSURE FOR WORKERS' PENSATION.AS PROVIDED BV SECTION 37000f THE LABOR CODE. FOR THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE.AS REQUIRED BV SECTION 3]00 OF THE LABOR COIJE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSVED. MV WOFjI-(ERS'^.OMPENSATI �INSUR�CE CARRIER AND POLICY NUMBER ARE: CARRIERyt�'{'�Ft- POLICV NUMBER� (iNIS SECTION NEm NOT.3E CCMPLL7ED OF THE PEHMfT IS FOR ONE HUNDRED DOLLARS(E100)OH LESS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY AN'/PERSON IN ANV MANNER 50 AS TO BECOME SUBJECT TO THE WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOVED BECOME SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 37000E 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 TO ONE HVNORED THOUSAND DOLLARS(f 100.000),IN ADDITIOY TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3]08 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES. CONSTRUCTlON LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTFUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED ISEC. 3097,CIV.C.I. LENDER'S NAME LENDER'S ADDRESS I CERTIFY THAT 1 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 HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE AB-MENTIONED PROPE RN FO TION PURPOSES. E NA(PRINT)�//�'� / r'V y SIGNATIIR. PERMITTEE DATE WHITE-Depaliment Copy,YELLOW-Finance Copy,PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy