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Home My WebLink About18975 ��,�� r�1 I �' CITY OF DIAMOND BAR - � � DEPARTMENT OF COMMLTNITY&�bEVELOPIvIENT SERVICES c 21825 E.Copley Lhive (909)860-3195 Fax(909)861-3117 PRESS � "'%.+� BUILDING PERMIT APPLICATION FIRMLY QJOBSITE GJD / �I�fprl S�� S � DATECATION ,I (C� �, NU BER �� ItrC Q ADDflESS � � Gf G�� / 4 � ISSUE �L TYPE OCC APN LOT TRACT __ _ DATE �� CONSL GROUP p OWNER ��G�� `l ADDRES ZONING SETBACKS � Z CITY ZIP � 7EL FRONT RW ;1 p APPUCANT TEL._ S DE SIDE STREET RW ❑ z Q coNrRa,cTo�#PP��ANCEINSTALLERg�� SIDE ❑ Q ADDRESS _ � CITY ak�wnnrl!�e �f�_ TEI. PROPOSED USE �w ARCH/ENG/ ✓)�� - z DESIGNER a ADDRESS NO.DWEL. NO. NO. UNITS STORIES BEDROOMS � CITY ZIP__ TFL.__ � v� DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDEf7 DECLARATION SFRlADD/REM O I HEREBV AFFlRM UNDEfl PENALTY OF PERJIIPY THAT I AM E%EMPT FROM THE CONTRAGTOqS LI- GHf8J0/C2lPOR W CENSEUWFORTHEFOLLOWINGREASON(SEC.7031.SBUSMESSANOPROFESSIONSCODE:ANVCITYOR (n CJ CWNTVWHICHREOUIRESAPERMITTOCONSTRUCT,ALTER.IMPROVE.DEMOLISH,ORqEPAIRANViiRUC- W PdtiO/DeGk w TURE.PRIOP TO ITS ISSUANCE.ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FI�E A SIGNED w STATEMENT THAT HE OR SHE IS LICENSE�PURSI/AN'TO THF PROVISIDNS OF THE CON7RACTORS LI- � CENSE LAW�CHAPiER B(COMMENCMG WITH SECTION 10001�F�IV'.SION 3 C1F THE BUSINESS AND PRO- � POOUSP2 FESSIONSCO�E)ORTHATHEORSHEISE%FMPTTH�REFROMANDTHEBASISFORTHEALIEGEDE%EM?- � � TION.ANVVIOLATIONOFSECTION7031.SOVANYAPPLICAN�FORAP[PMITSJ9J[C(5'fHFAPPLICANTTO Z Re-Roof � A GIYIL PENALTV OF NOT MORE THAN FIVE MUNDREO OOLtARS(S5o0).)�. � Q LII,ASONMEROFTHEPROPERTY,ORMVEMPLOYEESWiTHWFGESASlF1EIR50LECOMPENSATiGN, � COfi11f1EfC18I Z WILL DO TME WORK,AND THE STRUCTURE IS NOT INTEN�ED OR OFFERED FOH SALE(SEC.7064,BU51- J � NESS AND PROFESSIIXJS CODE:THE CONTRACTORS LICENSE LAW DOcS NO�APPLY TO AN OWNEF OF � DROPERTV VlFiO BUILOS OR IMPROVES THEREON,AND WHO DOES SIICH WORN HIMSELF OR NERSELF OR Q THROUGHHISORHEFOWNEMPLOYEES.PROVIDEDTMATSUCHIMPROVEMENTSARENOTINTENDEDOR m QOFFERE�FORSALE.IF,MOWEVER,THEBUILD:NGORIMPROVEMEN?ISSOLOWITHINONEVEAROFCOMPLE� Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING'.HA1 HE OR SHE DID NOT BUILD OH � IMPROVE FOq THE PURPOSE OF SALE�. w ❑I.ASOWNEROFTHEPROPEHTV.AME%CLUSNELYCONTRAC7INGWIiMLICENSEDCONTRAGTORS � TO CANSTRUCT THE PR0.IEGT(SEG.]064,BUSINESS AND PROFESSIONS CODE:THF CONTRACTORS LI- VBN8110f1 � ADJ.AREA W GENSEUWDOESNOTAPPIYTOANOWNEROFRPRO�ERTVWNOdVIi.D50FIMPROVESTHEREON,AND --- = WMOCANiFiAGTSFORSUGNPROJEGTSWITHACONTRr1CTOR(S�LIGENSCDPURSUANTTOTHECONTf1AG QUANTITY DESCRIPTION FEE ~ TORS LICENSE LAW). Y J � C_�I AM E%EMPT UNDER SEC. B.6 P.C.FOR THIS REASON Q � U � � onrE owr+Ea � � Z - U W � LICENSED CONTRACTORS DECLARATION W Q � IHEftEBVAFFIRMUNDEflPENALTYOFPERJUfiYTMATIAMLICENSE�UNUEHVHOVI510N50FCHAVIEH � /!I � 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 UF THE BUSINESSAND PP.OfE55i0�'S CODE,AND Z [v X MV LICENSE IS IN FULL FORCE AND EFFECi �( �y � LICENSE GLA55_�� _ LIC.NO. /�"� � /' /- �7 7 ~ DATE�D L� CONTRACTOfi d U w � WORKERS'COMPENSATION DECLARATION -� Q = U � I HEREBV AFFIRM uND�R PENALTV OF�ERJl1PV ONE OFTHE fOLLOWING DECLARATIONS: (� Q � IHAVEANDWILLMAINTAINACERTIFlCA7EOFCONSENTTOSELF�INSUPEFORWORKERS' _ Z COMPENSRTION.ASPROVIDEDBYSECTION3]OOnFTHELA80RGODE.FORTHEPERFORMANCE U ¢ OF THE WOPK FOR WHICHTHIS PERMIT IS ISSUED. � 0 w IHAVEANOWILLMAINTAINWORKERS'COMPENSA'IONINSURANCE,ASPEOUIREDBVSECTION G 3�Do OF iHE LA�OR CODE,FOR THE PERFORMANCE OF THC WORK FOR WHICH THIS PEflMIT iS 0 ISSUE�.MY ORKERS'COMPENSATION INSURANCE GARPoER AND POLICV NUMBE9 ARE�. CONSTRUCTION Q � cnaaieR � S PLAN REVIEW ZPOLICY NUMBER ELECTRIC Q �. � Q fR115SECTIONNEmNOTBEODMPLETEDOFh1EPERMfiIS�OFONEHUWRE��LLARS�5100)OqLESS). PLUMBING _� w MECHANICAL Z I GEftTIFV TNAT INTME PERFORMANGE OFTHE WORK FOR WHICN THIS PERMIT IS ISSUED.I Lj' SHALLNO(EMPLOVANYPERSONINANYMANNERSOFSTOBEGOMESUBJEGTTOTHE � WORKERS'COMPENSATIONUWSOFCALIFOPNIq,ANDAGFEETHATIFISHOUL00EGOME INS?ECTIONFEE _ = SUBJECTTOTNEWORKERS'COMGENSATIONP V ONSOFSECTION3�OOOFTFELABOR - COOf, SHALLFORTHWITHCOMPLVWITHTH VISIONS. ISSUANGE � / / SMIP p DATE: �� - APPLICANT: '✓ -- -- w ENERGY P/C J WAflNING:FAILURE'O SECURE WORNERS'COMPENSATIIXJ COVERAGE IS VNIAWFU�,AND SHFLl9E - J � SUBJECTANEMPLOYERTOCfliMINALPENALTIESANDCIVILFINESUPTOONEHl1NDREDTHOUSAND ENERGVPERMIT r DOLLARS(ftoo.oao),IN ADDITION TO THE COST OF COMPENSATION,DAMAGESAS PROVIDED FOR 14 — J SECTION 3)oeOF THE LA60a CODE.INTFRFST ANO ATTORNEY'S FEES. RETENTION FEE'. I • � _"- � CONSTRUCTIONLENDINGAGENCY PRE-ALTFEE: � o - Q I NEREBY AFFIqM UNDER GENALTV OF PERJUflV THAT TNERE IS A CONSTRUCTIGN�ENDING AGENGV � FOR THE PERFORMANCE OF THE WOFN FOR WHICHTHIi PERMIT IS ISSUED(SEC.3097,CIV.C.1. - Z w � LENDEN'SNAME_ _ j F- LENDER'SAD�RE55 _ J /� � TOTALFEES /,� / �/ � I CERTIFV THAT I HAVE FEAD THISAI'PLIC:AT'�ON AND STATE THAT THE ABOVE INFOFMATION IS GOFREGT ,�`� J4i w I AGREE TO COMP�Y WITH ALL CITY AND CAl1NTV ORDINANCES AND SiAiE lAWS HELA7ING TU BUILOING [Y � CONSTRUC'ION,AND HEREBY AUTHORRE REPRESENTATIVES OFTNIS COUNTY TO ENTER UPON THE Z ABOVE� TIONED PqOPERTV FOF INSPE�PURPOSES. COMMENTS _ O j � �— m PFRMITTFF _ INT) — // , {„� — ¢ /_ //1 _—__ � �� SIGNATUREC PERMITTEE �A E = RECPT.NQ PAID BV VALIDATION ~ WHITE-Oe anment Co YELI.OW-Fnance Co PINK-Assessor Co GOLDENROD-File Co GREEN-A icanfs Co P PY� PY� PY� PY� PW PY � ��_ , e .� � �,4 �,X„�„�, �¢ .. , � � r � � � � � �� .�� ' _ _ ��„,�,u � �_ _ __ _ _ __ . . --- __ _ _ ; _ _ _ _ � . _ _ .. _ __ _ , _ _ _ _, �� ``� v �= � � � �� $�� 'p ��r� _ _ _ .a, °� ` . �*�.� �� a�. :; ��,�' __ _. _ _ ° r�,� __ __ . . Y� ' � ' � � R"i��. }� i� .. ... ._ . . .. . . . . .. .. . . . . .. .. � �� ' �.!� A��r. �� r��; , _ _ � .L:�. _ _ _ _ DLtMOXD BAR i 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 JOBSITE ADDRESS en C�s ADDRESS//( ld�V APN_LOT TRACT-- / OWNER C�I�Ge e. ADDRES CITY ZIP TEL APPLICANT TEL. CONTRACTOFOPPLIANCEINSTALLER$1NG ADDRESS 382.1 Indi Istr Ave Y CITY 2krwnn4 Ce fll"TEL. 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 REPAIRANYSTRUC- 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 THERE FROM AND THE BASIS FOR THE ALLEGED EXEMP- TION,ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJEC TS'IHF APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($500)): D 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 TO AN OWNER OF A PROPERTY WHO BUII.DS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S) LICENSED PURSUANTTO 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 FULL FORCE AND EFFECT ��g� LICENSE CLASS - LIC.NO. II--h CONTRACTOR 4 AT D E 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' COMPENSATION.AS PROVIDED BY SECTlON 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 RKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: ISSUED. M 6P CARRIER :;JGOU& POLICY NIJMBER U-2 (THIS SECTION NEED NOT BE 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 15 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 WORKERSCOMPENSATIONP V ONS OF SECTlON 3700 OF THE LABOR CODE,SHALL FORTHWITH COMPLY WITH TH VISIONS. �1 - 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(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 PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC. 3097,CIV C.) LENDER'S NAME LENDER'S ADDRESS 1 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 A130VE TIONED PROPERTY FOR INSPECjJpN PURPOSES. TTEE INT) PERM; SIGNATURE 0 PERMITTEE DA E Tn 00 CC 0 LU z 0 in z Cr 0 0 W 0 W U) U) cn U) Cr 0 C) W U Z W 0 U U) LL 0 tTE Ix a- X W 0 U W 073 (n C) Z W 0 UL OT Ui W d 0 a- CL Z W F LU CL 0 Z E m APPLICATION,I PERMIT 1_7 P/C I ATE 4 L. NUMBER# D� ISSUE TYPE OCC DATE CONST GROUP ZONING SETBACKS FRONT RW^ REAR^ SIDE/SIDE STREET RW^ SIDE^ PROPOSED USE N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREANALUATION SFR/ADD/REM W Garage/Carport W Patio/Deck W LL PooVSpa 0 Z Re-Roof Commercial Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U H U W J W � ^'^'J) LV 007 CL Z U W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES�j2 0 COMMENTS RECPT N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy