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Home My WebLink About18587 �,� CITY OF DIAMOND BAR � � DEPARTMENT OF COMI�fUNTCY&DEVELOPMENT SER�IICES T-W � 21825 E.Cop►ey Drive (909)&60-3195 Fax(909)861-3I17 � ` PRESS � -.�:� BUILDING PERMTT APPLICATION �� ' FIRMLY � JOBSITE APPLICATI /� PE MIT � P/C o ADORESS�Q � ' _�� DATE � �"L �2– NUMBER� It � ISSUE C3 i O �� TYPE OCC APN LOT TRACT_ �;-�-- DATE � CONST. GROUP p OW N EFi �,�1�l�'iP��L!)A J ��;7 �.El./�� —� ADDRESS ZONING SETBACKS Z CITY ZIP 7E�" -� y ` FRONT flW ❑-- — � APPLICANT TE ____ REAR !7 _ a SIDE/SiDE STREET RW ❑ a CONTRACTOR SIDE ❑ ADDR � � CITY � ZIP �i � TEL.' PROPOSED USE � "U' �� C w ARCWENG/ y, -- z DESIGNER�l' — --- NO.DWEL. NO. NO. � ADDRESS 11NiTS STORIES J BEDROOMS� � CITY ZIP__ TFL_ _ � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � � OWNER-BUILDER DECLARATION SFRfADDlREAA � I HEREBY AfFIRM UNDEF PENALTY OF PEflJURY'HAT I AM F.%EMPT FROM iHE CONTRACTORS LI- � Garage/Carport W CEYSEIAWFOqTNEFOIlOWI11GREASON(SEG.'/a31.5BU51NE5SAN'J�ROFESSIONSCp�E.ANVCITYCR U COUNTYWHICMREOUIRESAPERMITTOGON57RUCT,ALIEF.IM�ROVE.DEMOUSH.CRREPAIRANVSTRUC- W P8110/D6Ck Z TURE,PHIOR TO ITS ISSUANGI:.AL50 REQUIRES THE APPLICANi FOR SUGH PERMIi TO FlLF A SIGNED w w STAtEMENT THAT HE OF SHe��S��CcNSED P1iii5UANT'O THE?ROVISIDN.4 0:THE CON'RACTORS u- � CENSE LAW(CHAPTEP 9(COMlAENCING WiTH SECTION 7ooD)(1F DNiSION s�F THF BUSINESS AN�PRO- V" POOUSpe I � FESSIONSCAOE�ORTNATHEORSHFISEXE4IPTTHEREFROMANDTNEBASISFORTHEALLEGEDExEMP- � — � TION.ANYVIOLATIONOFSECTION7031.SB'�ANY4PP'�IC�N�fORAPERMIT�J9JEG�5-fHEAPPLICANTTO Z Re-Hoof � A CIVIL PENALTV OF NOT A/ORE THAN FIVE NUM1Df1ED DOLL4RS(l5001 j. O ❑I,ASOWNEHOFTHEPFl�JPERrVORMYEAIP'_OYEESWiTHW5GE5P:'1�E'�RSOLECOMPENSAT�ON, ❑ COfI1fTCtCial Z WILL DO THE WORK,AND THE�iTRUCTURE�5 NOT IN i EN�E�JH OFFEHED FOH SALE!SEC.70d6.BU`I- J NE55 AN�PROFESSIONS GOOf:'THE GOM RACit)HS LICENSE lAW DO`cS NO�APFiY TO AN OWNER OF � 7ROiERTYWHOBUILDSORIMi'POYESTNEREON,AND'NHO'JOESSUCHWOfiKHIMSELFOFHERSELFOR � 2 THROUGH HIS OR HER DWN EMPLOYEES.PROVIDED TMAi�UCN�MPAOVEMENiSAaE NOT INTENDEDOR w OFFEFlE�FORSALE.IF,HOWEVf'R,THEBUILOINGORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE- � TION.THE OWNER-BUI�DER WI_L MAVE THE BUFDEN OF PROVING'NAl HE OH SME Dlp M1OT BUILD OR Z IMPROVE FOR TME PURPOSE 0=SA�E). _ ❑I.ASOWNEROF7HE�W�PEFTY,AAIE%ClU51VELVCCINTRACTINGWIfHLICENSE�CONTRACTORS � TO CONS7RUCT THE 7ROJECT(SEC.�Oa1,BUSINESS AND PRUFESSIUNS CODE:TMF GONTRAGTORS lt- VdIU2210f1 ADJ.AREA_ W CENSEUW�OESNOTAPPLYTDANOWNEROFAPROVEFTVWMOdUII.D50HIMPPOVESTMEHEON,AND � NMOCONTFACTSFOqSUCHPFIOJEGTSWITHACONTRACTOA(5)IIGEhSEDPURSUANTIOTHECONTRAC� QUANTITY DESCRIPTION FEE TORSIICENSELAW.). � — Y J � -;I AM E%EMPT UNOER SEC. B.8 PC.FOR THIS FEASON Q � -----— — — V � � DATE _ OWNER _ __ U � LICEWSED CONTRACTORS DECLARATION w Q � 1 HFFIEBY AFFIRM UNDEft PENAlT1 OF PE9JURY TNPT 1 AM IIGENSED JNOEA PRO`/�SIONS OF CHAPTEA �i a, 9(COMMENCING WITM SEGTION]000)OF DIVISION 3 Of THE BUSINESS AfvD PPOf-"e5510�'S CODE.AND Z X MY UGENSE IS IN FULL FORCE PND EFFECT W �/J � � UCENSE cLA55 �� ' ` �C— LIC.N�. p "" � a p� J w DATE�/�_� � CONTAACTOF� � WORM;ERS'COMPENSATION DECLARATION Q = U � I HEREBV AFFIRM UN�ER PENALTV OF PERJURY ONE OF THE FOLLOWING DECI APATIONS � Z Q ZIINVEANOWILLMAINTl�INACERTIFICA7EOFCONSENTiO�ELF�INSUftEFOflWORKEFS' _ ¢ �.MP[NSATION,AS PROVIDED BY SEGTION 3)OU OF TME LABOil CODE,FOH THE PERFORMANCE W /OF TNE WORK FOR WMIf:N TMIS PERMIT I$ISSUED. � � w � 1 MAVE AND W LL MAINTRIN WOqKERS'COMPENSPTInN INSUFANCE.AS REOJIRED BY S[CTION -----�.��/� n_ Q 3]0o OF THE LAAOP.CAUE,FOR THE PERFORMANCE OF THC WORK FOR WHICH TNIS PEflMrt IS 'tiC �7� ISSUED.MV W RS�� PENSf� NSURA GARRIERAND POLICY NUMBEHAFE CONSTRUCTION ��[� J j CARRiE�__ � .-._— PLAN REVIEW _ � PoucvHUMeeR_t� — --- I ELECTRIC Z --- Q � ��ssEc7iavuEmruorE�Fcsx,�R�EooF'}+EaEw,�rriswFor�EN��nnaEooav.as�s�ooloa�[ss�. PLUMBING .... W MEGHANICAL Z I CC�iTIFY THAT IN THE PERFORMANCE OF THE WOiiK FOP WMCH TF115 PERMIT IS'�SSUEO,I ----�- — (,r} SHALL�Oi EMPLOYANI'PEii50N�N ANY MANNER SUAS�O 9EGOME SUBJE(:T'O THE INS?ECTION FEF � WORKERS'GGMPENSAT',O^1 LAWS DF GAL FORNIA,AND AGREE TMAT IF 1 SHOUlO EECOME — � SUBJECIIOTHEWORNI=RS'COMPENSATIONPROVISIONSOFSECTIDN]]OOOFiHEUBOR � CO�E,I SHALI FORTHW'TH GONPIV WITH THOSE?ROVISIONS. ISSUANCE _. � SMIP p DATE:_ _ APPLICANT: _ — —��— -- � ENERGY P/C —� WARIJING:FAILURETCSECUFE'NORKERSGOMPENSATIONCOVERAGEISUNLAWFUL,ANDSHALLBE — - — `-- J � SUBJECT qN EMPWVEF TO GHI�7INAL PENALTIES AND CNIL FINES UP TO ONE HUN�FE�THOUSAND ENEftGY PERMIT �OL�RS If i 00.006).IN ADDITIOM TO THE CGST OF GOMPENSATION,pAMpGES AS PFOVIDEO FOR 1N — JSECTION 370BOF THE LABOR CODE INTEREST.AhDATTORNFV'S FEES. ^_ ¢ _ RETENTION FEE: _ • _— � CONSTRUCTION LENDINGAGENCY PREALTFEE __ O Q I MEREBY AFFIRM UNDER FENAII Y OF P=RJURV THAT TMERE IS A CONiTPJCTION LENDING AG£NCY __. � FOR THE PEFlFORMhNc;E UF IHk WOFN FOR WhICH THIS PERM�T IS ISSUEG ISEC.309],CIV.C.). � Z — W j LENDEN'S NAME,_______ -- --- _ _ _ � H LENDER'SADDRE55 _ //�/ � ICERTIFYTNATInAYEREADTMt.iAPP��IGATtDNANOS�AfETHATTHEP80�'E��+FORMATIOM1ISf(KiRECT TOTAL FEES 2� � 4� w IAGREETOGOMPLYWITMALLGIiYANfJCOUNTYORDINAkCESAND$TATEtl�W$HELATINGTOBUILDING � CONSTRUGTiON.ANI]HEREBVAIITHORIZE AEPRESENTATNE50F TN15 COUNTV TO ENTER UPON hiE ZABOV NTIONEDPROPEFTf{O S�PURPCSES. COMMENTS _ � � ___—` — m PERMITTEE AM ( WT� _—___— — � — ¢ q :�� , -- � SIGNAiI.iPF � MItTEE � 7ATE--�—��—��— '---� = RECPT.'VO. ___. __ PAIDBY �__VALIDATION _ ~ �HI?E—De anment Co YEILOW—Finance Co PINK—Assessor GoFY�GO�DENRO�File Co GREEN—A IlcanTs Go F PY, PY. PY. PP PY �t ,�� x�' w�a �a��;"�'gs� r c ��a � � �^� �� 3� �� " �:�� r� ' �� , � � � ,. , o . . �`. _ .. ,.� . 4. .:�� `b�. . ... . ,. . . � . . .. .. ... . .. ..... . _.... . _. ... . �.. � s a �:-nu,�e�r. v�ae� , �r. -�� ,ii.� ._ _. ___ ... . .. ��,a� �s � � _ _ _ _ _ __. _ _ � _.. _ _ _ _ _ _: _ _ _ _ _ ___ _ � �,��, �E u�� , ;�� -°�W � � �� __ � �� .: ��r �,�� ; : .� r � .�F �.! .e . ._ . . ._. .... . . ..... . ... .._. ��. � � V �`.� r :s,. . .. . . . . . ... .... ..... .. .. ..... . ..... . ....... ... .. . . �� 9 a ��. .;�. 4�. d. � �'� ... . . � w. . .. . . . . . .. . ..... ..... ... ...... . . �.2 �.:y y�'. i ... .. .. . ... ...... . . . . ... .. ... . . ...... ..... ...... . ..... . . .. ',C�'y . u: tl� �� . �� °� �` � �i,� .2 ,1., . .. . . . . .. .. . .. . . .. ... . .. . .. .. . _ _ . ..� '..G '�?R��,... . .R�n .. . . . OI CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION JOBSITE ADDRESS I't lu APN LOT TRACT y� OWNER V\Ab)&J d" ADDRESS CITY ZIP TE 1 ••� ( APPLICANT TE CONTRACTOR ADDR CITY ZIP TEL. ARCH/ENG/yy, DESIGNER I 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 f HE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(1500)): - ^ I,AS OWNER OF THE PROPERTY,OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK,AND THE STRUCTURE IS NOT IN T ENDED 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 W ITHIN ONE YEAR OF COMPLE- TION.THE OWNER-BUILDER WI L HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE 0-SALE). ^ 1,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 BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S) LICENSED PURSUANTTO THE CONTRAC- TORS LICENSE LAW). TI I AM EXEMPT UNDER SEC. B 8 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 n Q_ LICENSE CLASS IC LIC N0. DATE CONTRACTOR' WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: yAVE AND WILL MAINTAIN CERTIFICATE CONSENT TO SELF INSURE FOR WORKERS' AS MPENSATN,AS PROVIDED BV SECTI TION N 3 37000E THE LABOR OR CODE CODE, FOR R THE PERFORMANCE F 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 W RS' 1� PENS NSURA CARRIER AND POLICY NUMBER ARE: CARRIER POLICY NUMBER T (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 IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER 50 AS TO BECOME SUBJECT TO THE WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORK I-RS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE,I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE:APPLICANT: WARNING: FAILURE TO SECURE'NORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP 10 ONE HUNDRED THOUSAND DOLLARS($100,000),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 THIIL 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 ABOV NTIONED PROPERTY FO SPECTION PURPOSES. PERMITTEE AM (TNT)� •V SIG NATURE P MITTEE DATE ITE-Department Copy,YELLOW-Finance Copy,PIN PRESS FIRMLY APPLICATI °°��//�� PE MIT P/C DATE G�L Q Z NUMBER # ISSUE TYPE OCC y t� i CONST. GROUP DATE 1 V ZONING SETBACKS FRONT RW^ REAR ^ SIDE/SIDE STREET _ RW^ SIDE � PROPOSED USE C N0. DWEL. N0. NO UNITS STORIES I BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM Garage/Carport LLI Patio/Deck LL PooVSpa Z Re-Roof Commercial Ib Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U U w w C7 CIO 0 Q U Z 0 LU CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INS?ECTlON FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES CIO COMMENTS RECPT NO PAID BY VALIDATION