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Home My WebLink About18588 (11) �� CITY QF DIAMOND BAR � DEPARTMENT OF COIvIIvIUNTi'Y 8t DEVELOPMENT SERVICES 21825 E.Copley Drive '�� (909)860-3195 Fax(9(19)861-3117 - PRESS �� BUILDING PERMIT APPLICATION -� G' ,. FIRMLY y JOBSITE (j"�,'a, �\ , ��j�y ,�pR t APPLICATIO o ADDRESS_�C.V N Vvv��>�� DATE_� ,�� PERMIT ��j p/C NUMBER `/� � m ISSUE APN LOT �lT�RACT DATE (U G'�� ONST. GROUP p OWNER ,��V�--�n�F--S -� -- o ADDRESS � ZONING SETBACKS FRONT Z CITY ZIP 7E RW ❑ p APPLICANT TEL. REAR �� — z --- SIDE/SIDE STREET Ryy �_ _ aCONTRACTOR ry SIDE �� — � ADDRES � � CITY ZIP � TE 2,��<��tl PROPOSED USE ' � t( w ARCWENG/ ' t,A�//�� ''� T z DESIGNER�[t"r W — NO.DWEL. NO. a ADDRESS l NO � CITY ZIP TFL.__ UNITS STORIES �_gEDROOMS � '2 DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION p SFRlADD/REM � I HEREBV AFFlRM UNDER PENALTY OF PERJUPY THAT I AM EXEMPT FFiOM THE CONTRFCTORS LI- G2f8Q0IC81F10fI W CENSEUWFORTHEFOLLOWINGRERSON(SEC.]03t.501151NE55ANJFqOFE55lONSrO�E:ANVCITYOR (n � GWNTVWHICHqEQUIRESAPERMITTOCONSTRUGT;ALTER,IMOPOVE.DEMOLISM.CRREGAIRANYi"RUC- W pa�i0/DBCk w TURE.PRIOR TO ITS ISSUANCE:,AlSO REQUIRES THE APPUCAN7 FOR SUCH PERMIT TO FI�E A 513NED W � STATEMENT THAT HE OR SHE IS UCENSED PUfiSUANT TO THE PROVISIONS OF THE CON7RAC70RS�I- � CENSE LAW(CHAPTER 9(COMIAENCING WITH SECTION]000)OF DIVISION 3()F T.VE B1151NE55 AND PRO- LL POOUSPO O FESSIONSCADE)ORTMATHEGFSHEISE%FMPTTHFREFRDMANOTHEBASISFORTHEALLEGEDEXEMF- � �. V TION.ANVVIOLATIONOfSECTIDN]031.SBVAN�4PPLICAN'FORAPERMITSU9JEC(SMFAPPIICANTTO Z Re-Roof � A CIVIL VENALTV OF NOT MOflE THAN FNE HUNDRED DOIURS(f5oo)��. � Q ❑I,ASOWNEflOFTHEPROPEPiYORMYEMPLOYEESWiTHWAGESA�THE�RSO�ECOMPENSATiON, � Commercial Z WILL DO iHE WORK,AND THE iTRUCTURE IS NOT INTENO[D OR OFFEFED FOH SALE(SEG.70<4,Bll�l� J � NESS ANO PROFESSIONS GODf::THE CONTFAGTVRS LIGENSE lAW GOeS NO'APFLY TO AN OWNER OF j - PROFERTYWMOBUIl�50RIMPRWESTHEREON,ANDWHODOESSUCHWORKHIMSELFOFHERSELFOR � TMROUGM HIS OR HER OWN EMPLOVEES,7ROVIDEO THAT SUCH IMPROVEMENTSARE NOT INTENDED OR m 0 OFFERE�FORSALE.IF,HOWEVE'P,7HEBUILDMGORIMPROVEMEtJiISSOLJWITMINONEYEAROFCOMPLE- Z TION,hiE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING'.HAT HE OR SHE DIO NOi BUILD OR � IMDROVEFORTHEPURPOSE.OFSALE). w CI,ASOYINEROFTHEPWJPERTV,AMEXCLUSIVELYCONTRACTINGW'THLICEMSEDCANTRACTORS — Q TO CANSTRUCT iME PRQIECT(SEC.�040,BUSINESS AND PROFESSIONS CO�E:THE CONTqACTORS�I- V8II12IIOf1 _ADJ.AREA W CENSEUWDOESNOTAPPIYTOANOWNEROFAPqOPERTVWMOdUI1.D50HIMPROVESTHEflEON,AND - � `AT�IOCONTRACTSFORSUCHPFlOJECTSWITHACONTRACTOR�SII.IGENSEDPURSUANTTOTHECONTRqG QUANTITY DESCRIPTION �E Y TORSUCENSELAW.). QCl I AM EXEMPT UNOER SEC. ___ __,_ B.8 P.C.FOR THIS REASON Q � U � DATE _ OWNER F- Z — - C� � LICENSED CONTRACTORS DECLARATION W Q � I HEREBYAFFIftM UNDER PENAI TY OF PERJURY TMAT I qM�ICENSED UNDEF�RUVISIONS CF CHAPTEF � � 9(COMMENCING WITM SECTION 1a00�OF DIVISION 30F THE 6USINESS AND PPOFESSIONS COOE.AN� z `X MY LIGENSE IS IN FU//LL FOFCE D EFFECT. /- /1 � LICENSE CLlyCS 1--� �NIC _ LIC.NO. �`✓ � ` � � � /;� � w DATE V�_ v _ CONTRAGTOR� d � � WORY.ERS'COMPENSATION DECLARATION a � I HEREBYAFFIPM UN�ER PENAI.TV OF PERJURY ONE OF THE FOLLOWING DECIARATIONS: U � Z � I HAVE AND WILL MAINTAIN A CERTIFlCATE OF CONSENTTO SELF�'�NSURE FOR WORKERS' ¢ Z = Q CAMPENSATION.AS PROVIDED BY SECTION 31�o Of TME LABOR GODE FOR THE PERFORMANCt U OF TNE WORK FOR WHI�H THIS PEHMIT IS ISSUED. � � w I HAVE AND WILL 61AINTAIN WORKERS'COMPENSATION iNSUPANCE,AS REOUIRED BV SECTIDN Q � 3loa OF THE LABOR CODE,FOF THE GERFORMANCE OF THE WOFK FOR WHICIiTHIS PERMIT IS � \ ISSUED.MY WORKEFS'COMPENSATIOM1�+INSURANCE CARRIER PND POLICY NUMBERARE' CONSTRUCTION �� y u j c^RRiER F�� _ PLAN REVIEW � ZPoucrNUMeeA_ "- r _ ELECTRIC ¢ � (iHISSECTIONNEmN0T3FQ.'X1P�EfEDOFTHEPEGiANiISGOFONEHUMREDDOLLeAS(f10])OFLESS). PLUMBING W - - Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL C'} SHALL NOT EMPIOY AN'f PERSON IN ANY MFNNER SOAS TO BEGOME SUBJE(:T TO IHE -�� -- (JJ WORKEFS'GOMPENSATION LAWS OF CALIFOHNIA,ANDAGFEE THAT IF I SHOULD BECOME INS�ECTION FEE = SUBJECi i0 THE WORKERS'COMPENSATION PROVISIONS OF SECTIQN 3]OOOF THE LABOR � — — CDDE.I SHALL FORTHWITH COMPIV WITH THOSE PROVISIONS. ISSUANCE � ��f`r p OP.TE:_ APPLICANT: SMIP ___ � W - J WARNING FFIIURE TO SEGURE WORKERS'GOMPENSATION COVEHqGE IS UNLAWFUT AND SHAIL BE ENERGY P/C J � SUBJECIqNEMPLOVEFTOCRIMINALPENALTIESANOCIVILFINE5UP700NEHUNDRE�THOUSAND ENERGYPEFMIT � � �OLLARS(StCa o00),IN ADDIT�ON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDE�FOR IN J SECTION3]090FTHELABORCODE.INTEREST.AN�ATTORNEV'SFEFS. � �� RETENTION FEE: w _ _ - o CONSTRUCTION LENDING AGENCY PRE-ALT FEE' � . � IHEqEBVAFFIqMUNDEHVENAITVOFPERJURYTHATTHEREISACONSTFUC?IONLENDINGAGENCY � FOR TH"c VtMFONMANCE OF TH�=WOF:K FOR WHICH THIS PERMI7IS 155'JE��SEC.3091,CIV.C.). — Z w j LENDEH'SNAME ___ _ - -�- � I- LEN�ER'SADDP�ESS � TOTAL FEES l 2 �(� � I CERTIFV THAT I HAVE FEAD TM 5 PPPIICATIONANC STAT�iMAf iHE A90VE INFORMATION I$CORREC7 � I AGREE TO COMPLY WI7H ALL CITV AN 'JNTY OROINANCES AND STATF LAWS RELATING TO AUILDING �� CONSTRUCTION,AND HEREBY AUT RE EPRESENTATNtS OF THIS COUNTV TO ENTER I,PUN TH= Z ABOVE�MENTIONEDPROPERTV RINSP TIONPURPOSES. COMMENTS 0 J � -_ m PER EE NAM ( I � d � , ,.4- - Uj SCNATI�RFOFPE M� EE" � E - � RECP?.tVQ __ PAID BY VALIDATION WHITE-Departmern Copy,YELI.OW-Finance Copy,PINK-Assessar Copy,GOLDENRO�File Gopy,GREEN-ApplicanYs Capy . ,. � g�� F,��a��: r ` �� =�. �� x ��' � �i a -� � � A,�� ,� �. � . n. .�� e .� r2�"�'�`� � t _ _ _ _ �� . � _��, �{;- p,� _ _ � a�� _ _ . ' _., _ I __ _ _ _ _ _ ; __ __ _.__ _ _ _ _ _ _.. _ __ �� ..� �" �ti. �-'N` . . . .. . . . .. . .... .. .... . . . ...... s n�+n. � � � � , .__. _. ._. . _. �a-0 C�`w` H��. � p� p,�2 fi, � � . I %" �" v f�. . . . . . .. . . _.. _.... ..._ . .._.. .._... _.__ � � „� z y� - � .. — . . ... . . . .. $ $h "� �� . ._ . . . .... .... _ ..... ._. ..... ...... ..-. ° - �"�'�r� . . _ . . .. ... � _� ; �. , . _. . . _ ._. __.. ... ...... _.. _.. , ��G , � .... .... .... .. . . .. .... ...... ....... ...... .. ... . ... .. .. � t 3�'Ii' ?. } A„ Y.��r� i . . . . . ..... . . . . ... . .. . ... ... .... . ._ ....... .. ... ... ... . . ,�.#Y,�, .#r .. ._. , {�iF< .� . �*�f.- ..�a.. ... ... . . ... ... ...._. ... . .._ . . ... . . .... ��Wj CITY OF DIAMOND BAR DEPARTME'�TT OF COMMUNTIY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(9(19)861-3117 BUILDING PERMIT APPLICATION ADDRESS_��V{mil VvV V�=d�/ APN LOr T RACT � �� OWNER�j��5-�'�-- ADDRESS I CITY ZIP 7E APPLICANT TEL. CONTRACTOR ry ADDRES � CITY ZIP�TE�y��<��;,j�{�,*� ARCWENG/�, �TAT 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 REOUIRESA PERMITTO CONSTRUCT,ALTER,IMPROVE. DEMOLI.SM,CR REPAIRANY 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 ANO THE BASIS FOR THE ALLEGED EXEMP- TION.ANV VIOLATION OF SECTION 7031.5 BV ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(f 500)I: ^ I,AS OWNER OF THE PROPERTY,OR MV EMPLOYEES WITH WAGES AS 1 HEIR SOLE COMPENSATION, WILL DO THE WORK,AND THE STRUCTURE IS NOT IN i ENDED OR OFFERED FOH SALE(SEC. 70aa,BUSK NESS ANO PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW GOES NOT APPLY TO AN OWNER OF PROPERTY WH08UILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THFIOUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE. IF,HOW EVER,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). C I,AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTING W ITH 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 B'J II.DS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PFIOJECTS WITH ACONTRACTOR(SI LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). CI I AM EXEMPT UNDER SEC._B. 8 P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENAI TY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 30F THE BUSINESS AND PPOFESSIONS CODE.AND MY LICENSE IS IN FULL FORCE D EFFECT. �f L/ LICENSE C S� �� LIC NO .I DATE�s r� �dl j^' _CONTRACTOR � WORY.ERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENAI.N OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORKERS' /COMPENSATION.AS PROVIDED BV SECTlON 37000E THE LABOR CODE FOR THE PERFORMANCE /OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. / vi 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. MV WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE' F CARRIER POLICY NUMBER r (THIS SECTlON NEm NOT 3E(XJMPLL7ED OF THE PETWYT IS FOR ONE HUNDRED DDLLARS(5100)OR LESS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY AN�/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 37000E THE LABOR CODE.I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. GATE: APPLICANT: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP IOONE HUNDRED THOUSAND DOLLARS(StoO,000),IN ADDITION 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 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTFUCTION LENDING AGENCY FOR THE PERFORMANCE OF TH=WOF:K FOR WHICH THIS PERMIT IS ISSUED ISEC. 309],CIV.C.). LENDER'S NAME LENDER'S ADDRESS I CERTIFY THAT I HAVE READ TH S APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT I AGREE TO COMPLY WITH ALL CITY AN UNN ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTlON,AND HEREBY AUT IZE EPRESENTATIV ES OF THIS COUNTY TO ENTER UPON THE ABOVE�MENTIONED PROPERTY RINSP TION PURPOSES. PER EE NAM (I ) ��.'� SICNATLIRF OF PE M EE" I WHITE-Department Copy,YELI-OW-Finance Copy,PIN _��a � �� PRESS FIRMLY