The URL can be used to link to this page

Home My WebLink About18589 �- CITY OF DIAMOND BAR � DEPARTIv1ENT OF COMMUNTfY&DEVELOPMENT SERVICES 21825 E.Copley Drive '� (909)860-3195 Fax(909)861-3117 ; PRESS �"'-..�=`w BUILDINGPERMITAPPLICAT101Y � ^ � - FIRMLY �� JOBSITE G�n''�O �1,1 APPLICATI `� m`� PERM P/C o AD�RESS�✓ �� ry�f{ _ A~ DATE� ` rV L► NUMBER � � Jt � ISSUE q /�� J TYPE OCC APN___�+LOT TRACT__ �,��, DATE__ I L/ '� 1– CONST. GROUP p OWNER l/� ��'i�L�JOW ��T_�i-tic=(�-- ZONINC SETBACKS ADDRESS z CITY Z�P 7E j,� FRONT RW ❑__` APPLICAN7 _ __ TEL__ REAR ❑ Z -- SIDE/SIDE S7REET _ RW ❑ m CONTRACTOR SIDE C; _ ¢ � � _. � ADDRE/��.:.�,��'�� 1 N ,/ PFiOPOSED USE � � i e1O � CITY J',�-_-��Q�y�{�.. ZIP� TEL y. w ARCH/ENG/ ' { �<��t�� Z D E S I G N E R�� --r NO.DWEL. NO. NO. � a ADDRESS UN1TS STORIES ___�__BEDROOMS � CITY ZIP__ TFL.__ _ � — DESCRIPTION 50.FT FACTOR PSF ADJ.AREANALUATION cp � OWNER-BUILDER DECLARATION SFR,'ADDlREM O � I HEREBV AFFIRM UNDE17 PENALTY OK PERJUPY THAT I AM F.XtMPT FROM THE CONTRACTORS LI� � Garege/Carport W CENSELAWFORTHEFp�IOWIN�REASON(SEC.'/031.SBUSINESSANOP40FESSIONSCODE�.ANVC1?VOR U COVNTVNAiICHRE0UIRESAPERMITTOCONSTRUCT,ALIER,IM�ROVE.DEMOl15H.CRREPAIRANYSTRUC- W Py110/�BCI( Z TURE,PRIOfl TO ITS ISSUANCf:./L50 flEQUIRES THE APPL�CANT FOP SUCH PEFiMIi TO�ILE A SIGNEf1 w w STATEMENT THAT HE OF SHe'�S L�CENSED Pl.�F5UA1l�'O THE?ROYISIJNS OF THE CnNTRAf.10R5 LI- � CENSE LAW(CHAPTER 9(COMIAENCING W�TH SECT�ON)000)OF DIVISION 3(�F THE 9USINESS AND PRO- V' POOUSPB � O FESSIONSCAOE)ORiHATHEGRSHEI$EXEMPTTH�REFROMAN�TNEBASISFORTHEALlEGEOEXEMP- � U TION.ANYVIOLATIONOFSECTIi]N1031.SPYANYnPP�:IC<N�FQRACEHMIT6U9JEGf5-�HfAPPIIGANTTO Z Re-Roof � A CIVIL PENALTV OF NOT A/ORE 7HAN FNE NUhDRED DOILARS(S5o01�: - O ❑l.ASOWNEqOFTHEPROPER�VORMYEMP�O�EESWiTHW54E5.451MF,R50lECAMPFNSA��UN, Q Comm�rCial Z WILL DO TNE WORK,AND THE 3TRVCTURE IS NOT 1N i ENOED OH OFFEPEU FOH SALE(3EC.70<4,BU"I- J NESS AND PROFESSIONS CODE::THE GONTRAGTURS UCENSE LAW DO�S NO"APPLY TO AN OWNER OF � PROPEflTYWMOBURD50ftIMFf10VtSTHEHEON.AN7WHODOESSUCNWORXMIMSELFOFHE0.5ELFOR � � TMROUGM MIS OR HER OWN EMPLOYEES.PROVIDE�THAT fUGH�MPPOVEMENTSA�E NOT INTFNDE�OH m OOFFFAEOFORSALEIF,NOWEVE'R,THEBUILDINGORIMPiiOVEMEN�IS50LDWITHINONEVFAROfCOH1PLE- Z TION,THE OWNER�BUIIDER WI_L MAVE THE BUPDEN OF PROViNG'.Hpi HE OR SHE DID hoT BUIID OR � IMPROVE FOR THE PURPOSE 0=SALE). �y,� C71.ASOWNEROFTHEPFOpEfiTY.AAIEXC�USIVLLVCCINTR4CTINGWITNLICENSE�CONTRACTORS [[ T�C�NSTRUCT TME PROJECT(SEC.]04a,BUSINESS AND PRUfE5510NS CODE�.TNF CONTRpCTORS ll� VdIUd�10� ADJ.AREA W CENSELAW DOESNOTAPPLVTbANOWNEROFAPROPERTVWMOdUII.D50RIMPPOVESTHEREON,AND � YMOCONTRAGTSF095UCNPF'.QIECTSWITHAGONTRACTOR{5)IICEh5E0PUR5UANTlOTHECONTRAC� QUANTIN DESCRIPTION FEE Y TORSLICENSELAW.). — � -'.��AM EXeMVT UNOER SEC. 0.3 PC.FOA THIS REASON Q � -- _ U � � DATE __ _ CWNEP ._ ____'_ U Z W � LICENSED CONTRACTORS DECLARATION � Q � I HEFEBV AFFIRM U4DE(3 PENAIT�+'OF PE9JURY THAT IAM LIGENSEO JNOEH FP(JJ�SIONSOF CHAPTER � � 9(GOMMENCING WITH SECTION l000)OF D�VISION.f OF THE BU51NES5 AIvD PPOFE551Jk5 CODE,AND Z X MY LICENSE IS M FUL�FORCE PND EFFECT m � LICENSE CLA S �� "'�_ LIC.NO. 7�b� � � ~ DATE Z_ CONTRACTO�{.1 � b, a C� W a� WORk:ERS'COMPENSATION DECLARATION Q = U � 1 HEHEdY AFFlRM UN�eR P[NALTY OF PERNRV ONE Of iHE'rOL�OWiNG DECLARATIONS� � Z Q � I HAVE AND WILL MAINTAIN ACERTIFICATE OF CONSENTTO SELF�MSURE FGR W09NERS' _ Z MPENSATION.AS PROVIOED BY SECTION 3100 OF TNE LABOF CODE,FpR TFIE PEfiVOFMANCE V ¢ F TNE WORK FOq WHIf:M TMIS PEFMIT IS ISSUEO. � � w I HAVE AND WILL MAINTI,IN WORKEPS'COMPENSATION INSURANC'c.AS REOUIRE�BY SECTION —/=�� Q 3]00 OF TNE LABOR CO[lE.FORTNE PERFORMANCE OFTHE WORK�OR WIIICH iH15 PERMIi IS — — � ISSUED.MV WORI(EFS'COMPENSATION INS�f NCE CARRIEF AND 70�IGV NUMBERARE: GONSTRUGTION j � �`V � � PLAN REVIEW CARRIE9. � L � PoucvNUMeEa ��_y�"" e _-.— '� ELECTRIC _._.___ ¢ (iNISSECTIONNEmNOTPEO7MPLEfEDO�iNEPERM1VTISFnF(YJEHUhORED0IX1AA5(f100�ORLE55�. PLUMBING ._ _ � w MECHANICAL Z I CERTIFV THAT IN THE PERFORMANCE O�THE WORK FOF WHICH THiS VE9MIT IS ISSUEU,I -. � SHALL NOi CMPLOV ANY FERSON I�'ANY MANNER SOAS TO BEGCME SUBJE�:T lO fHE vj WORNERS'COMPENSATI�J 1AW50f CAI�FORN�A AN�AGHEE TMAT If�SNOUI�BECOME INS"ECTION FEE j SUBJEGT TO TME WORK[RS'GOMPENSAiION PROVISIONS OF SECTION 3]OOOF iHE U80R � � Go�E,I SNALL FORTHJIITH COMPIV WITH THOSE PROVISIONS. ISSUANCE � SMIP p DATE:__ ,\PPIICANT'. _ -�- -- w ENERGY P/C J WARNING:FAILURE'O SEGURE WORKERS'COMPENSATiON GOYEHAGE I5 UNLAWFUL,AND SHALL BE � - `-- J � SUBJECTANEM'IOVERTOCHIAIINaLPENALTIESAN�GIVILFME5UP700NEHUNDREDTHOUSAND ENERGYPERMIT DO�v�RSIS:o0,0oo),INADDITIONTOTrIfCCS'OFCOMPENSA"ION,DAMAGESASPFOVIDEOFOflIN -- - �� -- J SECTION 3'1080F iHE LABOR CODE.INTEREST,AND ATTORNEv'S FEFS. f7ETENTION FEE: � _" d CONSTRUCTION LENDWG AGENCY PR6AI_T FEE� _.. � i MEFEBY 0.FFiqM UIrDER PENAI.fV VF PeRJURV INAI IHFRF IS ACON�TF�)CTION LENDING AG£NCY _ __ � FOq THE PEFFOFMANGE Of THE WUFK FOH WHICH THIS PERM�i IS ISSUEJ!SEC.309'!,CIV.C.�. Z — — W ? LEN�EH'S NAME_ ____ ---_ `� _ _._ _ S F— IENDER'SADDRE55 ,/� � I 1 +�I� � ICEflT'��Y!Y�ATiHAYEftEA�Tt11:iAPV�_'CA'I'JNANDS'ATETMATTHEAHO�EIN�ORMAi1nNI5GORFECT TOTAL FEES � 1 / w IAGHEETOCOMPLYWITMA�LGI'7YA UNTIOFOINAN(:ESANOSTATEIAW$RELATINGTOBUIID'NG � � CONSTRUGTIONANOMEREBYA RIZE EPRESENTAiIVESOFT COUNTYTOENTERUPi)NTHE ZABO' E ' JPRUPEP GflIN oNauarosE. COMMENTS �_ � '�� L� - -- — — m - MIIiEENAM (PRMT) � __-- - -- Q � s��'�--_ -- � SIGNAiI'R��P RMI�EE i �ATE _ \ 1 RECPT.\'O. __ PAID BY VALIDATION_ _ ~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—Fife Ccpy,GREEN—ApplicanYs Copy 4 h... �� ...� , � �: �_.. �, aw�. &.�u ere.r x l�.:'� s �q f -�p � v .. ..�k�'., ..� . �� . � � .. _�S� .. . �'3re � ny�� . . . . {<. . _ � � . .. . . .. .. ... .. . . . .. ..... ... . . . -y�-.� at�a€�� .wa . ..:. .... .. ...... ..._.. . ... ... . . . .�. �,g�,.a»c.a .�; �,,,.. mv� ... . . .... .... .. ... . . .. .. . .. .. ... . . .. ...... ... .... ...... ...... ..... .... .... ..... .. . .. .. '. . . . . .. .. . .......... .. ... .... .. . .... . .. ... .. . ... . . .... ._... . ,..... . ....... ...... . ... ... . .. ..��. .. .. .... . ....... .. ..... . . ..... .... .. . ... ... .. .... . . ...... . ...... ._.... ..... . .. .... . . ....� . . . .. . .... .... ... .. . . .. ... .... . .. ... . .. ... ........ ...... ....._ . ..... ..... . � .. . . . .. . ... .. .. . . ... ... . ... ...... . ....... ...... .. ...... . .. .. �: �,.� �a� °�k �.S"al�y ^k `�i%`:�'y' .. __._ .. ._.. ... ... � "5 rti"t;" �-r o � ". . .. ... . ... .. .. . ..... . ..... . .. - � � ��r f" Sd� t3, � ' ' < �, r� �., �� P;:� � _ �_ 4 .. ... ... ..._ _. . ._ .. .. � �;` �, ... ..�. �, ... . ..... . ._. ... . . ..... .. ._ . . . . .. .. .... . ..._ . ..... ...... ...... .. ... . . ��. �ufi�i.•, kh 4 �i,�::.. �.. � � �,. .e. _�� .. . . . . . . .. . .... .... . ...... ....... ... ... .._ _. ..... � hsq . � �� ; �� ' _ w. �:� � r,�� « � _ , w��w, � _ _ _ � � ��t. r ..�,�, . . _ CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION G�n JOBSITE A ADDRESS tiiJ .�'1 APN LOT TRACT ---C Cy OWNER t+Y� � > 1 ADDRESS CITY ZIP TE !r� APPLICANT TEL.- CONTRACTOR ADDRE r i N CITY ZIP TE 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- TORE. 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 SUBJEC ES THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($500)): ^ I,AS OWNE R OF THE PROPERTY. OR MY EMPLOYEES W iTH WAGES AS T HEIR 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 WI L 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 L.I. CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BIJIIDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW). LI I AM EXEMPT UNDER SEC. B. &P.0 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 PPOFESS:ONS CODE,AND MY LICENSE IS IN FULL FORCE AND EFFECT LICENSE CLA S C,LIC N0.TZi._h i WAb5 DATE--J��-_-_CONTRACTOi{.L WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINTAIN ACERTIFICATE OF CONSENT TO SELF INSURE FOR WORKERS' CCC��MPENSATION.AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE F THE WORK FOR WHICH THIS PERMIT IS ISSUED. HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE.AS REQUIRED BY SECTlON 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS'COMPENSATION INSU NCE CARRIER AND POLICY NUMBER ARE CARRIER �rv f 1 % 3'7)AC POLICY NUMBER (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 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 TO 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 PENAE:rY 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 I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT AGREE TO COMPLY WITH ALL CITY A UNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTlON.AND HEREBY A RIZE EPRESENTATIVES OF T COUNTY TO ENTER UPON THE ABO Vff E D PROPER OR IN ON PURPOSE f MITTEE NAM (PR,NT)0-2- SIG NATUREP RMI>q[EE DATE WHITE-Department Copy,YELLOW-Finance Copy, PIN 1)(r) PRESS FIRMLY APPLICATIC}I�^f z. 10 a PERM P/C DATE(J NUMBER(,h # ISSUE r� TYPE OCC 0 DATE V CONST GROUP ZONING SETBACKS FRONT RW REAR 1 1 SIDE/SIDE STREET RW^ SIDE PROPOSED USE<1�i el� VA-A N0. DWEL. N0. N0.I UNITS STORIES A BEDROOMS 1! DESCRIPTION S0. FT FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM U) Garage/Carport W Patio/Deck LL Poo(/Spa 0 Re-Roof Z 0 Commercial n f Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U I- U w W CD Z m a Q U Z 2 0 W L CONSTRUCTlON C?. PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INS?ECTlON FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES 12+9U COMMENTS RECPT N0. PAID BY VALIDATION