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Home My WebLink About17827 CITY OF DIAMOND BAR �x�`r� ��` DEPARTMENT OF COMMUNTI'Y&DEVELOPMENT SERVICES I 21825 E.Copley Drive � (909)860-3195 Fazc(909)861-3117 PRESS \�»�~ BUILDING PERMIT APPLICATION FIRMLY o� JOBSITE , APPLICATION ADDRESS_ ' �) DATE ��' PERMIT � �/� p/C NUMBER d g °O APN L TRACT ISSUE TYPE OCC DATE CONST. GROUP p OWNER � — p ADDRESS ZONING SETBACKS z C�T�' � ' ZIP TEL. FRONT RW n p APPLICANT TEL. REAR � z SIDE/SIDE STREET R�y C, a CONTRACTOR SIDE �- � ADDRESS � C�TY ' EL. PROPOSED USE 0 o ARCWENG/ z DESIGNER nw. ADDRESS NO.DWEL. NO. NO. UNITS STORIES � CITY ZIP TEL. BEDROOMS � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATIDN Q OWNER-BUILDER DECLARATION O SF WADD/REM p I HEREBY AFFIpM UN�ER PENALTV OF PEFJURY THAT I AM E%EMPT FROM THE CONTRACTORS LI- Gdlfl B/Cd W CENSEUWFORTHEFOLLOWINGREASON�SEC.7031.58USINESSANDPROFESSbNSCODE:ANYdTVOF (n 9 �On Z COUNTVWHICHREOUIRESFPERM17TOCONSTRUCT,ALTER,IMPROVE,�EMOLISH,ORREPAIRANVSTRUC- w TURE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FlL[A SIGNED w Patio/Deck �w $TATEMEN7 7HAT HE OF SHE IS LICENSED VUf75UANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW�CHAPTER 9(COMMENCING WITH SECTION]000)OF DNISION�OF THE BUSINESS AND PRO- � POOVS(J8 O FESSIONSCODF)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEAIIEGEJE%EMP- (!J U TION.ANYVIOLATIONOFSECTION]o31.5BYANVAPP�IGANTFOFAPERMITSUBJEGTSTHEAPPLICAN7T0 z Re-Roof F A CIVIL PENALN OF NOT MORE THAN FNE HUNDRED DOLLARS(f500).): � ❑I,ASOWNEROFTHEPROPERiV,ORMVEMPLOVEESWITHWAGESASTHEIR50LFCOMPENSATION, � CORlmOfCidl Z WILL DO THE WORK,AND THE STRUCTURE IS NOT INTEN�ED OF OFFERE�FOR SALE�SFC.]oda,BU51- .J � NE55 AN�PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW�OES NOT APPLV TO AN OWNER OF � PROPERTV WHO BUILDS OR IMPROYES THEfiEON.AN�WHO DOES SUCH WOPK HIMSELF OR HERSELF OR WTHROUGH HIS OR HER OWN EMPLOVEES,PROVIDE7 THAT SUCH IMPROVEMENTSARE NOT INTEN�EDOR m Q OFFERE�FORSALE.IF,HOWEVER,THEBUILDINGOq1A1GROVEMENTI550LDWITHINONEVEAROFCOMPLE- Z TION,THE OWNER�BVILDER WILL HAVE THE BURDEN OF PROVING THAT HE DR SHE DID NOT BUILD OR � IMPROVEFORTHEPURPOSEOFSAL[). w ❑I,ASOWNEROFTHEPROPERTY,AME%GWSIVELVCONTRPCTINGWITHLIGENSEJCONTRACTORS � TO CONSTpUCT TME PR0.)EGT(SEC.�oaa,BUSINESS AN�PqOFE5510N5 CODE:THE CONTRACTORS U- VelUetlO� ADJ.AREA W CENSEUWDOESNOTAPPLVTOANOWNEfiOFAPROPERTYWHOBUILD50RIMPROYESTHEREON.AND = WHOCONTRAGTSFOqSUCHPROJECTSWITHACONTRACTOR(S)LICENSEDPUPSUANTTOTHECONTRAC- QUANTITY DESCRIPTION ~ TDRSLIGENSELAWJ. FEE Y � ❑I AM EXEMPT UNOER SEC. B.8 P.C.FOR THIS REASON J � U LL OATE_ OWNER � z _ U Q� LICENSED CONTRACTORS DECLARATION � W � I HEREBVAFFlHM UNDER PENALTY Oi PER�URY THAT I AM LICENSED UNDER PROVISIONS OF CNAPTEq � n � B(COMMENCINGWRHSECTION7000�OFDIVISION30FTHEBUSINESSAN�PROFESSiOVSCODE,ANO Z �X MV LICENSE IS IN F F E AND EFFECT � �/] r/7 m � UCENS ��'– LIC.NO. "" �" � y� � U DATE. CONTRACTOR 4 I d w J (/L 1 l�- � WORKEFiS'COMPENSATION DECLAftATlO ¢ � � I k1EREBV AFFIRM UNDER 7ENALTV OF PERJURV ONE OF THE FOLLOWING DECLARATIONS: U U� Z � _I HAVE ANO WILL MAINTAIN A GERTIFICATE OF CONSENT 10 SELF-INSURE FOR WORKERS' a Z = ¢ COMPE ATION,ASGROVIDEDBYSECTION3�OOOFTHELABORCODE.FORTHEPERFORMANCE U WORN FOF WHICH THIS PERMIT IS ISSUED. � O W I HAVE AND WILI MAINTAIN WORKERS'COMPENSATION INSURANGE,AS REOUIRE�BY SECTION Q3TOOOF THE 1,�4BOR CODE,FORT E PERFOFMANCE OF THE WORK FOp WHICH 7HI5 PERM1715 J ISSUE�,MY K 5'.�O N TION I U CE CAqRIER AND POLICY NUMBERARE: CONSTRl1CTION � � j CnaaiEa PLAN REVIEW � POLIGV NUMBEFi ELECTRIC Z _ . Q 0 (IFIISSECTKYJNEmNOTBEWMFLETE�OF'FIEPERMITISf-0RIXJEHUf�DREDDOLLqRS(5100)ORlE55). PLUMBING � � W .. Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOP WHICH THIS PERMIT IS ISSUEU.I MECHANICAL C.�S SHALL NOT EMPLOY ANY PERSON IN ANV MANNER 50 AS TO BECOME St18JECT TO THE (/) WORKERS'COMPENSATIONLAWSOFCALIFORNIA,ANDAGREETHATIFISNOULDBECOME INSPECTIONFEE � SU6JECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3lD OF T E LABOR � c i /�^q T wirHcoua�vwiru,y� ba vi ioNs. ISSUANCE O (/ / - p DATE:� � , � "�qPPLICANT: �=��'�'� SMIP W 'J WARNING�.FAIWRETOSECUREN/ORKERS'COMPENSAiIONCOVERAGEISUNIAWFUL,ANOSHALLBE ENERGYP/C J � SUBJECTANEMPLOYERTOCRIMINALPENALTIESANOCIVILFMESUPTOONEHUNDREDTHOUSAND ENEFGVPERMIT DOILARS(f100,00D).IN AOOITION TO THE COST OF COMPENSATION,DAMAGESAS PROVIDED FOR IN J SECTION Jl]e OF THE LA60R CO�E,INTEREST,ANDATTORN[Y'S FEES. RETENTION FEE: v � W O CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � I HEREBV AFFIRM UNOER PENALTY OF PERJURV THATTNERE IS A CONSTRUCTION LENDING AGENCV �� FOR THE PERFORMANCE OF THE WORN FOR WHICH THIS PER611T IS ISSUED(SEC.3oe�,qV.C.�. -�- Z W � LENDER'S NAME � H LENDEf7SADDRESS � ^'"� w I CERTIFY THAT I HAVE REA�THIS APPLICATION AND STATE TMAT THE ABOVE IAFORMATION IS CORRECT. TOTAL F E ES / � d I AGREE TO COMPLY WITH ALL CITV AND COUNTV OR�INANC:ES AND STATE LAWS REIATING TO BUILDING ��j CONSTRUCTION.AND HEREBY AUTHORI2E REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE Z ABOVE�MFNTION D GROPF�R V FOq I SPECTION PURPOSES. � �� . � � �� COMMENTS J � m P EEFJyM�� RIN '� n M [n L. L [:L _._ � 51 NA RE OF PEFMI E �ATE � RECPT.NO. PAID BY VALIDATION WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy i ��. �w �� `�d w..�,�r '� � ��ti,`�'� '�`� iu � �i �� u�� `.��° r ��.�a . w`�� . N � .,�. _a .. , ..�, � -� . �. . . � , .. ,� .�� ` +.nc r • '_ h . , . ..... . � . . ��. . '�� ... �-.. � _ . . .. ._. .. ' � t yF _ ... . . . . . .. ... ... __ _ . . ... '. r � � ��9� .. ... �.,. � �. 5 m,z..,iisf§�'r�'�r.`C+ .. ... ... ��. .. ... . .... ... .. ... .... . .. ..... ...... ..... . ...... .... . . ... ji i . . . . . . .. .... .. . . .. . . . . . . .. _ . . _. ... . �. �,'��i�� i��i E��9 � �� a�s��€��y ��,?�� s ��i �a�' ,r � �ak�,��,��' ��, - ' �' �� =,' _ 7 m e � � u � .-. '.. " £� � �6_ '' . � ,�oa �.r� i .. .. . . .. . ... .. ... . . . .._ ....... �, -',r i'. r �, x��u� �`. �i � y�re �� r i��F —u�� €il�C�� . '4 ar § � ��. J ... . . .... .... . . .. . . ... ..... . � ''` ' � �, . . . ... . .. . . . . . . __. .. �t,E,�� ,�_�k m fi.: k a� � � >�� .„� §�.a,- �i� �.i�� '�� n�' .. .. . ... . . .._ . ... .. .. _.. .._. . .. .. .. '�. .= ,r a , , ._ . . ... . _ ... . ... _ .. ._ ; b� . r �t� � � :a�. � e g 0 " '. t �Gq&� � '"i�t . ._. .. . . . .. .. ._ . ... . . . .._.. . . .. 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 APN L TRACT OWNER ADDRESS CITY ZIP TEL. APPLICANT TEL. APMAN CONTRACTOR 3823 I d n ushyAn. ADDRESS CITY EL. ARCWENG/ 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 REQUIRESA 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 THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($500).): ^ 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 NOTAPPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). EI 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 B(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN F SAND EFFECT. LICENS LTC. N0. DATE.CONTRACTOR 4 1 c WORKERS'COMPENSATION DECLARATI 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' COMPS ATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMANCE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION 3700 OF THE IAABOR CODE, FORT E PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY K S',S N TION I U CE CARRIER AND POLICY NUMBER ARE: / CARRIER/ 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 370 OFf LABOR ,I TH COMPLY WIT R VI IONS. ij DATE:/APPLICANT: V 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 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 I CERTIFY THAT I 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 ABOVE.ME ITION D PROP R Y FOR I SPE5 TION PURPOSES. fl 111C (C ME FJyMN1EE RIND LZr Z L SI NA RE QF PERMI E DATE IF r 14 APPLICATION r PERMIT/P/C DATE I "I, �J1 NUMBER I 0�� # 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 LL PooVSpa 0 Re-Roof Z Commercial co Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U 0 w W 0 n Z m U W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING b MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT � 3(2) 1 RETENTION FEE: PRE-ALT FEE: TOTAL FEES COMMENTS RECPT. N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy