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Home My WebLink About18591 f�_ CITY OF DIAMOND BAR � � i; DEPARTIv1ENT OF COIvIMUNTfY&bEVELOPMENT SERVICES � � 21825 E.Copley Ilrive (909)860-3195 Fax(909)861-31 l7 PRESS �' �� BUILDING PERMIT APPLICATION � � �. . FIRMLY � JOBSITE �� r-�u APPLICATIO `�/)^n� PERMIT a p/C o ADDRESS_ _ ""�/ DATE �`d �' NUMBER � � � APN LOT TRACT DATE � �} CO ST. GROUP p OWNER '. ��- _- p ADDRESS � ZONING SETBACKS Z CITY ZIP 7E , FRONT Ryy � � APPLICANT TEL._ REAR � 4 SIDE/SIQE STREET RW LI Q CONTRACTOR SIDE C — Q ADDR t- PROPOSED USE � � CIN �_'ZIP TEI�F��,�� w ARCH/ENG/ � z DESIGNER � w - NO.DWEL. NO. ! NO. a ADDRESS ^ � CITY ZIP TEL. UNITS STORIES � BEDROOMS ''`� m -- -- � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION p SFR/ADD/REM � I HEREBY AFFIfiM UNDER PENALTY OF PEPJVRY 7HAT I AM F%EMPT FROM THE GONTRFGTORS LI� Gdfd9B�C8fPOf1 W CENSELAWFORTHEFOLLOWINGREASONjSEC.'031.SBUSINESSAN�VSiOFE5510NSCpDE:ANYCIiYOR (f� � GOUNTVWHiCHREOUIRESAPEHMITTOCONSTRUCT,ALTER,IMOROYE.DEMOLISH,CFREPAIRANVSiRUC- W PBUO�DBCk W TURE,PRIOR TO ITS ISSUANCE,AL50 REOUIRES THE APPLICANT FOR SUCH PEI7MIT TO FlLE A Si[;NFD w � STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE VROVISIONS OF THE CONTRACTORS LI� � CENSE LAW(CHAPTER 9�COMMENCING WITH SFCTION�000)OF�IVISION 3 OF TNE BUSINESS AND PRO� LL' POOVSPd O GESSIONSCOOE)ORTHATHEORSHEISE%EMPT7HFREFROMANDTHE8A5!SFORTHEALLEGEDE%EMF� � U TION.ANVVIOLATIONOFSECTION]0�1.5BVAN✓APF�ICAN'FOR4PERMITSU9JECf57HEAPPUCANTTO Z Re-Roof S A CIVIL PENALTV Oi NOT MORE THAN F VE HUNDRED DOLLARS(f5oo)��. Q71,ASOWNEflOFTHEPflOPER'TY,ORMYEMPLOYEESWITHWqGESAJlHE�RSOIE(XJMPENSATiON, 0 COff1R10ICi21 Z WILL DO THE WORK,MND THE STRUGiJRE IS NOT IN i ENOLD GR OFFERED FOH SALE(SEC.70<4,BU��I� J � NESSAND PHOFESSIONS CODE:THE CONTRACTORS L'CENSE LAW GO�S NC'AVPLY TO AN OWNER OF � - PROPERTVWHOBUILDSORIMPRDVESTNEREGN,ANDKM1IODOESSUCNWORKNIMSELFORHERSEIFOF wTHHOUGH HIS OP HER OWN EM�IOYEES,PROVIDE[7 ThAT SUCH IMPROVEMENTSARE NOT INTEN�ED OR m � OFFEREDFORSALE.IF,MOWEVER.TiEBUILDINGORIMPROVEMENTISSOLOWI7HINONEYEAROFCOMGLE- Z TION.THE OWNER-BUIIOER WII_L HAVE THE BUR�EN OF PROVING�HAT HE OR SFE DID NOT BUILD OH � IMPROVE FOR THE PURPOSEOi=SALE). . �y,� L`I.AS ONTIEROFTHE PRUPERTV AM E%CLUSNLLYCONTRACTING WITH LIGENSED CONTRAC?ORS � TO CONSTRUC?THE PROJECT�SEC.]osa,BUSI�ESS AND?ROFESSIONS CODE:TME CONTRPGTORS ll� V0IU2IIOf1 ADJ.AREA I W CENSE UW�OES NOTAPPLY TiJ AN OWNER OF A PRO°EaTV WNO dVII.DS OR IMPFNJVES TMEiiEON,FND � WHOCONTFACTSFORSUGHPROJEGTSWITHAGONTRACTUR(SIIICEM1S[OPUHSVPN710THECONTRAC- QUANTITY DESCRIPTION Y TORS UGENSE LI1W). _ FEE Q ❑I AM E%EMPT UNDER$E�. _ __. ... - - B.8 P.C.FOR THIS REASON Q � U � DATE OWNEP� 1- Z — — — - U � LICENSED CONTRACTORS DECLARATION w d CC I MEflEBYAFFIRM UNDEfl?ENAITY OF PERJURY iNAT I AM IICENSED JNDER GRG'JISIONS OF CHAPTEa � d 9(COMMENCING WITH SECTION 7000)OF DIVISION J OF THE BUSINESS AND PPOFc55JNS CODE,AND Z `X MY UCENSE IS M FULL FORCE�jND EFFECT. J� /' m � UCENSE CLASS C s��" L F�r C__ LIC.NO._�V I W I� � H � (��►/' U DATE ��7G. _ CONTRAGTO .�]�+cd1 � a W � WORKERS'COMPENSATION DECLARATION Q � I HEREBV AFFIRM UNDER PFNAITV OF PERJURV ONE OF iHE FOLLOWMG nFCLARATIONS. V � Z � I NAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENTiO SELF�INSURE FOR WORKERS' a Z = Q MPENSATION,AS PROVIDED BV SECTION 310o nF TME LqBOR GO�E,FON THE PERFORMANCE U Q OF THE WORK FOR WHICH THIS PERMIT IS ISSUE�. � w 1 HAVE ANO WILL MAI�TAIN WOkKEFS'COMGENSATIDN INStiRANCE,AS REOUIRED BY SECTION (((111 /� Q3]0o OF THE LABOR CODE.FOR THE PERFORMANCE OF THC WORK FOR WHICH THIS PERMIT IS —Q�/ r LA� J ISSUED.MY WORK "OMP ATIOjyyy�lRANCE C�RRIER AN�POUCV NUMBERAqE: CONSTRUCTION _� ��_�__��U GARRIER �VtI��V > PLAN REVIEW ZPOLICYNUM6ER_,I�� Z --.— ELECTRIC Q — � (iHissEcnCNNEmNoii3E�Ma�ErEooFnEFEwu'isFOi'iavENuwaEo00.lnRs(Eim�oaLess). PLUM�BING W Z I CERTIFY THAT INTHE FERFORMANCE OF THE WORK FOR WHICM TNIS PERMII IS ISSUED,1 MECHANICAL CJ SHALL NOT EMPLOY qNY PERSON IN ANY MANNEF SOAS TO BECOME SUBJEf:T TO TNE � — (n WORKEFS'CONPENSATION LAWS OF CALIFORNIq,AN�J AGflEE THAT IF I SHOULD BECOME INS.'�ECTION FEE = Sl19JECT TO THE WORK'eR5'COMPENSATION PROVISIONS OF SECTION 370[OFTHE LABOR - � -- CO�E.I SHALL FORTHW TH COMPLV WITH THOSF PROVISInNS. ISSUANCE � � �— p DATE: 4PPLICANT: SMIP W — J WANNING�.FAILURE TO SECUFE WORNERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHAlLBE ENERGY P/C ___1 � SUBJECTAN EMPLOVEF TO CRIlAINAL PENALTIES AND CIViI FMES UP TO ONE HUN�REDTHOUSANO ENERGY PERMIT � � DOLLARS(t100,000).IN A�DRION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDEO FOP IN _ . _ _ J SECTION3]OBOFTHEtABORC.()�F.INTEREST,ANDATTORNEV'SFEES. CC RETENTION FEE: a OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: _, _ Q IHERE9VAFFIRNUNCER�ENAITYOFPERJURVTHATTIIEREISACOh:SiPUCTION�ENDiNGAGENCY � FOR THE PEHFORMAM10E OF THI=WOFK FOR WHICH THIS PERMIT IS ISSUEO(SEC.3091,CIV.C.). — — Z W S LENDEN'SNAME_ ___ _ � LENDER'SADD{iFSS � � � TOTALFEES ^ � I CERTIFV THPT I MAVt HtFU 1HI5 APPLICATION AND STATE THAT THE ABOVE INFORMATION IS COqqECT � ` j�` �� I AGREE TO COMPLY WITH ALL CITY AN�COUNTV ORDINANGES AND STATE SAWS RELATING TO 9UILDING / � CONSTRUCTION.ANO HEREBY AU7HORIZE REPRESENTAT�.VES OF THIS NTY TO ENTER UPUN THE !� Z ABOVE�M TIDNED PROPERTV=0R INSPECTION PURPOSES. COMMENTS � J � _. _ _- m PE TTEENAME T) � Q _- �_ � °' �-��--- � � SIGNATURE OF�PE IFEE DATE � � RECP?.NO. __ PAID 8Y _ VALIDATION WHITE-Department Copy,YELLOW-Finance Copy,PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-AppliCanPs Copy � ��.��,� ._ � ;� � ,w� � �� "�� - `� �°� � � � � � ., • �o = � ��e ._., .�.��'�� . � i� _ _ _ _ : _ � -�� ,��n � �E�.. �� a ,�, �,� , .. �--- _. � ,�. � '�� .. -- _ . _. __ _ _ _. _. . _ __ _ ___ ' _ _ __ _ _ _ _ _ t _ _ S » � �� e.�� '�� i'�. ,r,��4�' , � ,, �� _ 4;�a i i e u d2i „ . . . . . . .. . . . . ..... .... .. ... . .. ... ... ..... . .. ,i. � �a � ,pr- �x� � . .. .. .. ... . .. ... . .. . . . . . ...... ...... . ....... . ..... ...... ..... ��; I C� ` i � � ��.� � � �, �- + _ _ . ,� r , _�„ M ii . ..... . �. F f. � �� .. .. . .. . .. . .. . .. .. . .. . .. ...... .... . . ...... ... ... ... ... ... .... . �. �� i £ � � ` , .��. 4 :.. ....... . . . .. ... ...... .. ... . . . . . .... ... . .. .. .... . � CITY OF DIAMOND BAR DEPARTMENT OF COMMUNffY&DEVELOPMENT SERVICES 21825 E.Copley LJrive (909)860-3195 Fax(909)861-31 17 BUILDING PERMIT APPLICATION JOBSITE�� ADDRESS I! + APN LOT TRACT__ OWNER' ' �� ^�%�,�,�,�,�,�, ADDRESS CITY ZIP 7E�' APPLICANT TEL. CONTRACTOR ADDR CITY� ZIP TEI( ARCH/ENG/ DESIGNER +� ADDRESS CITY ZIP TEL. OWNER-BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM F%EMPT FROM THE CONTRACTORS Lt CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE: ANV CITY OR COUNTY WHICH REOUIRESA PERMIT TO CONSTRUCT,ALTER,IMPROVE. DEMOLISH,CR REPAIRANV STRUC- TURE,PRIOR TO ITS ISSUANCE,AL50 REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUAPT 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 E%EMPT THPRE FROM AND THE BASIS FOR THE ALLEGED E%EMF� TION.ANV VIOLATION OF SECTION 7031.5 BV ANV APFLICAN' FOR A PERMIT SUBJEC(S THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(5500)I. ,7 I,AS OWNER OF THE PROPERtt,OR MV EMPLOYEES WITH WAGES AS 1HFIR SOLE COMPENSATION WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED CR OFFERED FOH SALE;SEC. 7oA4, BUSK NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW GOES NO'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 COMPL E- TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING ',HAT HE OR SHE DID NOT BUILD OH IMPROVE FOR THE PURPOSE OF SALE). L� I,AS OWNER OF THE PROPERTY,AM E%CLUSIVELY CONTRACTlNG WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT;SEC. 7osa,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI� CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO d'J II.DS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(SI I ICEN SED PURSUANT TO THE CONTRAC- TORS LICENSE LAW). I AM E%EMPT UNDER SF�. B. 8 P.C. FOR THIS REASON DATE OWNER LICEt7SED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENAL N OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PPOFESSIONS CODE,AND MY LICENSE IS IN FULL FORCE ND EFFECT. /' L^'j/ LICENSE CLASS C L LIC. N0. �V A + � / ( i DATE L' �r CONT RACTO �� WORMERS'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' MPENSATION,AS PROVIDED BV SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. 1 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 WORK''OMP ATIO[�}y$y1RANCE CARRIER AND POLICY NUMBER ARE: CARRIER-'-I��V"nJt(VJ POLICY NUMBER, � �=1 ��-�_�_ (THIS SECTION NEED NOT RE OJMPLETED OF THE PERMIT IS FOF ONE HUNDRED DOLLARS(St00)OR LESS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, 1 SHALL NOT EMPLOY AM' PERSON IN ANV MANNER SO AS TO BECOME SUBJECT TO THE WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME SIIBJECT TO THE WORK'e RS'COMPENSATION PROVISIONS OF SECTlON 3700 OF THE LABOR CODE.I SHALL FORTHW TH COMPLY WITH THOSE PROVISIONS. DATE: 4PPLICANT: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRIIAINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS(t100,000),IN ADDITIOtI TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37080E THE LABOR CODE. INTEREST,AND ATTORNEY'S FEES. CONSTRUCTlON LENDING AGENCY 1 HEREBY AFFIRM UNDER PENALTY OF PE RJU RV THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THI=WOFK FOR WHICH THIS PERMIT IS ISSUED(SEC. 3097,CI V.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 CAWS RELATING TO BUILDING CONSTRUCTION.AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS NTY TO ENTER UPON THE ABOVE�M TIONED PROPERTY =OR�INSPECTION PURPOSES. J�V PE TTEE NAME T){(/y��/_� SIGNATURE OF PE IFTEE Dq WHITE-Department Copy,YELLOW-Finance Copy, PIN PRESS FIRMLY