The URL can be used to link to this page

Home My WebLink About18593 �,� CITY OF DIAMOND BAR � DEPARTME�rT OF COMMUNTCY&DEVELOPMENT SERVICES C 21825 E.Copley Drive (909)860-3195 Fa�t(909)861-3117 • � PRESS "%�� BUILDINGPERMITAPPLICATION _ FIRMLY � JOBSITE O c 1 �.��r. /�_ � " APPLICAT M �y � PERMIT P/C o ADDRESS_ �v ' �7 (ti DATE R� V NUMBER k o ISSUE ^ TYPE OCC °-° APN�� LOT TR T �A7E , � CONST. GROUP p OWNER �.�'��IJ �}� . ��__ p ADDRESS -�-- ZONING SETBACKS Z CITY ZIP 7E ,ry -,� / � FRONT RW ❑ o APPLICANT TEL._ SIDE/SIDE STREET RW ❑ Z ¢ p SIDE ¢ CONTRACTQ (7__________ _ n Q ADDRE 1 .� _ _ � CITY ZIP l�TEL� ej PROPOSED USE UP I-(C� w ARCH/ENG/ ' � z �ESIGNER � ADDRESS �� -- NO.DWEL. NO. NO. UNITS STORIES �_BEDROOMS � CITY ZIP__ TFL._ � cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION ¢ OWNER-BUILDEA DECLARATION � SFR/ADD/REM p I HEFEBY AFFliiM UNDER 7ENALTV DF PERJURY'HAT I AM[MEMPT FPOM 7HE CONTRACTORS L'�- G229B/CdfpOlt � W CENSEIAWFORTHEFOLLOWINGREASON(SEC.]09158USMESSANDGROFESSIONSCO�E:A4YGITVOR (n Z COUNTVWHICHREQUIRESAPERMITTOCONSTRUC',ALTER,IMOROVE.�EMOLISH,CRREPAIRANYSTRUG W PBIIOIOBCk TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w STATEMENT 7HAT HE OR SHE IS LICENSED PURSUAIR TO THE PROVISIONS OF TIIE CONTRACTOftS LI� W � CENSE LAW(CHAPTER 9�COMMENGNG WITY�SECTION�000)OF DIYISION 3^F THE BUSINESS AND PRO- � POOVSPB FESSpNSGODE)ORTHATMEORSHEISE%EMPTTMFREFROMHNDTHEBPSISFORTHEALIEGEDEXEMP- � � TION.ANYVIOLATIONOFSEGTION�031.SBYANYAPPLICANiFORAPEHMI�5U9JE::fSIHkAPPI.iCAN7�0 Z Re-Root � ACIVIL PENA�TV OF NOT MORE THAN FNE HUNDRED DOLLARS�f5oo))�. � � ❑I.ASONMEROFTHEPROPERTY.OaMVEMPLOVEESW�THWAGESAS7HE;RSOLECOMPENSAiiON, ❑ Comm0lCiel Z WII L DO THE WORK,AND THE STRl1CTUilE IS NOT IMEND[�OH OFiEREO FOH SALE!SEC.]04d,BU"�� J � NESS ANO PROFESSIONS CODE:THE CONTRACTORS LICENS�LAW DOES NO"AGP�V TO AN OWNER OF ? PROPEFTV Nh10 BUILDS OR IM PROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF DP � THf7WGH HIS OR HER OWN EMPLOYEES,PROVIOED THAT£UCM IMPROVEMENTS ARE NOT MTENDED OR m QOFFEREDFORSALE.IF,HOWEVER,THEBU�LDINGORIMPROVEMEN'ISSOLDWITHINONEVEAROfCOMP�E- Z TION,THE OWNER-BUILDER WILL MAVE TME BURDEN OF PROVING�MAI HE OR SME DID NOT BUILD OR � IMPROVE FOR THE PURPOSE OF SALE�. w ❑I,AS OWNEROFTHE PROPERTV AM EXCLUSIVELVCCINTRACTING WITN LICENSED CONTRAC-ORS � TO CONSTRUCT THE PR0.IECT(SEC.704<,BUSINESS AND PROFESSIONS CODE:THF CONTRACTORS LI� VelUa�ion � ADJ.AREA W CENSE LAW DOES NOTAPPLV TD AN OWNER OF A PROPERTY WHO dUll f7S OR IMPROVESTMEREON.AND � WHOCONTRACTSFORSUCHPROJECTSWITHACONTRACTOq(511.ICEtv;CDPURSUANTTOTNECONTRAG QUANTITY DESCRIPTION FEE Y TORS LICENSE LAW). ¢ J Q ❑I AM ExCMPT UNDEfl SFG _ B.A P.C.FOR THIS REASON Q � U LL � DATE OWNER �' Z --- � --- -- U w � LIGENSED CDNTRACTORS DEGIARATION W Q CC I HEREBV AFFIPM t�NDEF PENALTY OF PERJl1RY'HAT i AM LICENSED tINOER PROVISIONS OF CHAP'FR � d 9(COM6IENCING WITH SEC'ION l000)Of�IVISION 90F THE BUSINESS AND G�AfESSiONS CODE,ANO Z `X MV LICENSE IS N FULL FORC N FFEC�T � m � LICENSE CLA S � �� 'JC.Nq. � I � L � _ � ��] J U DATE C� CONTRACTOR_\__y 1�N,� ` a W � WORKERS'COMPENSATION DECLARATION Q = U � I HEREBV AFFlRM UNDER PENALTY OF PERJURY ONE 0=THE FOLLOWING DECLARATIONS: Z Q O IHAVEANDWILLMAINTAINACERfIFICATEOFCANSENTTOSELF-INSUREFOPWORKERS' _ MPENSATION,AS PROVIDED 9Y SECTION 37000F THE LABOR CODE FOR THE PERFORMANCE U ¢ OF TME WORK FOR WHICN THIS PERMIT IS ISSUED. � � I HPV=ANO WILL MAINTqIN WORNERS'COMPENSATION INSUPANCE,PS REOUIRED BV SEGTpN n ` Q37oa OF TH'e LABOR CODE,FOR TME PER=ORMANCE OF THC WORK FOR WHICHTHIS PERMIT IS l/�Q I�� J ISSl1E�.MV Y/ORKE 'CO NSATI ANCE�RI"eR AND POIICY NUMBER ARE' CONSTRUCTION _ _._.._ . � (�� j cnaaiea_ � PIAN FiEVIEW zaoucvNUMeEa__�_�_ — � — ELECTRIC _ ', ¢ i � (iHISJEGTIONNEmNOTBEQx.APL.EIEDOFTNEPEHANi15FCRONEHUI�DREDDOl1/�i5(5100)ORLESS�. PLUMBING �. W II Z I CERTIFV iHAT IN THE PERFORMANCE O^THE WORN FOR WHICH THIS PERMIT IS�SSIJED,I MECHANICAL _-...._____._ _._..__._-_._ � SHALL NOT EMPLOY ANV PERSON IN ANY MANNER SO AS TO BECOME SU9JEf.1 TO THE i � WORKERS'COMPENSATION LAWS OF CALIFORNIA,ANO AGREE THAT IF I SHOUL�BECOME INS�ECTION FEE = SUBJECT 70 THE WORKERS'COMPENSAiION PROVISIONS OF SECTION 3`OJ OF TNE IABOR ` I GODE,I SMALL FORTHWITH COMPIY WITH THOSE PROVISIGNS. ISSUANCE � SMIP /f�__ I p DAiE�. APPLICANT�. _._ — -- J WARNING�.FAILJqE TO SECURE WORKERS'COMPENSATION COVERAGE I5 UNLAWFUL,AND SHA�L BE ENERGY P/C _ � SUBJECTAN[MPLOYER TO CqIMINAI.PENALTIES AND CIVIL FlNES UP IOONE HUNDRED THOUSAND ENERGY PERMIT } OOLLARS�f100,000�,INADDITIONTOTHECOSTOFCOMPENSAiION.DAMAGESASPROVI�EDFORIN -------�-- — J SECTION310NOFTHELABORCODE.INTEFEST,ANDATTORNEV'SFEES. I�ETENTIONFEE: � � CONSTRl1CTION LENDING AGENCY PRE-ALT FEE � O Q I HEREBV AFFIRM�NDER PENALTV OF PERJURV THA'THEiiE IS ACONSTRUCTION LE4DING AGENC,Y � �O{i THE f ER WRMANCE OFTHE WOFK FOR WNICH THIS PERMIT IS ISSUED(SEC.30B1,GV.C.). — Z W I j LENGEN'SNAME .___ _ � 1— LENDEa'SAD�RE55._ ____ _ � I CERTIFY 7HAT I HAVE READ THIS APPLICATION ANO S7ATE THAT THE ABOVE INF(1RMATICJN IS(:(]RRFCT TOTAL FEES I� � w I AGREE TO COMGI.V WITH ALL CITV AND COUNTV ORDINANCESA4D STATE L4W5 RELATING TO 9UILDING d � CONSTfiUCT'�ON,ANDHEREBVAUTHORIZEREPRESE4TAiIVE50FTHI5COUNTVTOENTERUPiJNTHE Z AOOVE-MERTI�H OPEFlTY�Oi11NSPE ' RPOSES. COMMENTS � J � -- -- m PERMITTEENAME!P �� ("� ---- Q ,� G' � SIGNATURE PER TTE[ � DR1E = RECPT.NO. _ PAID BY VALIDATION ~ WHITE—Department Copy.YELLOW—Finance Copy.PINK—Assessor CoDY•GOLDENR06—File Copy,GREEN—ApplicanPs Copy ;� �� .�� .. � =� �� a � ��- � b ��:�� z f . , ,� � �� A ��. ° � � w � _. �� . � :�—., ,�� .� ., ,,. _ � � . ��'�� _ _ � _ _ _ , ..... . . . . .... ...... ... . . . . . . .... .. 3 . . . .... ._... ..._.... _.._... ..... ._... . ....:; . . . . .. ..__ _.... ._.. ...... .... . ..._.'; __... ...... ...... ._... ...._. _.... . .. ..._ ..'�.. ,, .^ i� a��"� `��Ei �f��'g,lb }��_ _ _ _— — _ �C � t�n � 'dd,�C4' a , , : � �. � . . . .. . . . . .. ... .. . } � „�, � ',. '� � . , _.. _._ ._.. .__ _. . � a . .' .'J. 7; • � .. . . . . . ..... _..... _.. _. ...... .__.. _ . .. .. �,��.,y �' -. ._ ... .. ... ... . � �.F ��. ��rsl�1 .� . . . . . . _.... ..... . ... ... 1 � __. _... _. �-t � . . . . . . . ... . . . . . .. ... ....... ... ... ..... ....... . ..._ . . �� { I ` . . . . . .. . .. . . .. . . .. . .. . .. +r 4 } �'�.-s.. . .. . . . . ... ... .... .._ . .. .. . ... . . . . .... . .... .... ..... .... .. . DIA,110 D BAR U9 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 0 J EEO ADDRESS APN LOT TR OWNER\�'O�GYGRON ADDRESS A 1 R 4 CITY ZIP TE-.5 APPLICANT TEL. CONTRACT?&- ADDRE CITY ZIP q TEL DESINER/ DESIGNER L�'t 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,CR REPAIRANV 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 SUBJEC IS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($5M)). ^ I,AS OWNER OF THE PROPER TY.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. BU" (- 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 T. HAT 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 AUII.DO OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW). C I AM EXEMPT UNDER SEC. B. R 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 PPOFESSIONS CODE,AND T MY LICENSE IS IN FULL FORC N FFF EE L % 5 C 1 Ylr� LIC N0. 2 LICENSE CLASS wVAV 0 DATE CONTRACTOR I-G WORKERS'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 BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF 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 WORK! CO P NSATI ANCF,ORIER AND POLICY NUMBER ARE: CARRIER POLICY NUMBER (THIS SECTRY NEED NOT RE OCMPLETED OF THE PERMIT IS FOR ONE HUNDRED DOLLARS($100)OR LESS) IC E RTIFY 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 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 ACONSTRUCTION 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 COMPI-Y 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-MERT7�/4 OPERTY FOR INSPE RPOSES. PERMITTEE NAME(P 7 czTSIGNATURE PER TTEE)AA TE APPLICAT N (� �y PERMIT P/C DATE NUMBER # ISSUE TYPE OCC DATE LI_ CONST. GROUP ZONING SETBACKS FRONT RW ^ REAR ^ SIDE/SIDE STREET RW ^ SIDE ^ PROPOSED USE UD((C� N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM W Garage/Carport LLI Patio/Deck L LL PooVSpa Z Re-Root Commercial Valuation I- ADJ.AREA QUANTITY DESCRIPTION FEE J I- U J J w z m 0 Q 0 Z Q 0 W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT 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