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Home My WebLink About18594 (11) CITY OF DIAMOND BAR �'�` DEPARTIvIE'��T OF COMMUNTtY&DEVELOPMENT SERVICES 21825 E.Copley Drive " (909)860-3195 Fax(909)861-3117 : � PRE$S � �.�^� BUILDING PERMIT APPLICATION � I FIRMLY } JOBSITE �/1 r1� ��- _ APPLICA �7 PERMI rC,j P/C o ADDRESS_ V av _ _ DATE � ' ��' NUMBER� � # m ISSUE � TYPE OCC APN--7�� LOT TA`A^C,T�,, ,� DATE_ � � �+ CONST. GROUP p OWNER ��[/W�I!-t�LR.k�w I�J'TY�i� _ " ADDRESS ��-- � ZONING SETBACKS � ' FRONT RW ❑ OCITY Z1P 7E � REAR f]_ o APPLICANT TEL_ SIDE/SIDE STREET RW ❑ a CONTAACTO SIDE ❑ � ADDRE M — PROPOSED USE � C�7y ZIP TE - � w ARCH/ENG/ �/^ "'" z DESIGNER �rX-�- ------ NO.DWEL. NO. NO. a ADDRESS_ � � UNITS STORIES __�BEDROOMS � CITY ZIP_� TFL._ N DESCRIPTION 50.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR(ADD!RFM i O � I HEREBV AFFIRM UNDER PENALTV OF PERJURV 7HAT I AM F%EMPT FROM iHE CONTRACTOq$LI- � Garage/Carport W CENSELAWFORTNEFOLLOWMGREASON(SEG.r03+..5flJ54NE5SAN�VapFES510NSCODE:ANVCITYOR _ U COUNTVWMICHPEOUIFESNPEHMIT�OCONSTRl1CT,ALTEP,IMOROVE.DEMOLISH,CRREPAIRANViTFt1C- W P8[IO/DOCk wTURE,PFIOR TO ITS ISSUANCE,RL50 REOUIRES THE APPLICAM FOR SUCH PEFMIT TO�ILE 4 SiGNED w � STATEMENT iFAT HE OR SMe iS LICENStD PURSUAtJT TO THE GROVi>ION��F THF cONTRACTORS li- � CENSE LAW(CMAPTER B(COMMENGING W�7N SF(:TION 1a0o)OF�IVISION](`F THE BUSiNE55�N�P�10- u" PooVSDB O FESSIONSCODE�OFTHATNEORSHEISEkEMVTTH�PFFROMANDTHEBASISFORTH[ALLEGEDExEMY� � U TION.ANVVIOLATIONOFSECTION]03t,5B�ANYAPPLICAN'�ORAPERMRiJ9JE[:ISIHf.qPPLIGANTTO Z Re-Root � AQVILPENALTVOFNOTMOR[THANFlVEHUNDREDDOLLARSff50o!)'. O ��I,ASOWNEROFTHEPfiOPEF?Y,ORMYEMPLOY�ESW�.THWnl:ESA��I�fF;aGOLECO4PEN5AT�ON, ❑ Commercia� Z WILL DO TME WOflK,ANO THE STRUGNFE IS NO7 INitND[D OF OFFERED FOH SALE!SEC.7p46,BU:'.I� J NE55 AND PROFESSIDNS COOE THE CONTRACTORS LI::ENSE LAW CiOES NO"A�PLV TO FN OWNER OF � PqOVEaTYWr40BUIlD50RIMPRO'JESTMEREON,AN�WHODOESSUCNWOfiKNIMSELFORNEflSF'�.FOR � � THROUGM HIS OR HER OWN EMPLOYEES,PFOVIDED THAi SUCH IMPROVEMFNTSARE N(�T MT[NDED OR � w OFFEREOFORSPLE.I�.HOWEVERT1iEBUILOMGORIMPROVEMFNT15SOLDWITHIN(1NEvEARO�COMP�E � TION.THE OWNER-BUILDER WILL HAVE 1HE BURDEN OF PRDVING'HA7 H[OR SHE�IO NOT Bu1LD OH Z IMPROVEFORTHEPUPPOSEOFSALE). � �1,AS OWNER OF THE PROPERTY,PM EXCLUSIYE�V C(1NTRACTiNG'NI(H LICE`�SED CONTflACTORS � TO CANSTRUCT THE FROJECT(SEC.]066,BUSINESS FN'J PRUFESSIUNS CODE.TME GONTR�CT(JHS LI- V8I112IlOfl ADJ.AREA_ W CENSEUW�OESNOTAPPLYTOANOWNEAOFAPROPERTVWHOdt:I1.D50HIMPFOVESTHEREON,AND = N1-IOCONTRACTSF�RSUGHPROJEGTSWtTM0.GONTRACTOR�:�1�cEM1�CD�U435UANT10TliECAN?RAG QUANTIN DESCRIPTION FEE ~' TORSLIGENSELAW.). Y J � i;1 AM E%EMPT UNDER SFC.___ .._ ___—_B.d PC FOR TM�S REASON U � ' —__ � i � DATE __ CWNEfl __— —____ U �"— Z W � LICENSED C'JNTRACTORS DECIARATION W ¢ � 1 HEREBY AFfIPM'.;NDER?ENALTY OF PEqJURY THAi I AM LICENSED J�vDER PPOJ�SIONSOF CNAF?ER � � 9(GOMMENCINGWITHSEGTION7o00�OFDIV1510NJOFTHEBU51NES5AfvDPPOFES51JM15CODE.AND Z X MY LICENSE IS IN FULL ORC q D EFFECT � �, � , - � � � UCENSEC SS _ _ UC.N0.. � J U DATE D __ CONTFACTO�,_ . . � W a=�' WORKERS'COMPENSATION DECLARATION a � U � I NEREBV AFFlRM UNOER PENALTV OF FERJURY ONE OF THE fOi IGWi`1G DECLARAiIONs Z Q � _IH ANDWILLMAINTAINAGEPTIFICATEOFGONSENTiOSEIF�INSI.'REFORWORKEFS' _ Z PENSATION.AS PROVIDED BV SECTION 3�oD OF TnE LPHOR CO�E FOF THE 7E9FORMANCE w Q F iNE WOFK FOR WHICH THIS PeRMIT IS ISSUED. � � w I HPVF AND WILL MAINTAIN WORKCRS'COMPENSATION INSURANCE,AS FEOUIRED BY SECTION . /"` 4 �10a OF TH'e 1A60RCODE,FORTHE PER�OPMANCE OFTHE WORK FOft WHICH THIS PERMIT IS y � ISSUED.MV WOP S'C PENSATIo,r.�y�ANCE Gq+�—R�IENAND PULICY NUMBERARE: CONSTRUCTION _.._._ __ ¢ ��{/ PLANREVIEW ] cnRR�.Ea__o� - --- - 0 POLICV NUMBER � �'�=_'?��, -- ELECTRIC . . Z Q � (iHISSFf.i1C✓JNEmNLTBEO7MRETEDOF'M1IEPERANiISFOFONEHUNDREDD01.l.efi£(E10D)ONLCSS) PLUMBING _.__ w MECHANICAL Z 1 CERTIF'/TMAT INTHE PERFORMANCE Of THE 1YOPK FOR WHICH TMIS PERMIT IS ISSUED.I — �}' SMALL NOT EMP.OV PNY PEHSON IN PNV MANNER SOAS TC BECOME SU6JEl:T TO THF INS?ECTION FEE � WU�KERS'GOMPENSATIGN UWS OF CAUFORNIA AM1D AGREE TM4T IF I SHOULD BECOME � SUBJECT TO THE WOFKERS'COM>ENSAT ON PFlOVISIONS OF SECTION 37]OOF THE LABOR I ISSUANCE _ � CODE 1 SHALI FORTHWITH GOM7 Y WITH TH(1SE PROVISIDNS . _-7� O �� SMIP _ f.7� � DATE _'__ APPLICANT _ ._ w ENERGY P/C _ _ J WAFNING:FAILUHE TO SECVRE WORKEflS'COMPENSATiON COVERAGE I5 UNIAWFUL,AND SHALLBE J SU&IECTANEMPLOVERTOCRIMINALPENALTIESANDGIVILfWE5UP700NEHUNDREDTHOUSAND � ENERGY PERMI� ._ _ � _ DOLLARS IS100,D00).IN ADDITION"G THE COST Of GOMPENSPTION.DAMAGES AS PROVI�ED FOR IN r'T � SECTIDN 37080F TNE LABOa(;OpE.INTEREST,ANOATTORNEV'S FEES. RETENTION FEE: � w CONSTRUCTION LENDWG AGFNCY PRE-ALT FEE: � — � i HEHEBY AFFIRM JYDER PENALT�OF PENJRV THAT THERE IS ACONSTFUC?�ON LENDING AGENCV _- � FOR THE PERFORMANCE OF iHE WOFK FOR WHICFI THIS PEFMIT IS ISSUEG ISEC.3C91.CIV C.�. Z W � LENJEH'S NAME___T _'_ ___,.— — _ _ _ H LENDER'SADC�RFSS._ ---- � -- TOTAL FEES , w I CERTIFY TNq' MAVE RtAV iHiS AP9LIGFTION AND STATE THAT�ME ABOVE IIvFORMATIO�15 CURRECT. � � I qC;HEE�O COMPLV WITH ALL CITV AhD COUNTv ORDINANCES AND STATE LAWS RELATING TO BUILDING � CONSTRUCTION.AN'J HEREBV AU'HORIZE REP PTNES OF 1'HIS COVNTV TO ENTER UPJN THF Z ABOVE-M NEG 7ROFERTY=0R INSP N PUR� SES. COMMENTS . — 0 J � —__— m PE ITTEE NAME(PR /��s /1� '----- - - -- Q `7 (f� _ __—____."__. —"" ._ — � SIGN0.T1iRE �£R IiLCC DATE HECPT.NO. PAID BY VALIDATION ~ �iTE-Depanment Copy,YEU.OW-Finance Copy,PWK-Assesso�Gopy,GOIDENRO�File Copy,GREFN-ApplicanCs Copy ��, . ,. , � � . � � x � � � �° �� , � ,�� w " . � ��k " � � " �, � ' ,�`� • ,. , � : . . k� o��.. � ��<�. . . �� _ _ __ _ _ _ _ m ��,�.� � ,� _ ��` �� +�� ,' , s;,, _ _ _ _ __ _. _ _ ' _ . __ _ _ __._ . i �� 1 �� .� �� 1 _ _ _ _ _ x, r ;�;��?�� 6 ��,tr� � � , "'k � i� : _ � �s �� , _ �%d ¢ �<<,. ,., , .. .. .. . . . . . . .. .. ... . . ..... ...._. .... ...... ....... ' ..�'�.' �. �• `g",;r I a ;n � �{ dv �9 .. . .. . ... .. . .. .... __. ._... ... .. . ... . �� € ��. � � �,'��"�� t . .... .. . . .. . . . . . ... .... . . .. .. _ . . _ ..... . ,� +��.�a��_... a.. . . .... . . . ..... . .. .... .. .... .. _.. . .. ...... . . .. ....... ... � CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION JOBSITE/� ADDRESS p t.)C_AN�ff Vr§) APN LOT TRACT OWNER IMNttfLRE�7ti ADDRESS CITY ZIP TE APPLICANT TEL. CONTRALTO ADDRE N CITY ZIP TE ARCH/ENG/' ��A DESIGNER'Vd,-�- 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 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($5m)) C I.AS OWN ER OF THE PROPERTY.OR MY EMPLOYEES WTH WAGES AS THFIR SOLE COMPENSATION WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC 7044 BlffI. 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 OFCOMPLE- TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). C I.AS OWNER OF THE PROPERTY.AM EXCLUSIVELY CONTRACTING WITH 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 BUILDS OR IM PROVES THEREON AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW I. [TI AM EXEMPT UNDER SEC.A 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 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE.AND MY LICENSE IS IN FUL ORC A D EFFECT.- A1 LICENSE C SS LIC N0. � DATE CONTRACTOR 4 WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS. I H6Vt AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' 20MPENSATION AS PROVIDED BY SECTlON 3700 OF THE LABOR CODE. FOR THE PERFORMANCE F THE WORK FOR WHICH THIS PERMIT IS ISSUED. V 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 15 ISSUED MY WOA S'C PE IQN NOAB-RIER AND POLICY NUMBER ARE. Y J \ CARRIER� -yV / .,� J r.� POLICY NUMBER 1�7 ! -- (THIS SECTOR 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 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 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WOFK FOR WHICH THIS PERMIT IS ISSUED(SEC 3097,CIV C.) LENDER'S NAME LENDER'S ADDRESS CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION,AND HEREBY AUTHORIZE REP ATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-M NED PROPERTY FOR INSP IN PURP SEES, PE ITTEE NAME(PR SIGNATIIHE PER ITT EE- "' DATE 06 0 w 0 Q 0 0 M w U W 0 U 0 Z Z 0 W LU W 0 I- I- U W a U3 C/3 c W LU w z 0 0 I- C) J LL IZ W 0 2 d W H W LU a CD Z J DO m (/3 C n V- ITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy ZONING N0. DWEL. UNITS SETBACKS FRONT REAR SIDE/SIDE STREET SIDE DESCRIPTION SFR/ADD/REM Garage/Carport Patio/Deck PooVSpa Re-Roof Commercial PERMIT I 19 NUMBER{U TYPE CONST. STORIES_I BEDROOMS OCC GROUP PRESS FIRMLY RW^ RW^ - EI N0. N0. SQ. FT. I FACTOR PSF 2V Valuation I III JU V ADJ.AREA QUANTITY Q U z U W 2 CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTlON FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES COMMENTS 10 RECPT N0._PAID BY VALIDATION DESCRIPTION ADJ.AREA/VALUATION FEE nyr\