The URL can be used to link to this page

Home My WebLink About16778 (45) �,� CITY OF D]AMOND BAR �_w� DEPARTMENT OF COMMtJr1ITY&DEVELOPIvIENT SERVICES ` 21825 E.Copley Drive (909)8603195 Fax(909)861-3117 PRESS BUILDING PERMIT APPLICATION ' �� FIRMLY y JOBSITE C,IJ`A��'SH q� APPLICATION PERMIT '-�P/C o ADDRESS_��_'y 3� ��V �,] DATE NUMBER # � ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP ¢ OWNER �l.YN,A�+Q. I��f�,L(��(.� O o ADDRE55�,A�i� ZONING SETBACKS OCITY ZIP " ,;TEL `.�8�- `L REORT RW ❑ o APPLICANT �� H� TEL SIDE/SIDE STREET RW O z m CONTRACTOR C�le^�I'StTN �l/L SIDE ❑ o ADDRESS 11� 11'Li�C- 9� �— � �r�_-- _�S ti� PROPOSED USE � CITY{,y��^'_ ZIP� `1�I TEL. i , oARCWENG/ �z DESIGNER NO.�WEL. NO. NO. d ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-6UILDER DECLARATION SFR/ADD/REM O p I HEREBV AFFIRM UN�ER FENALTV OF PERJURV THAT I AIA EXEMPT FROM THE CONTRACTORS L6 G3f89B/CBfPOA W CENSELAWFORTHEFOLLOWINGREASON(SEC.7031.SBUSINESSAN�PROFESEIONSCADE:ANVqTVOR (n U CWNTYWHICNREQUIRESAPERMITTOCONSTRUCT,ALTEF,IMPROVE.DEMOUSH,OftREPAIRANVSTRUC� W P8�i0ID8Ck Z TURE,PRIOR TO ITS ISSVANGE,ALSO RE9UIRE5 THE APPLIGANT FOR SUCH PERMIT TO FlLE A S�GNED w w STATEMENT THAT HE OR SHE IS LICENSEO PURSUANT TO THE PFOVISIONS OF THE GONTRAGTORS LI- � CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 30F THE BUSINESS AND Pq0- � PoOUSpa FESSIONS CODE)DR THAT HE OR SHE IS EXEMPT ThEREFROM AND THE BA515 FOH THE ALLEGED EXEMP- � TpN.ANY VIOUT�iON OF SECTION 7031.5 8V ANV APPIICANT FOR A PERMIT SUBJECTS THE APPLICANT T0 Z R0-ROOf � ACNIL PENALTV OF NOT MORE THAN FNE HUNDflE��OLLARS(f500).�: Q ❑I,ASOWNEROFTHEPROPERN.ORMYEMPLOVEESWITHWAGESASTHEIRSOLECAMPENSATION, � Commercial I Z WILL DO THE WORK,AND TNE STRUCTURE IS NOT INTENDE�OR OFFERED FOR SALE(SEC.]044,BUSI- J NESS AND PqOFES510NS GJDE:THE CONTRACTOFS LICENSE lAW DOES NOT APPLV TO AN OWNER OF � PROFERTYWHOBUILOSORIMPROVESTHEflEON,ANOWHODOESSUCHWORKHIMSELFORHERSELFOR m � THROUCaHHI50RHEflOWNEMPLOVEES,PROViDEDTHATSUCHIMPROVEMENTSARENOTINTEN�EDOft QOFFEREDFORSILLEIF,HOWEVER,THEBUILDINGORIMPROVEMQJTISSO�DWITHINONEYEAROFCOMPLE- Z TION,THE OWNER-BUILDER WILL HAVE THE BUflDEN OF VROVING THAT HE OR SHE DIO NOT BUIL�OF � IMPROVE FOR THE PURPOSE OF SALE). w ❑I,ASOWNEROFTHEPROPERTV,AME%CLUSNELVCONTRACTINGWITHLICENSEDCONTRACTORS � TO CONSTRUCT THE PROJE:CT(SEC.7041.BUSINESS AND PROFESSIONS CODE:THE CDNTRACTORS LI- Vdludli0fl ADJ.AFIEA W CENSE LAW DOES NOT APPI V TO AN OWNER OF A PROPERTV WHO BIIILDS OR IMPROVES THEREON,AND � � WHOCANTRACTSfORSUCHPROJECTSWITHACONTRACTOR(S)LICENSEDPl1RSUANTTOTHECONTRAC- QUANT�TY DESCRIPTION FEE Y TORSLICENSELAW.). � J � 7 I AM EXEMPT UNDER SEG. 0.&P.C.FOfl THIS REASON Q � U 2 u" DA1E OWNER F" Z U W � LU�ENSED CONTRACTORS DECLARATION W � I HEREBYAFFIRM UNDER PI:NALTV OF PERJUFiY THAT I AM LICENSED UNOER PROVISIDNS OF CHAPTER � d 9(COMMENCING WITH SECI'ION]000)OF DNISION 30F�THE BUSINESS AN�PROFESSIONS CODE,AN0 Z X MY LICENSE IS IN FULL FORCE AND EFFE T. ,/ Q LICENSE CL4SS�v�� LIC.NO. � 4 �� b j/ j V DATE �- '' '_• CONTRACTOR � ' Y.� d W I a� WORKERS'COMPENSATION DECLARATION � � � a �y� i�,t, �� ' �� U n A I HEREBY AFFIRM 11N0ER PI=NALTY OF PEFJURY ONE OF THE FOLLOWING DECLARATI 5: y 1yY C Y�� IHAVEANOWILLMAINTAINACERTIFlCATEOFCONSENTTOSELF-INSUREFORWORKERS' _ CqAPENSATION,AS PROVIOED BV SECTION 3]DOOF THE LABOR COOE.FOR THE PERFORMANCE U ¢ OFTME WORK FOR WHICH THIS PERMIT IS ISSUED. � 0 w I HAVE ANO WILLM111NTAIN WORKERS'COMPENSATION INSUFANCE,AS REOUIFED BV SEG�ION Q370o OF THE LABOFI CODE.FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS _ ISSUED.MV WORKF:RS'COAAPENSATION INSURANCE CARRIER AND POLICV Nl1MBERARE' CONSTRUCTION � _ _.._..._._. '--.......__ _—_--_"___ � CARRIER PLAN REVIEW Z voucv NUMeea_ ELECTRIC Q � (1}iISSECTN7NNEmNOTBE�v1PLEfEDOFTHEPEM.VTSFORONEHUfOHE000LLPRS(E1ao)ORLESSj. PLUMBING w MECHANICAL Z I CERTIFY THAT IN l'HE PERFORMANCE OF THE WORN FOF WHICH TH'S PERMIT IS ISSUED.I (�J SHALL NOT FMPLO'/ANY PERSON IN ANV MANNER SO AS TO 9ECOME SUBJECT TO THE Uj WORKEiiS'COMPENSATION�AWSOFCALIFORNIA,ANDAGRFETHAT'.FISHOULDBECOAAE INSPECTIONFEE � SU&IECT TO THE WORKERS'COMPENSAT1 ON P OVISIONS OF SECTION 3100 OF TNE LABOP ��A !� CO ,ISHALLFOPTHWITF+COMPLYY`W17iTH0 PROVI$IQNS. ISSUANCE r� Z� L p DATE: ,��`�� APPLICANT. L–L ( ��N1i SMIP ._ ` .,..._. . .. .,._ .�___.__.. w ENERGY P/C - J WARNING:FAILURE705ECVREWOPKERS'C04APENSATIONCOVERAGEISUNL4WFUL,AN�SHALLBE � SUBJECTANEMPLOVERTOCRIMINALPENALTIESANOCIVILFlNESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOLLARS(j100,000),IN AD[11TION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN (� J SECTION 3]OB OF THE LABOR CODE.INTEREST,ANDATTORNEY'S FEES. RETENTION FEE: P�� I I i I � d CONSTRUCTION LENDING AGENCY pRE-ALT FEE � O � I HEREBY AFFIflM UNDEH PENALTY OF PEfiJURV THAT THERE IS A CONSTRUCTION LENDING AGENCV � FORTHE PERFORMANCE C�FTHE WORK FOR WHICH TMIS PEaMIT IS ISSI;ED(SEC.�091,CIV.C.�. Z W � LEN�EIi'S NAME F— LENDER'SADDRE55_ , � TOTALFEES � I CERTIFV THAT I HAVE READ THIS APPIICATION AND STATE iHAT THE ABOVE INFOPMATION IS CORRECT. w I AOREETO COMPLV WRH 4LLCITV AND COUNTV OR�INANCES AND STATE lAWS RELATING TO BUILDING � CONSTRUCTION,ANDHER=BYAUTHORIZEREPFESENTATNESOFTk�ISCOUNTYTOENTERUPONTHE ZABOVE�M TIOIVED PROPI=RTV FOF INSPEGTION VVRPOSES. COMMENTS � �Ft �� . � ¢ PEFiMITTE E NT)� �—�� _O � � � SIGNATUREOFPERMI EI� � � DATE ' = RECPT.NQ _ PAID 8Y __ VALIDATION ~ WHITE—Department Copy.YELLOW—Finance Copy,PINK—Assessor Copy.GOLDENROD—File Copy,GREEN—Applicant's G py �-,��`��i s � � �" � ��. y � .. . . . . . . '��,�. 'r�ailx �1.. '�. , �".N�".�6�„�"��I�C��i� . . . . .. .. . . _ ..� .. .. ..... . . . .. . . ... .. .. . ... . .. � � ' _ � i - � ��. � �� - � �. . . : t '. ' . . .. . . . . . . .. .. .. . .... .. .._ . . M.4',F� .�`;�d�� ' t ��n . . . ` - � < .i , '; _' , ��::��. .. . . . . .. . .... . . . .. .. . ..... .. . . .... . ... ._. .. n y e � ' � ' , ,� 1..:- ` . . . .. . . . . .. .. ... .. .. . . .. .g .�: .. . _�� , � � s � . _ ,. . � .,, A�+ # ' ... ... .. . . . .. ... . ..... .._.. ... .... . . ..... ....._ ._.. ._._. .._. _... ..... ._.... 0 0 u<�iii�� 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 ADDRIESS_�� '�J r� �V LI.1 Vi,�(,.SK�/�1 APN LOT TRACT OWNER� 1.YV(.A-+t. [�f�,L(�L'�+( ADDRESS�L CITY ZIP,3TEL. �6�- �L TEL. APPLICANT�t H- � CONTRACTOR C:J�/'617�( it[/L SS 11 � N10�'C-9 r}TT��- ADDR CITY��"°'ZIp��, ��TEL._i 'aZSR,� 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 IAW FOR THE FOLLO W ING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE:ANV CITY OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT,ALTER,IMPROVE. DEMOLISH,OR REPAIR ANV 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.ANV VIOLATION OF SECTION 7031.5 BV ANV APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(1500).): ^ I,AS OWNER OF THE PROPERTY,OR M V EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC. 7044,BUSI- NESSAND PROFESSIONS GDDE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON,ANO 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,HOW EVER,THE BUILDING OR IMPROVEMENT IS SOLD W(THIN 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 E%CLUSIVELV 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 OFA PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS W ITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). ^ I AM EXEMPT UNDEFI SEC.0. &P.C. FOP THIS REASON DATE OWNER LR�ENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PE:NALN OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH SECI'K)N 7000)OF DIVISION 30F�THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORC A EFFEgT.',r � �� b �t(��I IC NO L LICENSE CLASS� � �� DATE� �' 1 ' � CONTRACTOR Y WORKERS'COMPENSATION DECLARATION 1 � �I I HEREBY AFFIRM UNDER PI=NALN OF PERJURY ONE OF THE FOLLOWING DECLARATI S: I HAVE AND WILL MAINTAIN ACERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' COMPENSATION,AS PROVIDED BV SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WILL M/11NTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED 8V SECTION 3700 OF THE LABOFI CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MV WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER POLICY NUMBER_ (THIS SECTION NEED NOT BE COMPLETED OF THE PERMIT IS FOR CM1E HUNDRED DOLLARS(1100)OR LESS). I CERTIFY THAT IN 1'HE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLO'/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 P OVISIONS OF SECTION 37000E THE LABOR R;HWITH COMPLY NWDiAH� �PROVI$IONS. CO,1SIHALL Fx0 / / A �� • „ '� R APPLICANT DATE �� -�E J L� 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(5100,000),IN ADChIT10N 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 REP,D THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH 4LL CITY AND COUNTY ORDINANCES AND STATE IAWS RELATING TO BUILDING CONSTRUCTION,AND HERBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE�M TIONED PROPI=RN FOR INSPECTlON PURPOSES. PFt� ��, I PERMITTE E NT) ^/ l � i _�� '0 �SIGNATURE OF PERMI EF DATE Ix 0 0 w z 0 0 z m 0 W � Z W a 0 W U Z W U H Z W 0 Z W Q W 2 H �1 LL Z 0 d X W U w Z Q W Q D Z Q W Z C7 Cn 1- W J LL J W d WHITE-Department Copy,YELLOW-Finance Copy,PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Cbpy