The URL can be used to link to this page

Home My WebLink About15210 �i��i i �'✓ � �j �� CITY QF DIAMOND BA� �� , DEPARTMENT OF COMMiTNITY&DEVELOPMENT SERVICES 21b6Q E.Copley Thive Suite 190 �, •,. �e`" {904)86Q-3195 Fa�(9Q9)$62-3117 PRESS � �� BUII.DING PERMIT APPLICATION FIRMLY � ODR'E8S_��✓U`.�;C.A�Yi�(,`''a� ��". DATECATIODL. ��/1 NU BITEfi I �,Z � #/C � �.�.� �� .�`��,� � ISSUE TYPE OCC APN lOT T AGT pATE CONST. GROUP � OWNER t� �'1 � ADDR SS � ` I Y -3 ZONING SETBACKB � CITY ' ZIP TEL.��- FRONT RW C} APPLICANT � ��L. ��=fj�{�' REAR �"� ,r C7 � SIDFISIQE STREET_�� RW i a' O CONTRACTQR LY "}a''Y� �►�`� ��Jct,=' SIDE CJ_. t� ADORESS Q 5 —.--. �- �-�' FipPQSED USE C7 '��Q ' �.. Q Cll"Y Z3P �.��_ T�:��' � ARCWENG/ �,, �f,�» DESIGNER 3�7Y!"t C i��D � ADL7ftES5 NO.DWEL. NO. NO. UNITS STORIES SEbROt77MS � � CITY ZIP TEL. � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREA/VALUATION � QWNER-BUILDER DECLARATION SFFtADU1REM _ (� I HEREBV AFFlRM UNDER PENALTV OF PERNRY TNAT I AM EXEMPT FpOM THE CONTRACTqRS LI� GBfeaB/C9f�0!! W CfMSEIAWfflR7NEf'a.lOFY9J(iNEM15UN(SEC.7o3i.58USNiESSaNDPFiOFE55qF15CbDE:ANYCITYOR tJ) . � CaAJTYVYHICMRE0U1RE8APERMiTiOWNSTFUCT,ALTER,IMPROVE,DEMOLISH,OflRE7AIPANVSiRUC- W P811q/DBGk TURE,PHIOH TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCM PERMIT TO FILE A SIGNEb .� S7lR£MEN7 TH/iT HE OR SHE IS ItCENSEO PUftStiMtf TO 7HE PR�VIS�NS OF 7NE CCM1IiRACTpRs U- � CENSE UW(CHAPTER B(COMMENCINO WITH SECTION 7900)of DIVISNJN 3 Of THE BUSWESS AND PRo� u' o6USp0 O FESSIONS COpEj QR T!IAT HE Ofl SHE IS EXEMPl THEPEFROM AND 7HE 6ASIS FOR THEALIEGED EXEMP• TION.hNY VIOLATION aF SECTiqN 7ui1 5 8Y AMY APpIiCANT FOR APERMiT SU&IECTS TNE APPLiCANT i0 Z Ae�Roof � A qVIL PENALTV OF NOT MOiiE THAN FIVE HUNDREQ OOLIARS(SboO�.)� � �I,ASOWNEAOFTtlEPqORERTY,ORMYEMPIOYEESWITNWAGE5A5TMEiR50lECOMPENSATqM. 0 (`,pRyrtyetC� Wflt DO THE WOFlK,ANb THE STRUCTURE k5 NOT INTENDED OR OFFERED fOR SALE�SEC.7045,HUSI- J NESS AND PflOFE$910N9 CODE:THE CONTMCTOR5 UCENSE lAW DOES NOT APPLV TO AN OWNER OF � PFIQpERTYWtiOFittkD50RM1PflDYESTMEPEON,ANDYlHOD6ESSUCNVtiK1RKHiMSELFQRHERSELFOR � CG TFIHOU6MHISORMEHOWNEMPIOYEES,PROVIDEpTHAT5Uq11MPflOVEMENTSARENO7INTENbEDOR m l.0 UFFEREDfORSALEIF,HfJWE4ERTME6UIlpMGORIM7ROVEMEN71S50lDWITHINONEYEAFlOGWMPI.E- � TION,TF�OWNER$V4DER NAt1 NAYE TFiE BUF�EN OF PRtfV1NO TFiAT NE t?R SHE�IO NOT aUitD QR � IM7ROVE FOIi TH[PURPbSE OF SALE). W C4ASOWNEROFTNEPROPEPTY.WEXCiUSNEIYCANTRACTINOWITHUCEN&EDCOMTMCTORS ('r TO CANSTRUCT THE PRQ.7ECT(SEC.'76�4,BUS�NESS AND PfiOFES5�ON5 C06E:THE CONTMCTORS l�- V8�U0I1011 � �� A0.1.AREA �J CENSELAWbOESNOTAPPLYTOANOWNEpOFAPROPERTYWI��IUBUIlA90R�MPROVESTHEflEON,ANfJ -- Z wt+oaar�rp,..crsr�suata.ao.rEcrsvnn�AcarrRacroa�s}uc�nsEOPuasu�rornEcroNTrjnc pUANTtTY DESCRIPTION FEE �- roas ucENSF uw.}. ...—.- � J � L ❑i AM E%EMPT Ul�ER SFC. $,d P,C.�OR T}t75 REASON U CL � pATE __OWNER __�. U �s[ � l�ICENSED CONTRACTORS dECLARATION w CL IkER6BYAfFiHM UNQER PEHAL7Y OF FERJURY THAT i AM UGEYSED UN�Eft PftOYiSKK�750F GNAPTER � , T � L J,J j` � Y(COMMENCINCi WITH SECTqN YOOOj C}F DIVISION 9 OF THE BUSINESS AND PROF�SSIONS COC'c,AN� Z �� /� ?G MY LIGENSE IS IN FULL FOPGE AND EFFEGi � (1 i . IS W ry,.��+—�� '}�/y/� � f�•• rf/ � UCENSE CL4S�___`,�.�5�_ LIC.NO._Q¢�. / ,� � J jQ f CUNTAACTOq � E' � U Ds.7E_-Sl_ �" � .--- �} .` . �. W WORKERS'COMPFNSATIQN OECLAAA�� P� .ry � ,{,�'� Q r U � t MEHEBY11FflfiM tXiDEft PENH:7Y OF AEFtR1RY C}N60�THE F6�GOWING DEGIARATiONSr �`°- Z � Q � �!HAVE MIO WILL b1MNTAtM ACE4iTlFICATE nF CANSENT TO SELF-INSURE FOR WORKERS' _ L'qMPENSA'f70N,AS PRpV�DED 8V SECTtON 3'/a0 OG THE UBQfl COpE,FOp THE PEPFORMANCE �U TME WORK FpR WHICM THIS PERMIT 15195UEp. � C� I HAVE Mlp W�LL MNHTAIN WORKERS'COMpENSP:7iON MSURANCE.AS RFOIIIRED EY SECTION � '�J � 370p OF 7F7E 1A86R Q7L7E.FOR THE VERF4RAIANGE OF THE WOHK FpR WNICl#THIS PEftMiT IS � � �7 ; iSSUEU.AiY�S'COMPENSA:K7N1N&UHANC CAFlR�EPAND➢6�ICYNUMBEflARE: � �GONSTRUCTION ��' -/ j c.�.aa�Ea " ..-��p PLAN REVIEW t� ..._.. � vaicvNUMeEa---.,'�„-F=�C� ��,—�_� ELECTRIC �� Q 0 (IFIISSE'c7K�NEH)NOTBEmlA�tFrEClaFn�EPEfM�6GOHaNE�aIN)ViEDo(X1Aas1S�ro)oatEss) PLUMBING � i CERTIF'17HAT tN TNE AEAi4I�74iANCE OF iNE WORK�O(i WNICHTHi5 PERM�T cSISSUEp.I MECFIANICAL. �� (� SFIAI.4 N07 EMPLOY pNY PER" IN ANY MANNER SOAS TO 9ECOME 5U8JECT TO 7HE � WOqKER$'O(3tIP£NSATpNUW50fCtlifORNiA.ANDAGAEETMA7SPtSH(7VLD8ECAME �NSPECTIONFEE __.. 'y � SUBJECTTqTHEWOFNERS'GOMPENSATIONPROVISYJNSOFSECTION37DOG THELABOR �SSUANCE ,,,__. IIII__„�,r�y,�I�1,_ � �'� �� GODE,I SMA,4�F/CIfl�THWITH CQMPLY TM TNOSE PRq(y�ISIO)NS, j � �-=-v�-�K!!/- �^✓ � SMIP .J tT L, *�pi,) p DATE: APPLICANT ....— 7 �± �p bl� �+^� ENERGY PtC �i��i'Di.Ci��i il� '^� WAqNING:FAILURE TO SECUAE WORKGRS'C VENSA COVEflAGE IS VNUiYlFUl,ANG 5MqLL BE �7 �" �J-y 5U&IEC7AN EMPWYER TO CFIMINAL PENnL? 5 AND L FIrvES U7 TO ONE MUN�PED THOUSAND ENEROY PERM4T '� ��'�%�*�' D�itAftS{ft00.000),INAOD�TKKiTOTHEGOSTOFCCkhPEN5AT10N,DAMAGE5A5PftOV1DEDFORiN �. �) � SECTION37oBOFTNELAflOFiWDE.INTEREST.ANDAiTORNEI"SFEES. RETENTIONFEE: 1 ,,,__ ... V d CONSTRUCTION LENDiNG AGENCY pqE-A�� _....,—.,.,.�... .. � IHEREBYAFFiRMUNOERPENPITYOFREF�1UftYFHA7TMEAEiSAtANSTt�IC51QNlENaWC�AGENCY i,1l�YJ`'�� _, FOR THE P[RFORMANCE OFTNE WORN Pofl WMIGHTMIS PERMIT IS 155UE��SEG.3097,GIV.C.j. ��t� Z W �L tENDEP'S NAME .. ."S' F,^�y IEWEP'SRpORESS__. ......_.____ '+- ICERTlFYTHATtNAVEftEAD7HiSAPPItCATKKiAttlQSTRTETtil�7TMEA80VEIMF6flMATpNiSCARRECT. TVTttL FEGS ' . Y /^ � �AGREE TO COMPI.Y WITH ALL CITY AND COUNTY OP�INANCES RNO 51ATE LAWS flELATMG TO BU�LDIN13 \p\ � GONSTRUCTION,AND MEREBV AUTIIOFRE REPRESENTAiIVES QF THIS COUNTY TO ENTEFi UPON 7HE py�'Cv i" � � ��`J� V � RBOVE-{dENTKK1£DPFqPERTYW/R�INSPECi'IONPURP65ES. CCIMMENTS {� —. � �� Y � � � '1c,[� , t� _ � � � ERMITTEE N I � -� �—�(_ p(3 / � ., '�.�—_�.�'^ � NATUR PE MlFTEE OATE � RECPT.NO.„ ,PAID BY VAL��AT�ON�- WFi1TE-papartment CaPy.YELLOW-Finance Copy,PfNK-Assassor Copy,GQiDENR4a-File Gopy.GREEN�--lippiieanYs Gopy ro..a a ' �"r �`e�`�`� , �� = �C��e., �. '�� :� ., . t� -a k. °�'- � � � � �. ' . �'y``� � a� ■ ! � . ��ry�'��:�.:�I � � sr�"� �"s: 6 � � ' � A �� ' , _� �':� � . � - � . � �� r t _ _ __ - � �,f — � � � � ,�. a e � � .��, � . , _ -- � r . _ _ '� r � �. � .:. . ..... ...... .. _. ._ __.. .. ..� .... _.,.._ . _.... .___ ._.._. .. �.�`.,�F� "�' � ._ .... _._. .�� ... . .... _.. . � ` .. ��. l ^�Zf.._.�� .� ._.. ... � .. .. . . .. . .. .. ..._. ... _._. ....... �. � . .. . . .... . .. ._. . . _... ...... . ..._.. � , ,. _,�� w,�h� . ..._ .. ...._ _... . � �+ 1 e �'_ i ., ,, . ...... ..,. .r:';.,:. . �..�„ �.�..` .�. . ... . (j ' ...c..'• a"�/�,' I�1Q /�GC�i�4_ � _ �f� `2 . '�l _� Z� �: __�P � _ i U - 2� -� __ 1.=3�' — i� Ys" Gf/t _ �-�U_ /�-c�.rEsF f� _ ' 4 ,. � _ _ __ � � , ��. � _ ��,�� , � '�� ", ��,��» . _ ; , ��a�� ,�- � � � _ __ � , �� — � � ,, r� � 'k�� " ��t_ ,� � �:�,�� . . ... .. ... . ._ ... _ ._ ... .. _.. � � . _ _ m�,��,� *�`�"�Pm �"'.�' . � � _. .. .._ ... .. . _.. . � e � � �` � ��,.4'��'1�"�'� � r Y�� p'��`,9^�'�.' - . .. .. .. . _ ��a �i,g �`� "1�-,��+�� ° : ? ��TM� z��''��'�� y�� — _ _ � � � � ��,�.�_� ��,.�,��"-�� _ .. _ _ � _ � ...v.., CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION PRESS FIRMLY JOBSITE ADDRESS JOU-dYCkSk APN LOT T ACT OWNER t!�Y1 ADDRESS � I Y-3 cb, CITY Dian� ZIP TEL. 3 APPLICANT-4.vh "TEL. f/6 S"9jj6 CONTRACTOR t'Y'M ADDRESS Q: CITY ZIP ARCWENG/ S 5 N DESIGNER c 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).): ^ 1,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 NOT APPLY 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.) ^ 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. 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORCE AND EFFECT. LICENSE CLASS LIC. N0./ DATE Y CONTRACTOR ��yy RK NS AN WO ERS COMPE ATION DECLAA 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' COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE THE WORK FOR WHICH THIS PERMIT IS ISSUED. 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 IS ISSUED. MY WORK S'COMPENSATION INSURANC CARRIER AND POLICY NUMBER ARE CARRIER_ r7/ POLICY NUMBER(7-0 (THIS SECTION NEED NOT BE COMFU-7ED OF THE PERMIT IS FOR ONE HJPIOREDDOLLARS(E100)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 SECTlON 37000 THE LABOR CODE,I SHALL FORTHWITH COMPLY%TH THOSE PR ISIONS. DATE:f2_�2C.,(__0&_APPLICANT: WARNING: FAILURE TO SECURE WORKERS'C PENSA COVERAGE IS UNLAWFUL,AND SHALL BE SUBJECTAN EMPLOYER TO CRIMINAL PENALT SAND L 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-MENTIONED P RO PER TY FOR INSPECTION PURPOSES. I/ �JJ,J i-I(A k � ERMITTEE N I 6p2(-00 NATUR PE MITTEE DATE PERMIT DATLICATION_)00 /VV DATE C NUMBER ISSUE TYPE OCC DATE CONST.GROUP ZONING SETBACKS FRONT RW^ REAR.9^ SIDE/SIDE STREET Zc RW ia-' ^ SIDE^ ROPOSED USE 0 N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM Garage/Carport LU Patio/Deck LLr LL ooVSpa 7 Z Re-Roof 0 Commercial 03 MAY 0 9 20 Valuation a ADJ.AREA QUANTITY DESCRIPTION FEE -J D OC I k- U W LU Z u- 1 II U z U UJ U) tl 1CONSTRUCTlON PLAN REVIEW I i ELECTRIC PLUMBING c- ' MECHANICAL INSPECTION FEE ISSUANCE 1111 II 1'/7000/na SMIP ENERGY P/C"1TY OF DIAMOND ENERGY PERMIT ND S I Y RETENTION FEE: it JL� PRE-ALT�fFyF� TOTAL FEES COMMENTS RECPT N0. PAID BY VALIDATION I WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy