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Home My WebLink About17819 �` CITY OF DIAMOND BAR �--� �w'� DEPARTMENT OF CORM�fUNITY&.DEVELOPMENT SERVICES � � 21825 E.Copley Drive PRESS "� (909)8b0-3195 Fa�c(909)861-3117 ��-��y BUILDING PERMIT APPLICATION FI RM LY o ADDRIESS��' �' ��((�_ l�(°I { ��(,� ��` 7 (J APPLICATION PERMIT f Y�� PIC d/ �_�_ ._�_ � �— DATE_. G �� NUMBER� # ��Z' � ! � ISSUE , t� �_�''1 TYPE OCC APN.�_ LOT TRACT._ DATE ��'1 �►-soNST. GROUP p OWNER �_j_y- �/�,•! Y't � � � �� rr 1��`� � ZONING SETBACKS o ADDRESS�� Ci ��C��+l�j,Y"�_�a-� �� Z C�Tyr;.� e'��1 �y ��^�P TEL. FRONT RW ❑ o APPLICANT'` ^ 'e� TEL.�;��(\ '��'� S DE/SIDE STREET RW ❑ m CONTRAGTOR � 1=1 � � SIDE ❑ � ADDR SS ` _ "' � _ d ,> -�; � PROPOSED USE � CITY��; ZI !��l.. �,TEL. " �'-� . ;� �w ARCH/ENG/ ;^� � z DESIGNER !_�'� ��'f��'�+� � (-C..(� I��.� j�.li�'/� NO.DWEL. NO_ NO. a ADDRESS ` UNITS STORIES BEDROOMS � CITY ZIP TEL. `n DESCFiIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � � OWNER-BUIL�ER DECLf�RATION SFR/ADD/REM O � I HEREBY AFFIR61 UNOER PENALTY OF GERJURY THAT I AM E%EMPT FROM THE CONTflACTORS LI- � Garage/Carport W CENSEUWFORTHEFOLLOWINGREASON(SEC.7031.5BUSINESSAN07ROFESSIONSCODE:ANYGTYOR U C�UNTVWHICHREol11RESA.PERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUG W pati0/DBCk wTURE,VRIOR TO iTS ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNEO W � STATEMENT THAT HE OR SHE IS LICENSED PUPSUANT TO THE PROVISIONS Of THE CONTRACTOR$LI� �,L POOVS 8 � CENSE LAW(CHAPTER 9�COMMENCING WITH SECTION�000)OF�IVISION 3 OF THE BUSINESS AND PRO� 'rt P r O FESSIONSCODE)ORTHATHEORSHEISEXEMPTTME4EFROMANDTHEBASISFORTHEALLEGEDEXEMP� u U TION.ANYYIOLATIONOFSECTION]031.5BYANVAPPLICANTFORAPERMITSUB..ECTSTHEAPPLICANTTO Z Re-Roaf � AGIVILPENALT70FNOTMORETHANFIVEHUNDREDDOLLARS�55ao).): � ❑I,ASONMEROFTHEPFOPERTY,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, � COfi1fI1BfC18I Z WILL DO THE WOFK,AND T�iE STRUCTURE IS NOT INIENUED OF OFFEREO FOri SALE(SEG.]Oba,BU51� J � NE55 AND PROFESSIONS CO�E:THE CONTRACTORS LICENSE LAW DOES NOT APPLv TO AN OWNEFi oF � PqOPERTYNMOBUILDSORIMPROVESTHEREON,ANDWHO�OESSUCHWORKHIMSELFORHERSEIFOR m � THROUGHHISOf7HEROWNEMPLOVEES,PROVIDEDTHATSUCHIMPROVEMENTSARENOTINTENDEDOR w OFFEREOFORSALEIF,HOW'EVER,THEBUILDINGORIMPROVEMENTISSOLDWI'HINONEYEAROFCOMPLE- � TON.7HE OWNEREUILDEFI WILL HAVE THE BUFDEN OF PROVING THAi HE OR SFIE�I�NOT BUILD OR Z IMPROVEFORTHEPURPOSEOFSALE). _ ❑I,ASOWNEflOFTHE:PROPERTV.AME%CLUSNELVCONTRACTINGWITNLICENSE�CANTRACTORS � TO CANSTFUCT THE PROJ[CT(SEG.�040,BUSINESS AND PROFESSIDNS CODE THE CONTRACTOftS LI- VflIUflI1011 �� ~��,) ADJ.AREA W CENSE UW DOES NOTAPPLY TOAN OWNER OF A PROPERTY WMO BUILDS OR IMPROVES THEREON,PND ' I F WHOCONTFACTSFORSUCHPROJEGTSWITNACONTRAGTOR(5)LIGENSEDPURSUANTTOTHECON7RAC- QUANTITY DESCRIPTION FEE TORSLICENSELAW.). Y � ❑I AM E%EMPT UNDFN SEG B.8 PC.FOR THIS REASON Q L�\ � � � � � J � LL' DATE oWNEP_ V W � LICENSED CONTRACTORS DECLARATION �j � I HEREBY AFFIRM UNDER PENALTV OF PERJUFV THAT I AM LICENSEO UNDER PROVISIONS OF cHAPTER � � /�; d 9(COA�AAENCING WITH SECTION 7000)OF DIVISION 30F THE Bl1SME5S AND PROFESSIONS GO�E,AND Z , `X AIV LICENSE IS IN FULL FOFICE ANO EFFECT C , � ...� � - � IICENSE CLASS�r�� LIC.NO. J�� J � �'� � � � V DATE_.�y_;��1T�,� GONTRACTOR[ '�S��C Yl�1�, � a - W ¢� WORKERS'COMPENSATION DECLARATION '�`' ��-'� � Q � U � I HEREBI'AFFlRM UNDEF PENALTV OF PERJURV ONE OFTHE FOLLOWING DECLARATIONS: \ !-�` � Z /" ... 1 4� Q � �� I HAVEANO WILL MAINTAIN AGERT'.FlCATE OF CONSENT TO SELF-INSJRE FOR WOf1KERS' 2 � Q CAMPENSATION,ASPROVIDEDBYSECTION3�ooOFTHELABORcoOE,FORTHEPERFOPMANCE �U OFTHE WORK FOFI WNICH THIS PERMIT IS ISSUEU. � � w I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRE�BV SECTION Q 3]OOOFTHELABORCODE,FORTHEPERFORMANCEOFiHEWORNFORWHICHTNISPERMITIS �3� 7d — ISSUE�.MV WORNERS'COMPENSATION INSUflANGE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION � ¢ � k'_��,i�;� l� PLAN REVIEW �7I �" � CARRIER�-. . �.-� Z POLICV NUMBER_ � � t (7'�t��l�'<- �,��! '�' �'�� ELECTRIC -�✓ ��'�� ¢ �missEcnoHNE¢�noreE�rnr�FrEooFn+EPEw,�rt�swaor�ENuwaEoaxuas6�m)oa�Ess). PLUMBING �"fi� `� .� � -i. w MECHANICA� L-� . Z I CERTIFVTHAT IN THE PE�FOFMANCE OF THE WORK FOR WHIGH THIS PERMIT IS ISSUED,I --�- (} SHALLNOTEMPLOYANVPERSONIN:INYMANNERSOASTOBEGOME5U6JEGTTOTHE INSPECTIONFEE Uj WORKEaS'COMPI:NSATION LAWSOF CALIFORNIA,AND AGR�E THAT IF I SHUUL�BEGOME = SUBJECT TO THE 1NORKERS'COMPENSATION PROVISIONS OF SECTIDN 37�OOF THE LABOH ISSUANCE ' ��} `�l� CAD,I SHALL FOqTHW1T!1 COMP'_V W TI SF PROVISION . O ":? � { SMIP . l�'�-' � DATE: -` �.\b �qPPLICANT� �t,: �/,_ I' LI--I---�_tn�— w ENERGY P/C J WARNING AILUflE OSEWREWORKERS'COMPENSATIONCOVERAGEISl1NLAWFUL,ANDSHALLBE J � SUBJECTANEMPLOVEHTOCFIMINALPENALTIESANDQVILFINESUPTOONEHUNDREDTHOUSAN� ENERGYPERMIT DOLLARS(f100,000),IN AGDITION TO THF COST OF COMPENSATION,DAMAGES AS PROVI�ED FOR IN J SECTION�]OBOFTHELAEIOftCODE,INTEREST,ANOATiORNEV'SFEES. RETENTIONFEE'. � A w CONSTRUCTION LENDING AGENCY PRE-ALT FE : � O �A � 1 HEREBV AFFlLiM UNDEF PENALTV OF PERJURY THAT THERE IS ACONSTflU�TION LEN�ING AGENCV � "v�rL � FOP THE PERWRMANCE DF THE WORK FOR WHICH THIS PERMIT I$ISSUED�SEC.3091,CIV.C.). �/ � / ' K�+ LY W _q cc. S LEN�ER'S NAME . CY .. � - - 1- LEN�ER'SADDRE55_ ��(1'r`/ � ICERTIFVTHATIHAVEREADTHISAPPLICATIONAVDSTATETHA7THEABOVEINfOFMATIONISGORREGT. TOTAL FEES' �(/"'�'�� . �� ' W I AGHEE TO COFAPLV WITN Al L CI'V AND COl1NTV ORDINANCES ANO STATE LA'vYS RELATING TO 6UILDING � � CONSTRUCTION,ANDHENEBVAUTHORIZERFPRESENTATIVESOFTHISCOUNTVTOENTERUPDN'HE z ABOVE-MENTIONED Pfip1�ERTV FOR INSPECTION Pl1RPOSES. � COMMENTS p 1 � � �� '�r ��l?�'+� �i�� m RMI EE NRME�PRINI � --�-- � ' .r %�e� 3��3�/c'Z-- _. _� Uj SIG UR�OFPERMITT�J E _ - RECPT.NO. , PAID BY VALIDATION ~ WHITE-Department Copy,YELLOW-Finance Copy,PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy �� ' i r.. �, �. � r.�°� �.. �� ,�k 9 _ R `en'� jIDq m �, 'W};� .,y . . . . , . . . . o b, a } r 4't, , � . . -'a�d��h . 2�z�z Z�` z�z�vy �� _ $�2fo�� _ �1 ��0�. . �i � _G� / ;,., �� _ , ,,. � � � � �. �°� f. ry�� _ , � _ � Z��Z � ��.v ��,� �� e ,� f C� �� .�� 8.�� w�s� s��- �� C2.�w. _ _ _ _ _ _ : � � �� , '� �� '�"� 'a� � �a„�� _ _ ! � � �� v; �`�i�"�'_� �< � ;.� d�l 3' �tr,s d i : . .. . _. _.__ .._.. .._ . _ .. . . _ ._ _ . . .... ... . _._. .._ .. .. _.. .... . ` . � � a a a� �. � € =,�+ aa��. � p � � ,� � .`� _ �- �,r . .. . .._ ... .. .. . ... . ... .. . .... . .. .. ._ . .... _.. ... _... . ._.. . �",r�'� � '4 `.^, .-. e� � �� s� P ! x� rR$ �'.y i �� t� i � � � c � � � �r� � ";�� v� �; �� r��,��,� s�� i �,a ��,��,, .... ... ... .... . .. .. . .. .. . ...... ..... ._ ..... _. .... ... ... . .. :. , "�� ," ��ik 3�.�,w�„' �r �� . �t�M,E, . .. . .. _. . JOBSITE<�� r ! "/ ADDRESS' [(j (2 I�{ �(J f N ,_LOT TRACT. APN------r v OWNER_(YC,•a:_3 1 ADDRESS 71 r'e'},2•9 4 61P TEL. APPLICANT'� --' P rl TEL. CONTRACTOR(-=T ADDR$S CITY ZI/.TEL. 1 -Y ARCH/ENG/ DESIGNER a! IIk(1 , 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 FIE 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).): ^ I,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). E7 1.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 ACONTRACTORS) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). ^ I AM EXEMPT UNDER SEC. B. 8 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 FOFICE AND EFFECT �I)LIC. N0.J LICENSE CLASS DATE CONTRACTOR R.° 1/,: CYO i In ON C R WORKERS COMPENSATI DE LA ATION 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 OF THE WORK FOFI 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 WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER k_G AA 5. POLICY NUMBER\1 I (THIS SECTlON NEED NOT BEOOMPLErED OF THE PERMIT IS FOR ONE HUIJDREDCOLLARS($100)OR LESS) I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I SHALL NOT EMPLCIY 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 1NORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR COD 1 SHALL FORTHWITH COMPLY W T�r�1SE PROVISION DATE: "� �k_[,r-APPLICANT/---'L�.--- WARNING:AILURE 0 SECURE WORKERS'COM EP NSATION COVERAGE IS UNLAWFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL 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 LAEIOR 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 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 PROPERTY FOR INSPECTION PURPOSES. F� NAME z ,� % 3SE U) DO Er 0 in w 0 a[0 w w DO cn CO cc 0 ci w U W 0 U 0 Z DO 0 X w 0 U rn UJ ci Q W cQ J Ii Z C7 DO ci w J L I 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 APPLICATION/�,PERMIT f i P/C/ DATE j3___NUMBER I_ 1 # C 2-/'! ISSUE I/TYPE OCC DATE � NST. GROUP ZONING SETBACKS FRONT RW^ REAR^ SIDE/SIDE STREET RW^ SIDE^ PROPOSED USE N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION S0. FT. FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM U) Garage/Carport W Patio/Deck 29 0 1 LL PooVSpa Z Re-Roof Commercial Valuation--0 ADJ.AREA QUANTITY DESCRIPTION FEE Q L U U W W z Ir\ v � Y\ a Q U z Q 0 W 73(070 CONSTRUCTION / 37 PLAN REVIEW 1 . ELECTRIC 5 L' FCT Y PLUMBING L1 MECHANICAL L--j L,..z h. INSPECTION FEE ISSUANCE SMIP 15+..." ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FE : P/v.�.2 TOTAL FEES COMMENTS RECPT. N0. PAID BY VALIDATION X/I WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy f Z��o Z C� lU- p,Y p.Je [5)"L�-°�WEST Sf-09 0