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Home My WebLink About16648 (9) � _ �� CITY OF DIAMOND BAR , � i -1 DEPART'IViENT OF COMMUNITY&DEVELOPMENT SERVICES ` 21825 E.Copley Drive .-� (909)860-3195 Fax(909)861-3117 "�'� PRE$$ -�� BUILDING PERMIT APPLICATION r' FI LY �� JOBSITE � APPLICATION r,r� � �� PERMIT ��'y ' � P/C ADDRESS � DATE «� NUMBER �Y p � ISSUE (�, TYPE OCC p OWNER �+'" T B�! �7"�c DATE `i'' �� CONST. GROUP p ADDRE S f ____ (J ZONING SETBACKS z CITY ZIP TEL. -'�c30O FRONT RW ❑ � APPLICANT TEL. REAR ❑ QSIDE/SIDE STREET RW ❑ ¢ CONTRACTDR SIDE ❑ ADDRESS . � CITY ZIPsr�cd[�TEL.��'•/* --�I'�p PROPOSED USE w ARCHlENG/ ��b�� -�`F� w DESIGNER_�JId. NO.DWEL. NO. NO. � ADDRESS � CITY ZIP TEL. UNITS STORIES BE�ROOMS � u� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION � SFR/ADD/REM p I HEREBV AFFIRM UNDER PENAITV OF VERJUPY THAT I AAA E%EMPT fROM THE CONTRACTORS LI- G8fd98/C0fF10fI W CENSELAWFORTHEFOILOWINGREASON(SEG]091.SBUSMESSANDPROFESSIONSCOOE:ANYCITVOR (f� U CAUNTYWHICHRE�UIRESAPERMITTOCONSTRUCT,AL7ER,IMPROVEDEMOLISH,ORREPAIRANVSTRUC- wTURE,PRIOfl TO ITS ISSUANCE,AL50 RE�UIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNE� w Patio/Deck � STATEMENT THAT HE OR SHE IS LIGENSED PURSUANT TO THE PROVISIONS OF THE GONTRACTORS LI- � � GENSE LAW(CHAPTER 9(COMMENpNG WITH SEGTION IaoO)OF�IVISION 3 0F THE 9USINE55 AND PRO- POOUSP2 � FESSIONSCODE)ORTHATHEORSHEISEXEMPTiMEIiEFFOMAN�THEBA515FOqTHEALLEGEDEXEMP- � V TION.ANYVIOLATIONOFSECTION7031.SBYANYAPPLICANTFORAVERMITSUBJECTSTHEAPPUCANTTO z RB-ROOf � ACIVI�PENALTY OF NOT MORE THAN FIVE HUNDRED DOLURS(f5ao).): � 71,ASOWNEROFTHEPROPEflTV.ORMVFMPIOVEESWITHWAGE5A5THEIRSOIECOMPENSATION, � CommefCiel WILL DO THE WORK,AND THE STRUCTUNE IS NOT INTENDE�OR OFFERE�FOR SALE;SEC.]044,BUSI- J � NESS AND FROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER Of � PROPERTV NMO BUILDS OR IMPROVES THEPEON,AND WHO OOES SUCH WORK HIAASELF Oq HERSELF OR CC THROUGHHISORHEROWNEMPLOVEES,GROVIDE�THATSUCHIMPROVEMENTSARENOTINTENDEDOR m Q OFFEREOFORSAIE.IF,HOWEVER,THEBUILDINGOflIMPROVEMENTI550LDWl?HINONEYEAROFGOMPLE- Z TION,THE OWNER-BUILDER WILL HAVE THE BUflDEN OF PROVING THqT HE OR SHE�ID NOT BUILO Ofl � IMPROVE FOR TNE PUHPOSE OF SALE). w 71,ASOWNEROFTHEPROPER?YAMEXCLUSIVELVCONTRACTINGWITHLICENSEDCONTRACTORS � TO CANSTRUCT THE PflQIECT(SEC.7044,BUSINESS ANU PROFESSIONS CADE:THE CONTRACTORS LI- Vffluaflon ADJ.AflEA W CENSE UW DOES NOTAPPLY TO AN OYMER OF A PFOPERTY WHO BL'ILDS OF IMPROVES THEREON.AN� � WHOCONTRACTSFORSUCHPROJECTSWITHACANTRACTOR(S�LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE Y TORSUCENSELAW.j. � ,7 I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON J � a � U � � DATE OWNER H Z W � LICENSED CONTRACTORS DECLAFiAT10N W Q � I HEREBV AFFIqM IJN�ER GENALTV OF GERJURY THAT I AM�ICENSE�UNDER PROVISIONS OF CHAPTEF � d 9(COMMENCING WITH SECTION]000)OF DIVISION 30F THE EUSINESS AND PROFESSIONS CODE,AND Z X MV LICENSE IS IN FULL FORCE AND EFFECT � IICENSE S LIC.NO. �� j � J V OATE �N CONTFACTnR 0_ W � WORKERS'COMPENSATION DECLARATION ¢ � IHEREBYAFFIRMUN�ERPENALTYDFPERJURVONEOFTHEFOLLOWINGDECLARATIONS�. Z Z _I HAVE AND WILL MAINTAIN A CERTIFICAiE OF CONSENT TO SELF�INSURE FOR WONKERS' _ ¢ COMPENSATION.AS PROVIUED BV SEC710N 3]00 OF THE LABOR CODE,FOP THE PERFORMANCE `U Q �WORK FOR WHICH TFIS PERMIT IS ISSUE�. � QQ IMAVEANOWILLMr11NTAINWOflKERS'GOM?ENSATIONWSUFANGE,ASRE�UIREDBVSECTION \� �� `\�` 37000F THE LABOR CODE.FOR THE PERFORMANGE OG THE W K FOR WHICHTHIS PEFMIT IS � � ISSUE�.MV WORKEFS'/CO�M�PE ATION INS E CARRIER 0 POLICV NUMBERARE CONSTRUCTION � V j CARRIER_ S`FQ�� PLAN REVIEW �. Z voucrrauMeER_ ELECTRIC I� ¢ � (7H55[GTIONNEmNOT8E0OMPLEfEDOFTHEPERMfT15FORONEHUPDRED�OLW35(b1W)ORLE55;. PLUMBING Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUE�.I MECHANICAL �._�.�. C�J SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE " Uj WORKEFS'COMPENSATIOlvM1LAW50FCALIFORNtA,AhDAG ETHATFISNOULDB OME INSPECTIONFEE _'�� '' � I �. . . � SUBJECTTO THE ORKERS'CO�.IPENSA710N PROVISIONS F SECT N 3]OOOFT LA O ..J_��-� ' � ; CO ,I AL�F flTHWITHCOMPLVWITHTHOSEPROVI N ISSUANCE Q p �ATE: / APPLICANT: � SMIP :� 4 . I � _ wWARNING�FAI�URE TO SEWRE WORKERS'COMPENSATION COVEFAGE IS UNLAWFUL,AND SHALLBE ENERGY P/C I� � SV&IECTAN EMPLOYER TO CRIMINAL PENALTIESAND CIVIL FINES UPTO ONE HUN�RED THOUSAND ENERGY PERMIT DOLLARS(5100,000�,IN ADDITION TO THE COST OF COMPENSATION,DAMACES AS PROVIDED FOR IN f � SECTION3]OBOFTHELABORCODE.INTEREST,ANDATTORNEV'SFEES. RETENTION FEE: c2�" �.:fi ' � �� _._ _._.. �: _..._ � CONSTRUCTIDN LENDING AGENCY PRE-ALT FEE: O � I HEPEBV AFFIRM UNDER PENALTV OF P FJU T AT THERE IS ACONSTRUCTION LENpING AGENCV FOR THE PERFORMANCE OF THE WORI FOR HI 1 THIS PERMIT IS ISSUED(SEC.3091,CIV.C.). Z �W � LEN�ER'S NAME��\��7 H LEN�ER'SADDRE55 � TOTAL FEES ��,�f� ¢ I CERTIFV THAT I HAVE READ THIS APPLICATIONAND STATE THATTHEABOVE INFORl.1ATION IS CORRECT. w IAGREE TO COMVLV WITH ALL CITV AND COUNTY ORDINANCESAN�STATE L4W5 RFI,ATING TO BUILDING d � CONSTRUCTION,ANDHEfiEBVAUTHORIZEREPRESENTA7NE50FTHISCOUNTVTOENTERUPONTNE Z ABOVE-MENTIONLD PROPERTV FOR INSPECTION PURPOSES. Q �� COMMENTS � m GEqMITTEE 1 (PA (/�J/ f.!) I D "'� ��. � � SIG URE OF PERMITTEE DATE = RECPT.NO. ' �� PAID BY �� VALIDATION ~ WHITE—Depatlment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—ApplicanPs Copy � ,_�� _ �� `�" u � oy �— � �� ` _ � �� ,��'�� ' . , `T�13`�'� �'" ' ; .. . � � � — w.� .. _ � � � � a � � � � � � �r ' � r � E _' ��,t��(#�'��'��-r� �•� �.. ;� i �� '� �; z, w ' . _. . .. . .. _ ._.. . ... ... . .. � � N � ti:�� ° �� .F' ... .. . . ._ � c�r�+�,�� . . . :- : �, .. .. . . . .. .. ... .. . � ; tl Y r N . � . q .. ... . . .. _ . . ..... . . .. . ._. . ... ... ... .. . . � !� � ,� u 'iu�� ! r rn ��. _.� r 3 " ,�.�'P�€�'6 - ."� . . .. ... .. .. .. . . .. ._ . . . . . .... MIKEO= JOBSITE 0 -45147 ADDRESS/AL 9,%2 APN T TR�AAC OWNER ADDRE S Y ibler" CITY ZIP TEL. APPLICANT TEL. CONTRACTOR ADDRESS CITY ZIPf'c TEL.QI 0 ARCH/ENG/�' r DESIGNER 1 41 ADDRESSrI 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($500).): ^ 1,AS OWNEROFTHE 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 - 3 I/ �� Q �S LIC. N0. /, LICENSE / / / DATE Cam/N CONTRACTOR 777 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' COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE WORK FOR WHICH THIS PERMIT IS ISSUED. 1 HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION 3700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THEW K FOR WHICH TH PERMIT IS IS ISSUED. MY WORKERS'CCOMPE ATION INS E CARRIER 0 POLICY NUMBER ARE: CARRIER POLICY NUMBER (THIS SECTION 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 AG E THAT F I SHOULD B OME SUBJECT TO THE ORKERS'COMPENSATION PROVISIONS F SECT N 37000E T LA 0 CO I ALL F RTHWITH COMPLY WITH THOSE PROVI N DATE:APPLICANT: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE SUBJECTAN 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 LABOR CODE. INTEREST,AND ATTORNEY'S FEES. CONSTRUCTlON LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF P RJU T T THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WOR OR HI 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 PROPERTY FOR INSPECTION PURPOSES.. PERMITTEE(PR Ad � 114 0/1 SIG URE OFPERMITTEE DATE 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 I� PERMIT/ S P/C / NUMBER # DATE 1 ISSUE,/ � TYPE OCC I DATE 'k' CONST. GROUP I ZONING SETBACKS FRONT RW ^ REAR ^ SIDE/SIDE STREET RW ^ SIDE ^ PROPOSED USE N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREAIVALUATION SFR/ADD/REM U) Garage/Carport W Patio/Deck LL PODVSpa 0 Re-Roof Z Commercial R71 ,:x Valuation ADJ.AREA QUANTITY DESCRIPTION FEE r tr K U w on Z 2 U W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL ^ f h INSPECTION FEE ISSUANCE SMIP HIM ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES COMMENTS C" RECPT. N0. PAID BY �, VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy -7113-,}