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Home My WebLink About16693 � CITY OF DIAMOND BAR - � DEPAR'TMENT OF CONIIvIUNITY&DEVELOPIvfENT SERVICES �� . 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 PRESS BUILDING PERMIT APPLICATION FIRMLY o� JOBSITE f ! / n <' � ADDRESS_I��_� 7 b�I�,(11 ��L� DATECATION � ,�•� �' NUMB R /��y �� pfC OCC � APN I.OT TRACT D TEE ONST. GROUP p OWNER ��i p ADDRESS ZONING SETBACKS z CITY ZIP TEL. FRONT RW ❑ � APPLICANT TEL. REAR � z SIDE/SIDE STREET RW ❑ QCONTRACTOR �w1n�_�._.__L,A .__� SIDE � o ADDRESS �Q��i��F�� PROPOSED USE ��-L% �� -'�- ��c`��'}'Y�,�� CITY fh�e i ia..sa i',a ZIP al� TEL. � o ARCH/ENG/ z DESIGNER w NO.DWEL. NO. a ADDRESS NO. � CITY ZIP TEL. UNITS STORIES BEDROOMS � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREA/VALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HEREBY AFFIRM UN�EF PENALTV OF PERJURV THAT I AM E%EMPT FROM THE CANTRqCTORS LI� GOfe 0/Cef oft W CENSELAWFORTHEFOLLOWINGREASON�SEC.7037.58USINESSANDVROFESSIONSCOOEANYCITY�q (n 9 P U COUNTYWHICHREOUIRESAPERMITTOCONSTRl1CT,ALTER.IMPROVE,DEMOLISH,ORREPAIRANYSTRUC- w TUFiE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES TNE AVGLICANT FOR SUCH PERMIT TO FILE A SIGNE] w Patio/Deck � STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- � CENSE LAW(CHAPTEF9(COMMENCING WITH SECTION]000)OF DIVISION 30F THE BUSINE55 AND PRO- � Pool/Spa O FESSIONSCOOE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFOflTHEAILEGEDE%EMP- � V 710N.ANYVIOLATIONOFSECTION]031.5BVANYqPPLICANTFORAGERMRSUBJEGTSTHEAPPLICANTTO Z Re-Roof � A CIYIL PENALTV OF NOT MORE 7HAN FIVE HVN�RED DOLlAHS(5500�.): � uI,A50WNEROFTHFPqOPEFTV,ORMYEMPLOVEESWITHWAGESASTHEIR50LECOMPENSA710N. � COmmefCi91 Z WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7046,B1151- J � NE55 AN�PROFESSIONS WDE:THE CONTRACTOPS LICENSE LAW�OES NOTAPPIv TO AN OWNER OF PROPERTVWHOBUILDSORIMPROVESTHEREON,AN�WHOOOESSUCHWORKHIMSFLFORHERSEIFOR � � THROUGHHISORHEROWNEMPLOVEES,PROVIDEDTHATSUCHIMPROVEMENTSARENOTINTENDEDOR m QOFFEREDFORSALE.IF,HOWEVEP,THEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE Z TION,THE OWNER-BUIL�ER WILL HAVE THE BUR�EN OF PROVING THAT I1E Ofl SHE DID NOT BLIIID OR � IMPROVE FOR THE PURPOSE OF SALE). w OI,ASOYMEROFTHFPROPERiV,AMEJ(GLUSIVELYCONTRFGT'NGWITHLICENSEDCONfRAGiORS � TO('ANSTRUG7 iHE PROJEGT(SEC.��14,BUSINE55 AND PROFESSIONS COOE:THE CONTRACTORS LI- V2IUallOfl ADJ.AREA W CENSE LAW DOES NOTAPPLY TOAN ONRJER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND � WHOCONTHACTSFORSUCHPROJECTSWITHACONTRACTOR(S�LICENSEDPURSUANiTOTHECONTqqC- QUANTITY DESCRIPTION Y TORSLICENSEUW.). FEE � C7 I AM E%EMPT 11NDEN SEC. B.8 P.C.FOR THIS REASON Q � U � ¢ �ATE OWNER F� Z - U � LICENSED CONTRACTORS DECLARATION W Q � I HEREBY AFFIRM UNDER PENAITV OF PERJURY THAT 1 AM UCENSED UN�Efi PROVISIONS OF CHAPTER d 9(COMMENCINGWIiHSECfION7oo0)OFD'.ViSION30FTHEBUSMESSANDPROFES510N5CODc.AN� � ^ `d I �/Cf C.�. �� l� j_F X IAY LICENSe'IS IN FULL FOPCE AND EFFECT Z e w UCENSE CLA55_ .s�,��f m �' ( �� `' �^ � �, O C-�(� LIC.NO S �E�!� / � .!.:�n'- �t M��.I/�r�/��t.._ � , J 1/��`-'f r��.� V DATE L�Z�S—O� CONTRACTOR d . � w .�_��l.l� �-.J-.} i , ' � WORKERS'COMPENSATION DECLARATION - - 1 � 'Z_ �"c`f={� ii r'--- L. � IHERE9YAFFIRMUNOERPI=NALTVOFVERJURVONEOFTHEFOLLOWINGDECLARATIONS: � t�'�'� � � L{+V(_� t 1 � �HAVE AND WILL MpINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' ¢ CAMPENSATION,AS PROVIDEO 6V SECTION 37000F'HE IABOR CODE,FOR THE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED. � QW IHAVEANDWILLMAINTAINWORKERS'COMPENSATIONINSURqNCE,ASREOUIRE�BYSECTION 3]oa DF THE LABOFl CODE,FOF THE PERFORMANGE OF TME WORK FOR WHIGH THIS PEFMIT IS ISSUEO.MY WORKERS'CAMPENSATION INSl1RANCE GAHRIER AND POL'�CV NUMBERARE: GONSTRUCTION Q �+� � CARRIE(iyL- (1�-lt�u.ta„(1 iAA (w.(S• PLAN REVIEW Z rouGYNUMeEA_ �A (�7(�(� � ELECTRIC ¢ � (IHISSECTIONNEmIWTBE�.1PLEfEDOFTHEPERAUTIS�ORONEHU1�DfiEDDOl1MS(E100)ORLESS). PLUMBING � - W Z I CERTIFY iHHT IN THE PERFOFMANGE OF THE WORK FOR WHICH THIS PERMIT I5155UED,l MECHANICAL (J SHALL NOi EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE -�� (/� WORKERS'COMPENSATIO�LAWS OF CALIFORNIA,AhDAGREE THAT F I SHOULD B COME INSPECTION FEE SU&IECTTO THE WORKERS'COMPENSATION PROV IONS OF SECTI N 370o OFTH IABOR � �J t � CODE.I SHALL FORiHWITH COMPLv WITH T ' �VISInNS. ISSUANCE L-. . ( �L� � � p DATE:G^Z��Q _ qppLICANT: SMIP W J WARNING:FAILURE TO SEC'JflE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND HALLBE ENERGY P/C J � SU&IECTANEMPLOYERTOCRIMINALPENALTIESAN�CIVILFWESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOLLARS(f1oo,000�.IN AD�ITION TO THE COST OF COMPENSATION.DAMAGES AS PROVI�E�FOR IN J SECTION 3]OB OF THE LA80R CODE.MTEREST,AND ATTORNEV'S FEES. ¢ RETENTION FEE: OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: � IHEREBYAFFIRMUNDERPI=NALTVOFPERJURVTHATTHEREISACONSTRUCTIONlEN01NGAGENCY � FOR THE PERFORMANCE O�THE WORK FOR WHICH THIS PEflM1T IS ISSUE�(SEC.3oW,qV C.). Z w � LENDER'S NAME .__ _ - `=---�� F— LENDER'SADDRESS " � w ICERTIFYTHATI�IAVEFEAJTHISAPPLICA710NANOSTATETHATTHEABOVEINFORMATIONISCORRFCT. TOTA FE� 2 � 200��`J 1 / ♦� LL� � I AGREE'O COMPLY WITH ALL CITV AND COUNTV ORDINANCES AND STATE LAWS RELATING TO BUILDING { L/ � CONSTRUCTION,ANDHERFBYAl1THORIZE�iEPRESENTATNE50FTHISCOUNTVTOFNTFRIIPONTHE Z ABOVE�MENiIONED GFOPE TY FOR INSPFCTION PIIRPOSES. � COMMEN S J - � _ _^ ___ m PFRAII E AME(PRI T) • -_ --��--"'" ��"�.T` � �—�"� � � SIG T R MI Fj DATE - � � RECPT.IYO. � �__ PAID BY VALIDATION WHITE—Departmen[Copy,YELLOW—Finance Copy,PINK—Assessor CoDY,GOLDENR06—File Copy,GREEN—Applicanfs Copy �� H � ��' - �a�E +��; � , ' ��'��r.n,�.��a . � e � 3 � � > > r . a . a � �_ _.� E . .�„ � _�� . _�� . �'I.?:r—�! i �:� � ��.�ti � . .. ..... _ .. _.. .. ... . . . .. .. .. ... . , .. a£ J��"z 8€�..... .. .... ... ... _... . .. .�. �� _ �:� �� . _ u, � . P. �� , m s„ r : _ ��rvq °��'L I ' ��. ;, °— . —: � "� .'�ti �' ... ._. . _... .. ._. . '. I t' .. .. . ... . . ... .. . . .. . .. .. _. .... .._. . . � ��}5 �� a�r �1,i ;� al�� ^�rI?r=;�, � "' = 1 . � 7 a, ... . .... .. . _ ... .. .j .� �� .L�1,.5 .,, ....... . .. . ........ ... .. . .. . ... . ..... . ..... . 9 � � i > . 1 fi°.5 . .'��. . �. �' E � . _._ . . ... ��. �. .h � .. ... . . �- — i � _ r^t� � ta� �� a�, "' ".�� i � � � . � , �� _ °; r, r :.. { _ CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION JOBSITE A MO ADDRESS bf ADDRESS I APN LOT TRACT OWNER Y=q� ADDRESS CITY ZIP TEL. APPLICANT TEL. CONTRACTORqAzC a"LA tV ADDRESS CITY Ai 7A C�?,g ra ZIP aim TEL. 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 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 30F 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).): ^ 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). ^ 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 ACONTRACTOR(S) LICENSED PURSUANTTO THE CONTRAC- TORS LICENSE LAW.). ^ I AM EXEMPT UNDER SEC. B. &P.0 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. G... �t LICENSE CLASS LIC. N0. 2{n 2 7 DATE G Z�-0 I CONTRACTOR WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: 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 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 15 ISSUED. MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER CA La-4(A.(J POLICY NUMBER_"(c71! 1 (THIS SECTlON NEED IVOT BE COMPLETED OF THE PERMIT IS FOR ONE HUI'DRED 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 F I SHOULD B COME SUBJECT TO THE WORKERS'COMPENSATION PROV IONS OF SECT! N 3700 OF TH LABOR CODE,I SHALL FORTHWITH COMPLY WITH T OVISIONS. DATE: 0 APPLICANT: If,AaA WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE I5 UNLAWFUL,AND HALL BE SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100.000),IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 370$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 PROPS TY FOR INSPECTION PURPOSES. PERMI E AME(PRI T)�, P1 SIG T R MI DATE WHITE-Department Copy,YELLOW-Finance Copy, PIN PRESS FIRMLY APPLICATION PERMIT/I ". P/C DATE s NUMBER# ISSUE TYPE OCC DATE CONST.GROUP ZONING SETBACKS FRONT RW^ REAR^ SIDE/SIDE STREET RW^ SIDE^ PROPOSED USE�-L r Y�Cal �- �4' lA( N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREAIVALUATION SFR/ADD/REM U) Garage/Carport W Patio/Deck LL Pool/Spa 0 Z Re-Roof 0 Commercial 5 M Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U 0 W -J (D IX Co -L L J fl L LL lr'' L{.�t_ I,t. CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING 1 - MECHANICAL INSPECTION FEE ISSUANCE 2-Y SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTA FE4 2 5 2001 L; � 2t COMMEN S 1/,A RECPT. N0. PAID BY VALIDATION