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Home My WebLink About17589 �,` CITY OF DIAMOND BAR �.' - DEPARTMENT OF COMMUNTI'Y&DEV�LOPMENT SERVICES �,L� 21825 E.Copley Drive (909)860-3195 Faac(909)861-3117 PRESS ��'%��• BUILDIN PERMIT APPLICATION FIRMLY o� JOBSITE � � APPLICATION i' PERMIT ''' � (� p/� ADDRESS I �' L . � DI�r( DATE I - �� UMBER \L`� q � �� . ISSUE 7ypE APN Z�3 ,I_OT� TRACT Lf O � DATE CONST. GROUP p OWNER �' ZC:1.1 p ADDRES �� k ZONING SETBACKS z CI '�IP I3 TEL. FRONT Ryy �_ o APPLICANT TEL�' " - G REAR C z SIDE/SIDE STREET RW [-_ a CONTRACTOR ' E�r�. � SIDE ADDRE S � CITY� I ZIP TEL. - F'ROPOSED USE - w ARCH/ENG! - �(� z DESIGNE 'f✓ a ADDRE S �� ' .., NO.DWEL. NO. NO. <n UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADD/REM O � I HEREBV AFFIRM UNDER PENALTY OF PERJURV THAT I AM EXEMPT FROM THE CONTRACTORS LI- GflfO B/C8 OR W GENSEIAWFORTHEFOLLOWINGHEr150N(SEC.7031.SBUSINESSANDPROFESSIONSCODE:ANYCI7VOR (n 9 � U GOUNTYWHICHREQUIRE5�4PERMITTOCANSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANVSTRUC- pgfl0/DBCk Z TURE,PRIOR TO ITS ISSUP,NCE,AL50 RE�UIRES THE APPLICANT FOR S�CH VERMIT TO FlLE A SIGNED w w $TATEMENT THAT HE OR SHE IS LICENSED Pl1R5l1ANT TO iHE PROVISIONS OF TNE CON'RACTORS LI- O� CENSE LAW(CHAPTER 9(COIUMENCING WITH SECTION]000)OF DIVISION a OF THE BUSINESS AND PFO- � POOVSpO FESSIONSCq�EJOFTHATHEOPSHEISE%EMPTTHEREFROMAN�THEBASISFORTHEALLEGEDEXEMP- � V TION.ANYVIOLATIONOFSF:CTION'l031.SBYANVAPPLICAN7FORAPERMITSUBJECTSTHEAPPLICANTTO Z Re-Roof A CIVIL PENALTV OF NOT MOpE THAN FlVE HUNDR ED DOLLARS(35o0j.): O ❑I,ASOWNENOFTHEPROVERTY,ORMYEMPLOYEESWRFIWqGE5A5TNEIR50LECOMPENSATION, O CDrt1rtIBfCIdI Z WIIL DO THE WORK,AND 1HE STRUCTURE IS NOT INTENOEU OF OFFERED FOR SAIE(SEC.7044,BU51- J � NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTYWHOBUILDSOFIIMPROVESTHEREON,ANDWHODOESSUCHWOFKHIMSELFORHERSELFOR � wTHROUGHHISOflHEROWNEMPLOVEES,PROVIDE�THA7SUCHIMPROVEMEN'SARENOTINTENOFDOR m � OFFEREDWRSALE.IF,HON/EVER.THEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE- Z TION,THE OWNEF�BUIL�EN WILL HAVE THE 6UFDEN OF PROVING THAT HE OR SHE OID NOT BUILD OR � IMPROVEFORTHEPURPOSEOFSALE). w ❑I,ASOWNEROFTHI:PROPERTY,AMEXCLUSIVELVCONTRACTINGWITHLICENSEDCONTRACTORS � TO CONSTRUCT THE PRQIECT(SEC.]046,BUSINESS AND PROFESSIONS COD"c:TME CONTRqGTORS U- V2IU8t1011 ADJ.AREA W CENSEUWDOESNOTAPPLY70ANOWNEROFAPROVERTVWHOBUILDSORIMPROVESTHEflEON,AN� - WHOCANTqACTS FOR SUGH PROJEGTS WITH qGONTftACTOR�S)LIGENSED PUHSUANTTOTHE CANTRAC- ~ TORsucemseuw.�. QUANTITY SCRIPTION FEE Y � ❑I AM EXEMPT UNDEH SEC. _... _._— B.8 P.C.FOR THIS REASON Q � U �' � DATE OWNER � Z (.� � � LICENSED CONTRACTORS DECLARATION w ¢ � I HEREBYAFFIRM UNDER PI=NALTV OF PERJUF HAT IAM LICENSE�UNOER�ROVISIONS OF CHAPiER � � 9(GOMMENCING WITH SEC�ION]000)OF D'NI N 3 OF THE B��S AND PROFESSIONS CODE,AND Z 1X MY LICENSE IS M FUL FORCE AND EFFECT ,�///�y m � LICENSE CL4S� LIC.NO� (r//��/ � � U DATE GONTFACTOR+ �� L(B(7 ' p. W Q ��S � WORKERS'COMPENSATION DECL A7101Y �� z7 a � I HEflEBY AFFIRM UNDER PI=NALTV OF PERJURY ONE OF THE FOLLOWING OECLARATIONS� U � Z � IHAVEANDWILLMNINTAINACFRiIFICATEOFCONSENTTOSELFINSUREFOPWOflKERS' a Z = a COMPENSATION,A;�PROVIDED BV SECTION 3�OOOF THE IABOR CODE,FOR THE PERFORMANCE U Q FTHE WORK FOR WHIGH THIS PERMII IS ISSUE�. � w I HAVE AND WILL M/JNTAIN WORKERS'CO PENSATION INSURANCE,0.S RE�UIRED BV SECTION QQ 3]00 OF THE LABOF;CODE,F�R THE PE ORMANCE OF THE WORK FOR CH THI MIT I$ ��,CI�� ' i�� ISSUED.MY WORKERS'COM ENSATIO IS�U�9R�A.NCE CARRIER AND P V MB n : CONSTRUCTION b ^7 j CARRIER�✓�C� If R�F'��1G` ' _ PLAN REVIEW '� 6 � �_.,. 1 ZPOLICY NUMBER_ ELECTRIC Q � (I}iI55ECTpNNEmIWTBENMPLEfEDOFTHEPERMRIS�ORONENUnDqED�OLLA0.S(5100)ORLESSj. PLUMBING W Z I CERTIFY THAT IN THE PERFORMANCE OF THE WONK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL (J SHAIL NOT EMPLOI'ANV PERSON IN ANY MANNER SOAS TO BECOME SUBJECTTO THE � WORKERS'COMPEIISATION LAWS OF GALIFORNIA,ANDAGREE THAT IF�SHOUL�BECOME INSPECTION FEE � SUBJECTTO THE WORKERS'COMPENSATION PROYISIONS OF SEGTION 3700 0F THE LABOR �� i CODE,I SHALL FOR�HWITH COMPLV WITH THOSE PROVISIONS. ISSUANCE _ _ `.CI� � .lfp �ATE' _ APPLICANT: SMIP W J WARNINa:FAI�URETO SEGJRE VJORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SMALLBE ENERGY P/C J � SUBJECTAN EMP�OVER TO CRIMINAI PENALTIESAND CIVIL FINES UPTO ONE HUN�fltD THOVSAND ENERGY PERMIT OOLLARS(Sl W,oaa�,IN A��ITION TO THE COS�OF COMPENSATION,DAMAGES AS PROVIDED FOR IN J SECTION 37oB OF THE LABOfl CODE,MTEREST.AND ATiORNEV'S FEES. y� �¢ RETENTION FEE: �y�,��-� d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O � IHEPEBVAFFIRMUNDERPI=NALTYOFPERJVRYTHFTTHEFEISAGONSTRUCTIONLENOINGAGENCY FOR THE PERFORMANGE OF THE WORK FOR WHIGH THIS PERMIT IS ISSUE�(SE(:.3�9],GIV C.). W j LENOER'S NAME � F— LENDER'SADDRESS y � I CERTIFV THAT I HAVE REAIJ THIS APP�I A ION AND STATE THAT TME ABOVE INFORMATION IS CORflEGT. TOTA�FECL�}�]+ �L�.r d� �� 1 AGREE TO COMPLV ITH P. AN UNiV ORDINANGES I1ND STATE lAWS RELAT�NG 10 BUILDING e^Y�")"� iJ/ ' � � CONSTRUCTION RE Y THO Z EPHESENTATIVES OF THIS COUNTY TO ENTER UPON THE �'�'�•V < < <�� Z NBOVE�MlEN�IO D P IN P TION 7URPQSES. COMMENTS � �.1 �� . _ m PERMITTEE NAA1 Q � � SIGNATURE OF DATE F RECPT.NO. PAID BY VALIDATION WHITE—Depariment Copy,VELLOW—Finence Copy,PINK—Assessor Copy,GOLDENRO File Copy,GREEN—ApplicanCs Gopy �� , � �M � �� , � � � � �� ,� ��,��` ��F �� ' . .'� � � ,� w •� , �, _ .�� ' _ , , � ,,-� . , :2 't � cU � ��r� �t� � � "�, �. S!�-�J �7 `� G-i�--S>i � !�. r,� �� S � .� _ ,_ `-3 .,. ,�.=I _ _ � / X - , ; , - _ _ � _ � , .,s � 13" : .. ... . ..... . ..._.. ..... . . � x �. 5� . .. . .. .. .. . ... .. .. ... . ... ... .. . _ � r �� .� �� . a,* � � ��i3 i�,'� � n� a ._ . . ... ... ... .. ..... . ....... ... ... . ._.. ... .. r .�, � � ..N „ .. . .... . ... .__ _.. . �i r - a _ .." i �.,': , �� .. ... .. .. .... .. .. . ._. .. . .._ ... ... . .. ... ... ...... . . . . .,: �� : a��, �'� _ � ' . . � w _ �� _ u. �, n� ` ' " _'�, F�� _ _ ��r...f .�r JOBSITE I �� DI.�1, ADDRESS L APN Z�33,I_0��TRACT�C7�C. OWNER��'ZC:/I ADORES�� k CI '�IP�/TEL. APPLICANT�� TELL'--G CONTRACTOR Pi°r�° ADORE S-' CITY ZIP TEL.. ARCH/ENG/- �!� DESIGNE��41/ ADORES� " 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 FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE:ANV CITY OR COUNTY WHICH REQUIRES.4 PERMIT TO CONSTRUCT,ALTER,IMPROVE,DEMOLISH,OR REPAIR ANV STRUC- TURE,PRIOR TO ITS ISSUP,NCE,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- FESSIONSCODE)ORTHAT HE ORSHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION.ANV VIOLATION OF SECTION 7031.5 BY ANV APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(5500).): ^ I,AS OWNER OF THE PROPERTY,OR MV 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 CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OFI 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 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 EXCLUSIVELY CONTRACTING W ITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC. 7044, BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- CENSELAW DOES NOT APPLY TO AN OWNER OFAPROPERN WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS W ITH A CONTRACTOR(S)LICENSED PURSUANT TOTHE 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 PI_NALN OF PERJUR HAT I AM LIC E NSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH SECf10N 7000)OF DIVI I OF T B NESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FUL FORCE AND EFFECT /G rY � I 71 �j� �I S/ LICENSE CLAS LIC. N0. IY DATE CONTRACTOR+ IfBE7 WORKERS' 0 R �� z7 C MPENSATION D CL AT IdtY I HEREBY AFFIRM UNDER PI=NALN OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MNINTAIN ACERTIFICATE OF CONSENT TOSELE-INSURE FOR WORKERS' COMPENSATION,AS PROVIDED BV SECTION 37000E THE LABOR CODE, FOR THE PERFORMANCE F THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WILL M/JNTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BV SECTION 3700 OF THE LABOFI CODE, F�R THE PE ORMANCE OF THE WORK FOR CH THI MIT IS ISSUED. MY WORKERS'COM ENSATIO dSURANCE CAR R IER AND P V MB A S CARRIER S�� (t�, F'�/�I' POLICY NUMBER (f}il3 SECTpN NEED IWT BE NMPLETED OF THE PERMR IS FOR ONE HUNDRED DOLLARS(3100)OR LESS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOI'ANV 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 SECTION 3700 OF THE LABOR CODE,I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE:APPLICANT: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL eE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS(5100,000),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 01=THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC. 3097,CIV C.). LENDER'S NAME LENDER'S ADDRESS I CERTIFY THAT 1 HAVE READ THIS APPL A ION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. 1 AGREE TO COMPLY ITH A.AN UNN ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION RE V THO Z EPRESENTATIV ES OF THIS COUNTY TO ENTER UPON THE ABOVEE-M� D P IN P TION PURPQSES. (�L PERMITTEE NAM SIGNATURE OF DATE CITY OF DIAMOND BAR�' DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 WHITE-Department Copy,YELLOW-Finance Copy, PIN BUILDIN PERMIT APPLICATION PRESS FIRMLY N