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Home My WebLink About17655 CITY OF DIAMOND BAR �x�' `� `� TG �: � � DEPARTMENT OF COI�IIvfUMTY&DEVELOPMENT SERVICES 21825 E.Copley Drive �� (909)860-3195 Faac(909)861-3117 PRESS BUILDING PERMIT APPLICATION FIRMLY y� JOBSITE �J � APPLICATIDN PERMIT jn\ P/C o ADDRESS_��'„_(I �. ��,4d1T� !�}JC DATE �I�V� �NUMBER� ��^'' p � ISSUE TYPE OCC °�° APN LOT TRACT___ DATE CONST. GROUP p OWNER ____ p ADDRESS ____ ZONING SETBACKS z CITY ZIP TEL. FRONT Ryy � � APPLICANT _ TEL. REAR � � -- z SIDE/SIQE STREET RW Q ¢ CONTRACTOR��. El.�=t_T'�t C_ /AlC SIDE � � ADDRESS /�{�:;A 'Ti�!�4=� .�;l�C sZ � CITY "��LI"rt,C��J� ZIP �}c.7c(t TEL.SI�� 17 � PROPOSED USE o ARCH/ENG/ v �z DESIGNER NO.DWEL. NO. NO. � ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADD/REM � p I HEREBY AFFIRAA UNGER PENALTV OF PEHJURV THAT I AM E%EMPT FROM TNE CONTRACTORS LI- � Garage/Carport ' W CENSEL4WFORTHEFOLLOWINGFEASON(SEC.7031.SBUSINESSAN�PROFESSIONSCODE:ANYCITYOR U COUNTYWHICHREOUIRES4,PERMITTOCANSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC wTURE,PRIOF TO ITS ISSUAIJCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck I � SiA7EMENT THqT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF TME CANTRACTOHS LI- � � CENSE LAW(CHAPTER 9(COMMENCING WITH SEGTION]000)OF DIVISION 3 OF THE BUSINESS ANO PRO POOUSPB � FESSIONSCADE�ORTHATFIEORSHEISEXEMPT7HEREFROMANDTHEBASISFORTHEAL�EGEDEXEMP- (3 U TION.ANYVIOLATIONOFSECTION7031.SBVANYAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO z Re-Roof A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLLARS ff Soo)J: 0 ❑I.ASOWNEROFTHEPROPERTY,ORMYEMPLOYF.FSWITHWAGESASTHEIRSOIECOMPENSATION, � Commercial Z WILL DO THE WORN,ANO THE STRUCTURE IS NOT IMEN�E�OP OFFERE�F09 SALE l,SEC.104d,BUSI� J � NE55 ANO PFlOFESSIONS 6�DE:THE CONTRACTOAS LICENSE LAW DOES NOT APPIV TO AN OWNER OF � PROPERTV WHO BUILDS OR IMPROVES THEflEON,AND WHO DOES SUCH WORK HIMSELF OR HEPSELF OR � THfiOUGHHISORHEROWNEMPLOYEES,PROVIDEDTHATSUCHIMPROVEMENTSARENOTIN7EN�EDOR m Q OFFEHE�FORSALEIF,MOWEVER,iHEBUIIDINGORIMPROVEMEN'ISSOLDWITHINONEYEAROFCOMPLE Z TION,THE OWNEfl-BUILDER WILL HAVE THE BURDEN OF PROVING THA7 HE OH SHE DID NOT BUILD OR � IMPROVE FOR TME PURPOSE OF SALE). w ❑I,ASONRJEROFTHEPROPERTV,AME%CLUSIVELYCONTRACTINGWITHLICENSEDCONTRACTORS � TO CANSTRUCT THE PRQIECT(SEC.7o46,BUSINESS AND PROFESSIONS CODE:THE CANTRACTORS LI- Veluatl0n ADJ.AREA W CENSELAWOOESNOTAPPI.YTOANOWNEROFAPROPERTVWHOBUILDSORIMPROVESTHEREON,AND � WHOCONTflACTSFOR5l1CHPROJECiSWITHACONTRACTOR�S�LICENSEDPURSUANTTOTHECANTflAG QUANTITI' DESCAIPTION FEE Y TORSLICENSELAW). O ❑I AM EXEMPT UNDEFI SEC. B.6 P.C.FOR THIS REASON Q � U � � DATE OWNER F' Z W � LICENSED CONTRACTORS DECLARATION W ¢ � I HEREBVAFFIRM UNDER PF-NALTV OF PERJURV THAT I AM LICENSED VNDER PROVISIONSOF CHAPTER � I d B(COMMENCING WITN SEC110N]Oa0)OF DIVISION 3 OF THE BUSINE55 AND PROFESSIONS CODE,AND Z ' X MV LIC[NSE IS IN FULL FOFCE AND EFFECT. � � LICENSECLASS ` IL7 LIC.NO. ��J(�%�S � � ~ DATE ��5�C,� CONTRACTOR d W � (�11�� 1 '�ti/W7i7HRERS'COMPENSATION DECLARATION Q 1 � I HEREBV AFFIRM UNDER PE:NALTV OF PERJURY ONE OF THE FOLLOWING�ECURATIONS: Z Z _IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-MSUREFORWORNERS' _ ¢ CAMPENSATION,AS PROVIDED BV SECTION 3]Oo OF THE 1A60R CODE,FOR THE FERFORMANCE U OF THE WORK FOR'NHICH THIS PEflMIT IS ISSUED. w � x � W IHAVEANDWILLMAINTAINWORKERS'COMPENSATIONINSURANCE,ASRE�UIREDBYSECTION Q 3700 OF hIE LABOR CODE,FORTHE PERFORMANCE OFTHE WORK FOF WHICH THIS PERMIT IS ISSl1ED.MV WORKERS'CAMPENSA'ION CINSURANCE CARFIER AND POLICV NUMBERAfiE: CONSTRUCTION � CARRIER �T_�-_ir� i-ly�� PLAN REVIEW Z POLIC,V NUMBER_ O��[o��Q� �� BC CJCD(�� ELECTRIC � b Q .—_ � (�Hl55ECT10NNEmNOTBENIAPLEfcDOFT}�EPERMRISFOROAEHUNDREDDOLLARS(E1ao)OFLESS). PLUMBING _., Z I CERTIFV THAT IN T�E PERFORMANCE OF THE WORK FOR WHICHTHIS PEFIAIT IS ISSUED,I MECHANICAL � SHALL NOT EAAPLOV ANY PERSON IN.�NV MANNER SOAS TO BECOME SUBJECT TO THE � WORKEFS'COMPEMSATIONLAWSOFCALIFORNIA,AN�AGREETHATIFISHOULOBECOME INSPECTIONFEE ? SUBJECTTOTNEIMJRKERS'COMPENSATIONPROV ONSOFSE TION a OFTHELABOF � \j� GODE.ISHA R'"HWITHCOMPLYW THOSEP VISI 5. ISSUANCE *,./cJ � -� _ �� l _�, C, p DATE: APPLICANT: . � SMIP _____...__.__._ J WARNING FAILUFE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALLBE ENERGY P/C LL SU&IECTANEMPLOVEFlTOCRIMINA�PCNALTIESAN�CIVILFlNESUPTOONEH'JNDRE�THOUSAND ENERGYPERMIT DOLLARS(f 100,000�,IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOF IN J SECTION3]o90FTHEV1BaRGO�E,INTEFEST.AN�AT70RNEV'SFEES. RETENTIONFEE: � OCONSTRUCTION LENDING AGENCV PREAIT FEE: � 1 HER[BVA�FIRM UNDER PI:NA�TV Of PERJURV THAT THERE IS ACONSTRUCTION LENDING AGENCY FOfl T!{E PERFORMANCE 01-THE WORH FOR WHICH TH'.S PERMIT IS ISSUED(SEC.309],CIV.C.�. -- Z w = LENDER'S NAME � H LENDEF'SA�DRE55 � I CERTIFV THAT I HAVE REAU THIS APPLICATION AND STA7E THAT THE ABOVE W FORMATION IS COPfiECT. TOTAL F E ES � � J�V w I AGREE 10 CAMPLV WITH ALL CITYAN�COUNTV ORDINANCES AND STATE LAWS RELATING TO BUILDING a � CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATNES OF THIS COUN'V TO ENT'cR t1PON THE Z ABOYE�MENTIONED PROVEHTY FOF INSPECTION PURPOSES. COMMENTS � �--(� /f _ �iAl7 L 7 K�.1J�� Cil�-t�lU.�(/�'}C-1� __...____ m P AME(PR / C _.__ _ .- . __ ¢ � �'�� / �-%J p�' cn ,��_ � SIGNA UREOFPcRM EE ATE = RECPT.NO. PAID BY VALIDATION ~ WHITE—De artment Co VELLOW—Finance Co PINK—Assessor Co GOLDENR06—File Co GREEN—A licanfs Co P PY� PX PY. PY� PP PY i� � '� a�"e��s'�� a ��w��' a��.��. a��i� � � b��' ��a�..,m . - ,... �. . . ��.� . .n`_ ` ` e .a, . ,.. �� :. .._ E...ff �... , .L�(x�. .� Uik i t r 9iP"�' . tl ,Z�f,/�UG ��' �: b .�� = � � _ _ _ w : � , �� o. � _w� _ �,fl,�, � s, _ � _ _ _ .t. Cy a_ r °�3t� ... . .. ... _. .. 9 a�� c�i;��y � 3a m,��f+r��i�'d.` .. _. .. . ��. • '. t ,�. 7 Q � ... . .. ... . ....... . . . .. ... ._... _. .. .— --- '�. i 5(� uu �i _ r�" �. �'�P3 ,'��'.tl�'{j,1Y p„ . �. : ,;. . . . .... . . . ��.i . , � .. .. .. ... .. ... . . . . ..... .. .... . . .._ .. . _ ! q�' b . l �' ' F�'� M � .. . a c ! � ;s. _ . .. ... _ . .. ........ .... ..._.. 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 JOBSITE ADDRESS-r'//�-��•4(cc A-Z APN LOT TRACT OWNER ADDRESS CITY ZIP TEL. APPLICANT TEL. CONTRACTOR,+i i . I.rc_T�t C IA-LC ADDRESS may;A EG.aJ'Z CITY'R&_jLFLCEr.i �ZIP 9c'7C TEL 5Zr.g&L 7 d3)7 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 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).): ^ 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 ODDE: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 70W)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORCE AND EFFECT. (^'� r LICENSE CLASS ICS LIC. N0. 7J 4 DATE 2�/S-C,;?CONTRACTOR ,�ti/',Q�i7RRERS'COMPENSATION DECLARATION C1 2�� 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 IS ISSUED. MY WORKERS,COME PE NSATIONINSURANCE CARRIER AND POLICY NUMBER ARE: EN CARRIER KE7 r.4- . I-�.: Fu POLICY NUMBER-OXIG,-o r7A OX41r I1001IP'9717 (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 AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS'COMPENSATION PROVS OF SE TION 0 OF THE LABOR CODE. I SHA R HWITH COMPLY W THOSE P VISIgNS. 0 \ �� C DATE: APPLICANT:I YI WARNING: FAILURE TO SECURE WORKERS'COMPENSATION 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 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 PROPERTY FOR INSPECTION PURPOSES. ,L s '74 � P AME(PR F�+ /\ p �vsj i} ' J SIGNATURE OF P RM EE 15ATE APPLICATION��I <� )PERMIT f 1 \P/C DATENUMBER J I1N # ISSUE TYPE OCC DATE CONST.GROUP ZONING SETBACKS FRONT RW^ REAR^ SIDE/SIDE STREET RW^ SIDE 0 PROPOSED USE N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREAIVALUATION SFR/ADD/REM CO Garage/Carport W Patio/Deck LL Pool/Spa 0 Re-Roof Z Commercial m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J 0 cc: U W W 0 Z D- Z 2 U W CONSTRUCTION PLAN REVIEW ELECTRIC'-. b PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES U1,C COMMENTS RECPT N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy