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Home My WebLink About17312 cl�oF D�orm sa� �,,,��-.--...-----:,_,, -`�r"''�`` DEPARTMENT OF COMMUIVITY&DEVELOPMENT SERVICES r ` �� ! , 21$25 E.Copley Drive {904}%60•3195�ax(909)861-3117 �� RE�� `'%��' BUILDING PERMIT APPLICATION FIRMLY Q DDRESS __�� L � ��. �l�l't7`��.�V� DATEtCATi�O}N �g � NUMBER :�/ �^–._�/C �\_..4..{ � o iSSUE TYPE OCC °D APN LOT __ TRAGT_ DATE CCJNST. C,ROUP p OWNER _ `L ADDRESS ZQNING 5ETBRGKS � Cf7Y � ZtP TEL. _ R�O�NT RW ❑ zAPPLICANT _ TEL SidE/SIDE STREET RW � Q CONTRACT R � d SIDE _ CJ � ADDRESS� v'� f r < . /� Q GI7Y ZlP�� TEL PROPOSED USE � �y ��-'� . �t.�� _ QARCHtENG Cr� z DEStGNER` – NO.DWEI. NO. Np. � ADDRESS _ UNtTS STORIES BEDROOMS � CITY ZIP TEL. `n -- DESCRIPTION SQ.FT. FACTdR PSF ADJ.AREANAIUATiON ca � OWNER•BUILDER DECLARATION SFRlADOiREM d 0 !MEftESY AF�1RM UNDEft PENALTY OF PERJVHY THAT�AM EXEMPT FflOM THE CtiNTRAC7QRS LI� Gdf896/CflfpOR W CENSELAWFOfiTHEFOLLOWINORFASON(SEC.loa1,50USINESSANDGROFESSIONSCQDE:ANYGTYOR {f) . ZCOUNTYWHICHREQUIRESAPERAAItTOCpNSTRUCT,ALTER,IMPFqVE.DEMOLISH,OPREPAiRANYSTRUC. �j,J Pdti01L}eCk � TIN�E,PR16R TO ITS ISSUfuVCE.ALSO REOUIFES TYE APPL�GANi FqR SUGH pERMiT TO FILE A SIGNEO W .g STA7EAIENT THAT HE QR SHE!S LICENSED PURSUANT TO THE PROVISIONS OF 7HE CONiRACTQRS li- � CENSE LAW�CHAPTER 9(COMMENqNtl WITN SECTION 7000)C1F DIYISION 3 OF T4E 6USIN655 AND PRO- u' POOUS(1d FESSIONS CtlOEj ORTriATHE OR 5NE iS E%EMPTTHEREFROlA ANpTHE BA515 FOR TNEALIEGED EXEMV� (, � TMNI.ANYYKkUTtON6F5E:GTK}N703/.58YANYAFPLICANTFORAFERAAfTSU6JECiSiH€APPL�CANTTO Z Re-Roof � A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLAAS{SSoo).): a OI.ASOWNEHOf7HEPROpEqTVORMVEMPLOVEESWITHWAGESASTH€IRSbLECOMPENSAT10N, � �ommercial � WfCL OO THE WORK,AN�THE STRUCTLIRE iS NOT INTENI7ED Oq OFFEfiED FqR SA4E(SEC.704a,BUSi- J NESS AND PROFESS1aN5 COC7E THE CANTRqCTORS LICENSE lAW pOES NOT AFPLV Tb AN OWNER OF L" ! � pROPERTYNh108U1L�50PIMPROYESTHEREON,AN�WH40QESSUCHWORKHIMSEIiOftHEPSELFOR � ��{� i�� , � THROUCH HIS OR HER OWM EMPLOVEE5,PROVIDE�THAT SUCH IMPROVEMENTS ARE NOT INTENL�ED OR m QOFFEREOFORSALE.IF,HOWEVER,7HEBUILDINGOfliMPAOVEMEN71SSOLDWi`HINONFVEAROFCOMPLE z TIQN.THE OWNEq-9UIlDEf��Wl�l HAYE THE BURDEN OF PROVlNG THAT HF OR SHE Dib NqT BVILD OR = IMPROVE FOR THE PURPOSE C}F SALE). � �I,l,SOWNEROFTHEPROPERTV,AME%CLUSIVELYCON7FACTINGWIiMUCENSE[/CONTRACTOFiS [C TQ CONSTRUGT THE PAQlECT(SEC.70d4,BUSINESS AN6 PROFESSIONS CODE.THE CONTRAGTOflS LI� V1IU211011 _� ADJ.AREA W CENSEL4WOOESNQTAPPLYTQANOYINEPOFAPROAERTYWH09UitD50RiMPROVESiNEAEON,AND � WHOCAN7fiACTSFOR5UCHPROJECTSWITHACONTRACTORiS�LICENSEDPUqSUAtJTT4THECON7RAG Q(�ANTITY DESCRIPTION FEE � ioftSt�CENSELAW.}. � O t AM E%EMPT UNDEP SEC. 8.&P.C.F4P TWS REASON Q �s . _ ^ ..._..� ._.._..,_ U a � pATE ___. OWNER " F _'- W a¢ CI{:ENSED CQNTRACTORS�ECLARATION W CC I HEFiEBV AFFIRM UNDER VEIVALTY OF PER.IURY TMAT I AM UCENSED UNDEfl Pft�VISIONS CF CHAPTER V. p. 9(C4MMENCING WITH SEC710N I0o0)OF DIVISION 3 OF THE BUSINE55 AND PHOFESSIONS COOE.AND Z �X MY�FCENSE iS IN FtRI FORCE AN6 EFFECt. �s/ .�+^ m � UCEN5E G1A55�_� LIC.NQ._�y(�. � � DATE t� (�Y_.� . CONTRACTOR._�.,�^� '�y.�+� d W � WONKERS'COMPENSATiON DECLARATION Q � 1 HEREBY AFfIHM UNOER PENPLtt OF PEftJt1R'!QNE Of THE FOLLOWING DEGIARATIONS: U �5 Q � � � _,I HAVE AND WIL4 MAInITAIN A CERTIFICATE OF CONSFNT Tp SELF-INSUFE Fpq WOfiKEFS' S CAMPENSAT�ON,AS f�ROViDED BV SEGTIpN:i7oo OF THE LABOR COpE,FOP THE PERFORMANCE U Q GF THE WORK F4R wNiCH 7HIS pEftFiR 15 iSSVEO. � � � _I HAVE AND WIL4 MAINTAIN WORKE%5'COMPF.NSATION INSUftANCE,AS REOUIRFD 8Y SEC710k 6 3"/0o pF iHE LABOR CO�E.FOR THE PERFORMANCE OF THE WOHK FOR WHICH THIS PEPMIT IS ISSUED.MV WOAKERS CpMPENSATION iNSURANCE CARqIER AYD POUCY NUMBEFARE: CONSTRUCTION �r+�� j� � � - .�.-.. }J PI_AN REVlEW ��t�� CARRIER_'—' .. ._ .. ..._ � f ELECTRIC 7 z POIICYNUMBER__.._. ...---- �_._ . Q Q (7HISSECTpNNE�NOI'BEOJMPLEfE�UFTHEPERMITISFOPOtJEHUf�[IHEDCIX1ARStL1m10RlE5Sa. PLUMBWG ..�. ._, -.. — Zf cER`IFY THAT IN THE PERFQRMANCE OF iHF WORK FOR WHICN tN15 PERMIT IS ISSUE6,I MECHANICAL ,_. .r.. _-..- {;y SHALl.NOT EMPIOY AI�IY PfRSOt�+�N 1wY MAtuNER SOnS i06ECOtAE SUBJECf TO TNE � �j WpflKER$'COMPENSA71bNI.AWSOFCALIFORNIA,AN�AGPEETNATtFISH04J�D8ECAME INSPECTIONFEE SUBJECT70THEWORKERS'COMPENS OVISIpN50FSEG��ON37000FTHELABOR Li -+- ~ CAOE,tSHALLFORTHiMITHCOMPIY THQSE qOVISI4NS. �SSUANCE a-' � P.�� _" � .. ... � L�.7 . 0 pA7G:_1D 7.��APPUGANT ... SYIIP _._.�� _�_....e,r_ W ENERGY P/C -t WhRNING:FAILURE TO SECURI'WORKERS'COMPENSATIDN COVERAGE IS UNLAWFUI,ANO SHALL 8E �-- J SUBJECi AN EMPIDYEP T�CRIMiNAL PENALTIGS ANp CNii KME9�P 706NE HUNDRED?HOUSAND tL ENEflGY PERMI7 DOLI.ARS(S1fln,a0o},1N PB01T14M TOTHE COST Of C6MPENSATION.DAM�tGES AS PROVIpEQ FOR IN —� � SECTION 3]aB DF THE�ABOR CODE,INTEFEST ANU ATT6RNEY'S FEE$. RETENTION FEE: .___.. a CONSTRUCTION LENDING AGENCY PqEAIT FE6: _. . .—..— — a � I NEAEBY A�FIRM UNI)Fq PENALTY OF PERJIIRY THAT TNCRF:IS ACONSTHUC:IION IENDiNG AGENCY n- FqR THE PERF-0RMANCE OFTF�E WORK F'O(i WIIICH THIS PEFMIT IS ISSUE�(SEC.3D9�,CIV.G�. �� 4 Z' ._-_... _...__...�_ W � LENPER'S NAME _.�__...._�..__._. ._ _- �...__. . .� _..__..T k_- LEN�ER'SADDRESS�_,.__.. _...._.-� _--. / W I(:EqTIFYTHATINAVENEAD7HI5APPLIC0.TIONANPSTATETHATIHEABOYE�INFGYMRT10NiSCOftRECT. TCITAL FEE� ��4`1�'J��` " ' `� � ^~ � I AGREE TO CDMPIY WITH ALl C ITV AN�COUNTY OR�INANCES AN�STATE LAWS RF.LATING Tq BUILD WG � ' . �__ �NSTitUCTION.ANn HEREBV P,UTHORZC REPRESENTATNES OF l HIS CpUNTY TO ENTER UPON THE p Y '�� ZABOVEMEMTIQNED PftORERTY F4(t tNSPECTION PVRPOSES. �`"� f COMMENTS�.�'V r �i" .... �^' �. .r• '`'� ��-� �' � Q — � -- � ��'i' . t��.� .�1--__ - f��. m PERMI E INT) `.y ' . ¢ _ .. _ _..._ vy �0�Z�'�Q� — � � _ —_.— y �__ � SIGNATURE F MITT DATE f�L� i_ �a� /r��y� (� = RECPT�O. _<� y_ PAlD BY�-i e__L? VAUDATION _ ~' WHITE—Depertmsnt Copy,YELLOW—Finance Gopy,FINK—Assessor Copy,GOIDENR00--Pite C�y,GREEN—Rppficant's Copy ��1.� r' ti �� ,�� y�xr � ��"�� a �,�� e �mr �+ .� � � � � � �� ` '� �� .� . � �-�-03 �- �' . 5.; �� _ _ � �� .� �.�,��._ ��_ , g � � A , � �� , �; � _�� _r� ��:� � �a..�� e kL Y � �ti� : I 5�, � � i^- tf �y'�Mi .� .... . ... ... . _ . . ��i� .i 4ii��,�`��'J��"�`� j`4' .. . .. .. . ... . ..... .. . .. . .. .. . . . . ... . . �'� f�Z 3 . i' _ .. .. . . � _i �: r. . .. . . t �:.. � ., � , .. ... . .... . .. ..... . : r ,. ,.�. P ... ... . . ... .. � '�. r€,r �„ .'� . ... . . ._ . . . . .. . .. ��. ; � .��1 t .... . .. . , .. i .,, . ._ . _ r � _ �� f :� ��a��'u�� ,�^�r �, _ s �^ � �r � �. r� =a 6 ..h ,s'� . . .. . .. � ...' � .. .�� ... .. . .. .. . .. .... ..... .. .. ... . .. . + � "� �f �r � r. � � ' � � .., _ ,� �4r,. .' _ s��c�€ ��"��a�,r .. � _ __ .. 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_LE 2 7 5.A APN LOT TRACT OWNER ADDRESS CITY ZIP TEL. APPLICANT,TEL. CONTRACT R E fS ADDRESS CITY ZIP � TEL. ARCH/ENG/'q 4 77 DESIGNER 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 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 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. G LICENSE CLASS L.7r1 ^ LIC. N0. S9 I r�V DATE_T,0 .-J I •�Q CONTRACTOR fS 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 FROVIDED 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'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER POLICY NUMBER (rHIS SECTION NEED NOr 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'COMPENS OVISIONS OF SECTlON 3700 OF THE LABOR CODE.I SHALL FORTHWITH COMPLY THOS ROVISIONS. AT P CA T 10-2 6 0 D E: AP LI N 11 1 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 ADDITICIN 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 P.UTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. PERMIEINTO D-26 0l SIGNATURE(OF MITT DATE APPLICATION PERMIT P/C DATE D i,/ NUMBER I Zj/2_-01-44 1 ISSUE OCC TYPE DATE CONST. GROUP ZONING SETBACKS FRONT RW ^ REAR ^ SIDE/SIDE STREET RW ^ SIDE ^ PROPOSED USE ��v I(t. %'r/, N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM CO Garage/Carport W Patio/Deck W LL PoolSpa 0 Re-Roof Z Commercial 'tdf�l 7 Valuation-� - i ADJ.AREA QUANTITY DESCRIPTION FEE J Q U cc U W W 0 Z DO C1. Q U Z U W CONSTRUCTION L ! n PLAN REVIEW? ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE �lI)1 C a SMIP . ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES rr COMMENTS RECPT N0. 61 PAID BY4K L�O�VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy nJ I - 7:i