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Home My WebLink About18008 (32) _ ��t �, CITY OF DIAMOND BAR ''Rq�s� DEPARTMENT OF COMMI_INI'I'Y&DEVELUFMENT SERVICES ��'"'� �".. � "'�� 21825 E.Copley Drive ` (909}860-3195 Faac(909}$61-3117 pRE$$ BUILDING PERMIT APPLICATION F(RMI.Y � JQBSiTE >- � ^� ,�, f� APP�ICATION PERMIT P/C o ADpRESS�,;2La��-'_►"1'I I�I��'� .� DATE MBEFi�� #,/'"� ISSUE - '= APN LOT_. TR�A/CT DATE � UZ-=_��gT.__ GROUP p OWNER ��.+`,__�t:::, ��(?�";�/��-""�.{i � ADC7RESS -`;,�+=++=-., 24NING SETBAGKS Z CITY �_ ZIP . TEL. FFiON7 RW ❑ � APPLICANT � �d� TEL. � � REAR � — z - SIQE151DE STREET RW ❑ � CONTRACTOR � + ��% � � SIDE � � ADDRESS ' �y d CITY��u�� G��'�_j�_ TEL PROPQSED USE � ��,��I,�� . ��,r�h4 (y(./ ',.,;�7 y�,� w�, ARGN/ENGJ �'� z DESIGNER w Nd.DWEL. NO. NO. cx. ADDRESS__ ua UNlTS STORlES BEOROflMS" N GITY __._ ZiP TEI. � DESGRlPTIQN SQ.FZ. FACTdR PSF AdJ.AREANALUATION pC qWNER-BUILDER DECLARATION SFR/ADD/REM O [� I NEAEBY AFFIRM UNRER PENALTY�pERX�ftY 7HAT t AM EXEMPT FPlJM THE CONiRACTpRS LI� Ga/8Q9/CBfpOfl W CENSEUWiORiHEFOLLOWINGREASON(SEC.1o31.58USINE59lWDpROFESS10N5CODE'.ANYCITVO% (n �J COUN7YWHIC.HRE(]UIRESAPERMITTOC�NSTRUCT,ALTER,IMPtipVE,OfiMOLlSH,tJRREPAiflANYSTRUC- [jJ pyjI0/DBCI( W TURE,PRIOR TO ITS i55UANCE,ALSO REdVIRES THE A7PLICANT FOR SUCH PERMIT TO FILE A SIGNEh W STATEAIENT THAT HE OR SHE IS LICENSE�PURSUANi TO THE PROVI510NS OF TNE CONTRACTORS LI. ._......__.., � CENSE UW(C#iMTER 9(COMMENClNG WITH SECTION 70W}OF OIY3SION 3 4F THE BUSINESS AND PRO�� +��OIJSpB -'� ` � FESSIfJNSCODE)ORTHATMEORSHEISEXEMPTTHEREFROMAND7HEE3ASISFORTHEALL6GEDEXEMP� � � TION.ANYVIOLATIONOFSECTION7031.5B�ANVAPpLICANTFORAPEFMITSUBJECTSFHEAPPUCANTTO Z Re-Roofi �,. AGIYi�PENAtTY OF NOT MOftE THAN FlVE NUNDREb 6D�.CARS(SSW).j: � ::71,ASOWNEROFTHEPROPERTV.ORMVEMPLOVEESWITHWAGESASTFIGIRSOLEGpMPEN5ATION, � COIIltt18fC10I � WILL 64 THE WORK,AND THE STRUCiURE IS NOT iN7ENOEL�OR OFfEftE�FOR SA�E;SEC.7044,BUSi� J ._. � � NESS AN6 7RQFESSI�S("ADE:THE CONTRACTORS LICENSE LAW DpES NOT APPLV TO AN OWNER OF � PROPERTV WHO BUII�S OR IM PROVES THEREON,AND WNO OOES SUCH WoqK HIMSELF OR HERSELF OR LG TNflOUGHMISQRHEROWNEMPICJYEES,PROVtOERTHA75UGMiMPROVEMENTSARENOTIN7EN27E00fl � ' O 4FFEFEDFORSAIE.iF.HOWEVER,TNEBUILDINGORIMPROVEMEN'iIS50LDWITNINONEYEAROFCOMPLE� � TqN,7HE OWNER-6UILDER WILI.HqVE THE BURDEN OF PROVWG THAT HE OR SHE�ID NOT eUiLD OR � iMPROVE FOR THE P4FRP45E OF 5ALE}, �,y� OI,ASOWNEflOFTHEPROPERTV,AME%CIUSIVELYCONTpAC71NGWITHUCENSEDC6NTRACTORS �� TO CONSTRUGT 7HE PROJECT(SEC.7064,BUSINES�'a ANO PROFESSIONS CODE:THE CONTIiACTQftS U� \ta��yjlpn A�J.AREA W CENSE IAW pOES FiOTAPPlYT6AN OWiVER OFAPAaPEPTY WHp eUIIOS OR tMPROVES Tt{EREON,AND - � NMOCONTRACTSFC7RSUCHPROJECTSWITIACONTPACiOFi�S)LICENSEDPUqSUANTTOTHtCONIRAG QUANTITY DESQRIPTlON �E� � TOFSLICENSELAW). af]I MA EXEMPT UNDEF SEC. �.8 P.C.FOR TMIS REASON Q � u � — � ¢ C1ATE OWNER H Z � as7[ LICENSED CONTRACTORS OECLARA710N W CC IHEREBYAFFIRMUNL1ERpENAL7YOFPFRJURYTHAI`iAMLICEN5FDUNbERPROV151pN50F�HAPTER � �� 9(COMMENCINO WITH SECT�ON 7aco}OF�1vtSIc�N a OF TtiE euSINE3SAN0 PRqFESSiONS CODE AND z X MY CICENSE IS M Ftq.L FPRCE AND EFFECT. /''� .(,�,,+/y1� a IICEN5E CtAS �5.,�_,�{�tIC.NO.��-./ ' � � T— �,�/',/�,,»,�-}� W pATE ��. CON7t7ACTOR�"'�"'"�L`! � r � WORKERS'GOMPENSA710N DECLARATlON Q � IHERE6VAFFIqMVNDERPENALTYOFpERJI;RYONEOFTHEFOILOWINGDECLARATIQNS: Z d .......11...IHAVEFNDWILLMPINTAINACERTIFICATEOFCANSENTTQSEIF.INSUREFORWORKERS' ¢ f � Q �COMPENSATION.ASf'ROVIDEDBYSECTf�N;i7o00FTHELABORQO�E,FQRTMePERF4F3MANCE U W � OFTNE WORK FOR WHIC.H TNiS PERAtiTlS iS5UED. ,� aW _i HAVE AND Will MAWTAIN WOftKERS GQMPENSAT�ON IN5UflANCE.AS REQUIRE6 BY SECTIQN 9l0o PF THE LABOfl CODE,FOR THE PERFORMANCE OF iHF WOpK FOR WHICHTHIS hEliM1T IS )�//�� '"�_ ISSUECJ.MV WORKERS'CAMPENSATION INSURANCE CARftIEfl ANb POLICY NVMBEftARE CONSTRUGTION ___ �(„+�.__. i��. �p -T } GARRIER NT� � PLAN REVIEW � paicvwur.+aEa_.__.' ELECTRIC ¢ 0 (niLSS[C77cNtJEE4rvO78ECIJMF1..EiEOC�FittE°EiiNT�5WR4NEFft#dlFtEOD:A.tJsA5t5�mYOG{.E5S7. P�UMBING _.. _. W Z,^ I CEfl�IFY T4AT IN TFI[FERFORMANCE(]F TNE'WORK FO({WHICH THIS PEftM1T 1S tSSVE�,i MECHANEGAL C..S" SHALI.NOT EMP�OY ANY PERSON IN ANY MAf:NER SOAS TO BECOME SUCJECT TO?HE —� ^ �� — V'j WORKERS'COMPENSATION IAWS OF CAUFORNIA,AND A4REE iNAT IF I SHOULD BECOME INSPECTION FEE � SUBJEGT TO THE WORNEftS'COMPEN5ATION PROYiS16NS QF SECTION JIDG qFTHE tA6Q� — �-- CODf, SHAI.IFORTHWiTHCOMPLVWiTHTHqSEPROVI51CiN5. � ISSUANCE , a � �}-�}�� sna�P p DATE. �pPPIICANT: ....__''�`1' /_�w�_.,_ .._e ..'_ W RT..T�" J WARNING',FILUETOSECUREWORKFRS'CLIMPENSATIOMCOVERAGEiSUNIRWfUI,ANQShtAttBE ENERGYP�G � SUBJECT AN EMPIOVER TO CRIMINAI PENA�TIES ANp CIV�L i'INES UP 70 ONE MUNDRED THOLISAND ENERGY PERMIT DQLLARS(fI0p,0at�,IN ADOITIDN 7q THE COST Of COMPEM9ATION,DAMAu'ESAS PFpVIDED FOR W --- � _�,i SECTION 31o84F TNf LABOR l'ApE.INTERESi,AkDATTORNEY'S tEES. CC RETENTION FEE: [� CONSTRUCTI4N LFNDIN6 AGENCY PRE•A�T FEE� O � I HE9EBYAFFIHM UNDER PENALTY OF PERJURV THAT THERE IS A CONSTRUCTipN LENUING AGENCV �- F4RTHE PERFqRMANCE 4F THE WORK fOA Wl�.ICH TNlS PERMiT�S ISSUED{SEC.3091,GtV.G.}. " � W � I.ENDER'SNAME. _...._._ . .�._....—. .._..., F- LENDER'SADORE55 `� � �` TOTAL FEES � ,�� W ICERTIG'YiHAfIHAVEREAD7HISAPPLICATIONANDSTATETNATTHCA�4VEINF'qRMATIONISGOR%kGT. � f AGREE TO CUMPLY WITH AlL�.ITY AN�COUMTY OR�INANCESAYO STATE LAW5 RELAtiNG 10 8U1(.UWG � CQNSTflUCT7QN.AN6 HERE6V AUTHOAI2E REPftCSENTATiVES OF 7HI5 COUNTY i0 E.NiEq UPON THE Z ABOVE�MFNTIQNED PROPERTI'FUR INSPECTIOh'PURPOSES. COMMENTS__,,,"_ � -'' '` �-�-�-�-�'-�' _._ � ��- � PFRMiiT NAf.tE(R�Ni� . " " _ ...— �.. � �..-t=.�-.- � sicNanaE oF PEaMni EE � onr� RECPT.h0. 1 ��U�_u V FAID BY VAttDATtON z ~ `-' JWHITE-Department Copy,YELLOW-Finance Copy,PINK-Assessor Copy,GOLDENROD--File Copy,GREEN-AppliaanPs Copy �,�,a F ':r.�-r� da.�° �� - . . s , �a �� § .'r�;��,�;��+!ii.� ,?`..a,� y�� g�h��,��,r ..a° . , . . . � � .. ..... _ .. '��/Tl�' �� . L . � S1/��'� � . � � � � �� a �� _ �� `f�� a � �� . ��,�� 5 ��i . �t s"��a �� _ i � . � �� '�� ` .,.�� Ns-�� y�+�,q �.. "� �`''$$ _.+` . . . _. .. E s�.��t �y"'� S �h.$5�� . .. ... . . . .. . . .. � '� �?�;= ...,_ i .�.e 7 �, �i . . . . . . . . . . ... .. '.... t : � ; . . . . . ... . .. .. ._ "' ��c�t ��` p�S i� y .., F4r�'7=fi#,w�F M..a.�'� 5� .�,.L+�� . `.... . . . . . .. . . . . . .. ... . . .. .. ... . . k �: (�7.," . .. . .. . . . . �"� � -�:sk � -*�"B'�^�4� �' . . . .. ... .. � ,� t=!. i � �a �,o t; t i _ .. . . .. .. .. . . .. .... - . . . w;r�>; E� � '�€ ��i �v . . . ... .. ... .. .. . g; �. . '� .� . . .. . _ � �t� � 'a�� ` �� .��r� "��a�*�'��'�,i- .. . .._ ... . . .. . .._ . - . .... _., . ri.�, .'-c3e.im ,.,.. , . ._� .c7. i.�a ��.du .. ._. . _. - . . . . __ �� 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 APN LOT TRACT OWNER--' 12 69d/t- �S- ADDRESS CITY ZIP TEL. APPLICANT TEL. CONTRACTOR ADDRESS CITY 1 A-�1 tin f41r1 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 REQUIRESA 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. LICENSE CLAS I L LIC N0. DATE CONTRACTOR 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 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 (THIS SECTION NEED NCT 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 PROVISIONS OF SECTION 3700 OF THE LABOR CODE,SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS DATE: _APPLICANT.AA„�i'7 M/41 + WARNING: F LU E 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 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 PROPERTYFOR INSPECTION PURPOSES. I PERMITT NAME RIN� SIGNATURE OF PERMITTEE DATE APPLICATION PERMIT 1�f P/C DATE. U I-NUMBER-:,-- # ISSUE TYPE OCC DATE f nl CONST. GROUP ZONING SETBACKS FRONT RW^ REAR^ SIDE/SIDE STREET RW^ SIDE^ PROPOSED USE o= , N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREAIVALUATION SFR/ADD/REM W Garage/Carport LU Patio/Deck L LL PooVSpa Z Re-Roof 0 Commercial 5 m Valuation 2K IL-'h ADJ.AREA QUANTITY DESCRIPTION FEE J U I- U W W m J CL Z Z 0 W CONSTRUCTlON �I + 7. PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES 1 .5() COMMENTS RECPT N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy S�j�ay