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Home My WebLink About19001 `--1� _- C1TY OF DIAMOND BAR � DEPARTMENT OF COMMUNITY&DEVELOPNIEN'T SERVICES ; - .:� 21825 E.Copley Drive J� PRESS (909)860-3195 Fa�c(909)861-3117 "''�'"'•� BUILDING PERMIT APPLICATION / FI R M LY a DDR'ESS�"�1�� C � APPLICATION PERMIT I U�r P/C O�� ' o DATE I/._�Z'O�L NUMBER � � n � APN LOT TRACT DA EE `,i��ONST. GROUP °C OWNER k/� ECr O p ADDRESS c % ZONING SETBACKS Z CITY IP TEL. FRONT RW ❑ � APPLICANT TEL. REAR ❑ o SIDFJSIDE STREET RW iJ � CONTRACTOR� L, m0 SIDE ❑ p� ADDRESS ^ o U � CITY W•C�r'�y'� ZI ^ TEL�IG'StiZ��i['9�f PROPOSED USE w ARCWENG/ z DESIGNER�',/ �lfu- NO.DWEL. NO. NO. a ADDRESS z» UNITS STORIES BEDROOMS � ciTv � G�^.a-�� ziP�l/?_K1 TE�.___ . � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AHEANALUATION cn � OWNER-BUILDER DECLARATION SFR/ADD/REM � O 0 I MEREBY AFFIRM UNOER PEN�LTY OF PERNRY THAT I AM EXEMPT FRON THE CONTMCTORS LI- � GaragelCarpon I W CENSEIAWFOR7MEFOLLOWINCiREA50N(SEC.7v31.58USN'lESSIWDPROFESSIONSCODE:ANVCITVOR U COUNTYVhiIqiREIXIIRESAPERMITTOCONSTRUCT,�ITER,IMPqOVE,DEMOLISM,ORREPAIRANY57AUG W patio/Deck � WTURE.PRIOR TO RS ISSUANCE.ALSO RC-0UIRES THE APPLICAN7 FOR SUCH PERAUT TO FILE A SIGNE� w � STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROYISIIXJS OF THE CONTMCTOR3 LI� � CENSE UW(CNAVTER B(COMMENCINCi VATH SECTION 7aoo)OF OIVISION 30F THE BUSINESS AND PRO- � PaoVSpa e FESSpNSOODE)ORTHATHEOR5HEISE%EAIPTTHEREFROMANDTHEBASISFOFhIEALLEOEDE%EMP� (� TION.ANYVIOLATKKJOFSECTION7o31.68VANVAPPLIGINTFORAPERMITSU&IECTSTHEAPPLICAMTO Z Re-Roof � ACIVIL PENhLTY OF NOT MORE THAN FIVE HUNDRED DOLLAR&(t500).): 0 OI,ASONMEROFTHEPROPERTV.ORMYEMPLOYEESWRHWAQESASTHEIRSOIECOMPENSATION, O Commercial Z WILL DO THE WOFII(,AND THE STRUCTURE IS NOT INTENDEO OR OFFEHED FOR SALE�SEC.70aa,BU51� J NESSAND PqOFESSIONS CODE:THE CONTRACTORS UCENSE LAW DOES NOT APPLY TO AN OWNER OF � PROPERTYYhWBU1LDSORIMPROVESTHEREON,ANDNMOWE55UCHWORKHIMSELFORMERSELFOq m � iHROUGH HIS OR HEH OYM EMPLOYEES,PHOVIDED 7H�7 SUCH IMPROVEMENTS ARE NOT INTEN�ED OR WQ oFFEREDFORSALEIF,HOWEVERTHEBUILDINGORIMPNOVEMENTISSOLDVATHINIXJEVEAROFCOMPLE- Z TqN,THE OWNERAUIIDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR � IAIPROVE FOR THE PURPOSE OF SALE). W ❑I,AS ONMEROFTHE PROPERTV,AM EXCLUSNELV CONTMCTINC NATH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC.�oH,BUSINESS AND PROFESSIONS CODE:THE CONTMCTORS LI- VBIUetlOfl ADJ.AREA W CENSEUWDOESNOTMPLYTONIOVYNEROFAPHOPER7YWIWBUILASORIMPROVE6THEREON,AND � NMOCOMRAGTSFORSUCHPRQIEGTSWITHACONTRAGTOR(3)UCEN9EDPURSUANTTOTHECONTMO QUANTITY DESCRIPTION FEE TORS LICENSE UW.). ' J I O ❑I AM EXEMPT UNDER SEC. B.8 P.G FOR 7HI5 FiEASON U � � � ', � DATE OWNER V � LICENSED CONTRACTORS DECLARATION W � 1 HEREBY�FFIRM UNDEP PENALTV OF VERJURY THAT I AM LICENSED UNDEFi PROVISIONS OF CHAPTER d G(CqAMENCINCi WITH SECTION]000)OF OIVISION]OFTHE BVSINE55 AND PROFESSIONS CQDE,Ml0 Z � X MV IICENSE IS IN FULL FORCE AND EFFECT. m �• LLI � UCENSEGU55�►-+� LIC.NO. Q�^ � V DATE II�I Z�'�"D�L- CONTHACTOR�Q�'�+�� I r d v W � WORKERS'COMPENSATION DECLARATION a � U � IHEREBVAFFIfIMUNDERPENAL7VOFPERJURYONEOFTHEFOLLOWING�EqAM710N5: fn Z �/ Q � ��I HAVE ANO WILLMAINTAW�CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' _ � COMPENSATION,AS PROVIDED BV SECTION 37ooOF THE LABOR CODE,FOR THE PERFORMANCE 'U OF THE WORK FOR WHICH THIS PEfiM�T IS ISSUED. � � � _IHAVEANOWILLMAINTAINWORKERS'CAMPENSATIONINSURANCE,ASREWIREDBYSECTION , QQ 3]ooOF THE LABOR CODE,FOR THE 7ERFORMANCE OF THE WORK f-0R WHICH THIS PERIAI7IS ISSUED.MY WORKERS'�PEI�SATIDN INSURANCE CAFRIER AND POI.ICV NUMBER ARE: CONSTRUCTION � � CARflIER � PLAN REVIEW Z Pa.ICY NUMBEa Od I ��l ELECTRIC Q � 0 (itussEcttoNNEIDNoieE0.�MPlEiIDOF7HEPERMfSinROHEMI�DREDDOIiPASR��)�LE55} PIUMBING w MECHANICAL � z I CERTIFV THAT IN T}iE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUEO,I (�} SHALLNOT EMPLOY M!Y PERSON IN ANY MANNER SO AS TO BECOME SU&IECT TO THE N WORKER5 CdAPEN5AT10N LAWS OF CALIFORNIA hN�AdREE TMAT IF I SNOULD BECOME INSPECTION FEE � SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3100 OF THE LABOR � � CADE,I SHALL FORTHWITH COMPLY WITH THOSE PROVISKKJS. � �SSUANCE � DATE: ��=APPLICANT ��" //AD I/ SMIP � � � ENERGY P/C W�flNING FAILURE TO SEGURE WORKEFS'COMPENSATION CAVERAGE IS UNUWFUL,AND SHALL BE � SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES ANO CIVIL FINES UP TOONE HUNDRED THOUSAND ENERGY PERMIT DOLURS(f100.000),IN ADDITION TOTHE COST OF COMPENSATION,DIIMRGES RS PROVIDED FOR IN /� ¢ SECTqN 37oB OF THE LABOR CODE,INTEREST,AND A770RNEY'S FEES. RETENTION FEE: �1.�`� a CONSTRUCTION LENDING AGENCY pREALT FEE: �� I HEFE9Y AFFIRM UN�ER PENALTY OF PERIURV THAT THERE IS A CONSTRUCTION IENDINO A(3ENCV � � FOR THE PERFORMANGE UF THE WORK FOR WHIGH THIS PERMR IS ISSUED(SEC.JODI.CIV.C.). Z W � LENDER'S NMIE F— LENDER'SADDRESS W IGERTIFVTHATIHAVEflEADTHI3APPLICATIONANDSTATETHATTHE�BOVEINFOftMAT10NI5CORRECT. TOTAL FEES �R '��,\ � � � 1 AGPEETO CAMPLV WITH ALICRY AND GOUNTY ORDINANCES ANO STATE UWS REIATING TO BUILDINO V V CONSTHUCTION,AND HEFEBV AUTHORIZE REPRESENTATIVES OF THIS CAUNTV TO EMER UPON THE Z ABOVE-MEMKKJED PROPEFTV FOF INSPEGTION PURPOSES. COMMENTS � V /�'[ �d dew�c�' � N PEFiMITTE �A7�rNT) �/ A If�f `fi�T � SIGNAT OF PERMITTEE DATE = RECPT.NO. PAID BY VALIDATION ~ WHITE—Department Copy,VELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROa-File Copy.GREEN—Applicant's Copy _ p 'r�� -t '�._ = 'i3 i �t : � � m � *a a 9�� s �.a � �� i �. �I� °�° a re� �� : g (': g'�a � '�`� � � rc �� "fl3;r'� ,'"�➢� �' �d � � �'� �''� p •`� � � � a �°�. a �9�,,�, , � �x ��..�� I�r�� a�� „� � ..�� °�° �a�� '��,� � , � r�. _.� , o _� s �,,� � � � � .. . . ��.. . ... .. ��,,::� . . .. ,, ... . ... .. .. .... ... ... .. _ � . .�� . ... . � .. .. . �.. � �� .. � �. . . . .. ..... . .... ,. _/` �� I��-�,� �. : �� , wl�"3�jb� ' ,_,. - ,�lZlla3 �-.�. _ �Nec �6�+a z/Z�rlo3 �.�-� _ _ ., v .�� ,� � � -� , , �fi� � � _ �„��>��s��n��. . ; . _ � _ _ _� _ , £� �� , ��,�� ,�y�"�� _ P� �1 F. �� . � a t�># i�t .. i'�:� ,,�.',,. ....... . .. .. . . ..... .. . . ... ..... . ... .... . ....... .. �'�i � ��. �,e. � � .,; �� m, � ,_ , � ��s ` �. a � �'mk�d, .� �� i�, � a�`�F . CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION ADDRIESS �!f/:flC�,y CI) 0 2 0 LL 0 W z 0 0 zd 0 APN LOT TRACT OWNER k/.Iv Cr [4/e/6/1Q40- ADDRESS L.b TEL. CITY r11Atw�i IP APPLICANT TEL. CONTRACTOR m0 ADDRESS/Irk-4/Q//E Ire' CITY W. CG r/,-A--ZIP TEL(/. jtiZ�[9Y ARCWENG/ DESIGNER W ADDRESS CITY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESSAND PROFESSIONS CODE:ANY CITY OR COUNTY WHICH REQUIRESA PERMIT TO CONSTRUCT.ALTER,IMPROVE,DEMOLISH,OR REPAIRANY 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 B (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 OFCOMPLE- TKO,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). ^ 1,AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC. 7041, 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.). OWNER-BUILDER DECLARATION W U LI 0 Z C cc LU W W V�/ F �Id cc 0 LL I 0 W CD Cn F- 0 M W LL Q W CL 0 d W Cr W CL CD Z 0 C, ^ I AM EXEMPT UNDER SEC. B. &P.C. FOR THIS REASON DATE OWNER ls-Ali # ZIP LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER B(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE.AND MY LICENSE IS IN FULL FORCE AND EFFECT. LICENSE CLASS e-J5 1- LIC. N0. D2 DATE//-I2 O1-CONTRACTORQ+ ^LF- �tblr WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: t'I 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'COUPATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER'<E S POLICY NUMBER OM I DZ (THIS SECTION NEED NOT BE ODMPLETEDOFTHE PERMIT E FORONE HUNDRED DOLARS($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 SECTlON 3700 OF THE LABOR CODE,I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. { DATE: I (--APPLICANT: 4114151f 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. 3087.CIV.C.). LENDER'S NAME LENDER'S ADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. 1 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. V i,it 1�'d PERMITTEE(PRINT) SIGNATUPA OF PERMITTEE DATE PRESS FIRMLY APPLICATION PERMIT I v P/C 0 DATE NUMBER ISSUE TYPE OCC DATE CONST GROUP ZONING SETBACKS FRONT RW^ REAR^ SIDE/SIDE STREET RW^ SIDE^ PROPOSED USE N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM CI) Garage/Carport W Patio/Deck LL Pool/Spa es Z Re-Roof Commercial M Valuation ADJ.AREA QUANTITY DESCRIPTION FEE Q cc W J UJ CD Z J a Z CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING Li J_VS) MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: (1� t TOTAL FEES COMMENTS RECPT N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy