The URL can be used to link to this page

Home My WebLink About19002 1� _ CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&,DEVELOPI�NT SERVICES 21825 E.Copley Drive PRESS � (909)860.3195 Fax(909)861-3117 ��'��"� BiT��.0 G PERMiT APPLICATION FIRMLY o ADDRIESS� O ff �7 l DAPEICATION I } .I�a�UMBER I`�`�'"�p�C 4��( l �i� c� ISSUE \_ +'��,J E OCC APN LOT TRACT DATE ` Q v ONST. GROUP p OWNER K /iL� ADDRESS�1� E'fl�l� G �S ZONING SETBACKS ^ gCITY Q�/�.��ZIP TEL FRONT RW ❑ APPLICANT TEL. REAR ❑ � SIDE/SI�E STREET RW ❑ CONTRACTOR C/Q .,li m0 4 SIDE ❑ i � ADDRESST/D�,/ �'/ � l/ 4 � ciTvW G�vi.�i4- ZIP�].�L TEL6Zb�Z �t^Jy'✓ PROPOSEDUSE w ARCH/ENG/ z DESIGNER r—�1��L' NO.DWEL. NO. NO. a ADDRESS � i� T Lr UNITS STORIES BEDROOMS � CITY�Q� ZIP�7y/ TEI��'f�i �e3^ � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADD/REM O Q I MEREBY AFFIRM UNDER PENALTY Of PERJURY THAT 1 AM E%EMPT FROM THE CONTRACTORS U� � Garage/Carport W CENSE UW FOR THE FOLLOiNING REASON(SEC.7o31.5 BUSINESS RNO PROFESSIONS CODE:MlYCITYOR U COUNTYWHICHREWIHESAPERMITTOCONSTRUCT,PLTER,IMPROVE,DEMOLISH,OqPEPAIflANYSTRUG W patio/Deck W TURE.PRIOR TO I7S ISSUMICE,ALSO REQUIRES 7HE APPLICANT FOR SUCH PERMIT 70 FILE A SIONE� w � STATEMENT THAT HE Ofl SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI� L � CENSE UW(CHAPTER 9(IXNAMENCINo WITH SECTION]ao0)OF UIVISION 30F THE BUSINESS AND PRO- � PooUSpa �7/ FESSIONS CODE)OR TH.4T HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEOEO EXEMP� � TION.MIVVIOUTIONOFSECTION7o31.6BVANVAPPUCRNTFORAPERMITSVBJECTSTHEAPPLICAN7T0 z Ra-Roof � A CIVIL PBJALTY OF NOT MO�RE THAN FIVE HUNDRED DOLURS(t5oo�.�: � ❑I,ASOWNEROFTF7EPROGERTV,ORMYEMPLOVEESWITHWAOESASTHEiRSOLECOMPENS�TION. � COff1RIBfCl81 Z YVILI DO iME WORK,AND TNE STRUCTURE IS N071NTENDEO OR OFFERED FOR SALE(SEC.7oN,BU51� J NE55 AND 7ROFESSIONS q70E:THE CONTRACTORS LICENSE UW DOES NOT APPLV TO RN OWNER OF � VROVERTY'MIOBUILDSORIMPROYESTHEREON,ANDYMODOESSUCHWORKHIMSELFORHERSELFOF � � THROUGH HIS OR HER OMM EMPLOYEES,PROVIDED 7HA7 SUCH IMPROVEMEN7S ARE NO71N7ENDED OR m � OFFEREDFORSAIEIF.H01MieVER.TiEBU1LDINGORIMPROVEMENTI550LDWITHINONEYEAROFCAMPLE- Z TION,TXE OWNER-Bl11LDEP WILL HAVE THE Bl1HDEN OF PROVIN6 THAT HE OH SHE DID NOT BUILD OR � IMPROVE FOR 7HE PURPOSI'c OF SALE). ❑I,ASONMEROFTNE PROPEFRV,AM E%CLUSIVELV CANTRACTMG WITM LICENSED CONTRACTORS Q TO CONSTPUCT THE PROJECT(SEC.la4a,BUSINESS AND PROFESSIdJS CODE:THE CONTRACTORS LI- VBIUe�lOf1 ADJ.AREA W GENSEUWDOESNOTAPPI.YTOANOWNEflOFAPROPERNWHOBUILD50RIMPROVESTHEREON,AN� � WHOCOMMCTSFORSUCHPRQIEGTSWITMACONTMCTOR{S�LICENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION FEE Y 70RS LICENSE LAW). � ❑I AM EXEMPT UNDEFi SEC. B.8 P.C.FOR THIS REASON � � lL �DATE OWNER � W � UCENSED CONTRACTORS DECLAFlATION w � I HEREBYAFFIRM UNOER PF:NAITV OF PERJURY THAT 1 AM LICENSED UNDEP PROVISION$OF CHAPTER � � ,/� . � � 9(COMMENCINOWITHSEClION70W)OFDIVISION30FTMEBUSINESSANDPROFESSIONSCODE,AND Z Y► � AIV UCENSE IS IN FULL FOFCE AND EFFECT. G lLl m J � LICENSE CLASS��z�—LIC.NO. I�� j V DATE � ��y' ��— CONTMCTOR G [� a W � WORKERS'COMPENSATION DECLARATION � . `� � � IHEREBVAFFIRMUNDERPI:NALTYDFPERJURYONEOFTHEf-0LLOWINGDECLAMTIONS: � Z � �I HAVE AND WILL M/JNTRIN A CERTIFICATE OF f:ONSENT TO SELF-INSURE FOR WORKEHS' _ CdAPENSATION,AS PROVIOED BV SECTION 3]ao OF THE LABOR CODE,FOR THE PERFORMANCE U Q OFTHE WORK FOR WMICH TMIS PERMIT IS ISSUED. � � w I HAVE AND WILL M/�MTRIN WORKERS'COMPENSATION INSURANCE.AS REOUIRED BY SECTION /� Q 3]00 OF THE LABOP',CODE,FOR THE VERWRIAANCE OF THE WORK FOR WHICHTHIS GERMIT IS • y ' � ISSVE�.MY WORKERS'COMPEN ATION INSURANCE CARRIER AND POUCV NUMBERARE: CONSTRUCTION O � CARRIER��G O�� (��/ ^ PLAN REVIEW � Z POLICYNUMBER��IDO � O N�i+�-- � 7 ELECTRIC � Q � (illssEc.�tnNNE�iYo7sEaR.1PLEfEDOFniEaEw.�TSFORONEFAIWRED0a1ARSlttao)ORLESSI PLUMBING �S� w MECHANICAL J d z I CERTIFV THAT IN 1HE PERFORMANCE OF THE WORK FOR WHICH THIS PERAIIT IS ISSUED,I (� SHALL NOT EMPLO`/ANV PERSON IN ANYlMNNER SO AS TO BECAME SUBJECT TO THE N WORKERS'COMGEIJSATION UWS OF CALIFOFiNIA,ANDAOREE THAT IF ISHOULD BECAME INSPECTION FEE 1` ? SUBJECTTOTMEW'ORKERS'COMPENSATIONPROVISIONSOFSECTION3]OOOFTMEUBOfl ISSUANCE U� � CODE,I SHALL FORTHWITH COMP�Y WIiH THOSE PROVISIONS. ./J ` p OATE: u�I–'b�Z. APPUCAN7� �/f�,��/�D�� SMIP �,1� W ENERGY P/C J WARNINO:FAIWHE TO SEGURE WORKERS'COMPENSATION COVERAOE IS UNLAWFVL,ANO SHALL BE J � SV&IECTAN EMPLOYER TG CRIMINAL PENALTIES AND CIVIL FINES UP TOONE MUNDRE�THOUSAND ENERCaY PERMIT DOLLARS(f100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROYI�ED FOR IN 1 `''� � SECTION 3708 OF THE UBOR CODE.INTEREST,AND ATTORNEV'S FEES. RETENTION FEE: e�- �+O a CONSTFlUCTION IENDING AGENCY PRE-ALT FEE: � C�T O � I HEREBY AFFlRM UNDER PENALTY OF PERJURY THAT THEftE IS A fqNSTRUGTION LENDING AGENCV �- FOfl THE PENWRMANCE OF TME WOFK FOR WHICH THIS PEHMIT IS ISSUED(SEC.300�,dV C.). Z W � � LENOER'S NAME H �ENDER'S ADORESS � IGENTIFYTMATIHAYEREADTHISAPPLICATIONAtJDSTATETHATTNEABOVEMFORM�TIONISCORRECT. TOTAL FEES ' � IAGREE TO CAMPLV WITM iGLI GRY M1D CAUNTY ORDINANLES AND STATE LAWS RELATINO TO BUILDINO � � � CONSTHUGTION,PND HERf_BY AUTHORRE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE �>> Z ABOVE-MENTIONED PROPFiRTY FOR INSPECTION PUHPOSES. COMMENTS �� ',� /'11_[s�--O�a C�.�I/ m PERMITT E NAME(PRIIfrJ Q Cn � ! I ~ 51 R F PERMITTEE� DATE RECPT.NO. PAID BV VALIDATION WHITE—Department Copy,VELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy L � t .. t. . , t ,m.a�m�'a .. � �'� ° 'ma"�as�'F�«�ti�y.��: #� a,a� a"�b�;� �. , . ,�d ��A��+�.` i�y��.. �� „�, ,� . g�n a, . � 3% ,„��`,�' �g .. � �� .. . � � � . . . n��'� �a¢'a�` '"T."YizG��s� �n�. w , . . / .� m '� _ - ��' _,�-- � : � _ � _ � , � � �� , : � a�` � ` ��y .. �.,.� � „ , f t � _. . ; . . . _. _.t . . . _.... . .. ... ...... .. .... ....... . .. .... ...... � ..... . ..... ..... .....� . �� . . . �'�.. 1 }�y� .. . . . . t . _. ..,. ...... . ._... .. .... .__.. ._ . .. .. ... .._. . .._.. .—. ..__ .._..z P ... . . . . � . � . � r , _ . .. _. . . . ... � �, ,,. . r� - . ,,. . ._ . . _. ... _ . .. .. _. ..� a . � . ,. . ... _ .. ._ . . . .. ._ .. ._ .. . _ ... _ r: �., .. �.,, > r�, i . . - ..�:. , .... �� t a`.'.� 3 r , .� ._ .. .... .,. _. . . .. . .._ ._ _ _. ._ . . __ .� � .... ..:..' .. .. . . ..... _.... .__. _.._. . .� . . ... ... .. .... ..._ ._... ...._. _... .. __.. t d '. '�.. . . . , �'�. , , ' ` . . . . . . .. _. _._ ._.'_". , .i n � _ r✓l_►10� �� i E - � �, - � � _ 3 ��/l�� , �Z: �. _ �� , — � � . � _ �. _� .__ _ , . _ . � : 3 __ _ _ ; .. . _ _ a. . _ � P . s , � � ,_ o r. . , .� . , � . ..... .. .. _... ....,.. .._.. ._.... .. .. .. ._. . . _._ ..... _._.. . ..... _. .. i '.�m ° .:, .. ... : � _._. ... .... .._ , _. . _. ... �� _ _ _ � � � � e �� . //� a t � . : _ __ _ _ _ . __ _ . _ _ _ _ _ _ , �� _ � _ _ ; � � �� - � � � _ . � p _ _ _ __ _ _ _ _ __ ____ . __ , ; � __ _ _ _ _ _ . � _ _ _ __ . _ � _ __ _ _ _ _ . __ _ _ _ _ _ f _ _ _ _ , _ _ _ � � � _ _ _ _ _ __ _ __ ., ; � _ . _ _ __ _ _ � rz E _ � ��t ��d:: � ��i�� j€��I'��(;�'' � _ _ _ _ _ � 1� �� f�� N J€� ( 9 �� I� � ; I vl I ��, ; . _ _ _. _ _ _ — _ --- rt ,' [ , — — _ _ _ € _ ___ _ _ __: E � , �,i _ _ . � (l �� ,� , , € _ _ _ _ _ _., _. _ __ -- — i � 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 O ff!7 APN LOT TRACT OWNER K/tip ADDRESS In Ii/f-T 6L0-S K p TEL. CITY &A APPLICANT TEL. CONTRACTOR 404 a mo 4 ADDRESS T,/D'(,'/y 4 CITY W Gh L,/4-ZIP/7 7/TEL6Z6 1Z 3'Ef� ARCH/ENG/ DESIGNER r-,E'A ADDRESS a it-0 T L CITY 6-A IAf 01,44-ZIP/71/!TEUA_&�tee 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).): ^ 1,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 W ITHIN 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- TOPSLICENSE 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 CLASS e] LIC. N0. I a �1-- DATE 40 Z. CONTRACTOR 141- 1 p 40 44_.e4_ 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 LABORCODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS'COMPEN ATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER,L 0 Gam//� POLICY NUMBER J�//LDO 7 (THIS SECTION NEE)NOT BE COMPLETED OF THE PERMIT IS FOR ONE HUNDRED OOELARS($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.I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. �� DATE: [J-/i--b�L APPLICANT: L�-'_44/-�0-•II 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($100,000),IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE. INTEREST,AND ATTORNEY'S FEES. CONSTRUCTlON LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC. 3097.CIV.C.). LENDER'S NAME LENDER'S ADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. Toll ^--'e PERMITT E NAME(PRINT)AI 0 SI R F PERMITTEE7 DATE APPLICATION I I I �1 a PERMIT e 00- P/C DATE I UMBER°.7�# 1, ISSUE J E OCC DATE Q y ONST.GROUP ZONING SETBACKS FRONT RW^ REAR^ SIDE/SIDE STREET RW^ SIDE^ PROPOSED USE"Si )k N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM U) Garage/Carport W Patio/Deck V- Pool/Spa 2.75 0 Z Re-Root Commercial Valuation ADJ.AREA QUANTITY DESCRIPTION FEE CE: Z -Y1 f".5 U LA�t Z W CONSTRUCTION PLAN REVIEW ELECTRIC$ PLUMBING :S 0 MECHANICAL J o INSPECTION FEE ' ��fp� ISSUANCE„W SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: . �0 PRE-ALT FEE: TOTAL FEES y $ COMMENTS RECPT. N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy