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Home My WebLink About18022 (32) CITY OF DIAMOND BAR '`� �`` DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �"""`� � �.�� 21825 E.Copley Drive ' ; (909)860-3195 Fax(909)861-3117 PRESS -�� BUILDING PERMIT APPLICATION FIRMLY y JOBSITE 31��,� +j��1„n �� /a �n•"7 APPLICATION 5 �� pERMIT i p/C o ADORESS��y �1 �I(1� � l�- ''7 � DATE NUMBER `- rv'" # � ISSUE-� � TYPE OCC APN �Q�T --- TRACT DATE �� CONST. GROUP p OWNER IC.� p ADDRESS __. ZONING SETBACKS Z CITY ZIP TEL. FRONT qy�/ ❑ � APPLICANT ' TEL REAR � aSIDE/SIDE STREET RW ❑ ¢ CONTRACTOR_ _ SIDE � � ADDRESS PROPOSED USE CITY �g� TEL. w ARCH/ENG/ ��OOtl Q. 90712 z DESIGNER � ADDRESS NO.DWEL. NO. NO. � CITY ZIP TEL. - UNITS STORIES BEDROOMS � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HEREBY AFFIRM UN[)ER PENALTV OF PERJI;PY THAT I AM E%EMPT FRDM THE CONTRACTORS LI- G8f8JQ/C2fPOfS . W CENSELAWFORTHEFOLLOWINGREASONISEC.]o31.5BUSWESSANDPROfES510NSCODE:ANvqTYOR (f� '. U COUNTYWHICHREOUIRESAPERMITTOCONSTRUCT,ALTER,IMPRWE,�EMOLISH,ORREPAIRANYSTRUG � W TURE,PflIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANi FOR SUCH PERMIT TO FILE A SIGNED W Patio/Deck � STATEMENT THAT HE OR SHE IS LICENSE�PUiiSUANT TO THE PROVISIONS OF 7HE CONTRACTORS LI- � � CENSE LAW(CMAPTER 9(GOMMENGMG WITH SEGTION]Oo0)OF DIVISION 3 OF��HE 6USME55 AND PRO- POOUSPa � FESSIONSCODE)ORiHATHEORSHEISEXEMPTTHEREFFOMAN�THEBA515FORTHEALLEGEDEXEMP- (� V TION.ANYVIOLATIONOFSECTION7031.5BYANYAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO Z Re-RoOf A CML PENALTV OF NOT MORE THAN FIV E HUNDRED DOLLARS IfSW).�: � ❑I,ASOWNEROFTHEPROPERTV.ORMYEMPLOYEESWITHWAGESASTHFIRSOLEC.OMPENSATION, � COmmefCial Z WILL DO 7HE WORK,AN�THE STRUCTl1RE IS NOT INTENOED OR OFFERED FOR SALE(SEC.]04a,BUSI- J � NE55 AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW OOES NOT APPLV TO AN OWNER OF � PROPERTV NMO BUILDS OR IMPROVES THEREON.AND WHO�OES SUCH WORK NIMSEIF OR HERSELF OR � THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED DR m Q OFFEFEOFORSALE.IF,HOWEVER,TiEBUILDINGORIMPqOVEMENTI550LDWITHINONEYEAROFCOMPLE- . Z TON,THE OWNER�UILDEH WILL HAVE THE 9URDEN OF PROVING THAT HE OR SHE DI�NO1 BUILD�R I � IMPROVEFORTHEPURPOSEOFSALE). �y,� ❑I,RSOWNEROFTHFGROPERTV,AMEXCWSIVELYCONTRACTINGWITHIICENSE�CONTHACTORS � TO CANSTRUCT THE PROJfCT(SEC.7044,BUSINE55 AND PROFESSIONS CODE'.THE CONTRACTORS LI- VelU2[IOfI ADJ.AREA W CENSEUWDOESNOTAPF_VTOANOWNEROFAPflOPERTVWHOBUILDSORIMPROVESTHEREON.ANO F WFiOCONTRACTSFORSUCHPROJECiSWI'.HACONTFACTOR(S)LICFNSFDPi1RSUANTTOTHECONTRAC- QUANTITY DESCRIPTION Y masucENSE�aw�. FEE O ❑I AM EXEMPT UNOEIl SEC, B.8 P.C.FOR THIS REASON ¢ 7� U � � OATE OWNER H Q w � LIGENSED CONTRACTORS DECLARATION W Q � 1 HEREBV AFFIRM UNDER PLNALTV OF PERJURV TNAT I AM IICENSED UNDER PROVISIONS OF CHAPTER � d 9(COMI.AENCING WITH SECI"ION]000)OF DNISION 3 OFTHE 6USINF55 AND PROFESSIONS CODE,AND Z �X MV UCENSE IS IN FU F09 E AND EFFECT � � � ,, m I � LICENS r LIC.NO.� � V �ATE CONTRACTOR _ d W � WORKERS'COMPENSATION�ECLARATION a � I HEREBYAFFIRM UNDER PI:NAL7Y OF PERJURV ONE OF THE FOLLOWING DECLARATIOfJS'. Z Z _IHAVEANDWILLM/JNTA�NACERTIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' ¢ 2 Q CAMPENSATION,A�'.PROVIOED 8V SFCTION 3]no OF THE LABOR CODE,FOR THE VERFORAAANCE U Q OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED. � Qw I HAVE PN�WILL MlJN1FIN WOHKEFS GOMPENSATION INSURANCE,AS REQUIqE�BV SECTION 3700 OF TH L BOR COD F THE PER RMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUE�.MV A SL1RANCE CARRIEP ANO POLICY NUMBERARE: CONSTRUCTION J � CARFIER PLAN REVIEW � POLICYMl1ABER� F � Z - ELECTRIC ¢ � (1HISSECTIONNEmIVOTBEWMREfEDOFTHEPERMITISFOFiIXJEHUMREDDIXIARS(5107)ORLESSG PLUMBING _ ' � Z I CERTIFV THAT IN THE PERFOPMANCE OF THE WORK FOR WHICH THIS PFFMIT IS ISSIIED,l MECHANICAL C7 SHALL NOT EIdPL01'ANV PERSON IN ANV MANNER SO AS TO BECOME SJBJECT TO THE y WORKERS'COMPENSATION LAWS OF CALIFORNIA,ANDAGREE THAT I�I SHOUID BECOME INSPECTION FEE � SUBJECTTO THE WORNERS'COMPENSA ON RAOVI ONS OF ECTION�]oa OFTH BOR WITHCOMPLYWITI�TF� VI�O �� ISSUANCE �" : � 1 ■R� / p DATE`I��;�� APPLICANT: f �� _ sMiP ___. i J WPANING:FAILU E TO SECUqE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALLBE ENERGY P/C _._ � SUBJECTANEMPLOVERTOCRIMINALPENAL'IESANDqVILFWE5UP700NEHUNDREDTHOUSAND ENERGVPERMIT �OlLARS(f 100,0001.IN AD�ITION TO THE COST OF COMPENSATION.DAMAGES AS PflOVIDED FOq IN � SECTION3'!OB OFTHE LABOfl GODE,MTEREST,ANO/TTORNEV'S FEES. RETENT�ON FEE: OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: � INEREBYAFFIRMUNDERP'�.=N/�iVOFPERJUFVTHATTHEREISACONSTRUCTIONLEN0INGAGENCY � FOF THE PEFFORMANCE 01=THE WORH�OR WHICH THIS P[/1MITIS ISSUE�(SEC.3091,CIV.C.). ----- z W ? LENDER'S NAME � F— LEN�ER'SADDRE55 w TOTAL FEES �,, � I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS COPRECT. � I AGREE�O COMPLV WITH O,LL qTV AND COUNTV OfiDINANCES AND STATE lAWS pELAT'�NG TO 6UILDING � CONSTRUCTION,AND I+EREBYAUTHORIZE aEPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE Z ABOVE�MENTION PROP RTY FOR I SPEGTION PURPOSES. COMMENTS � V �V�\✓` _ ¢ P MI F� (PRINT (/ � 1 /y /y o �n � `_�l/�,____�"l_._-SeS�" _. �- V f�r � � • � � ICN UREOFPERM EE ��AT"c� - , = RECPT.NO. PAID BY ..y � VALIDATION ~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—Applicanfs Copy ,�� ai�s�a� � i s� i � n d i !�i��i B »�^��i � a�y�"�, a .� �' g�� - r ,�.i�,.� �� 1�� ° ° � � ��'`��' '! a,.,� �_�ir;w":`. - � ".` �. ` ` . , . . , . . `-� ;��"�:&uw� �`�.. r.��'� . � .. �.. . .. . .... . . .... ..... . ��`�r-/%� .�� _ � _ m �� . � � � �� ff -� _, ��n � ��.e�• s.� _.; ,� z�; ,�,� ; _ _ _ _ � ; � _ , �P � �� i�� :� �� ° ��; � �� " �� _ _ _ � '. r a b��_��m�'��a� '�'��'�� a�ib . ..._ . ... . . _ ... , � �� 1 � r a� �� i�, aa`€ �� &� m�� i�� ,�m� _ _ � .., �a�b �I� • � �� , ; � � sr9�� _ _ �� ti� �� ,�� "@ � � �� , , � � �� a� � ;� � , �; ', µ , : _ _ _ _ �� z 4W �� „ � � �. ,�> „�..r.1��.f _.. .... .. DIAMOND DAR I CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION E J�b 3 ? 111 C I dd P ADDRE n 4 fl I 5 ee APN TRACT OWNER I� '7 ADDRESS CITY ZIP TEL. APPLICANT?r7/��+ 1. ��t O1!}ro TEL CONTRACTOR- ADDRESS CITY 3 23�� .TEL. ARCH/ENG/ CA.90712 Lakewood 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 OWN ER 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 15 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 APP'_Y 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.). 11 I AM EXEMPT UNDER SEC.S. &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 FU FO E AND EFFECT. Y 4 LICENS UC. No. 111 !Q 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 X OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION 3700 OF TH L BOR COD F THE PER RMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MV A SURANCE CARRIER AND POLICY NUMBER ARE: CARRIER POLICY NUMBER (THIS SECTION NEED 140T 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 BEC E OMM SUBJECT TO THE WORKERS'COMPENSA ON RROV IROVI ONTION 370 B WITH COMPLY WIT T VI 0 ////�� ////^�� CCC� DATE^APPLICANT: WARNING: FAILU 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 ACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OIF THE WORK FOR WHICH THIS PERMIT 15 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-MENTION PROP RTY FORI SPECTION PURPOSES. c lace P MI FF(PRINT/5 n„�] SIGNATURE OF PERM EE DATE APPLICATION 0 y 7ERMIT P/C DATE NUMBER/v# 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.AREANALUATION SFR/ADD/REM U) Garage/Carport W Patio/Deck Pool/Spa Z Re-Roof 0 Commercial 5 Valuation ADJ.AREA QUANTITY DESCRIPTION FEE -J U cc U W W lA 1 DO CL U Z W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES COMMENTS RECPT. N0. PAID BY ..y � VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PIN PRESS FIRMLY