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Home My WebLink About17300 C�M�F DIAMOND BAR n � �` DEPARIM�NT OF COMMUNTI'Y&DEVELOPMENT SERVICES I 31 E2,3 E.Ce1�ley Drive � "� , (9�9)!fe•31h3Fax(909)B61-3117 % PRESS `"�� BU�LIING PERMIT APPLICATION / FIRMLY } JOBSITE v � /�� ` /. � APPLICATION s ' PERMIT ��oD P/C / o ADDRESS� '' ��1'��j� t j:� ' "��j��Y�E^' ' DATE �L�'%��"�I NUMBEF #�— o� ISSUE TYPE OCC � APN LOT TRACT DATE ZGI O CONST. GROUP p OWNER `L ADDRESS ZONING SETBACKS Z CITY ZIP TEL. FRONT RW ❑ � APPLICANT TEL REAR ❑ � SIDElSIQE STREET RW ❑ z m CONTRACTOR f IA t'��'! I'� �f. SIDE ❑ � ADDRESS" ' ,(� ''rt'l.:'L � , i y�iy� T i � CITY _ r�7 > ��'i ZIP� .,�'TEL. /%'C�' YLj PROPOSED USE t+_ � ' C `-r �i` • b �(' �w ARCH/ENG/ �y'�-'�1 — z DESIGNER NO.DWEL. NO. NO. A, � ADDRESS UNITS r STORIES / BEDROOMS � CITY ZIP TEL. � � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADDlREM O I HEREBV AFFIRM UNDER PENALTY OF PERJURV THAT I AM E%EMPT FROM THE CON7RACTORS LI- Gflf8J8/C2fpOlt �W CENSELAWFORTMEFOLLOWINGFEASON(SEG.]031.SB1151NE55ANCPflOFESSION5CO0E:ANYCITYOR (n U COUNTYWHICHRE�UIRESAPEflMIiTDCONSTRUGT,ALIER.IMPROYE,DEMOLISH,ORREPAIRANYSTflUG- W pyi10/DBCk w TURE,PRIOR TO ITS ISSUANCE,ALSO RE�UIFES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W STATEMENT THAT HE OR SHE IS LICENSE�PURSUANT TO THE PROVISIONS OF THE CONTRACTOFS LI- � CENSE LAW(CHAPTER 9(COMMENpNG WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � POOVSp2 FESSIONSCODE)ORTHATHEORSHEISE%EMPTTHEREFROMANOTHEBASISFORTHEALLEGE�E%EMP- � �� TION.ANVVIOLATIONOFSECTION7U31.SBYANVAPPLICANTFORAGERMITSUBJECTSTHEAPPUCANTTO Z RB-R001 ACIVIL PENALTV OF NOT MORE THAN FNE HUNDRED DOLLARS�f5oo).): ❑1,AS OWNEROFTHE PROPERTV,OR AAV EMPLOYEES WITH WAGES ASTHEIRSOLE COMPENSATION, Z 0 Commercial WILL DO THE WORK,RND THE STRUGTURE IS NOT INTENDE�OR OFFERE�FOR SALE(SEC.�044,BU51- J � NE55 AND PROFESSIONS WDE:THE GONTFACTOFS IICENSE LAW DOES NOT APPLV TO AN OWNER OF � PROPERT'WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OF HERSELF OFi � THRIXIGH HIS OR HER OWN EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OF m � OFFEREDFORSALEIF,HOWEVER,7}iEBUILDINGORIMPROVEMENTIS50LDWITHINONEVEAROFCOMPLE- Z TION.THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SFIE DID NOT BUILD OR � IMFROVEFORTHEPl/RPOSEOFSALE). � ❑1,AS O WNER OF THE PROPERTV.AAA E%CIUSIVELY CONTRACTING W ITH LICENSED CONTRACTORS � TO CONSTRUCT THE PROJECT(SFC.]044,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- V0IU0IlOf1 '�{� � ADJ.AREA W CENSEUWDOESNOTAPPLYTOANOYMEROFAPROPERTVWHOBL'ILDSOPIMPROVESTHEREON,AND � WHOCONTRACTSFORSUCHPROJECTSWITHA�NTRACTOR(S)LICENSEDPURSUANTTOTHECONTflAC- QUANTITY DESCRIPTION FEE Y TORS LICENSE LAW.). � ❑I AM EXEMPT UNDER SEC. B.&P.G FOR 7HI5 REASON � � � � DATE OWNER � Z w � LICENSED CONTRACTORS DECLARATION W Q � I HEfiEBY AFFIRM UNDER PENALTV OF PERJURY THAT I RM LICENSED UN�ER PROVISIONS OF GHAPTER � � 9(COMMENCING WITM SECTION 7000)OF DNISION]OF THE BUSINESS AND PROFESSIONS GODE,qN0 Z X MV LICENSE IS IN FU L FORCE AND EFFECT. � w � .. � _, - __ � - � � IICENSE CLASS � � � LIC.NO. � F. J V DATE GONTRACTpR � d W I� -� . . ...� /, ;.. '_ � WORKEFS'COMPENSATION�DECLAR/�I�ION �� Q � U � IHEREBVAFFIftMUNDEflPENALTVOFPERJURYONEOFTHEFOLLOWINGDECLARATIONS: �� Z i Q � IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORVlORKERS' _ Z COMPENSATION,AS PflOVIDED BV SECTION 3'lCOCFTNE UBOR COOE.FOR THE PERFORMANCE U ¢ OFTME WOFK FOR WHIGH THIS PERMIT IS ISSIIE�� W I HAVE ANO WILLMAINTAIN WORKERS'COM�ENSATION INSURANCE.AS REOUIRED BYSECTION Q 37000F THE LABOR CODE,FOR THE�ERFORMANCE DF THE WOPK FOR WHICH THIS VERMIT IS . � ' � � i � ISSUED.MV WORKERS'COMPENSATqN INSUMNCE CAl11�lER AND POLICY NUMBER ARG CONSTRUCT�ON �/'� ' " F J � GARRIER PLAN FEVIEW � POLICY NUMBER ELECTRIC Z ¢ (fHISSECTKXJNEECINOTBEf1]MRFTEDOFIFIE�EMMf6FOHONEHUPDREDOttIl3i5(f100)ORLESS). PLUMBING � w MECHANICAL Z I CERTIFV THAT IN THE PERFORMANCE�F THE WORN F�R WHICH TI115 PERMIT IS ISSU[D,I (,'} SHHLLNOTEMPLOYANYPEFSONIN0.NYAIANNEIIS�ASTOBECOMESUBJECTTOTHE � WORKERS'COMPENSFTION LAWS OF CALIFOI�INIA„WD�GREE THAT IF I SHOULD BECOME INSPECTION FEE SU&IECT TOTHE WORKERS'COMPENSAiION PROVISION9OF SEC710N 31U�OF THE LABOR � CADE.I SHALLFORTHWITH COMPLY WITH T1/1SE�IAOVISI�HS. �SSUANCE � � SMIP p DATE: APPLICANT J WARNING:FAILURETOSECUREWORKEPS'COMVENSATIONCOVEMGEISUNLAWFUI,ANDSHALLBE ENERGYP/C � SUBJECT AN EMPIOVERTO CFIMINAL PENALTIES ANO GIVI�FWES UP TOONE HUNDFED THOUSAND ENERGY PERMIT DOLLARS�51aa,o0a).IN ADDITION TO THE CAST Of COMPENSATION,DAMAGES AS PROVIDED FOft IN J SECTION 3708 OF THE LABOP CODE.INTEREST PND ATTORNEY'S FEES. RETENTION FEE: Q a CONSTRUCTION IEND�NG AG[NCY PRE-ALT FEE: O Q I HEREBV AFFIflM UNDER PENALTV OF PERIUFY THA7 THERE IS A CONSTRUGTION LENDING AGENCY n- FORTHE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUt1J(SEC.309],CN.G.). Z w 2 LENDER'SNAME � F_ LENDER5ADDRESS . � �:/ // � I CER7IFY THAT I HAVE READ THIS AVf'LIGHTION AND STATE THAT THE NBOVE INFORMATION IS COFREGT. TOTAL FE ES � � � w I AGREE TO COMPLV WITH AlL CITY AND COUNTV ORDINANCES AND STATE LAWS FELATING!O 3UIL�ING � CONSTRUCTION,AND HEREBYAUTHORIZE REPRESENTATIVES OF THIS COUNTY TO EN'ER UPONTHE � A90VE�MENTIONED PROPEFTV FOR INSPECTION PURPOSES. Z - COMMENTS 0 � j :�r �F. '_ � _�:_ a - m PEfiMITTEEN (PiiIN�� ,---- i� � /l' �'��4>/ � sicNmur� F � on-E = RECPT.NO. PAID BY VALIDATION ~ WHITE—De artment Co YELLOW—Finance Co PINK—Assessor Co GOLDENROD—File Co GREEN—A IicanYs Co P PY. PY� PY. PY, PP PY t �� a � � • �:t� Li � �,�� ' ". . . `'� , � '�� mr. � „� �'� �. �; r — , �� ., �» .b� *o-�G�,�i � � ` �"J�'U� Q � �' _ /, � , i 'I I� _ II __ I', _ __ i i , � _ .� � � � ... .. .. ... . .... ._ .. �.... f/,... y /t��a . . .. .. . _. ... .�. ..._ ... , , s l�� / , � , � z �.� �� ,�� p �� r >�� .� � , _� ; _ �6``""'r't'�-�— �2�_ j 2 2�0 1—�_ _ � �� e.� s 4 .. _ �� _ �� ; � , � _ _ _ ' � � �°' �� „ °�� ' '�� ' � _ � �. � _ _ _ F _ i I�., ��, t � ��_� 'I�t� re�i ��,. ,eC';� *;. . . .... _. .. .._ . .... .... .. ... . ..... .. �� JOBSITE I ADDRESS APN LOT TRACT OWNER ADDRESS CITY ZIP TEL. APPLICANT TEL. CONTRACTOR t Lr t' ' %�� ' L ADDRESS 7 c�'rl' 1.-� r r+Yillg CITY_r 4i 121K-4;ZIP . r TEL./%"C'YLr ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER-BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 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 PERMITTO 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).): ^ LAS 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 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 NOTAPPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S) LICENSED PURSUANT TOTHE 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 FUI,LFORCE AND EFFECT. LICENSE CLASS- 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 (MHOS SECTION NEED NOT BE COMPLETED OFTHE PENT IS FOR ONE HUNDRED OCLLAAS($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 50 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:APPLICANT 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. 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 PERTY FOR INSPECTION PURPOSES. ABOVE MENTIONED PR 0 firK+. /C_ PERMITTEE N(PRINT SIGNATURE F DATE rri 0 0 W w 0 0 M 0 w w CO Cr 0 w U Z 0 U 0 ]C 0 Z 0 170 d YC W 0 U N 0 Z 0 W J Z 0 W Z 0 0 W J J LLi W 0 Cr CITY IMF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (9119)Nf. 195 Fax(909)861-3117 BUILDING PERMIT APPLICATION PRESS FIRMLY APPLICATION,' PERMIT I 3oQ P/C DATE le-/- n/+ NUMBER # ISSUE TYPE OCC DATE Z GROUP I 0 CONST. ZONING SETBACKS FRONT RW^ REAR ^ SIDE/SIDE STREET RW^ SIDE ^ PROPOSED USE-w e + '_ +u t'C, N0. DWEL. N0. N0. / UNITS ' BEDROOMS STORIES DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREAIVALUATION SFR/ADD/REM U) Garage/Carport W Patio/Deck LL Pool/Spa 0 Z Re-Roof Commercial Valuation �'/ ADJ.AREA QUANTITY DESCRIPTION FEE J U !r I- W J W z a Q U Z 2 0 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.t if PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy