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Home My WebLink About16969 err�o�Dt�tolw a�z �� r � `�� DEPART'MENT OF CC?I�'IIviUI�tITI'c�DEVEL(}PMENT SERVICES 21825 E.Copiey Lhive (904)860-3195 Ftix(449)861-311'7 PRESS BUILDING PERMiT APPLICATIdN FIRMLY � ADDR'ESS!V'�7��' �� N�-�`�� ' APPLICATION� �� ,� PERMIT ��„ C P!C J�%!_...!j` J o DATE tJUMBER t�� # v 1 {� � APN LOT TRACT � ISSUE � s � TYPE OCG �+`� DATE �f� f✓ CONST. GROUP p OWNER,.LA1��h.��,��c' �` 1"��r p ADdRESS ��7I . ZdNING SETBACKS PftONT 2 CITY R- 1 Z! TE . .. � REAR RW ❑ � APPLICANT — — �� '� StDE1SlDESTREET� _ R�/ � z � CONTRACTOR_ '(_ �, SIpE U -- � AdORESS � �... � CITY Z�p TEL ` PROPOSED USE � ARCH/ENGI �p � , z DESIGNER S��y; �,.� �� r � ADDRESS ��tt2��-'�t.��,�. `'��'��u NO.DWEL. NO. ,•� NO. � G�TY ZiPC ' �'i`EL.y��1�—� UNfTS STQRIES Cr BEDROOMS � � -�,�j dE&GRIPTION SLt.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATIqN � Q Sf WADdlREM Q I HEftEBY AFFIi31d UNDER pENAtTV OF PERJURV THAT I AM EXEMPT FROM TM6 CONTRAC70{�5 U� G8f8J8/C2fF10R � W GENSELAWFORTHEFOILOWIN4REASON(SEC.7031.5BUSINESSANDPROFESSIONSCODE:ANYGTYOR (() WC� COUNTYWHICNAEQUIRESAPEflMITTOCaM17STRUCi,AlTER,M#PRQVE,(}EAqliSH,ORREPAIRANYSTAVG W P8110/DBCK TURE,PRIOR TO ITS ISSVANGE,AL56 REOUIRES 7HE APPLICANT FOP SUCN PERMIT TO FIIE A SIGNED W .jr STATEMENT THAT NE OR SHE IS LICENSED pURSUANT Tp THE PP�VI510NS qF THE CONTflACTORS U� � CENSE L0.W{GHAPTER 9(COMMENC7NG WtTN SEC7ION Tb9o;�F DIVIS�N 3 OF 7HE BUSiNE55 RND PRO� � PDqUSpB FESSIONSC4�E�ORTHATHEORSHEISE%EMPTTHEREFROMANDTHEBASISFORTHEAL�EGE�E%EMp� (� TION.ANYVIpLATIONOFSECTIQN7031.58YANYAPCLICAMFQftAPERMITSUBJEGTSTHEAFPUCAN7Tp Z Re��Raoi � ACIV(I.PEtdA(,ryOFFip7MORETHANFtVEHUNOREDDOILARS(t500;.); � ❑I,ASOWNEROFTHF.PROpERTVOqMYEMPLqVEE9WITHWRGE9A5iHEIRSOLECOMPEN&ATION, � �flmmerciaf � M/ILl b0 FHE WaAK.AND TNE STRUCTURE iS NOT IMTENDE�Oft OFFEflE6 FGfi SAIE{SEC.7644,BUSt�� J � NESS AN�PRaFESSIONS fADE�.THE CONTRACTORS LIGENSE LAW D065 NOT APGLY TO AN OWN€R OF � PROPERTV WHO BUILDS 4P IMPROVES THEREON,ANO WHO DOES SUCH WOqK HIMSELF OR HERSELF OR CC THROUGN HIS 6R NER 4WN EMPC4YEE5,AROVID£D Tt{AT St7CF#IMPSi6VEMENTSARE NOT WTENpED OR � � 6FFER60WRSALE.IF,H6WEVER,THEBUILDMGORIMPFWEMENTISSOIDWITHINON[YEAROFCOMPLE� �. TION,THE OWNER�BUILDEH WILL HAVE THE BUqDEN�F PqOVING THAT HE OR SHE O:D NOF BUII.D OA � lMPFiOYE FOR FHE PUftPpSE OF SALEj. W JI,A5CIWNEROFTHEPROPERTV,AME%CLUSNELYCONTqACTINl3W17Ml,ICENSEDCONTRA�TORS [r TO CONSTRUCT 7NE PqOJECT{SEC.70aA,gUSINEES AND PROFESSIONS cODE THE�UNTRACTORS�i� Y37U0tiOtt ADJ.AF7EA = CENSELAWQOESNOTAPPlYT6fiNOWNEROFAPHOPEPTVWMOBUILUSOPIMPRpVE57HERECNJ.AND - � WHOGSNTflAC75FORSUCHPRQIECTBwITHACON7RACTOR(S�UCEN$EDPURSUANTTOTHECONTRAC� QUANTITY DESCRIPTIOFI � TORSLICENSELAW). FEE Q ❑I AM EXEMPT UNDER SEC. __„ 8.A P.C.F�R THIS REASON Q 'y U — w � — • ._..._.. Z � U 4 LICENSED CONTRACTQRS CLARATION � � Q � 1 HEREBV RFFIRM UNDER PENALTV OF P�RJUHY TMAT I AM LICENSED UNqER PROVISION bF CHAPTER � [L 9(COMMENdNGWtTN5e4TiON7�0o}OfQtViSiON30�7HEBUSINESSANDPFKJFESSIONSCODE,AMO Z L}� MY tiCENSE IS IN Fl,1Ll FOflCEAND EFF�GT m � UCENSE CLASS�,_ iIC.NO. � ... .._�...�.� � � DATE_ CON7RAi,TOft, d W -.._ � WORKERS'COMPENSATlON DECLAftA?!ON 4 � IHERE@YAFFIqMUNDERPENALTYOFPERJI;RVONEOFTNEFOLLOWIN��ECLARATIQNS: U U? 2 � .,_IHAVEANDWIlLMA1NTAINACEqTIFICATEOFCONSENTTOSELF�INSUREFORWORKERS' ¢ " 2 COMP�MSATI�N,AS PROVIDE�8Y SEGTION 3�ao4F THE�ABDN GODE,FOft TNE PERFOftMAMCE U 4F THE WORK FOfl WHIGN T'HIS GERMI'IS 156L'tD. W � � � �!HAYE AND WILL MA�NTAiN WORKERS'COMPENSATiOk INSURANCE,AS REOU�RED 8Y SEGTiUN q 3700 OF THE LABOR CODE,FOR THE PERFORMANCE Of THF.WORK FOR WHICN iMIS PERMI715 \F�A��f' �(' 1 J ISSUECJ.MY WORNERS'CAMPENSATKIN tNSURANCE CARftlEft ANU Pol7CY NUMBEftARF' CONSTRUCTION �1�r �G ¢ cnaaiEa_._ . ._._. PLAN REVIEW ,�^' r� . > _ � POLICYNUMBER� ¢ -- e�ecraic � Q t¶+u-sec��EnrooTaFcpr,�a.�rEaoFr.�r�wart�rr�swaon�uuwaEoo�u.aRs�Siayoa�Ess). PLUMBING �y w Z I CERTIFY THAT W TNE PEAFORMANCE OF TNE WOPK F4P,WHICH iH15 PERMIT GS ISSUED,( MECHANICAL _:� G`7 SHALl tJOT EMPLOv IWv PEqSON iN ANY MANNEF SO AS TU BECpME SUBJECT TO THE ' ��j'� (/} WORKERS'COMPENSATIONLAWSOFGAIIFOflNIA,AN�AGREETHATIFISHOULOBECOME INSPECTIONFEE �`•� SUBJECT TO THE WQRKER5'CAMPEN5AT�N Pft4YtSiONS OF SECTION 37460F THE tABOR �� -.��• �y��,-i--^- L�^ a CADE,ISHALLfoRTMWITHCOMVLYWIiHTHC1ScPRQVI510N5. ISSUANCE �� -�' ��"� ":'�� -_ L,�� _�.w� - art �F v p DA7E:_ .._ APPLICANT: _... . SMIP �7 �� ENERGY PIG � � �t WARNINC.:FA!lURE i4 SECL'flE'tJOftKERS'COMPEN5ALION GOVEftAGG 15 UNIAWFU�,AND SHAI�8E � StIBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CNIL FINES UP TO qNE NUN�REq THW SANp �., p'� , � � �..w DqLIP,RS�f1oq.0oo),INADDITIONTqTHEGOSTOFCOMPENSATION.OAMAGESASPRpVIDEOFQRIN ENEF'iGYPERMIT Y � SECTIONa7oaQfTHEIAeONt;aOE.lNTEREST.ANDATTOftNEY'SFEES. � . � W ...�, RETENTION FE�: �,,, � � CONSTRUC710N IENDlNG AGENCY PRE-ALT FEE: . � � I VIFREBVAFFIRM UlJ17El1 PENALTV OF PEfiJUqY THAT THERE IS A CpNSTRl1CTIQN LEN�tNG AGENCY � � FflRT}tE PFRWRMAMCE O£�THE WQRK FOR riWCH TMS PEAMfT IS ISSUED(SEC 3o9t,CIV C.}. `-""-�- � Z w �_ — � LENDER'S NAMG_,,,__ , _ " �'-� LEN�ER'SADOfiE55 _ "'.`-__.-. ... ._ W� h ^ � � ICERTIFVTHATIHAVEREADTFISAPPL�CA�IONANOSTATETHATTNEABQVkMGpRMAT0.�NI5CORRECT TOTAL.FEES��. q!i� � �}�� j, d i AC:REE T4 COMPIY WITH AL�CITY ANB G9UNTY ORDINANCESANO STATE LAWS REt ATMG TO BUILOING �� 0 Z t� \/ � CANSTRUCTIpN,ANO HEREBY 1UTHORIZE NEPRESENTATIVES OF THIS COUN7Y70 ENTER UpqN TH� Z ABOVE-MENTIONED PROPERTV FpH INSPECTION PUftPOSES. COMMENTS a _tZ�-�1�m� � �� - — m PE TTEEPifiMEfPRINT) �` f+ � f 1t �� Ct� I+YV"V _�..(�, (Jf y..'.?J` � SIG ATUREO MIT EE �� TE -{��} "' (��---- }'�``"- � t � RECPT.Np. � " ...� PA�D BY `�Lj� yqL�pqT10N---�`��+Y�— WHI E—Department Copy,YELLOW—Fi�a�ce Copy,PINK—Asssssor Copy,GOLOENRpD—file GoRY.GREEN—AppiicaoPs Copy . � . � , , . . . ... � . . +.f� ....,. . '� � ,�"":!, . . . � . . . . . '. . .. ... . . ... .:� t .. . . . . i• s � i i� � _ � .. ., � �� ,. . fi T $.t��e � _ �Z�-o Z �--, . . . :� �� .'1c�1,-) � � � ' � . � . . .. .. .. .. .. . .. . . ...'. . ��. �� . . � .�^.". '' ... ��_ - - .. . -.: � . .. ... . . . �� . . ,`��5,."f7`�YG_� . � . . . � . .. . .. . .. ... . .... . . . .. . � . .. . .. . . . ._ .. .. . �� , z � � � ��y _ 1 � t� � � � lo �� _ _ � . by /�- � �� !�Al . ` - c� :� �,�� 'd-�b��- �� .�;. .. ��r^/� � . .. .��' /".. -.. . . . .. . .... . .. . ...._ .. . .. � . . . . . �- .... ^ 'I/ .�. .. . .� ... . ... .. . .. .. . . .. ..... ....... .... � �. �. ...� . .. "-�\ ... . .. . . . .. . . � � ��, , .... . . ... .. ._.. .. ... . ._. . ._.. . .. .. . . . . .. . . .. .. .. .. . �� ,.. .. . . �� -..- _ y .... (�'!��f� {i''aJ1 �u�� , v� �S:�r� L -5 C��(`��n 4-�i a� �� r/t�L ; �,��ti �� -�, ��7 t-:-� r- � _�_ _ �� J�.� _� , _ �-_�. -- _ .a-�o�.� � r,�.�- , _ ti �.�'� ��'� ��-- . _ — � . �t.t(-u6.�ey ��oc.('tro��) .1� M.[�L�JG-� �E, g.t[�4X9 ��G? �c'�u4-c.- �1-Ib•�o1, ►.,o Pu3N� pE�ti i Ye.-�. ��J� � �;_�s ,�+� cv`wE�� >w� � 5�.�� ;� �Ra.�,a @ c�,p�c-�. w�.�- ohC, � ' j�i,��+� �5 �—=-� ' �✓ �' � ��, � � ' �A'll✓S ,,r �, _ � ��lf,� /'��'97`W�is {�� ✓�T l� � _, �;C�Z?�o i._ � A�U-k�� ZS �' Lo� �G�.v� GG��-te- -''N�� vcSED �v�.c�2Z�t�, � � ..� � . �' _` � p c� or'- c-�1-Q",�Cs 1'oo T�N� � � � . � ,��, �rxr� G�..�'r. Sc-aLv«e ScvC-EP T ,� __ � _- � � 2 - 2. �(�-'� I' Q- �W P�-5�-�� _ �, ,. � G►- ��o p � � � '� '� �"�.7`� � /Cc��79�� 'el� '�� . �,y �,� d3 C1,� .�t� ---� , _ �� . a ;�� d �. , _ _ . _,r _ � � _ Ugmgpm CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION JOBSITE L Z7 S'cv fN»A N C-FIC1L ADDRESS APN LOT TRACT 2 OWNER.T_A�i,&AI C-E 1Z-n EV NM N J ADDRESS Kr-E- 1=�Pt T I -A* 11-: CITY IL-'wl_ZI TEL(7G�0 :Z;; APPLICANT- CONTRACTOR-St o L ADDRESS CITY ZIP TEL. ARCH/ENG/ DESIGNER r7�s ADDRESS CITY ZI EL.'t (AVV 61b 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).). C1 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 MAO 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- 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 ACONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW). ^ I AM EXEMPT UNDER SEC. B. &P.C. FOR THIS REASON X-i �-0 LICENSED CONTRACTORS CLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISION 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 LIC. NO DATE CONTRACTOR WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: -1 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 NOT 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 WOPKERS'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($100,000),IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES. CONSTRUCTlON LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC. 3097,CIV.C.). LENDER'S NAME LENDER'S ADDRESS I CERTIFY THAT I HAVE READ TI-IS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. PE TTEE NOME JPRINT) SIG ATURE 0 MI EE TE If AV WHITE-Department Copy,YELLOW-Finance Copy, PIN 6�j�x- F PRESS FIRMLY APPLICATION21 f PERMIT 1 i q P/C OF DATE+NUMBER #I ISSUE TYPE OCC DATE CONST.GROUP ZONING SETBACKS FRONT RW^ REAR^ SIDE/SIDE STREET RW^ SIDE^ PROPOSED USE N0. DWEL. N0. N0. UNITS STORIES L.-BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM U) Garage/Carport W Patio/Deck LL Pool/Spa Z Re-Roof 0 Commercial CIO Valuation ADJ.AREA ot It QUANTITY DESCRIPTION FEE J U 0 w -J DO J CL Q Z 2 0 w CONSTRUCTION • }�/ n J��J PLAN REVIEW 111-1/�� ELECTRIC PLUMBING MECHANICAL INSPECTION FEE G,_} ISSUANCE SMIP fn-I ENERGY P/C ENERGY PERMIT Huh I P? RETENTION FEE:Act It/ PRE-ALT FEE: TOTAL FEES,3Y45. 14 4 Fj(J4 9 COMMENTS RECPT. N0. PAID BY VALIDATION SS�11 I:, �-s; �� ,,, �� {"cut-w�c� �- I ?cs?� , �_,�___ _ l�p�� 1-16��01,ND Pu3Nr1 rat,i YG�, �� -ta(-ua.�25L��rt�oc4'troti�� ,�T Mc4)I�:li-�� r ua � 5"rt��tv�tbA'� R�>S� alms� �5 )Cj�&�717AJhl AN?ANIN Shod,ZVOK,v, if. �y2-?�o c_�?d�U-(o2 be�7,$ �ia Lo�-%�G-c.cx�Gc��-te---'NG��. �'vcsc-r� ��c,�;, �cv� Ec,Q.c�r. Sc-�Lv c�c Scv C--EP 0�j or=- ��v,Jt� !=oo Tl �U� �, � _