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Home My WebLink About17773 f� CITY OF DIAMOND BAR � DEPARTMENT OF COMMUNTI'Y&DEVELOPMENT SERVICES 21825 E.Copley Drive �909�sbo-3 i9s F��909>sbi-3 i i� PRESS BUILDING PERMIT APPLICATION FIRMLY JOBSITE APPLICATION PERMIT -7 P/C o ADDRESS_ZZ�JO Indian Creek DATE_ OZ�ZS�OZ NUMBER !! 7l� # �Z-6� � ISSUE � j�L j�� TYPE OCC APN LOT TRACT DATE / / CONST. GROUP p OWNER �- S� 5�:.�¢�� t o ADDRESS'Z'l " '�' w `'_.1�trF ZONING SETBACKS z CIN w1�':�� s ZIP TEL. �2�•-Ll El-l�'SZ- FRONT RW ❑ p APPLICANT TEL. 5 DE/SIDE STREET RW ❑ z �y m CONTRACTOR_�W I`/ E SIDE ❑ _ � ADDRESS PROPOSED USE Alterinq foundation �C�OSEt o CITY ZIP TEL. — and 9ame�•00m w ARCWENG/ z DESIGNER w NO.DWEL. NO. NO. a ADDRESS � CITY ZIP TEL. - UNITS STORIES BEDROOMS � cn DESC TION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SF D/ EM O Q I HEREBY AFFIRM UNDER PENALTV OF PERJURY THAT I AM EkEMPT FHOM THE CONTRACTORS�J- G0fflJ0/C2fpOfl W CENSELAWFORTHEFOLLOWINGREASON(SEC.]031.SBUSINESSANDPROFESSIONSCODE:ANYCITVOR (n U COUNTYWHICHFE�UIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANVSTRUC- w TURE,PRIOfl TO ITS ISSUANGE,AL50 REOUIRES THE APPLIGANT FOF SUGH PERMIT TO FlLE A SIGNED w Patio/Deck STATEMENT THAT HE OR SHE IS LICENSE�PURSUAM TO THE PROVISIONS OF THE CONTRACTORS LI� � CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVIS�ON 3 Of THE BUSINESS AND PRO- LL POOUSPB FESSIONSCODE)ORTHATHEORSHEISE%EMPT7HEREFROMANDTHEBASISFOfiTHEALLEGEDE%EMP- (� � TION.ANVVIOLATIDNOFSECTION7031_59VANYA7PLICANTFORAPERMI7SUBJECTSTHEAPPLICANTTO z Re-Roof A CIVIL PENALTY OF NOT MORE THAN FNE HUNDRED DOLLARS(f500�.�: ❑I,AS OWNER OF THE PROPERTI,OR MV EMPLOVEES 1YITH WAGES AS THEIR SOLE COMPENSATION, O � Commercial Z WILL DO THE WORK,AND iHE STflUCTURE IS NOT INTENDED OR OFFERED FOP SALE(SEC.]049,BUSI- J � NE55 ANO PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF � PROPERTY WMO BUILDS OR IMPROVES THEREON,AN�WHO�OES SUCH WORK HIMSELF OF HERSELF OR Q TMROUGHHISORHEROWNEMPLOYEES,PROVIDEDTHATSJCHIMPqOVEMENTSARENOTINTENDE00R m QOFFEREDFORSALE.IF,HOWEVER,THEBUIL�INGORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE- Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR � IMPROVbr1'OR THE PURPOSE OF SALE). w (/fA50WNEFOFiNEPROPERTV,AME%CIUSIVFLYCONTRACTINGWITMLICENSE�CONTRACTORS � TO CANSTRUCT THE PROJECT(SEC.loa4,BIJSINE55 AN�PROFESSIONS CODE:THE CONTRACTORS LI� V8II19�1O11 ADJ.AREA W CENSEUWDOESNOTAPPIVTOANOWNEROFAPROPERTVWHOBUII.DSORIMPROVESTHEflEON,ANO � WNOCANTRACTSfOqSUCHPROJECTSWITHACONTflACTOR�S)UCENSEDPURSUANTTOTHECANTRAC- QUANTITY DESCRIPTION FEE Y TOflS LICENSE LAW). �[ J O LJ I AM E%EMPT UN�[R SEC. B.8 P.C.FOF THIS REASON Q � U � � DATE OWNER U Z W � L.ICENSED CONTRACTORS DECLARAT N w CC I HEREBYAFFIqM UN�ER PENALTV OF PERJUFV 7HAT 1 AM LICENSED UNDER PR �ISIONS OF CHAPTER � d e�COMMENGING WITH 5EGT10N]o00)OF�IVISION 30F THE BUSINESS FND?ROFESSIONS GODE,AND Z LX MV LICENSE IS IN FVIL FORGE AN�EFFEGT. m � LICENSECLASS_ LIC.NO. � � � J U DATE CONTFiACTOIi a W � WORKERS'COMPENSATION DECLARATION Q � I HERE6YAFFIRM UNDEF PENALTY OF PERJl1RY ONE OFTHE FOLLOWING DECLAflATIONS: Z � IHAVEANDWILLMAINTAINACER7IFICATEOFCONSENTTOSELF-INSUREFORWORKERS' _ QCOMPENSATION,AS PROVIDED BY SECTION 3�Oa OF TNE LABOR CODE,FOfi THF PERFORMANCE 'U OF iHE WORK FOR WHICH THIS PEFMIT IS ISSUED. � � w I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS HEQUIRED BY SECTION / h Q 3700 OF THE LABOfl CODE.FOR THE PERFORMANCE OF THE WORK FOP WHICH THIS PERMIT IS � �[ �Q ISSUED.MV WORKEFS'COMPENSATION INSURANCE CARRIERAN�POLICY Nl1MBERARE: CONSTRUCTION J � cnaRieR PLAN REVIEW 0 POLICVNUMBER Z � ELECTRIC Q � (1HISSECTICNNEFDNOTBECOMPLEfEDOFTHEPEHARiISFORONEHUPDREDDCILAfiS(SI00)ORLESS). PLUMBING _ W Z I CERTIFV THAT IM1 THf PERFORMANCE OF THE WORK FOF WHICHTHIS PERIAIT IS ISSUED,I MECHANICAL C} SHALL NOi EMPLOV ANV PERSON IN:1NV MANNER SOAS TO 6ECOME SU6JECT TO THE � WORKERS'COMPF_NSATION LAWS OF CAIIFDRNIA,AND AGREE THAT IF I5FI0ULD OECOME INSPECTION FEE _ SUBJEGTTOTHEWORNERS'COMPENSATIONPROViSIONSOFSECT'ON3�OOOFTHELABOR � � � CADE,ISHALLFORTHWIiHCOMPLYWITNTMOSEPROVI510N5. ISSUANCE f ^�-� � SMIP '�.'l= p DATE' APPLICANT J WAflNING FAILURETO SECURE WORKERS'COMPENSATION CAV[fiAGE IS LNLAWFUL,AND SHALLBE ENERGY P/C __...__ � SUBJECTANEMPLOYERIOCftIMINALPENALTIESANOCIVIIFMESUPTOONEHUNDREOTHOUSAND ENERGVPERMIT OOLLARS(S10a,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PflOVIDED FOR�N J SECTION37080FTHELAAORCODE,INTEREST,ANOATTORNEV'SFEES. RETENTIONFEE: �T�: � � CONSTRUCTION LENDING AGENCV PREALT FEE: O � I MEREBV AFFIRM UNDER PENALTV OF PERJURY THAT THEFE IS ACONSTRUC'ION LENDING AGENCY FOR THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED(SEC.309�,qV.C.). Z w ? LENOER'S NAME � H LENDER'SADDRESS W� TOTAL FEES — ��`"�- �J.�1 C I CEFTIFY THAT I HAVE READ THIS APPLICATION AND STATE TNAT THE ABOVE I4FORMATION IS CORRECT. � � IFGREE'OGOMPLYWITHALLGI7YANDCOUNTVOaDINANCE5AND5TATELAWSREI.ATIN6TOBUILDING (�� GONSTRUGTIDN,AN�MEREBV AL'THORIZE REPRESENTATIVES OF THIS GOUNTYTO ENTER UPON'HE ,`�t � Q A60VE�MENTIONEO PqOPEqTY FOF INSPECTION PUHPOStS. COMMENTS ��^�� 7+ � S J �i1-S��t�'"� �.�t�� ,.{-� � � m PERMITTE AME(PRINTi �-jL+ �j (n ,��.F:a,;'..:� h��., �i-�`-.�'�� •� � ( 4--'1;�_ _ . ._.. _-- . �`' N SIGNATUR ITTE'.E �� DATF -T = RECPT.��0. PAI�BY VALIDATION ~ NJHITE—Deparlment Copy,VELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GR EN—Applicant's Copy � ��, r a � .; i� �� L ��. �. " _. . _ _ . . . . . . . .. �� _ �,a� � � �'- � ,...�' .. .. 'h� .. .. . .� . ..� '. .. ... � .�. . . . .. ... ... . ..�. V �1 �. . �.. . �� Y . . ... .. . �.. � . . . . . , . . . .. . . ..... ....... ,. ... _. . . . .. .. .. (J' ....... ... . .. .. . . . '. '. . . .. . . . . . . .. . . . . .. .. . ... ._. . . ... .. .. ..._ . ..... ... ._. ... .... ..... ..., . . ... ... .. .... . .. .. . ... . . . . . .. . ... ... . ... ... .. . ... ... . .. ..... ... . .. .. .. _... _ ... I. , �' . . . _ .+< a , ;i . . . .._ _.. . . .. ._. ..... ��. �3 , . . d - . .. . .. .... . ... .... . . . .. . .. . .. .. ��T .�. �' . 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 2250 Indian Creek APN LOT_TRACT OWNER�-S.S wFm ADDRESS CITY w(C.-1 11A 0 ZIP TEL._1_•'L162-ML APPLICANT TEL. �yI'�E CONTRACTOR-OW ADDRESS CITY ZIP TEL. ARCH/ENG/ 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 CITYOR COUNTY WHICH REQUIRESA 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).): ^ 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 W ITHIN ONE YEAR OF COMPLE- TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVbrl'OA THE PURPOSE OF SALE). -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- TORS LICENSE LAW.). I AM EXEMPT UNDER SEC. B. &P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARAT N I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PR''ISIONS 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. 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 ((HIS 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 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 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-MENTI NED PROPERTY FOR INSPECTION PURPOSES. 0 c f J PERMITTE AME(PRINT) SIGNATUR ITTEE DATE APPLICATION PERMIT'7 P/C 02/25/02 02-60 7t 7 DATE # NUMBER 7 ISSUE 2' ,TYPE OCC L DATE r/f CONST. GROUP ZONING SETBACKS FRONT RW^ REAR^ SIDE/SIDE STREET RW^ SIDE^ PROPOSED USE Altering foundation/closet and gameroom N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESC TION SQ. FT. FACTOR PSF ADJ.AREAIVALUATION SF D/EM U) Garage/Carport W Patio/Deck LL Pool/Spa Z Re-Root Commercial Valuation 2 0,000 ADJ.AREA QUANTITY DESCRIPTION FEE J 0 U W J W 0 Z J CL Q U Z 2 U W CONSTRUCTlON �J . PLAN REVIEW LAS ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP 6'. ENERGY P/C ENERGY PERMIT RETENTION FEE: .TT(: PRE-ALT FEE: J . TOTAL FEES -AV r COMMENTS RECPT. N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy,PINK-Assessor Copy,GOLDENROD=File Copy,GREEN-Applicant's Copy