The URL can be used to link to this page

Home My WebLink About17899 i_� , � CITY OF DIAMOND BAR �} -��j� I� DEPARTMENT OF COIvIIviUNITY&DEVELOPMENT SERVICES � 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 PRESS "<�„.,'' BUILDING PERMIT APPLICATION FIRMLY y JOBSITE � �7 �� "fl:��1��./�r�,�� - APPLICATI .D�__ NUMB R1_��1�� P// � o ADDRESS C� -F�'t V/ DATE � # � ISSUE TYPE OCC APN LOT T ACT DATE �� CONST. GROUP � OWNER �'► t � a o ADDR SS ZONING SETBACKS �TY ' ZIP TEL. 7 FRONT RW I l PLICANT. ` TEL. REAR ❑ O � SIDE/SIDE STREET RW ❑__ a CONTRACTOR 'r � SIDE ❑ � ADDRES PROPOSED USE � CITY ZIP TEL. w ARCHJENGI z DESIGNER _ NO.DWEL. NO. NO. a ADDRESS UNITS STORIES BEDROOMS � CITY ZIP 'TEL. � DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUIL�ER DECLARATION SFR/ADD/REM O p I HEREBY AFFIRM UNDER PENALTV OF PEHJURY THAT I AM EXEMPT FROM THE CON7RAGTORS LI- G8f8J8/CdfPOfl W CENSELAWFORTHEFOLLOWINGREASON(SEC.�o3i.5BU51NESSANDPROFE5510N5CO0E:ANVGITYOR (n U COl1NTVWHICHNEOUIRESAPERMITTOCANSTRUCT,ALTEF,IMPROVE,DEMOLISH,OiiREPAIRANVSTRUC� W pali0/DeCk wTURE,PRIOR TO ITS ISSUANCE.ALSO REOUIRES THE APPLICANT FOR SUCH PEFMIT TO FILE A SIGNED w � STATEMENT THAT HE OF SHE IS LICENSE�PURSUANT TO THE PROVISIONS OF THE CONTRACTOFS U- � CENSE LAW(CHAPTER 9(COMMENCING WITH SECTIDN]000)OF DNISION 3 OF THE AUSMESS AN�PRO- � POOUSPB O FESSIONSCOD�ORTHATHEORSHEISE%EMPTTHEREFROMANOTHEBASISFORTHEALLEGEDE%EMP� � U TION.ANVVIOLATIONOFSECTION7a3t.5BVANVAPPLICANTFO(iAPERMITSVBJECTSTHEAPPLICANTTO Z Re-Root � A CIVIL 7ENALTY OF NOT MOfiE THAN FNE HUN�RED DOLLARS(f5oa).): � ❑I,ASOWNEROFTHEPflOPERTV,OFMYEMPLOYEESWITHWAGE5A5THEIR50LEGOMPENSATION, � COR1R18fC131 Z WILL DO THE WORK,AN�THE STRUCTURE IS NOT INTENDED OR OFFEREO FOH sALE(SEG.�oaa.6USI- J NE55 AND PROFESSIONS CODE'.THE CONTRACTORS IICENSE LAW DOES NOT APPLY TO AN OWNER OF � PROPERTYWHOBLIILDSORIMPROVESTHEREON,ANDWHODOESSUCHWORKHIMSEIFORHERSELFOR m � THROUGHHISORHEROWNEMGLOYEES.PROVI�E�THATSUCHIMPROVEMENTSARENOTINTENDEDOR w OFFEREDFORSALE.If,HOWEVER,THEBUIL0INGORIMPROVEMENTISSDLDWITHINONEYEAROFCOMPLE- � TION,THE OWNER-BUIIDER WILL HAVE THE BURDEN OF PROVING THAT NE OR SHE OID NOT BUIL�OR Z IMPROVE FOR THE PVRPOSE OF SALE). _ ❑I,ASOWNEROFTHEPflOPERTV,AMEXCLUSNELYCONTRACTINGWITHLICENSE�CONTRACTORS w TO CANSTRUGT1TiE PROJEGT(SEG.1004,BUSMESS AND PROFESSIONS CODE THE CONTRACTOFlS'J- Valuation ADJ.AREA W CENSELAWDOESNOTAPPLVTOANOWNEFOFAPROPERTYWHOBUILDSORIMPROVESTHEAEON,AND � WHOCONTRACTSFORSUCHPROJECTSWITHACANTRAGTOF(5)LICENSEDPURSUAMTTOTHEGONTRHC� QUANTITY DESCRIPTION FEE TORS LICENSE LAW). O ❑i AM E%EMPT UNDER SF_C. ..B.8 P.C.FOR THIS REASON U � � -.-- - � LL' DATE OWNER_ - ~ i Z U I � i Q W � LICENSED CONTRACTORS DECLARATION ¢ � I HEREBV AFFIFM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNIJEH PHOVISIONS OF cHnPTER � d 9(COMMENCINGWITHSECTION7000)OF�IVISION30FTHEBUSINESSANDPROFESSIONSCO�E,AND Z X MV LICENSE IS M FULL FOFCE AND EFFECT. �/ m � LICENSE CLA S lr��_ LIG.NO. �O • � � �� _ WDATE ' � CON7RAc�OR � d � � � � WORKERS'COMPENSATION DECLARATION �-- � � U � I HEREBYAFFIRM VNDER PENALTY OF PERJURY ONE OFiHE FOLLOWING DECLAHATIONS�. Z - L/ Q v � I HAVE AND WILL MAINTRIN A CERTIFIGATE OF CONSENT TD SELF-INSUftE FOfl WORKERS' _ �^ QCAMPENSATION,AS PROVIDED BY SECTION 3]00 OF THE LABOR CODE,FOR THE PEftFORMANGE `U OFTHE WORK FOR WHICH THIS PEflMIT IS ISSUED. � � _ w �I HAVE AND WILL MAINTAIN WOflKEFS'COMPENSAT'ON INSURANCE,AS REOUIRED BV SECTION , , `. � -�.��. � ��}/v J(� Q 3]00 OF THE LABOR GODE,FOR THE PERFORMANCE OF THE WOf1K FOR WHICH THIS PERMIT IS ISSUE�.MV WOR COM ENSATION f�SURANCE ARRIEF AND POLIGY NUMBER ARE: CONSTRUCTION j CARRIER � n rv '''�I'� % PLAN REVIEW � POLICY NUMBER � / ��7 �Y�� • ELECTRIC Z \ Q J � (1NISSECT%7fJNCmNOTBEO�IAPIETEDOFTHEPEPMf7'IS�ORONEHUI�DREDWLLMS(f100)ORLESS) PLUMBING .. L w MECHANICAL Z I CERTIFY THAT IN THE PERFORMANGE OF THE WOHN FOR'NHICH THIS PERMIT IS ISS'JED,I (� $HALL NOT EMPLOV ANY PERSON IN ANY M EF 50 O B(:OME SU9JECT TO THE INSPECTION FEE � WORKERS'COMVENSATION LAWS OF CA OR IA,A A AT'F I SHOULD BECAME SUBJECTTOTNEWORKERS'COMPENSAIONPOVIIO TION3�OOOfTHELABOR � CODE,I SHA OR H TH COMPLY WIT 'HO P 5 ISSUANCE � - � SMIP p OATE: "� PLICANT: — — w ENERGY P/C J WARNING�FAILUFiE TO SECUFiE WORKERS'GO SATID COVERAGE IS UNLAWFUL,AND SHALL 9E � �� - � --�� J SUBJECTAN EMPLOYERTO CRIMINAL PENALT� ND CIVIL FINES UP TOONE HUNDftED THOUSAND � DOLLARS(f100 uo0).IN PADIiION TOTNE COS FCOMPENSATION.DAMAGES AS PROVIDE�FOR IN ENERGY PERMIT _ J SECTION 3]aOOF TIIE LABOft CODE,INTEFEST,ANJATTOPNEV'S FEES. RETENTION FEE: Q � CONSTRUCTION LENOWG AGENGY PRE-ALT FEE: O � I HEREBV AFFIRM UNDFR PFNALTV OF PERJl1RV THAT 7HERE IS ACONSTRUCTION IEN�ING AGENCY . _ � FOR THE PERFORMANCE OFTHF WORN FOR WHICH THIS PERMIT IS ISSUED ISEC.3097,CIV.C.). Z ._. ....__ __ W � LENDER'SNAME ..._ — __ .__ F- LENDER'SADOFESS -- �^ � I CERiIFY THAT��HAVE REA�THIS APPLICATION A�D STATE THATTHE ABOVE INFORMATION IS CORRECT. TOTAL FEES 5��/ .� W IAGREETOCOIUP'�vwRHALL(:ITYANDCOUNTYORDINANCESANDSTATELAWSRELATINGT08UILDING � CONSTRUCTION,ANDNEREBYAVTHORIZEREPRESENTATNFSOFTHISCOJNTVTOENTERUPONTHE ZABOVE-MENTIONE�PROPERTV FOR INSPECTION PURPOSES. GOMMENTS - � � ,^ r L � m PEPMITTEE AM (PRI q -- �-- - U7 _�L� � SIGNAT'JREO I E DATE RECPT.NO. PAID BY VALIDATION _ — —__ ~ WHITE—Depariment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—Applicant's Copy l ,� = s, � '�. i i i � �� s � ' �+ = iP a �yr,�n �" � ��.a'�. � y � p � p�� ,� �' - p�t � � :�a P a� ,�a i € i 6 i � s , �:A. �,.�"��'�� t°'. „ � a�� _ . - _ . �� .��`� v . , �. . . °."id��l�l��a . ,�,� .N ��.'�i�� a� . . ."; � � ,.�_._._.1 ... ... . . .. ... .. . ... .. .... .... .. .... . .... .. f� '2 �6 1 f- � .. .. ... . .. . ��. _ . .. � ._.... ... . ._.. . _.. .... .. . � � , � �2 ��, _ �/�o.� ��- _ : _ _ ��o� ��- _ _ _ — — F,� ,� � � ��x��, �� , .e _ _ _ _ _ ��_�� ,�� . �� '� �� _ _ __ _ _ ___ _ _ _ _ E ��,�� ' �� '�� ,� �� , �� . _ _ _ _ _ ��a�� ,�� ,��' ''' r�� c ��"�w�� _ ��, ��, ��a�a � _ _ _ _ _ _ _ __ r� �"'�r��r¢�k��"� �� a��`�"�a�„�� a � r� r _.. ._ ._ - _ .. � �� - - � a ir �„a ^� �r��r��e,� a� i �. °�ii � 1��P��'�"` � a _ �, _ �a� � a��a ��e ��s sir�� .. � r , 3��eh � ��. ' - "��m.' _. .__. . _. . ... _.. . ..... . ... .. _. ....._ .. .. . . _. ... _. ,. ��. �� i ,, . �d ._ __. ..._ �� a� . ��:� 0 o� 0 CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION JOBSITE��J ��"fl' �t��/�r��' ADDRESS_ � �.�1(s><VI APN LOT T ACT OWNER�K d-t o ADDR SS �TY ZIP - ^ PLICANT. � zl �. 0 0 W U Z W U H Z ]C LL Z 0 d W 0 U Q W J 2 F CONTRACTOR ADDRES CITY ARCH/ENG/ DESIGNER ADDRESS_ CITY �S� ZIP'T'EL. OWNER-BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSELAW FOR THE FOLLOWING REASON(SEC. 7031.5 BUSINESS AND PROFESSIONS CODE:ANV CITY OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT,ALTER,IMPROVE,DEMOLISH,OR REPAIR ANV STRUC� TURE,PRK)R 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- FESSIONSCODE)ORTHAT HE ORSHE ISEXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP� TION.ANV VIOLATION OF SECTION 7031.5 BV ANV APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(SS00),I: ^ I,AS OWNER OF THE PROPERTY,OR MV EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC. 7066. 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 W HO 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. 8 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/F�ORCE2AN,D E-FFECT. C LICENSE C��LA//$$S�I.i��LIC. N0. -/0 DATE_:Y_..'CONTRACTOR 1; 77 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 BV 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 BV SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MV WORIy�R'COM ENSATION �p�SURANCE ARRIER AND POLICY NUMBER ARE: CARRIER 5 FIr/�U (THIS SECTION NEED NOT BE OJNAPLETED OF THE PERMR�IS FOR ONE HUNDRED DOLLARS(5100)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 M ER SO 0 B COME SUBJECT TO THE WORKERS'COMPENSATION LAWS OF CA OR IA,A A AT IF I SHOULD BECOME SUBJECT TO THE WORKERS'COMPENSA ION P OVI 10 TION 3700 OF THE LABOR CODE,I SHA OR H�T�H COMPLY WI GATE: y��x/PLICANT:_ WARNING: FAILURE TO SECURE WORKERS'CO SATIOff COVERAGE IS UNLAWFUL,AND SHALL BE SU&IECT AN EMPLOYER TO CRIMINAL PENALTI ND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS(f100 000),IN ADDITION TO THE COS F COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3700 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 OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC. 3097,CI V.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�MENTIONEO PROPERTY FOR INSPECTION PURPOSES. fl ��U PRESS FIRMLY WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy