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Home My WebLink About18124 (10) CITY OF DIAMOND BAR `� ��f��(:� ��` DEPARTMENT OF COMMUNTTY&DEVELOPI�NT SERVICES � � _ I _ 2]825 E.Copley Drive �.) ' (,�� (909)860-3195 Fax(909)861-31 l7 � PRESS BUILDING PERMIT APPLICATION FIRMLY QJOBSITE �r�� r..o. 1 � C�Z / A� + DATEICATION �`�/ �-4? NU BER / tl1 ? r �lC Q ADDRES£+.-�J �l��L.�(.l !�/`� � ISSUE � . � TYPE OCC APN_ !`+� LQT� TRACT — DATE �,��G c.� CONST. GROUP p OWNER ��I J __ o ADDRESS ___ ZONING SETBACKS z CITY ZIP TEL FRONT Ryy � p APPLICANT T REAR � z�. SIDE/SIDE STREET Ryy � Q CONTRACTOR SIDE � p� ADDRESS__ � CITY 3SZ3�I1dUS�AVP TEL.__� PROPOSED USE o ARCH/ENGJ Lakewooa,CA. 907t2 �z DESIGNER NO.DWEL. NO. NO. a ADDRESS � CITY ZIP TEL. UNITS_ STORIES BEDROOMS � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREA/VA�UATION Q OWNER-BUILDER DECLARATION SFR/ADDlPEM O Q I HEREBY AFFIRM UN�ER PENALTV OF PERJUFV THAT I AM EXEMPT FROM TNE CONTRACTORS LI- G8f898�C2fpOf1 W CENSELAWFOHTNEFOLLOWINGREASON�SEC.1031.SBUSINESSANDVROFESSIONSCODE:ANVCITVOR (n U CWNTVWHICHREDVIRESAPERMITTOCONSTRUCT,Al7ER.IMPROVE,DEMOLISH,ORREPAIRANYSTRUC- wTURE,PRIOR 70ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMR TO FILE A SIGNED w Patio/Deck � STATEMEN7 THAT HE OR SFiE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CANTRACTDHS LI- � CENSE LAW�CMAPTER 9(GOMMENCING WITH SEGTION 1000)OF UIVISION 9 OFTHE BUSINE55 AND PRO- LL POOUSpB � FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGE7E%EMP- (� U TION.ANYVIOLATIONOFSECTION7031.58VANVAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO Z Re-Roof A qVIL PENALTY OF NOT MORE THAN FNE HUNDRED DOLLARS(5500).�: p ❑I.ASOWNEROFTHEPROPERTYORMYEAdPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, � Comm8fCi81 Z WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDEO OR OFFERED FOR SALE(SEC.]046,BUSI- J � NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE�AW DOES NOT APPLV TO AN O'NNER OF ? PROPERTV WHO BUILDS OR IMPROVES THEREON,AND WHO DO[S SVCH WOPK HIMSELF OR HERSELF OR 2 THROUGHHISORHEROWNEMPLOVEES,PROVIDEDTHATSL'CHiMPROVEMENTSARENOTINTENDEDOR m Q OFFERE�FORSPLE.IF,NOWEVERT1iE8UILDINGORIMPROVEMENTI550LDWITHIIVONEYEAROFCOMPLE ,, Z TION,THE OWNER-BUILOER WILL HAVE THE BURDEN OF PROYING THAT HE OR SHE DID NOT BUILD OR � IMPROVEFORTHEPURPDSEOFSALE). w ❑I,ASOWNEROFTHEPROPERTV,AMEXCLUSIVELYCONTRACTINGWITM�ICENSEDCONTRACTORS � TO CONSTRUCT THE PROJECT(SEC.7oaa,BUSINE55 AND PROFESSIONS CODE THE CONTRACTORS LI� Veluetl0fl ADJ.AREA W CENSELAWOOESNOTAPPLYTOAN05YNEROFAPROPERTVWH�Bl111D50RIMPqOVESTHEFEON,AND � WHOCONTRACTSFORSUCHPROJECTSWITHACONTRACTOP(S�LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION Y TORSI.ICENSELAW)_ FEE Q ❑I AM EXEMPT UNDER SEC. B.8 P.G FOR THIS REASON Q � U � � onrE owNEq H Z U � LICENSED CONTRACTORS DECLARATION W Q � I HEREBVAFFIRM UNOER PENALTV OF PERJURV THAT I AM LICENSED UNDER PROVISIONS CFCHAPTER � , d 9(COMMENCINGWITHSECTION]000)OFD.VISION30FTHEBUSINESSANDPROFESSIONSCODE,AND Z `X MV LICENSE IS W FUL OR �AND EFFECT. j 'j'7('' f� / � LICENS S � LIC.NO.� I �� V DA7E � CONTRACTOR� d W � WORKERS'COMPENSATIDN DECLARATIO Q Q � I HEREBY AFFIRM UNDER PENALTV OF PERJURY ONEOFTME FOLLOWING OECLARATIONS: Z � IHAVEANDWILLMAINTAINACERTIFICATEOFCONSE4TTOSELF-INSUREFORWOqKEFS' a Z = Q _ �LOMPENSATION,AS PROVIDED BV SECTION 3]o00F THE LABOR CODE,fOR THE 7ERFORMANCE U Q ^ ; OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED. � � /{��TrnVE FND WILL MAMTAIN WORKERS'COMPENSAiION INSURANCE,AS REOUIRED BV SECTION Q 37oa OF THE L BOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSl1E�.MY R RS' SATI I I URANCE CARRIER AND POUCV NUMBER ARE: CONSTRUCTION J j CARRIEF PLAN REVIEW ZPOI.ICYNUMBER �_ ELECTRIC Q __ � (IHISSECTKXJNEmNJTBECOMPLETEDOFTHEPERMRISFORONEHUrDFEDDOLIAfiS(E100)ORLESSI. PLUMBING W Z I CERTFV iHAT IN THE PERFORMANCE OF THE WORN FOR WHICH iHIS PERMIT IS ISSUED,I MECHANICAL (J SHALL NOT EMPLOY ANV GERSON IN ANV MANNER SO AS TO BEfAME SUBJECTTO THE � WORKERS'COMPENSATION LAWS OF CAUFORNIA.ANDAGR[E THAT IF I SHOULO BECOME INSPECTION FEE = SUBJLCTTOThI WORKEflS'COMPENSATIONPROVISIONSOFS TICN3]OOOFTHEIABOR �E I TMCOMPLV WITH HO P OVI51 ISSUANCE o �� l�ce _ - , DATE: PLICANT: SMIP w ENERGY P/C 'J WARNING:FAIWRETOSECVREWORKERS'COMPENSATIONCOVERAGEISUNLAWFUL,ANDSHALLBE J LL SU&1[CTANEMP�OVERTOCRIMINALPENALTIESANDqVILFINESUPTOONEHUNDREDTHOUSAN� ENERGYPERMIT DOLLARS(Tt o0,000�,IN A�DITION TO THE COST OF GOMPENSATION,DAMAGES AS PROVIDED FOR IN J SECTION3IOBOFTHELABORCOCJE,INIEHt51,ANUATTORNEV'SFEES. OC RETENTION FEE: OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: ___, � IHCf1EBYAFFIRMUNDEflPENALTYOFPERJURYTHATTHEREISACONSTRUCTIONLEN�INGAGENGY FOR THE PERFORNANCE OF THE WORK FOR WHICH THIS PEFMITIS ISSUE�(SEG.3091,CIV.C.). ---� Z W = LEN�ER'S NAME � H LEN�ER'SADDRESS � TOTAL FEES �s , �(� � I CERTIFY THAT I HAVE READ THIS AP{'LICATION AND STATE TIIAT THE ABOVE INFORMATION IS COf1FECT w I AGREE�O COMPLY WITH ALL CITYAND CCUNTY 09DINANCES AND STATE LAWS flELATING TO BUILDING � � CONSTRUCTION,AN�MEREBY PUTHORIZE REPRESENTFTIVES OF THIS GOUNiY TO ENTER UPON TNE Z PBOVE-MENTIONEO G OPERTY FOR MSPECTION PUFPOSES. COMMENTS � 1�. ��. 1 e __ _ m P MIT E NA (P /�' � ^ w � J C�-- � SIGNATURE OF PERMITTEE �ATE - = RECPT.NO. � G� PAID BY VALIDATION WHITE—Department Copy,VELLOW—Finance Copy,PINK—Assessor Copy.GOLDENROD—File Copy,GREEN—Applicant's Copy 3� � 4 �g6� Q.^iWr9'�'ry ��u . . . . . , �" . . . ��_i.- G s'�� ma�F�3"� m� .. . .. . .... . . . . .... ..... . .. .... .p 3 ,_ i d -....__ . .. . . _ ...... . . ..... �. ... .. .. . - � k i£��i��. .. .. ..... ... ....... . ..... .... .. .. ��. . .. .... ..... .. ..... ..'��. F '1 ; �5..� s4f >��, , .e 3 ��. � i' . �' � $` IE' : .. .. . .. ... .. .. . ... . . . .... ... .... ..... .... . .. .... ... ... ..... .. �FI a-e � ��i(1f ��b�� . F L i.^ i�. � �E sJl, e1P� ..:` . � s . ..... .. ... ...... ...... .... .. . ... .. .... . . _ ` a�a � ` = ... . ... . .... .. . ... . ... .. .. �t s i � ' €� .._... .. .. ,i c; . .. .. . ... .. ... .. .. ... . . ... .. .. . � - ��,� � _ . .. ... �. .. .. w, , . .. . . . . .._ .. .. _.. . . ... . .. ri,._ �. .. . ... .. .. . . .. ` � P :``.r4 � .., . . . a ..: � �� ' ''',� ... . . ... .. . . .. .. . ..... .. ...... . .. ... ... . ..._.. .. .... ... ;il Ji -r' », � r q � . . , ,� 6 �� ' . ...... .. .. . . CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION E ADDRES 92D�o,,.a I ^ p/ # ] DDRE L APN L TTRACT OWNER�j I ADDRESS CITY ZIP TEL APPLICANT T CONTRACTOR ADDRESS APPLIANCE ERA INC CITY 3823Indu0fAva TEL. ARCH/ENG/Lakewood,CA 90712 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 ANYSTRUC- 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 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 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 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 FUL OR AND EFFECT.-j,..T� w J ��- / C i IT �� LICENS LIC N0. WS DATE CONTRACTOR 1410A 1,0 Wf j/�� WORKERS'COMPENSATION DECLARATIO(/� 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' /bOMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. VE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION 3700 OF THE L BOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY R RS'SATI I URANCE CARRIER AND POLICY NUMBER ARE' CARRIER POLICY NUMBER (THIS SECT)ON 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 TH WORKEfIS'COMPENSATIO V.ISI-ONSTION 3700 OF LABOR nE I TH COMPLY WITH HO P OVISI/Y)//V/I-t"/I/--i) DATE: PLICANT: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE 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 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-MENTIONED P OPERTY FOR INSPECTION PURPOSES. W I I I. Jle P MI E NA(P r!' SIGNATURE OF PERMITTEE DATE WHITE-Department Copy,YELLOW-Finance Copy, PIN PRESS FIRMLY 6PIPPLICATION 7 PERMIT P/C DATE/, NUMBER 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 CO Garage/Carport W Patio/Deck LL � PooVSpa �3 Re-Roof Z Commercial co Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U U W W m - / d Z CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES(f 50) COMMENTS GL PAID BY RECPT NO VALIDATION