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Home My WebLink About18421 J� C[TY OF DIAMOND BAR `�� I DEPARTMENT OF COMMUNITY&bEVELOPMENT SERVICES }. 21825 E.Copley Drive � (909)860-3195 Fax(909)861-3117 PRESS � �� BUILD[NG PERMIT APPLICATION FIRMLY y JOBSITE /1�� W APPLICAT�N?� � b � PERMIT P/C o ADDRESS �' ' OATE NUMBER # � ISSUE /� TYPE OCC APN L07 TRACT _ DATE � � ��-- CONST. GROUP p OWNER p ADD SS .� � s1 f . ZONING SETBACKS z CITY� ZIP T - �e FRONT qyy C � APPUCANT TEL._ REAR � z SIDE/SIDE STREET RW ❑ Q CONTRACTO SIDE � ADDR� r ._ � CITY �ZIP TEL. -C PROPOSED USE I � ARCH/ENG! z DESIGNER a ADDRESS -- NO.DWEL. NO. NO. � CITY ZIP TEL. UNITS STORIES BEDROOMS � � DESCRIPTION SQ.FT. FACTOfl PSF ADJ.AREANALUATION Q OWNER-BUILDER DECLARATION SFR/ADD/REM O � I MEREBV AFFIRM UNDEF PENPLTV OF PERJVHV THAT I AM FXEMPT fROM THE GONTRAGTORS LI- G8f89B/C2lpOh W CENSEUWFORTHEFOLLOWIMGREASON�SEC.'/o31.58U5ME55ANDPROFE55lONSCODE:ANVCIiYOR ((� U GOUNTVWMICHREQUIRESFPERMITTOCDNSTNUCT,qITER,IMPROVE.�EMOLISH,CRREPAIaANViTRUC- W TUFE.PRIOR TO ITS ISSUANCE,AL50 REOUIRES iHE APPLICANT FOR SUCM PERMIT TO FILE A SIGNED w P3�i0/DBCk � STATEMENT THAT HE OF SHE IS LICENSED PURSUANT TO THE PFOVISIONS OF THE CON"RACTORS u� � CENSE LAW(CHAPTER 8(COMAAENCING WITH SECT�ON 7000)OF DIVISION 3 OF THE BUSINESS ANO PRO� LL PDOVSpB O FESSIONSCODE)ORTHATHEC�RSFIEISE%FIAPTTHFqFFiiOMANDTHE0A515FOqTHEAILEGEDE%EMV- � V TION.ANVVIOLATIONOFSECTION]031.SBYANYAPPLICAN'FORACERMITSU9JECf5fHFAPPLICANTTO Z qe-Foof � AqVIL PENALTV OF NOT MORE THAN FNE HUNOFED DOLLARS(f5ao))�. � ❑I,ASOWNEROFTHEPROPERN,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATiON, � Commercial Z WILL DO THE WORK,AN�THE STflUCTUflE IS NOT IN i ENDED OR OfFERE�FOR SFLE(SEC.70C4,BU�I- J � NE55 AND PROFESSIONS CODf::THE CONTRAGTOflS�ICENSE LAW�OcS NO;APPLY TO AN OWNEF OF ? — PROPEFTYWHOBUILDSORIMFROVESTHEREON,ANDWHODOESSUCHWORKHIMSEIFORHERSELFOF wTHRIXIGHMISORHEROVJNEMPLOVEES,PROVIDEDTHATSUCHIMPROVEMENTSARENOTINTENDEDOR m � OFFERE�FORSALE.IF,HOWEVEiliHEBUILDINGORIMPROVEMENTIS50LDWITHINONEYEAROFCOMPLE- Z TIIXJ,TfiE OWNERBUILDEH WI��.L MAVE 7HE BURDEN OF PROVING'HAT HE OR SHE DID/.OT BUIL�OR � IMPROVE FOR THE VURPOSE OF SAIE). w ❑I,ASONTJEROFTHEVW�PERTY,AMEXCLUSIVELYCCINTRACTINGWRHLICENSEDCONTRACTORS � TO CONSTRUCT THE PRQIECT(SEC.]asa,BUSINESS AND PROfESSIUNS CODE:THE CONTqACTORS I I� V81110�1Of1 � ADJ.AREA W CENSELAWDOESNOTA7PLYTOANOWNEROFAPROPER'YWHOdJ11.O50RIMPROVESTHEREON,AND — - � YMOCONTRACTSFORSUCHPFIQIECTSWITNACONTRACTOR(5)1_ICEhSEDPURSUANTTOTHEGONTRAC- QUANTITY DESCRIPTION � TORS LIGENSE lAW). FEE � ❑1 AM EXEMPT UN�ER SFC. _ 8.8 P.C.FOR THIS REASON Q � U � — � — DATE OWNcR H � Z -- U � LICEIVSED CONTFACTORS DECLARATION W Q • '� � IHEflEBVAFFIfiMUNDERPENALTVOFPERJUR�THATIFMLIGENSEDUNDERPROVi510N5OFGHAPTER � 1LVC �'� � B(GOMMENGING WITM SECTIO��OOO�OF DNISION 3 0F THE BUSINESS AND VPOFESSiONS GODE,AN� Z �X MY IIGENSE IS IN FUL�f NNO EFF CT. �''] Q LICENSE S_��_ LIC.NO. • / ��'� � ~ DAiE�: � �"'� CONTRACTO d U w � WORI<ERS'COMPENSATiON DECLARATION Q � I HEREBV AFfIRM UNDER PENAI_TV OF PERJUR�ONE OF THE FOLLOWING DECIARATIONS�. Z Z I HAVE AND WILL MAINT�41N A CERTIFICATE OF CONSENT TO SEIF�INSURE FOR WORKERS' ¢ _ Q �ENSATION,AS PR7VIDED BY SECTION 3]0a OF THE IABDR CODE,FOH THE PERFORMANCE U O HE WORK FOR WMIGH THIS PERMIT IS ISSUED. W � � w 1 HAVE AND WILL MAINT�SIN WORKERS'COM7ENSATION INSURANCE,AS RFOUIRED BV SFCTION QQ A1aa OF THE UB ODE F i1�THE PER:ORMA E OF THC WORK FOR WHICHTHIS PERMIT IS ISSUE�.MV W K 5'CO ENSATION INSUfl�E CA�ER AN�POLIgY NUMBER ARE: CONSTRUCTION � CAPFIER �p � PLAN REVIEW Z POLICY NUMBER_ ��" — ELECTRIC Q � (iHISSECTIONNE�NOTBECi7MRETEDOF7HEPERMITIS�OFONEHUI�DREDU0LLAR5(51m)ORLE55�. PLUMBING ♦ � z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.1 MECHANICAL I (} SHALL NOT EMPLO�ANY PERSON IN AM1V MANNER 50 AS TO BECOME UBJEf.T TO THE — � WORKERS'COMPENSATION LAWS Of CNUfO ,Ah HGREE TH �� H LD BECOME INS�ECTION FEE � SUBJ CTTO TME WORM.ERS'COMPENSHTI P9 VI NS OF S TIO ] F THE IAdOH � I� QR K'RH COMPLV WITH HOS P IS N5. � ISSUANCE __ _ � �� +— p DATE�. � :4PPLICANT: SMIP J WARNING�.FAI URE TO SECURE WORKERS'GOMPENSATION COV AGE IS U LAWFUL,AND SHALI BE ENERGY P/C � SUBJECTANEMPLOVERTOCRIMINALPENALTIESNNOCIVI�FlNES PTOO MUNDREDTHUUSANU ENERGYPERM�T OOLlANS(5100000),INADOITIONTOTHECOSTOFCOMPENSATION, A SASPROVIDEDFORIN ��-�. J SECTION370BOFTHELABOROJDE,MTEREST.ANDAPORNEV'SFEES. 1 1. Q RETENTION FEE: w — _— O G�NSTRUCTION LENDING AGENCY PRE-ALT FEE: _. _ ¢ IHEREBVAFFIRMUNDERPENAI_TYOFPERJURVTHATTHEREISACONSTfiUCTIONLEN0INGAGENCV � FOR'HE PERFORMANCE OF THE WOnN fOR WMICH THIS PERMITIS ISSUEC(SEC.309].GIV.C.). Z w j LENDEH'S NAME _ � F- LENDER'SADDRESS � TOTAL FEES �p� � � I CEflTIFV iHAT I HAVE ftEAD THIS APPLICATIONANO STATE THAT TME ABOVE INFORMATION'i5 GORFECT W I AGREE 10 COMPLY WITH ALL GITY AND COUNTV ORDINlWGESANO STATE lAWS RE�ATING TO 9UILDING � � � CONSTRUCTION.AND NEREBV NUTMORIZE FEPFESENTATIVES OF THIS COUNiY TO ENItH UPC1N TI-.E Z ABOVE NlIONE�PROPEFTV FOR INSPECTION Pl1RPOSES. COMMENTS Q � � __'.. _.— .-- � —_ _ m PEfl A�.]((PRINT) (� }C Z � T7 C�� ICyj,IA .RE OF PERMI - �1E � = RECPT YO. ._ PAID BY VALIDATION ~ WHITE—Department Copy,VELLOW—Finance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—ApplicanYs Copy .�� „ z, , �� _ � ^� � �� s" "�� ., o;.� � � } ��a �� r a � � • M1 • , ° ,�.. aa� � � _ � t � ., . ��...��,t.�� .,• ' '�� _ _ ' -_ _ __ ,_. _ _ _ ' _ __. _ _ i _ _ _ _ , _ __. __. __. _ : __ _ .___ __._ __..._ __ _ � __ _ .._ _.__ + E�� h ,.� �� — __ � � _ __ _ _ ___ j�� ,�-� ,�t 4 � y� ,,-, . �t,� F� t �� _ � �, �a �,r,Y � � __ ��;; � ��w,i� �y _ _ _ . _ _ • d , _ __ _ , , , ..,,u . , �°�- �4 .I. � ' .... .. . . .. . . .... . .. ..._. .._.. ._.. .... .. ._.. i re- .. . . . . ._ . . �rF � � e' i ... .. . .. .. . . ... .. .. . . . .. .... ... . .... ...._ ...... __ ._.. ..._. � X, r � � ' �,�� __ — k:M ... . .. . . . . .. . ... .. .... � � e�+�� i�. . v . . . . . . . .... . ._. .. .. .. .... .._.. _. . ... .. _. .. CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION JOBSITE ADDRESS ADDRESS APN LOT TRACT OWNER�. ADD SS CITY ZIP T APPLICANT TEL. CONTRALTO AD(I WS It- CITY&ZIP TEL. " ARCH/ENG/w� 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 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 CR 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)). U I,AS OWNER OF THE PROPERTY,OR MY EMPLOYEES WITH WAGES AS T HEIR 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 IMFROVES 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 WL.L HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). O1 ,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 SOII.OS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PFIOJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW). U T AM EXEMPT UNDER SEC._8 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 B(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL F AND EFF CT NSE CI QSS LIC N0, -CONTRACTO DATE WORKERS'COMPENSATION DECLARATION 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' COM ENSATION.AS PROVIDED BY SECTlON 3700 OF THE LABOR CODE, FOR THE PERFORMANCE 0 HE WORK FOR WHICH THIS PERMIT IS ISSUED . 1 HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION 3700 OF THE LAB ODE. F MTHE PERFORMA E OF THE WORK FOR WHICH THIS PERMIT IS ISSUED MV W K CO ENSATION INSURA E CA BIER AND POLI�V NUMBER ARE CARRIER, �-C POLICY NUMBER')L (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 UBJEGT TO THE WORKERS'COMPENSATION LAWS OF CAUFO AN AGREE TH I H LD BECOME SUBJ CT TO THE WORE ERS'COMPENSATI PR VI NS OF S TIO 7 F THE LABOR I $tIA�. QR'ITH COMPLY WITH HOS P IS NS. DATE APPLICANT WARNING FAI URE TO SECURE WORKERS'COMPENSATION COV AGE IS U LAWFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES P T00 HUNDRED THOUSAND DOLLARS(f 100,000),IN ADDITION TO THE COST OF COMPENSATION,A 5 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.CIV C.) LENDER'S NAME LENDER'S ADDRESS 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 ABOVE NTIONED PROPERTY FOR INSPECTION PURPOSES. (PERtZ A(PRINT) Cyj�IA RE OF PERMI-"0 TE WHITE-Department Copy,YELLOW-Finance Copy, PIN PRESS FIRMLY APPLICAT PERMIT P/C DATE NUMBER # ISSUE/� TYPE OCC 1 DATE 0_+ 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.AREA/VALUATION SFR/ADD/REM W Garage/Carport W Patio/Deck LL Pool/Spa 0 Z Re-Roof Commercial m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J H U w W z wel 36 a Q U Z U W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT - RETENTION FEE: � PRE-ALT FEE: TOTAL FEES 0 COMMENTS RECPT N0. PAID BY VALIDATION