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Home My WebLink About18336 CITY OF DIAMOND BAR t��- � ��r'� - �� DEPARTMENT OF COMMLJNPfY&DEVELOPMENT SERVICES � 21825 E.Copley Drive ��, . � � 3 (909)860-3195 Fa�c(909)861-3117 PRESS BUILDING PERMIT APPLICATION FIRMLY y JOBSITE 1I APPLICATION PERMIT P/C o ADDRES$,�� 7 r►` '� DATE ��Z- NUMBER 3:�� # � ISSUE TYPE OCC APN LOT TRACT DATE F �L CONST. GROUP p OWNER '� � f�L+�. Gv "" ADDRE S '1� (-6n' r� *w�`r. ZONWG SETBACKS z CITY �Q.N'"�� Y� ZIP TEL. �D - �-�@I FRONT RW ❑ o APPUCANT S��^t-- ___ TEL._�. REAR � zQ SIDE/SIDE STREET RW ❑ Q CONTRACTOR SIDE ❑ ADDRESS ,/ � CITY ZIP TEL. PROPOSED USE hlvu//p� A." o ARCHIENG/ z DESIGNER w NO.DWEL. NO. NO. i � ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS � cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREA/VALUATION � OWNER-BUILDER DECLARATION SFR/ADD/AEM O p I HEiiEBV AFFIRM UNDER PENALTV OF PERJURY THAT I AM E%EMPT FROM THE CONTRACTORS LI- G3f2 J8/C$fPOfI W CENSELAWFORTHEFOLLOWINGREASON(SEC.7031.SBUSINESSANDPROfES510NSCO0E�.ANVCITYOR (n U COUNTYWHICHREQUIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,�EMOLISH,ORREPAIRANYSTRUG W TURE,PPIOfl TO ITS ISSUANGE,AL50 flEQUIRES THe APPLICANi FOR SUCH PERMIT TO FILE A SIGNEU w Patio/Deck � STATEMENi THAT ME OR SHE IS LICENSE�PURSUANT TO T11E PROVISIONS OF THE CONTRACTORS LI- � � CENSE LAW�CHAPTER 9(COMMENCING WITH SECTION�000)OF DIVISION 3 OF THE BUSINESS AND PRO- POOVS{10 Q FESSIONSCODEJORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDE%EMP- (� U TION.ANYVIOLATIONOFSECTION7031.SBYANVAPPLICANTFORAPERMITSl1BJECTSTHEAPGLICnNTTO Z qe-Fioof A qVIL PENALTY OF NOT MORE THAN FIVE HUNDRF�DOLLARS�f500�.)� Q ❑I,ASOWNEROFTHEPROPFR7V,OR�AYEM7LOVEESWITHWAGESASTHEIRSOLECOMPENSATION, 0 COfflfflBfC18I Z WILL DO THE WORK,AN�THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.]444,BVS': J � NE55 AND PROFESSIONS CODE.THE CONTRACTOqS LICENSE LAW�OES NOT APPLY TD AN OWNER OF � PROPERTV MhiO BUIlDS OR IMPROVES THEREON,AND WMO�OES SUGH WORK HIMSELF Oq HERSELF OR wTHROUGH HIS OR HER OWN EMPLOYEES,PROVIDED THAT SUGH IMPROVEMENTSARE NOT MTENDE�OR m 0 OFFEREDWRSALE.IF,HOWEVER,THEBUILDINGOFiIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE- Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE Oq SHE DID NOT BUILD OR � IMPROVE FOR THE PUFPOSE OF SALE). �y,� ❑I.ASOWNEROFTHEPROPEflTY.AMEXCLUSNELVCONTRACTINGWITHLICENSEDCONTRACTORS � TO fANSTRUCT THE PPQIECT(SEG]Odl.BUSINESS AND PROFESSIONS CODE�.THE CONTRACTORS L'.- VaIU0t10l1 ADJ.AREA W CENSE lAW DOES NOTqPPLV TOAN OWNER OFA PROPERTV WHO BUILDS OR IMPqOVESTHEREON,AND -- � VM1iOCONTRACTSFORSUCHPRQIECTSWITHACONTFACTOR�S)LICENSEDPURSUANT70THECANTFAG QUANTITY DESCRIPTION FEE Y TORS LICENSE�AW.). � ❑I AM E%EMPT UN�ER SEG. B.6 P.C.FOR THIS FEASON Q ?� U � 1 + � oATE� �I �4 1'- awuFa 1 �l1.�4ti F- Z • W � LICENSED CONTRACTORS DECLARATION W Q � I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT I AM LICENSED UNOER PROVISIONS OF CHAPTER � � 9(COMMENCINOWITHSEC710N]000)OFDNISION30FTHEBUSINESSANDPROFESSIONSGODE,AN� Z L `X MY LIGENSE IS IN FULL FORCE AND EfFEGT. m 7 O�✓/��C. !��✓ �� LICENSE CLASS LIC.NO. � � J U �ATE CONTRACTOR � W � WORKERS'COMPENSATION DECLARAT�ON Q � I NEREBV AFFIRM UNDER PENALTV OF PERJURV ONE OF THE FOLLOWING DECLARATIONS: Z � IHAVEANDWILLMAINTAINACERTIFICATEOFCANSENTTOSE�F-INSUREFORWORKERS' ¢ 2 CAMPENSATION,AS PROVIDED BV SECTION 3�00 OF THE LABOR CODE,FOR THE PERFORMANCE U OFTHE WORK FOR WMICH THIS PERMIT IS ISSUED. w � � w I HAVE AND WILL MAINTAIN WORKERS'COMPENSATiOV INSURANCE.A5 REOUIRED BV SECTION Q 3]00 Of THE LABOR CO�E,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUE�.MV WORKERS'COMPENSATION INSURANCE CAR9IER AND POl'CV NUMBERAR[: CONSTRUCTION J � CARRIER PLAN REVIEW � POLICY NUMBER Z ELECTRIC a � v � (IHISSECTIONNEmNOTBECOMPLEfEDOFTNEPERANTISfORONEHU�ORm�OLWlS(E1W10RLESSI. PLUMBING Z I CERTIFV THAT IN THE PEFFOPMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL C�7 SHALL NOT EMPLOV ANV PERSON IN dNV MANNER SO AS TO BECOME SUBJECT TO THE � WORKERS'COMPENSATIOIv LAWS OF CALIFORNIA,AhD AGREE THAT IF I SHOULD BECOME INSPECTION FEE � SUBJEGTTO THE WORKERS'GOMPENSATION PROVISIONS OF SECTION 3loa OF THE LABOR � � . CODE,I SHALL FOflTHWITH COMPLv WITH THOSE PROVISIONS. �SSUANCE 0 p DATE' APPLICANT: SMIP J WARNING FAIIVRETO SECUftE WORKERS'GOMPENSATION COVEFAGE IS UNLAWFUL,AND SHNILBE ENEPGY P/C � SU&IECTANEMPLOVERTOCRIMINAI.PENA�TIESANDCIVILFINESUPTOONEHUNOREDTHOU5AN0 ENERGYPERMIT �OLLAHS(S 700,000�,IN AD�ITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDE�FOR IN ¢ SECTION3700OFTHELABORCODE.MTEREST,ANDATTORNEV'SFEES. RETENTIONFEE: nw. CONSTRUCTION LENDING AGENCY PRE-ALT FEE: �_�_� � O � IHEREBYAFFIflMUNDERPENALTYOFPEFJURYTHATTHEREISAGONSTRUGTIONLENDINGHGENCV I FOF THE PEFFORNANGE OF THE WOFK FOR WHIGH THIS PERMITIS ISSUE�(SEG.3091,GIV.G.). Z � W ? LEN�ER'S NAME � F- LEN�ER'SADDRESS — -__._____.__ .... _ J /� w ICERTIFYTHATIHAVEREADTMISAPPLICATIONANDSTATETHATTHEHBOVEINFORMATIONISCORRECT. TOTAL FEES /-� " v � I qGFEE TO GOMPLY WITH ALL GITYAND GOUNTYORDINlWCESAN�STATE LAWS PELATING TO BUILOING \V � GONSTRUGTION,AN�HEREBY FUTHOHIZE HEPHESEN�ATIVES OF THIS GOUNTY TO ENTEF UPON THE Z ABOVE�MENTIONED PROPEflTV FOR INSPECTION PU OSES. GOMMENTS p 1 �' ,c � .'— � J •�w .. {a•.:'"' � ]— ^ � -. . . .___.__.- - ___— QPE h E NAME(P ) � �v Z^ � SIG ATURE OF PEFMITTEE DAT �!� �! = RECPT.NO. PAID BY�!� �I VALIDATION ~ WHITE—Department Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENROD—Pile Copy,GREEN—ApplicanYs Copy �" �� `E_ � i i ',ro' - '' � �'�,, ,�u ... . m i�t..�a� ,g�t`��°� '-v' . �.,a�k��$��=s �,��.��. � � . . . ... .. _ . .... .... .. g s� aar ... .. .... . : = 4 m . _ ; , � ,_ ...... . - : � - , �,�,� � -. . ' � .' i :__ . .. ... ... . . .. ... .... ... .. .. . ... _.. .. ...._. . .. .. s� 6 � a�. 4 ..:- . v i � � ., �` ; �.� s : � . ., � � `�r ' 3�(� ., ..t�+ ' .. . . .. .. . ._.. ..._. .. __. .... ... , .,, . . . . ..... _. .. � '� ' � _ .._. .. ... .. ... ... . �. ; fi . .. . . . .. . . .. ... . .. ... .. _ 1, U'�' �_ _ r � _ F .. .� a � , x . r ti.... "^"�.'� .. . ._. ... .. . ..... . .. .... .. CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION PRESS FIRMLY JOBS,;Z� ADDRIES$ APN LOT TRACT OWNER f.tflC i- ADDRE S 1)L 6n r- *trt�r. d CITY Yk�ZIP TEL 0--7#I 442 APPLICANT TEL. CONTRACTOR 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 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).): ^ 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). ^ 1.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 I �L OWNER h JCtiiFil- 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 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 WORKERSCOMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER POLICY NUMBER (THIS SECTION NEED NOT BE COMPLETED OF THE PERMIT IS FOR ONE HUNDRED DOLLARS($10))OR LESS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 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.CJ. LENDER'S NAME LENDER'S ADDRESS 1 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-MENTIONED PROPERTY FOR INSPECTION PU OSES. PEhENAME(PI SIG-NATURE OF PERMITTEE DATE APPLICATION PERMIT P/C ,re CL NUMBER/f 3:360 # DATE„ ISSUE TYPE OCC DATE 7,14 F/ -z- CONST GROUP ZONING SETBACKS FRONT RW ^ REAR ^ SIDE/SIDE STREET RW ^ SIDE ^ / t�cv/FsL A1 PROPOSED USE N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREANALUATION SFR/ADD/REM U) Garage/Carport W Patio/Deck LL Pool/Spa Z Re-Roof Commercial Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U F- U W W 0 Z ,4,.- c' Z W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: �- TOTAL FEES C?s° COMMENTS RECPT N0.e.2-7 PAID BY��/I VALIDATION '! WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy