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Home My WebLink About18074 CITY OF DIAMOND BAR - �`` DEPAR'I'MENT OF C01�9vfUNTI'Y�DEVELOPMENT SERVICES ,�1 � 21825 E.Copley Drive � �i% (909)860-3195 Fa�c(909)861-3117 PRE$S BUILDING PERMIT APPLICATION FIRMLY o ADDRIESS�� Q�'� S � rr. DATEICATION � �L�`�MBER f�� iY/C �� o� ISSUE TYPE OCC APN L T TRACT DATE CONST. GROUP p OWNER � _ o ADDRESS ZONING SETBACKS z CITY ZI TEL 86/—nsf1G FRONT RW ❑ � APPLICANT _ TEL. REAR ❑ � SIDE/SIDE STREET RW ❑ z ¢ CONTRACTOR SIDE ❑ o CDTD`rRESS�� Z�P�y-�p�;TEL.��/.. PROPOSED USE �� w ARCH/EKG/ '��— ii-""� Tr T �" wDESIGNER NO.DWEL. NO. O. � ADDRESS UNITS STORIES BE�ROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF A�J.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADD/REM O � 1 HEREBY AFFIRM UNDER PENALTV OF PERJURV THAT I AM E%EMPT FROM THE CONTRACTORS LI- G3f0Q8�C8fP01'I W CENSEUWFORTHEFOLLCWINGREASON(SEC.]OJI.SBUSINESSANDPROFESSIONSCAOE:ANYCITYOR (n U COUNTYWHICHRE�UIRESAPERMITTOCONSTRUCT,ALTEF.IMPROVE,�EMOIISH,ORREPAIRANYSTRUC- W patio/Oeck w TURE,PRIOR TO ITS ISSUNVCE,ALSO REQUIRES TME APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w STATEMENT THAT HE OR SHE IS LICENSEO PURSUANT TO THE PROVISIONS OF THE CONTRACTOftS LI� � CENSE LAW(CHAPTER B�COMMENCING WITH SECTION 700D)OF DIVISION 3 OF THE BUSINESS AND PRO- � POOUSPB FESSIONS CODE)OR 7HA711E OR SHE IS EXEMPT THEREFROM AND THE BA515 FOR THE ALLEGED EXEMP- � TION.ANYVIOLATIONOFSECTION]03159YANVAFPLICANTFORAPERMITSl16JECT5THEAPPLICANTTO Z Re-Roof ACIVIL PENALTV OF NOT MORE THAN FNE HUNDRED DOLLARS�5500).): Q ❑I,ASONRJEROFTHEPROPERTV,ORMYEMPLOVEESWITHWAGESASTHEIRSOLECAMPENSATION, � CORIR18fC18I Z WILL DO THE WORK,RNO THE STRUCTURE IS NOT INTENDED OR OFFERED fOR SALE(SEC.7add,OUS- J � NE55 PND PROFESSIONS GODE:THE CANTRACTORS LICENSE LAW OOES NOT APPiY TO AN OWNER OF ? PqOPERTY WHO BUILDS OR IMPROVES THEREON,AND WMO DOES SUGH WORK HIMSELF OR HERSELF OR Q THROVCaHHI50RMEROWMEMPLaYEES,PROVI�EDTHATSUCMIMPROVEMENTSARENOTINTEN�EDOR m QOFFEREOFORSALE.IF,HON'EVER,TiEBUILDMGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE- Z TION,THE OWNEREUIIDEFi WIIL HAVE 7HE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR � IMPFOVEFORTHEPURPOSEOFSALE). W l71,ASOWNEROFTHEPROPERTV,AMEXCLl1SNELYCONTRACTINGWRHLICENSE�CONTRACTORS � TO CONSTRUCT THE PRQI[CT(SEC.]044,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- V8IU8�IOf1 ADJ.AfiEA W CENSEUWDOESNOTAPP�VTOANOWNEROFAPROPERTVWHOBUILDSORIMPROVESTHEFEON,AND = YIFIOCANTRACTSFORSUG�PROJECTSWITHACONTRACTOR(5)LICENSEDPVRSUANTTOTNECONTRAC- QUANTITY DESCRIPTION FEE ~ TORS LICENSE LAW.�. Y J � LJ I AM EXEMPT UN�ER SEG. B.8 PC.FOR THIS REASON Q � � lL � DATE OWNER F Z w � LICENSED CONTRACTORS DECLARATION W Q I HEREBYAFFIRM UN�ER PLNALTY OF PERJl1RY THAT IAM LIC[NS[D UNOER�ROVISIONS OF CHAPTER Z �� ',� �� .. O ' � e(COMMENqNGWITHSECTION7000�OFDIV��510N30FTHEBUSINESSANOPROFESSIONSCODE,AND `X MV LICENSE IS IN FULL FORtCE AND EFFECT m - • I � � LICENSE CLASS� - �6 LIC.NO. � ` .�\�. I U DATE��_j�� CON7RACTOR d W J pL I � WORKERS'COMPENSATION DEC Q � � I HEREBY AFFIRM UN�ER PENALTV OF PERJURV ONE OF THE FOLLOWING DECURATION5: Z � INAVEANDWILLMAMTAINACERTIFlCATEOFCONSENTTOSELf-INSl1PFFORWORKFRS' _ CqMPENSATION,AS PROVIDED BV SECTION J]OOOF THE LABOR CODE,FOR THE PERFORMANCE U a OFTHE WORK FOR WHIGH THIS PERMIT IS ISSUED. � I � W I HAVEANO WILLMAINTAIN WORHEFS'COMPENSATION INSURANCE,AS RE�UIRED BY SECTION Q 3]0o OF TFE LAPON CO�E.FOR THE PERFORMANCE OF TNE WOflK FOfl WHICH THIS PERMIT IS 0 ISSUED.MY WORKf PENSATIOyINSURANCE GPRIEF AND POLICV NUMBENARE: CONSTFUCTION j cnaRieR��17 I �i PLAN REVIEW 0 POLICV NUMBER_ �A fl I�II�� ELECTRIC Z Q � (�}iI55ECTKKJNEmNOTBECOMPLEEDOFTHEPERMITISFORONEHUNDf2EDDOl1ARS(5100�ORLESS). PLUMBING `'� W Z I CERTIFY THAT IN"HE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL (,'} SHALL NOT EMPLOY ANY PERSON IN ANY MANNCfi 5G AS TO BECOME SUBJECT T�THE � WORKERS'COMPENSATIONLAWSOFCALIFORNIA,ANDAGREETHAT ' aULD OME INSPECTIONFEE � SUBJECTTOTHEN/ORNERS'GOMPENSATIONPftOVI510N50F5 ON3]�JO R � CODE,I SHALL FOFtTHWITH COMPLV WITH TMi ROVI, ISSUANCE � � �' .�� p DATE:��APPLICANT: SMIP J WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAW SHALL BE ENERGY P/C ..__._ � SU&IECTAN EMPLOYERTO CRIMINAL PENALTIES AND GVIL FlNES I1P TOONE HU ED THOUSAND ENERGY PERMIT �^� DOLLARS(5100.G00J,IN ADDITION TO THE COST OF COMVtN5A710N,DAMAGES A ROVIDED FOR IN ! J SECTION 37080F'NE LABOR CODE,INTERESi.ANJATTORNEY'S FEES. RETENTION FEE: 1 ., � d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O � I HEREBY AFFIqM UNDER FENALTY OF PERJURV THAT THERE IS AGONSTRUCTION LENDING AGENCY � FORTHE PERFORMANGE OFTNE WORK FOR WHICHTHIS PEFiM1T IS ISSUED�SEC.3a91,CIV.G.). Z W S LENDER'SNAME � � LEN�ER'SA�ORESS __ J � TOTALFEES ¢ i GERlIFY TMAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOYE INFORMATION IS CORRECT. ` 1 � w IAGREETOCOMPLVWITHALLGITYANDCOUNTYORDINANGESANDSTATELAWSRELATINGTOBUILDING �� d � GONSiRUCIION,ANDHEREBYAUTHOflIZEREPFESENTATIVE50FTHI5GOUNTVTOENTERUPONTHE Z ABOVE-MENTIONED OPI=RTV FOR INSPECTION PURPO�. COMMENTS � J _ / Y ¢ PERMITTEENA (PRINT � ... (n � �� /'r _.— — ___-. __ � SIGNAT EO P TTEI= ATE ' .�' _ ' S RECPT NO. � U PAIDBV VALIDATION ' �� ~ e ariment Co VELLOW—Finance Co PINK—Assessor Co GOLDENRO�File Co GRE A IicanPs Co P PY, PX PY, PY. — PP PY x� A , � � � �� '� . ,��_ u,'r ��°�"� � � .,.�,� �� i ��.�� , ` � _ x. 1 �/ � �: � ` Z4..� ,,, u� `�_. ,�. , �� • ��a� , a�� _� r " �.:. , �� _� ��=' �•� ,a r _ __ �� ' ,��, � �� _ m ,� _�., '��"�� : ,. YC � `� ` .. . _.. ... .. ..... ... .... .... . ..... . .... ._.. ._.. .. ..._ ...._ ...... ,. � � . i :; ,i r .. e f�:.��x. .- ' . . . . . ._ .. ... . . ... ... ... . . +^��:�3 7 11: �o- ��,r E ,..' „ ��0. � ,'. S � : q .. .. .. ._ .. .. .._ .. .. . ... .. . _. ... .._ . . ... . .. . .. ��. ��,a � � � . � . .._, ' iX`= r ` ,' _. . .._. ... .. . . _.. .. _... . .. ......_. .. .. .. .. .... .. . . ..... �; � ., � ..._.. .. . _.. _ "s --, �= '. . z i � ','�, ws'�� c . . . .... . ....... _... . .__. ....._ ..._ ._._.. . ......_ _... ..:; 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��Q,'f rr. APN L T TRACT OWNER ADDRESS CITY ZI TEL.g6/-)fl APPLICANT TEL. CONTRACTOR ADDRESS/ CITY ZIP TEL. lic%y5fiM ARCH/E TT��TT 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 REQUIRESA 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).): ^ 1,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). 0 I,AS OWNER OF THE: PROPERTY,AM EXCLUSIVELY CONTRACTING 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.0 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 FORCE AND EFFECT LICENSE CLASS LIC. N0. DATE CONTRACTOR On oe e!:7:) WORKERS'COMPENSATION DEC I 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 SATIOr,INSUANGE CARRIER AND POLICY NUMBER ARE, ISSUED. MY WORKF P EN I NS CARRIER !/C / POLICY NUMBER_VIf p (THIS SECTION NEED NOT BE COMPLETED OF THE PERMIT IS FOR ONE HUNDRED DOLLARS($100)OR LESS). I CERTIFY THAT IN-"HE 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 ULD OME SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF S ON 37 0 LA R IN CODE. I ORTHWITH COMPLY WITH TH ROVI SHALL F P A T DATE:AP LIC N WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAW SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HU ED THOUSAND DOLLARS($100,000). IN ADDITION TO THE COST OF COMPENSATION,DAMAGES A ROVIDED FOR IN SECTION 3709 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES. CONSTRUCTlON LENDING AGENCY I HEREBY AFFIRM UNDER FENALTY 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 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 OPE'RRTTYFOR INSPECTION PURPOSE -TIT- PERMITTEE NA(PRINT SIGNAT E 0 P TTE1=ATE CE: sn LI" rPERMIT f f P/C tl DATE MBER # ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ^ REAR ^ SIDE/SIDE STREET RW ^ SIDE ^ PROPOSED USE 1 11. 4Ae N0. DWEL. N0. 0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREANALUATION SFR/ADD/REM CO Garage/Carport W Patio/Deck LL Pool/Spa 0 Re-Roof Z Commercial co Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U U W J W a J Q U Z Q S U W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: !! 1 ., PRE-ALT FEE: TOTAL FEES t7 COMMENTS RECPT. N0. PAID BY VALIDATION ' .. . apartment Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy