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Home My WebLink About18079 (10) _ __ , �� . CITY OF DIAMOND BAR ��—k3`��'��,.� DEPART1vIENT OF COI��v1�UNPI'1'&.DEVELOPMENT 3ERVICES � 1 � y� 21825 E.Copley Drive � �J �go9�sbo-a i9s F��90�>sbi-3i 1� PaESS "%>�' BUILDING PERMIT APPLICATIOIV Fi LY � JOBSITE "7 1 �'7� � i r� ,� APPLICATION PERMIT � � P � ADDRESS -�`" "`'' � ' J ` � °� ` fDRTE^• �-3�t"�'- NUMBER�„��,_ � f6SUE ' �!.?� �,� ��ST. GRdUP APN �4T TRAGT DATE — p OWNER Er�* tal f�c,lr��<-�� — `'� ADpRESS :1`�'S�f^; ` �r'I'C �r'kzrNf. 7L:�E- ZONtNG SE'iBACKS � FRQNT RW =1 W GITY -s,)tr�r+li��t' ZIF `i/7&.;-TFE. �rt'� IdC.�St• � APPLICANT �js/��'E�•J ii6+t.��'� TEL., - REAR _ ❑ p SIDE1SiQE STREET RW C� � GON7RACTOR t1C- �c"�- ��•� �i+ / SIDE � � ADDRESS PROPOSED USE "i F Y C t� 1- r �' a GITY ZIP TEI._— /;�,�� r>c%y�.� `" ,dl.�� f' ti-f'.� w ARCH/ENG/ ^'�''��; � � DESlGNER Np.DWEL. N4. NO. aW. ADDRESS tlNfTS SFORIES BEDROC7MS � CITY . ZIP TEL. � `� OESGRIPTION S{�.FL FAGTQR PSF AdJ.AREANALUATION cn � OWNER-BUILDER DECLARATION SFR/ADD/REM O ^V I HERE9Y AFFIRM IINDEP PENALTY OF PERJURV THAT I AM FXEMPi FRl'}M THE CONTRACTOftS LI� GflfaJ8/C8fp0(I ty.1 CENSEIAWFORTHEFOt�OWINGREASON(56C.]0.31.SBUSMESSAN�Aft�FES510NSCDDE:ANYCITYOA (f� � � COUNTVWHICHREQU�RESAPERMiTTOCANSTflUCT,A�TER.IMGROVE,DEMOLiSH,ORHEPA�flANYSiRUC� (jJ patio/Deck � TURE.PRIOR TO ITu ISSUANCE,ALSO RE�UIRES'NE APPIIGANT FOR SUGFI PEFMI7 TO FILE 0.SIGNEp w .� STATEMENT THAT HE OR StiE IS LIGEN5E�PURSURNT iQ'tttE PROY1510N5 OF TNE CONTftACTQRS�I� (L POOUSpB .1,�- GEN56LAW(CHAPTER 9(COMMENCING WITH SECTION 7000)OFPNISION�OF THE BUSINESS ANDPRp- O PESSIONSGO�E�ORTHATHEOPSHEISE%EMPTTHEREFROMANDTNEBASISFORTHEALLEGEDEXEMP• � 7ION.RNYVIOUTIQN�FSECTKtN7031.58YANYAPPLICANTF4FAPEFiMiT5U8JECT5TFiEAPPtiGANTT{} z Re-Roof � qCIY1LPENALTVOFNOTMORETHANFIVEHUNDREDDOLLARS(35ooj.)� � CII.A54WNEROF7HEPROPERTY.ORMYEMPI..OYEESWI7HWAGESASTNEIRSOLECOMPEtJSAT10N, � �DiTtlflBtCM?i � WIiL tXl THE W6RK,ANO THE STGRICTURE IS NOT INTENDED OR OFFEFE6 F4R SAIE{SEC.7a44,BUSI�� J � NE55 AND PROFE5510N5 CODE:THE CONTRACTO%5 LICGNS[LAW D4ES NOT APPLY TO AN OWNER OF = PROPERNWHD8U1lD50RiMPFOVESTNEREON,ANDWNQ00ES5UCHWOftKHiMSELFORHEftSELFt1H m [� THROUGH HIS OR N6R OWN EMPLOYEES,FROVi0E0 THAT'SUCM IMPROVEMEN'SARE NOt�NTENDEO Oft Q6FFEREDFORSALE.IF,HOWEVER.iHEBUILDWGOFIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE� � Tt6N,THE OWMEft$UI�RER Wilt HAYE iNE BURDEN OF PftOViNG THAT HE Ofl SNE OP6 NOT BUIID OR = IMPRQVE FOR TME PURPOSE OF SALE), W ❑I,ASOWNEROFTHEPROPERTY,AME%CLU5IVELYCONTRACTMGWITHLICENSEDCANTRACTOqS [= TO CONSTRUCT TNE�ROJECT 15EG.?OA3,BJSINESS AND PftOFc55IONS COO'c_7NF GONTRAGTOAS li� VelUetiOti � ADJ.AREA _ UJ CENSELAWDOESNOTAPPLVTOANOWNEpOFAPROPFRTVWN6BUILp50RIMVqC1VESTMEREON,AND � WHOCQNTRACTSFOftSUCHPflO.)ECTSW�THACANTRACTOR{5)LICENSEDPUPSUAN7TOTHECONTRAC- QUANTITY DESGRIPTION FEE � TOFS IiCENSE�AW). J � � ❑I AM E%ER4PT UNOGfl SEC- 8.d P.C.F4R TNlS PEA56V Q v 4�+- �Z�,-' •��_ �v,r�En�` ��-.2� --- r.,,._ -•y � z w Q UGENSED CONTRACF6RS DECIARATiON ' � � w � IHEREBYAfFIflMUN�ERPENAl.TYOFPERJUftYTHAT1AMLiCENSEDUN�ERPROVISION50FCtfAPTEfl � p_ 9(COMMENCMG WI'fN SECiiON 7aoo7 6F D��.VISION 3 OF TH[Bi15MESS AN6 PROFESSIONS C6DE,AND Z 7C AIV UCENSE IS IN FULL FpRCE AND EFFECT. m W � � UCENSE CU1SS LIG.NO._ .. .. � U DATE, CONTRACTOR d W p� WdRKERS'CflMPENSATiON DEC�ARATI6N a � i HERE�YAFFIfiM UNDER PENAI.TY OF YEAIURY ONE OF TY.E FOlIOWiNG�ECtA?,ATfONS: � � Z Q � !HAVE ANp WILL MAINTAIN A CERTIFICATE QF CONSENi TO SELF-INSURE FOR WORKERS' 2 d �—CAMPENSATI6Pt,AS�fA�ViDE6 8Y SFC730N 3�naqF"FiE LAeOp CaDE,FOF THE PERF6FMANCE �U OFTNE WOFK FOR WHICH TH13 PERIAIT IS ISSUEP. � � _.._ W IHA4EPNDWILLMAINiAINWORKEHS'COMVENSATIONINSURANCE,ASREOUIRE08VSECTION ,'`�� 4 37a0 OF THE IABOR COOE,FOR THE PERFORMANCE OF Th1E WbRK fOR WHJCHTHIS PERMIT IS 3, � ISSUED.MY WQRKERS'C6MPFNSATION INSllRANC:E f,ARRiER ANO POL�.CY NURABER ARE: CONSTRUCTION _^ f > PLAN REVIEW � � _.... CAftq1ER t� POUCYNUTABER - — ELECTRIC _ Z �=C (iHISSEct%)NNEmNOTBEWMREfEUOFTHEPEWAITISFC%IONEHUI�DREDDI'JL1AR5(510�)011LESS�. PLUM$ING � I CEflTIFY THAT IN THE PERGORMANCE OF THE WORK FOP WkiCN THIS PERAiIT[S ISSVED,i MECI'IANICAL _ .�. ��. Z � (,�J SHAI.L NOf FI�APLOV ANV PERSON IN ANV MANNER SOAS TO BECOME SUBJECTTO 7NE INSPECTION FEE � WCRKEAS'COMPENSATIONIAWSOFCALiFORNIA,ANDAGREETHATf�ISHOULDBEGOME -�� -- f„�. � SUBJECT70THEWORKERSCOMFENSATi(7NPPOVISIONSOFSECTION3]OOOFTHELABOR ISSUANCE ,. ___. �"'J � CODF,I SI1ALL FOpTHWITH COMPLY WITH TNOSE PROVISIONS. � O SMIP . ` }�� ' � �ATE:_.,., APPLICANT�. _..._ — —......... � ENERGY P1C _... .. � � WARN�NG:FAILURE TO SECURE W�RKERS'COMPENSATION fAVERdGE IS UNLAWFUL,AtJO SHALIDE �y SUBJECTANEMP40VEHTOCRIMINA4PENAL7IESAN�CIVILF'�NESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT ... WIi,ARS{Si00,W6j.W0.RP�T�4NTOTHECOu70FGOMPENSATiON.DAMAGE5A5PHOYiD"tDFOftIN � ` � SECTION370BOFTHELAFORCC7DE,MiEREST,ANDATTGFiNEY'SfEES. RETENTIONFEE: � W CONSTRUCTION IENDING AGENCY PRE-A�T FEE: -- � __ CL I+tERE9YAfFiRMUNDEpPENALTYDfPERJURYS#+ATThfEREiSACONSTRUCT10Ni.ENDiNGAC�ENCY , _,__ d- GOR THE PEFFORMANGE OF THE WOflH FOri WHICH THiS PERMiT IS i^aSUE6(sEC.309].CIV.C.i. � W ? LENDEWSNAMf__.__,....�—..---- � � � F— IENDEft'SAp0RE5S _ ��- r ///�� i CER7IFY TNAT i HAVE ftEAD THIS APpUCATiONAN4 STATE THAT TNE AHQV[INFORMAT�ON IS C4RRECT. TOTAL r E ES '� � � � W I AGREE TO COMpLY W�iH ALL CiTY AND COUNTV OftDiNANCES AN�STATE LAWS RELATMG TO 6VILDiNG � CONC7RUCTION,AND HEflEBYAUTHORIZE REPRE5�NTATIVES C7F THIS COUNTV TO ENTEfi UPON THE A80V-MENT��MEQ PP4PERTY F4R INSPEGTt�N PVfiP65E5. GOMMENTS ... _, � ,. �-�1/��/��!L. { f+' f �F � !7 __ ..__ PE TTEE NA (�RINT) � _ -- �,,.• ""— ` � i>,C'^� � �� d 4.. �( ^�.� "A �ir.,. -l(,!..-. �r ��tr .......� �• �,. � �-'a�._ rry GNAUREOFPEftMITf[E . dA7E � r FECPT.NO. PAID BY VA�IDATI6� � � -- - WNITE—Department Copy.YELLOW—Flnance Copy,PINK—Assessor Copy,GOLDENR40—Fila Copy,GREEN—Applicarn's Copy ar' �� y^ � u��: .�� '�p �� — .��t�a�, i ,�ai,�"�"`�q��Gi'.��.n ...f� .M"a�� `z ��_� _ .� � � . . .... . m � l�""V v `;, ' ./��Y�� ' � , � ,' _ r — ,'� o-.��_ - ` 4 �= i � �'i�ti�6 � - �a �.�� .. ... ...... . . ... .. _. ... .. . _. _.... ._ .... .��. i � P �'E� �� r�i�,,.��e � °a ,.,.. . ... ... _ . . .. . . ... ...... �: °"�� ' �a��s��C��,€, _ _ _ �. �� a _ _ __ _ E �� i� s�a Em F �� a , -� � , _ __ . ��_� s„ , � �'� � �'�� • - . ; � �� 5 � _ °°� � � ��r - . �, ,,�'� ��_ ��. ' _ � �� , � e � � � . � � - _ � ,�� '� .r; CITY OF DIAMOND BAR\�_\\{ DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION PRESS APPLICATION PERMIT ADDRIESS p- JIL rDATE /-NUMBER L -1 --+- APN LOT TRACT DAT E TYPE OCC OWNER Er�* metal c'Et'€-'�3 E CONST,GROUP ADDRESS Sr'kr'1&---. _ �!N- ZONING SETBACKS CITY al�r-�a1L'A.')'3.-/t'ZIP �i/74.%-TEL 5e9 io FRONT RW^ APPLICANT 6_A&SeLI((.1 riEatTEL. REAR^ SIDE/SIDE STREET RW CONTRACTOR-cJc�o-,Vic,dz ^ SIDE^ ADDRESS CITY ZIP TEL PROPOSED USE C CI ARCH/ENG/ DESIGNER ADDRESS N0. DWEL. N0. N0. CITY ZIP TEL. STORIES BEDROOMS OWNER DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION B SFR/ADD/REM UILDER DECLARATION Gara I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS I.J. e/Car ort CENSE LAW FOR THE FOLLOWING REASON (SEC.7031.5 BUSINESS AND PROFESSIONS CODE: ANY CITYOR 9 COU (n p T P N W i YWHICH REQUIRES A PERMITTO CONSTRUCT,ALTER,IMPROVE, DEMOLISH,OR REPAIR ANY STRUC- /D k TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED at STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRAC w o ec TORS LI CENSE LAW(CHAPTER 9(COMMENCING WITH SECTlON 7 000)OF DIVISION 3 OF THE BUSINESS AND PRO. 0 Pool/Spa 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 SLIBJECTS THE APPLICANT TO Z Re-Roof A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($500).): ^I.AS OWN ER OF THE PROPERTY,OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, 0 Commercial WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC. 7044,BUSI- NESSAND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILD I S OR MPROVES 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 CONSTRUCTTHE PROJECT(SEC. 7044, BUSINESS AND PROFESSIONS CODE.THE CONTRACTORS LI- Valuation ADJ AREA CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- QUANTITY DESCRIPTION TORS LICENSE LAW.). FEE ^ I AM EXEMPT UNDER SEC. B. &P.C. FOR THIS REASON J < A7'aJ LICENSED CONTRACTORS DECLARATION w I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH SECTK)N 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND ED MY LICENSE IS IN F ULL FORCE AND EFFECT. Co LICENSE CLASS LIC. N0. DATE CONTRACTOR CL WORKERS Q COMPENSATION DECLARATION U I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS Z I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' 2 COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE U OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. W 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 CONSTRUCTION ISSUED. MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER PLAN REVIEW POLICY NUMBER ELECTRIC (THIS SECTION NEED NOTBEODMPLETEDOF THE PERMIT IS FOR ONE HUNDRED DOLLARS(E100)ORLESS). PLUMBING I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED,I MECHANICAL 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 INSPECTION FEE SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE.I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. ISSUANCE- DATE:APPLICANT. r SMIP WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C 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 ENERGY PERMIT SECTION 3700 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. RETENTION FEE: CONSTRUCTION LENDING AGENCY PRE-ALT FEE: 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 ISSUE D(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. TOTAL FEES 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 ABOV MENTIONED PROPERTY FOR INSPECTION PURPOSES. COMMENTS PE TTEE NA(PRINT) GNA URE OF PERIA TTEE DATE RECPT. N0. PAID BY VALIDATION (ID Cc 0 ww 0 co W 0 Cr 0 In W U Z W 0 V Cn 0 Ix d X W 0 H U w Tn W W 0 0 w J uJ W 0 Er d W Er W CL. li WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy /�9.,.