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Home My WebLink About17667 , � CI'fY OF DIAMOND BAR 1��"'1 Y�.c:� - �``` DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � � . 21825 E.CopleY�iye � I��3 �' (909)860-3195 Fa�c(.904)861-3117 PRESS \�.��'� BUILDING PERMIT APPL�IC�qTION � �� FIRMLY o DDRIESS.—`b�� /�"�"1`I�IM r�� Piq� �ar DATEICATION �,1 i� U'� NUMB R� #/C f � ISSUE �'} TYPE OCC APN O TRACT DATE X•-" CONST. GROUP °C OWNER O O " ADDRESS ZONING SETBACKS oCITY ZIP TE REART RW = � o APPLICANT TEL. SIDElSIDE STREET RW ❑ ¢Z G SIDE ❑ CONTRACTOR_ _.__ Q ADDRESS �OPOSED USE 1�! � CITY ZIPa�n� TEL. � ARCH/EN / �� U� . �z DESIGNER NO.DWEL. NO. NO. a ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLAFATION SFR/ADD/REM O Q I HEREBV AFFIRM VNDER PENALTY OF PERJURY THAT I I1M EXEMPT FROM THE GONTRAGTORS LI- G2f092/CBfPOfI W CENSEUWFORTHEFOLLOWINGREASON(SEG7031.5BU5INESSAN�PROFESSIONSCADE:ANYCITYOR (n C� COUNTVWHICHREOUIRESAPERMITTOCONSTflUCT,ALTER,IMPROVE.DCMOLISH,ORREPAIRANYSTRUC- W P81i0/DBCk Z TURE.PfiIOR TO ITS ISSUANCE.AL50 REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W w STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PPOVISIONS OF THE CONTRACTORS LI� � CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION]000)OF DIVISION 3 0F THE BUSINESS AND PRO- �'1' PooVSpa QFESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEaEFROMANDTNEBA515FORTHEALLEGE�E%EMP� � U TION.ANYVIOUTIONOFSECTION]D31.SBVANVAPPLICAMFORAPERMITSUBJECTSTHEAPGLICANTTO Z Re-Roof �'{, � A CIVIL FENqLTV OF NOT MOflE THAN FIVE HUNDRED DOLLARS�f50D).): 0 �I,ASOWNEPOFTHEPROPERTY,ORMVEMPIOVEESWITHWAGESASTHEIRSOLECOMPENSATION, � Commercial Z WILL DO THE WOFN,AND THE STRUCTURE IS NOT INTENDE�OR OFFERED FOR SALE;SEC.104C,BU51- J NESS AND PROFESSIONS WDE:THE CONTRACTORS LICENSE LAW�OES NOT APPLY TO AN OWNtN OF � PROPERiVWHOBUIL�SORIM7ROVESTHEFEON,ANDWHOWESSUCHWORKHIMSELFOFHERSELFOR � 2 THFiIX1GH HIS OR HER OWN EMPLOYEES.PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m WQ OFFERE�FORSALEIF,HOWEVER,THE9UILDMGORIMPROVEMENTISSOLDWI?HINONEYEAROFCOMPLE- Z TION,THE OWNER-9UILDER WILL HAVE THE BUR�EN OF PROVING TNAT HE OR SHE DID NOT BUIL�OR � IMPROVEFORTHEPURPOSEOFSALE�. ❑I,AS OWNER OFTHE PROPERTV AM EXCLUSIVELV CONTRACTMG WITH LICENSED CONTRACTORS � TO GONSTRUCT TME PRQIECT(SEC.]044,BUSINE55 AND PFOFESSIONS CODE:THE CANTRACTORS LI- VaIUOIlOf1 ADJ.AREA W CENSELAWDOESNOTqPPLYTOANOYMEROFAPROPEflTYWHOBUIL�50RIMPROVESTHEREON.AND = WHOCONTRACTSFORSUCHPR0.IECTSWITHRGONTRACTOfl(5)LIGENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION FEE Y TORS LICENSE LAW.). � ❑I AM E%EMPT UNOEfl SEC. B.6 P,C.FOR THIS REASON U � __ � � OATE OWNER F Z w � LICENSED CONTRACTORS DECLARATICN W Q � Q I HEREBYAFFlHM UNDER PENALTV OF PERJURY TNFT I AM LICENSED UN�ER PROVISIONS OF GMAPTER � d 9(COMMENCING WITH SECTION 700010F DIVISION 3 0F THE BUSINESS HND PHOFESSIONS COOE,AN� Z X AIY LICENSE IS IN ULL FOPCE AND EFFECT. � O 1� m b � � UCENSE CLAS � n�� LIC.NO. J V DATE� ` CONTRAGTOFKC� n- W � WORKERS'COMPENSATION DECLAFiATION � i � Q � U � I HEREBY AFFIRM UN�ER PENALTV OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: Z Q '. � IHAVEANDWILLMAINTAINACERTIFlCATEOFCONSENTTOSELF-INSUREFORWORKERS' _ � CAMPENSATION,AS PROVIDED BV SEGTION J]OOOF THE LABOR CODE,FOR THE PEflFORMANCE U I Q OFTHE WOi7K FOR WHICH THIS PERMIT IS ISSUED. � � W I HAVEAND WILIMAINTAIN WORKERS'COMGENSATION INSURANCE,AS REOl11RED 9V SECTION S�(/,J� Q 3]OOOF THE LABOR CODE,FOR THE PERFORM NCE OF THE WORK FOR WNICH THIS PERMIT IS n r� �� 0 ISSUED.MY WORKE 'C�M7ENS�ON INSU�NCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION �� i 1�(A N j CARflIER_� � �� PLAN REVIEW � POLICY NUMBEP_ �' ELECTRIC Q Q (iHIS5ECT10NNEmNO OEDJMPL mOFT1�EPERMfTISFOROVEHUPDRED �siro;oa�Ess). PLUMBING w MECHANICAL Z I CERTIFY THAT IN'fHE PERFORMANCE OF THE WORK FOR WHICH T E IT IS I t/[�,I (J SHALL NOT EMPLOY ANV PERSON IN AN PNNER 50 AS TO EC E S ECT TO E � WORKEHS'COMPENSATIONlAW50F ALIF IA,ANDAG ET ATIFI OULDB OME INSPECTIONFEE ? SU&IECTTOTHEWORKERS'CAMPENSAL NP VISIONS �S CTION 000 7H 1A80R . O�E,I HALL OFlTHWITHCOMPLVWIT HOS P VI51 S ISSUANCE o � -.�a't� p DATE:�Y U�APPLICANT: SMIP w ENERGY P/C J WARNING:FAIIURETOSECUREWORKERS'CO NSATIONGOVERAGEISUNVIWFUL,ANDSH L BE "" LL SU&IECT AN EMPIOYERTO CRIMINAL PENALTIES AN�qVIL FlNES UP TOONE HUN�REO TMOU � ENERGV PERMIT ❑OLLARS(5100.000),INADDITIONTOTHECOSTOFCAMPENSATION,DAMAGESASPROVIDEDF IN J SECTION 3]OB OF THE LABOR CODE.INTEREST AN�ATTORNEV'S FEES FETENTION FEE: � d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: Q I HEREBY AFFIRM UNDER PENA�TY OF PERJURV THAT THERE IS ACONSTRUCTION LENOING AGENCY d FOR TNE PERFORMANCE OF iHE WORK FOF WHICH 7HIS PERMIT IS ISSUED(SEC.3091,GIV.G.�. W � LENDER'S NAME F_ LEN�ER'SADORE55_ � ICERTIFYTMATIHAVEREADTHISAPPLICATiONANOSiATE1HFTTHEABOVEINFORMATIONISCORREGT. TOTAL FEES l ` �l+ � w I AGREE TO COMPIV WITH ALL qTY AND COUNTV ORDINANCES AND STATE LAWS RELATING IO BUIL�ING l � CANSTRUCTION.AND HEREBY AUTHO RE REP TATNES OF TNIS COUNTV TO ENTEA UPON THE Z ABOV NTION D ROPEFTV F PECT P R OSES. COMMENTS � J � m PEPMI EE NAAIE(PRl � O� ....__..-__ � SIGN UREOFP DATE = RECPT.NO. PAID BY VALIDATION ~ . WHI —De art ent Copy,YELLOW—Finance Copy,PWK—Assessor Copy,GOLDENAO�File Copy,GREEN—Applicanfs Copy d ii� n s L a �` . � .� A �� d � �- _ ��"`�� /tolo� �� , ; � , � y �, ,- , a � ,�� „ y �� ; L � d 9;.� �t� j g §�� .. .. . .. _ .. . _. . . . . .. .. . . ` IAI � � ��"�� `��,"� �_ _ � :� _.,, .�� ; � _ _ _ _ �, � ac � �� , , g � , _ _ ��; h _�� . . "y 4 ��. 9 . v, i r�.:. `mte� � . _.. .. .. .. . .. . . .. ... _ .. . . ... .. ..... .. ._. .. . . . . . . .. _ y". a ,k� �'� � _ � �., ' _ ��s � �" . y ' 4 t.�. p a . . .. ... ... .. ... ... ... ... . . . . ... .. ..... ...... .... . . ..... . .. .. .. ... . .. "�7 ..'dd.sn�� ,.�E �. ��. CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive. (909)860-3195 Fax('903)861-3117 BUILDING PERMIT APPLIC�-TION PRESS '(� (,��FIRMLY JOBSITE y�p/��/�p M �b�2��1 i I��"I � pig� �q r ADDRESS APN 0 TRACT OWNER ADDRESS CITY ZIP TE APPLICANT TEL. G CONTRACTOR ADDRESS CITY 1. ! "(_I_�e_.t�_ZIPa �n �TEL. ARCH/ENG�/V�[�71 � �I' 1 U v 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 REOUIRESA PERMIT TO CONSTRUCT,ALTER,IMPROVE. DEMOLISH,OR REPAIR ANY STRUC- TURE,PRIOR TO ITS ISSUANCE,AL50 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- FESSIONSCODE)ORTHAT HE ORSHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED E%EMP- TION.ANV VIOLATION OF SECTION 7031.5 BV ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(f 500).): �I,AS OWNER OF THE PROPERTY,OR MV EMPLOYEES W ITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC. 7046,BUSI- NESSAND 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 W(THIN 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 0 WNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTlNG W ITH 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 W HO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS W ITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAG TORS LICENSE LAW.). ^ I AM E%EMPT UNDER SEC. B. 6 P.C. FOR THIS REASON GATE 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 ULL FOfICE AND EFFEC� T}. �p�� n LIC. N0. LICENSE CLAS DATE Z CONTRACTORKC 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 BV 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 37000E THE LABOR CODE,FOR THE PERFORM NCE OF THE WORK FOR WHICH THIS PERMIT IS U�NCE CARRIER AND POLICY NUMBER ARE: PENS N IN S ISSUED. MV WORKE C M Q I ��.� �� CARRIER POLICY NUMBER (TFIIS SECTlDN NEm NO BE OJMPL ED OF THE PERMIT IS FOR IXJE HUNDRED DOI.IARS(S10D)OR LESS). I CERTIFY THAT IN'fHE PERFORMANCE OF THE WORK FOR WHICH T E IT IS I UED,I SHALL NOT EMPLOY ANV PERSON IN AN ANNER SO AS TO EC E S ECT TO E WORKERS'COMPENSATION LAWS OF ALIF IA,AND AG E T AT IF I OULD a OME SUBJECT TO THE WORKERS'COMPENSAT N P VISIONS F S CTION 000 TH LABOR ODE,I HALL OFITHWITH COMPLY WIT HOS PR VISI S 1 �� UZ APPLICANT I DATE: I j WARNING: FAILURE TO SECURE WORKERS'CO NSATION COVERAGE IS UNLAWFUL,AND SH L BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOU D DOLLARS(5100,000),IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED F IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. CONSTRUCTlON LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJU RV 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 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 AUTHO IZE REP TATIVES OF THIS COUNTY TO ENTER UPON THE ABOV NTION D ROPERN F PECTI P R OSES. PERMI EE NAME(PRI 0� SIGN URE OFP DATE 0 0 w 0 LL 0 w z 0 a z m w 0 0 w 0 Z W � W U Z W U F- 0 Z N W Z O Q X W O U w C/) Z Q W Q D li J d O N N Z W H N W L� Z J m N WHI-De art ent Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLUtNHVl�hue Gopy,tilittrv-nppucanrs copy -U�=�' 1 Y�'ci y�I�� /toloL�,