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Home My WebLink About17671 i .. - _ �?`... _ CITY OF DIAMOND BAR t��,�}�1�-��'� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �� 21825 E.Copley Drive '� (909)860-3195 Fax(909)861-3117 � �� PRESS � �'�»�� BUILDING PERMIT APPLICATION FIRMLY } JOBSITE 1 �,�p �^y APPLICATION �+2 PERMIT d ADDRESS�`�]0 �—UL r-�.I i--►m Dr' 1/1 '� �f f ' 7' �/C o V DATE NUMBER / T'�PE OCC °^ APN I_OT TRACT DATEE � I � CONST. GROUP p OWNER p ADDRESS ZONING SETBACKS z CITY ��,1� ZIP TEL. 5 FRONT qyy � o APPLICANT _ TEL. REAR � ¢ SIDE/SIDE STREET RW � a CONTRACTOR_ SIDE � � ADDRESS � C�TY ' � ZI TEL. G ' i PROPOSED US I' C�f i�7 w ARCH/ENGI �� Z DESIGNER � a ADDRESS NO.DWEL. NO. ryp, N CITY ZIP TEL. UNITS STORIES BEDROOMS � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNEfi-BUILDER DECLARATION p SFFVADD/REM p I HEREBY AFFIRM UNDEF FENALTY pF PERJURV THAT�AM EXEMPT FROM THE CONTRACTORS LI- G3fe 0/Ce W CENSEUWFORTHEFOLLOWINGREASON(SEC.7031,SBUSWESSANDPFOFESSIONSCODE:ANYCITVOR (n 9 �70n ZCOUN7VWHICHREQUIRESAPEHMITTOCANSTRUCT,ALTER,IMPROVE,DEAAOLISH,ORREPAIRANVSTRVC- W PdtiO/DBCk W TURE.PRIOR TO ITS ISSUANCE,AL50 FEOUIRES THE APPLICANT FOR SUCH PERMIT TO FlLE A SIGNED W � STATEMENT THAT HE OP SHE IS LICENSED PUqSUANT TO h1E PflOVISIONS OF THE CONTRACTORS U- � CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION]000)OF DIVU^ION l OF THE BUSINESS hND PRO� � PDOUSPB O FESSIONSCODE�ORTHATHEORSHEISE%EMPTTHEREFROMANDTHEBASISFORiMEAILEGEDE%EMP� (� V TION.ANYVIOLATIONOFSECTION'l031.50YANYAPPLIGANTFORAPEFMITSVBJEGTSTHEAPPLICANTTO Z Re-Roof v � ACIVILPENALTV OF NOT MORE THAN FIVE HUNORED WLLARS(3500j.): � ❑I,RSOWNEFOFTHEPFOPERTV,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATIDN. � COrtlrtlefClal Z WILL OO TME WORK,AND THE STRUCTURE IS NOT INTEN�ED OR OFFEFED FOR SALE(SEC.�odd,AU51- J N NESS AN�PROFESSIONS CADE:THE CONTRACTORS LIC[NSE LAW OOES NOT AVPLY TO AN OWNER OF � PROPERTV WHO BUILDS OR IMVROVESTHEREON,AND WHO DOES SUCH WORK NIMSELF OR HERSELFOR Q THROUGH HIS OR HER OWN EMPLOVEES,GFOVIDED THAT SUCH IMPROVEMEN?SARE NOT INTENDED OR m W OFFEREOFORSALE.IF,HOWEVER,THEBUILDINGORIM7ROVEMENTISSOLDWITHINONEYEAROFCOMPLE- � TION,THE OWNER-BUILOEfl WIIL HAVE THE BURDEN OF PROVING THAT HE Ofl SHE 010 NOT BUILD OR � IMPROVEFORTHEPUflPOEEOFSALE). w ❑I,ASOWNEROFTHEPROPER7Y,AMEXGWSNELYCONiRAGTINGWITHLICENSEDGONTRACTORS � TO CANSTRUC7 THE PROJECT(SEG�044,BUSINESS AN�PROFESSIONS CODE:THE CONTRACTOqS LI- V8IU0I1011 ADJ.AREA W CENSE LAW DOES NOTAPPLY TOAN OWNER OF A PROPERTV WHO BUILDS OR IMPROVES THEREON,AND = WIIOCONTRACTSFORSUCHPROJECTSWITHACONTRACTOR(S)LICENSEDPURSUAN7TOTHECONTRAC- OUANTITY DESCRIPTION FEE ~ TOqSLICENSEUW.). Y . � ❑1 AM EXEMPT UN�ER SEC. B.d P.C.FOR THIS REA504 Q � U I LL' �ATE OWNER H Z U � LICENSED CONTRACTORS DECLARATION W Q � I NEFE6Y AFFIRM UNDER PENALTV OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHA7TER � d 9(COMMENCING WITH SECTION 700070F DIVISION 3 0F THE BUSMESS AN�PROFESSIONS CO�E,AN� Z `X MY LICENSE IS IN FULL FOFCE AND EFfECT � F3��,3['fl�I��.No 6 G�- � � uceNse�cryus`s V DATE V l �i � I("�� CONTRACTOR��_C.�y , Ja w '—rv � WORKERS'COMPENSATION DECLARATION ¢ � IHERE6VAFFIRMUNDERPFNALTVOFVERJURVONEOFTHEFOLLOWINGDECLARATIONS: U [/� Z � I NAVE AND WILL MAINTAIN P GERTIFICATE OF GONSENT TOSELF-INSUFiE FOR WORKERS' _ Q COMPENSATION,AS PFiOVIDED BV SECTION 370o OF THE 1A80R CODE,PoR THE 7ERFORMANCE U OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. � O w �1 HAVE AND WILL MAINTAIN WORKCRS'COMPENSATION INSURANCE,AS REOUIRE�BV SECTION . Q3�0o OF THE IABOR GODE,FOP THE PERFORMANCE OF THE WORK FOq WHICH THIS PERMIT IS / '�'J,�'\ ISSUEO.MV WOR� C4MPE SATION INSU NCE CARpIER AND POLICY NUMBERARE: CONSTRUCTION /�V J j cnRRIER 1��11� PLAN REVIEW Zvoucv rvumeeR_ `�a.�(��'l.F'�i —(°1� _.._— ELECTRIC ¢ �v�'�T— � (iHISSEC�KKJNE�NOTBEOJMPLCfEDOFTHEPEFif�MISFORONEHUPDRED00LLARS�EIW�ORLESS�. P�UMBING W - Z I CERTIFY iHAT IN THE PEFFORMPNCE OF THE WORK FOR WHICH THIS?EflM1T IS ISSUED,i MECHANICAL C} SHALL NOT EMPLOY'ANV PERSON IN ANV MANNER SO AS TO BECAME S'JBJECT TO THE (/) WORKERS'COMPENSATION LAWS OF CALIFORNIA.ANDAGREE THAT IF I SHOUL�BECOMF. INSPECTION FEE ' = SU&1ECTT0 THE WORNERS'COMPENSATION VISIONS OF SECTION 3]0o OFTHE LABOR /C�Of1E.1 SHALL FORTHWITH COMPLY WITH TI SE ROV`IONS. ISSUANCE O / 'r, I ` • V p OATE!��_i"� /C„� qpPLICANT `�� SMIP _ W �T `� J WAFNING:FAILURETO SECURE WORKERS'COMPENSATION CAVERAGE IS UNLAWFUL AND SHALL 9E ENERGY P/C J —_ � SU&IECTANEMPLOYERTOCRIMINALPENALTIESAN�CIVILFWESUP7ooNEHUNDRE�TNOUSAND ENERGVPERMIT DOLLARS(f100000),IN A�DITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN J SECTION3]OBOFTHELABOFCODE,INTEREST.AN�ATiORNEV'SFEES. j, �'� [[ RETENTION FEE: � OCONSTRUGTION LENDING AGENCY PRE-ALT FEE: r � IHEPEBVAFFIRMUNDERPE-NALTYOFPER..URYTHATTNEREISACONSTqUCTIONLENDINGAGENCV FOR THE PERF-0RMANCE O�rHE WORK FOR WHICH THIS PERMIT IS ISSUEO(SEC.309],CIV.C,�. .. W � LENDER'SNAME �� 1— LFNDER'SADORESS � TOTAL FEES / I , �j � � I CERTIFY THAT I MAVE REA!)THIS APPLICATION AN�STATE THAT THE ABOVE INFORMATION IS CORRECT w I AGflEE TO CAMPLY WITH ALL CITV AND COUNTV ORDINANCES AND STATE LAWS PELATING TO BUILDING d � CANSTRUCTION.AND HEREBY AIf�HORIZE REPRESENTATNES OFTHIS COUNTV TO ENTER UPON THE z A80VE- F.NTIONEO PROPENiV FOR INSPECTION GURPOSES. � +� . I,� ��C�� COMMENTS J � v QPERMITT A (PRINT) � ...�� ..._ �n '1.� �.�.- Z _ Uj SIGNATUREOF ER E...................._.-^". DATE � -��' ' � • � RECPT.��0. PAID BV VALIDATION WHITE—�epartment Copy,YELLOW—Finance Copy.PINK—Assessor Copy,GOIDENR D—File Copy,GREEN—Applicam's Copy n�r� �� i &'. �d�i� i� � � � ��.�- � ��. , nr� Nr,k ai�r�.� . i , . . . . . . . _. , �/�,��z ,� _ _ � � �� - � � � � � � � ��» t� ;� q ,�� fi :�� _ ��, �, �� :� � � � a�u.'�s� �i; �ta � 9'�"`�q�� —� . .. .. .. .... ... ... .. ._... . � �� !ri �A ...... . ... . . . . . ._ .. — .. �� J6 � .. . . . . re -` = � {� i. � , ��. t '� r� ,, . .. .. . . . . ... . . . . .... . ... . ... ... ... . '. �� u�.�d�s� .�,.�� ys��.��,; � �,. . _ . .... . ..... ._ .. . .. . � �. a _ , z�� ... . . ... .. .. ... . . ... I ,i i r'' - � - . Ne , � " a P �! : i ' ` a.„ _ .. . . . . .... .. ... .. ... . .. .. . . m� t �- e = . .... . _. . . .. .. ... . . ._ . . ... r=a A�,.r�e� - . . ��. 6,;��, � � d� ..� CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION ADDRIESS lib]g I-c j ;--J.J r t m Dr f?, . Bc APN LOT TRACT OWNER ADDRESS CITY ZIP-TEL. 5 APPLICANT TEL. CONTRACTOR_ ADDRESS CITY ZI TEL C i 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 PERMITTO 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(5500).): ^ 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.). ^ 1 AM EXEMPT UNDER SEC. 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 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORCE AND E FFECT. EF LICENSE cLLAS S�JCI -' � �IC. NO.VvV/" DATE 0 1/i I h�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. 1 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 WORK F 'COMPE SATION INSU NCE CA R 7IER AND POLICY NUMBER ARE � I e ^U1 CARRIER EJ 1 \ ...000 POLICY NUMBER (THIS SECTION NEED NOT BE COMPLETED OF THE PEPAHT 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 SUBJECT TO THE WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS'COMPENSATION P VISIONS OF SECTION 3700 OF THE LABOR /CODE.I SHALL FORTHWITH COMPLY WIT N SE ROV IONS. DATE! 1 9/C2..�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)5150,000). 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.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-ENTIONED PROPERTY FOR INSPECTION PURPOSES. ir(<.CA,V&. PERMITT A(PRINT) 1-k V�Z SIGNATUREOF ER E....... . ........ .--^ DATE WHITE-Department Copy,YELLOW-Finance Copy, PIN 1� PRESS FIRMLY APPLICATION PERMIT' 7 jb 0 2 I P/C Q DATE NUMBER # ISSUE TYPE OCC DATE CONST GROUP ZONING SETBACKS FRONT RW REAR SIDE/SIDE STREET RW SIDE PROPOSED US ^�m n� I� Ctl i J-P-) C N0. DWEL. NO . N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREANALUATION SFR/ADD/REM U) Garage/Carport LU Patio/Deck LL Pool/Spa 0 Z Re-Roof (7, 0 Commercial M Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U I- U W W Z m a Q U Z 0 W CONSTRUCTION L(/ PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES /I , 7D COMMENTS RECPT N0. PAID BY VALIDATION