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Home My WebLink About17669 ci�-sr oF n�orrD B�x ��(`-� �.�1 �'�`� � DEPARTMENT OF CONA�tUNITY&DEVELOPMENT SERVICES `—�� ._I.•w� � 21825 E.Copley Drive (909)860-3195 Fa�c(909)861-3117 � ��' PRESS BUILDING PERMIT APPLICATION FIRMLY ¢ ADDRIESS 1I� t I�" �)IZ(rI i� ��j APPLICATION� / �� PERMIT � � p/C o DATE NUMBER g_ °p APN OT TRACT ISSUE TYPE OCC DATE � CONST. GROUP p OWNER p ADDRE}S-S� ZONING SETBACKS Z CITY V�U� 1� ZI �' +TEL. FRONT RW n S APPLICANT _ TEL. REAR � Z r� -- SIDE/SIDE STREET R1p/ � m CONTRACTR R_[�C�- SIDE � � ADDRE S i� } � CITY �-�_ ZI TE . - �l PROPOSED USE ��" 0 o ARCH/ENG/ �z DESIGNER NO.DWEL. NO. NO. a ADDRESS cn UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION S0.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION p SFR/ADD/REM p I HEREBV AFFIRM UNOER PENALTV OF PERJURV THAT I AA�E%EMPT FROM THE CONTRACTORS LI- GBfaJB/CBfPOfI W CENSELAWFORTHEFOLLUWINGREASON(SEC.7C31.5BUSINESSANDPROFESSIONSCODE:ANVCITVOli (n ZCOUNTVWHICHREQUIRESAPERMITTOCONSTFUCT,ALTER,IMPfiOVE,DEMOLISH,ORREPAIRANYSTRUC- W P8�10/DBCk w TUHE.PRIOR TO ITS ISSUANCE,ALSO RE�UIRES THE APPLICANT FOR SUCH PERMIT TO FIIE A SIGNED w � STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTqACTORS LI- � CENSE LAW�CHAPTER B(COMMENGING WITH SECTION�000'�OF DIVISION 3OF THE BUSINESS ANO PRO- � Pool/Spa � FESSIONSCODE�ORTMATHEORSHEISEXEMPTTHEREFROMAN�THE6ASISFORTHEALLEGEDEXEMP- (� U TION.ANVVIOlAT10NOF5F.GTIONi031.5BYANVAPPLICANTFORAPERMITSUBJECiSTHEAPPLICANTTO Z Re-Aoof D � A GIVIL PENALTV OF NOT AIORE THAN FIVE HUNDREO OOLLARS(S5ool.): Q OI,ASONlNEROFTHf:PFOPERTV,OqMVEMPLOVEESWITHWAGESASTHFIR50LECOMPENSATION, O COmrtlBfClffl Z WILL DO THE WORK,AND THE STRUCTl1RE IS NOT INTEN�ED OR OFFEPED FOR SALE(SEC.�044,BUEI- J � NESS AND PROFESSIONS CODE:THE CANTRACTORS LICENSE LAW DOES NOTAPPLV TO AN OWNER OF � PROPERTY WHO BUILDS OR IMPROV ES THEREON,AND WHO DOES S�CH WORK HIMSEIf OR HERSELF OR � THRWGNHISOqHEFOWNEMPLOVEES,P4iOVIDEDTHATSUCH�MPROVEMENTSARENOTINTENOEDOR m Q OFFEREDFORSPLEIF,HOWEVER,THEBUILDINOORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE- Z TION,THE OWNER�BUILDEi WIIL HAVE THE BURDEN OF PROVING THAT HE OR SME�IO NOT BUILD OR � IMFROVEFORTHEPURPOuEOFSALE�. W ❑I.ASOWNEROFTH[PROPEF�Y,AME%CLUSNELVCONTRACTINGWITHLICENSEDCONTRACTORS ¢ TO GONSTRVCT THE PHOJECT(SEC.70a6,BUSINESS AND PROFESSIONS CODE:THE CONTRAC7pR5 LI- VelUefi0fl � ADJ.AREA W CENSELAWDOESNOTAPPLYTOANOWNEROFqpROPERTYWHO8UILDSORIMPflOVESTHEREON,AND � WHOCANTRACTSFORSUCHPROJECTSWITHACONTRACTOR(S)LICENSE�PURSUANT'OTHECONTRAC- QUANTITY DESCRIPTION Y TORSLICENSEUW.�. FEE Q ❑I AM EXEMPT UNDEN SEC. _ B.8 P.G FOR THiS REASON Q � U � � DATE ,.. OWNER � Z U � LICENSED CONTRACTORS DECLARATION W � I HEREBYAFFIRM UNDER PENALTV OF PERJURV THAT IAu LICENSED UNDER PROVISIONS OFCHAPTER � d 9(COMMENCING WITH SEC�ION]000)OF DNISION 3 OF THE BUS W E55 AND PROFESSIONS CO�E,AND Z `X A7V LICENSE IS IN FULL FOPCE AND EFFECT. m � LICENSE CLAS �!�, ..JC�.��K��yIC.NO. � V DATE_� _�_�{��_�_T CONTRACTOR � d W ` � � WORKERS'COMPENSATION DECLARATION a N I HEREBVAFFlRM UNDER PENALTV OF PERJURY ONE OFTHE FOILOWING�ECLAflATIONS: U � Z 0 IHAVEAN�WILLMAINTAINACEFTIFICATEOFCANSENTTOSELF-INSUFEFORWORKERS' a Q COMPENSATpN,A::PROVIOED BV SECTION 3�ooOF THE LA9OR CODE.FOR THE PERFORMANCE U OFTHE WORK FOR WHICH THIS PERMIT IS ISSUE�. W W � Q �I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANGE,AS REQUIRE�BV SEGiION , ,/� � 3�o00F THE LABOFl CO�E,FOR THE PERFORMANCE OF THE WORK FOR WHICHTHIS PERMIT IS � � ISSUEO.MY WORKE'RS' OMPE�ON IN�CE C�R pND POLICY NUMBER ARE CONSTRUCTION (% J j cnaaiEa_�_ PLANREVIEW Z POLICVNUMBER_�I��,T_��(� ELECTRIC Q � (IHISSECT70NNEmIVOTBECL'1MPLEfEDOFTHEPERMIT15FORIXJENUf�OR�DOLWiS($100)ORLESSj. PLUMBING , W Z I CERTIFY 7HAT IN THE PERFORMANCE OF TNE WORH FOR WMICH THIS PERMIT IS ISSUED,I MECHANICAL C.rJ SHALLNOTEMPLOI'ANYPERSONINANVMANNERSOA5T08ECOMESUBJECTTOTHE (/� WORKERS'COMPENSATION LAWS OF CALIFORNIA,ANO AGREE THAT IF I SHOULD BECOME INSPECTION FEE = Sl1RJECTTO THE WORKERS'COAIPENSATION PROVISIONS OF SECTION 3JOOOFTHE LABOR CODE,I SHALL FORiHWITH COMPLv WIT OSE PROVISIONS. ISSUANCE � 2 /� p DATE�-��y,�. qppLlC SMIP LlJ -,.....,.. .., ,. " .._ �. J WAPNING:FAILVRE TO SECUpE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHA'_LBE ENERGY P/C J � SU&IECTAN EMPIOVER TO CRIMINAL PENALTIESAND CIVIL FINES UP TOONE HUNORED THOUSAND ENERGY PERMIT �OLlARS(f 100,0001.IN AO�ITION TO THE COST OF COAIPENSATION,DAMAGES AS PROVIDED FOfi IN J SECTION3]OBOFTHELABORCODE,INTCREST,ANDATTORNEY'SFEES. / w RETENTION FEE: O GONSTRUCTION LENDING AGENCY PRE-ALT FEE: � IHEREBVAFFIRMUNDERGLNALTV�FPERJURVTHATTHEREISACONSTRUCTIONLEN�INGAGENCY � FOR THE PEPFORMANCE nF iHE WORN FOR WHICH THIS PERMITIS ISSUE�(SEC.3oW,qV C.). --�- Z W � LEN�ER'S NAME F— LENDER'SADDRESS � TOTAL FEES l � . 7� � I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATF iHAT THE A60VE INFORMATION IS CORRECT w I AGREE TO COAAPLY WITN ALL CITV AND COUNTV ORDINANCES ANO STATE L4W5 RELATING TO 6UILDING d � CONSTRUCTION,AND HFREBV AUTHORIZE REPRESENTATIVES OFTHIS COUNTV TO ENTER UPON TI1E Z ABOVE�M NTIONED PROGEaTV FOH INSPECTION PURPOSES. COMMENTS s _.�-1n �a�� J � m PER EE NA E(PPINT � �e--x""�-�� -( l�1 l6�- - � � �nTuaE o�.esa�ree oarE � RECPT.��0. PAID BY VALIDATION WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—Applicanfs Copy _ �� "��g��"_ . �1v4� . .4z ;"�"i �� G 4 �� k� ��iffi " . . , . . � �P�i"�Rer... s �c�.�{,�:, . . . _ �/Y/�� _ _ � _ � �� '�i �s��A� A� c�,� ! a�s ��i ; i hi �^ �� R `�� p�� ap��.�� ; _ _ n _; �e s.'-�E��,��,�'�-,, <.i a � m � �' �. _ ',5 .p. € _ ��. 3 '� . :": x s .. ,� . ... ... ...... + ��. � a v ... . . .. . _.. .. ... . .. .... . .... .. �� . . . .. ... .,. , ti .. .m, x .. ' .. v 'it s ` . ... . .. . .. .. .. . . .. . . . .. ... . . . . .... . ....... .. ... .. . . (.e �'... ,i. . .�. =i� I '�:��.. . ._ .. ..... ... .._ ........ .. .. .. . ' �., .. . ... . .. ... .. . ... . ..... . .. . �' �: �q� £' ��. � �. 'a v_,cn �3 +J .f�;< ..... . ... .. .... .. . .. ... . ,. .s�. d� E� €'. . . .... . . . .... _ .._ . DI MIOND BAR i CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION JOBSIT,ADDRESS lIl i-)o)re(ri �Oa APN 6�OT TRACT OWNER ADDRESS 0 4�00<y CITY O 1 UE.ZI i +T E APPLICANT TEL. CONTRACTOR& ADDRE S i� CITY u+-ZIOjjjffY TE-"II 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(B500(): D 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). D I,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 ACONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). D 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 CLAS�IC 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 LABOFI CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS'OMPEON IN;: CR AND POLICY NUMBER ARE, CARRIER--��-- POLICY NUMBER_3.L 1 (THIS SECTION NEED NOT BE COMPLETED OF THE PERMIT 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 PROVISIONS OF SECTION 3700 OF THE LABOR CODE,(SHALL FORTHWITH COMPLY WIT4 OSE PROVISIONS. DATAPPLIC- 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 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-M NTIONED PROPERTY FOR INSPECTION PURPOSES. PER EE NA E(PRINT (19 t o�- I ATUREQE.PSRMMFKE DATE WHITE-Department Copy,YELLOW-Finance Copy, PIN 02I PRESS FIRMLY APPLICATION��7 PERMIT/C DATE NUMBER ISSUE TYPE OCC DATEd CONST GROUP ZONING SETBACKS FRONT RW REAR ^ SIDE/SIDE STREET RW 0 SIDE D PROPOSED USE 4 N0. DWEL. N0. F' LZ N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREANALUATION SFR/ADD/REM U) Garage/Carport LU Patio/Deck LL Pool/Spa Z Re-Roof Commercial Ib Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U U W W 0 z m d Q U Z 2 U W 7b CONSTRUCTION • PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE - SMIP ( ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES I ' . 7b COMMENTS RECPT. N0. PAID BY VALIDATION ^,%^,/^,