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Home My WebLink About17670 CITY OF DIAMOND BAR "�J��7� - �'�` DEPARTMENT OF COMMiJNITY&DEVELOPMENT SERVICES i� �r� ,, 21825 E.Copley Drive � �`�� '% (909)860-3195 Fax(909)861-3117 PRESS -�� BUILDING PERMIT APPLICATION FIRMLY i y JOBSITE 1I I�316 APPLICATION �I/� � PERMIT �'7 �]/� P/C i � ADDRESS__ Y!� DATE � � �NUMBER / / '� # ! � ISSUE TYPE OCC ! APN I,�OT TRACT DATE � CONST. GROUP p OWNER p ADDRESS___�� 9t� ZONING SETBACKS z CITY �lC�, t�:VAP" ZI� TEL��Sq��U^�'I FRONT Ry� � I � APPLICANT _ TEL. REAR ❑ z SIDE/SIDE STREET RW ❑ ¢ CONTRACT �C SIDE � o ADDRES Z�— _ o CITY �_ ZI TEL. �._ �-f11 j PROPOSED US O /"Q (;ZJ/ o ARCHIENG/ _ z DESIGNER w NO.DWEL. NO. Np, � ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREA/VALUATION � OWNER-BUILDER DECLARATION SFR/ADD/REM O � I HEREBV AFFIRM UNDEF PENALTV OF PERJI.'RY THAT I AM E%EMPT FROM THE CONTRACTORS ll- G3f2 JB/CflfPOfl W CENSELAWFORTHEFOLLOWINGREASON�SEC.]031.SBUSM[SSANDPROFESSIONSCADE�,ANVCITVOq (f� U COUNTVWHICHflEOVIflESI\PERMITTOCONSTRUC7,ALTER,IMPROVE,�EMOLISH,ORREPAIRANVSTRUC- w TURE,PRIOq TO ITS ISSUANCE,A�50 REQUIRES THe APPLICANT FOfl SUCH PERMIT TO FILE A SIGNED w Patio/Deck � STATEMENT TNAT ME OR SHE IS LIGENSE�PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- � � CENSE UW�GHAPTER 9�Ci�MMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- POOUSPB 0 FESSIONSCODE)ORTHATHEOFSHEISEXEMPTTHEREfROMANDTHEBA515FORTHEALLEGEDE%EMP- (� U TION.ANYVIOLATIONOFSECTION7031.5BYANYAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO Z Re-Roof A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDFED DOILARS IfSoo).)� Q ❑I,ASOWNEHOFTHEPROPERTV,ORMYEMPLOVEESWITHWAGESASTHEIRSOLECAMPENSATION, 0 COffIff10/C18I Z WILL DO THE WORK,ANO THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALL(SEC.]ada,BUS.- J � NESS AND PROFESSIONS CODE THE CANTRACTORS IICENSE LAW OOES NOT AGPLY TD AN OWNER OF ? — PROPERTVWHOBUILDSORIMPROVESTHEREON,lWDWHODOESSUCHWORKHIMSELFORHERSELFOR � THROUGH HIS OR HER ONT'EMPLOYEES,PROVIOED THFT SUGH IMPROVEMENTSARE NOT INTEVDE�OR m Q OFFEREDFOflSALE.IF,HOWEVER,hIEBUILDINGORIMPfiDVEMENTI550LDW17HINONEYERROFCOMPLE- � TION,THE OWNER-BUIL�EfI WILL HAVE THE BURDEN OF PROVING TMAT HE OR SHE DID NOT BUILD OR � IMPfiOVE FOR THE PURPOSE OF SALE). w ❑I,ASOWNEROFTHEPFOPERTY,AMEXCLUSIVELVCONTflACTINGWITHLICENSEDCOMRACTOFS � TO CqNSTRUCT THE PRQII:CT(SEC.7014.BUSINE55 AN�PROFESSIDNS CODE'.THE CONTRACTORS LI- V8II18IIOf1 � ADJ.AREA W CENSEIAWDOESNOTAPPI_VTOANOWNEROFAPROPERTVWHOBUILDSORIMPROVESTHEREON,AND � WHDCONTqACTSFORSUCHVROJECTSWITHACANTRACTOR(5)LICENSEDPVRSUANTTOTHECONTRAC- (]UANTITY DESCRIPTION FEE Y TORS LICENSE LAWJ. O ❑I AM E%EMPT UNDER SEC. B.8 P,G.FOR THIS REASON Q ?� U � � DATE OWNER � Z U � LICENSED CONTRACTORS DECLARATION W � I HEREBV AFFIqM UNDER P[NALTV OF PERJVRV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � d 9(COMMENCINGWITHSECI"ION]000)OFDIVISIDN90FTHE6USINESSANDPROFESSIONSCODE,FND Z X MYIICENSEI5INFULLFORCEANDEFFECT � LICENSE CLASS�_i��H C�LIC.NO, � U OATE�_�� I7 L CON7RACTOR d W � WORKERS'COMPENSATION DECLARATION Q � IHEREBYAFFIRMI/NDEqPI:NALTYDFPERJUFYONEOFTHEFOLLOWINGOECIARATIONS'. Z Z .__IHAVEANDWILLM/JNTAINACER7IFICA7EOFCONSENTTOSELF-INSL1RFFORWO(iNERS' a 2 ¢ COMPENSATION,AS GROVIDED BY SECTION 3�0o OF THE LABOR CODE,FOP THE PERFORMANCE U OFTH[WORK FOR WHICH THIS PERMIT IS ISSUED. w � � w .�I HAVE AND WILL MI,INTAIN WOflKERS'COMPENSATION INSURANCE,AS REOUIRED BYSECTION ---��777 � � � 37000F THE LABOR CODE.FOR THE PEFFORMANCE OF TNE WORK FOR WHICHTHIS PERMIT IS / ,//� � ISSUED.MV WORK_,S.'y�C-O�MP NSATION rWS�UR�ANCE C RIER AND POLICY NUMBERARE: CONSTRUCTION /' / V j caRRiEn �J,/'�V`�/Q�L� �("Z1��/� PLAN REVIEW I ZPOLICVNUMBER_L.��y�j_d��=v� ELECTRIC Q �✓ l {V � (iHI55EC'IONNE��JOTBEOJMPLEfEDOFTHEPERWTISFORONEHUPDRED�OLLfiRS(57071ORLE55�. PLUMBING W Z I CERTIFV TNAT IN THE PERFORMANCE Of THE WORK FOR WHICH THIS?ERMIT IS ISSUED,I MECHANICAL C� SHALL NOT EMPLO\'ANV PERSON IN ANY MANNER SOAS TO BECOME SJBJCCTTO TFIE � WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE TFtAT IF I SHOULD BECOME INSPECTION FEE = SUBJECTTOTHEWORKERS'COMPEhSFTIONPROVI510N50F5ECl'ION3]ooOFTHELABOR , WDE, SHALLFOH�HWI�HGOMVIYWIiHTHOSEPFOVI510N5. ISSUANGE � � . /f� p �ATE: C�APPLICANT ��J�L'�'�1 SMIP __..._ �LJ W —�1�._..._.._. .T— J WARNING:FAIIURETO SECIJRE WORKERS'COMPENSA'ION COVERAGE IS UNLAWFUL,AND SHALIBE ENERGY P/C � SVBJECTANEMPLOVERTOCRIMINALPENALTIESANDGIVILF'�NESUPTOONEHUNDREDTHOUSFND ENERGYPERMIT OOLLARS(f t oo,oao).IN ADOITION TO THE COST OF COMPENSATION,�AMAGES AS PROVIDED FOR IN J SECTION3]OBOFTHELABC�RCODE,MTEREST,AN�ATTORNEV'SFEES. �� ¢ RETENTION FEE: • O CONSTRUCTION LENDING AGENCY PRE-ALT FEE: __. � IHEREBVAFFIRMUNDERP[NALTYOFPERJURVTHATTHEREISACONSiRUCTIONLEN0INGAGENCY ., FOR THE PERFORMANCE OF iHE WOFK FOR WHIGH 7HI5 PERMIT IS ISSUE�(SEG.309],GIV.G.). W ? LENOER'S NAME � F– LENOER'SA�DRESS /� wICERTIFYTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMNTIONISGOFRECT TOTAL FEES I r�s / �/ � 1 AGREE TO COMPLV WITH ALI.CITV AND COUNTV ORDINANGES AND STATE lAWS RELAT'.NG TO 6UI�DING � CONSTRUCTION,pNpHEREBYAUTHORIZEREPRESENTqTIVE50FTHI5COUNTYTOtNiERUPONTHE Z ABOVE�MENTIONE�PROPERTV FOF INSPECTION PURPOSES. COMMENTS � -��' Lun� --- J � m PERMI EE NA INT) ...__..__ - f �q I d� � � .�_,-..�,,, t7 � SIGNATUREOFPERMITTEE DATc T— = RECPT.NO. PAID BY VALIDATION ~ WHITE—Departmen[Copy,VELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy � f . � ��w, va� ; �.�� G 3�� 8 �i�"<.F'- �'� ��. * �' ' � ��F �N�� g� > a . � N , r a . m . _'.. � j �� u ^ e, o-.' °� � 6 k , , .. a . a�.� _ _ . � � i ��w ��. k ^ M&� r . - r ..,�.:. .�:. . , .. ..ue . . . � ,� :. , : . r . �... e.,.. ...��.�.. � ..� . ......_ __. ...... �. . .. .. . .. ...�� .. .. . ... ... . . . .. . . .. .... ... . � �.� 7 s �. - � `' � n��'�p m.�p'�i. . ... . . ... .. .. . .... � � . . ..... ... .. . .... . .... . .��. . . ...... .. .... .... . .. ��.. . � ., . � ,�,. a . . ... .. .. .... . .. ... .... ... . ...... ..... ... ... ... ... ..... Y �e�S t � I � � I I �' �i�., ,��&�'� � 8 I¢i : ... .. . .. . . . _ . _.. .. . .. ._ . . .._. ... .. a �s'��-�`� d�6�d�l� ��R�' `��s. . � � . � i � � '�� -` . . .... ..... . . . _. . . .... .. ... .... . va �% i a! s s� s � �.. �� F��ri ��ft� ` ' � . �� _ ��.�11 m � I�r�i� ��'& . � �. i �' � �`�ra� ��-'N��p� -` . ... ..... .. . .... ... .... . . .... . . ..... � : .� -- ... .... .._ .. . . . . . .._ � i � �g � 4 ar�' im �� t€io � d ' _ _ _ �� ` '�"� �r � ,'� "r:. �a� � �� ;��6aA�a+�a� �r� _ CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION I � 3 J r' D ADDRESS V( fr tI im R( 4a A PN I10 TRACT 0 J OWNER ADDRESS_t)'- > CITY L2441,IIC&C ZIFKtL_KS TEL.cy6g� APPLICANT TEL. CONTRACT-C ADDRES Z CITY ZI ftE-jM TEL. x_8"'I L2 j 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 FORTHE FOLLOWING REASON(SEC. 7031.5 BUSINESS AND PROFESSIONS CODE:ANY CITY OR COUNTY WHICH REQUIRES A 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(5500).): U 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 W ITHIN 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). a 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 NOTAPPLY TO AN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). U T 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 EFFECT LICENSE CLASSr_y- i CLLIC. N0. �6J-0 /� DATE Y+CONTRACTOR KGC Q/ 1 WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: -1 HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' COMPENSATION,AS PROVIDED BY SECTION 37000F 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 ISSUED. MY WORKiSNSAT ONIA ERIER AND POLICY NUMBER ARE: CARRIER L� z. POLICY NUMBER (')43? (THIS SECTlON NEED I'IOT BE COMPPLETE D OFF 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 C ODE.SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. �� DATE:�J'C�APPLICANT.-�J'w'°�1 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 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 AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. -4� Luny PER,MI EE I'INT) ol SIGNATURE OF PERMITTEE DATE WHITE-Department Copy,YELLOW-Finance Copy, PIN PRESS FIRMLY APPLICATION aw PERMIT/ '��]/� p/C DATE NUMBER/�0 # ISSUE TYPE OCC DATE CONST.GROUP ZONING SETBACKS FRONT RW^ REAR^ SIDE/SIDE STREET RW^ SIDE^ PROPOSED US o re(,�/ N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREAIVALUATION SFR/ADD/REM C� Garage/Carport W Patio/Deck LL Pool/Spa 0 Z Re-Roof Commercial CD Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U U W W CD Z Fn a- Q Z 2 0 W CONSTRUCTION/ /V PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTlON FEE OfN Of ISSUANCE SMIP C ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE- T OTAL FEES COMMENTS RECPT. N0. PAID BY VALIDATION