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Home My WebLink About18660 �. CITY OF DIAMOND BAR �� ! I Y�� :l � DF..PAR"TIVTENT OF COMMi1NI7'Y&�bEVELOPMENT SERVICES r � ��. 21825 E.Copley Drive `=�' � � (909)860-3195 Fax(969)861-3117 PRESS ��'<�r� BUILDING PERMIT APPLICATION FIRMLY o DDR�ESS�� I S �(�J�(�'�yV�,��. � APPLICATION �� PERMIT �I �� P/C DATE NUMBER �� # � ISSUE TYPE OCC � APN LOl" TRACT_ DATE CONST. GROUP p OWNER DSG�, 1 p ADDRESSc�.I l�(S U�E. 20NING SETBACKS z CITY��tiNO�� ZIP4�'?(�S 7EL. CS �G �� FRONT RW ❑ � APPLICANT 1..A(Z1Z.�. S TEL�`��,,, REAR �� SIDE/SIDE STREET RW ❑ z Q CONTRACTOR ?�-1-+ 5�R W?i�c_f.� NeA'-(�`jLS SIDE L Q ADDRESS f 7'�QC. 25 '2ti 2 a CITY�.g�'y��rJu� ZIP r'_ TEL. ' 4 PROPOSED USE w ARCH/ENG/ z DESIGNER w — NO.DWEL. NO. NO. I a ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � -- - cr� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADD/AEM i O p I/IEREBY AFFIRM UNDER PENALTV OF FEAJURV THAT I AM F%EMP1 FROA�THE iANTRRCTORS LI- GefdJe/Cdry011 W CENSEUWFORTHEFOLLOWINGREASON�SEC.7031.58USINESSANOFFOFESSIONSCODE:ANVCITYOR (/� U COUNTVWHICHREOUIRESAPEHMITTOCONSTR�CT.ALTER.IMPROVEDEMOLISH,CRaEPAIRANVSTRUG W P3IIO�OBCk Z TURE,PRIOR TO ITS ISSUANCE.AL50 REOUIi1E5 THE AFPLICANT iOR SUCH PERMIT TO FILE A SIGNED w S7ATEMENT THAT HE OR SHE IS LICENSED VVRSUANT 70 THE VROVISIONS OF THE CONTRACTORS LI- w � CENSE LAW(CHAPTER 9(COMAIENCING WiTH SECTION]x0)OF�IVISION 3 OF THE BUSINESS AND PRO- � POOUSP2 � FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANOTHEBASISFORTHEALLEGEDE%EMP- � U TION.ANYYIOLATIONOFSEGTION10�1.5BYAN'/APPLICAN'FORqPERMIT5U9JEG�fS'fHFAPP�IGANTTO Z Re-Roof � p GNIL PENALTV OF NOT MORE THAN F VE MUNDRED�OLLARS(SSW).�: - � GI,ASOWNEROFTHEPROPERtt,ORMYEMPLOYEESWiTHWAGESASIHEIR50LECOMPENSATiON, � COrttrtlerCial Z WILL DO TNE WORN,AND THE STRUCTl1RE IS NOT INi END[D OH OFFERED fOH SPLE!SEC.7041,BU�I� � NESS AND PROFESSIONS CODE:iHE CONTRACTORS LICENSE LAW GOeS NO�APPiV TO AN OWNER OF � PROPERTV WHO BUIL�S OR�MPROVES THEREON,AND WHO OOES Sl1CN WORK HIMSELF OH HEiiSELFOR � THqOUGM HIS OR HER OWN EMPLOVEES,PROVIOED THAT SUCH IMPPOVEMENTS ARE NOT INTENDED OR m QOFFEREDf-0RSALE.IF,HOWEVERTMEBUILDINGOPIMPROVEMENiISSOLDWITHINONEYEAROFCOMPLE� Z TION,THE OWNER-BUILDER WII1 HAVE THE BUPDEN OF PqOVI�G:HAi HE OR SHE DID NJT BUIID OR � IMPROVE FOH TNE PUPPOSE OF"SALE). w �I,ASOWNEROFTHEGROPERTY,AME%GWSIVELVCONTRAGTING'NITHLIGENSEDCONTflAGTORS Q TO CANSTRUCT THE PRQIEGT(SEC.704a,BUSINESS AN'J PROFESSIONS CODE:THF.CONTRACTORS LI- VdIUdS1011 � ADJ.AREA W CENSE UW DOES NOTRPPLY TOAN OWNER OF A PiiOPERTV WMO dUII.DS OR IMPPOVESTHEREON.AND � WFiOCANTRACTSFORSUCHGFIOJECTSWITHACONTRACTOR�S)ilCEhsEDPURSUANTTOTHECONTRAC- QUANTITV DESCRIPTION �E TORS LICENSE LAW.). Y � J O 'J I AM EXcMPT UNOER SFC. B.8 P.C.FOR THIS REASON Q � U � — � DATE _ OWN'cR _ V Z W � LICEIVSED CONTRACTORS DECLARATION w � I HEREBV AFFIFM UNDER PENAI_TV OF PERJURV'HAT I AM LICENSED UNDER PROViSIONS OF CHAPiER Lyr � O �R � T E .r S� d 9(COMMENCING WITH SECTION 7000�OF DNISION 3 OF THE BUSINESS HND PPO�ESSiONS CODE.AN� Z X MV LICENSE IS IN FULL FORCE/WD EFFECT. �W T/ ��-e p / � LICENSE CLASS_,��_ LIC.NO. �D KJ � U DATE .S�-.�'��_� CONTRACTOR n- W � WORICERS'GOMPENSATIO ECLARATIO a � I HEREBV AFFIRM UNDEF PENAI_TV OF PERJURY ONE OF THE FOLIOWING�ECLARATIONS: Z � __I MAVE r1ND WILL MAINT4IN q GERTIFIGATE OF CONSENT i0 SEIF-INSURE FOR WORKEqS' _ Q CAMPENSATIDN,AS PROVIDED BV SECTION 370o f7F THE UBOR CODE,FOR THE PERFORMANCE w Q OF THE WORK FOR WHICM TMIS PERMIT IS ISSUED. � w I HAVE AND WIL�MAINT4IN WORKERS'COMPENSATIIJN INSURANCE,AS REOUIRED BV SECTION Q 3]ao OF THE�ABOR CODE,FOR THE PERFORMANCE OF THF WORK FOR WHICHTHIS PERMIT IS ISSUE�.MV WOflKEP5 COMPENSATION INSURANCE CARRIER AND POLICY NUMBER AFE: CONSTRUCTION j cnaaiEa _...��7�r�Qr�-_ �L��1�_.__-- ---._.- ------. PLANREVIEW o aoucv NUMBEa J/��f�/� � __— ELECTRIC z ¢ `Q (i11IS5CCTqNNEmNOTBE4'Mf'LETEDOFTHEPERMfTIS�ONEHUI�DRED00LWiS�5100�IXilESS). PLUMBING � Z I CERTIFv THAi IN THE°ERFORMANCE OF THE WORH FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL (�' SHALL NOT EMPLOY AM1V PERSON IN ANV MANNER SOAS TO BECOME SUBJE�TTO iHE � WORKERS'COMPENSA"IONlAW50FCALIFORNIA.ANDAGREETIIAT:FISHOULOBECAME INS''ECTIONFEE __. = SLIAJFCTTO TNF WORY.FRS'COMPENSA'ION PROVISIONS OF SECTION 3100 OF 1NE LABOR � CODE.I�HALLFORTHNIITHCOMPLVWITHTHOSEPR ISIONS. ISSUANCE ( � ` r� � � f SMIP p OATE'. � APPIICANT - — J WARNING'.FAILUflETOSECUREWORKERS'C MPENSA NCOVEFAGEISUNLAWFUI,AN�SHALLBE ENERGVP/C __ � SIIHJECTAN EMPLOYE9 TO CR�MINAL PENALTIES AND CIVIL FINES UP IOONE HUNDRED THOUSAND ENERGV PERMIT DOLLARS(f t OO.00q,IN AODITIGN TO THE COST OF COMPENSATION.DAMAGES AS PROVIDE�FOR IN J SECTION 3lOB OF THE LABOR CODE,INTEREST,AND ATTORNE�'S FEES. RETENTION FEE: �.U� ¢ ._--...____. ____ _ d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: - O -- � �HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS A CONSTFUCTION LENDING AGENCV � FOR THE PERFOPAIANCE OF THE WOFK FOR WH��CH THIS PEPMIT IS ISSUED(SEC.3091.CIV.C.�. — Z W -- � LFN�ER'S NAME _ — F- LENOER'S AOD�'1C55 � TOTAL FEES � I CERTIFY THAT I HAVE READ THIS APPLICATION AND S1A-ETHATTHEABOVE INFORMATION IS CARRECT g 1� � w IAGREE TO COMPLV WITH ALL CITY AND COUNTV ORDINANCESAND STATE LAWS HELATING TO 9UILDING d � CONSTRUCTiOtJ,ANDHERE6V4UTHORI2EREPFESENTATNE50FTNISCOUI+TVTOENTERIIVONTHE Z ABOVE-MENTIONEDGPOPEAT�'FORINSPECTIONPURPQSES. COMMENTS Q __ � Z �'� l-+�a��-`� _ — m PERMITTEE N/ �;P INT) '.--7 Q �� -- — � _ ��.,,� � N OF PERMI'TEE DATE = RECPT y0. PAID BY O ALIDATION ~ WHITE-De anmen[Go YELI.OW-Finance Co PINK-Assessor Co GOLDENROD-File Co GREEN-A licam's Go P PY. PY, PY� PY, PP PY � � � �� r �. . ,. �� ;�� F �� e = � �°� ��, �� . � • � * » _ _ b .� . n �, . _ ,�� ` �� e�� _ _ �' _ . _. _ . . _ _ . ; p _ . _ ._ ; � _ _ __. _ _ ; , _ _ _ __ __ _ ; _ . __ _ ; �t *.�`ya'"`s�,�§�Ei�' 'r i�s?'� ' . ..... ... . ..... .. . .. . .. . ... . ... ._ _._.. _ . .. .i .._. ___ . , �r$��x � � ; �� ,�� 4�� +�k�� .f �� _ __ _ _ __ � ,,� — '� ti ; �:,, � . _ _ __ _ �m� � ` ' r� ; �r a � ri� :,, �! _ _. e a. p �i ... .... .. . . . .. . „ � y�:. i,, i. . .. ... . . ..... . ...... .... _... ..... .. .._. . -�� .,� � ,,. ... .. . . ... ..... . .. i . n��..,s.� .... .... .. .. .... . .._. .. . .. . . .. .. ... ...... ._... ...... ...... .. .... ...... ... . . . JOBSITE r^� 1 �� (\�, ADDRESS'�1.��I S t)I_1 (J APN L01"TRACT OWNER DsG{a [ � ADDRESS�.1 I �I S URE. CITY�tiN{5��ZIP9�'7 c,�5 TEL C7��, �� APPLICANT�(�,�, i TEL�� '��„ CONTRACTOR�1..I-,5'lE�R Wfl�[c_fZ I�eA'-f�TLS ADDRESS f 7•KgY.. 25 12ti CL CITY�„py�3?'Z,��rIcJ�ZIP�TEL. 0 ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. IDWNER-BUILDER DECLARATION I NERERY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE IAW FOR THE FOLLOW IN G REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE:ANV CITY OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT,ALTER,IMPROVE. DEMOLISH,CR REPAIR ANV 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- CENSELAW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THERE FROM AND THE BASIS FOR THE ALLEGED EXEMP- TION.ANV VIOLATION OF SECTION 7031.5 BY ANV APPLICAN'FOR A PERMIT SUBJECTS'fHE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(E500),I: u I,AS 0 WN ER OF THE PROPERTY,OR M V EMPLOYEES W iTH WAGES AS 1 HEIR SOLE COMPENSATION, WILL DO THE WORN,AND THE STRUCTURE IS NOT INTENDED OH OFFERED FOH SALE;SEC. 7044,BUSK NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOS APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMP ROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OH HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE. IF,HOWEVE R THE BUILDING OR IMPROVEMENT IS SOLD W ITHIN ONE YEAR OF COMPLE- TK)N,THE OWNER-BUILDER WII1 HAVE THE BURDEN OF PROVING : HA7 HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE 01= SALE). v 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 NOT APPLY TO AN OWNER OF A PROPERTY WMO BUILDS OR IMPROVES THEREON.AND WHO CONTRACTS FOR SUCH PFIOJECTS W ITH A CONTRACTOR(S)iICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). CJ I AM EXEMPT UNDER SEC. B. 8 P.C. FOR THIS REASON DATE OWNER LICEIVSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENAI_N OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PPOFESSiONS CODE.AND MV LICENSE IS IN FU L FO RCE AND EF F EC T. L �Q^' / LICENSE CLASS 4--�JV I � LIC. N0. �V� DATE.S�-.�i �""�Z�CONTRACTOR WORI(ERS'COMPENSATIO ECLARATIO I HEREBY AFFIRM UNDER PENAI N 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 BV SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS NSATION INSUR RIER AND POLICY NUMBER ARE: ISSUED. MV WO RKE RS COMPE AN C E CA R A / 7 / / Y r I �f��l�i CARRIER� / POUCV NUMBER_�/��J�� (THIS SECTION NEED NOT BE�MPLETED OF THE PERMR IS FOF ONE HUNDRED DOLLARS(E1001 OR LESS). I CERTIFY THAT IN THE"ERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANV PERSON IN ANV MANNER SO AS TO BECOME SUBJECT TO THE WORKERS'COMPENSA"ION LAWS OF CALIFORNIA,AND AGREE TNAT IF I SHOULD BECOME SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR OSE PR ISIONS. CODE.I HALL FORTHVIITH COMPLY WITH TH / DATE. r7�APPLICANT G f WARNING: FAILURE TO SECURE WORKERS'C MPENSAJA N COVERAGE IS UNLAWFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS(E100.000),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 t HEREBY AFFIRM UNDER PEN ALN OF PERJURY THAT THERE IS A CONSTRUCTlON LENDING AGENCY FOR THE PERFORMANCE OF THE WOFK FOR WHICH THIS PERMIT IS ISSUED(SEC. 3097,CIV. C.1. 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 4UTHORIZE REPRESENTATIVES OFfHIS COUNTY TO ENTER UPON THE ABOV E-MENTIONED PROPERTY'FOR INS ECTION PURPOSES. P PERMITTEE N (P INT) �^7 �i % � ] Y / J / / / _�/—/�� N OF PERMITTEE DATE 0 0 0 I I 0 w z 0 z m w 0 W U Z W U F-- Z N Z 0 Q d X W 0 U w cn Z Q Q Z Q W Z C7 0 0 J J LL J Q W 0 d Z W 2 Q W d C7 Z 0 m H CITY OF DIAMOND BAR DEPARTME'�1T OF COIvIIvIUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION PRESS FIRMLY WHITE-Department Copy.YELI-OW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy