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Home My WebLink About18158 , r �� CITY OF DIAMOND BAR ��1 ��_j� � DEPARTMENT OF COMMUNIT'Y 8c DEVELOPMENT SERVICES 21825 E.Copley Drivc �� pRESS " (909)8(i0-3195 Fax(909)861-3117 �""-v�� BUILDING PERMIT APPLICATTON FIRMLY o DDRIESS_ ��U ��'�/N P✓� DATEICATION ��,7�� NUMBER S�_ #/C��` �� ISSUE r �. TYPE OCC APN LOT�i-- TRACT DATE `' �� '' CONST. GROUP � OWNER !l. O " ADDRESS S ZONING SETBACKS oCITY ZIP TEL. ��/KG�� FRONT RW ❑ APPLICANT �dYL TEL. REAR ❑ z SIDE/SIDE STREET RW ❑ m CONTRACTOR a'C e"� SIDE ❑ � CIT`( E � ZIP � C TEL. �ZS��7_S� PROPOSED�E � Z G S� w ARCHIENG/ -�r � J z DESIGNER S'/�(i/ -%l�C/�� NO.DWEL. NO. a ADDRESS �/`}�9 �' T / UNITS ORIES � BEDROOMS � CITY �� N ZIP� TEL. G�SF�'/�� `n DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION v� OOWNER-BUILDER DEGLARATION SFR/ADD/REM Q I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT I AM EXEMPT FROM THE CONTRACTORS LI- G3fd9B/CdfPOfl W CENSELAWFOHTHEFOLLOWMGREASON(SEC.J031.5BUSINESSANDPROfE5S10N5CODE:AN1'dTVOR (n U COUNTYWHIGMREOUIRESAPERMITTOGONSTRUGT,ALTER,IMPROVE,OEMOLISH,ORREPAIRANYSTflUG- W PatiolDeck Z TURE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES TN"e RPPLIGANT FOH SUCH PERMIT TO FILE A SIGNED w w STATEMEN?THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- � CENSE LAW(CHAPTEF 9(COMMENCING WITH SECTION 7oaa)OF DIVISION 30F THE BUSINE55 AND PRO- � POOUS OFESSIONS CODE)Ofi THAT HE OR SHE IS E%EMPTTHEREFROM AND THE BA515 FOR THE ALLEGE�EXEMP- V TION,AN�VIOLATION OF SECTION 7031 5 BY ANY APPLICANT FOR A PERAAIT SUBJECTS THE APPLICANT T0 Re-Ro � ACIVILPENALTVOFNOTMORETHANFNEHUNDREDDOLLP.RS(ESaO).): . O ❑I,ASONTlEROFTHEPROPERTV,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, COR1R10fCIaI Z WILL DO THE WORK,AND THE STRUCTUflE IS NOT INTENDED OR OFFERED FOR SALE(SEC.]016,BVSI- J NESS AN�PROFESSIONS CODE:TME GONTRAGTORS LICENSE lAW DOES NOTAPPLV TO AN OWNER OF � PROPERTYWM09UILDSOHIMPROYESTMEREON,ANDWHODOE5511CNWOfiKHIMSELFORHERSELFOR m � THROUGHHISORHEROWNEMP�OVEES.PHOVIOEDTHATSUCHIMPROVEMENTSARENOTINTENDEDOR I W OFFERE�WRSPLE.IF,HOWEVER,THEBUILJINGORIMPROVEMENTISSOIDWITHINONEYEAROFCOMPLE� � TION.THE OWNER�BUIL�ER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR Z 161PROVEFORTHEPl1RPOSEOFSALE). _ ❑I,ASO4MEROFTHEPPOPEfiTV,AMEXCLIISNELVCONTfiACTINGWITNLICENSEDCONTRACTORS w TO CANSTRUCT THE PR0.IECT(SEC.]044,BUSINESS AND PROFESSIONS CODE:THE CONTRACTDRS LI- �^ p� Valuation ADJ.AREA W CENSELAWDOESNOTAPPLYTOANONMEROFAPROFER7VWHOBUILDSOHIMPPOVESTHE(aEON,AND = WHOCONTRACTSFORSUCHPROJECTSWITHACONTRACTOR(5)�ICENSEDPURSUANTTOTHECONTRAG �UANTITY DESCRIPTION FEE ~ TORS UGENSE LAW.). Y J � ❑I AM E%EMPT UNDER SEC. B 8 P.G FOR THIS RERSON Q � U 2 � DATE owN[n U Z w � LICENSED CONTRACTORS DECLARATION w Q Q I HEREBV AFFIRAI UNDEF PENALTV OF PERJUFY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER � a e(COMMENdNGWITMSEGTIONt000)OfDIVISION30FTHEBUSINESSANDPROFE5510NSCO0E,AND Z X MV LIGENSE IS IN FULL FORGE ANO EFFEGT. W m � LICENSE CLASS �—� LIC.NO. � � � � H J V DATE � �D CONTRACTOR d W � WOFiKERS'COMPENSATION DECLARATIDN � � a � U � IHEREBYAFFIqMUNDERPENALTYOFPERJURYONEOFTHEFOLLOWINGDEGLARAT10N5: Z Q 0 IHAVEANDWILLMAINTAINACERT!FICATEOFCONSENTTOSELF-INSUREFO(iWORKERS' 2 CAMPENSATION,ASPROVI�EDBVSECTION3]o00FTHEI.ABORCODE,FORTHEPERFORMANCE U ¢ OF THE WORK FON WHIGH THIS PEFMIT IS ISSUED. � � w I HAVEAND WILL MAINTAIN WORKERS'CAMPENSATION INSURANCE,AS flEQUIRED BV SECTION Q 3]oaOFTHELABORCO�E,FOiiTHEPERFORMANCEOFTHEWO (FORWHICHTHISPERMITIS �O� 4O ISSUED.MV WORKERS'COMP 10 SURAN pRRiER POLICV NUMBER APE: CONSTRUCTION _ G j caRaieR PLAN REVIEW �q [ ZPOLICY NUMBER � ELECTRIC Q � �i}11SSECTiONNEmNOTBECOMPLE7EDOFTHEPERMITISFORONEHUPDRED00LLARS15100)ORLESS). PLUMBING W Z I CE4iTIFV THAT INTHE PERFORMANCE OF THE WOFK FOR WHICH THIS PERMIT IS ISSUE�.I MECHANICA� CJ' SHALL NOT EMPLOV ANV f ERSON IN 1NV MANNER SO AS TO BECOM=SUBJECT TO THE � WORKERS'COMPENSATION LAWS OF CALIFORN�.A AND AGREE TNAT IF I SHOUL�BECOME INSPECTION FEE ? SUBJEGTTOTHEWORKERS'COMPENSATIONPROVISIONSQy{ECTION9]00 FTI{EIABOfl CODE J SHA L FORT ITH GOMNLV WITH THOSE PROVI�'J,/'� ISSUANCE �°� p DATE:�_�APPLICANT: _________-_J�� "`.�Ci�� SMIP � ��/ w ENERGY P/C J WARNING�.FAILURE TO SECUFE WORKERS'COMPENSATION COVERAGE IS UNLAWFUI,AND SHALL BE J � SU&IEGTFNEMPLOVEFTOGRIMINALPENALTIESANDCIVILFlNESUPTOONEHUNDREDTHOUSANO ENERGYPERMIT DOLLARS(f100,000�,IN AODITION TO THE COSTOF GOMPENSATION,DAMAGESAS PROVIDED FOq IN J SECTION37oBOFTHELABORCODE,INTEREST.ANDATTORNEv'SFEES. RETENTIONFEE' � Q � CONSTRUCTION LENDING AGENCV PRE-ALT FEE: O � I HERE6VAFFIRM UNDER PENALTY OF PERJURY THATTHERE IS A CONSTRUCTION LEN�ING AGLNCV � FOR THE PERFORMANCE OF iHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.309'!,CIV C.). Z w � = LENDEfi'S NAME � F- LENDER'SADDRE55 — /1 /� ^ W ICERTIFYiHATIHAVEREADTHISAPPLICATIONAN�STATETHATTHEA60VEINFORMATIONISCORRECT. TOTAL FEES —12� 1� i !�S^� � 1 AGREE TO COMPLY WITH ALL GITV AN�COUNT'DR�INANCES ANO STATE LAWS REIATING TO BUILDING I 4 � CANSTRUCTION,HNDHEFIEBYAUTHORIZEFEPRESENTATIVESOFTHISCOUNTYTOENTERUPONTHE ABOVE�MENTIONE�PROVERTV FOF INSVECTION PUFPOSES. z COMMENTS__ 0 � ' / ( � � � m PEHMITTEE NAME(PflINT) � �/1.� G-�_-OZ- N SIGNATUREOFPERMITTEE DATE - = RECPT.�O. PAIO BY VAUDATION _ ~ WHITE—Department Copy,YELLOW—Finance Copy,PWK—AssessorCopy,GOLDENROD—File Copy.GREEN—ADPlican!'s Copy �` �" ' i�'. E � � ° G�» � � "� �i � , � _ ' iliE iff�. `��f� { '. �d �.ti � P� r,��. � ,. . a. . . . < . =IE" . . , , _ ��.. .. .,.k`le� sdu�N .. . ..�+IRa"€�..ox.�.i�}��Ris..�„�4' . .. .. � �/ � . . ... . .. _ ... ._. ... . ._. �.�.. r . i i.F� �f �z .��7� � ` �.. '.��E i,�: _ _ � � �"�r � �� _ .� �'�'� mi � ia 8� � a61 . �� . v � �pa� � `'a �� _ � at � 7�" � ''��"�'�`�-�°��h°�w .��. ��- �+P � �( _ p � �� r�� a � i� " � -a � t�i �c � ��, �i€r , _ � �, �t ��.�i ��. ��&'��. . , q. E ie .� .,'� .. .. ... ... . . .. . .. .. . .. . .. _.. .... ._ _.. .. . . .. . .�� _ ��.� �. . .: �..: i 'r z � "� , .,- . . . .. ... .. .. ... ... . . .. ... ... . ... ... . . ...... .. ... . .... .. . i �� r� ,��? �` CITY OF DIAMOND BAR MENT SERVICES ELOP DEPARTMENT OF COMMUNITY CL DEV 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION '1 33 PRESS FIRMLY JOBSITE N /70 7��ti' f / �/E ADDRESS APN LOT-y-TRACT OWNER I ADDRESS CITY ZIP TEL. 19�4 33 APPLICANT TEL. CONTRACTOR 0 C° ADDRE E c' CITY VIA ZIP TEL.J ZS'175� ARCI'UENG/�r DESIGNER T/ ADDRESS-21-)!2 43 CITY-N ZIP TEL GaS��'F-� 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 APERMIT TO CONSTRUCT,ALTER,IMPROVE,DEMOLISH,OR REPAIRANY 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($500).): ^ 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). ^ 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.). ^ I 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 L2 . 3 C LIC. N0. LICENSE CLASS ( � -o� CONTRACTOR IU J / DATE WORKERS'COMPENSATION DECLARATION/40 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 LABOR CODE. FOR THE PERFORMANCE OF THE WO FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS'C OMP a 10 SURAN BRIER POLICY NUMBER ARE: CARRIER POLICY NUMBER (THIS SECTION NEED NOT BE COMPLETED OF THE PERMIT IS FOR ONE HUNDRED DOLLAAS($100)OR LESS). IC E RTIFY 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 ECTION 3700 F THE LABOR CODE J SHA L FORTITH COMPLY WITH THOSE PROVI NT Y APPLICA DATE: 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. t CONSTRUCTION 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. I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE CONSTRUCTION ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. ] PERMITTEE NAME(PRINT) t: J SIGNATURE OF PERMITTEE DATE (D LL w 0 M 0 W U Z LIJ 0 C) 0 U] 0 Q Cr X w 0 U w C/] U] LU W I APPLICATION PERMIT P/C D 9 L DATE NUMBER# ISSUE f�. TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ^ REAR ^ SIDE/SIDE STREET RW ^ SIDE ^ PROPOSED USE V Z G 5e J8 N0. DWEL. N0. UNITS DRIES BEDROOMS DESCRIPTION SCI. FT FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM U) Garage/Carport w Patio/Deck L.I LL PooVS Re-Ro Commercial CD Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U U W J W CD z m a Z 2 U W JC�4 CONSTRUCTION PLAN REVIEW [ ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE . SMIP ,I C ENERGY P/C ENERGY PERMIT RETENTION FEE: C� PRE-ALT FEE: �A TOTAL FEES 92,91 I ZS^ COMMENTS RECPT N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GHEEN-Applicant's Copy