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Home My WebLink About18745 ` r, � C[TY OF DIAMOND BAR �-�, ��Q�I: - � � DEPARTME'�iT OF COIvIMUNTfY&DEVELOPMENT SERVICES � 21825 E.Copley Drive � /�,� (909)860-3195 F�(909)861-3117 `�NJ1` pRE$$ � W BUILDING PERMIT APPLICATION �S�— � ,,._... FI MLY � JOBSITE � �, L� � � qppLICATION � �2 PERMIT (�. p/C o ADDRESS_ � . � M�j�'1 Y' DATE NUMBER � g� /(`) OCC � APN O'f TRACT DA EE ��' 4"�' ONST. GROUP p OWNER �i0/IL< � p ADDRESS ZONING SETBACKS z CITY �;-z,.._.d I,Ysw ZIP TEL. ' n'"377" FRONT qyy _ � APPUCANT TEL. REAR r zS�DE/SIDE STREET RW ❑ a CONTRACTOR ra SIDE � ADDRESS .? .f 'C• s L rljS � CITY ZIP� � TEL. � ,- PROPOSED USE e��V'�- W"" '' � � ARCH/ENG/ f � ' �P a � r�- z DESIGNER � �C' Z-�'7L.� � � ADDRESS '— NO.DWEL. NO. � NO. � CITY ZIP TFL. UNITS STORIES BEDROOMS cn -- — � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADD/REM O Q I HEREBV AFFIRM UNDER PENALTV OF PERJUPY THAT I AM EXEMPT FROM TME CONTRAGTOqS LI- G8f09B/C8(P012 W CENSEUWFORTHEFOILOWINGREA50N�SEC.1031.58U51NES5RNDFROFE5510N5CODE:ANVCITYOR (n U GOUNTVWMICHRE4UIPESAPERMITTOCONSTRUCT,ALTER,IMPROVE.DEMOLISH,CRREPAIRANYSTRUF w TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIFES THE APPLICANT FOR SUCH PERMIT TO FILE F SIGNED W PdliO/DBCk � STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI� LL � CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION]a0o)OF OIVISION 3 nF THE BUSINESS AND Pq0- PDOVSp2 O FESSIONSCADE)ORTHATHEORSHEISEXEMPTTHEqcFROMANOTMEBA515FORTHEAIIECEDE%EMV- � V TION.ANVVIOLATIONOFSECTION7031.SBVANVAPPLICAN,-FORAPERMRSUBJECTS"MEAPPLICANTTO Z Re-Root � AqVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLLARS(f500).): Q ❑I,ASOWNEROFTHEPROPERTV,ORMVEMPLOYEESWITHWAGESASIHEIR50LEGOMPENSATiON, � Commercial Z WILL DO TME WORK,AND THE STRUCTURE IS NOT INTEN�[D OR OFFERED FOH SALE(SEC.7044.BUtI� J � NE55/VJ�PROFESSI�NS CODE:THE CONTRACTORS LICENSE LAW DOES NO'AVPLY TO AN OWNER OF � PROPERTY WHO BUILDS OR IMGROVES THEREON,AND WHO DOES SUCH WOFK HIMSELF OR MEPSELF OF Q THROUGHHISORHERONTlEMPLOVEES,PFOVIDEDTHATSUCHIMPROVEMENiSARENOTINTENDEDOR m w OFFEREOFORSALE.IF,HOWEVERTHEBUILDINGOFIMPROVEMENTISSOL7WITHINONFVEAROFCOIAPLE- � TION.THE OWNEREl11LDER WILL HAVE THF BUROEN OF GROVING'.HA7 HE OR SHE 010 AOT BUILD OR Z IMVROVE FOR THE CURPOSE OF SALE). �� ❑I,AS ONTJER OF THE PROPERTV.AM EXCLUSNELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PRQIECT(SEC.]oes,B1151NE55 AND PROFESSIONS CODE.THE CONTqq�TORS U- V8111B(IOfI __�___ ADJ.AREA W CENSELAWDOESNOTAFPLYTOANOWNEROFAPROPERTVWMOdUII.D50RIMFROVESTHEREON,AND � WHOCONTRACTSFORSUCHPROJECTSWITNAGONTRACTOR(5)I.ICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION Y TORSLIGENSELAW.). FEE � ❑i AM EXEMPT 11N�ER SFC. _ ._________B.8 P.C.FOR THIS REASON Q � U lL -- � — DATE OWNER N Q w � LICENSED CONTRACTORS DECLARATION w ¢ � I HEREBYAFFIRM UNDEfl PENALTY�OF PERJUFr TMAT I AM LICENSED UNDER PROVISIONS OFCHAPTER � � 9�COMMENCING WIiH SECTION 7000�OF DiyISION 3 OF THE BUSINESS AND PPOFESSiONS CODE,AND Z �X MYLICENSEISWFULLFORCEANDEFFECT m I �'�ts r.L. � I � LICENSE CLAS_--��__ LIC.NO. � U DATE ' � �b CONTRHCTOR�'�_1 w d W � WORKERS'COMPENSATION DECLARATION Q � I HEFEBV AFFIRM UNDER PENALTV OF PERJURV ONEOF THE FOLLOWING DECURATIONS�. Z Z _1 MAVE AND WILL MAINTAIN ACERTIFlCATE OF WNSENT i0 SEIF-INSURE FOR WOFiKERS' ¢ I _ Q COMPENSATION,AS PROVIDED BY SEGTION 3l0o OF TME LABOR CODE,FOR THE PERFORMANCE U OF TME WORK FOR WHICH TMIS PERMIT IS ISSUED. W � � Qw I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTqN 3100 OF THE LABOk CODE,FOR THE PERFORMANCE OF THC WORK FOR WHICH THIS FERMIT IS ISSUEO.MV WORKERS'COMP NSATION INSURANCE CARRIER ANJ POLICV NUMBER ARE' CONSTRUCTION r��y C, _. J � CARFIER S� _ �"(� _ PLAN REVIEW � POLICYNUMBER %,L��'��;�j. _ .— ELECTRIC Z — Q � (1HISSECiIONNE�NOTBENMPLEfEDOFTHEPERMRISWFONEHUPDRED70l1ARS(51CO�ORLESS�. PLUMBING W Z I CERTIFv THAT IN THE°ERFOfiMNNCE OF THE WORK FOfl WMICN THIS PERMIT IS ISSUE�.I MECHANICAL � SHAIL NOT EMPLOV ANY PERSON IN AM1V MANNER 50 FS TO BECOME SUBJE(:T TO TME � �- (n WORKEflS'COMPENSA'ION LAWS OF CALIFORNIA,AND AGREE THAT IF'i SHOULD BECOME INS:'�ECTION FEE � SUBJECTTO THE WORN'.ERS'COMPENSATION PqOVI510N5 OF SECTION 3]0o OF THE LABOP -- -� CODE,I SHALL FORTHWITH COMPLV WITH THOSE PROVISIOJNS. ISSUANCE � � �.+�•N.,,/ �� SMIP ��-- p DATE�. G' APPLICANT: J WARNING:FAILUHE i0 SEGURE WORKERS'COMPENSATION GOVERAGE IS UNLAWFUI,AND SHALL BE ENERGY P/C � SU&1cCTAN EMPLOYER TO CRIMINAL PENALTIESAN�pVll FINES UP TO ONE HUNDRED THOUSANO ENERGY PERMIT DOLLARS(f 100.000�,IN ADOITION TO THE COSTOF COMPENSRTION,�AMAGES AS PROVIDED FOR IN J SECTION370BOFTHELABORQ7DE.INTEREST,ANDATORNEV'SFEES. — ��—� � RETENTION FEE: d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O __ � I HEFEBV AFFIP,M UNDER PENAI_TV OF PERJUR�THAT THERE IS ACONSTPUCTION LEN�ING AGENCV � FOR�NE PERFORMANCE OF THE WORI(FOR WHICH THIS PERMIT IS ISSUEC(SEC.3091,CIV C.). Z w = IENDEN'SNAME � F— LENDER'SADDRE55 � TOTAL FEES r �_ ( (� � I�EFTIFV TM�1T�MAVE REA�7HI5 FPPLIGAIIONAND SiAiE TMAT iHEABOVE MFORMATION'SCORRECT w I AGFEE TO fAMPIY WITH ALL CITV AND COUNTV ORDINANCESAN�STATE lAWS REUTING TO AUILDING d ,U CONSTRUCTIDN,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COIJNTV TO ENTER UPON THE Z ABOVE�MENTIONED PROPERTV FOR INSPECTION GURPOSES. COMMENTS � �� /C — � _ m PERMITTEE M1AME(PRINT) � /w/�/J� --- � SIGNATUREO , RMITTEE , DATE / = RECPT.NO. PAID BY VALIDATION ~ WHITE—De artment Co YELI.OW—Fnance Co PINK—Assessor Co GOLDENRO�-File Co GREEN—A IicanPS Go P PY. PY� PR PY. PP PY � ;� .. � ., �� , �� '�� ' � p . � �� , �,� �: � � ti��. � � � � � �, � � • � . �� _ _ ',�1 � _ ' _ __ n �� ,� � _ _ _ '�"��, � �� _ : _ _. ._ __ _ _ _ __ _ _ _ . _. __ _ . _ _ __ ; � ,� rtt�� — �_ __ _ „ , � � ,�� ` � .�w r'�' �� fr I ;, . .... . . . ... ... .. . ... .. . .. ._ -- �. q� � ,r a �dsa .•' ..P � ;��> � ��.�':� i I , � _ _ _ �. �� i,., _ _ _ � r.�"� � , � a ; �K r _ _ . r �j �� _ _ _. �,, �'' � ,.. ,: `'!�i __ � _ „��_ _. _ _ _ __ ' CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION JOBSITE J-�I ADDRESS! APN OT TRACT OWNER kk�l h L ADDRESS CITY�;z„��I}ow ZIP TEL. APPLICANT TEL. CONTRACTOR*PI ADDRESS f C• CITY ZIP TEL. 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 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($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 THAI HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). LI 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 A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW). EI 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 S 1- LICENSE CLAS LIC N0. J --3 DATE"0 vb CONTRACTORS WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS. (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 WORK FOR WHICH THIS PERMIT IS ISSUED MY WORKER'COM NSATION RANCE CARRIER AND POLICY NUMBER ARE CARRIER POLICY NUMBER/,b 323 g. (THIS SECTION NEED NOT BE COMPLETED OF THE PERMIT 15 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 WORM ERS'COMPENSATION PROVISIONS OF SECTlON 3700 OF THE LABOR CODE,I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. / 7�„ DATE�APPLICANT. � .* . P-1-1 WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP 10 ONE HUNDRED THOUSAND DOLLARS(5100,000),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 ACONSTRUCTION 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-MENTIONED PR OPERTY FOR INSPECTION PURPOSES. / t H. f-1 UR PERMITTEE NAME(PRINT) + • SIGNATURE 0 . RMITTEE G� 17-DATE WHITE-Department Copy. YELLOW-Finance Copy, PIN PRESS FIRMLY APPLICATION v2 PERMIT DATE NUMBER# ISSUE TYPE OCC DATE CONST GROUP ZONING SETBACKS FRONT RW REAR EI SIDE/SIDE STREET RW^ SIDE PROPOSED USE t'-- �d Gvr�'S L eti rI7S /�ore N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM Garage/Carport U) W Patio/Deck 0 Pool/Spa Z Re-Roof Commercial D Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J 1 0 u-i c� z m a Q U Z U W Y Q CONSTRUCTION 1 C� PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C_ ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES r_((� COMMENTS RECPT N0. PAID BY VALIDATION