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Home My WebLink About18925 CITY OF DIAMOND BAR �` �� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive ,�, �909>a6o-s i9s F��909�a6 i-3 i i� PRESS `�.„�' BUILDING PERMIT APPLICATION FIRMLY o DDRESS�� O/.�C--��IE.� D�, DATECATION � K� /,�-NUMBER �� #lC L/L -/I�'-� o� ��.. ISSUE I `^ „v, �TYPE OCC APN a f7 LOT� TRACT �Z�J S� DATE CONST. GROUP p OWNER �'Z AC��E� �i C_AR1ZL ''F.►= �114�-�5 ADDRESS l O' O C E L K�• ZONING SETBACKS z CITYPL/rVLowlp Aj� ZIP91'1l05 TEL�9�0'A'�S� FRONT RW ❑ � APPLICANT TEL. REAR ❑ o SIDE/SIDE STREET RW ❑ Q CONTRACTOR_ SIDE ❑ � ADDRESS � CITY ZIP TEL. PROPOSED USE �- '� w ARCH/ENG/�—+ t� �z DESIGNER ��E" �� 5��' NO.DWEL. ` NO. NO. a ADDRE S�i2 b t1.1 AYE. UNITS STORIES BEDROOMS � CITY sMID D� ZIP� TEL.I��S-1�40 � DESCRIPTION SQ.FT. FACTOR PSF A J.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM ' � 0 � �� 0 I HEflEBV AFFIRM UNOEfl PENALTV OF PERJURY THAT I AM F%EMPT FROM THE CONTRACTORS LI- � Garage/Carport ��^,,,� W CENSELAWFORTHEFOLLOWINGREASON(SEC.]D31.SBUSMESSANDPROFESSIONSCODE:ANYCITYOA U COUNTVWHICMREQUIRESAPERMITTOCONSTRULT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANVSTRUC� W Pffi10/DBCk /� "� ' Z TURE,PRIOR TO ITS ISSUANCE,AL50 RWUIRES THE APPLIGANT FOR SUGH PEflM1T TO FILE A SIGNED W , r .� W STATEMENT THAT HE OR SHE IS LICENSED PUflSUANT TO THE PROYISIONS OF THE CONTRACTORS LI� � � CENSE lAW(CHAPTER 9(COMMENCING WITH SECTION 7000)DF DIVISION 30F THE BUSINESS AND PRO- � POOI/Spe � FESSIDNSCADE)DRTHATHEORSHEISE%EMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP� (3 � TION.ANVVIOLATIONOFSECTION]031.SBVANVAPPIICANTFORAPERMITSUBJECTSTHEAPPLICANTTO Z qe-Roof F ACIVIL PENALTV OF NOT MORE THAN FNE HUNDRED DOLLARS�ESOD�.): O ❑I,ASOWNEROFTHEPROPERTV,OflMYEMPLOVEESWITHWAGE5A5THEIRSOLECOMPENSATION, � COfill118fCIaI Z WILL DO THE WORN,AND THE STRUCTUPE IS NOT INTENDE�OR OFFEFED FOR SALE ISEC.]044,BU51- _I � NESS AND PROFESSIONS GODE:THE CONTRAGTORS LIGENSE LAW DOES NOT APPLV TO AN OWNER OF ? PROPERTYWHOBUILDSOFIMPROVESTHEREON,ANDWHODOESSUCHWORKMIMSELFORHERSELFOft m � THROUGH HIS OR HER OWN EMPLOYEES,PFOVIOE�iHAT SUGH IMPHOVEMENTSARE NOT INTEN�ED OR w OFFEREDFORSALE.IF,HOWEVER,THEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE- ' � TION.THE OWNEH-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR Z IMPRO.V�FOP THE PURPOSE OF SALE). W MASOWNEROFTHEPROPERTV,AME%C�USNEIVCONTRACTINGWITHLICENSE�CONTRACTOFS � TO CONSTRUCT THE PROJfCT(SEC.]04/,BVSINE55 AND PROFESSIONS COOE:THE CONTFACTORS L6 V8Il18IlOf1 ADJ.AREA W CENSE LAW�OES NOT APPI V TO AN OWNER OF A PROPERTV WHO BUILDS OR IMPPOVES THEREON,AND � WHOCANTRACTSFORSUCHPROJ[CTSWITHACONTRACTOR�S)LICENSED URSUANTTOTHECONTRAC- QUANTITY DESCRIPTI N FEE Y TOHSLICENSELAW.�. � J O ']I AM E%EAIPT UNDEFl SEC. B.8 P.C.FOfl THIS REASON Q �� U 2 LL DATE 1 OWNER U Z W � LICENSED CONT TORS CLARATION W Q � I HEREBYAFFIFM VNDER PFNALTY OF PEflJURY THAT I AM LICENSED UND[fi PROVISIONS OF CHAPTER �I l f't � e(COMMENCING W'�TH SECTION]000)OF DIVISION J OF THE BUSINESS AND PROFESSIONS COO'c,AN� Z f V �U 'X MV LICENSE IS IN FULL FOHGE AND EFFEGT. � � � , � LICENSE CLASS LIC.NO. � J V DA7E CONTRACTOR d W � WORKERS'COMPENSATION DECLARATION a � U ,��-� � I HEREBYAFFIRM UNDER PF_NALTV OF PERJURY ONEOFTHE FOLLOWING OEGLARATIDNS: y Z Q � IHAVEANOWILLMAINTAINACERTIFfCATEOFCONSFNTTOSELF-INSUFEFORWORKERS' S CAMPENSATION,A6 PROVIDED BV SECTION 3�ooOF THE LABOR CODE,FOR THE PERFORMANCE U Q OFTHE WORK FOR WMIGH THIS PERMIT IS ISSUED. � � W I HAVEAN�WILLMAINTAIN WORKERS'COMPENSATION INSURANCE.AS REQUIRED BV SECTION ` Q 37ooOFTHELAeOHCO�E,FORTHEPEAFOPMANCEOFTHEWORKFORWHICHTHISPERM1T15 1� ISSUED.MY WORKF.RS'COMPENSATION INSl1RANCE CARRIEP AND POLICV NUMBER ARE: CONSTRUCTION 3 J j PLAN REVIEW - GARRIER _ _ Z POLICYNUMBER_ ELECTRIC ��` Q \ � (�FiISSEC110NNEmNOTBE00MREfE�OFTHEPERMTISFORONEHJNDREDDOLIAAS(51oo)ORlE55). PLUMBING � �.�, L= �� . w MECHANICAL ...__-----.._..__ _.._--___..._.._i-'I�,J�} . ` Z I CERTI�Y THAT IN'-HE PERFORMANCE OF THE WORK FOF WHICH THIS PERMIT IS ISSUED,i . ___ � \ , (fJ SHAILNOTEMPLOYANYPERSONIN.4NYMANNERSOASTOBECOMESUBJECTTOTHE J �I � WORKERS'GOMPENSATION LAWS OF CALIFORNIA,AN�AOREE THAT IF I SIiOULD BCCONE INSPECTION FEE \ � SU6JECT TO THE WORKEflS'COMGENSATION PROVISIONSOF SECTION 3]0o Of TME IABOR V .V.V `, � � CODE,I SHALL FOFITHWITH COMPLV WITH TFOSE PROVISIONS. ISSUANCE v�� SMIP p DATE: _ APPLICANT: � w ENERGY P/C J WARNING:FAILURE TO SEGVRE WORKERS'COMPENSATION COVERAGE IS UNUWFUL,AND SNALL BE � SU9JEGT AN EMPLOYER TO GRIMINAL PENHLTIES AND GIVIL FINES UP TOONE MUNORE�THOUSAND ENERGY PERMIT �� " � DOLURS(f100.G00),IN ADDITION TO THE GOST OF COMPENSATION,DPMAGES AS PROVIDED FOR IN --— � SECTION37080FTHELABORCODE,MTEftEST,ANDATTORNEY'SFEES. RETENTIONFEE: � � a CONSTRUCTION LENDING AGENCY PRE-ALT FEE: Q I HEREBV AFFIRM UNDEH FENALTV OF PERJURY THATTHERE IS ACONSTRI/CT�ON�ENDING AGENCV � FOR THE PERFOHMANGE OFTHE WORK FOF WHICH THIS PERMIT IS'�SSUED ISEC.]a9�,CIV C.). � Z � w _ a 2 LEN�Efl'SNHME � F_ LENDER'SAD�RESS__....... ...___ . r r3 l. � IGERT�FYTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATIONISCORRECT. TOTAL FCES •� �� '—""/ � W I AGREE TO COMYLY WITH ALl CITY AND COUNTV ORD'�.NPNGES AND STNTE LAWS ilEIATING TO BUILDING � d � CONSTRUCTION,ANDHEPEBVAUTHORIZEHEPREo'ENTATNESOFTHISCOUNTVTOENTERUPONTHE � 'y Z ABOVE-MEN ED PROPI=RTY F INSPECTION PURPOSES. V z�'�Z� COMMENT$ � � m P ENA a 6 � � � A REOFPER EE TE = RECPT.�O. PAID BY VALI�ATION ~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanPs Copy . � _;�. a. �+�:s,i��i . . . �� . /'! �� . , �P . k".�.�.�"�'��U3�"�'��n � . �. l..��. ��. .� .. . ..... . ... . .. . � . . ..... ' /rT 0�` .. . . �_.,__._._�._ . /�� r . . � .. �� ...... .. �,.. .. ... . .._ . . � �. �. ... . .. ./�.:��'��. � � . . �. . . �. .. .. .. .. ... . ,. . .. F4!"`i-.,"� ��..��'..�. . ..�� . � ' .... ... _.. � .. . ... . ... .. ... '. .z�� ,��-- �-��3 ��/� _ �-� 3 �� a� � ,�� z � —� _ � � . �r�� ,�- � ' �°`� �, �s _ _ � � G�� /'�' �D �i�� ° �' , ; _ _ . , . _ ... � ,�, _ _,��,� �� x � � � _ _ } m �� , a � � � � : ,t __ ; , � �� 4 ," � � CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION JOBSITE ADDRESS� � Loi c s jt Dirk. APN 4 S LOT TRACT-4 2 n A"axt-FLUI{,4-�c(5�5 OWNER C3 AV&M,-Ai C ADDRESSIOpCELR CITYDLIISMOiJP AK ZIP91r165 TEL. 'S i(D-.44 50 APPLICANT TEL. CONTRACTOR ADDRESS CITY ZIP TEL. ARCH/ENG/,-+ 4 V" k DESIGNER I V' / 52.16 W"t&4 AYE. ADDREIS CITY�4 o hl D Y ZIP TEL. h1.5- 2140 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 REQUIRESA 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 THAT HE OR SHE DID NOT BUILD OR IMPROVV� FOR THE PURPOSE OF SALE). ,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 AP PLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S)LICENSED URSUANT TO THE CONTRAC- TORS LICENSE LAW.). ^ I AM EXEMPT UNDEFI SEC. B. 8 P.C. FOR THIS REASON DATE OWNER LICENSED CONT TORS CLARATION 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 MV LICENSE IS IN FULL FORCE AND EFFECT. LICENSE CLASS LIC. N0. DATE CONTRACTOR WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PF NALTY 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 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 WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE CARRIER POLICY NUMBER (THIS SECTION NEED NOT BE COMPLETED OF THE PERMIT IS FOR ONE HUNDRED DOLLARS($100)OR LESS). I CERTIFY THAT IN--HE 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.I SHALL FOFITHWITH COMPLY WITH THOSE PROVISIONS. DATE:APPLICANT. 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. 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-MEN ED PROPERTY F INSPECTION PURPOSES. A * F PER EE TE AR CO 0 co 0 0 ELI 0 0 Cr 0 1D 0 z W a- c) So- Crz 0 0 W U Z W 0 U 0 Cn Q W W w W H cc: 0 0 d X W 0 U W CIO CI) C1 W J Z C7 APPLICATION L, PERMIT��p/C/�- / n DATE NUMBER o # � ISSUE TYPE OCC DATE CONST.GROUP ZONING SETBACKS FRONT RW^ REAR^ SIDE/SIDE STREET RW^ SIDE^ PROPOSED USE 1 F,- N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF A J.AREANALUATION SFR/ADD/REM Garage/Carport w Patio/Deck LL.I LL PooVSpa r Z Re-Roof 0 Commercial m Valuation ADJ.AREA QUANTITY DESCRIPTI N . FEE Q U CC U w J Z CL CL Z W IU CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING L- MECHANICAL INSPECTION FEE ISSUANCE, •V V SMIP ENERGY P/C ENERGY PERMIT�� • RETENTION FEE: PRE-ALT FEE: -..ti c TOTAL FEES G �� 3 7 Z COMMENTS V RECPT N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy