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Home My WebLink About17626 � CITY OF DIAMOND BAR �y� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 PRESS � ��»�� BUILDING PERMIT APPLICATION FIRMLY o DDRIESS_�I��L��L�Y �C- DATEICATION 'l^_ i_,�� NUMBER ��.� p/C o �-- p'_ ! °^ APN I_ T TR CT �SSUE TYPE OCC p OWNE� �! / DATE CONST. GROUP p ADDRESSL'�, ZONING SETBACKS Z CITY.�i?4.''4.E'/e f / EL. FRONT RW C o APPLICANT _ TEL. REAR �- Z SIDE/SIDE STREET RW G Q CONTRACTOR� Q C , SIDE � ¢ ADDRESS_�� 6 ' . •--- � A C /� ZIP%�S TEL(/TLr� PROPOSED USE 0 z DESIGNEfl a ADDRESS NO.DWEL. Np, N� � CITY ZIP TEL. UNITS STORIES BEDROOMS � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATIDN � OWNER-BUILDER DECLARATION O SFR/ADDlFEM p I HEREBV AFFIRM UNDER PENALTV OF PERJURY THAT I AM EXEM�T FROM THE CONTRACTORS LI- GBfdJB/CBfPOh W CENSELAWFORiHEFOLLOWINGREA50N�SEC.]031.SBUSINESSANDVROFESSIONSCODE:ANVCITVOfl (n w COLINTVWHICHREOUIRES�GFERMITTOCONSTRVCT,ALTER,IMPROVE,DEMOLISH,ORflEPAIflANYSTqUC- W Patio/Deck TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE P.PPLICANT FOR SUCN PERMIT TQ FILE A SIGNED W � STATEMENT THAT HE OR SHE IS LICENSED PUflSUANT 70 THE PflOVI510N5 OF THE GONTRAGTORS LI� � CENSE LAW(CHAPiER 9(COMMENCMG WITH SEG'ION�000)OF�IVISION 3 OF THE BUSINE55 AND PRO� u' POOUSPB O FESSIONSCODE)ORTMATHEORSHEISE%EMPTTHEREFROMAN�THEBASISFORTHEALLEGEDEXEMP� � U TION.ANYVIOIATIONOFSEGTION7031.5BYANYAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO z Re-Roof F AGNILPENqLTYOFNOTMORETHANFNEHUNDREDDOLLAR5�f5Do).): � ❑I,ASONTJEROFTHEPROPERTV,ORMYEMPIOYEESWITHWAGESASTHEIRSOLECOMPENSATION, COfflfflBfCldl Z WILL DO 7ME WORK,AND TFiE STR�CTURE IS NOT INTEN�E�OR OFFERED FOR SALE(SEC.1044,BU51- � � NE55 AND PROFESSIONS CODE�THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO!W OWNER OF � PROPERTV WHO BUILOS OF',IIAVROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR 2 7HROUGH HIS OR HER OWM EMPLOVEFS,PROVIDED THAT SUCH IMPROVEMENTSARE NOT INTENDED OR m QOFFEREDFORSPLE.IF,HON'EVERTHEBUILDINGORIMPROVEMENTISSOIDWITHINONEYEAROFCOMPLE- Z TION,THE OWNER�BUILDEFI WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE 01�N07 BUILD OR � IMPROVE FOH THE PURPOSE OF SALE). �y,� ❑I,ASOWNEROFTHFPROPER7Y,AME%CWSNELYCONTRACTINGWITHLICENSEDCONTRACTORS � TO CANSTRUCT THE PROJ[CT(SEC.7osa,BUSINE55 AND PROFESSIONS CODE:THE CONTRACTORS LI- V01Uatlon ADJ.AREA = CENSEUWDOESNOTAPP�_YTOANOWNEROFAPROPERTVWHOBUILDSORIMPROVESTNEREON,AND � WHOCONTRACTSFORSUCHPROJECTSWITHACONTRACTOR(5)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION Y TORSLICENSELAW.). FEE O ❑I AM EXEAIM UN�EIi SEC. _ B.B P.C.FOR THIS REASON Q � U � DATE OWNER H � LICENSED CONTRACTORS DECLARATION W � I HEREBV AFFIRM UNDER PENALTY OF GER.;l1RY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � d 9(COMMENCING WITN SECI'ION]000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z � `X MV LICENSE IS IN FVLL,�QR=EAf�E CT t� � LICENSE CLASS �1 �� LIC.NO. [ ��J�`� � V DATE � CONTRACTDR N/ d W r G � V�RKERS'COMPENSATION DECLARATION Q � I HEREBV AFFIqM U�DER PENALTV OF PERJURV ONE OF THE FOLLOWING�ECLPRATIONS: U '� � Z � IHAVEnN�WI AINTAINACERTIFICATEOFCONSENTTOSELF�WSUREFORWORNERS' ¢ Z = Q COMPE N,ASPROVIDEDBVSECTION37000FTHELABOPCODE,FORTHEPEFFORMANCE U Q O WORK FOR'NHICH THIS PERMIT IS ISSUED. W Qw _I HAVE AND WILL MA�NTAIN WORKEFS'COMPENSATION INSURANCE,AS HEQUIRED BV SECTION � 370o OF THE 1A80R GODE,FOR Th1E PERFORMANCE OFTHE WOflK FOR WHICH THIS PERMIT IS ISSUED.MV WORKERS'CAMP �ATION^INSU/Rp)NC/�c ARRIE ��PO/�LCV Nt1AABER/q�',--�' CONSTRUCTION j CARRIER__��/1!1 C.-�� /�� .F--L--t� pLAN REVIEW Z POLICV NUMBER�/�/J��/� � ELECTRIC Q b"" "' �"'� 1�7-p__�.�� ... � (iHISSECTICNNEmPK1TBEOJMPLEfEDOFh£PEHMfrISFOFONEHUNOfiEDDIX1AR5 ORLESS). PLUMBING W Z I CERTIFVTHAT IN TI�PERFORMANCE OF THE WORK FOR WHICH IS RA1IT IS ED,I MECHANICAL C} SHALLNOT PLOV NVPERSONINi1NYMANNER S TT E (J� WORKERS' MPF ATIONLAWSOFCALIFORNI ,AN7 T ULD COME INSPECTIONFEE � SUBJECTT THE 7RNER5'COMPENSATIONP VIS EC ION 0a ELA90R � CO I S Al1 F "H541TH COMPLY WITH THO P V ISSUANCE � / p DATE: '� " _ PPLI NT�. SMIP W _ _ _ J WARNING:F URE SECURE WOqKERS'COMPENSATION VERAGE ,AND SHALLBE ENERGY P/C J � SUBJECTAN MPL ERTOCRIMINALPENALTIESANDqVILFIN OONEHIJNDREDTHOUSAND ENERGYPERMIT DOLLARS(f100,0 ,IN ADDITION TO THE COSTOF COMPENSATION,DAMAGESAS PROVIDED FOR IN J SECTION 3]OB OFTHE LABOR CODE.INTEREST,ANDATTORNEV'S FEES. w RETENTION FEE: O CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � I HEREBV AFFIRM IINpER PENALTV OF PERJURV THAT THERE IS ACONS?RUCTION LENDING AGENCV FOF TNF PFRFORMANCE OF THE WORK FOR WHICHTHIS PERMIT IS ISSUE�(SEC.309],CIV C.�. -� Z W � LENDER'S NAME H LENDER'SA�DRESS � -_ W I CERTIFV THAT I HAVE READ 7HIS APPLICATON ANO STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTAL FEES � IAGREETOCOMPLYWITHALLCITVANDCOU YORDINANCESANDSTATEUWSRELATINGTOBUIL�ING � CONSTRUCTION,ANDHEREI3VAUTHORi pESENTATIVESOFTIIISCOUNTVTOENTERUPONTHE Z ABOVE-MENTI OPEFlTVFORI ECT N PURPOSES. � � �� COMMENTS J � m PERMITTEE ME(P � -�� ¢ t� � ! 2�Z _ � � SIGNATUREOFPERMI EE D E � • � RECPT.NO. PAID BY VALIDATION WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—ApplicanYs Copy �°�-a � r a�,„ - s�s a „' '�f �,t,�'� � �`�' n�� « ; w �., a � � �� ,��r i � � Nu o _ . h �', , e � �; ��z .,a�a� °� _. � � �.� ..� ..... L! I.�,[�/c-7�. ..'��%'� . . . �� ... ... � .... '.... .... ..... ...... _ ... . . ..... ... . .. . . .. .. . .... ... ... _.. . . ! >.e� � 55�� _.. .... . . ... . ... .. _. .. . . .... . ... . .. ... .... .... ... . ... ... .. . .... ... . . .... . ..... ..... . . ..... . ..... . .... ��i � ti; ' _i . ..... . ... .. .. . ... . .. .. . . . .. ... . . ..... . . .... ..... ..... .. ...... ��;. fi '� �. ia£ '" � �6 �� ' n„ <r� '� „�� i��k�� ' ^�� '�"��«.r��,�,s."� �`� �t� ; -: �. _�' � t r� , s� e� � � , , � : , � o � � � �3 - �� r ., , � � _ ; °� ��r� �� +�"�' a ,-',. ; , :E< � - is � ,�, � i .., _ „ � �, r _ _ _ � h .. .. . e �m`"'�e., s �. .., . .. OI JOBSITE ADDRESS APN_T TRACT OWNE )S ADDRESS,',Imo,- CITY../.91-I/e A< /E APPLICANT TEL. CONTRACTOR 0 L, ADDRESS, CITY ZIP /_-- TEL�/_�� 7Jg1L. o�o�� ARC/6/v 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 REOUIRESA PERMITTO 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).): 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 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 NOTAPP_Y 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. 8 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 FUL RCEAA E CT/Gh 7;71 LICENSE CLASS I LIC. N0. ) DATE CONTRACTOR/' lA� RKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WI AINTAIN A CERTIFICATE OF CONSENT TO SELFINSURE FOR WORKERS' COMPS N,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE 0 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'COMP ATION INSUR N CFr HRIE D POLICY NUMBER_ / CARRIER � POLICY NUMBER 4' N (THIS SECTION NEED OT BE COMPI ETED OF THE PERMIT IS FOR ONE HUNDRED DOLLARS OR LESS). I CERTIFY THAT IN TH PERFORMANCE OF THE WORK FOR WHICH IS RMIT IS ED,I SHALL NOT PLOY NYPEPERSON IN ANY MANNER T S T T E WORKERS' MPE ATION LAWS OF CALIFORNI,AND T ULD COME SUBJECT T THE ORKERS'COMPENSATION P VISI EC ION 00 E LABOR CO is A9 F"HWITH COMPLY WITH THO P V DAT / E: PPLI NT WARNING: FA URE SECURE WORKERS'COMPENSATION VERAGE,AND SHALL BE SUBJECT AN MPL ER TO CRIMINAL PENALTIES AND CIVIL FIN 0 ONE HUNDRED THOUSAND DOLLARS($100,0,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 1 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL CITY AND COU V ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION.AND HEREI3Y AUTHORI PRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTI OIN FOR I ECT NPURPOSES. PERMITTEE ME( I ZIL SKI URE OF PRD E CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION I APPLICATION r-\� PERMIT � /C DATE 0� 1 NUMBER r . p ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW^ REAR ^ SIDE/SIDE STREET RW 0 SIDE ^ PROPOSED USE N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREANALUATION SFR/ADD/REM U) Garage/Carport W Patio/Deck .L PGDUSpa 0 Z Re-Roof Commercial m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U 2 H U W W 0 Z DO CL Q U U W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES COMMENTS RECPT NO PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PIN PRESS FIRMLY