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Home My WebLink About17644 � CITY OF DIAMOND BAR � ��_(,'' -�'`` DEPARTMENT OF COMMiJNITY&DEVELOPIviENT SERVICES`+—�� '"� I 2I825 E.Copley Drive (909)860-3195 Fax(909)861-3117 � I�3 PRESS `"'-�� BUILDING PERMIT APPLICATION FIRMLY � JOBSITE �} APPLICATION PERMIT / P!C o ADDRESS_��a � �E�-�'�'��Q� DATE �'" NUMBER l<� �� # oro ISSUE TYPE OCC APN LOT _ TRACT DATE CONST. GROUP °C OWNER O `` ADDRESS ZONING SETBACKS oCITY ZIP TEL. FRONT RW ❑ APPLICANT _ TEL. REAR ❑ � - SIDE/SIDE STREET RW ❑ z m CONTRACTO u 1�I SIDE ❑ � � ADDRESS �� '-=t�' � � � CITY my`C'1J ZIP�ggC TEL.��'��'`7gr.�� / PROPOSED USE F.17�i0 �!� / ' �/� oARCWENG/ . � ��•y .�r� �z DESIGNER NO.DWEL. NO. NO. a ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION cr� � OWNER-BUILDER DECLARATION SFR/ADD/REM O I HEREBY AFFlRM UNDER PENALTV OF PERJURY THAT I AM EXEMPT FROM TNE CONTRACTORS LI- Gdf2(JB/CB�OfI W CENSELAWFORTHEFOLLC�WINGREASON(SEC.10915BUSINESSANDPROGESSIONSCODE:ANYCITYOR (n U COUNTYWHICHREOUIHESAPERMRTOCONSTflUCT,AL�Efl.IMPROVE,�EMOIISH,OflREPAiRANYSTRUG W patiolDeck Z TURE,PRIOR TO ITS ISSUANGE,AL50 RE�UIRES TNE APPLIGANT FOR SUCH PERMIT TO FILE A S�GNE� w W STATEMENT THAT HE OR SHE IS LIGENSEO PUNSUANT TO TME PROVISIONS OF THE�NTRACTOftS LI� � CENSE LAW(CHMTER 9�COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND Pfl0- LL' PoOUSpa � FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP� � TION.ANYVIOLATIONOFSECTION7031.5BYANYAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO Z Re-Roof r ACIVILFENALTVOFNOTMORETHANFIVEHUN�REnDOLLAR5�f500).)� Q �I,ASOWNEROFTHEPROPERTV,ORMYEMPLOVEESWITHWAGESASTHEIPSOLECOM�ENSATION, � COmmBfcial Z WILL DO THE WORK,AN�THE STRUCTURE IS NOT INTENDED OR OFFERE�FOR SALE(SEC.�Cda,BUSI- J NE55 AND PROFESSIONS CODE:TNE CONTRACTORS UCENSE UW OOGS NOT APPLY TO AN OWNER OF N PROPEflTVNMOBUILD50RIMPROVESTMEREON,ANDWHODOESSUCHWOftKHIMSELFOflHERSELFOR � Q THROUGH HIS OR HER OWN EMPLOYEES,PROVIDED THAT SUGH IMPROVEMENTSARE NOT INTENOEDOR m W OFFERE�FORSALEIF,MOWEVER7FiEBUIL�INGORIMPROVEMENTI550LDWITHINONEYEAFOFGOMPLE- 0 TION,THE OWNER-BUILDEFI WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE OID NOI 9UILD OFl Z IMPROVEFORTHEPURPO<�EOFSALE�. _ ❑I.q50WNENOFTHF:PROPERTV.AME%CLUSNELVCONTRACTINGWITHIICENSEDCONTRACTORS � TO CONSTRUCT THF.PF0.1[CT(SEC.to46,6USINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- VelUation r �^ ADJ.AREA W CENSELAWDOESNOTAVPLY70ANOWNEROFAPROPERTVWHOPl1II.O50RIMPROVESTHEREON,AND = WHOCONTRACTSFORSUCHPROJECTSWITHACONTRACTOR(S)LICENSEDPl1RSUANT70THECONTFAC- QUANTITY DESCRIPTION FEE ~ TOFSLICENSELAW.). Y J � ❑I AM EXEMPT UNDEH SEC. B.8 P G FOR THIS REASON Q O U � � LL DATE OWNER � z � w � LICENSED CONTRACTORS DECLARATION w � I HEflEBY AFFIRM UNDER PENALTV OF PERJURV THA?I AM LICENSED UNDER PROVISIONS OF CHA7TER � p. 9(CAMMENQNG WITI�{SECTION'lo00)OF DIVISION 30F THE BUSINESS AND PROFESSIONS CODE,AND Z X MV LIGENSE IS IN FULL FOkCE AND EFFECT � LICENSE CLASS �–�� LIC.NO. �// �� ,� ^ J V DATE C� CONTRAC W �_. � WORKERS'COMPENSATION DECLARATION � � � ¢ � I HEREBVAFFIRM UNDER PENALTV OF PERJURY ONE OFTHE FOLLOWING DEGLARATIONS: U (/) Q 0 IHAYEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF�INSUREFORWORKERS' _ Z CAMPENSATION,A'3PHOVIDE06VSECTION3]'JOOFTNFLABORCOOE,FORTHEPERFORMANCE U Q OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED. � 0 W �I HAVEAND WILIMAINTAIN WORKERS'COMPENSATION INSUHANCE,AS REOUIRED BV SEGTION Q 37000F THE LAB09 COOE,FOR THE PERFORMANCE OF THE WOPK FOa WHICH THIS PERM1T15 L)f' rlG�' ISSUED.MY WORKh_RS'CaMPEN ATION INSl1RANCE CARPoE ND POLICY NUMBEfl ARE: CONSTRUCTION J�� CARRIER ��'� �� PLAN REVIEW ZPOUCYNUMBER ~ � , ELECTRIC Q 0 (iF11SSECTI�NNEmNOTBEO7MPLETEDOF7HEPERMIiISFOHONEHUWFE�00LLAR5(St00�ORLESS). PLUMBING w MEGHANICAL Z I CERTIFV THAT M THE PERFORMANf.E OF THF WORK FOF WHICH THIS PERMIT IS ISSUED.I L} SHALLNOTEAIPLOVANVPERSONINANYMANNERSOASTOBECOMESIJBJECTTOTHE � WORKERS'COMPENSATIONLAWSOFCALIFORNIA,ANDAGREETHATIFISH BECOME INSPECTIONFEE SUBJECT?O THE WOFKERS'COMPENSATION PROVISIONSOF SECT N 3�0 F E LAB � ISSUANCE �� ' GOOE, SHALL/ORTHWITM COMPLV WITH TH PROVISIONS. p �ATE: "L� APPL NT: . SMIP ��R �� . :��;_,. : S�' w ENERGY P/C J WARNING:FAILURE TO SECURE WORKEflS'COMPENSATION COVER E IS UNLAWFU,A SHA�LBE LL SU&IECTANEM�LOVEFTOCRIMINALPENALTI[SANDqVILFINESU TOONEHUNDRE HOl15AND ENERGVPERMIT DOLLARS�f I00.o0aj,IN A�DITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN J SECTION�7000F THE LA90H GOOE,INTEftEST,ANDATTORNEV'S FEES. RETENTION FEE: I. � � a CONSTRUCTION LENDING AGENCV PRE-ALT FEE: O � I HEREBV AFFIRM UNDER PENALTV Of PCRJJRV THATTHERE IS ACONSTRUCTION LENDING AGENCV � FOR THE PERFORNANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3a9],CIV.C.;. W S �ENDEF1'S NAME � F— LENDER'SADDRESS /I �J � ICERTIFVTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEMFORMATIONISCORRECT. TOTAL FEES ,�7 Gl, 7 L` � I AGREE TO COMPLV WITH ALL CITY AND COUNTV ORDINANCES AND STATE lAWS RELATING TO BUILOING � CONSTRUGTION,AND HEREBY AUTHORRE flEPRESENTATIVES OF THIS COUNTV TO EMEfl UPON THE ZABOVEMENTIONED PROOERTV FO�INSPECTIO RPOSES. COMMENTS � 7;".�� .�� _ m PERMITT (PFINT� Q � � NATII FPEPMITTEE � DATE ''�� '�( �/ l� - � = RECPT.N0. �___. PAID BY _.�Z_'f"y VALIDATION ~ WHITE—Oepartment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicaM's Gopy ��a��t i a�?�� r � rd^�^�°�" ��' � ��*�sa .n � s a;m� u:, �a �,�;� ,�.k �i� �� I _ , _ , _ . . . . . ,. . _ ..��w.r�'n � ;r�;� e�..., ��/��G' •a�� _ � � � . _ _ , . �„,,' �a � i� x��, _ � , . ., �,.q ,��. � : � � 1 , a � � r p � ,� at �, .. 2 eLy .... . . .. . . .. ..... .. . .. .... ... . .. .. ...... ...... .... ..... . :r 1 es� i ��w��fi Y 3 . . ...... .. .. .�4 b�t}' �� ._.. g � , �'� ..� � xs GI � . .... ... ... . .. . ... .... ... . . . . . . � ...�. {...�IIN "�': 2 m •• • .. . ._ ..._ ... _. ... ..._ ..._ ��. i � � 4 . . . .. ... . .. ... .. ... . .. .... . . . ..... . .... ..... ... ... ...... � 5 }� E�..a 43' � <v= �l��r-%��%.�� .;�; �f t�i.€ er � . ._ . . .... .... ... _... . . . . ..... ....... . . .. _ ... _._. . _ ...... � r �, Y . � . .> . "�. � � .s ', -- � f . .. .. .. _.. .. _.. ... . . ... .. .. ... ... . ... ...... . ._. ._. .. ...... _..... _ CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 --� 1 �3 BUILDING PERMIT APPLICATION PRESS FIRMLY JOBSITE ADDRESS APN LOT TRACT OWNER ADDRESS CITY ZIP TEL. APPLICANT TEL. LA e> S2 CM E�4 C. CONTRACTO R ADDRESS W---Y, CITY my�C ZIP__TEL. 70F ARCWENG/ 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 LF 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).): 0 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 PURSUANTTOTHE CONTRAC- TORS LICENSE LAW.). 73 I AM EXEMPT UNDER SEC. B. &PC, 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 / 7J/ L-39 LIC. N0. LICENSE CLASS DATE 1 CONTRAC WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY 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 ATION INSURANCE CARRIE ND POLICY NUMBER ARE ISSUED. MY WORKERS' Q OMMPPE � Q CARRIER• � 'fl- '- POLICY NUMBER (THIS SECTION NEED NOT BE COMPLETED OF THE PERMIT IS 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 SHO BECOME SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECT N 370 F E LAB HWITH COMPLY WITH TH PROVISIONS. A OR T CODE. y SSHH LLL / I/ 0 DATE:APPL NT: f WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVER E IS UNLAWFU,A SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES U TO ONE HUNDRE HOUSAND DOLLARS($100.000),IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3700 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 I 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 FOB INSPECTION; =05E PERMITT(PRINT) 32 I NATO FPERMITTEE DATE Er 0 w Lu U-1 0 M U 0 C/) 0 W 0 w u� z ¢ w 2f Z C W I APPLICATION PERMIT/P/C DATE NUMBER(6� # ISSUE TYPE OCC DATE CONST.GROUP ZONING SETBACKS FRONT RW^ REAR 11 SIDE/SIDE STREET RW EI SIDE EI PROPOSED USE/-0-A iA 09 N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREANALUATION SFR/ADD/REM U) Garage/Carport W Patio/Deck Ui LL Pool/Spa 0 Z Re-Root Commercial co Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U U W J W Z DO J Z 2 U W I CONSTRUCTION . PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE:/. PRE-ALT FEE: TOTAL FEES COMMENTS A 2 e/ly '7 A. > VALIDATION I RECPT N0.J PAID BY WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy