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Home My WebLink About14246 . � ` ' _1�_ CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � 21660 E.Copley Drive Suite 190 / (909)860-3195 Fax(909)861-3117 ``� PRESS ��+�'� BUILDING PERMTT APPLICA� FIRMLY � JOBSITE = �j PL ATION ) j PERMIT !C l o ADDRESS .�P.yyJ�y�.dy'!.¢v` D (f�' Z�'� DATE / /v �� NUMBER-I��il' �d� $ ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP °C OWNER O " ADDRESS -��Lal "Lw�� d� ZONING SETBACKS z CITY � ZIP TEL. REART RW_ ❑ g APPLICANT TEL. SIDE/SICE STREET RW O � CONTRACTOR SIDE 1-1 , o CITYR.,(�p�, '��,�1C71P i!�>3 TEL.QC9•-S�Z.-1�3'S' ROPOSED USE �1 wo ARCH/ENGJ � DESIGNER NO.DWEL. NO. NO. ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECLARATION SFR/ADD/REM BO I HEREBV AFFIRM UNDER VENALTV OF PERNRY THAT I AM EXEMPT FROM THE CONTMCTORS ll- G8f899IC8fPOf1 CENSELAWFORTHEFOLLOWINGRFASON(SEC.7031.SBUSINESSANDPROFESSIONSCODE:ANVCITVOR (n C� COUNTVNRiICHREOUIRESAPEfM11TTOCONSTRUC7,ALTER.MPNOVE,DEMOLISH,ORREPAIRANVS7RUC- W palio/DeGk w TURE,PRIOR TO ITS ISSUANCE,AL50 REQUIRES THE APPLICANT FOR SUCH PEflMIT TO FILE A SIGNED w � ST�TEMEM THA�HE OR SHE IS IICENSED PURSUANT TO THF.PROVISIONS OF THE CONTRACTORS L4 � CENSE U1W(CNAPTER Y(COAIMENCINO NATH SEC710N 7000)OF DIVISION 3 OF THE BIISINE55 ANO PRQ � PooUSpa FE6SqN5CODE)ORTHATHEORSHEISEXEMPTTHEFEFROMANDTHEBASISFORTHEALLEGEDEXEMP- (� TION.ANVVIOUiIONOFSECTION7a31.58YANVAPPLICAMFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Roof � A CML PENALTY OF NOT MORE THFN FIVE HUNDRE�DOLURS(5500).): ^ ❑I,ASOWNEROFTHEPqOPERTY.ORMVEMPLOVEESWITHWAGE5A5THEIR50LECOMPENSATIOM, O COfilfil8(C18I � Y/ILL 00 TF/E WOHIC,AND TME STRUGiUflE IS NOT INTENOED OR OFFERE�FOR SAiE(SEG.�044,BU51� J � NE55 AND PROFESSIONS COOE:TME CONTRACTORS LICENSE UW DOES NOT APPLY TO AN OWNER OF � PROPERTY VAiO BUN.OS OR IMPROVES hIEREON,AND MMO DOES SUCH WORK HIMSEIF Ofl HERSELF OR C= THROUI3FI HIS OR MERONM EMPLOVEES.PROVIDEDTHAT SUCH IMPROVEMENTS ARE NOT INTENDE�OR m QOFFEFEDWRSALEIF,N�WEVERTNEBNL�MGORIMPROVEMENTISSOLDNATHINONEVEAROFCAMPLE� Z TqN,TNE OWNEN-BUILDER WILL HAVE THE BUH�EN OF VROVING TH�T ME OR SHE DID NOT BUILD OR � IMPROVE FOHTHE PURVOSE OF S�LE�. ❑I,AS OM/NEROF THE PROPERIY,M/EXCLUSNELV CONTMCTING WRH LICENSED CONTMCTORS Q TO CONSTRUCT TNE PqQIECT(SEC.]ON,BUSINESS AND PROFESSIONS CA�E:T-IE CANTFACTORS LI� V8IU8IlOf1 ADJ.AREA W CENSEUWDOESNOTRPPLVTOMlOWNEflOFAPROPERTYWHOBUILDSORIMPROVESTHEREON,MlD � WHOCONTMCTSFORSUGFIPR0.IECTSWI'HACONTMGTOR�S)LICENSEDPURSUANT70TMEGONTRAG QUANTITY DESCRIPTION FEE � TORS UCENSE UWJ. � ❑I AM EXEMPT UNDER SEC. B.6 P.C.FOR THIS REASON Q 3 � � � DATE OWNER_ F" Z _-- w 4 IICENSED CONTRACTORS DECLARATION w � I HEREBY�FFWM UNOER PENALTY OF PEfUUflY THAT I NA LICENSED UN�ER PfiWI510NS OF GHAPTER � �A � � Y(COMMENCING WITH SECTION 7000)OF DIVISION 30F THE BUSINESS AND PROF[SSIONS COUE,AND Z �� MY LICENSE IS IN FULL FORCE AND EFFECT. m � LICENSE CLASS��LIQ NO. � v � � (3 � V DATE t��' � 7 CONTRACTOR c � O- d W � WORKERS'COMPENSATION DGCLARATION U �y �;-L;�. N I HEREBV�FfIRM UNOER PENiLLTV OF PERIURV ONE OF THE FOLLOWING DECLARATIONS: � � Z 0 IMAVEANDWILLMAINTAfNACERTIFlCATEOfCONSENTTOSELF-INSUREFORWORKERS' = Y/ j � COMPEN5.ITKKJ,AS PROVIDE�BV SECTION 370o OF THE UBOR fADE,FOF THE PEHFORMANGE U OF TNE WORK FOq WHICH THIS PERMIT IS ISSUE�. � � �� '.�.rl I W � U,..I NAVE IND WILL MAIMAIN WORKERS'COMPENSATION INSURANCE.AS REOUIRED BY SECTION ''d A Q 3700 OFTHE LABOR CODE,FOR THE 7ERFOHMMICE OF THE WORK FOR WHICH THIS PERMIT IS �,l�S,'l f.y ' � ISSVED.MY WORK 5'COMPENSATpN INS R�PN�CE C�A�Rf�/R AND PO�iGY NUMBER ARE'. CONSTRUCTION '' � �� < �� j CARRIER `�� "Wl/`� � PLAN REVIEW � ... � � f ZPa�cYNUMBER_�¢��5� � ELECTRIC . .._ .___._�___ Q � (IHISSEC710NNE�NOTBECp.iLE'fEDOFhEPERMTS�OR�NE41lN�OPEDDd1ARS(f1m�0{iLE55} PLUMBIN � w I CERiIFYTHAT IN THE PERFOFMANGE OF TME WORK FOR WHIGH THIS PEfiM1T IS ISSl1E�,I ,MECHANICAL Z (} SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SOAS TO BEGOME SUBJECT TO THE � WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGFEE 7H/T IF I SHOULD BECOME INSPECTION FEE = SU&lECTTO THE 1NORNERS'COMPENSATION PflOVI5pN5 OF SECTION 3700 OF THE LABOR � � CADE,ISHALLFORTHWITHCOMPLYWITHTHOSEPROVISIONS. � ISSUANCE Z.� � SMIP p DATE:�� APPLICANT: . -- -�--'-� -'-- --- I w ENEFGY P/C J WAHNINGFAILURETOSECUREWORKERS'COMPENSATIONCAVERAGEISUNIAWFUL,AND HAILBE , � SU&IECTANEMPLOVEP70CPoMINAIPENALTIESAN�CIVIIFINESUPTOONEFIUNDREDTHOUSANO ENERGYPERMIT OOLLARS(f100.000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN J SECTI�!3708 OF THE L480R CO�E,MTEREST,AND ATTORNEV'S FEES. RETENTION FEE: 2 � GONSTRUCTION LENDING AGENCY PRE-ALT FEE: Q I HEREBYAFFIRM UNDER PENALTV OF PERJURY THAT THERE IS ACONSTRUCTION LENDINGAGENCY � fOR THE PERFORMANCE OF iHE WORN�OR WHICH THIS PERMIT IS ISSUED(SEC.30W,CIV.CJ. - �� Z � W � LENDER'SNAME_ � F- LENDER'SADORESS � TOTAL FEES � I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CARFECT. W I AGREE TO CAMPLY WITH ALL CITY AND CAUNTY ORDINANCES AND STATE LAWS REUTING TO BUILDING � CONSTRUCTION.AND HEREBV AUTHORIZE REPRESENTATNES OF THIS COUNTY TO ENTER UPON THE ZR80VE�MENTIONED 7ROPEFTV FOR INSPECTION PURPOSES. COMMENTS � � �'?a ,� ro-cl� Q PERMITTEE NAME(PRINT) N �-.,.� - �I�i-99 � SIGNAT�URE F PERMI� TTEE T' DATE � = RECPT.NO. PAID BY VALIDATION ~ WHITE—DepaAmen[Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy . _ ., . , . n�r� . , � `�'r� ... a 7'"�. �. �i`^-�+� �� `,.�.w�u�,�:,�.� ` �� ,�� w��° s=� , w ,asW�:��u�r'*,a�� ` 'i�W "d�^� ,„ , . � �� s , t �. � � �,d � ,��. t � r`�6„� '� �'��% ! o ��„' �� `�, " $ .. r� ,-�, d. ��-�� s �o-;s �� u �' ` �"'�� zh � ,� � , . r " � , _ _ ' r a� � � . . ... , � , `3,�.. °�b�.�C•� �.i'��. .... ._ . . _. . . .. ... ... _ . . . . . � �� , ,�`... -'l _. .. .. . .. . . . . . .. . .. ..... .. . .. . . .. .... t!�� g I�'-�2� �.'�� ' � , c�l� _. �� ..�-�- �S . _ � ,�.� , ; ,. . ; , , .. , � a , .,� � -� � �'� '�', `Tl�.v,� t��,�.. �,.�� `� s,�-.�� w� 1' _ i ` _ _ _ _ ._:�� x4, � . m. _ � ' , a»� G�� a�s � P�� ,:- �� v mw4. `� �an�,.=s �� ,, _ �. , _ � _;� , , _ ti ,,'�_ ,,.��_, JOBSITE= p J Z,� ADDRESS APN LOT TRACT OWNER ADDRESS CITY ZIP TEL. APPLICANT TEL. CONTRACTOR ADDRESS 2?4WA� CITY ja 7AIP �'I2 7 3 TEL.9C9'--2-I 0�0 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 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 CML 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 VA4000NTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANTTOTHE 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 B(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORCE AND EFFECT. i/- 8 LIC. N0. (v LICENSE CLASS v ,1 X3 DATE I!-I(^ Y 7 CONTRACTOR Ora_jy_ 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 37000F 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 WORK S'COMPENSATION INS RANCE CAR R AND POLICY NUMBER ARE CARRIER POLICY NUMBER (THIS SECTION NEED NOT BE COMPLETED OF THE PERMIT IS FOR ONE HUNDRED DCLUWS($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 WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE,I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE:APPLICANT: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND HALL 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 ACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC. 3087,CIV.C.). LENDER'S NAME LENDER'S ADDRESS I 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 CONSTRUCTION.AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. '?a r� i'ACt/ PERMITTEE NAME(PRINT) D SIGNATURE F PERMIT TEE DATE } c Q 0 w 0 0 0 Cn U3 or W � Z W or W 0 Z W Q W F 2 4 00 cn 0 W Q W Z 0 C!J 0 w J J I w w CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 BUILDING PERMTT APPLICAFFPA PRESS FIRMLY PL ATION jj PERMIT /C J DATE NUMBER- ISSUE TYPE OCC DATE CONST, GROUP ZONING SETBACKS FRONT RW ^ REAR ^ SIDE/SIDE STREET RW ^ SIDE ^ tL � ROPOSED USE N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREAIVALUATION SFR/ADD/REM Garage/Carport w Patio/Deck LL PooVSpa Z Re-Roof Commercial 5 m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE U IT W W �r A 7 10 CL Nov 0 ['y rl aJ Y� raj\J CONSTRUCTION 'T< PLAN REVIEW ELECTRIC PLUMBIN_ MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES COMMENTS RECPT N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy 1 /