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Home My WebLink About17068 - y J ,. , CITY OF DIAMOND BAR '��1 ��'��\ �\� � �;� -, � ��"'� DEPARfiI�NT OF COh�IIv1ITtJTTl'&DEVELOPMENf SER � 21825 E.Copley Drive ,/'� 1 � J � " (909)860-3195 Fa�c(909)861-3117 ,/- PRESS . •`%�x`w BUILDINGPERMiTAPPLICATION �'"'� FiRMLY � JdBSITE �+�r iw-;,,.. � -. ' �+ APPLICATION f � PERMIT P/C �[" i � � ADDRE5S i i�+^��+1 �� .-E l-;y#;°"""�'r` DATE.._.� � -4+�Nt1MBER__�� `_'!:�� c� ISSUE �� TYPE OCC APN LQT TRAGT DAFE C4NST. GRflUi' °C OWNER �'T�1�f. � p —_ ADDRESS ZONING SETBAi�KS � GITY_ ZEP TEL. REART �w [� � APPLICANT PA\� �G�1r�1 TE�/11Fi-�irrY-'4�i ! g�p�g;pE STREET RW ' ❑ � CONTRACTpR ""L�`�.�'1P�� C+ SIDE _ ❑ � ADDRESS �-41 PROPQSED USE_ � cirv 1t2v�,niF�_ z3� T��. - ��'�'t j _ w ARCH/ENG/ , Q��,�„� aG � DESIGNER NO.DWEL (U. NO. � ADDRESS -- .�� ,�, �-�—�[� UNtTS STORIES $EDROOMS � CITY �"C.�C'n r.i ZIP TEL.�_L=.�?� � - DESCRlPTION St}.FT. FACTOR PSF ADJ.AREA1VAlUAT10N cry � OWNER-BUILDER DECLAFATION SFRlADDtREM O (� I HEREBV AFFIPM UNpER PENALTY OF PERJURY THAT I AM E%EMpT FRCkA THE CONTRACTCIRS LI- � Garage/Garport LLJ CENSE LAW FOR THE FOLIOWIN4 REASON(SFC.Ta3�.58USINESSAND pROFESSIONS CODE:ANY GTYOR � CIXINTYWHICHREOUIRESAPERMtTTC7CONSTRUCT,AITER,�M7A4VE,DEMOUSH,ORREPAiRANYSTRUG W patl0/DBCI( W TURE PRIOR TO IT9 ISSUANCE,ALSO RE�UIRES THE APPLICANT FOFl SUCH PERMIT TO FILE A SIGNED � STATEMENT THAT H6 OR SHE#S LICENSED PtlRSUANT TO THE AROVISIONS QF THE CONTNtClC1R5 LI- � CENSE LAW(CHAPTER 9 iCOMMENGINp WITN SECTI�N 1606)OF DIVI51pN�OF THE BUSINESS AND PRO� �" POOUS(J8 FESSIONSCOOE)ORTHA7HEOflSF1EISEXEMPTTMEREFflOMAN�THt8A515FORiHEAILEGEDEXEMP� (�J � T16N.RNYVI6LRTKKiOFSECTiON?431.56YANYAPP�IGhN'fiORAPEAM4TSUB.tECTSTHEARPUGANTTO Z Re-Roof � A CIVIL FENALTY OF NOT MORE 7HAN FNE HUNDRED DOLIARS(S5oo�.): a U�.FSOWNEROFTHEPROPERTV,ORMYEMPLOYEESWITHWAGESASTHEIPSQLECOMGENSA710N, 0 COt71t719fCid) ,–+`. Witl D4 THE W�RK,AND THE STRUCTttRE 7S NOT IMTENDED OR flFFEflEo F6R SAIE tSEC.�6dd,BUSi�� J NESS AND PROFESSIONS CODE:7HE CONTRACTOp5 LICENSE LAW DOES NOT APPLV TO AN OWNER OF �'—n PR07ERTYWHOBUlLDSQHIIAARt?VESTHEHEON,AN�WHODOES6UGHWORKHIMSEIfOftHERSELFOA m � THROl1CH HIS Ofl NFR OWN Et.ipIOYEES,PiiqViOEJ THAT SUCH�MPROVEMEMSAftE NOi INTENqED OR WO QFFEREDFORSALE.IF,H4WEVER,THEBUILDINGORIMPROVEMENTIS56LDWITHINONEYEAPOFCqMPLE- TMN,THE OWNER�BUftDER W1U.HAYE THe BURDEN�F PR4ViNt3 T4AT Me Ofl SHE DIO NOT BUtiD OH � IMPROVEFORTHEPURPOSEOFSALE). �� W ❑I.q50WNEROFTHEPRQPERTY,/ME%CLU5NEI.YCONTRACTMGWITHLICENSEDCONTRACTOR5 (Z TO CANSTRtKT THE PftOJ£GT{SEC.70db,8USlNESS AND PR�FESS16N5 CODE:TNE CANTRACTORS L:� ValUdtiOfi ADJ.AFiEA_, W CENSEUW[70ESNOTAPP'_VTOANOWNERCIFAPROPERTVWH08UILDSORIMPROVESTNEREON,ANP ; � NhqCQNTRACTSFORSUCH?RQIECTSWITHACONTMCTOR{S1lICENSEDPURSllAN7TOTHECON7RAC� QIJANTITY [�ESCRfPT14N FEE TORS IiCENSE IAW,j. � J -I ZZ �`i " ❑{AM EXEMpT UNOEP SEC. Ei.8 P.C.FOR THiS flEA50N Q � � - `-' Z ,".i, C� '�' � � OAtE OwNER U -�—� �ICENSED G4NTRACTORS DECIJtRATiQN �j � d CC 1 HEREBYAFFIRM UN�ER PF.NAl7Y OF PE9.lURY THAT I AM LICENSED UNOER PR�4ISIONS OF CHAPTER �, � 8(COMMENCAJG WITN SECTiON 7�i}6}dF DIVISiDN 30F TNE BUSINESS AND PROFE5SION5 C06E,AND Z w �']'�/�� }{ MY LICENSE I6 M fULL FpRCE AND EFFECT m Z �"Y �[K��rYS � � LICENSE SS �' �O LIC.NO. �� J � UATE �" "� COMRACTOR a W � WORKERS COMPENSATION DEGLARA710N Q� � U � 1 HEREBY AfFiAM UNDER PE'.NAtTY OF PERJURY ONE OF THe FOCI�WtNG 6ECI.ARRTIONS: Sf2 Z Q (� IHAVEANDWILLMAINTAINACERTIFICAiEOFGONSENTTOSELF-INSUREFqRWORKERS' 2 COMPENSAFIaN,pS PRpYiDEO BY SEC710N 3�txt OF THE 1A80R CO�E.FOftTHE PERFORMANCE U 4 OF THE WpqN FOR WHICH THIS PERMIT IS ISSUEb. � O w 1 HAVE ANb WILL MAINTAIN WORHERS'COMPENSATION INSURANGE,AS flEOUiREO BV SEG�ION � 3700 QFTHE LABOR COOE,FORTHE PERFbNMANGE OFTHE WORK FQR WHICH TF'.IS PERMIT IS 4SSUED.MY ERS'GORiPENSATN>N INSUR CE CApR7ERAND PCX.ICY NUMBERARE CONSTRUGTSON ^C ��I1��..�S�� PLAN REVIEW y cnaaiea—� �ty� ��'�'� � POLICV NUMBEa 'IJ_��,�_.��-�Z� ELECTRIC .� ��yST—,,,�,_v Q � �_ � ��ssEcnoHN[mrioTaEo�rtFreaoFTr+E��w�+�+EnuroRE000tuas�s+ao)oF1�ESS). PLUMBING __., W i CEHTifYi'HAT iN itiE PERFORMANCE OF T�iE Wq FOR WHt THIS RMIT tSISSUED,i AAECHARtICAI... � (J'' SHAL4 NOT EMPLOY ANY PERSqN IN ANY MANNE ME U Ef;T TO THE (,() WORNERS'C�MPEM1SAiIONLAWSOFCALIFOHNI DA. � T ATI I OULDBECOME INSPECTIONFEE - SUBJECTTGTHEW6AKFRSCO6iPEN5AT N? SION T a00FTHELA80R � �p�,1 �FORi WITH C4MPLV WR MOS OVI� ISSUAN(�E �,,,,,,. _,__,._. � 17ATE.^,,,_..�� APPLICANT; SMIP _ ... _ W EtJERCiY P!G J W0.RNING;FAILURE TO SECURE W6RKEA5 C I CAVERAGE tS UtVIAWFI&.,ANG SHAtL BE —"—"—"' """—" — � SU&IECT AN EMPIOVERTl7 CRIMINAL PENAlTIES D C L FINES UP TQ ON6 NUNDREDTNOUSANp ENERGV PERMIT DOItAflS(StOD,OW).IN AOD1710N TO THE COST OF COMPENSATIpN,DAMAGESAS PRO4IDED fOR IN � SECTI6N�7p80F iHE�A60R COpE,INTEiiEST.ANDATiOftNEY'S FEES. RETENTION F E: ,_ � W CC7NSTRUGTION IENDtNG AGENCY PRE-ALT FEE: o_ — O � I HEfiEBY AFFIPM VNDEfI PENALTY OF PERJUftY THA7 TNERE IS A CON4TRUCTION LENDLNG AGENCY � FOR 7NE 9ER WRAAANCE OF THE WOflK F�P WHIC.H THIS PERMIT IS ISSUED(SEC.30D],CIV.C.j. ^- W ,S� t.ENpEft'SNAME_ ........_.. - , FA I.ENDER'SADpRESS�_ 1 a � I GEFTIFY THAT I E A�THIS APPLICATIO D STATF THAt THE ABQVE 1NFOAMATION I5 CORRECt TOTAL F E ES \1 {j�� I AGREE TO PlV AlL tl OR�iNANCES AND SZATE UWS RELATING TD BUILD�NG { � � ��lJ a � CONSTR N,AN ERE Al ORI P RE5ENTATIVESOFTHISGOUNTVTOENTE(7UPONTHE � AB(WE-jA ION M'.. TY RM E ION PURFOSES. {�`QMMENTS. ..,__ .._.,.._ .... � J � ...__ ...__.. __ m PE NAME(PRI '� Q , • � "'_/'1� ._._ — [!S t� �... � SIGNATUREOFPERMITTEE ^ OATE � T2ECPT.N4. .,,�PAID BY VALIDATIdN _ �' WHITE—Department Copy.YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENFl4C�Fils Copy.6REEN—ApplicanYs Copy �a � . �� +;�ara ��b � � � �� 'p'�" �„��'"C ��.,��'. ;��`�1�.��'��.�m� ��`y� ,� `y �.,� s,.,',�� - . . ,_ . ,m r" � . _ ,�& .... . ... . . .. ... .. -- `� ^� ��a � � . . .,a , � _. ��., .; > . ,,�-� .�� l ,��r��''��'�' �� ,d �� _ � 4 �-�>:� �� , � �, � � �� ''� �-- . _ _ __ _ � f ; � g , m � r 6 � ��. �� a� � ��° , '"�;'"'s ' � .; � .' h-��` ��Sr�w�� s�� . . . ... . . . .. .. .. —� �A��j��us�� a��' 7' iz f : _ ... —. �� , � �,�n a ��:� �� = �r �4 '� i�� _ _ , P ,� � .Ai h �ia a::�x�,w,� ��"�y� � at�^, � , x � 1 - 4,. �� . . ._ . .. . . . . . ..... . . . .... _ .t: �� . .p �� 1">, a . . ... .. . . . .. . ._ . � � I � ,rt I � M B � �- . .. _ .. . . ..._ . . .. .. . ._. .. . ... .. .... ... � r. , � a � ��.. . 1a'' i nl :;i i�°a@ �y �h�" � .. . ... .. .... .. ..... ...... .. ... ... ��. ^ .�, §�;:� , , .I .. ... ... .. ... . . . . . .. . .._ ._. . (�Y CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SER 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION PRESS FIRMLY JOBSITE�g j�, , fll ADDRESS-- APN LOT TRACT OWNER elk!A T>4 ADDRESS CITY_ZIP TEL. APPLICANT TEV(Jf?-44 CONTRACTOR I C, ADDRESS 116&!Z L I CITY 19Vtd-19-7 ZIP TEA L4-q-&' D ESIN ER/ DESIGGNER 12!RR'M 4ASSOC- ADDRESS 1!%2 Z Is Lin I CITY qus"pZIP 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 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 IMPROVE FOR THE PURPOSE OF SALE). ^ 1,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 APP_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. &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 SECT ION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORCE AND EFFECT. 4 +C I S LO a, L CEN E SS LIC. N0. DAT// E �CONTRACTOR sei"S WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: -I 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 ERS'ION AND POLICY NUMBER ARE: MM �� e�v llffii SS�� CARRIER lI„ �� }�� 4�-4 J POLICY NUMBER 2)e rot: 3 ) ��// (THIS SECTION NEED NOT BE COMPLETEDOF il# PE FOi NE HUNDRED DOLLARS(5100)OR LESS). WHI H THIS RMIT IS ISSUED,I I CERTIFY THAT IN THE PERFORMANCE SHALL NOT EMPLOY ANY PERSON IN AME U ECT TO THE WORKERS'COMPENSATION LAWS OF T AT I ULD BECOME SU BJECT TO THE WORKERS'COMPENTI 00 OF THE LABOR M ejDE,I WITH COMPLY W 0 DATEAPPLICANT WARNING FAILURE TO SECURE WORKERS'COAGE IS UNLAWFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIUP 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. CONSTRUCTION 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 E AD THIS APPLICATIO D STATE THAT THE ABOVE INFORMATION IS CORRECT AGREE TO PLY H ALL U ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTR N,AN ERE A ORI R RESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-N ZONE RO TY R IN E ION PURPOSES. PE NAME(PRI)_/AO �/� SIGNATURE OF PERMITTEE DATE APPLICATION PERMIT P/C� DATE�V 1 NUMBER ISSUE TYPE OCC DATE CONST._GROUP ZONING SETBACKS FRONT RW^ REAR^ SIDE/SIDE STREET RW^ SIDE ^ PROPOSED USE_Uj) N0. DWEL. m. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREAIVALUATION SFR/ADD/REM Garage/Carport LLI Patio/Deck LU LL Poo(/Spa 0 Re-Roof Z 0 Commercial 5 m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE 0 U W LU 2245 0- Z 2 U W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION F E; („V PRE-ALT FEE. T FEES 1 V f� COMMENTS RECPT N0. PAID BY•VALIDATION WHITE-Department Copy,YELLOW-Finance Copy,PINK-Assessor Copy,GOLDENFIOD-File Copy,GREEN-Applicant's Copy 1CAPS