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Home My WebLink About15818 (23) CITY OF DIAMOND BAx ��R�D � �� --�' DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � 21660 E.Copley Drive Suite 190 �U N 1 9 1OQ2 . � (909)86Q3195 Faz(909)861-3117 PRES$ " ��`'��' BUILDING PERMIT APPLICATION FIRMLY � JOBSITE r APPUCATION �ERMIT �u P/C o ADDRESS � �^� DATE � �� NUMBER � U # � �SSUE " TYPE OCC APN LOT p TRACT DATE CONST. GROUP °� OWNER �j1�'J/L��// T• �� O �� LL' ADDRESS . - " ZONING SETBACKS o •�-� , w ��,��• FRONT RW ❑ CITY i / /9[ l5✓ ZI .-S TEL �j APPUCANT •T aq,�- ' ✓ TEL. SIDE/SIDE STREET RW O � CONTRACTOR SIDE ❑ ADDRESS � CITY ZIP TEL. PROPOSED USE _ � o ARCWENG/ r J � DESIGNER NO.DWEL. NO. � N . ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCR�PTION SQ.FT. FACTOR PSF ADJ.AREANALUATION y Q OWNER-BUILDER DECLARATION SFR/ADD/REM O p I NEREBV AFFlRM UNDER VENALTY OF PERNRV THAT I AM EXEMPT FROM THE CON7RAC70R5 LI- G2f890/C9fPOf1 W CENSEIAWFOR7HEFOLLOWINGREhSON�5EC.7031.5BUSINE55ANDPfiOFESSIONSCODE:ANVCITYOR (n � COUMVWHICFIRE9UIRESAPERMRTOCONSTRUCT,ALTEH.IMPROVE,DEMOLISH,ORREPAIRANYSTRUC- W Patio/Deck � TURE,VRIOH TO ITS ISSUANCE,/�LSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W � STATEAIENT THAT HE OR SHE IS LICENSEO PURSUAHT TO THE PROVISIONS OF THE CONTMCTORS LI� � CENSE UW(qiAP7ER Y(COMMENCINO N7TH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND Pq0- LL PooVSpa FESSqNS OODE)OR THAT HE OR SHE IS EXEMPT THEREFROM M!D THE BA515 FOP hiE ALLEOED EXEMP- TqN.ANYVIOII�TIONOFSECTION7N1.5BYANYAPPLICANTFOqAPERMITSU&IECTSTHEAPPLICAHTTO Z .Re-Rooi ,(/ � A CML VENALTV OF HOT MORE 7HAN FNE HUNORED DOLUIRS(i500).): � OI,ASOVMEROFTHEPROPERTV.ORMVEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, � COrtIrtIBfClfl1 � �' YALL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70N,BUSI� J N NESS AND PRDFESSIONS CODE:THE CAN7MCTORS LICENSE UW DOES NO7 APPLY TO AN OWNER OF � PROPEHfY W110 BUILDS OR IMPROVES THEREON,AND WHO OOES SUCH WORK HIMSELF OR HERSELF OR � THFqUGH HIS ON HER OWN EMPLOYEES,PROVIDED 7HAT SUtl1 IMPROVEMEN7S ARE NOT INTENDED OR m Q ,OFFEREDFORSALEIF.FIOWEVERIMEBUILDINGORIMPROVEMEHTISSOLDWITHINONEYEAROFCOMPLE- Z 'TION,THE OWNER�ULLDER WILL HAVE TME BURDEN OF PROVINO THAT HE OR SHE DID NOT BUIID OR � IMPROVE FOR THE PURPOSE OF SALE). w ❑I,�SONMEROFTHEPROPEHTV,AAIEXCLUSIVELVCANTRACTINGWITHLICENSEDCONTMCTORS Q TO CONSTRUCT THE PROJECT(SEC.70H,BUSINESS AND PROFESSIONS COOE:THE CANTRACTORS�I- 81U8fI0f1 � U� ADJ.AREA W CEHSE UW DOES NOTAPPLY TOMI ONMER OF A PROPERTY WFIO BUILDS OR IMPROVES 7HEREON,AND � WFpCONTMCTSFORSUCHPRQIECTSWITHACONTMCTOR(SjLICENSEDPURSUANTTOTHECONT{UG , QUANTITY DESCRIPTION FEE Y TORS LICENSE LAW.). ¢ J Q ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR T IS REASON � 3 Q � DATE — � OWNER ��~ U W � LICENSEO CONTRACTORS DECLARATION W � I HEREBY AFFIRN UNDER PENAITV OF PERIUfiY THAT I AM LICENSED UNOER PROVISIONS OF CHAPTER � . d Y(COMMENCINO WITH SECTION 7000)OF DIVISION 7 Of THE BUSINESS M!D PHOFESSIONS CODE,AND Z LL; AIY LICENSE IS IN FULL FORCE AND EFFECT. m 0 � � LICENSE CLASS LIC.NO. J V DATE CONTRACTOR a W t� WORKERS'COMPENSATION DECLARATION Q � U � 1 HEREBY AFFIRM UNDER PEN/�LT/OF PE0.IURV ONE OF THE FOLLOWING DECUMTIONS: N Z Q � I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSUHE FOR WORKERS' 2 � COAIPENSATION,AS PROVIDED BY SECTION 3100 OF 7HE UBOR CODE,FOR THE PERFORMANCE W OF THE WORK FOR NMICH 7HIS PERMIT IS ISSUED. � 0 w _I HAVE AND WILL MAIHTAW WORKERS'COMPENSATION INSUMNCE,AS REOUIRED BY SECTION Q 3700 OF THE UBOR ODDE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMI715 }+/� I nJ/J ISSUED.MY WORKERS'COMPENSATION INSUfUNCE CARRIER M1D POLICV NUMBER ARE: CONSTRUCTION 11�r�i S7'�L�'�Twr� W-/f jc,wqiER PIAN REVIEW � ��/ � VOLICYNUMBER ELECTRIC ` ryt 0 (TFCSSE(.'iIONNE�NOTBE001.�LEfIDOFhEPER1.rTISiaRONEMI�DREDDOLLNiS(t100)ORLESS} PLUMBING I�11!� � �"l 7flAA W ' 'd e LVUU Z 1 CERTIFY TMAT IN h1E PERFORMANCE OF THE WOHK FOf1 WHICH 7HIS PERMIT IS ISSUED,I MECHANICAL 1I�1�"t`v> -- (3� SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJEC7 70 THE v�i � �JI+AJ�1^ }�� e � � WORKERS'COMPENSATION UWS OF CALIFORNIA,AND AGREE 7HA71F I SHOUID BECOME INSPECTION FEE ��++ - 'nI "��(i+tlp�R/d BP S SU&IECTTOTHEWORKERS'COMPENSATIONPROVISIONSOFSECTION37000FTHELABOR ISSUANCE V` ��u,��•�H�T�I CODE,I SHALL FORTHWI7H COMPLV WI7H 7HOSE PROVISIONS. -_ � � SMIP p DATE: APPLICANT: . � . � ENERGY P/C J WARNINO:FAILURE 70 SECURE M/ORKEHS'COMPENSATION COVERAGE IS UNIAWFUL,AND SHALL BE � SU&IECT AN EMPLOVER 70 CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND ENERGY PERMIT DOLLMS(i100.000).IN ADDITION TO THE COST OF CAMPENSATION,DMIAGES AS PROVIDED FOR IN J SECTION 37oe OF 7HE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. RETENTION FEE: Q � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O , � I HEREBV AFFIHM UNDER PENALTY OF PERIURV THAT THERE IS A CONSTRUC710N LENDING AGENCY FOR THE 7ERFOfiMANCE OF THE WORK FOR WHICH THIS CERMIT IS ISSUEO(SEC.3087,CIV.C.�. Z W � LENDER'S NMIE ' � F- LENDER'SADDRESS W I CERTIFV THAT I HAVE READ 7HIS APPLICA710N AND STATE THAT THE ABOVE INFORMATION IS COHRECT, TOTAL FE ES � L � I AGHEE TO CAMPLV WITH ALL CI7V AND CAUNTY ORDINANCES AND STATE LAWS REU71N0 TO BUILDING . . CONSTRUCTION,AND HEREBY AUTHORIZE REPRESEN7A71VES OF THIS COUNTY TO EMER UPON THE � ZABOVE-MENTIONEDPROPE 7VFORINSPEC � RPOSES. COMMENTS � � '�'�� J i � m PERMITTEE NAME( IN7) ' Q � � � SIGNANREOFPERMIT7EE DATE , � RECPT.NO. PAID BY VALIDATION � � WHITE—Depertment Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENROD—Fiie Copy,GREEN—Applicant's Copy .. . .�.i��' i..t�,-.:.,. ...�. ..... . . . .� .. . .. •;. at . �.� '"�'.1:Y.� S `Y'5'r( "y l y �FP".'1. '1 i � .. � f 9 4 . . . . . . . . .� . .. . � . . . . . t� ... . ,.U' :,.1. ... r , � ca�� o� ��.�� R a�s��.��=��c�� . ` . ,� .�„ � f , � � . .:, � . � ��- �� _ „ , , . . } o � _o_; f, �� Z �-.�,e'= e � ��r;` a o- � 'i�' _ .� , e� �. ,. ,, .-sy .�"' ^ . . -�r � �� ',�'a ,' ,�.x. .:'- - ' ..,�, �-.� .''"� .. - �:" ' :.. �. `.'+r', ��, �� H.k�... � � . 4,.. .`. � ,_,. . , ��,:. . ��,_. _ _E ' ,� . .;��.,. :.;�-�-. �.;� SET BACK j FLOOR JOIST FTGS/FORMS/STEEL , ;�,!; FMA REC�MTS , - : �. ' ELECTRIC GROUND - � UNDER FLOOR DU.CT � ` . , . --- GROUND PLUMBING ; � . � : - UN,DER FLOOR,�,CJ�IDUIT - -- --��.�-�-.--_ ��..._� ----_._._.....______._. S�AB GRADE FIREPLACE FOUNDATION TEMP POWER , FIREPLACE BONQ BEAM � WATER SERVIGE " `' MI�D HT. BOND BEAM ROOF SHEATHING 8 Ff. BOND BEAM FRAMINGNENTILIATION • FINAL BOND BEAM ROOF COVER PRE=GRADIRIG � ROUGH HEA7ING BENCHINC� • • ' ROUGH ELECTRIC � �'� � � • ROUGH GRADiNG` � ROUGH PLUMBING '� �' �FINISH•�RADING SHOWEf�/TUB TEST � � - ' POOL EL�CTRIC •. EXT. LATH/SIDING ' POO.L FENCING WALL INSULATION POOL FINAL CEILWG INSULATION � OFFSITE IMPS. , � DRYWALL NAIUNG DEDICA IONS; SEWER � FINAL ENG. SEPTIC TANK , ,LANDSCAPElIRRIG. SEEP PiT/LL. � . _ . .- CN SITE IMPS: ---�--��-- GAS AIR TEST FINAL ZONI�IG � FlNAL CONST. ' � FI�RE DEPT. FINAL FlNAL HEATING _ HEALTH DEPT. RNA� r-iNAL ELECTRIC . . � , . �DEV:'FEES PAID-'�--'- . - •--- f"INAL PLUNIBIt�G " ENERGY � __._ --i---_-------- _____ � � ' R � O '� �:��: I ----- � -- ; +- � . -,� . .. . . • r., , ' - ---------- CONiMEiVTS . � ' �' ' �' ._, , . � .� � ; . - - --------- ,, . , . .� .._ .. . , . . :�;,;. - . . -- . . --,-.-_- - . E .. . . _ --------- ,,. . . . -. :, . ,::,;, . ;,-.... ,, - . ------ -. . -, - . .. --�=:---�r-�; --- SEPTIC TANK SIZE , , . .. , ;. ,.; SEEP P{T/tJ SIZE . ' � . � _ : �' I ;�'�. , _ ;��. . . . 3 y� . . .+f� ;��Jr�O�J.. �� y�`c3t�. ' ' .." '.) 1� ., � _� � .��' . i ' , i} 'd�� Y t� �' " � .� ��i«'� 'F t... +�-wi , .' _____".__�_�_ a4 ,{'�,�(7 S�. � .. f.�. ""' t �. .�.� _ _ ___ � � b y�.�`.' ��k"��'.. � f t .�b;y � . � � , '.,�.' _.'- �: N ; ��;i ,��,:} �.� ti� ��..----_._----- �� .� �, M - il IT\ t.� �! .� � - .T� "_ "_ I .�. I .1.� . -I I . ^ / I • '" ��it�u 0.�te��/ . �889/ I 21660 East Copley Drive, Suite 190 Diamond Bar, CA 91765-4177 909-860-31�5. Fax 909-861-3117 � Job Address: � � � . � I Dear�'roperty Owner: � An application for a building permit has been submitted in your name stating yourself as the builder of the property improvements specified. For your protection, you should be aware that as "owner-builder" you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. , Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the City or County. They are also required by law to put their license number on all pernuts for which they apply. If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $200.00 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. If you are an employer, you must register with that state and federal government as an emplo�er and you are s��bjPct to several obligations including state and federal income tax withholding, federal social security taxes, workers compensation insurance, disabiiity insurance casts, � � . and unemployment compensation contributions. There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to workers compensation insurance. For more specific information about your obligations under the federal law, contact the Internal Review Service (and if you wish, the U.S. Small Business Administration). For more specific information about your obligations under State law, contact the Department of Benefit-Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. I A frequent practice of unlicensed persons professing to be contractors is to secure an "owner- builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractor's State License Board in your community or at 1020 N. Street, Sacramento, CA 95814. Please complete and return the enclosed "Owner-builder" verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. C OF DI M ND BAR C� G��' _ � Dennis A. Tarango, C.B� ' Building Official CITY OF DIAMOND BAR �' .�.; !,., , , , - i OWNER-BUII.DER , , • JOB ADDRESS: f Y`S � D ,A/ � f�c`'l' Attention Property Owner: , An `owner-builder' building permit has been applied for in your name and bearing your signature. Please complete and return this information at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received by us. 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement (yes or no). 2. I (have/have not) signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction: Address Cit Name y • Phone Contractors License No. 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise, and provide the major work: Name Adci'ress City Phone Contractors License No. 5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: Name Address Phone Type of Work �- Signed �ir � � Property Ow er Social Security Number �� '� �� ' ��l`� Date 1� � 2� '-C��