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Home My WebLink About18620 �Y�.`('cc-'c_r � CITY OF DIAMOND BAR �� DEPARTME'�'T OF COIvIMUNITY&DEVELOPMENT SERVICES �,.; 21825 E.Copley Drive (909)860-3195 Faac(909)861-31 L7 PRESS � �� BUILDING PERMIT APPLICATION FIRMLY Q DDRIESS_ /�`I•/��E,�A __ APPLICATION � r f G� PERMIT �/ P/C� l�� o DATE NUMBER � p �� APN LOT TRACT D TE 1 � "— ONST. GROUP p OWNER ��C� S/ T p ADDRESS_��5 / ��f��;�� ZONING SETBACKS z CITY ZIP 7EL. FRONT qyy � o APPLICANT " �sY'/��.af+.r TEL.�/ ,(�,(�� REAR � _ Z ��'��.5 �` E��7'�To+� SIDE/SIDE STREET RW ❑ Q CONTRACTOR_�" ��,G LE.! SIDE U ADDRESS i`�� f/��,[� (�� r � CITY ZIP�� TEL.SI L ' c��1 PROPOSED USE oARCH/EN�� — z DESIGNER _ a ADDRESS --- NO.DWEL. NO. NO. cn UNITS STORIES BEDROOMS__ � CITY ZIP__ TFL._ � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION p SFR/ADDlREM � I HEREBV AFFIRM UNDER PENAITY OF PERJURV THAT I AM EXEMPT FROM THE GONTRACTORS�I- G2f8J0/CBfPOfS W GENSEUWFORTHEFOLLOWIMGREASON(SEG.�o31.56U51NES5ANOPAOFE5510N5CODE:ANVCITYOR (n U COUNTYWHIGHHEIXIIRESAPERMIT`OCONSTRUCT,AITER,IM�ROVE.DEMOLISM,ORREPAIRANVSTRUC� w TUflE,PRIOR TO ITS ISSUANCE:,ALSO REOUIRES THE APPLICANT FO(i SUCH PERMIT TO FILE A SIGNEO w Pd210IDeCk � STATEMENT THAT HE OR SHE IS 41C�NSED PURSUA�JT TO THE PROVISIONS OF TNE CON'RACTORS u- � CENSE LAW(CHAPTEF B(COM�AENCING W�TH SECTION]oao)OF�IVISION 3(1F THE BUSINESS AND PRo- LL POoVSpB O FESSIONSCODE)ORTHATHEORSHEISE%EMPTTHFqcFROMANDTHEBASISFORTHEALLEGEDE%EMP- (!� U TION.ANYVIOLATIONOFSECTION7031.SBYANVAPP�ICAN,-FOqAPEPMITSU9J[C�Sf!{FAGPLICANTTO Z Re-Root A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLLARS(5500))�. � ❑I,ASOWNEflOFTHEP{N)PER�`/,OFMYEMPLOYEESWiTHWqGE5A5TMEIR50LECOMPENSA��ON, � Commercial � Z WIIL DO TME WORK,ANO TME STRUCTURE IS NOT INTENO[D OH OFFERE�FOH SALE(SEC.7044,BUsI� J N NESS AN�PflOFE5510N5 COD[:THE CONTfiACTORS LICENSE LAW DOcS NO'APPLV TO AN OWNER OF = � ��A� .�� PFOPERTV WHO BUILDS OR IMPROVES TMEREON,AND WHO DOES SUCH WORK HIMSELF OF HERSELf OR YL7 � Q THROUGM HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTSARE NOT INTENOE�OR m � OFFEREOFOHSALE.IF,HOWEVE:P.THEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCOMvI.�- ' U � '��' Z TION.iNE OWNER-B111L�ER WILL NAVE THE BURDEN OF PqOVING:HAT HE OR SHE DID NOT 6UILD OR ,O 1�U � IMPROVE FOR TNE PURPoSEOF SALE). `, �� y,� CI,ASOWNEROFTHEPFI�PERTVAMEXCLUSIVELYCONTRACTIN3WITHLICENSEDCANTRACTORS Q TO CANSTRUC7 iHE PRQIECT(SEC.]UaO,BUSINESS AND PROFESSIONS CODE:THF GONTRACTORS LI- V21U8�1Of1 � ADJ.AREA W CENSEUWDOESNOTAPPLYTOANOWNEflOFqPqOPER'VWHOdUIID50RIMPROVESTNEREON.AND � � W/1000NTRACTSFORSUCMPFIQIECTSWITNAGONTRACTOR(�)I.IGENSEDPURSUANTIOTHECONTRAC- QUANTITY DESCRIPTION FEE Y TORSLIGENSELAW.). _ _ � G I AM EXEMPT UN�ER SFC._ __... ._ __ B.8 P G FOR THIS REASON Q ?� U LL DATE OWNER � ¢ Z — —"-- U � LICEIVSED CONTRACTORS DECLARATION w i ¢ 2 I MEREBVAFFIRM UNDER PENAI_TV OF PENURV THAT I AM LICENSEO UN�ER PROVISIONS CF CHAPTER � � 9(GOMMENCINGWITHSECTI0�7o00�OFDNISION30FTHEBUSINESSANDPPOFESSiONSCODE.AND Z �X MV LICENSE IS IN FULL FORCE NND EFFECT. m � LICENSE CLAS �__ �IC.NO. �� U OATE�� _ CONTRAGTOF _ d W � WORICERS'COMPENSATION DECI.ARATION Q � I HEREBV AFFIRM UNDER PENALTV OF PERJUFY ONEOF THE FOLLOWING DECLARATIONS: Z � IHAVEANDWILLMAINT�4INACERTIFlCATEOFCONSENTTOSE�F-INSUREFORWOHKERS' a Z = Q COMPENSATION,AS PROylOED BY SECiION 31000F THE LABOfl CODE,FOF THE PERFORMANCE U OF 7HE WORK FOR WHICH THIS PERMIT IS ISSUED. W � � w I HAVE AND WILL b1AMT�GIN WORKERS'COMPENSATION INSURANCE.AS REOUIRED 6YSECTION Q3]OOOF THE LABOR CODE,FOR THE PEFFORMAhCE OF THf WORK FOR WHICH THIS PERMIT IS � ISSUEO.MV WORKERS'COMPENSATION INSUFANGE GARRIER ANO POLICY NUMBER ARE' CONSTRUCTION � j cnRRiEa �� CG�((�ji PLAN AEVIEW � \„ z POLICVNUMBER_ �s L.r�LI(��L __ FLECTRIC ¢ — Q (7HISSEC110NNE�NOTBECf]MPLEfEDOFTHEPERMRIS�OFONEFIUWREDDOL.IARS(ft00�ORLES51. PLUMBING W Z I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WMIGH THIS PERMIT IS ISSUED,I MECHANICAL C'} SNALL NOT EMPl.OY ANY PERSON IN ANY MHNNER 50 PS TO BEGOME SUBJE<%f i0 IHE �� [n WORKERS'COMVENSA'ION LAWS OF CALIFORNIA,AND REE TYAT IF I �[7�0 BECOME INS�EGTION FEE _ = SUBJeCTTO THE WORNERS'COMPENSATION P �I51 S Of SEC O OOOF THE LABOR . — CODE, NA FORTHW'ITHCOMPLVWITHT fP B ISIONS. ISSUANCE Q � — p DATE: � � ��--� APPLICANT SMIP _ ��' W — J WARNING:FAILVRE TO SEC'JRE WOFKEFS'COMPENSATION COVE AGE IS UNLAWFUL,AND SHALLBE ENERGY P/C J � SUBJECTANEMPLOVERTOCRIMINALPENALTIESANDqVILFMESUPTOONEHUNOREDTHOUSAND ENERGYPEFMIT DOLLARS(S10o.o00;,IN A�OITION TO THE COST OF COMPENSATION,�AMAGES AS PROVIDE�FOR IN _�_ J SECTION3lOBOFTHELABORCO�E,MTFRFST.ANDATTORNEV'SFEES. OC RETENTION FEE: OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: � � 1 HEREBVAFFIRM UN�ER PENA�.TY OF PERJURY THAT THERE IS ACONSTFUCTIOh LENDING AGENCY � FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUEG(SEC.3097,CIV C.�. — Z W = LENDEN'SNAME � F- LENDER'SAD�RE55 � TOTAL FEES �.`5,�5„�J Z� '�J � I CEFTIFV THAT I HAVE READ THIS APPLICATIONAND STATE LHAT'FIE ABOVE INFORMATION IS GORRECT. w I AGREE TO COAAPLV WITH ALL CITV AN�COLINTV ORDINANCES AND STATE IAWS REUTING TO SUI�DING .{/L.' � 2 I � CONSTRUCTION,AND HEREBV NUTHORIZe'REPRESENTATIVES OF THIS COUNiV TO ENTER UPUN�"HE Z ABOVE�MENTIONED PROPERTV FOR WSPECTION PURPOSES. COMMENTS � �. " / — �' � i�ls � _ m PERMITTE_E'NA 'FI - ---' —'"-- — ¢ /� � -. Uj SIGNATU F PERMITTEE DATE - � / RECP?.NQ _ � PAID BY _ VALIDATION WHITE—Department Copy,YELI.OW—Finance Copy,PWK—Assessor Copy,GO�DENR �File Gopy,GREEN—A plican s opy - � � .;�� .. �:�� :� ��:� ��_, ,:, . ;. �� a � ' 9 =��' � � � � � � � _ ,� ., . � ,_,.. � � > . _ j . A � . q��3�'r-<C�`-..� _ _ _ �� , ��,�,. ., ,�� . ,��+ _ . . _ _ _ _.. .. _._ _ _._ :. _ _ _ __ . _ . . , _ _ _ __ —_ . ____ . _ __ ; _ _ . __ _.___ __�_ . _ _ _� � a��-� �;� �m ��,a� w � } _. �� _ _ _._ �� _ : � � � . �,. _ � r _ ; �� .�� _ _ , .,�, _ �� i;� _ �;� j�" -� �. , i �� , n �, ; , , _ __ __ °� i _. c �`'�� _ _ _ ' �. , ��az�� ' _ _ _ _ �� .,< < _ _ _ �� t�;�� _ _ _ . 6� � _ _ _ _ , �� \'r'F�c U1,1JI11�D B,lk i �-�� CITY OF DIAMOND BAR DEPARTME'VT OF COMMUNTII'&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION APN LOT TR A C T �� OWNER'S��i��ii,>�/y/� c�J- ADDRESS_��5/ CITY ZIP 7EL. APPLICANT+��TEL.�E�� CONTRACTOR� " (xJ,� LE.! ADDRESS�� (�(^' CITY ZIP�TEL..SLyL't��l ARCH/EN 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 PERMIT TO CONSTRUCT,ALTER,IMPROVE. DEMOLISH,OR REPAIR ANV STRUC� TUBE,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 B (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 ANV APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(5500)): I,AS OWNER OF THE PROPERN,OR MV EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK,ANO THE STRUCTURE I5 NOT INTENDED OR OFFERED FOH 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'HAT HE OR SHE DID NOT BUILD Ofl IMPROVE FOR THE PURPOSE OF SALE). C I,AS OWNER OF THE PROPERTY AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC. 70sd, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSELAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO d'JII.DS OR IMPROVES THEREON.AND WHO CONTRACTS FOR SUCH PFIOJECTS W ITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). G I AM EXEMPT UNDER SEC._B. 8 P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENAI_N OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PPOFESSIONS CODE.AND MV LICENSE 15 IN FULL FORCE/WD EFFECT. LICENSE C UC. N0. [�� DATE%CONTRACTOR WORfCERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENAI TV OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINTAIN ACERTIFICATE OF CONSENT TO BELF-INSURE FOR WORKERS' COMPENSATION,AS PROVIDED BV SECTION 37000E THE LABOR CODE, FOR THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE.AS REQUIRED BY SECTION 37000E THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MV WORKERS'COMP SATION INSURANCE CARRIER ANO POLICY NUMBER ARE' E'N 7 ) CARRIER�( �-Cl/��/ J / rr / POLICY NUMBER�L)J-��6)L_ V oo� V V (THIS SECTMJN NEED N078E Ef �MP L E DO F THE PEFUAIT IS FOF ONE HUNDRED DOLLARS(ft0010fi LESS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WNICH 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 I�GREE THAT IF I GIJLO BECOME SUBJECT TO THE WORKERS'COMPENSATION P�ISI 7S OF SEC 0 00 OF THE LABOR CODE,I HA FORTHWITH COMPLY WITH T P B ISIONS. DATE: � L�L?APPLICANT WARNING FAILURE TO SECURE WORKERS'COMPENSATION COVE AGE IS UNLAWFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS(f 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 1 HEREBY AFFIRM UNDER PENAI TY OF PERJURY THAT THERE IS A CONSTFUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUEG(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. I AGREE TO COMPLY WITH ALL C.ITV AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION,AND HEREBY/lUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE AROV E-MENTIONED PROPERTY FOR INSPECTION PURP OS ES. / �/ �� F PERMITTE� E'NA RI/ SIGNATU FPERMITTEE pA� WHITE-Department Copy,YELI-OW-Finance Copy,PIN PRESS FIRMLY