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Home My WebLink About17834 �� CITY OF DIAMOND BAR - �yr�� DEPART?v1ENT OF COMMUNITY&DEVELOPIvIENT SERVICES ','�'y 21825 E.Copley Drive �% (909)860-3195 Fax(909)861-3117 PRESS �A�^ � BUILDINGPERMTTAPPLICATION FIRMLY y JOBSITE �� I� APPLICATION l�1_� O�UMB R �� #/C 0 ADDRESS ti DATE � o ISSUE TYPE OCC °�° APN I_OT TRAi T DATE CONST. GROUP p OWNER �InC�, Y��I l� p ADDRESS ZONING SETBACKS z CIIY _�� ZIP TEL. FRONT RW ❑ � APPLICANT _ TEL. REAR ❑ QSIDE/SIDE STREET RW ❑ ¢ CONTRACTOR_ SIDE � � ADDRESS o ��Ty + • - PROPOSED USE w ARCH/ENG/ 3��' z DESIGNER k�kNWQOf},CA. 9O7�Z w — NO.DWEL. NO. Np, � ADDRESS � CITY ZIP TEL. UNITS STORIES BEDROOMS cn cn DESCRIPTION S4.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADD/REM O � I NEREBV AFFIRM UNDER FENALTV O:PERJURV THAT i AM EXEMPT FROM THE CONTRACTORS LI- G8f8JQIC8fpOfl W CENSELAWFORTHEFOLLOWINGREASON(SFC_�031.58USINESSANDPROFESSIDNSCODE:ANVdTVOR (n U CAUNTVWHICHREQUIRESAPERMITTOCONSTRUCT,ALTER,IMPfiOVE,DEMOLISH,ORREPAIRANVSTflUC- w TURE,PRIOR TO ITS ISSUIWCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W Patio/Deck � STATEMENT THRT ME OR uME IS LICENSED PURSUANT TO THE PPOVISIONS OF THE CONTRAGTORS LI- � � CENSE LAW(CHAPTER e((:OMMENCWG WITH SECTION�o0ol oF�IVISION 3 OF THE BUSINESS AND PRO- PooUSpa O FESSIONSGODE)ORTMATHEOF7SHEISEXEMPTTHEREFFOMANDTHEBASISFOfiTHEALLEGEDE%EMP- (� U TION.ANYVIOLA710NOF51=CTION7031.SBYANYAPPLICANTFORAPERMITSU&lECTSTHEAPPLICANTTO Z RB-ROOf � A CNIL PENALTV OF NOT MORE THqN FNE HUNDRED DOLLARS(f500).)�. 0 ❑I.ASOWNEROFTHL'PROPERN,ORMVEMGLOVEESWITHWAGESASTHEIRSOLECOMPENSATIUN, � COR1fIlEfC18I Z WILL DO THE WORK,AND'fHE SiRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7044,BUSI- J � NESS AND PROFESSIONS COOE:THE CONTRACTORS LICENSE lAW DOES NOT APPLY TO AN OWNER OF � PROPERTV WHO BUILDS OH IMPROV[S THCREON,AND WHO DOES SUCH WOflK HIMSELF OR HERSELF OF Q THROUGHHISORHEROVliVEMPLOVEES,PPOVIDEDTHATSUCHIMPROVEMENTSARENOTINTENDEDOR m Q OFFEREDFORSALE.IF,HOWEVEfl,THE8UILDINGORIMPROVEMENTI550lDWITHINONEYEAROFCOMPLE- Z TION,THE OWNER-BUILDER WILL MAVE THE 9UROEN OF PROVING THAT HE OF SHE DI�NOT BUILD OR � IMPROVE FORTHE PURPOiE OF SALE�. w ❑1,AS OWNEROF THE PROPERTV,AM E%CLUSIVEIY CON7RACTING WITH LICENSED CONTRACTORS � TO CONSTRUCT THE PRQIECT(SEC.7044.BUSINESS AND PROFESSIONS COOE:THE CONTRACTORS LI- Va1118tiOn ADJ.AFlEA W CENSEUWDOESNOTAPPLVTOANOWNEROFAPROPERTYWHOBUIL�5091MPROVESTHEREON,AND � WHOCON7RACTSFOpSUCHPROJECTSWITHACONTRACTOR(S)LICENSEDPUFSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE Y TORS IICENSE LAW.). � ❑IAM EXEMPT UNDER SEC. 8.8 P.C.FORTHIS REASON � � ¢ � U � � DATE OWNER U Z W � LICENSED CONTRACTORS DECLARATION w ¢ � I HEREBYAFFIRM UNDEH PENALTY OF PERJURV THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER � .. p. B(COMMENCING WITH SECTION 7000)Oi OIVISION 30F THE 9USINESSAND PROFESSIONS COOE,AND Z X MV UCENSE IS M FULL FORCE AND EFFECT. J �"' ' �Z 2 � `' LICENSE S �� LiC.NO. � _ � � J U DATE � CONTRACTOR d W � WORKERS'COMPENSATION DECLA I ``� � Q � I HEREBY AFFIRM UNDER F'ENALTY OF PERJUPV ONE OFTHE FOLLOW�NG DECLARATIONS: Z ZI HAVEAND WILL MAINTAINACERT��.FlCATE OF CONSENTTO SFIF-INSURE FOfl WORKERS' _ ¢ CAMPENSATION,AS PROVIDED BV SECTION 3'/0o OFTME LABOR GODE,FOR THE PERFORMANCE U Q OF THE WORK FOFt WHICH THIS PEFlMIT IS ISSUED. � w I HAVEAND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOl11RE0 BY SECTION O 7oa OF THE LABOH CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMiT 15 ISSUED MV�y�q}R/�5 RS' OA NSATIO INSUPANCE CARRIEa ANO PO�ICV NUMBER ARE: CONSTRUCTION � CAftRIER 1 1� � PLAN REVIEW 0 aoucv uuMeEa_ � C I e �� ELECTFi�C Z _— `` ¢ (iF115SECTIONNEECNOT8E�.IPLETEDOFTHEPERM1UTISFORONEHUN�REDDOLLARi(5100jORLESS). PLUMBING .\�v � Z I CERTIFY THAT M��HE PERFORMANCE OF TNE WORK FOR WHICH THIS PERMIT IS ISSUE�,I MECHANICAL � SHALLNOT EMPLOV ANV PERSON INANV MANNEF SOAS TO BECOME SUBJECT TO THE � WORKERS'COMPENSATION�AWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOMC INSPECTION FEE � SUBJECT TO THE VVORHEFS'COMPENSATION PROVISIONSOF SECTION 3�aoOF THE LABOR `� � � I 5 FOfiTMWITH COMPLV WITHy T�MnOSE P��QQQ VI51��0 Q I ISSUANCE � ��/ O �� ,,l��l/ , v�� SMIP p DATE: APPLICANT: _.__.. J WARNING:FAILURE TO SECU{iE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALLBE ENERGY P/C _ __, _ � SUBJECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOLLARS jtl oo,000),IN ADI]ITION TO THE GOST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN � SEGTION 3708 OF THE LA6JR CODE,INTEFEST,AND ATTORNEY'S FEES 1�-- RETENTION FEE: I ..� � CONSTRUCTION LENDING AGENCV PRE-ALT FEE: O � I HEREBYAFFIRM UNOEfl VENALTV OF PERJURV THAT THERE IS ACONSTRUCTION LENDING AGENCV . FOR TME PERFORMANCE(>F THE WOPK FOR WHICH THIS PEFMIT IS'�SSUED jSCC.]OB�,CIV C.�. -- W 2 LEND[RSNAME � F— LENDER'SAD�RE55 /� � I CERTIFV THAT I HAVE REN�THIS APPLICATIOH AND STATE THAT TH[ABOV[INFORMATION IS CORRECT TOTAL FE ES �� r�../'L.� I W 1 AGREE TO COMPLV WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS fiELATING TO BUI�DING � CONSTRUCTION,ANDHEREBVAUTHORIZEREPRESENTATIVESOFTNISGOUNTYTOENTERUPONTHE � ABOVE�MENTIONED 7ROPI:ftTV FOR INSPEGTION PURPOSES. Z COMMENTS � tiil � ( ,� W�( ��C� m PER NAME RINT) � �,^ Q ��'�e I NC�,�,t� 3�28� - -� --- � Uv � SIGNATU EOFPERMI E�.= �ATE = RECPT.NO. PAID BV VALIDATION ~ WHITE—Da artment Co VELLOW—Finance Co PINK—Assessor Co GOLDENRO�File Co GREEN— IicanPs Co P PY� PY. PY. PY. MP PY r i i � '�� u�.�" '� ��a '�i i r _ ;€n �i �W�ii ��g�p��.: �� Er,. a�.. & � � ,k�.� "v . , : �. , � . »�.�� _��:��k��u��' ; __ � a q�.., , � .. � . ��+�"�."� _ _ _ _ ' � i r� _ ' i ' is 1 �� dam Mu�;�9�'f� i °�� i�� '�` " �� i��3��u�a� i�,��r�6`�� .: _ _ � � ,�� ..�� I '; i�" ;� . . . . . .. .. . .. . . ,'. �wi� - . t �� . � r � � .. ... .. . . . . ... . ... ... . . . .. .... . . ._ . .._. .. ., , # . — .._.. . �;'��"�� 1��a�� . �; �' ;�,`i� ; "� ;rr�� _ � �;� a u� - 2�� P: �� n �rs� ; -,., .. ... . .. . ... . ... .... . . _ . .. ............. . ... . ... ... . .. .. . . , ',� ti . i� �. : � � a i m�� _^ � �'��`,-�¢ _ �. '�,. .. ...... ... ... .... ... . . CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION PRESS FIRMLY JOBSITE ADDRESS�Q APN I_OT TRA T OWNER�Ir1C', �(�(1�A� ]- ADDRESS CITY � ZIP TEL. APPLICANT TEL. CONTRACTOR_ ADDRESS CITY' 3 �� ARCH/ENG/ DESIGNER k�kRWQOf},CA.90712 ADDRESS CITY ZIP TEL. OWNER-BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT i AM EXEMPT FROM THE CONTRACTORS LI- CENSELAW FOR THE FOLLOWING REASON(SEO 7037.5 BUSINESS AND PROFESSIONS CODE:ANV CITY OR COUNTY WHICH REQUIRES A PERMITTO CONSTRUCT,ALTER,IMPROVE,DEMOLISH,OR REPAIR ANV STRUC- TURE,PRIOR TO ITS ISSU/WCE,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((:OMMENCING WITH SECTION 7000)OF DIVISION 30F 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 SE=CTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(5500).): ^I,AS OWN ER OF THC-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,BUSK NESS AND PROFESSIONS(:ODE: 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 OWV 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 W ITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). ^I AM EXEMPT UNDER SEC. B. 8 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 SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MV LICENSE IS IN FULL FORCE AND EFFECT. u''n/ /-I� L.�— LICENSE S� � LIC. NQ �� DATE S�CONTRACTOR P WORKERS'COMPENSATION DECLA I I HEREBY AFFIRM UNDER F'ENALTV OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINTAIN ACERTIFICATE OF CONSENT TOSEEF-INSURE FOR WORKERS' COMPENSATION,AS PROVIDED BV SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMANCE )OF THE WORK FOFI WHICH THIS PERMIT IS ISSUED. �� T��I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION �� 700 OF TH E LAB 0 R CODE,FOR THE P E RFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS INSURANCE CARRIER AN D POLICY NUMBER ARE: 1 $ N / / CARRIER 1 1 t,.^��LA %% POLICY NUMBER �C I E OO GI (THIS SECTION NEEC NOT BE CTNAPLETED OFTHE PERMn IS FOR ONE HUNDRED DOL(ARS(5100)OR LESS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN.ONY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF 1 SHOULD BECOME SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 37000E THE LABOR 15 L FORTHWITH COMPLY WITH'i�TrHn'OS1E PR VISIO v� �/ 1�1/�� DATE � ��APPLICANT c�V,�F�LVIA 'Ii f WARNING FAILURE TO SEf.URE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS(5700,000),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 F'ENALTV OF PERJURY THAT TNERE IS ACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC. 309],CIV C.I. LENDERS NAME LENDER'S ADDRESS I CERTIFY THAT I HAVE REND THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT 1 AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OFTHIS COUNTY TO ENTER UPON THE ABO M ENTIONED PROPI= VE� R N FO R I N S P E C TI ON PU RP 0 SES. � �� Q / fd �'P�P\ �I )I // / / / I PER NAME RINT)y A_+ -/��I�/F/_� / 1 v V\ � J / SIGNATU E OF PERMI E • D�AT Y .� { E � J WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy