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Home My WebLink About18060 CITY OF DIAMCIND BAR -''f''�`'`� DEPARTMENT OF COMMtJNi'3"Y&D£VEL4PMENT SERVICES � 21825 E.Copley Drive �`�`"� (909)860-3195 Fa�c(909)861-3117 PRESS �`%w�` " BUlLDING PERMIT APPLICATION FIRMLY � JOSSITE �v� /� /� APPLICATION PERMIT V P/C �a� ADDRE58��fs E T7?.N F✓�� DATE T �1 Ci Z._ NUM8ER r�'�'� # �, ISSUE TYPE OCC -- APN_ �.OT. TRACT _ _._ DATf CQNST. GRdUP p OWNER WA_Q, /49y1Q C:�"G.t�..� — c, ADDRESS��- h .t��rG,a �/��-� ZONING SETBACKS W CITY ZIP TE�� '�j�I��, FRONT RW ❑ � APPUCANT „��p �'f�(.t��-n�s TEL.___ _ REAR ❑�_..— �-��''��' SIDEISIGE STREET RW C] � CQNTRRCTOR�3 C.�J7� I'� /T S S 0 C.. _ SIDE _ ❑— i � ADDRESS��z,.�'�_t/EfR.^�A' A"'✓�=' PAOPQSED USE �Hi 1z^�'f-- �r/�%�...��'.t a cirv,N-. rf..��.�o�a ziP �f i� rE�.f,�___4'0'7 f�� w ARCH/ENG/ � DESIfiNER NO.DWEL. NQ, NO. � ADDRESS UNITS_ STORIES BEDRflOMS � C�Ty ZIP_--- TEL. `n DESCFtlPTION S{2.FT. FACTOR PSF ADJ.AREANALUATION cn � OWNER-BUILDER DECLARATION SFWADDIREM O Gj I HEREBV AFFIRM UNC�ER PENAL7V OF pERJURV THAT i AM E%EMP7 FROM THE CONTRACTORS LI- � G8f'dJB/CB�pOR LLI CENSELAWFORTFIFFOLLOWINGREASON(SEC.7o31.58115WESSANCPROFES510NSGODE:ANYCiTYOfl G_7 COUNTVWHiCHiiEQUiRESp.PEAMiTTOCONSTRVCi,ACTEft,iMPROVE,DCMOUSH,OflftEPAiRANYSTliUG� W P8210/DBCIC GTURE,PRIOR TO ITS ISSUAIJCE.AL50%E�UIRES THE APPLICANT FOR SUCH PERMIT TO FILE A 51GNEU � STATEMENT THAT HE Oft SHE 4S IiCEN5E4 PUftSUANT T4 THE PflOYi51UN5 OF TF�GONTRAGT4RS LI� p00US 8 � CENSE LAW(CMAPI'ER e(COMMENCING WITN SECiIC1N�D00)OF UIVIS14N 3 OF THE BUSINE55 AND PRO� � P � FESSIONSCOpE)OflTHATHEORSMEISE%EMPTTIiEHEFROMANDTHEBASISFORTHEALLEGE�EXEMP• � TION.ANYVKX.ATiONOFSECTIffN703i.58YANYAPPUCANTF4PAPERMITSU9.7EC75THEAFPIICANT70 Z R8-ROOf � ACNI4PENqLTVOFNOTMOPETHANFIVEHUNDREp�OLLAR51f500)J: Q ❑I,ASOWNEflOFTNEPROpERN.ORMYEMPLOYEESWITNWAGESASTHEIRS6LECOMPENSATION, � G6tit1119fCi81 _ �n WILL DO THE WORK,ANO TNE STRllCTURE IS NOT INTENbED OR OFFERED FOR SAI.E{SEC.]flad,BUSI� J � NESS AN�PRt7FES510N5 CODE:THE CONTRACTOpS LICENSE LAW DOES NOT APPLY TO AN OWNER OF j p410PEftTYWNOBViIDSQRiMPROVESTHEREON,ANDWHQDOE^u5UCHWQRKHIMSELFORHERSELFOfl m . � THROl1GHHiSORHEROVMEMPLOYEE5,PROVIDEOTHATSUCHIM?(iPVEMENTSARENOTiNTEND6DOR WQ pFFEqEDFORSALE.IF,HOWEVER,THEBU�L�INGORIMPflOVEMENTI5501DWITHINONEVEAqOFCOMPLE- � TKNi,TtiE OWNEft-SUIIDEfl WFII FIRVE TME BUftDEN QF PftOViNG THAT HE OR SHE DI`J N4T HUtl6 OR � IMPROVE FOR THE PURPOSL OF SALEJ. !J I.AS tlWNEfi OF THE PROPERTV,AM E%CLUSNEIV CQNTflACTING W ITH L'�CENSED CONTqACTOftS � TR CONSTAUCT TNE PRA!£CT{SEC.7044.BUSiNESS AND PF�FESS30NS CDDE:THE GONTRACTQRS�� VH7U8ti0� ADJ.AREA Lll CENSELAWDOESNOTAPPIVTOANOWNEROFAPROPERTYWMOBIIILI]SORIMPROVESTHEREON.AND FWHOCONTRACTSFORSUChlPROJECTSWITHACOkTRAC?C1Rj5jI10ENSEDPUR5UAN7TOTHECONTRAC� QUANTITY RESGRIPTION FEE 70R5 UCENSE LAW}. CC 6.8 P.C.FOft TH15 iiEA50N Q Q U i AM EXEMPT UND£P SEC. .. . v .. 'y-,.. __ � � DATE __ �._ �WNEA ..—. U ,��, W �It;ENSED CONTRACFORS DECIARATION � Q � [� i HER£BY AFFIfiM VJNDER PENALTY�F PERJURY THAT I AM UC=NSED VNREF PROVISIQNS OF CHAPTER � �h T J� � J l� � 9(COMMENC�NG WITN SEC716N 7000}04 D�V�SION 30F THE BUSINE55 ANO Pi'ibFESSIONS CODE,AND Z S{ MV UCENSE IS W FULL FORCE AND EFFECT. m /�''��._ �'�� LICENSECLASS �^` � LIC.NO_ �� .�.� � � DATE�� -- . C6NTRACTOR., A L...�-P. o- W _ � WGRKERS'CdMPENSA7I6N DECLARATION a � U � i HEREE3Y AFFiRM UNDEft PENAI.TY OF PERJURY OfiiE dFTHE FCN.IO�NG 4EClARkTiONS: Gf) z Q L7 �,,,,IHAVEANDWILLMAINTAWACERTIFlCATEOFCONSENTTOSELF-INSUREFORWORKEftS' 2 QCOMi'B!$ATt6N.AS PROVIDEb 8V SFCTIattJ 370o OF THE 1A80R C06E.FOi{THE PERFOpMANCE W OF TNE WORK FOq\VHICN THIS PERMR IS ISSUED. � Q � IHAYEANDWILLMAINTAINWOFiKERS'GOMPENSAfIONINSURANCE,ASREQUIREDBYSECTION Q �37000FTHELABORCODE.FOflTHEPERFORMANCEOFTNEWORKFORWHICHTHISPERM1T15 � ISSUED.MY WOAKFRS'CAMPENSA11Oh'MSURANC.F CARRIEfl AN6 POIiCY NU6iBER ARE: CONSTRI�CTION Q �/ �, CARRlER�"'��'~M� ��r �N'�K� PLAN REVIEW _.... � aoucv NUMaEa�4/�_�._,�C'��.-l�T+ ELECTRIC . `.� ¢ �7`i I�T_—_ � (iHIS$ECTiC7NNE9.1N0T6EWMREfEDOFh1EPEW�AfTISFORONEHINDRFDWI.I.AR5�b100)URLESS). PLUMBING , � �CEflTIFY THAT 7N THE PERFORMANCE OF THE W{7RK F6R WHICH THI5 PERAtIT tS ISSUED,� �ECHANICAI. � � (,� SHAL L�7 EMPLOV ANY PERSCIN IN:1NY MANNER SOAS TO BECOME SUBJECT TO THE �NSPECTION FEE �- � Uj iVOflKERS'COMPENiATIONLAWSOFCAUFOPNIA.ANDAGREETHATiFISHOULDflECOME � �. ., —� r SUBJECT'Q THE WORKk':ft5'COMPENSATiON PflOVIS70Nu OF SECTIpN 3�OOOF'HE LABOP �"1 i"'i R' � ' ,��j_ ��_ � CO��E,)I S�HALL FOn%THWITM COMPLV WIT}I TNOSE PROYISIONS. ISSUANGE .__ _/�,t�.� .�i-- � LU �G- APPLICANT:��/�-C.-�_�(�CMT�F�A'� SMIP _. _.G��7�_." .—.... p UATE:�— ]L!1—._�..1 � ENER�Y PIC . ..�.� � WARNING:FAILURE TO SEGURE W6RKER5'COMPENSA710N COVERhGE IS VNLhWFVL,AHD SHAIi.BE � 6UBJECTANEMPLGVERT4CRIMINALPENALTIESANDCNIL.FMESUPTqONENl1NDREDTNOUSAND ENERGYPEFIMIT � - DOLLhAS{{idO,OWj.tN AbDiiipN TQTIIE COST OF COMPENSATIQN,DAMA6ES AS PR4VIDED FOR IN J SECTION3�OBOFTHELABORG4DE,MTEREST,ANDATfORNEY5FEE5. RETENTIONFEE: _�,__ �' — � W CONSTRUCTI6N IENDING A6ENCY PRE-ALT FEE: .... � . . CL I HEREBY Af�iRlA VkOER PEVA�7Y 6f flEAJURY IHAT TNERE 15 ACGNSTRUCTlON LEND4N4 AGENCY .. .....—..�-- d- FOR TNE PERFORM1iANCE OFTHf wntiN LOR WHICFI THIS PE3iMiT iS�5`aUEp�S£C.999'!.CiV.C.). �^�� — _._ W = LENDER'S NAME .—.__.. � � I.Et3DERSARORESS� __ /''� ('''' """I]]] ' � IGEfl11fYTNATtHAVEAEADTHiSAPPLiCATiONANDS?ATE7HATTHEA&OYEINFffRMATtONl5COftftECT. �IJTAL 1-EES �'� � ' �� i AGREE TO COMPLV WITH ALl CITY ANp COUNTY ORDINANCES ANO STATE UWS RELATWG TO BNLDING �� CONSTRUCTION,AND HEFlEFV AUTHORIZE R[PRESENTATNES OF THIS GOUNTY TO[NTER UPON THE � ABOYE��+IENTIONED PflOPER'.Y i'OR IN°'iPFCTi(�N PURF45E5. _ __ _ � COMMENTS^.. � �r�U�`'�'f G t}-�"t�e4�'`� — — m PER E NAM (PRINT) /�,��'7 . � _G� Z , ,� r„ r�� ` '�o � _ _ _ , � SIG TU NMITT ' nR`TE FiECPT.�O. PAID BY�� VAUDATION�--- _ ' ~ WH1TE—Department Copy.YEILOW—Finance Copy.PWK—Assessor Capy,GOLOENROD—FileCopy,C�REEN—Applicanfs Copy �re � .G� U �� Ntir+�ka � � n.. a�in '"�91 �� . ".��`8�'�� - � . _ � . . . . . . . . ,. . .. . .. .. . , . ., , ��. r v. ._ .._.. ; . . .. .. . . .. .. . . _ . . : . ; ,y =�a �v �. �. " _'... 5 � ' .�- . , 9.;;^; . �i ._.. .... . ... ... . .. .. ... ... .. .: . . ._ ..:.. _.... ... . �: � ! - . _.. . ._ . _. . . . .. . ._ .. .. . _ .... ... . ..... ._ _.. . � ° =��u i�n�a � ,W�� , �. ; � x. s . iz i��i ; . . . .. . ... ... ... ... .. . . .. ��i � k � a� � � r.�'��¢"��"�"��"�'�� 4�'„' �e.i,� � . k�€ ... _ .. . . .... .. _ . .. . .... .. . _.._ __ . .. .. . _.. �. 's �, �"�' �':� '... � 7� � '�. i 3 H sqa: . .._ .. ... . . ...... _ .... ... . ._ .... ., � � �� _,�� ... _. . . . . . .. ... ��. ",- - _ �w �:•t- �, �. �s " f . — .. ... . ... . . . . .. , ' w"� �i �s,= 9 �,, . ... . ... .. .. . . . '° Xr°t ,;i � . . a �� .�Hi ��:n�4lr� � �..., . . . .. . .. . ... . ..... . ... . ..... ... . - � : _'. . � "�-'.. . .,,: . .. . ... ',.� v � F.�, '�. ,� �? -,.y � ., � . � J - . � .,� s'q a o a. �' .... . . .. . .... . . ... ._ . .. .. . ... ,. CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION JOBSITE !�/� / /DQ fs E�,� ADDRESS ft f}/ { . � APN L.OT TRACT OWNER WA/Nhk L�"LL� ADDRESS I 9"L/L/}N t�•rG.� 2. CITY ZIP TEC�vy sy�9z3/ t��'u APPLICANT v�i�/.QLtt-T,S-II��TEL. CONTRACTOR�7; L. i�f}�SSOC. ADDRESS�Z-2��n/iF/F-/� CITY,/V. 1'(.�Ilywra0 ZIP TE�,fI�l 4Q'��2�f7 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- CENSELAW FOR THE FOLLOWING REASON(SEC. 7031.5 BUSINESS AND PROFESSIONS CODE:ANY CITY OR COUNTY WHICH REQUIRES P. PERMI770 CONSTRUCT,ALTER,IMPROVE,DEMOLISH,OR REPAIR ANV STRUC- TURE,PRIOR TO ITS ISSUAIJCE.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- FESSIONSCODE)ORTHAT H E ORSHE ISEXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION.ANV VIOLATION OF SECTION 7031.5 BV ANV APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO ACIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(5500).): ^I,AS OWNER OF THE PROPERTY,OR MV EMPLOYEES W ITH WAGES AS THEIR SOLE COMPENSATION WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC. 7044,BUSI- NESSAND 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, HOW EVER 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 SALE7. ^I,AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSELAW DOES NOT APPL V TO AN OWNER OF A 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. �II LICENSE CLASS � -3G �/L�u LIC. N0. �� DATE�._ !%fi .. 0�CONTRACTORS. L,ff P. 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 BV SECTION 37000E 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 37000E THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MV W ORKERS'COMPENSATION IN SU RANCE CAR I R ER AN D POLICY NUMBER ARE: / J + J• P A � .{-'A/S K CARRIER f�'7 TI�•y�L/'� �/( e POLICY NUMBER�S[,6Z C��_,��[Gj 6 1 c r (t}{IS SECTION NEOO NOT BE COMPLETED OF THE P ERMIT IS FOR ONE HUNDRED DOLLARS(E700)OR LESS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN :1NY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS'COMPENSATION LAWS OF CAU FORNIA,RND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE,I SHALL FORTHWITH COMPLY W ITH THOSEPRO VI SIONS. f �� DATES-�'V2,APPLICANT:V�L--/I�C/S�>f-'�F-1��" WARNING FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS(f 100,000),IN ADDI LION 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 ACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(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 CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION,AND HEREEIY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. PER E NAM (PRINT)�/y/] 'f�^� ^"') SIG TUR ERMITT�"E• DATE WHITE-Department Copy,YELLOW-Finance Copy, PIN PRESS FIRMLY