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Home My WebLink About17973 (10) �` CITY OF DIAMOND BAR � DEPARTMENT OF COMMUNITY�DEVELOPMENT SERVICES ; r 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 PRESS ��'��K°� BUILDING PERMIT APPLICATION FIRMLY � JOBSITE ��'1I'�.� K3�� >- n _ �, ��a,�� _}.. APPLICATION PERMIT -7 P/C o ADDRESS� �� ' �` 1 DATE S � D��i NUMBER � 1 � p °r APN LOT TRACT DA EE S � O�Z-- CONST. GROUP p OWNER �Y1 C� ��.,U�y�'�`��v;1:' p ADDR��SS.�}-�+,J� t2.Li�l'_U:i�—L:.' ZONING SETBACKS z CITY 1JiCl {�)El-'ti-' ZIP il`�/4�!� TELQ!"� '�jL�`�t')L}-�71 FRONT RW (l � APPLICANT TEL. � REAR � z SI�E/SIDE STREET RW ❑ QCONTRACTOR � � � " ' �-� _ SIDE � p� ADDRESS�`.��j t� Y;«�'-i1'l�tV �� . .,r � CITY��,ryti- 21P��,�[�, TEL.'T1�7�K�C��'7�3 PROPOSED USE �'!L- , �2 o ARCH/ENG/ z DESIGNER w NO.DWEL. NO. NO. � ADDRESS v� U N ITS STORI ES BEDROOMS � CITY _ ZIP_ TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADD/REM O � I HERE9V AFFIRM UNDER PENALTV OF PERJURV THAT I AAA EXEMPT FROM THE CONTRACTORS LI- G8f8(JQ/CBfpOR W CENSELAWFORTMEFOLLOWINGREASON(SEC.�031.5BUSINEs"SANDVROFESSIONSCODE:ANYCINOR (n U COUNTVWHICHREOUIRESAPEPMIiTOCONSTRUCT,qL7ER,IMPROVE,DEMOLISH,ORqEPAIRANYSiRUG- w TUFE,PRIOR TO ITS ISSUANCE,ALSO REOUIflES THE AVPLICAN7 FOP SUCH PERMIT TO FILE A SIGNEJ w Patio/Deck � STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PFOVISIONS OF THE CONTRACTORS LI- � � CENSE lAW(GHAPTFR9(CAMMENCING WITH SECTION�000)OF DIVISION 7 OF THE BUSINESS AN�PRO- POOUSPe 0 FESSIONSCO�E�ORTHATHEORSHEISE%EMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP� � V TION.ANYVIOLATIONOFSECTION7031.SBYANVAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO Z RB-ROOf r A CIVIL PENALN OF NOT MDHE THAN FIVE Hl1NDRF�DOLLARS(SSooJ.J� ❑I,ASOWNEROFTHEPROPERTV,ORMVEM17PLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, 0 Commercial Z WILL DO THE WORK,AND THE STRUCTURE IS NOT IN7ENDED OR OFfERED�OR SALE�SEC.]04a,BU51- J � NESS AND PROFESSIONS CO�[:THE CONTRACTORS LICENSE LAW DOES NOTAPPLY TO AN OWNEft OF � PROPERTY WHO BUILDS OR IMPPOVES THEFEON,AND WHO DOES SUGH WORK HIMSELF OR HEflSEIF Orl wTHROUGHHISORHEROWNEMP�OVEES,PFOVIDEDTHATSUGHiMPROVEMENTSARENOTMTENUEDOF m � OFFEREDFORSALE.IF,HOWEVER,iHEBUI�DINGORIMPROVEMENTI550LDWITMINONEYEAROFCOMPLE- Z TION,THE OWNER-9UIL�EFi WILL HAVE THE BUFDEN UF PRUVING THAT HE OR SHE DID NOT BUIID OR � IMPFOVEFORTHEPURPOSEOFSALE). w ❑I,ASOWNEROFTHEPROPERTY,AMEXCLUSNELVCONTRACTINGWITMLICENSE�CONTRACTORS � TO CANSTRUCT THE PRQIECT(SEC.7040.8l1SINE55 AN�7 PROFESSIONS CO�E THE CONTRACTORS LI� VBIUa�10(1 ADJ.AREA W CENSELAWDOESNOTAPPLV70ANOWNEROFAPROPERTVWHOBUILDSORIMPROVESTHEREON,AND FWHOCONTRACTSFOFSUCHPROJECTSWI7HACONTRACTOfl(5)LICENSEDPURSUANTTOTHECONTRAC- OUANTITY DESCRIPTION FEE Y TORS LICENSE LAW.). O ❑I AM EXEMPT UNDEF SEC. _B.S PC.FOR THIS REASON Q � U � � � DA7E OWNER F- Z U � LICENSED CONTRACTORS DECLARATION w Q � I HEREBV AFFIRM UNDER PENALTV OF PERJUFY THAT I AM LICENSLD UNDER PROVISIONS OF CHAPTER � �a� � 9(COMMENCING WITH SECTION]000�OF DIV'.SION 30F THE BUSINESSAND PROFESSIONS GODE,AND Z X MV LICENSE IS IN FULL FORCEAND EFFEGT W '1 m 0 LICENSE CLA55 G�h(r;i�IC:.�IC.NO. •� �� V DATE "� '-�� U�;�- CONTRACTOR��.. C d W � WORKERS'COMPENSATION DECLARATION Q � I HEREBY AFfIRM UNDER PENALTV OF PERJUflY ONE OF THE FOLLOWMG DECLARATIONS: Z Z I HAVE ANO WILLMAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSIIPE FOR WORKEFS' ¢ 2 ¢ COMPENSATION,AS GROVIOED BV SECTION 31o00F 1HE LABOR COD'c.FOF THE VERFORMANCE U OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED. W � � W �I HAVE AND WILLMAINTAIN WORNERS'COMPENSATION INSURANCE.AS REOUIRED BYSECTION Q37000F THE LABOR CODE FOR THE PERFORMANCE OF THE WORK FOR WHICHTHIS PERMIT IS ISSVED.MY WORI(ERS'COMPENSATION INSURANCE CA RIER AND POLICV NUMBERAftE CONSTRUCTION j cnqqiEa��."��. . ��+yC"� . PLAN REVIEW � PO�ICV NUMBER_I C� J�IJ •^ �C':�- ZQ '�'-..• .. • ELECTRIC . _ � (�FISSECTKKJNEmNOTBECOMPLEfEDOfTHEPERMfTISFOFONEHUf�DR�DOLLAfiS(E1W)DFLESS!. PLl1MBING �'I S� W Z I CERTIFY THAT IN THE PERFORMANCE OF THE WORN FOR WHICF THIS PERMIT IS ISSUED,I MECHANICAL (� SHALL NOT[MPLO`/ANY PERSON IN ANV MANNER SOAS TO BECOME SUBJECTTO THE � WORKERS'COMPENSATION LAWS OF CAIIFORNtA,ANDAGREE THAT IF��SHOUL�BEGOME INSPECTION FEE = SUBJECTTO THE WOqKERS'COMPENSATION PROVISIONS OF SECTIVN 3]OOOF iHE LABOR -0� CODE,I SHALL FORTHWITH COMPLY WITH THO/E PROVISIONS. / ISSUANCE � _.:��(�� .�� C"'�J7:.LI `��L�- SMIP p [1ATE� "11_�5✓-7-�14�J� APPLI[:ANT: �� . J WARNINO:FATIWRETO SECURE WORKERS'COMPENSHTION GOVEFAGE IS UNLAWFUL,AND SMALLBE ENERGY P/C � SU6JEGTAN EMPLOYER TO CRIMINqL PENALTIES AND GIVIL FINES IIPTOONE HUN�REfJ iHOUSAND ENERGY PERMIT DOLLARS(5100,000),IN A�[]I710N TO THE GOST OF GOMPENSATION,OAMAGES AS PROVIDED FOR IN J SECTION370B OF THE LABOR CODE,INTEREST,ANDATTORNEY'S FEES. ¢ RETENTION FEE: 1 . UO OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: � I HEREBV PFFIRM LNOER PENALTV OF PERJUflY TNAT TNERE IS ACONSTRUCTION LENCING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHIGH THIS PCfiMITI5155U[�(SEC.3�9],CIY.G.). �—�- z w = LENDER'S NAME � H LENDER'SADDRE55 wICERTIFVTHATIHAVEREADTMISAPPLICATIONANDSTPTETHATTHEABOVEINFOFMATqNISCOqREGT. TOTAL FEES 6,�S v � IAGREE 70 COMPLY WITH AlL GITYAND COUNTV ORDINANGESANO STATE lAWS RELATING 70 BUILDING � CONSTRUCTION,AN�HEREBY FUIHOHILt HEPHESENTATIVES OF THIS COUNTY TO ENTER UPON THE z ABOVEMENTIONED P,flOPERTV FOfl INSPECTION PURPOSES. COMMENTS � 1 �"� . � __'_. m PEFMITTEE NAM INT) ¢ " ./ � y�' � SIGNAT G ITTEE DATE = RECPT.�O. PAID BY � VALIDATION ~ WHITE—De adment Co YELLOW—Finance Co PINK—Assessor Co GOLDENROD--File Co GREEN—A licant's Co P PY� PY� PY� PY� PP PY � �.�'�.� "�"�� - �� '�$,R� ii�,��vP.�� '"i� � a :; - �� _ ;.=7�Ui ^ i,, ��s� ,��,."�.� , _ . . . � , � , �, ��`�i=��; ��•aA � _ —� .„�, � �� -., �� ,�,-' � - . , .; - .. ' , � �N�� khd � IF ,. � ... .. . . . .. . .... .. ... . .. ' R.4 . .. ...... ... . .. xT�a�{k��I'��Y-�PE�S� �M� , . .. . . . . ; 3 E A 9�R�, Yfii'"�`�' �p �iJ� -.�� try §�� 3i€ ': ' 3 ,G " _ _ � ,,�� _. ; �, . a �� a w�� §I � ��s� �'�� m �, , , .. � w� . 4.. _ $; , , a , . �, � �, � � _ _ � �, G .. . . .. .. .. n�`:., � I i. RJi�t q. . ..+'�.k � � ., „ . ,:' .,F., � r , _ . JOBSITE QA- 1� 'm./J N302 ADDRESS-'�-)r��0-t APN LOT TRACT OWNER f_�YiC_-.J,U*it� y_1!7A/ ADDRF, SS�'�4J�t2 Li�i C lA'I i'• r��-C CITY!1 iCl)t'I-�'ZIP TEL.q'7Ct�tZEli� APPLICANT TEL. CONTRACTOR LaAedl 5v-, ADDRESS 3 Z1 Y; i 11�il'I.tV4*4rsf- C CITY',rrti-ZIP'k[C,TEL-Tl 7 CZ76 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- CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE ANY CITY OR COUNTY WHICH REQUIRES A 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). ^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- CENSE LAW DOES NOT AP PLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S)LICENSED PURSUANTTOTHE 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 SECTION 7000)OF DIVISION 30F THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORCE AND EFFECT. C( 1C L .�. LICENSE CLASS r•-I :.LIC. N0. 1 DATE CONTRACTOR 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 WORKERS'COMPENSATION INSURANCE CAF FIER AND POLICY NUMBER ARE Y CARRIER-1 11 e'\ POLICY NUMBER (THIS SECTION NEED NOT BE COMPLETED OF THE PERMIT IS FOR ONE HUNDRED DOLLARS($100)OR LESS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH 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 AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE,I SHALL FORTHWITH COMPLY WITH THO EE PPROWIISIONS. DATE:APPLICANT:Gi 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($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 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 HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. PERMITTEE NAM INT) _/ SIGNAT P ITTEE DATE 06 0 cc 0 C(_ 0 LU w U W 0 U C7 C/) 2 W 0 Z W cc w W 0 LL 0 Q W X W 0 U w C/) in LU W 0 I� z w d 0 W CL Z W cc Lb Q_ CD 0 m C/) C/) F 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 APPLICATION PERMIT P/C-7 Ii-v� DATE_NUMBER. ISSUE TYPE OCC S$02 D ATE CONST GROUP ZONING SETBACKS FRONT RW REAR^ SIDE/SIDE STREET RW^ SIDE PROPOSED USE e-a N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREANALUATION SFR/ADD/REM U) Garage/Carport W Patio/Deck LL Pool/Spa 0 Z Re-Roof Commercial co Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U U W W a U Z U w CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING�1 c) MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE:J . E!0 PRE-ALT FEE: TOTAL FEES COMMENTS F)r,0 RECPT. N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PIN