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Home My WebLink About18274 �x��,r��t � CTI'Y OF DIAMOND BAR � DEPARTMENT OF COMMUNTTY&DEVELOPIv1ENT SERVICES 21825 E.Copley Drive " �"'`'i� (909)860-3195 Fa�c(909)861-3117 PRESS �� BUILDING PERMIT APPLICATION FI LY y JOBSITE / .ry��I%,'a J'� /� APPLICATION{1 �,.� i�� PERMIT � P/C o ADDRESS �LL C��G�G7./Jl, C��-� DATE � ! t' NUMBER ri � — ISSUE � TYPE OCC APN LOT TRACT ____.___— DATE 4 s--� CONST. GROUP p OWNER _ o ADDRESS � i ZONING SETBACKS z CITY ZI . EL FRONT RW ❑_ � APPUCANT � TEL ,Z_!L -�. REAR ❑_ Z SIDE/SIDE STREET RW ❑ ¢ CONTRACTOR_ SIpE ❑ ADDRESS � ��c� � CITY ZIP TEL. PROPOSED US� o ARCH/ENG/ — z DESIGNER � ADDRESS NO.DWEL. NO. NO. � CITY _ ZIP TEL. UNITS � STORIES �_ BEDROOMS� � cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADD/REM O 0 I HEREBV AFFIRM UNGEi7 PENALN OF PERJURY THAT I AM EXEMPT FROM iHE CONTRACTORS LI- G8f8(JB/CBfPOfI W CENSEL4WFORTHEFOLLOWINGREASON(SEC.7o31.5BUSWESSANDPROFESSIONSCADE:ANVCITVOR (n U CDUNTYWHICHREOUIRESP,PERMITTOCANSTRUCT,ALTER,IMPROVE,DEMOLISH,DRREPAIRANYSTRUC- W TUqE,PRIOR TO ITS ISSUA:JCE.AL50 REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W Pei10/DBCk � STATEMENT 7HRT HE OR SHE IS LICENSED PVflSUFNT TO TME PROVISIONS OF THE CONTRACTOFS LI� � � CENSE LAW(CHAPTER 9(G7MMENCING WITH SECTION 7000)OF�IVISION 30F THE BUSINESS AND?RO- POOVSpe � FESSIONSCODE)ORTHATHEORSHEISE%eMPTTHEREFROMANDTNEBASISFORTHEA�LEGEDEXEMP- (!3� U TION.ANVVIOLATIONOFSE�TION7D31.SBYANVAP?UCANTFORAPERMITSUBJECTSTHEApPLICANTTO e-Roaf �J � A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(f500)J: � C71,ASOWNEROFTHEPFOPERTV,ORMVEMPLOVEESWITNWAGESASTHEIRSOLECOMPENSATION, � COfiIf118fCIflI Z WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDE�OR OFFEREO FOa SALE(SEC.�OH,BU51- J � � NESS AND PPOFESSIONS O�DE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER O'r � PROPERTV WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR 'i CC THf10UGHHI50RHEROWNEMPLOYEES,PROVI�ED?HATSVCMIMPROVEMENTSARENOTINTEN�EDOR m I Q OFFEREDFOflSALEIF,MOWEVER,THEBUILDINGORIMPROVEMP1TI550LDWITHINONEYEAiiOFCOMPLE . Z TION,THE OWNEFi-BUILDER WILL HAVE iHE BUP�EN OF PqOVING THAT HE OR SHE�ID NOT BUIL�OR � IMPROVE FOq THE PURPOSE OF SALE). w ❑I,ASOWNEROFTHEPROPERTV,AME%CLUSNELYCONTRACTINGWITHLICENSEDCONTRACTORS � TO CANSTRUCT THE PRQIE�:CT(SEC.7040.BUSINESS AND PROFESSIONS CODE:TNE CONTRACTORS�I- eti0fl '� ADJ.AREA W CENSELAWDOESNOTAPPLVTOANOWNEROFAP90PERTYWHOBUItD50RIMPROVESTHEREQN,AND � WHOCANTRACTSFORSl1CHPRQIECTSWITHACONTRACTOR(5)LICENSEDPURSUANTTOTHECONTFAG QU NTITY DESCRIPTION FEE Y TORS LICENSE LAW.). � J O ❑I AM EXEMPT UNDEFI SEC. B.8 P.C.FOR THIS REASON Q � � U � K O W � LICENSED CONTRACTORS D CLARATION W ¢ � I HEREBV P.FFIRM UNDER PF:NALT�OF PERJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � d 9(COMMENCING WITH SEC'.'ION loao)OF DIVISION 30FTHE BUSINESS AND PROFESSIONS CODE,AND Z X MV LICENSE IS IN FULI FORCE AND EFFECT. W CO � UCENSE CL4S5 LIC.ND. j r J V DATE CONTRACTOR d W � WOpKERS'COMPENSATION DECLARATION Q � IHEREBVAFFIRMUNDERPE:NALTVOFPERJURYONEOFTHEFOLiOWINGDEC�ARATIONS�. Z ZIHAVEANDWILLMi,INTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWORNEFS' _ ¢ COMPENSATION,A5 PFOVIDED BY SECTION 31oa OF THE LABOR CODE,FOR TNE PERFORMANCE U Q OF TNE WORK FOR WHICH THIS PERMIT IS ISSUED. � Qw I HAVE AND WILL MO,INTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIFED BY SECTION �']/71� 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ��1�( 0 ISSUE�.MY WORKERS'COMPENSATION INSURANCE CARRIEP AND POLICY NUb1BERARB CONSTRUCTION � �) Q � CARRIFR PLAN REVIEW ZPOLICV NLIMBER_ ELECTRIC ._ Q � (1HISSEC'IONNE�IJOTBECQ'dRE7EDOFTHEPERMIiISWRqJEHUNDREJDOLI.ARS(EiaD)ORLESS} PLUMBING _ _ —_ Z I CERTIFV TNAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUEO.I MECHANICAL �J SHALL NOT EMPLO�'ANV PERSON IN ANV MANNER SO AS TO BECOME SUBJECT TO THE Uj WORKERS'COMPENSATION LAWS OF CALIFORNIA,ANDAGREE THAT IF I SHOULD BCCOME INSPECTION FEE = SUBJECTTOTHEWORKERS'COMPENSATIONPROVISIONSOFSECTION3]aoOfTHELABOR +'�� CODE,I SHALL FOR�HWITH GOMPLY WITH THOSE PqOVI510N5. ISSUANCE O �, b /�' p �ATE: . ......_......... APPLICANT: ............. .._.....___.__....___._. SMIP t S7[�__.. J WARNING:FAILURETO SECUqE WOftKERS'COMf'ENSA'ION COVERAGE IS UNLAWFUL,AND SHALLBE ENERGY P/C . ..._ � SU&IECTAN EMPLOYER TO CRIMINAL PENALTIESAN�CIVIL F�NES UPTO ONE HUNDRE�THOUSAND ENERGY PERMIT COlLARS(5100,000�,IN AD�ITION TO THE COST OF GOMPENSATION,DAMAGES AS PROVIDED FOFi IN J SEGTION3]OBOFTNELABORCODE,INTEREST,ANDATTOFNEV'SFEES. � `�� p� FiETENTION FEE: OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: � I HEREBVAFFIRM UNDER PLNALTV OF PERJURV THA7THERE ISACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE Oi=THE WORN FOP WHICH THIS PERMITIS ISSUEO(SEC.3091,CIV C.). Z W � LENpER'S NAME F— LEN�ER'SADDRESS � TOTAL FEES � �� ICERTIFYThIATI'�1AVEREAJTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATIONISCOFRECT. W 1 AGREE'O COMPLY WITH P.LL pTV AND COUNTYORDINANGES FND STATE LAWS REI.ATiNG TO 6U:LDING � GONSTRUCTION,AND HEREBYAUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON TME Z ABOVE-MENIIONtU VROPEHiY FOR INSPECTION PURPOSES. COMMENTS � c / =J ��_-,C��(�/2/�%�'�I/I _..YC/�!l{q L117 _--__- ¢ PERMITjEE NA E(PRIN� � _�,�� 7 �Z (n � /��/�` � IGN lJ E EH I EE DATE = RECPT.NO. PAID BY VALIDATION ~ WHITE—Department Co YELLOW—Finance Co PINK—Assessor Co GOLDENROD—File Co GREEN—A IicanPs Co PY, PY. PY. PY, PP PY � � n ��: ' �� i � � �� ^� r � � �' � _ _ i.e, r ia i �.��."t:'�"��'��!w � �"�a-. ��m� ; . . , . �� s ��. _ . _,.,; , E � . a ° . .- . .�. �.. _ ' , �:.., � �.,..� � ,�i�a� . � .� . . . . .. . ��. . � . � .. �/� � ... ... . �. �� .� . .. .... . .. .... . ..... ...... .. _ , .. . ... .... .. , . ... . ... ... .. .. ._ ... .,. .�..: .. . . . , . .._ . ...... ....... ��. , . � �s� . ,.. ' .. . _.... ..._.... . .. .. ... . ... _. . ... ' �� ....... ..... .._... . . ...��. , ; .: r . . .. .. .. .. . ... . .._. _ . .... . _.._ . . ,. . . , .r... - i., __ ._. .__.._.. . .. . , , .� � '� � � �� .. .... . .. _ ... . �. _�.. �� ._. eN� > � �r 4 ... ... ... _.._ .. _ .. ... .._ _... . .. ... . � � � ��'1� ?��w,„ru�� ` s� � . � �= y — w�l� � ,,o� _ _ _ �� _ J: o- �.� � � � g ,.. ... . . _ CITY OF DIAMOND BAR �X��t DEPARTMENT OF COMMUNTI'Y&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION PRESS FIR�ALY JOBSITE//�� ,�??� ADDRESS�/G GJ�, .6Y( APN LOT_TRACT OWNER ADDRESS�� CITY ZI EL� APPLICANT� !i TEL.,�F��-C:- CONTRACTOR ADDRESS CITY ZIP TEL. 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 FOLLO W ING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE:ANV CITY OR COUNTY WHICH REOUIRESP,PERMITTO CONSTRUCT,ALTER,IMPROVE, DEMOLISH,OR REPAIR ANY STRUC- TURE,PRIOR TO ITS ISSUAIVCE.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 FIE 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 PROPERTY,OR MV EMPLOYEES WITH WAGES ASTHEIR SOLE COMPENSATION, WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC. 7044,BUSI- NESS AND PROFESSIONS ODDE: 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 W(THIN ONE YEAR OF COMPLE- TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOq THE PURPOSE OF SALE). ^ 1,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 APPLY TO AN OWNER OF APROPERTY 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 UNDEFI SEC. B. 8 P.C. FOR THIS REASON f LICENSED CONTRACTORS D CLARATION I HEREBY AFFIRM UNDER PF:NALN OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH SEC110N 7000)OF DIVISION 30F THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORCE AND EFFECT. LICENSE CLASS LIC. N0. DATE CONTRACTOR WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PF:NALN OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MP,INTAIN ACERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' COMPENSATION,AS PROVIDED BY SECTION 37000E THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WILL MP,INTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION 37000E THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE' CARRIER POLICY NUMBER_ (THIS SECTgN NEED IJOT BE CONIFLE7EDOF THE FfRMR IS FOR ONE HUNDRED DOLLARS(E100)OR LESS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I SHALL NOT EMPLOI'ANY PERSON IN ANV 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 37000E THE LABOR CODE,I SHALL FOR(H WITH COMPLY WITH THOSE PROVISIONS. DATE:APPLICANT: 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(1100,000),IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37080E 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 1 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. 1 AGREE TO COMPLY WITH P.LL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION,AND HERE BY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTIO PURPOSES. c i� �L��d/'ice� /�h n .�Yt�'t«� ui7 PER A EE(PRIN EF � _�� % IGN U E ER I EE DATE 0 0 ao 0 0 w z 0 0 z 0 0 IS W 0 Z W Q W 2 H ]C LL Z Q Q d X W 0 H U W Z Q W Q 0 � 0 z Q � w a 0 iz c� z 0 � s i-- WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy 1 //