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Home My WebLink About19051CD J LLJ J O Q 12LZ W S CCH CC W C, CITY OF DIAMOND BAR DEPARTMENT OF COMMUNTfY & DEVELOPMENT SERVICES 21825 E. Copley Drive (909) (909) 860-3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION ADDRIESS ;7-2,k 211 RED APN LOT TRACT OWNER `) / F ► R S ADDR SS � Eb FtP_ CITY D ZIP 117LC5TFEL4109 APPLICANT Tim Nock TEL. 1146451246 CONTRACTOR Nock Plumbin ADDRESS 11612 Knott St #17 _ CITY Garden Grove zip 92841 TEL. 7148951246 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, PROR 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 L, CENSE LAW (CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 O THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OH SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP TION. ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT 5U9JEC IS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS ($S00) )'. LJ I, AS OWNER OF THE PRG PER TY, OR MY EMPLOYEES WITH WAGES AS T HEI R SOLE COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OF OFFERED FOR SALE !SEC. 7044, BUSI- NESS AND PROFESSIONS CODE'. THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON. AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROl1GH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE. IF, HOWEVER, THE BUILDING OR IMPROVEMENT I$ SOLD WITHIN ONE YEAR OF COMPLE- TK7N, THE OWNER BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). C I, AS OWNER OF THE PROPERTY. AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT ISEC. 7044, BUSINESS AND PROFESSIONS CODE. THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY To AN OWNER OF A PROPERTY WHO OU11 D5 OR IMPROVES THEREON, AND WHOCONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW). LJ I AM EXEMPT UNDER SFC. _ R. A P . 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 OFTHE BUSINESS AND PPOFESSiONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT. 11 LICENSE ss C36 _ LID, NO, 707775 DATE_ CONTRACTOR_NOCK WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENTTO 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 ISSUEEED, X I HAVE AND WILL MAINTAIN WORKERS COMPENSATION INSURANCE, AS REQUIRED BY SECTION 3700 OFTHE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED. MY WOORTK.ERRS�COOMPENSATION � INSURANCE CA 'Ell ND P06GY NUMBERAF�iE,/� CARRIER 3 ��(J'.&N /qq ,IeY {.' �� POLICY NUMBEfl LTCB T TT nrrrT9�'yV �� !4 `•� Pte' (THIS SECTION NEED NOT 13E OOMPLETED 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 1107 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 SUBJECTTO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE, I SHALL FORTHV/ITH COMPLY WITH THOSE PROVISIONS. DATE. _j1. 1 APPLICANT. Tim Nock WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP 10 ONE HUNDRED THOUSAND DOLLARS (11m 000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3709 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES - CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FDR THE PERFORMANCE OF THE WORK FOR WHICH THIS PEHMITIS 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 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. -FI I (V'11 N C "14--- PERM, ryAME(Pft 7 /' , SI�NA IIgE OF PERMITTEE DATE PRESS FIRMLY APPLICATION ^ C„t PE DATE ati lJ d'►�FU MBER #/C _ ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR D _— SIDE/SIDE STREET RW ❑ _ SIDE ❑ PROPOSED USE NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION SFR/ADD/REM Cl) Garage/Carport WPatio/Deck LL Pool/Spa I Z Re -Roof 0 Commercial 5 In Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J Q U r U W w Z 1 Dishwasher c/o 41.50 m a Q U_ Z Q 2 W CONSTRUCTION PLAN REVIEW _ ELECTRIC PLUMBING 41.50 MECHANICAL _ IN57ECTION FEE _ ISSUANCE 25.00 SMTP ENERGY P/C ENERGY PERMIT RETENTION FEE: 1.00 PRE -ALT FEE: TOTAL FEES 6(7.50 COMMENTS RECPT.. NO. PAID BY VALIDATION WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD—File Copy, GREEN—Applicant's Copy ADDRIESSTZ— —'— —!, — t-- I,—IV APN LOT TRACT OWNER I—rt (Z. S_ ADDR SS — —1 E— CITY ZIP 7ELG APPLICANT Tim N— TEL. G CONTRACTOR Nack Plumb in ADDRESS 11612 Knott St 7 _ CITY Garden GY•ove zIP 92841 TEL. 7148951246 ARCH/ENG/ DESIGNER ADDRESS CITY ZIP _ TEL. OWNER -BUILDER DECLARATION I HERERV 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: ANV CITY OR COUNTY WHICH REQUIRES A PEFIMIT TO CONSTRUCT, ALTER, IMPROVE, DEMOLISH, CR REPAIR ANV 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 C?F 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 BV ANV APPLICANT FOR A PERMIT SUBJEC 15 THE APPLICANT TO ACIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS 15500) )'. - ^ I, AS OWNER OF THE PRGPERTY, OR M V EMPLOYEES WITH WAGES AS 1 HEI R SOLE COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOH SALE {SEC. 7044, BUSI- NESS AND PROFESSIONS CODE'. THE CONTRACTORS LICENSE LAW DO'eS NO' APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMP ROVES 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 BUILDMG OR IMPROVEMENT IS SOLD W (THIN ONE YEAR OF COMPLE- TK)N, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING -.HAT HE OR SHE CID NOT BUILD OH IMPROVE FOR THE PURPOSE OF' SALE). C I, AS OWNER OF THE PROPERTY. AM E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIUNS CODE: THE CONTRACTORS LI- CENSELAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO dU11.DS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(SI LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW). CJ I AM EXEMPT UNDER SEC, 8. 8 P.C. FOR THIS REASON DATE OWNEP, 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, ANU MV LICENSE IS IN FULL FORCE AND EFFECT. -7 C361 707/7S LICENSE SS _ LIC. Nq. NOCK --- CONTRACT DATE 0 WORMERS' COMPENSATION DECLARATION I HERERV AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: _ I HAVE AND WILL MAINT/NN A CERTIFICATE OF CONSENT TO SELF—INSURE FOR WORKERS' COMPENSATION, AS PROVIDED BV SECTION 3700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. X I HAVE AND WILL MAINT/VN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BV SECTION 3700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS RRIER ND POLIC Y ISSUED- MV W OR K R S ' COMPENSATIO N I NSURANCEC A N UMBER A E' E -T -N - /\If - - L -IJ I 3 CARRIER T^ f POLICY NUMBER V-'-- T T n-T.3C-•-[7 -- 4' (f<(IS SECTKXJ NEm NOT 13E COMPLETED OF THE PERMR IS FOH ONE HUNDRED DOLLARS (St W I OR LESS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY AN'/ PERSON IN ANY MANNER 50 AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISKNS OF SECTION 3700 OF THE LABOR CODE. I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. Tim NOCk -1 - APPLICANT. DATE: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL BE SUBJECT AN EMPLOYER TO CRIIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND DOLLARS (5100,000), 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 PENAITV OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3097, CI V. C.). LENDER'S NAME LENDER'S ADDRESS t 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 AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE -MENTIONED PRO RTY FO R INSP CTION PURPOSES. A OVE P E B E A L PERMI AM( (PR / SI—NA IIRE OF PERMITTEE E CITY OF DIAMOND BAR DEPARTME'tiTT OF COMMUNttY & DEVELOPMENT SERVICES 21825 E. Copley Drive (909) 860-3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION PRESS FIRMLY WHITE-Depanment Copy, YELLOW -Finance Copy, PINK -Assessor Copy, GOLDENROD -File Copy, GREEN -Applicant's Copy