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Home My WebLink About18986uj a Ca 2 CITY OF DIAMOND BAR DEPARTMENT OF COMMUMTY & DEVELOPMENT SERVICES 21825 E. Copley Ihive (909) 860-3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION JOBSITE 1.441 Pr's ADDRESS APN LOT TRACT OWNER ILL ADDRESS146 _ CITY P,9--7TEL. GI ANT APPLIC_ TEL. CONTRACTOR ADDRESS ' ' r CITY ZIP ' iELb- ARCH/ENG/ DESIGNER ADDRESS CITY ZIP __ TEL. _ OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPTFROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS OODB ANY CITY OR COUNTY WHICH RECUIRESAPERMEITTO CONSTRUCT. ALTER- IMPROVE, DEMOLISH, OR RERNP ANY STRUC- TURE. PRIOR TO ITS ISSUANCE. ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE ASIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OFTHE CONTRACTORS LI- CENSE LAW (CHAPTER Y (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OR SHEIS EXEMPT THEPEFROM AND THE BASIS FCR THE ALLEGED EXEMP, TION. ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJEC TS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE: THAN FIVE HUNURED DOLLARS IS500).j: ❑ I, AS OWNER OF THE PROPERTY. OR MY EMPLOYEES WITH WAGESAS THFIR SOLE COMPENSATION, O WILL DTHE WORK, AND THE STRUCTURE IB NOT INTENDED OR OFFERED FOR SALE (SEC. 701x. BUSI- NESS AND PROFESSIONS CODIE; THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO DOES SUCH WORK H'MSELF 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 13 SOLD WITHIN ONE YEAR OF COMPLE- TION. THE OWNER -BUILDER WILL HAVE THE 13URDEN OF PROVING :HAT HE OR SHE 010 NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). C1 1. AS OWNER OF THE PROPERTY. AM EXCLUSIVELY CONTRACTING W1 TH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7011, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TOAN OWNER OF A PROPERTY WHO aUII.DS OR IMPROVES THEREON, AND WHOCONTRACTS, FOR SUCH PROJECTS WITH ACONTRACTOR(S) LICENSED PURSUANT TOTHE CONTRAC- TORS LICENSE LAW). C1 I AM EXEMPT UNDER SEC. B. S P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENAI7Y OF PERJURY THAT 1 AM LICENSED JNDER PROVISIONS OF CHAPTER e (COMMENCING WITH SECTION 7D001 OF DIVISION 3 OF THE BUSINESS AND PP.OFES&ONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT C LICENSE SS F r 1_ LIC. NO. - -,� , DATE I �"J LR2am'-- CONTRACTOR � �v WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATX)N$: 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, 1 HAVE AND WILL SIA:NTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY SECTION 3700 OF THE LABOR CODE FOR THE PERFORMANCE OF T HE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' COMPEN§,AZION INSURANCE CARRIER AND POLICY NUMBER AAF.' CARRIER POLICY NUMBER (TNS SECTION NEED NOT BE OOMPLETEDOFTHE PERMIT IS FOR ONE HIRDREDDOUARS TPOU)OH LESS). 1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH T HIS PERMIT IS ISSUED. I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME "U ECT TO THF WORKERS' COMPENSATION LAWS OF CALIFORNIA. AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 37x0 OF THE LABOR COO E.I ALL ORTHWI_H COMPLY WIT .THOSE PROVISIONS. DATE: 1 1 7 Z APPLICANT: :.I . U 3- k 1=y \ WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. AND SLLSr SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DLXLARS (SID0,000), IN ADDITION TO THE COST OF COMPFNSATION. DAMAGES AS PROVIDED FOR IN SECTION 3700 OF THE LABOR CODE. INTEREST. AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFF IRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUFO (SEC. 3PO. CIV. C). LENDER'S NAME E,w � �, e C' _.: C • �y{I ' 1 `,� LENDER'SADDRESS J>Fv� C_ +SLI I` !t' �J Yr' 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 RFLATWG TO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES - PERMITTEEN E(PRINT) z k t 0 �' - SC UREOF __ITTEE DATE--_---- PRESS FIRMLY APPLICATION I 1 . I V- 11 P/C DATE 1 N RMIT ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE C4 aY Iy l4c NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREA/VALUATION SFFVADD/REM Garage/Carport WPatio/Deck LL Poot'Spa Z Re -Roof L Commercial m Valuation _ .t1 ADJ.AREA QUANTITY DESCRIPTION FEE U CC U W LU LU 0 Z _ CID J 0 U Z Q 2 U W CONSTRUCTION PLAN REVIEW ELECTRIC _-.- PLUMBING MECHANICAL INSPECTION FEE 1 ISSUANCE J SMIP go ENERGY P/C ENERGY PERMIT _ RETENTION FEE: • V PRE -ALT FEE: TOTAL FEES COMMENTS RECPT. NO. PAID B VALIDATION WHITE—Department Copy. YELLOW—Finance Copy. PINK—Assessor Copy, GOLDS OD—File Copy, GREEN—A licant's Copy f C_� �� 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 -/'44 kFj) ' APN LOT TRACT T OWNER ILL W ADDRESS CITY ZIP TEL. APPLICANT TEL. CONTRACTOR N ADDRESS CITY 1 j OVVIL"r 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- CENSE LAW FOR THE FOLLOWING REASON (SEC 7031.5 BUSINESS AND PROFESSIONS CODE ANY CITY OR COUNTY WHICH REQUIRESA 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 ISSW)): ^ I, AS OWNER OF THE PROPERTY. OR MY EMPLOYEES W,TH 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 CODIE: 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 APPLY TO AN OWNER OF A PROPERTY WHO aUII.DS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S) LICENSED PURSUANT TO THE 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 70W) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT 3(j LICENSE C SS C LIC NO. DATE A—_-1=-=- CONTRACTOR yL4k 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' COMPEN 5I ION INSURAN E CARRIER AND POLICY NUMBER ARE ( C CARRIER IE77(—I IZ _ER POLICY NUMBER (THIS SECTION NEED NOT BE COMPLETED OF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($100( OR LESS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE, I RTHWI"H COMPLY WIT THOSE PROVISIONS. 0 HHH ALLL A— r I DATE. — 1 L- APPLICANT. ---/-F p WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND ISALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($I W,OW), 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 A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3097. CIV. C). LENDER'S NAME N C"- j^I S ADDRESS LENDER 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. PERMITTEE N E (PRINT) r— La Z SIG URE or ITTEE DA APPLICATION RMIT P/C DATE NUMBER # ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ^ REAR ^ SIDE/SIDE STREET RW ^ SIDE ^ PROPOSED USE Y -Q IV r _r c F r, Z - NO. DWEL. NO. UNITS STORIES DESCRIPTION NO. BEDROOMS SQ. FT. FACTOR PSF ADJ. AREANALUATION SFR/ADD/REM U) Garage/Carport W Patio/Deck LL PooVSpa z Re -Roof L/ Commercial co J U I- U w LEI z m 0 W Valuation ADJ.AREA QUANTITY DESCRIPTION FEE CONSTRUCTION Cf PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMTP ENERGY P/C ENERGY PERMIT RETENTION FEE: *V_ PRE -ALT FEE: TOTAL FEES COMMENTS RECPT NO. PAID B VALIDATION WHITE- Department Copy, YELLOW -Finance Copy, PINK -Assessor Copy, GOLDS OD -File Copy. GREEN -A plicant's Copy