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Home My WebLink About16381 � J",�� c—"X,�-?�l Y��,'t-'� _ �_ CITY OF I7IAMONI7 BAR DEPARTMENT OF COMMUNITY&DBVELpPMEN'T'SERVICES w 21b60 E.Copley Drive Suite 390 {909)860-3145 Fat(944}$61-3111 PRESS ��`��'�� BUILDING PERMIT APPLICATION FIRMLY � JOBSITE J� � � APPLICAT�ON � � �� NU BER � �-k�r� #'�, �� o ADdRESS ! DATE c� — ISSUE t �� 'fYPE OCG APN l T TFiACT DATE "" CONST. GROUP p QWNER �� „_ " ADpRESS_„�_ � ZONING SETBACK5 w CiTY ZtP TEL. ` �RONT RW ❑T � APPUCANT 0� TEL REAR �___ � SIpElSIDE STREET RW ❑_,,� GONTRACT ,S(�' S� C- SIDE ❑ � C n.��%fi'Ji--"'-y^+e �U n-....--TEI. i PROPOSED USE , C�� —' � ARCNlENG/ �`�� ,� �'' �` DE5IGNER y� NO.dWEL. NO. NO. ADDRESS UNITS_._ STORIES BEDROOMS � CITY ZIP TEL. N DESCR�PTION SQ.FT. FACTOR PSF ADJ.AREANALUATIbN � � QWNER-BUfIDER DECLARATfON SFRlADD/REM 0 I MEflE@Y AFFIRM UMPEfi PENAL7Y OF PERJURY THAT I AIA E%EMVT FROM THE CON7RACTORS Li� Gdt8g9(GBt�OR � GENSEUWFOR1HEfq.tOWN1CaREhSONt5EC.70.45.58U5�lESSAt#DPftOFFSSKKJSCODE:ANYCiTYOP {j) COUN�YYMICHHEUUIRE5'�APERMITTOCON$TRUC7.PLTFR.IMppOVE,pEMOLISH,ORREPAIRANVSTRUC� W Patio/Deak NPE.PRqR TO ITS ISSUWCE.ALSO RE�4I�NES T11E ApPLICAN7 FOp SUCH PEFMIT TO FILE A SIONEQ � ,� STAtEM6NT THhT iiE OR SHE IS tlCEhtS W PURSUANT TO TH£PROVISIOFiS OF TNE CONiRACT4R5 I.I- Ij L� � CEN$E LAW(CN�DTEP 0(IbA1MENCINO WITH SECTION 7UOa)OF�IVISION 3 4F TME BUSINE55 AND Pq0- u' PaoUSpa a0 FESSIQHS CADE)9p 7tV.T NE ON SHE IS EXEMPT THEREfROM AND SHE BAStS F6A SHE%IE�ED EJCEMP� TqN,ANVVId.ft7%iHOfSECTiON7e31,SBVANYAPPL�CANTFORAPERM�TSUBJECTSTHEAPPLICANTTO Z Re-Roof � �CIVII PENALTY OF NOT NIORE THAN FIVE MUNOFED DOL4ARS({500).): � DI,A34WtiEROFFHE7HOPERtt,ORMYEUF�t.OYEESWI'fF!WAGESA'sTNE6;SOEECOMPENSATKiN, C3 CLStiimBt4Y8I WILL DO 7HE WORK,AND iHE STRUCTURE IS NOT INTENDED Ofi OFFEREO FOR SALE(SEC.�041,BUSi� J NES;C ANO PPOFESSIONS OWE:THE CANCflACTORS�10ENSE UW�bES N4T AVPLY TO AN OWNEfl bF � PAOPEHTYlYN08UROSORIAiPF40YESTFlEREON,ANOWtiQD�ESSUCHWORKNIMSEIFt}RXER5ELFOR � (Z THqfJUGH HIS OR HEN OWN EMVLOYEf_5.PRqVIDFp THATSUCN IMPRqVEMENTS ARE NOT INTENC7E�4R m � L.0 OFFEREQF4RSALE.IFHOIMEVFil,TNE9UlLDIN60FllMPPAVEA�11T65SOIDWITHlNONEYERROFCAMPI,E� " � TKKt.TY{E UWNER$UiLpER Wii,.t NAVE THE 9URCSEN OF PFOYINo THAT tiE OR SHE DID NOT 9UIL�OFi �j IM7M'?VE FORTNE PURpOSE tlF SALE). p 7.75 QN?lEfl OF THE PAOPEftfY,h3A EXCEUS�VEIY GON7RAGTING WITH IiCENSED CONTftACT4R5 /� � TO CONSTRUCTTHE PRpJECT(SEG.7oI4,BUSINE55 qN[J PROFESSIONS WUE:THE CONTRACTORS LI- 3liOn _„ �V ADJ,AREA 4J CEN9ElAWDOE3NOTAPPLY70ANOWNEFiQFApROPERTYWNOBUIL�SOflIMP%pYE57}IEREON.ANb " � VAiOCUNF1inGTSFOaSUc�iPH6JECT5W�THACQ`17RACTORtS}UCENSE6PUflSltANT70THECpN7FiAG QUANTITY DESGR�PTION FEE � TOH5 UCENSE UW.)' '—"—.'—.--'— — � J { � ❑i7�MEXENPTtRibERSEC.�___ ___ 13.8PC.foRTHiSqEaSON Q �I � . .� U � � ._._._— .._... DATE OWNEk___..,,. __ � .�� LiCENSED CONTRACTORS DECIARATIdN W � �FiEREBTAFFNiFi(/f�ERPENFLTYpFFER1UR1'FNAFIAMIlCENSEDUiJDERpAOViSiONSOFCHAFTER � � � i(COMMENCWOWITHSECTION70W�OFDIV!SION30FiHF9USINESSANCPROFeSS10NSCODE,AND Z � (�-, X MY UCENSE IS M NLL FOFICEANO EFiECT l f . tl1 � 1 4..;1 'L� � Q LIGENSE CU155,,. LIC.N0. ____ � �J p f'� �) �' DATE CONTRACTOR_,... � l C� — — -- -- U! � WORKERS'COMPENSATIpNDECLARATIpN � �� '�� > � _ � � � i HERE9Y AFFlRAt iJN6Ep PENM,TY OF PERJl1RV ONE Of TNE FOttOV71NG OECLARATIONS: � Z Q C} _71UYEtHt}Yf�ICMAiNTRMACERIlF�CATEC)FCON$ENiTOSEIf-iNSUflEFORWOFiRERa � � COMPENSA710N,A5 PROV!DED BY SECTION 370o pF THE UBGR CODE.FOfl THE PERFORMANCF. U ¢ OFTNf WORK FOR WMICN?HIS 7ERMIT IS ISSUED. � C� - W __IHAVEANOWIILMI\INTAINWpRKE%8'COMPEN5ATIONINSVRANCE,ASFEOUIREDBVSEGTION ( ,r-� Q 3704 bF TFIE tA00is GODE,FOR TH£PERFOFUAANCE OF THE WtJRK FbR WNICH THIS PERMIT IS �i., ( �� ISSUED.MY WORKEiRS'WAIPENSA71pN�NSURANCE CARRIEH AND PqLICY NUMBERARE: CONSTRUCTION �� v� � �.r '� PLAN REVIEW ] CARftiER__..._.— - - /n � aa.icrNut�eea__..__ _. .__. -.---_ ELEG7RIC _ _. _.. .....� � � �_.__ yR � R � (n+ssEcrr.�Net3�ivorocoor.+�ereooFn�aEawr�srr�aonerwrcri�oa:K.vws�siw)oa�ss} PLUMBING __...��.��-' � I CERTIFY THAT IN THE PERFORMANCE OF THE WQRK FOR WHICH THIS PERMIT IS ISSUEp,l MECHANICAL � �.� 5 c� � SHAI.L NOT EMPl01'ANY PERSON IN ANY MANNER 50 A5 TO BECAME SUB.I£CT TO THE (�j W01}KERS'COMPEFlS.iT!ONlAW30FCiLLiFORtitA,ANDAGREETHATIfiSHWt08EC6ME �NSPECTIONFEE �_ _ ___ = SU6JECTTOTHEWOFKERS'COM7ENSATI PPOVI SOF5 TION3]OOOFTNELABOR ' \ CAD ISH fORiHWiTtiGOMPtY W EP SIONS ISSUAf4CE +� ' *^�,,, "�__� _,._�,��4� � SMIP � .�. 1 l.. ._,,, •� �j �ATE._ �/ _ APPIICANT: _..__ - � ENFFGY P/C (� J WARNING:FAILUR6 TO SECURE WORICERS'COMPENSAT14N COVERAGE IS UNIAWFUL,PNb SHALL BE --�'�1�.." �'5-72!�na_!__ ` �y 5U8JECTANEMPl.bYERTOCR1RtINA4PENA�TIFSANQCIYiLPWESUPTOONEHUNDREDTMUU3AtaD ENERGYPERMIT � �� OOILARS(1196,600j,iN ADO�T�QN TO TNE COST OF COMPENSATIUN,DAMAGE9 AS PiIOVIDE6 FOR IN --- �--- ` � SECI'ION 3)OE Of THE UBOR COOE,INTEREST,ANO PTTpRNEYS FEES. RETENTION FEE: �� , __,,, ,._._ J~^- � CpNSTRUCTION LENpING AGENCY PHE-AL7 FEE: R�• .._ ` _^_ ,,,�LL I HEREBYAFFIRM UNOER�ENbLTV OF PERJURV THATTHERF��$A CONSTRVCT�ON LENDING AGENGY __ �_^_�_ _,_.,, FOR THE PERFOFMANCE Qf THE WORN FOp WHICH THIS PEflMIT IS IS5UED(BEC.308],dV.C.�. � .__. .....� eC LENbER'S NAME,�.__ � . � , _ s !,� LENDER'SADDRES$_ .... .. _ �� ICERTIiVTHATiHAVEftFAt1THiSAPPUCATiONAN[1STATETHATTHEA90VE�N�ORMATIONISCARqEGT. TIJTAL FEGJ •J��'� W I AGfiEE TO C'•OMPLV WITH ALL CITV AND COUNTV ORDINANCES ANO STATE UWS RE4ATING TO BUIL�ING /'� \�\ � C(XlSTAUGTN]N,AN6 HEHEBY AVTMbRI2E ftEPflESE ATlVES OF THlS CGUNTY Tp EMEftUPON iHE I J� ,��.r �� j j J �� VE-MENTIONEp PROpEBTV FOR WSPEC7'ION P sea COMMENTS LL � �� yr v � � �''i.� �- — _ -_._ 4 a ,w Ni� _ ... /> � . �. , _ � ,� ANREOFP£FpAtiTEE --....� Y y 4 � ��', � RECP7.NO. ...J �� PAID BY "��`_ VALIDATION `�� _ WHiTE—Department Copy,YEILOW—Finsnce Copy,PINK—Assesspr Copy,GOIDENROP-Fiie Copy.GREEN—Appiicant's Copy �� 1 ' l✓ll . �� . �� b�c�� :�� `� ��r;'`�� ":��:w _.; . . � � � �� ,��. � � �� 1 � ��.�,� � �� _ � ��_� :� � �� 4 � � �.� � � � . ._� .,. A. Za,-.,-f� . (-` .t ' `" � !�. � v .. , ..� � . ,� T_ ._ . .. ... ;`s"'� ., � ...'. _.. . ,, + .. • ` . ._. ... . 4 . �jK N. : '/ � —1 .__ . �.,.. . . . .. . l ..,.. ._ - .. .. . ... ... e � , .- _ . . <�. � :� � .. _ . .. � � ... . . ._..... .._. ..._ .. ..._ _ . ._. ' _ .;._.. ... . � . _..., ..... . . ' ,- . . .�._ ._. . � . . .. - . . . ._ ._ . . . -' ,�� .� +,, , _ ... . .. . a- ...._. .._ .... .._' :. �a � _, �,� ' . . '�. .. .. ._... .. . '_..:. ' '-. .: ___ _.... _... ._.... . l ,� � ..., . _ . . . � _.._.., ..,..� ...__ . - .. ..._ ....... .. . , ... ....... ._... .._.... `.� . � . � . ........ ._. ___. •a a i, ._ . _. . _. ... . . . . ... .. .. . _. .. _... ... _.._ ; �. � ra; ,�. gF s . �.� .�,�.«�.. ... .. � .i �a;� .?.,�..°u7.,,�,^�F� =a,, .. �a.,. . .. .. _. ° `7�l �1Oc��.. �� !�f'._�.��avCdj . �Z.d-�� ►-�T C,�ee� G--•�scxx,6{ ,. �� -�2 ��.ro s r�� tia�t� _ �-d5 ,�x� r�--c� _�- �o�s �rt Sc--� c��- � � � _ , / �'b a � .��t/ �:c��S'�f"� _��l SL�' , S��'�—��i�✓�.� 7��f ,��_ _' _ � _ ,� ,., �t/'�� O„�• _ � ��-. �s'�_!�� ; . _ _ _ . ��.��. . . . � ,.� _ �� ,� <� ��,,J � � ��- � ;� �� , _ r - •r�`�� "-�"' ��`� �f�s' _ _ — � . ��`� �� ~��"�� _. � _ _ _ _ _ �c. , — n � ��, te � �1 i _ _ � ��` „�� ,�$�"�a�� _ _ _ � �� ,�� a�. ._ ; . ._ _ . �T��` �,�,��P6�� . �. � � i.�Y�'�� *`� . n , . . . . .... .... .... . ... _. . .. .. ... . ........ . . fit -li � .s � ai�W� �� .. .. . � x�"�� i�"��t�� ' � �ai R�'s �S � '� � . � — _ . _ _ r.�s� �.'�*�i a `�« � � _ _. . _ . �;� � -r r �- � _ � �s�s6 u��'t �� +g «� � ��"��" F �.., ° � ;„ � .. � e_.�,�� ,.� _ _ — IIld�Iil�U lull. i CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY 8i: DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 (909)860-3195 Faz(909)861-3117 BUILDING PERMIT APPLICATION PRESS FIRMLY ��W JOBSITE j ADDRESS/ APN TRACT OWNER ADDRESS_,Z�P CITY ZIP TEL. APPLICANT des a TEL. CONTRACT R S n'S� ADDR CITY ZIP TEL. ARCH/ENG/�� 2�/� DESIGNER� r� ADDRESS CITY ZIP TEL. OWNER-BUILDER DECLARATION I HEREBY AFFIRM Ue1DER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE IAW FOR THE FOLLOWING REASON (SEC. 7037.5 BUSINESS AND PROFESSIONS CODE:ANY CITY OR COUNTY WHICH REWIRES'A PERMfTTO CONSTRUCT,ALTER,IMPROVE, DEMOLISH,OR REPAIR ANV STRUC- TURE,PRK)R 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 a (IpMMENCING 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- TKKJ.ANY VIOLATION OF SECTION 7031.5 BV ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT 70 A CIVIL PENALTY OF NOT MORE THAN FNE 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. 700, BUSI- NESS AND PROFESSIONS 900E:THE CONTRACTORS LICENSE LAW DOES N07 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 OFCOMPLE- TpN,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). ^ 1,AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC. 7014. BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE IAW DOES NOT APPLY 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 CONTRAG TORS LICENSE LAW.). ^I AM EXEMPT UNDER SEC._.,_. B. 8 P C. FOR THIS REASON DATE OWNEk LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 0(COMMENCING WITH SECTKNJ 7000)OF DIVISION 3 OF THE 9USINESS AND PROFESSIONS CODE.AND MY LICENSE IS IN FULL FOFICE AND EFFECT LICENSE CLASS LIC. N0. DATE CONTRACTOR WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATK)NS: I HAVE AND WILL AU\INTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' COMPENSATKNI.AS PROVIDED BY SECTION 3700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICN THIS PERMIT IS ISSUED. _,_I HAVE ANO WILL MJ\INTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BV SECTION 3700 OF THE IABOFI CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS'WMPENSATKKJ INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER POLICY NUMBER (THLR SE(.'TgN NEHJ IVOT BE OOMPLETF.DOF THE PEFNET LS FOR ONE HUNURED DOLLARS(5100)OR LESS 1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. 1 SHALL NOT EMPLOI'ANV PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT If 1 SHOULD BECOME SUBJECT TO THE WORKERS'COMPENSATI PROVI S OF S TION 3700 OF THE LABOR COD I SH FORTHWITH COMPLY W T E P 0 SIGNS DATE:.Ii 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 DOLURS(5700,000),IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTK)N 3708 OF THE IABOR C00 E,INTEREST,AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PE:NALN OF PERJURY THAT THERE IS A CONSTRUGTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED(SEC. 308].CIV.C.). LENDER'S NAME LENDER'S ADDRESS I CERTIFY THAT i HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATK)N IS CORRECT. I AGREE TO COMPLY WITH AI_L CITY AND COUNTY ORDINANCES ANO STATE LAWS RELATING TO BUILDING CONSTRUCTION.AND HEREI3Y AUTHORIZE REPRESE ATIVES OF THIS COUNTY 70 ENTER UPON THE VE-MENTK)NED PROPERTY FOR INSPECTK)N P SES. ri�G P AME INT /> D ATURE OF PERMITTEE D E WHITE-Department Copy,YELLOW-Finance Copy,PINK-Assessor Copy,GOLDENROD-File Copy,GREEN--Applicant's Copy 7(dam(_90 O1 W 4.1-aAcO. h4&0 po-N-LOlep smx,{, Z rG 5 r flG ti4�b�> �c 4-bo&s ar SEt-F Cc65c tl/G' %_ ,""omac