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Home My WebLink About18163 (10) z`�""X�-,:r�� f� CITY OF DIAMOND BAR DEPARTMENT OF COMMUNI7'Y&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Faac(909)861-3117 pRES$ ��^� � BUILDING PERMIT APPLICATION FIRMLY } JOBSITE �j�v I/ Qr APPLICATION (�\:. ' PERMIT hp/C o ADDRESS— /5 R!/��7��i\G-�-�� DATE ,. '� � '.I � �MBER �� . Ip � �_' ,�� APN LOT TRACT � ��. ISSUE TYPE OCC DATE CONST. GROUP p OWNER o ADDRESS i C- ZONING SETBACKS Z CITY �fP A/�! EL fl .� -� FRONT RW ❑ o APPLICANT � � '��E , � � REAR U Z � SIDE/SIDE STREET RW ❑ ¢ CONTRACTOR �- SIDE � ADDRESS ` � CITY ZIP�jyQ� TE�277�L' PROPOSEDUSE �, ti /�'� � � o ARC ENG/ z DESIGNER a ADDRESS NO.DWEL. NO, NO. � CITY _ ZIP TEL. UNITS STORIES BEDFi00MS � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDEP DECLARATION O SFR/ADD/REM p I HEREBV RFFIRAA 11N�ER PENALTV OF PERJURY THAT I AM E%EMPT FROM THE CONTRACTORS LI� G8f898/C2fPOfl W CENSELAWFORTHEFOLLOYJINGREASON(SEC.]031.SBUSMESSANDPROFESSIONSCODE:ANYGTYOR (n ZCOUMYWHICHqEQUIRESAPERMITTOCONSTFUCT,ALTER,IMPqOVE,DEMOLISM,ORREPAIRANYSTRUG W Patio/Deck w TVRE,PRIOR TO ITS ISSUANCE,AL50 NEOUIRES THE APPLIGANT FOR SUCH PERMIT TO FILE A SIGNED w � STA7EMEN?7HAT ME OR SME 15 LICENSED PURSUANT TO THE PRONSIONS OF THE CONTRACTORS LI� � CENSE LAW(cHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � POOI/Sp8 � FESSIONSCADE�OHTHATNEORSHEISE%EMPTTHEREFROMANDTHEBASISFORTHEALIEGE�E%EMP. � V TIDN.qNVVIOLATIONOFSECTION7031.5BVANVAPPLICANTFORAPERA7IT5UeJECTSTHEAPGLICANTTO Z RB-Roof � A CIVIL VENALTY OF NOT MORE THAN FNE HUNDRE�DOLLARS�f5oo).�_ � ❑I,ASOWNEROFTHEPROGERTV,ORMVEMPLOYEESWITHWAGESASTNEIRSOLECOMPENSATION, 0 Commercial Z NALL DO THE WOHN,AND TNE STRUCTURE IS NOT MTENDED OR OFFERED FOR SALE(SEC.7044,BU51� J � NE55 ANO PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNEfl OF PROPERTYWN09UILDSOflIMPROVESTMEREON,AN�WHODOE55UCHWORKHIMSELFOFHERSELFOR � � THROUGHHISORHERONTlEMPLOVEES,PROVIDE�THATSUGHIMPROVEMENTSARENOTINTENDEDOR m Q OiFEREDFOR5ILLE.IF,HOWEVER,THEBUIL�INGORIMPqOVENENTISSOLDWITHINONEVEAROFCOMPLE� Z TION,TME OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR � IMPROVE FOq THE PURPOSE OF SALE�. {� w ❑I,ASOWNEROFTHEPROPERTV.AME%CLUSIVELVCONTRACTINGWITHLICENSE�CONTRACTDRS � TO CONSTRUCT THE PROJECT�SEC.IOdb,Bl15MES5 ANO PROFESSIONS CODE:THE CONTRACTORS LI- VdIUdtlIXl v ADJ.AREA W CENSELAWDOESNOTAPPLVTOANOWNEROFAPROGERTVWHOBUIIDSORIMPROVESTHEREON,AND � WHOCON7RACTSFORSUCHPROJECTSWITHACONiRACTOR(S)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE Y TORS LICENSE LAW�. O ❑I AM E%EMPT UNDER SEG. 0.B P.C.FOR THIS�EASON Q � U � �ATE OWNER. � � UCENSED CONTRACTORS DECLARATION W � I HEREBY AFFIqM UNDER PENAL7V OF PERJURV THAT I AM LICENSEO l'NDEfl PFOVISIONS OF GHAPTER � d 9(COMMENqNGWITHSECTION7000)OFDNISION30FTHEBUSINESSANDPRO�ESSIONSCO�E,AND Z `X MV IICENSE IS IN FULL FORGE AND EFFEGT m � ucENSE c�nss La2�� i �1/uc.No. � w~ DATE LI // . �� CON7RACTOR a ��--�r'�-�(7�- / � WORKERS'COMPENSATION DECLARATION Q � I HEREBYAFFIRM UN�ER VENALTV OF PERJUFV ONE OFTHE FOLLOWING DECLARATIONS: U � Z � IHAVEANDWILLMAIN7AINACERTIFICATEOFCONSENTTOSEIF-INSUREFORWORKERS' a Z = ¢ COMPENSATION.AS PROVIDED BV SECTION 3]oa OFTHE LABOR CODE,FOR THE PERFORMANGE U OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. W � � W _I HAVEAND WILLMAINTAIN WORKERS'COMPENSATION INSURANCE.AS REOUIRED Bv SECTION �^ � Q37000F THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK F09 WHICH THIS PERMITI$ r G .� ISSIIED.MY WORj(�i5'CA PENSATION INS ANCE CAR ER AND POLICV NUMBER AFE: CONSTRUCTION J j c^qqiER • PLAN REVIEW � � ZPOLICY NUMBER� ._��b�."y► ELECTRIC ¢ 0 (niISSECT�orvNEmNJTBEoOMP�EfmoFhiEaERnUiISwRONEHUi�DRE000uaRs(Sim)aa�Ess�. PLUMBING W Z �CERTIFV THAT IN THE PERfORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUE�,I MECHANICAL C�3 SHALLNOTEMPLOYANYPEflSONIN:INVMANNER50A5TOBECOMESUBJECTTOTME � (/) WORKERS'COMPENSATIONLAWSOFGALIFORNIq,AN�AGREETHATIFISHUUL�BECOME INSPECTIONFEE � SUBJECTTOTHEWORKERS'COMPENSATIONPROVISIONSOFSECTION3]OOOFTHELABOR � VOUE,I SHALL FORTHWITH COMPLV WITH THOSE PROVISIONS. � ISSUANCE 4 � i��'�,.. r . p DA7E: Jc. r� �Z'APPLICANT: � ' SMIP `� w � � ENERGY P/C J WARNIN .FAILURE TO SECURE WORKERS'COMPENSATION COVEflAGE IS UNLAWFUL,AN� ALL 6E J � SUBJEC7AN EMPLOYERTO CRIMINAL PENpLTIES ANO GIVIL FlNES lJP TOONE HUNDFED THOUSAND ENERGV PERMIT DOLLARS(51DO,oW),INAD�ITIONTOTHEGOSTOFCOMPENSATION,OPMAGESASPROVI�EDFORW ._ � J SECTION 3700 OF THE LABOfl CODE,INTEREST,AN�A7TORNEY'S FEES, w RETENTION FEE: � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � I HEPEBVAFFIRM UN�Eil PENALTY OF PERJUFV THAT THERE IS A GONSTRUCTIDN LENDING AGENCY � FORTHE PERFORMANGE OFTME WOPN FOR WHIGH THIS PERMIT IS ISSUEO(SEC.3097,CN.C.). Z W ? LEN�ER'S NAME y F- LENDER'SADDRESS /'� wICERTIFVTHATIHAVEREADTHISAPPLICATIOfY/NDSTAiETHATTHEABOVEINFOfiMATIIXJISCORREC7. TOTAL FEES � � � � 1 �A,., l ��``1 � IAGREETOGOMPLYWITHALLQTVANOCOUNTVOHDINANGESANDSTATEUWSRELATINGTOBUILDMG i `i� ,r��.J' -� � CONSTaUGTION,AND MERE9YAUTHORIZE REPRESENTATNES OF THIS COUNTY TO ENTER UPON THE Z ABOVE-MENTIONEO PROPERTY FOR INSPECTION PURPOSES. COMMENTS o �� J � � m PERMI EE NAME(Pal ) � Q Cn / i Q j ` .._.._ � ATURE P RMI �ATE ' -�- � RECPL NO. _ PAID BY VALIDA710N WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Gopy,GOLDENROD—File Copy,GREEN—ApplicanPs Copy �"'� d�u.'-#� t �- � � �,��.� 5 �� „"� � ... 3 I ' �` f �. ""w'�`..Wa . ?�� . "`�'w. m . . . . . . t �� ,.^�,n ..,��`�.. �.S";i�'Sv$ � �/��'�� _ � = d � __ �..�. ; .�` R ��. ,�� - , r-; w,, �,I _ "�,_ . s ;� �� v � ��r �� s � � � �M.�`�� ..,,„�� ,� �� iu ��y �t�'� u�y�i i �� ,� . . . . . .. _. . _ .. . ... . . . _... ... . ._ . � �'°� �i k ��b� �N��9�(� �'fi(.. � �� ar �� :t, I _ _ _ _ �. �"�� _ _ am-c ,� � �� - �� „ _ �� t�� kit�"��am�"� _ R � ��X � + � �a�� f � ; ;: �� x _ ��s.�d :.�n � t.�r�. �- ' . .. m �r , .. .. . .. . ... . .... .. ..... . .... .. . . ... .... � b„� �°�.�� i;� �' � ,- .. . . . _ .. ... . ... . .. � �ye�' s= � ��, �� CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION JOBSITE ADDRESS-/5 ! b---C=,-�j--•/� APN LOT TRACT OWNER ADDRESS 2 t 0 0 CITY APPLICANT CONTRACTOR ADDRESS CITY ARCK/ENG/ DESIGNER, Zd-hP TT�tbs'f EL el' 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 V EAR 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 CONTRACTlNG WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC. 7044, BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- CENSE LAW DOES NOTAPPLY TO AN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). U T 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 3 OF THE BUSINESS AND PROFESSIONS CODE.AND MV LICENSE IS IN FULL FORCE AND EFFECT LICENSE CLASS Cs.'/(3 Y(I/RUC. N0. DATE LLB-//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 WORR(EPS'CO PENSATION INS ANCE CARR ER AND POLICY NUMBER ARE: CARRIER- POLICY NUMBER (1HLR SECTION NEED NOT BE 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 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 THOSE PROVISIONS. DATE: q APPLICANT. WARN IN . FAILURE TO SECURE WORKERS'C OMPENSATION COVERAGE IS UNLAWFUL,AND ERALL 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 3700 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. CONSTRUCTlON 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 LENDER'S ADDRESS 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. DESCRIPTION APPLICATION LICATION �.PERMIT MB ER DATE)P IJAUD TYPE OCC DATE CONST GROUP ZONING SETBACKS FRONT REAR SIDE/SIDE STREET SIDE PROPOSED USE N0. DWEL. UNITS DESCRIPTION SFR/ADD/REM Garage/Carport Patio/Deck Pool/Spa Re-Roof Commercial Valuation QUANTITY Q U Z 2 U W SQ. Ff. N0. STORIES FACTOR PSF ADJ.AREA CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTlON FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: RW RW N0. BEDROOMS PRESS FIRMLY ADJ.AREAIVALUATION FEE TOTAL FEES, COMMENTS RECPT N0. CI PAID BY a TTT'V VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy 4�klu-elef4