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Home My WebLink About18509 i ___._.._.� _...._--_. ,! CITY OF DIAMOND BAR c� �F � DEPARTMENT OF COMMUNI'I'Y&bEVELOPIv�NT SERVICES � � 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 PRESS � �-�� ,.. L G PERMIT AP CATION FI R M LY o� JOBSITE �' '' � APPLICATIONQ� j �� PERMIT '� Jl P/C �� r� ADDRESS� - — DATE � NUMBER r��V #-I�J�.�.L_"� � ISSUE �`)/IYPE OCC � APN LO" TRACT __ __ DATE � CONST. GROUP p OWNER�" i. �. I'}i • <.•;/n — � ADDRESS � �':z,n� /� �— ZONING SETBACKS o ��'i.-�' rL'- ,,J�, � � oCITY .�'-.I�; '+"'��;�� ZIP 7EL FRONT RW � _ o APPLICANT TEL._ REAR �_� z - SIDE/SIDE STREET RW �1 Q CONTRACTO�i��'" ' _'' �?'.r' I-+^,�k'��' SIDE j� _ ADDRESS ..s ".' C- i E��, -� � - > ' v' � CITY F'�',� ,;t+" ZIP /.�'s i ."'TEL ' x �_< < PROPOSED USE��T�� o ARCH/ENG! ' � ��' � �� — z DESiGNER — � ADDRESS — NO.DWEL. NO. NO. � CITY ZIP TEL. UNITS STORIES BEDROOMS__ � -- -- �n DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANAWATION p� OWNER-BUILDER DECLARATION SFR/ADDlREM O � I HEREBV AFFIRM UNDEii PENALTV OF PERJURV THAT I AM EkEMPT FROM THE GONTRAGTOqS LI� G8/2 jB/C2fP0lT W GENSEUWFORTMEFOILOWIMGREA50N(SEG.1031.SBUSMESSAN�V�OFESSIONSCO�EFNYGITYOR (n U GOUNTYWMICHfiE�UIRE5A7ERMITTOCDNSTRUCT,AITEFi.iM�FlCWE.DEMOLISH,CRREPAIRANVSTRUC� Z NRE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMIi TO FILE A SIGNED w PatiO/DBCk � STATEMENT'HAT HE OR SHE iS LICENSED PURSUANT TO THE PPOVISIONS OF THE CONTFACTORS LI� � � CENSE LAW(CHAPTER 9(COMAAENCING WITH SECT�ON 7000)OF DIVISION 3 nF TNE 8USINESS AND PR0- POOVSPa O FESSIONSCODE�ORTMATHEGpSHE15E%EIAPTTH�PEFqOMANDTHEBASiSFORTHEALIEGEDEMEM✓- � U TION.ANVVIOLA710NOFSECTION7031.SBYANYAPPLICAN'FORAPEHMIT>J9JEC(S�MFAPnLICANTTO Z Re-Roof A CIVIL PENALiV OF NOT MOflE THAN FIVE HUN�REO DOLLAFS(5500)): � ❑I,ASOWNEHOFTHEPqOPERTY,OFMYEMPLOVEESWiTHWAGE5A5THEIR50LECOMPENSATiGN, 0 Commercial Z WILI DO THE WORK,ANO THE'iTRUCTURE IS NOT IN�cNDL�ON OFFERE�FOH SFLE;SEC.7006,6UG1� J � NESS ANO 7ROFESSIONS CODE:THE CONTRACTORS LICENSE UW GO'c5 NO�APP�V TO AN OWNER OF � PROPERTV NA10 BUILDS OR IMG'ROVES THEREON,AND WHO DOES SUCH WOP,K NIMSELF OR HEHSELF OR � THROUGH HIS OR HER OWN EMPLOVEES,PROVIDE[7 THAT SUCH IMPROVEMENISARE NOT INTENDEDOF m O OFFERE�FORSALE.IF.HOWEVERiMEBUILDINGORIMPROVEMEN?ISSOLDWITHINONFVEAROFCOMPIE- Z TION,THE OWNER-BUIL�ER WI�L MAVE 7HE BURDEN OF PROVING�HAT HE OR SHE DID NOT BUILD OR � IMPROVE FOR THE PURPOSE OF SALE). w C I,AS OMMEROF THE PFTJPERTV,AM EXCLUSIVELY CC�NTRACTINC WIfH LICEHSED CONTRACTOpS � TO CANSTRUCT THE PR0.IECT(SEC.]ose,BUSINESS AND PROFESSIONs'CODE�.THE CONTHACTORS LI- V31U3�10l1 � ADJ.AREA W CENSEUWDOESNOTAPPLYTOANOWNEROFAPROPER'YWMOdJIID50NIMPPOVESTHEREON,AND -- — � YrtiOCONTRACTSFORSUCMPFiOJEGTSWITNAGONTRAGTOR(5)LIGEhSEOPURSVANTiOTHECONTRRG- � QUANTITY DESCRIPTION � FEE Y TORS UCENSE LAW). QG I AM E%EMPT UNDER SFC. 8.8 PC.FOR THIS FEASON Q � U � — -- CL — OATE OWNEP. F— Z W � LICEIVSED CONTRACTORS DECLARATION W ¢ � I MEREBYAFFIRM UNDER PENAI_TY OF PERJURY"MAT I AM LICENSED UNDER FROVISIONS CF CHAP�EF � � 9(COMMENCING WiTH 5EC�10�7000)OF�IVISION 3 0F THE BUSINESS AND PPOFESS�i.'JNS CODE,AN� Z X AIY LICENSE IS IN FULL FORCE NND EFFECT. � LICENSE CLASS_��.`� � LIC.NO. ��f/��1_� � F— J U �ATE _ GONTRACTOR�-�_�;;`�i� a W f � WORI<ERS'COMPENSATION DECLAfiATION Q � I HEREBYAFFIRM UNDER PENAI_TV OF PERJURY ONE OF THE FOLIOWING DECLARATIONS: Z � /IHAVEANDWIILMAINT4INACERTIfICATEOFCONSENTiOSE�F-INSUREFORWOFK[I75' ¢ S Q —�fAMPENSATION,AS VRDVIDED BY SECT�ON 31o00F THE LABOR CODE,FOR TME PERFORMANCE U Q OF TY.E WORK FOR WHICH iH15 PEHMIT IS ISSUED. � w I HAVE ANO WILL MAINT4IN WORKERS'COMPENSATI(1�11NSlIRANf.E,AS REOUIRE�BV SECTION 4� 3]OOOF THE LABOR CODE.FOR THE PERFORMANCE OF THE WORK FOR WHICN THIS PERMIT IS �SSVEG.MV WORKERS'COI�/PEVSATIOry INSURAh'f�CARRIER AND POIICY NUMBER ARE-. CONSTRUCTION � CARRIER�Z�r_C �) ;s�'I� PLAN REVIEW � \ , ZPOLICY NUMBER_C �� /��)��- ..—_ ELECTRIC �J J,� ,� Q � (rt+:ssEcnavN�mra7aEca.�a�FrEooFn�aEa�urisr�ordENur�naEo��a.iatis�sim�oa�Essi PLUMBING _ Z I CERTIFV THAT IN THE I'ERFORMANCE OF THE WOPK FOP WHICF THIS PERMIT IS ISSUED,1 MECHANICAL U' SHALL NOT EMPLOY ANY PERSON IN ANV MANNER SOAS TO BEGOME SUBJEf.T TO THE � WORKERS'C�MPENSAl10N LAWS OF CALIFOFNIA,ANpAGREE THAT IF I SHOU�IJ 6ECOME INS�ECTION FEE _� F SU9JECT TO TNE WORM:ERS'COMPENSATION PROVISIONS OF SECTION 370o OF THE LABOR �� CO�E.',SHALL FORTHN�ITH COMPLY WITH THOSE PROVI NS . ISSUANCE . _ � �� SMIP p �ATE:_� �� 4 � APPLICANT: �%�"L. ..�.t .. �; � __ wWARNING:FAIIURE TO SECURE WOFKEFS'COMPENSATION GOVEiiAGE IS UNLAWFUL,ANO SHALL 6E ENERGY P/C __ � SU6JECTAN EMPLOVEH TO CR�iMINAL PENALTIES AND CIVIL FINES UP IOONE HUNDRED THOUSAN� ENERGY PERMIT OOiLARS�f1D0,000�,IN ADDITION TO THE COST OF CONPeNSATION.DAMAGES AS PROVIDED FOR IN J SECTION37080FTHELABORC�DE.WTEREST.ANDATTORNEV'SFEES_ �� p� RETENTION FEE: __. ( � d CONSTRUCTION LENDING AGENCY PRE-AlT FEE' � � O � — ._ .._— _—_ � IFIEREBYAFFIRMUN�ERPtNA1V�JFFEFiJUHY'MAl7HtHEISAC�NSIFLCIIONLEN�INGAGENCY FUH�Ht VEHFOHMANCE OF�HE WOFK FOF WHICM THIS PERMIT IS ISSUFG(SEC.3097,CIV.C.). — W = LENOEN'SNAME � _— F— LEN�ER'SADDRESS {� � ICERTIFYTMATIHAVe�READTFiISAPPLICATIONAN�SiFTETHATThEABOVEINFORMAT10YISGOFFECT TOTAL FEES I I 1 � I AGPEE TO COMPLY WITH ALL(:ITY ANp GUUNTY OH�INANCESANIJ SiAi'c LAWS HELATING TO EIUILDING I � � GONSTRUCTION,ANC HEREBV AUTHORIZE REPRESENTATNES OF THIS COUNTV TO ENTER UPON TFE z A60VE�MENTIGNED PFOPERTV FOR INSPECTION PURPOSES. C MENTS � _ �'��`' �:-`�-- --- ��Y��_� QZ,�t�' � , �� - m PERMITi NAMA� _ __ 1_ (¢/� " �,rr � ��_. %�. f� �_' � SIGNAri E. � ;,.,� DATE—'_"'_._-- —_ _ _... = g:�� '�� RECPT.NO. PAID BY _��VALIDATION ~ WHITE—De artmentCo YELI.OW—FlranceCo PINK—AssessorCo GOLDENRO�FileCo GREEN—A IicanYsCo P PY1 PY. PY. PY� PP PY IU�1�IL ys „r ��. r. �� e � � � �� ; � � ��`�` � u � +� - j _ : � � ' �`Z�-d�{� . s . ` _ _ , � �j ��'� _ - �� _ . � j_ _ _ __ _ _ _ . _ ; � �� _ _ _ __ ;� �.. �., � �� I�� _ __ _ _ ; _ __� --- . _ _ . � _ _ __ ; _ __ __. _ �� '� f��°��+�t�P��;� — _ -- —_ ; � �� ; , , � �gi@ 4 F'k�� "�i �I� . . . . .. . . .. . . . .. .. . . . I' .. ' . ... .__ _... ..-. ..._ __.._ _. �� I� � , X>� rK' ( "f� , E . . ..... . . ...... ...... ..... .. ..._. . .__._ > . � � . Iv ` .... . ... . . .. . . . . : �;' ;. ,i�,�i, ... . . .... ... .. . . .. . . . . .. . ... . ....... ...... ........ _... .. ... ........ .. I °r� �fr�'!�. ..,, : . r. E� _.. ... .. . .. . .. .. ... . ... .. v � �� <� � .. . .. .. _.... . .. .. .... .. . ... _.. ... _.. ... _., .. . �. CITY OF DIAMOND BAR DEPARTMENT OF COMMUNTI'Y&DEVE�OPMENT SERVICES 21825 E.Copiey Drive (909)860-3195 Fax(909)861-3117 ,.. I�)IL��ING PERMIT APP�.ICATION JOBSITE� � ADDRESS_ 1 APN LO-'TRACT OWNER�i=�' l�'f i :^ �: ��---- CITY�;�� ZIP TE�. APPLICANT TE�. CONTRACTOO�f N�N__� �?�. r' � _+ n,��1�_� ADDRESS..�•",'[ i�� _N�N �4�_ ;�-� i,>T v CITY G�.�;�.;t?"ZIP/,�'�i'�TE�."x�-�-�. ARCHJENGJ DESIGNER ADDRESS CITY ZIP TE�. OWNER-BUI�DER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LI� CENSE�P,W FOR THE FOL�OW IMG REASON{SEC. 7031.5 BUSINESS AND PROFESSIONS CODE: ANV CITY OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT,ALTER,IMPROVE. DEMOLISH,CR REPAIR ANV STRUC� TYRE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APP�ICANT FOR SUCH PERMIT 70 FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRP,CTORS LI� CENSE t_AW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONSCODE)OR THAT HE OR SHE IS EXEMPT THFPEFROM AND THE BASIS FOR THE AL�EGED EXEM'/- TION.ANV VIO�ATION OF SECTION 7031.5 BY ANV APPLICANT FOR A PERMIT SUBJECtS THE APP�ICANT TO A CIVI�PENA�TY OF NOT MORE THAN FIVE HUNDRED DO�LARS(5500)): I,AS OWN ER OF THE PROPER TY,OR MV EMPLOYEES W iTH WAGES AS 1HEIR SO�E COMPENSATION, WI�L DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOH SALE(SEC.70x4, BUSK NESS AND PROFESSIONS CODE::THE CONTRACTORS LICENSE LAW GOc5 NO.APPLY TO AN OWNER OF PROPERTY WHO BUI�DS 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. IR HOWEVER,THE BUILDING OR IMPROVEMENT IS SO�D W(THIN ONE YEAR OF COMPLE- TION,THE OWNER-BUI�DER WIL�HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUI�D OR IMPROVE FOR THE PURPOSE OF SALE). C I,AS OWNER OF THE PROPERTY,AM E%C�USIVELV CONTRACI'ING WI T H�ICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC. 7os4, BUSINESS AND PROFESSIONS CODE'.THE CONTRACTORS LI- CENSE IAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO dull DS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PFIOJECTS WITH ACONTRACTOR(SI�ICEh SEO PURSUANT TO THE CONTRAG TORS�ICENSE LAW). G I AM EXEMPT UNDER SEC._8. 8 PC. FOR THIS REASON DATE OWNEP. LICENSED CONTRACTORS DECIJ�RATION I HEREBY AFFIRM UNDER PENAI_N OF PER7URY THAT I AM �ICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PPOFESSIONS CODE,AND MY LICENSE IS IN FULL FORCE NND EFFECT. LICENSE CLASS �� IC. NO. �s' 1 DATE CONTRACTOR�- WORI(ERS'COMPENSATION DEC�ARATION I HEREBY AFFIRM UNDER PENAL-TV OF PERJURY ONE OF THE FOL�OWING DEC�ARATIONS: _/I HAVE AND WILL MAINT4IN A CERTIFICATE OF CONSENT TO SE�F�INSURE FOR WORKERS' v COMPENSATION,AS PROVIDED BV SECTION 37000E THE�P,BOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WIL�MAINT,41N WORKERS'COMPENSATION INSURANCE,AS REQUIRED BV SECTION 37000E THE LAROR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSVED. MV WORKERS' C 0 EJ�"PENSATION INSURAN CARRIER AND PO�ICY NUMBER ARE-. , ,^' CARRIER��"i'I.� )4 ti�BFI�Y / PO�ICY NUMBER J� � �/r'�\�_,_ (THIS SECTKK7 NEm NOT BE COMP�ETED OF THE PERMIT IS FOR ONE H�MORED OOI IAEIS(5100)OR LESS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOP WHICH THIS PERMIT IS ISSUED, 1 SHAL�NOT EMPLOY ANY PERSON IN ANV MANNER SO AS TO BECOME SUB]ECT TO THE WORKERS'COMPENSAI-ION LAWS OF CA�IFORNIA,AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORMERS'COMPENSATION PROVISIONS OF SECTION 37000E THE�ABOR CODE.I SHALL FORTHN�ITH COMP�Y WITH THOSE PROVISIONS. s7 A' � ��f DATE: " APPLICANT: d t Jf WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COV[EPAGE IS UN�AWFUL,AND SHA��BE SUBJECT AN EM PLOVER TO CRIMINA�PENA�TIES AND CIVIL FINES UP IOONE HUNDRED THOUSAND DOL�ARS(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE. INTEREST,AND A'f"CORNEY'S FEES_ CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENA N OF PERJURY THAT THERE IS A CONSTRUCTION �ENDING AGENCY FOR THE PEH FORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CI V. C.). LENDER'S NAME LENDER'S ADDRESS I CERTIFY THAT I HAVE READ TEAS APP�ICATION ANO 51ATE THAT THE ABOVE INFORMATION IS CORRECT I AGREE TO COMPLY WITH AL�(:ITV AND COUNTY ORDINANCES AND STATE LAWS RE�ATING TO BUI�DING CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE A60VE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. PE'.RMI1T NAMA� SIGNATE. l. ,,, DATE Y v, WHITE-Department Copy,YE�L-OW-Finance Copy, PIN I�y.IL