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Home My WebLink About17731 > crrsr o��Di�orrn a�t ---- �'�`"" DEPART'I�NT OF COh9v[tJMTY&DEVELOPMENT SEitVICES 21825 E.Copley Drive �o�� " (909)860-3195 F�(909)861-3117 PRESS ' -4� B[TILDING PERMIT APPLICATION FIRMLY � ADDR'ESS G i .i DRT�IGATION�,„.7�.27�UMBER I t 7 -�� #/C �- "�� 2 �._ G�r��" .-�. �Z-�-. � c� ISSUE .� � TYPE OCC .- APN �4T TRAGT DATE -> ��----- C4NST. GRdUP °C OWNER _.�_� O ADDRESS_,��"'�'', ZONING SEfBACKS z ClTY _��*a TE�. R�ORT RW ;�T g APPLICANT „_ TEL. _.— SIDEISIQE STREET RW ;J� � CONTRACTOR i� �it� SIDE � �7 � ADDRESS� � PROPfJSED USE ��-� -"1� ��j� �� 4 GlTY-J�� ... ZIP � TEI. oARCH/ENG/ W dESiGNER NO.DWEL. NQ. NO. ri ADDRESS UN1TS STdRiES BEDRflOMS = CITY ZIP TEL. � dESCRIPTION Sfl.FT. FACTOR PSF ADJ.AREANALUATiON u� � QWNER-BUILDER DECLARATION SFR/ADDlREM O � I HEREBY AFFIRM UNDER PENALTV OF PERJURV THAT I AM EXEA�PT FRG1M THE COMRACTpRS LI� � Gflf9Q8/C2fpOft L1J CENSEIAWFOR7HEFOLIOWINGftEASON(56C.7a31.5A4JSINESSANOpROFES510NSCOpE;ANYGITYOf1 C.) COUNTYWri�HREqUiftESA7EAMiTTOCaN9TRUCT,A�TEP.iSfRR6VE,0EMOliSH,ORREPhiRANV^uTRUC (jJ pytl0/DBCK Z TURE,PRIOR TO I7S ISSU4NCE,ALSO REQUIRES'NE APPLICANT fOR SUCH PERMIT TO FILE A SIGNED W � S7ATEMENT THAT HE QR 9HE IS tICENSED PURSUANT 70?HE PftOY1Si�N5 4F TME G�dTRAC10R5 U- '� CENSE LAW(CHAPTER 9(COMMENCINtl WIiH SECTION]Ooo)OF DIVISiON a pF THE BVSINESS ANp PRO� � POOUSPB � FESSIONSCp�EJtlRTHATHEOR5HE�8E%EMPTTNEREFROMANDTHEBASISFORTHEALLEGEDEXEMP- (7 '" � TiON.ANYVFOIATKMi�FSECT�NT431.58YRNY4PP�_FGRNTFOflAPERMITSUBJECTSTHEAPPIICANTtO z RB•R06f � � ACIYILPENALTYOFNOTMORETHANFIVEHUNDREDDOLI.ARS(SSOOf.�: � C]I,RSOWNEROFTHEPROPERTYORMYEMPLOVEESWITHWAGESASTHEIRSOLEC4MPENSATION, � COiT1RI87Gid1 � � Will p0 THE Wt7RK,AND 7HE STRt7CTURE i6 M1'Ot INTENOED OR 4FFFRED FOR SAtE t�EC.76d4.BVSi� J NESS AND PROFESSIONS C�ODE:THE CONTPACTOpS LICENSE LAW DOES NOT AVPLV TO AN OWNER OF � PROPEATYWNOBUILDSOFIIMPRQVESTHEREON,ANDWNpDOE3SUCNWORKHIMSELFOftHEftSEIfOR � „ � THFiOUGHH�50RNERDNM1fFdPlOYEES,DRUVIDEDTHATSUCNiMPflOVEMENTSARENOTMTENDE00R m W pFFERE�F6R5AL6.If,HONIEyER,THE9UILDINGORIMPROVEMENTI550l.�WITHINONEYEAROFCOMPLE� 0 710N,TNE OWNEft�BUiiDEfi WI�i,HAYE THE BUflDEN OF PROVING T4AT HE OR SHE Q1�NDT BU7tD OR '�'- iMPROVE FOR THE PVRPO5E OF SALE). � ❑I,AS4YRJEROFTHEPROPERTY,AME%CWSIVELVGONTHACTINGWITHLICEN9EDCONTRACTORS � TO CONSTRUGT THE PROJEGT(SEC.T964.BUSINESS AMD RROF�SSIONS CODE:THE CONTRACTORS U� VeIUHfiOti ADJ.AREA_,_„ � L1J GENSEUWUOESNOTAPPLYTOANOWNERqFAPROPERTYWHOBUILp50RIMPROVESTHEfiEON,ANP � WFIOCONTMCTSFOfiSUpiPRQ1ECiSWITNACONTRACTOR(5)UCEVSEDOURSUANTTOTHECPNTRAC- Q�JANTITY DESCRtPTiON FEE Y TORSUCENSELAW.). � Cl I AM EXEMPT UNDEit SEC. B.&P C.FOfl THIS REASON J � �— C) �3 —_ � � oa7E� oWNER U W —��- UCENSED CC}NTRAGTQRS DECIAFCATi6N W Q (L I HEHEBYAFFIRM UNDER PfNAL7Y DF PER.;URY THAT I AM LICENSF�UN�ER PROViSIONS OK Ck1ARTER � � 9(COMMENCMfG WITH SECI tON 7000j 6F 6IViSi�N 3 OF TNE 8U4INESS ANO PROFESS'ONS COOE,ANO Z � MV LICENSE IS IN FULL FOpCE AND EFFECT �f�J,�' m � UCEN5ECLp55„�'��±y��_.. LIG.NO. �Tl�� DATE�� y�_.._ COtJTRAGTOfl. W cf� WC?RKERS'C4MPENSATION DEClARATidN � = a � i HEREBYAfffAlA UNDSR pENAITY Of PERdUFV ONG Of TNE FOlIflWiNG 6ECLARAT10N5: U CI3 Z Q CI IHAVEANOWILLMAINTAINACEHTIFIGA7EOFCONSENTTOSELF-INSUREFORWORKERS' 2 ��MPENSATION,AS PRpVIOEp BY SEC7IOtti 3T6o OF THE 1A80R CO'�F„FORTHE PERWqMANCE G} d OFTHE WC?RK FOR�NHICH THIS PERMIT IS ISSUE�. � � � __�HPVEANDWILLMAINTAINWQRKERS'COMPENSATIONINSURANCE,ASfiEOUIRED6Y5ECTION Q3�o00FTHELA90ftCOpE,FOHTHEPERFORMANCEOFTHEWORKFpRWHICHTHISPERM1T15 ��_(�{.�j _.,_ ISSUED.MY WORKE.�S'CAMP�E,t,��SATl,4�y}IN�SURAMCE ARfliEfi b KX�CY NUMBER AftE: CONSTRUCT�ON j CnRR�ER .___—✓�vn,�C .. PLANFIEVIEW �� "' � POUCV NUMBER_�„ I.Y�v�I C _ . ELECTRIC Z �2 � �tr�issccr�NEeunioraEo�ErepoFTr+�aEw.urisFORon=_NunAatooa.i.aas�5iao�oR�Ess�. PLUMBING _�......�,.—.. � t CERTIFYTHAT IN TNE PERFORMAMCE OF THE WOPoC FOR WFtiCH THIS PEflMiT�S ISSUEO,� MECHANICA� 2 — (,'} SNALL NOT EMPLOV ANY PERSqN IM1 ANY MANNEfl SOaS To BECOME SUBJECTTOTHE � WOflNERSCOMpENSATIONLAWSOFCAUFORNIA.ANDAGREETHATIFISHQULOBECOMG INSPECTIONFEE _ ._. — � SU6JECT70�HEW<)RKFRSC6iAPENSAT�HCROViSiONSOFSECT16Ha]OOOF7HEUBOR CODE,I SNALL FpqTHWITH C4MPLV WITH iHOSE PftOVI510NS. ISSUANCE . w� S�r•-.�' � SMIP `��, p DATE�, __ APPLICANT __.—,..— --. - " .,'—`.—'—'. W ENERGY P!G � WARNING:FAiLURE TO SECI.AE W6RKER5'GOMiPENSATiON COVERAGE�S UNLAWFUL,AND SHAti BE —'—^----" . .'—"—..... '.. J � SU&IECTANEMPLOYFRTOCRIMINALPENALI'IESANDCIVILFINESUPT40NENUNDflE�TNOUSAND ENERGYPEAMIT _ _ D�LLAAS{St0�A00).!N AQQITION TOTNE COST OF�MPENSATlON.�AMAGESAS PftOVIDED FOft IN --'—'—"—"— � r �� ;� J SECTION 3]080F THE LAPAIi COOE,MTEFEST,AND ATTOflNEV'S FEES. RETENTION FEE: _, •� � ' • � ._ ......_-_ � CONSTRUGTIOid CENDING AGEFlCY PRE�ALT FEE: _ __ O � IHER£BYAff1AMUN(�ERPEVAtTYOFPERIURYiNATTHEREiSACONSTftUCT'.ONLGMOtNPA�ENCY ,,,, �- FOfl THE GERFORAAANCE OF THC WORK FOR WkiCH TH�S PERMIT t5�SSUED�StC.303�,CIV.C.}. �� W = I.ENpEA'S NAME . —.._--. — � _.. � IEND[F3'SADOReSS�_.__. .._ c �-� „/ � .., � ICERTIFYTkATIHAYEAEADTHISAPPI..ICAFIpNANl�S?ATETHATTNEABOVEINFORMATtONlSCOA(iECT. �QTFtL('�EGS f � �-� ' �I~ W I AGR£E TO COMPLV WITH AtLCRY AND COUNTY ORDINANCES AN0 5?ATE tAWS RE4ATWO TO BUiLDiN6 � CONS7RlICTION,AND HEHEE'�VAVTHORIZE REPRESENTAiIYES OF TIIIS COUWTY'O ENTER UPON THE ,�{} � t�V � ABOVE�MENTIONE�PROPG�TYFORINSPECT�QkFURPGSES. COMMENTS �" �� ^�� a („ • ^' ! ......�e' ...._ '��... , � pERMI E NAME(PRINT) � jf��/' . ... ____.yC�__a�.- _ __ ! /�=�. Cn ,,�.._..�.�_____-a�:��./ j��" V:I'� � 51GNAY�MITTEE ATE �.... ... - -- S RECPT.NO. PA1D BY _ VAL@ATION_,. _ ~ WH1TE—Depatlment Copy,YELLOW—Finance Copy,PINK—Assessor Gopy,GOLDENROf?—File Copy,C�REEN—ApplicanYs Copy # K ha � � � �'..Yiy2 j. "�' ,.� ,._# i t� -'�'n�..�. ��' �� ai¢rs ��n �h� �,ar,, i �-�zua��7��€`�' . .. �. ��i " �� ,> , , 3 � _ . /� , ,r � �.� ��,� �,..,�; � _ ..n� � ..�«�� __ _ _ ; ; 9 ti� $� .. �,�..� � h1 , . . .. . . . .. .. . . . ... . . t� � i�,F�, � ik -9 fi� � °iF� 4 : . . ._ _.. .. . ... _.... . . i�h a��S � ��k��- .... .. ... .. . . . . .. ��"'�s� t�`�,�� ^,��s�.�'��`��°_� .. . . ... —.. .... . .... .. .. .. —�g��,�� I q�� t�; — — � = p ta�� , �` � a5 �€ �§ � � � � �� .._. ..... .... .... �. (8<i �-�G>�4 daµ .,�' . _... . . .. ... . . . .. . . ... . .. . _.. . z tA[ � �tl'� r '�. ��m�# `� 'IA'�MM1::� ��'��4� � �� .... . . ... .. .. ... �. 1 4, y "r( ' �& . . . . ... . .. .. . ..... .. . ._ .._ — .. 4Y � �� i - 3 �� .�' = u .e ... .. ... . ._. . . .... .. . .. .. _.. ... ._ _.. ... . .. ��. : ci° � ; _ . .��, . ...... . . , ` e.��."< ,� �i„ta •p�.. .'. ... . . .... . ..... . .. .. .. ..... .. . ... .... ..... ...,.. . CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVE�OPMENT SERVICES 21825 E.Copiey Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION PRESS FIRM�Y ODDRI A ESS_i�C Q_C� APN�OT TRACT OWNER Hi ADDRESS 3 CITY Vim vK TE�. APPLICANT TE�. CONTRACTOR 1/t) ADDRESS CITY ZIP CP.TE�. ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TE�. OWNER-BUI�DER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE t_AW FOR THE FOL�OWING REASON(SEC.7031.5 BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REQUIRES A PERMITfO CONSTRUCT.ALTER,IMPROVE, DEMOLISH,OR REPAIR ANY STRUC- TURE, PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APP�ICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE IAW(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 A�LEGED EXEMP- TION.ANY VIOLATION OF SECTION 7031.5 BY ANY APP�ICANT FOR A PERMIT SUBJECTS THE APP�ICANT TO A CIVIL PENA�TY OF NOT MORE THAN FIVE HUNDRED DOL�ARS($500).): 0 I,AS OWNER OF THE PROPERTY,OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WI�L DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SA�E(SEC. 7044, BUSI- NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE�AW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OFI 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-BUI�DER WIL�HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUI�D OR IMPROVE FOR THE PURPOSE OF SALE). ^I,AS OWNER OF THE PROPERTY,AM EXC�USIVE�Y CONTRACTING WITH �ICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC. 7044,BUSINESS AND PROFESSIONS CODE:THE CONTRP,CTORS LI- CENSE t_AW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUI�DS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PRO)ECTS WITH ACONTRACTOR(S)�ICENSED PURSUANT TO THE CONTRAC- TORS LICENSE�AW.). ^ I AM EXEMPT UNDER SEC. B.&P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DEC�ARATION I HEREBY AFFIRM UNDER PENA�TY OF PERIURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY�ICENSE IS IN FUL�FORCE AND EFFECT. LICENSE C�ASS�IC. NO. ��/ S Y-'/Ix�l DATE L-CONTRACTOR WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENA�TY OF PER]URY ONE OF THE FO�LOWING DECLARATIONS: -I HAVE AND WIL�MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE IABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WIL�MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION 3700 OF THE�ABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS'COMPS ATIO INSURA,NCE ARRIER 0 POLICY NUMBER ARE: CARRIER POLICY NUMBER (THIS SECTION NEED NOT BE COMPLETED OF THE PERMIT IS FOR ONE HUNDRED DO�LARS($100)OR�ESS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHAL�NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUB]ECT 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 tABOR CODE.I SHAL�FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE:APP�ICANT WARNING: FAILURE TO SECLRE WORKERS'COMPENSATION COVERP,GE IS UN�AWFUL,AND SHAL�BE SUBJECT AN EMPLOYER TO CRIMINA�PENALTIES AND CIVI�FINES UP TO ONE HUNDRED THOUSAND DOL�ARS($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST AND ATfORNEY'S FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENA�TY OF PER7URY 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 I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMP�Y WITH AL�CITY AND COUNTY ORDINANCES AND STATE�AWS RE�ATING TO BUILDING CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. c'I) PERMI E NAME(PRINT) SIGNA REO I'("fEE ATE APPL ERMIT P/C DATEICATION7 �. L7��l NUMBER(1 7 3# ��N ISSUE OCC TYPE DATE CONST. GROUP ZONING SETBACKS FRONT RW ^ REAR ^ SIDE/SIDE STREET RW ^ SIDE ^ PROPOSED USE N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. Ff. FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM U) Garage/Carport w Patio/Deck L- Pool/Spa Z Re-Roof Commercial co Valuation'•-AD7.AREA QUANTITY DESCRIPTION FEE J U H 0 w W 0 2 m 2 Q Z S U w CONSTRUCTION c�-�i PLAN REVIEW E�ECTRIC P�UMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY PJC ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTA�FEES COMMENTS S1 ..-�J j LT t ,.yam. RECPT. N0. PAID BY VALIDATION WHITE-Department Copy,YE�LOW-Finance Copy, PINK-Assessor Copy,GO�DENROD-File Copy,GREEN-Applicant's Copy