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Home My WebLink About17848 CITY OF DIAMOND BAR 1 Jr'�`' DF,PARTMENT OF COMM[JNITY&I3EVELOPMENT SERVICES �p � i 21825 E.Copley Drive 'UC. �" (909)860-3145 Fax(909)861-3117 , PRESS �"�Yh� $UILDING PEE2MIT AFPLICATION � FIRMLY � J48SITE �� ,�\ `�� , �--.C ' ' ` PERMIT i P/C �'^��_1 I PPUCATION ,�' ' o ADDRESS_ . ••� ��__[__ QATE ��UMBER 1 Y #�•1 4 1 Q ISSUE ► I�„(��,-_�1"1 TYPE OCC °-° APN LOT TRACT DATE �� ` � �'Gt?NST. GROUP p OWNER � a' ' '�',��''�,L� � AdDFtESS + t ( t� ��'�� _ ZO(VING SETBACKS Z GITY 1 ::r ,,' ZtP,_� TEL. FRONT RW ❑ � APPLICANT _ �_,{(�;,�_.,` TFL. S DEISIDE STREET RW CI Z '� CONTqACT4R� ' �� ' h�!� �" SIDE n � ADDRESS / .r 1 ��$' E-- (� �L�-i\ : x��t �� PROPOSED USE C1TY _�� ZIP t ck' TEL. , r ( � • o ARCWENG! -- W OE5lGNER _.___ NO.DWEL. NQ. NO. a ADDRESS � UNITS _ STORlES BEC}RflOhf5__ � CITY ZiP _ TEI. cn DESGRlPTION S4.FT. FACTOR PSF ADd.AREANAIUATION � OWNER-BUILDER�FCLARATIpN SFFUADD(REM O i HEREBY AFFIRM UNDER PENALTv OF GEHJUFV Tr1AT I AM EXEMpT FROM THE CONTqA�TqRS LI� G8f898/CB�Oft �W GENS[LAWf'ORTHEFOLIOWINGREASON(SEC.]031.56USINESSANDPPOFESSIONSCODE:ANYCITYOR ((� C.? �tRiTYWHiCHREWIRESAPERMiTTOCIX�ISTRUCT,Al7ER.&.iPROVE.0EbK7ll5H2ORREPAlRANYSiF�tG (,[j pa�iOlDeCk W TURE,PRIOR TO Il'S ISSUANCE,ALSp RE�UIRES THE APPLICAhT FOR SUCH PERAAIT TO FILE A SIGNEp w � S7qTEMEN7 THAT NE 00.SHE!S UCENSED PURSUANT TO TH�PRovISIONs OF 7HE CCNTaACT4RS�I� � .� CENSE(AW(qiAPTEfl 4(COMMENCING WItN SECTION 70o6j OF ONISION 3 OF THE BUS�NE55 ANp PRO� PDqUS�78 FESSIt7NS CpDE)OR THA7 HE Oq SHE IS E%EMPT TNEREFROM AN�THE DASIS FOR THE ALI.EGEO EXEMP� � TION.ANYVIOLATH?N�FSFCTtQNI031.58YAhVAPPLiCANTFORAPEfiMIT5U9JEGTSiHEAPPtICAN7T0 z Re-Roof � A CIVit PENAl7V OF NOT MORE THAN FIVE HUNDRED�OLUlRS(SSoo�.): � ❑I.AS4WNEROFTHEPRGPERTY,ORMYEMPLOVEESWITNWAGESAS?HEIRSOLECOMPENSATIDN. � COmmefGtai WILI QO THE WOPoC,AND THE STRUGTURE IS N4T INTENpED{Jfl OFFEftEfl fOR SA(.E{$EC.7ffad,6U5i� � NESS AND PROFESSIONS CODE:TME COMRACTORS LICENSE LAW DOES NOT APPI.Y To AN OWNER OF' � PROPERTV WHO BUILOS l7N IMPHOVES THEREON.AND WHO DOES SUCH WORK HIMSELF Oq HERSELF OR � THROUGH HIS OR NER OWH EMPIOYEES,PRbVIDEI3 TttAT SUCH IMPRbVER5ENT5 ARE NOT RJTENDE00'1 m QOFFERE�FpHSALE.IF,HOWEVER,THEBUILDINGORIMPROVEMENTIS50WW17HINONEVEAROFCOMPLE� � TIQN,THE OWNER^8111L�ER WI4.L HAYE T4E BURDFN OF PROVING THAT HE OR SHE O!D NOT 8UliQ Oft � 7MARpVEFORTHEPURPO5EOF5AlEj. W ❑I.ASOWNE%OFTH[PR6PER7V,AME%CLUSIVELYCONTRACTNGWITNLICENSEDGONiqACiOR5 p� To caNsraucr rHs rao.�ECT{ssc.�oe<.aus�Ness A»n er�oaess�orts cooe Tr+e wNTwcTORs u- Vaivatior ADJ.AREA UJ CENSELAWDOESNOTAPPLYTOANOWNER6FAPROPENTVWHOBUILDSORIMPRQVESTHEPEON,ANU — F WHOCONTflACTSFORSUCHPR4JECT9WITHACANTRACTpR(5)UCEVSF.DPURSUPNTTOTHECbNTRAC- QUANTITY QESCRIPTIQN FEE Y TORSUCENSElAW.}. � fJ I AM E%EMPT'UNOER SEC. B.8 PC.FO%THIS REASON J � _" Q a� � U � � ._. ...—.. � DA7E „_,__ �WNER� _..._ U � W '�—� LICENSED CONTRACTOftS DECLAftATiON W Q � I HEREBVAKFIRM UNDER PF:NALTY OF PERJU%v THAT IAM IICENSED UNDER PROVISIONS OF CHAPTER � (L 8(GOMMENOING WiFH SEC'40N 7oao}01-OIVISION 3 6F TNE BUSINESS AND PROFESS�NS C0'JE,ANO Z W MY LICENSE f5 W FULL FORCE AND EFFECT, m � UCENSE CI.ASS_ ;"' LIG.NO. �f �`!.._� j I J � OAFE t � �� GONTiiACTOfi. • � I�!"�,��_L-�` a � �,��"" '�ERS'GOMFENSATION DECLARATI6N -� ¢ � I MERE9Y AFFlfiM UNDER PENALTY OF PEAJlJR1 ONE OF rilE FaLIOWING DECIARAT10N5: Z � ✓�� IHAVEANbWILlMA1NTAINACERTIFlCATEOFCON$ENTTOSELF-INSUREFCIRWORKERS' _ � CDMPENSATION,A$Pft4Vi�ED 0Y SECTION 3lOo(:UF 7HE 1A64fS CQQE,FflRTHE PEftFOftMANCE w OF THE WOflK FOfl\YMIGH THIS PERMI7IS ISSUED. � L:.l W ;��I MAYE AND W7ll MAINTA7N WOV7KER5'(:6lAPENSAT�ON INSURANCf,tS REOUIRED qY SEGT�ON 1 � ,Q,� 37000FTHELABORCODE,FOpTHEpERFOFMANCEOF7HEWORKFOFWHICMTHIyPEflMIT15 {4 iJ ISSUED.MY W6RNEHS CAMYENSATiQN INSUftANCE CARftiER ANO P{}UGY NUMBEfl AflE' CONSTRI�CTION �1 Q - —�� ... —_" y cnaniEa,_ __ PLANREVIEW _� _ � aoucvuuMeea� .. . . ELECTRIC „ Q a (liNSSECii�NNEEDN078F�M1iREfEDOf7iiEPEi3Ml'ilSWRCNEHUNDRE6WLLARS(Ftab)CRI.ESS). PLUMBING _ „ � W I CERTIFY THAT INTNE pERFOflMANCE OF tHE WORK Poft WHI[;H THIS PERMIT IS ISSUEO.1 MECNANICAI. Z �. („� SHALLNOTEMPLGYANYPERSf?NINANYMANNER&OASIOBECOMEEUBJECTTOTNE � WORKERS'COMPENSATI(7N LAWS OF CAUFQRNIA,AND AGREETHAT IF I SHOULD BECOME INSPECTION FEE � - SU&tEGTTOTHEWGftKERs'CqMAENSATIONGROWSiONSOFSECTtpN37000 TNFtAeOR � � ' � E,I SHALL F RT�NITH COMPLV TH THOS� oVI5lOu5. 1`� ' ISSUANCE �'- 7"�) _..... ___,—,.. - ti�(y l ��j� SMIP .-j`i,,�___ p DATE: ,�,...'��PPLICANT: �i �j S'`"x� jt �� / � .. . � J WARNiNG:FAi�URE TOSCCVRE WORKEflS'G47�NFENSATION COVERAGE I5 UN(AWFUI,AND SHAtt BE ENERGY PIC _ ,__, W uUBJECTAN EMPIOYEftTO CRIMINAL PkNALTIES AND CNIL FINES UP Tf70NE HUNDRED'HC)115AND ENERGY PERMiT OOLLAflS(f 1 W,OUc).IN AbUI110N TO THE CO5T OF COMPEN5ATION.OAMAGES AS PApVIOED FOq IN �� - �— � SECTION 3T08 OF 7NE 1A80fi GCiDE,INT'EREST AND ATTORNFv'S FEES. RETENTION FEE: � � GONSTRUGTION�EN61NG AGENCY PRE-ALT FEE: C7 _ � I I IEREBV AFFIqM VNDEfi PENALTV OF PERJUFV THA'THERE IS ACONSTRUCTION LENDING AGENCV _ FOR THE PERFOiiMANCE QF LHE YYORK Fflft W}iiGN 7hIS PEftM�T IS ISSUED(S6C.3087.£IV G}. W —.. � tENDER'S NAME_,,,,� ,,,,, � LENDER'SAOORESS�� "' '�A` ` � � ICEFTIFVTHATIHAVEREADTH15APPLIGATIONAN�SiATETHATTHEA8CIVEMFORMATIONISCORRECT TQTAL FEES +�/�' � � ��'� f f� I� W tAGftEE IQ COMFIY WITH AlL ql'Y AND C6VN7YORDINANCESANO STATE tAWS itECAFIt�T�8Ui01NG v �V � CaJSTRUCTION,AND HERtB'f AUTHORIZE REpRESENTATNES OF THIS COUNTY TD ENTER UPON TNE 1�� ABOVE-MENTIONEO PROGE�7rY FUR IN5PECTION PUflPDSES. . �� ' COMMENTS......__..� ~—�. _ �.� f� 1 ny ry /) _ ��F-7 T�'��t"i ld� t`-'�� tr"�'� ��1iy." .. _ . ... � PERMIITEE E R�MT�i , � �— � � ,..�._�_. ^ � _i � � SIGNATlIREO P I ; .• � ` � "�- pqTF. � �� -- ..^ i ...... ... � RECPT NO. PAID BY VALIDATION s ~ WHI7E—qeparlment Copy,YEf.LOW---Finance Gopy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN--ApplicanTs Copy �� n a � ;� ,�a�,�' �e�i. �'��-'kkS�, a m,� T��"��"'F° i . . . �i =t .'� �..� "�'r�,a�",� ,�e ,__�"•��,. �� w � � � i � � . � Z �y —— ,, ,; „� � �.s� �� _ n ,i V k �iEt i�L i�a .et�r' h� ... s n .. .. . . .. . . .. ... _ ... .. '�� : p : , . . . . .. . .. . . . . . . _ _ ` a"'��k � i' + � atl��`��p��'�i8'sk� :" _ _ _ � ,� � � � , �� .�'�. r �m �� . � �� '� u � _ _ _ � �� „�I°'^I�F��u :i' *�"s� t"°"�"�'z : ,, . . . . . . ... . . . . .. . .. . � �4 r`P�,�e .... . . . "�I ,� �€� n�"��- . : ', ° � � _ : _ � � e.: �`�� r � _ r� . � � u � ' �; � "�Ke � ii�_" CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVE�OPMENT SERVICES 21825 E.Copiey Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION ADDRIESS_��J C[ .54 APN�OT TRACT OWNER mr'��( ADDRESS S E 1�'4 r lilt E t CITY I?ZIP TE�. APPLICANT TE�. CONTRACTOR 1-)-,7 471P(t ADDRESS/ 1 �C< h(�,��.-f\:Nl"tom( CITY ZIP£o-Y TEI., 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�AW FOR THE FOL�OWING REASON(SEC.7031.5 BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REQUIRESA PERM IT TO CONSTRUCT,A�TER.IMPROVE, DEMO�ISH,OR REPAIR ANY STRUG 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 CONTRP,CTORS 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 DO��ARS($500).): ^ I,AS OWNER OF THE PROPERTY,OR MY EMP�OYEES WITH WAGES AS THEIR SOLE COMPENSATION, WI�L DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC 7044,BUSI- NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE tAW DOES NOT 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. IF, HOWEVER.THE BUILDING OR IMPROVEMENT IS SO�D W ITHIN 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 EXCLUSIVELY CONTRACTING WITH �ICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC. 7044,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- CENSE�P,W DOES NOTAPPLY TO AN OWNER OF A PROPERTY WHO BUI�DS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAG TORS LICENSE�AW.). U T AM EXEMPT UNDER SEC._B.&P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DEC�ARATION I HEREBY AFFIRM UNDER PENA�TY OF PER]URY 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 CLASS LIC. NO.C�,G•-7_._ DATE_CONTRACTOR. ORKERS'COMPENSATION DECLARP,TION 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�ABOR 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 IJ�BOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS'COMPENSATION INSURANCE CARRIER AND PO�ICY 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 SUBJECT TO THE WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS'COMPENSAT ION PROVISIONS OF SECTIOPN 37000 THE�ABOR IS AL�F RT ITH COMPLY ITH THOS OVISIONS E T �VT DATE. PPLICANT. WARNING FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UN�AWFUL,AND SHAL�BE SUBJECT AN EMPLOYER TO CRIMINA�PENALTIES AND CIVI�FINES UP TO ONE HUNDRED THOUSAND DOLI�,RS($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOF,CODE,INTEREST,AND ATfORNEY'S FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENA�TY OF PER]URY 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. 1 AGREE TO COMP�Y WITH A�L CITY AND COUNTY ORDINANCES AND STATE IJaWS REIJ�TING TO BUILDING CONSTRUCTION,AND HEREB(AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENT)ONED PROPERTY FOR INSPECTION PURPOSES. . PERMITfEE E R T) SIGNATURE 0 P-DATE 0 PRESS FIRM�Y PP�ICATION Cq'_PERMIT P/C(� DATE t UMBER I J # �� ISSUE -C,-TYPE OCC DATE L4-/ONST GROUP ZONING SETBACKS FRONT RW^ REAR^ SIDE/SIDE STREET RW^ SIDE^ PROPOSED USE N0. DWE�. N0. NO. UNITS STORIES BEDROOMS DESCRIPTION SQ. Ff. FACTOR PSF AD).AREAIVALUATION SFR/ADD/REM U) Garage/Carport LU Patio/Deck LL Pool/Spa Re-Roof Commercial M Valuation AD7.AREA QUANTITY DESCRIPTION FEE J U 2 U W W 0 Z 03 J a U Z 2 0 LU CONSTRUCTION PLAN REVIEW >,- E�ECTRIC P�UMBING MECHANICAL INSPECTION FEE ISSUANCE �I SMIP ENERGY PJC ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: 0 TOTAL FEES X 41 s U --'IS(-'IS( COMMENTS RECPT. NO. PAID BY VA�IDATION WHITE-Department Copy,YE�LOW-Finance Copy, PINK-Assessor Copy,GO�DENROD-File Copy,GREEN-Applicant's Copy