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Home My WebLink About16516 (9) �_ �� CITY OF DIAMOND BAR ��, DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES -- 21660 E.Copley Drive Suite 190 PRESS (909)860-3195 Fax(909)861-3117 FI RMLY �`��w BUILDING PERMIT APPLICATION ,s�'��f��j� _ o DDRIESS��1 ' �t L��f G-f APPLICATION S—�� NUMBER "-��'Y #lC �� " DATE � APN LOT�_'TRACT .SvZIOG= �SSUE TYPE OCC ,� DATE CONST. GROUP p OWNER /6�� r'I-" ��GL�Q �'-� ADDRESS 1 z ZONING SETBACKS � CITY �_ ZIP " TEL. . � •! � FRONT RW ❑ APPLIC NT _ TEL. REAR ❑ � SIDE/SIDE STREET RW O CONTRACTOR_ SIDE ❑ Q ADORESS � t o, > PROPOSED USE � CITY ZIP_ TEL. � ARCHlENG! � DESIGNER� "'r '' � t- '➢ ��' '� ADDRESS � , NO.DWEL. NO. NO. /a 5 � UNITS STORIES BEDROOMS yCITY ��p11— ZIP � /='TEL.�� DESCRIPTION SQ.FT. ACTOR PSF ADJ.AREAN LUATION OOWNER-BUILDER DECLARATION SFR/ADD/AEM � - � � I HEREBV AFFlRM UNnER GENALTV OF PERJURV THAT 1 AM E%EMPT FROM THE CONTRACTORS ll- Gflf89B/CBfPOfI "` '-,, `�� I • W CENSELAWFORTHEFOILOWINOflEASON(SEC.]031.SBUSINESSANOPROFESSIONSCOUE:ANYCITVOR (n � COUMYMMKxIREIX11RE5�7ERMffTOCONSTRUCT,KTER,IMPROVE,DEMOLISH,ORREPRIRANVSTRUC- w patiO/DBCk NRE.PHIOR TO ITS ISSUMICE,AL50 REQUIRES THE APPUCANT FOR SUCH PERMIT TO FILE p SIGNED � STATEMENT THA7 HE OH SHE IS LICENSED WRSUIW7 TO THE PROVI5loN5 oF THE CON7PAC7oR5 ll- � CENSE LAW(CHAP7'ER 9(CAMMENCINO WITH SECTION 7000�OF DIVISION 3 OF THE BUSINE55 AND PRO- � POOVSpO FESSIONS CODEI OR 7HA7 ME OR SHE IS EXEMPT THEREFROM AND THE BA515 FOR THE AILEGFD E%EMP- TqN.ANYYKKATIONOFSECTION7031.5BYANYAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Roof � A CML PENALT'OF NOT AIORE THAN FIVE HUNDREO�OLUPS(S5o0�.)' ^ ❑I,A&OWNEROFTHEPROPERTV,OFMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, � COmmefCidl � WILL 00 THE WORKµD iHE STf1UCTURE IS NOT INTENDED OR OFFEPED FOR SALE(SEC.�046,BUSI- J NE55 AND PFpFE5510NS 1.'ODE:THE CANTMCTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF � PROPERTYVAIOBURDSORIMVROVESTHEREON,ANDWHODOESSUCHWOflKHIMSEIFORHEHSELFOR � [t THROUOMMISOqHEROWNEMPLOYEES,PROYlOEDTHATSUGHIMPROVEMENTSARENOTINTENDEDOR m QOFFEAEDFORSALE�F,FI�WEVERn1E9UILDINGOflIMPROVEMENTI550lDWITHINONEYEAROFCOMPIE- Z TqN,THE OWNER-BUILDER NALL HAVE THE BURDEN OF PROVING 7H�T HE OR SHE OID NOT BUIID OH IMPROVE fORTHE PUPPOSE OF SALEI. W ❑I,AS ONMEROF THE PROPER'fY,AM E%CLUSIVEIY CANTRACTINO WIh1 LICENSEU CONTRACTORS 4, � TO CONSTRUCT THE PROJECT(SEC.7ou,BUSINESS AND PROFESSIONS CO�E:THE CONTMCTOflS LI- Valu9ti011 1 A�J.AREA W CENSEUWDOESNOTAPPLYTOMIONMEROF�PROPERTYWN06UIL�SORIMPROVESTHEREON,ANO � 'MpCONTPACTSFORSU(�IPR0.IECTSWITHACONiRACTOR(S)LICENSEDPURSUMITTOTHECONTRAG QUANTITY DESCRIPTION FEE TORS LICEN3E LAW.j. ,! I 1 ¢ ❑I AM EXQAPT UN�F R SEC._ B.8 P.C.FOR THIS REASON Q y I ,�/ 3 — � - � S ,� r- � DATE OWNER U �S� �( � w � � LICENSED CONTRACTORS�ECIARATION W �1'� � I HEREBY AFFIRM UNDER PENN.TY OF PERIURY THAT I AM LICENSE�UNDEfl PROVISIONS OF CHAPTER Z w � Y(GVMMENCINO WITH SECTION 7000)OF DIVISION 30F THE BUSINESS AND PPOFESSIONS CODE,AND X MY LICENSE IS IN FVLL fOHCE D EFFECT m ' l, �\ � LICENSE,,,,CL){,SS_!�. LIC.NO. �I^7 S>'��/1 j J ~ DATE '�'. '[�`_ " ��% CONTRACTOR Y 6'L-L � /7C3�� d . -� r- W � � � r� �-� � NiORKERS'COMPENSATION DECLARATION a � I HEHE`/AFFIRM UNOER PENIU.TV OF PERIUPY ONE OF THE WLLOWING DECU1RAilONS: U � � C� �/ Q � � � ��-Ly��I NAVE AND WILL MIAIN'fA1N A CERTIFICATE OF CANSE4T TO SELF-INSURE FOR WORKERS' 2 / ��""ti/� �� '7d- / G�ONPENSATION,AS VROVIDED BV SECTION 3]oa OF THE LABOR CADE,FOR TNE PERFORMANCE U V F T1E W9RK FOI�WMICN THIS PERMIT IS ISSUEO. � �� t �� W IHAVEAWWILLAIAIMAINWORKERS'CAMPENSAT!ONINSURANCE,ASREQUIREDBYSECTION `' ^ Q 3'lo00FTNELABC�RCODE,FORTHEPERFORMANCEOFTHEWORKFOflWHICNiHISPERMITIS Tc I-T�Y�`1 ISSUED.MV WORKERS'COMPE/15A?WN INSURANCE CARRIER AND POLICY NUMBERARE: CONSTAUCTION �� '� .7 � C�flRIER�� i � PLANREVIEW L ^^^�� ZPouCYNUMBER,. � '��_� " { � ELECTRIC (� �S ) ' / � (tF16SECilONNEO)N0T9EIX.YAPLE�mOFiFEPEfUNTiSFORONEHItt�UREDDOLIARS(Sloo�q7LE55J. PLUMBING � '-+'� _ " ' /-) �./ � � \ ...___ i 1 / w ICERTIFYTiATINTHEFERFORMANCEOFTHENORKFOflWNICHTNISPERMITI5ISSUED.1 MECHANICAL __._.__,.. • '�✓___.....__._ .__ _..-. ' 'J /\ z _�s--v. (,'J SFIALL NOT EMPLOY ANY vERSON IN ANY MANNEH SO/5 TO BECOME SUBJECT TO THE / � WORKERSGOMP?NSATIONlAW50FC�LIFORNIA,ANDAGPEETHATIFISHOULDBECOME INSPECTIONFEE . � SU&IEGi l'O 7HE WORNEqS'COMPENSRTION PROVIS:ONS OF SEGTION 3]0o CF THE LABOR I i�k,l .\! � � CADE,I SHALL.FORTHWITH COMPIY WITH h105E PROV/IONJ ISSUANCE _ J J p DATE�.��a /�� APPLICANT: _��C�[t.-��L. SMIP � w ENEFGY P/C 1J \ J WARNING:FAILURETOSEWREVIORKERS'COMPENSATIONCAVERAGEISUNUWfUL,ANDSHALLBE q " / � SU&IECTANEMPLOYERIOGRIMINpLPENALTiESANDCIVILFlNESUPTOONEHUNOREDT10U5AND ENERGYPERMIT l� - �� DOLLARS�S100,OOO�.INA[I�ITIONTOTHECOSTOFCOMPENSATION,�AMAGESASPROVIDEDFORIN — - - Y � SECTION370BOFTMELAI30RCODE.INTEREST,ANDATTORNEV'SFEES. RETENTIONFEE: • =� ',J. d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: / Q IMEFE9YPFFIRMUNDERPENALIYOFPERJURYTHATTHEREISAGONSTRUCTIONLENDINGAOENCY � f d FOR THE PERFORMANGE OF THE WORK FOR WHICM THIS PEHMIT IS ISSUED(SEG.309],qV.C.�. � 1 �� Z �_� � w � LENDEfPS NPME � _._ F_ LENDER'SAODRESS � IGERTIFYTHATIHAVERE:ADTMISAPPUCATIONANDSTATETHATTHEABOVEINFORMATIONISCARRECT TOTAL FEES �� ,� t� w I AGREE TO COMPLV WITH ALL CITY AND COUNTY ORDINANCES AND STATE UWS RELATMG TO BUILDING � d CANSTRUCTION,AND ME9EBV AUTHOflIZE REPRESENTATIVES oF�HIS COUNTY TO EMER UPON THE Z ABOVE�MENTIONED PROPERTY FOR INSPECTION PURPOSES. COMMENTS � �,•� !d/{'z.fi m PERMITTEE NAME(PRINI� � a � -3L� �� y�- � SIGNA7U OF PERMITTEE DR7E � �" 1�.� � RECPT.NO. � PAID BY � VALIDATION WHITE-Department Copy,YELLOW-Finence Copy,PINK-Assessor Copy,GOIDENROD-File Copy.GREEN-Applicant's Copy �,��"� �� s�� w�� . �..�a�x '��,°� �� ;��'�°� i ' � "` � i , � � _ � �; z � �-a_ , � _ _ _ _ _. _ � , . _ � �'�� '� Z�j dl (_;�� p y � _. �_ .. . _ _ _- -- _ _ _ ....(_.,� .t r' � lE� .,.. i�eh� , _ .V �. . �, .>, " —_ ` — — ..... . ,. , _ _ -- ,..__ ...._.. —.. . �; ��.'S.-J ��, ,� � _ � �_ — — _ — — — ..� ., , o � ' ° ��1.l�.� ' — e _ ___ _._._ . � _ � t� , :� � _ _ _ _ _ _ _____ ;�:� � ��-. . 3 , . � E �.t�_ �. e_ _ _ __ _ __ ,`. Y ° sr � " r�°` n ' , � �`�-��f�� `r"= ,e� . w � ,Y� �;b k :�._ �. ' .a� '�'a'.� 1 �'�� ' ndiLN' _ �� "a — ,..... ._ _. , ... '. . ._ ..... _ _ . .... . �._ _._. .. _ ...... _ .. ___ ._ ,... .._ _. _. r, �� ; � � l� ,:- �__ _ � ._ _ ___ _,� � _ _ _ � �c�� , � '�' � _ _ _ — ��' ;— . . � � _ � � � . �._.. . _ _._ __ _ _ _ � ��+�' ; , , . . , . ,. _ .. , — — — ; _ _ _ _ �_ . _. ---___ , , _ ,�„ _ �—__ ..�.�__ — a � , , . � —�_ � — — _ _ — , r,.;�.� — � �—tt � ..� . �—�_;b�� t�— � _ , � , �.—_ _ _ _ __ .. .: , � _ .__ ._.. . . ^ ° �� _ _ __ . � _ �` — _ . � __ _ _ _ . __ a _ _ _ �' _ . .. . , , . ._ � _� � _ �- �. . � U � , � �.t,�, � „ � ��,. I�-�l _ � __ _....__ __ _ � ' �� _ � ..__.__ , � . __ ��: � l _ � `_ � ____ _ �-- —— _.. � � , t � _ __ _ _,_.. . __ - _ �� _ _ „ �� _ , _ � �: , ,,.�., _ . _ �___ _ _ _� _. o�.��.�� _ __ _ _._. _ __ _ ._ _ . __ _. _ _ __ _ . _ . _ _ __ _ . _ . _ __ __ _ _ _,. �_ ,F�..� . . . . __ _ _ _ . �r� � ��r,;��%,�,�� ""'�4�� _ _ _ � � �� __ _ _ _ — _ � � , _ . .... � .. �' r y � _ __ — _ _ _ �� . . , „ _ , r �,i:� w � y„� �� — _ �_ _ _. _ . __ _ _ � r lP � � .„v �,�'� ��C p _ . 3 , ,r , ad �, u _ �� , _ � � � r �� „ � . �P � � �� u"� `� _ _. _ },� , � �?. : �� d � ' r � �:.� � �� CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVE�OPMENT SERVICES 21660 E.Copiey Drive Suite 190 (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION PRESS FIRM�Y JOBSITE/ 70 ADDRESS APN LOT TRACT Svc 4- OWNER/d�r)ig 44 F� ADDRESS 1 ; CIl'Y�_ZIP"TE�.�I�Ir>-7�)71/�SI�� APPLICANT TE�. CONTRACTOR_ ADDRESS( > CITY ZIP TE�. ARCH/ENG/ DESIGNER c- ADDRESS Jh CITY ZIP L TE�.71't5'3 �I7'� OWNER-BUI�DER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE�P,W FOR THE FOL�OWING REASON(SEC.7031.5 BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REQUIRES A PERMITI'O 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(5500).): ^ 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 SA�E(SEC. 7044, BUSI. NESS AND PROFESSIONS CODE:THE CONTRACTORS�ICENSE�AW 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 BUI�DING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMP�E- 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 A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS�ICENSE�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 PER7URY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORCE D EFFECT J''� I 7s_(/ SS�IC. N0. " C LICENS E p(N LL _,,, J ��11 DATE�CONTRACTOR_NY i'L G Lr/*)�+7 f=] "II WORKERS'COMPENSATION DECLARP,TION I HERE AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DEC�ARATIONS: 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 F THE WORK FOR WHICH THIS PERMIT IS ISSUED. J �� J /� lam!J I HAVE AND WI�L MAINTAIN WORKERS'COMPENSATION INSURANCE.AS REQUIRED BY SECTION j 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER POLICY NUMBER. {7105 SEMlON NEED NOT BE ODMPLETED OF THE FERRET IS FOR ONE I II'DRED DO�LARS($100)OR LESS). 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'COMPENSATION PROVISIONS OF SECTION 3700 OF THE(ABOR CODE,I SHAL�FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE : •� :Tir APPLICANT: WARNING FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UN�AWFUL,AND SHAL�BE SUBJECT AN EMPLOYER 10 CRIMINAL 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 Al-fORNEYS FEES. A 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 LENDERS ADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH AL�CITY AND COUNTY ORDINANCES AND STATE LAWS RE�ATING TO BUILDING CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. u i A��Z x ,OF PERMIITEE DATE C APP�ICATION PERMIT P/C DATE C I�� 1 NUMBER# :.) ISSUE TYPE OCC DATE CONST GROUP ZONING SETBACKS FRONT RW^ REAR^ SIDE/SIDE STREET RW O SIDE^ PROPOSED USE N0. DWE�. N0. NO. UNITS STORIES BEDROOMS ACTOR DESCRIPTION SQ. Ff. P ADJ.AREAJVALUATION SF SFR/ADD/REM Rel \\ NV Garage/Carport W Patio/Deck LL Pooi/Spa 0 Z Re-Roof 0 Commercial M Valuation 1 ADJ.AREA QUANTITY DESCRIPTION FEE a 1 1.) w 'SOK � YY W O� m c-J J U 074- 1 CONSTRUCTION I 3 PLAN REVIEW ELECTRIC L P�UMBING MECHANICAL INSPECTION FEE ISSUANCE I3°-)��t* SMIP L(J ENERGY PJC ENERGY PERMIT..I- RETENTION FEE: PRE-ALT FEE: lI TOTA�FEES COMMENTS RECPT NO. 7,11 PAID BY VALIDATION WHITE-Department Copy,YE�LOW-Finance Copy, PINK-Assessor Copy,GO�DENROD-File Copy,GREEN-Applicant's Copy