The URL can be used to link to this page

Home My WebLink About17328 �� CITY OF DIAMOND BAR 4� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 ��5 l'�� PRESS ��' � BUILDING PERMTT APPLICATION FIRMLY � JOBSITE , � APPLICATION � `�. � PERMIT •1�`)�P/C/^1�.. � L�_ Q ADDRESS�� -� �� J�-s�i./� C`� p DATE UMBER J � �-' � APN I.OT TRACT S ��-� 7 ISSUE � i��J�PE OCC C�, DATE u ONST. GROUP p OWNER /�'1� "� ADDRESS " � v 1 ZONING SETBACKS Z CITY.��--� ZIpy�L�,_TEL�f`�%t��`�/ _ FRONT RW ❑ g APPL CANT _ TEL. REAR ❑_ � SIDE/SIDE STREET RW ❑ CONTRACTOR_ SIDE ❑_ �� ADDRESS .e' � CITY ZIP TEL. PROPOSED USE oARCWENGI � �j DESIGNER �f.d� �-�/�3� � ADDRESS��f C�� NO.DWEL. NO. NO. CITY ��- ,�,�jyr : ZIP� TE - � UNITS STORIES BEDROOMS u� / DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION O OWNER-BUILDER DECLARATION 7GU�-��I - SFR/ADO/REM `y �� ,, �j p I HEREBY AFFlRM UNJER PENALiV OF PERJUflV TH�T I AIA E%EMPT FPOM THE CONTRACTORS LI- G3fe JB/Cefp0ll �r,S W CENSEUWFORTMEfOLLIriVINGRE�SON(SEC.7031-SBUSINESSANDFROFESSIONSCODE:ANVCITVOR ' � COUNTV NMICFI REOUIRES�PERMITTO CONSTRVCT,ALTEF.IMPROVE,DEMOLISH,OR REPAIR ANV STALIF TVRE,PRIOR TO ITS ISSU/NCE,ALSO REOUIRES THE APPUCANT PoR SUCH PEiiMIT TO FILE A 516NED W Patio/Deck � �� [_, n 7� � STATEMENT THAT HE OR£HE 13 LICENSED PURSUANT TO TFIE PROVISIONS OF TME GONTflACTORS LI- � �' `'� �� CENSE UW(CHAPTER 9(CQMMENCINO WITH SECTION 7000)OF DIVISION]OF THE BVSINESS ANO PRO- POOUSPa FESSpNS CODE)OR THAT iE OR SFIE IS EJ(EMVTTHEREFROM AND Tl7E BA515 FOfl iHEALLEGED EXEMP- (�J TpN.ANVYKKATI0NOF51:CTION7031.5BYANYAPPLICANTFOFAPERMITSUBJECTSTHEAPPLICANTTO Z Re-Roof F A CML PENAL7V OF NOT MDRE THAN FIVE HUNDRED DOLLARS(55oo)J: � �LASOWNEROFTHEfPROVEfiTV.ORMVEMPLOVEESWITHWAGESASTHEIFSOLECOMPEN5A71ON, 0 Commercial WILL D�TME WOFi1C,AND 1NE STRUCTURE IS NOT INTEN�ED OR OFFE{iED FOR SALE(SEC.�os�,BUSI- J � NESS AND VROFESSIONS IbOE:THE CONTRACTORS UCENSE UW DOES NOT APP�V TO AN OWNER OF � PROVERTV WFIO BUILOS OII IMPROVES THEflEON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR Q TMK%IOHHISORHERON/NEMVLOVEES,PROVIDEDT}IATSUCFIIMPROVEMENISARENOTINTENDEDOR m QOFFEREDfORSALEIFFIOV/EVERT1iE8UIlDhIGORIMPROVEMEMI550LDWRHINONEYEAROFCAMPLE- • Z TION,TME OWNER�BUILDEi WILL MAVE THE BURDEN OF PROVING THAT HE OR SHE 01�NOT 9VILO Ofl � IMPROVE WR THE PUfiFOSE OF SiLLE). W ❑I,ASONMEROFTH'_PROPEHfY,AME%CLUSIVELYCANTMCT7NGWITHLICENSEDCONTqACTOqS � TO CONSTRUCT THE PR0.IECT(SEC.701l,BUSINESS AND PROFESSIONS CODE:THE COIVTRACTOflS LI- V21u8f10f1 ADJ.AREA W CHJSE UW DOES NOTAPF'LY TOAN ONMER OF A PROPERTYWFKJ BUILDS OR MPROVES THEREON,AND � WMOCONTiUCTSFORSUCHPRQIECTSWITNACONTRACTOR(S)UCENSEDPURSUANTTpTHECANTiUG QUANTITY DESCRIPTION FEE � TORS UCENSE IAW.). ^ ❑IAMEXEMPTUNDERSEC. B.BP.C.FOfiTHISHERSIXJ Q F '� ��„' � Y U � � 2 c� .� . I� � OATE _ OWNER U Z J � /k . �.. � LICENSED CONTRAGTORS DECLARATION w L � V C 1 HEREBV AFFIRY UNDER PENALTV OF PE0.IURY 7MAT 1 M/LICENSED UNDER PRGVISIONS OF CHAPTER � Y(COMMENCINO WITH SECTION 1000)OF DIVISION 3 OG THE BUSINESSpNO PROFESSIONS CODc',AND Z C� ^j TC W UCENSE IS IN FULL FOflCE AN�EFFECT. , LLI � J r�.7 � ` � LICENSE CLASS_ LIC.NO. � J •�f V�_ J .. � � �r �' ~ DATE f= ��"�CONTRACTOR d. � � � � l�fr . � �J � ��ORKERS'COMPENSATION DF_CLARATION ' Q ' �U�' �C}n, .a ��,J � /� '[�V ( � � I^HEREB�AFFIRM UNDER FENALTV OF PERIURV ONE OFTHE FOLLOWMG DECLARATIONS: Z i Y U�f' �l V l\S.J � /-�j/��[�IHAVEANDWILLMAINTAINACERTIFICATEOFCANSENTTOS[LF�INSUREFORN/OPKEFS' _ Q .�I" COMFENSATION,AS PROVIOED BV SECTION 3]DOOF THE LAflOR COOE,FOR THE PERFORMANCE 'U Q � F THE WORN FOF.WHICN TNIS PEFMIT IS ISSUED. � QW 1 HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS PEQUIRED BV SECTION � :l7000FTHEL1�80�.1COOE.FORTHEPERWRMANCEOFTHEWORKFORWHICF'.7HISPEHMI715 O ISSUED.MVWORK_S' I RANCEtSAPRIERAN�POLICVNUMBERARE: CONSTRUCTION � CARRIER__ �� w PLAN REVIEW d � y- P ICYNUMBER_� ��L�J�R J�c_7J"'f ✓/ rJ"7/J ELFCTRIC ,� r` � �"��sECIYxaNE�NDrBEcoHVL� EfIDOFn1EPEaMfiSwF�vEhu�RtUooul�as(Stao�ORLESS). PLUMBING • _ . _ W � Z I CERTIFY THAT IN fHE PERFORMANCE OF THE WORK FOH NMICH THIS PERMIT IS ISSUEO,I MECHANICAL � ' � ,��J�} C} SHALLNOTEMPL4iVANYPERSONINANYMPNNER50ASTO8ECOMESUBJECTTOTHE ul � WORKEFS'COMPENSATqNLAW50FCQIFORNIA,ANOAGREETHATIFISHOULD�ECOME INSPECTIONFEE r SUBJECT TO THE vJ9RKER5'CJMPENSA710N PROV1510N50F SECTION 3l0o OF THE LPBOR -r\ � S CADE,I SHALL F0V17HWIT COMPLY WITH TH9L�VRDVISIONS. ISSUANCE �� 'V � o /y �� J p �ATE: �7 �(J,.� PPLICANT urTi� SMIP Y �_ �L_____ � �w ENERGY P/C U Y WARNING:FMLURE TO SECURE WORKEflS'CdAPENSATION CAVERAGE IS UNUWFUL,AND SHALL BE � � SV&IEGTAN EMPLOYERTO GRIMINAL PENALTIES AND GIVI�FINES UP TOONE HUNDRED THOUSANO ENERGY PERMIT ��1��_� OOLLARS�5100,000).IN ADDITION TO TME GOST OF COMPENSATqN,DAMNGES AS PROVIDED FOR IN J SECTION3�OBOFTHELAB�RCODE,INTEREST,ANDATTORNEV'SFEES. (- � Q RETENTION FEE: �� ,�.� d CONSTRUCTION LENDING AGENCV PflE-ALT FEE: O �� I HEREBY AFFIHM UNDER f'ENALTV OF PERJURV THAT THERE IS A GONSTflUGTION LENDING AGENGV _ FOF THE PERFORMANGE OF THE WOFN FOR WHIGH T ,/V�RMIT IS ISSUED�5 C.1091,qV.C.). $ u' il!'�/V� �/!L��,.�� ENDER'SNAME _ ) H LENDER'SADONESS /� � TOTALFEES J � I CERTIFY THAT I MAVE flEnO THIS APPLICATION AND STATE hIAT THE ABOVE INFOFMATION IS CARREGT. J� �'�� I w I AGFEE TO GOMPLV WITM ALL GTY AND COUMY ORDINANGES AND STNTE lAWS REUTING TD BUILDING �, d � GONSiRUCTION,ANDMtHEBYAU�HOHIZEHEPPESENlATIVESOFIMISGOVNTY(OENTERUPONTME Z ABOVE-MENTIONED PROV�.=RTV FOR INSP CTION PURPOSES. /� COMMENTS � _ 7�"l'' �� _ ��. '�1��1 m PEPMITfEE�NAMEIPRIN � � L / —� e^ ) '—""� Cn . /� �� .�J �l �� rc Uj SIGN PERMITTE': DATE = RECPT.NO. T PAID BY VALIDATION ~ WHITE—De artment Co YELLOW—Finance Co PINK—Assessor Co GOLDENROD—File Co GREEN— IicanYs Co P PY. PY. PY. PY. MP M # i' t k�. g e.r. � '� . . .- . , 5..`: . ��*,�a. 3.�"J 2. r = .�.s �,,y�� .;� . .� , . . " ' th��'.�.��•:.-; � ry,;• �;P ��a��'�� S'�,.;� ';3�".,*�� a*�� k��i�e°r"�`�r � P,�r-y � �;., f'� � d � �, � s + ' . . " �::.��a€?�«�� . . . .. .. . ... ... .. . ^�u.. " .. �' .'�`��9 ,... �.�.�.E � . aa+7�*'a.Nu.�nt ,.. '�"'� . �-� ��. �� ,t,':��f�,��S•r, :! ,.. . '' .�, _ ... . .... ._ ... . ... ... ... . ... _ . .. . ._. . .. :� ._.. __ . .... ' -___ . .. .-...� ._. , �_. L.f�"5`A�'�E'� ` =F _ j �'_•,� .. ' . .. . . ��. _.i...mp �^ . . ._ . _.. .__. ..._. 3 t..!.0 ttt ,1�, L.F'tl'�4S:,.i.,` , �. , .. � ''s�4 i,i9 �<L.P .x� RP. ?- ' _ .... -.. . .... . . .. . .. ..� .. . .... _... _ . . . . . . . i �1K.,,�� .-+513i..iL , _.. .._ � _. ' ... . . . . _ . . . . ,.. ..- . .._. ..._ . _ __., , _.._ .. _ ._. _ . - � I'��.,��'� ��'s.." .. . . .... .. ... . , � � . .. . . . .... .. ... ... , ..... ...... . . . .. . .. ...._Ti �{ '7'.CC �4i,��- ... , . � .. . .. � . .. ... . .. .. .. , . . . . _ . s}�A� w , ,c�� _' _ " =�� 4[7 e /C� -- ,` " � � �=t=.�`si�is�,xrt%`t t': t t � �,:.._ .. , �—. ... ' . .. � �. . _ '_ ._. '`. ' . .. �_ .. ..... . .. . . . . . .. . . . . . . � E4a.r. � .,,i:`H � .�. // .._. ... ... . ... .. ... ... . _..... ... . . .... . _.. . ... .. ...... . _ , �. .,._ ._ j =r ,7 �� .J-� d �'"�l �f.d a p ..� !/f/"�, . . . . _ _. .. .. . . . . . .. .. � _.' _., ._�.- ._ . —. - -- � ��41)�,�t �'_ t � ; ��v � � r� } 1 f ' r r,� p t€'t j,•.�/�"/ ... . . t ' �: .. � . ,��F ... ._.. . . ...... . .. . . .... .... . _ . . . .. a=�i t x � t '� �t ` ., .... . - _ . ._. . '. ... _.. .. ... ... .. . . . . .. . N�.: � , �LL y i�� :��b'.�.Z' �' ... . . . ". . . .. . .... . . �. i.�°� � � �, , . _ _. . $ .. ": . � �.�7a __.. _...... . .. . ..... ... ... .. .... . ._..... .. . _. . .... . . � . a ,n�„ s : ��,�1-2 � � , � ,.�� ,�� - � � �`_ ��— — — _ ��,. �� .s_ _ r�, _ `� �` ._ � � � �� _ � � "�h. ' I`1�� } �. .:. 4 er . . . � ... .... .._ . ... .. .. . ... .. . . . , ._.. ._. . ..,. � 6 � a< <. � e . ( .. ... . . . . . . / I � C✓f �Z � �.fl/�'�_ _ . � �I 1 �� r � - � � : h �k�.»€ a ' ; '�'J �� pA �',—�QQ Ali�, .�.77C_iT[�J ..�2( ��Z �`_ . � „�., t.. — , . _ . . . . .. . _. . . . . i �. ...... ......... __... ... .. ........ .. .......... .. _. . .. ... .... . . ._... .. . . . .. . . .. . . . . t @ . .... ... ... .... . .. . ...... . . . . . . � __..�. , .._-.. _... ..... �.._. ...-__. ... ..... ....... . f . � . . . . .......... .. . . ........ .. ... . . . . . � ....... ._....... . ...... ..... .. ........ . . . ... .... . .... .... . .. ... . . .. ... .... .... .. .. . . . . .. . 3 � .._... , ..... .. ..... ...._.. ....... .. ..... . . . .... . . . . .. .. . . . . i _._..... _...._.. . ... .... . ...... ..... .. ..... . .... ..... .. . ....... . . . . X ..... ...... ... ..... .__... ..... .. ..... .. .... .. ......... . . .. ... .. ... . ... . .... . . .. .. . . .. Wfi � '.?�.... �4��.J��. �} ft+5 �....i � , ; _"._ . ....... . .. .. . : f"��.�"�` !a3E..�_1 , �:�:.a ...... ... .... _.. .... ... . . ._.. ._.. . . . . ... .. . ... # a..a.......,. . -. . __ .._ y... �� i'''}Y. .. �s ' . . .._.. .. .... . . .. . ... . .. . .. .. .. ...... ... .. . . .. 1 r, � w�� .. � t l � � , __ � _ i � �:, �; � " 1 � � g _ . CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117/mss I BUILDING PERMIT APPLICATION PRESS FIRMLY JOBSITE ADDRESS APN LOT TRACT-'S,: 77 � :r, 7 : OWNER :A// ADDRESS)V 41� CITY.-tl/ZIP ! Z-TEL�f�'9 1X/Y'-/ APPLICANT TEL- CONTRACTOR_4 4 ADDRESS CITY ZIP TEL- ARCWENG/ DESIGNER)(. 1 �-�/mod S ADDRES CITY/ZIP?TE"-- OWNER-BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOW ING REASON(SEC. 7031.5 BUSINESS AND PROFESSIONS CODE:ANY CITY OR COUNTY WHICH REQUIRES A PERMITTO 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-E 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 CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($500).): 0 LASOWNEROFfHF: PROPERTY. OR MY EMPLOYEES WITH WAGESAS THEIR SOLE COMPENSATION, WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC. 7044,BUSI- NESS AND PROFESSIONS()ODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS Oft 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-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). ^ 1,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 NOTAPFLV TOAN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). ^ I 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 MY LICENSE IS IN FULL FORCE AND E FECT LICENSE CLASS //�� LIC. N0. 57?-3 DATE CONTRACTOR/q•' 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 F THE WORK FOE 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 WORKS S'C pN I RANCEZSARRIER AND POLICY NUMBER ARE: -GG CARRIER �y n A UMBER h u/r/'7/J r P ICY/N U SEGf10N NEI NOT BECO PLETED 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 WO R S'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR KEER CODE,I SHALL H COMPLY VISIONS. WITN T Y/ / ,r T J/APPL ICANT E: DA ��i� WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL 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 3708 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(IF THE WORK FOR WHICH T P OMIT IS ISSUED IS C. 3097,CIV.C.). LENDER'S NAME VG LENDER'S ADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. 1 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 LOOP PURPOSES. PERMITTEENAME(PRIN L SIGN PERMITTEI DATE APPLICATION C PERMIT P V DATE ISSUE i J IYPE OCC DATE u d"ONST.GROUP -ZONING SETBACKS FRONT RW^ " REAR^ SIDE/SIDE STREET RW^ SIDE^ PROPOSED USE N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM s cj U) Garage/Carport 9 3 W Patio/Deck /2(j 0- ) 1 U- Poo!/Spa Z Re-Roof 0 Commercial 5 m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE � to CC 2- a ULI w lu m j a O Kc_c) f lye h0(7 1 V J� W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL�X�I 1.-J U INSPECTION FEE ISSUANCE SMIP ENERGY P/C U ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: 'JJ TOTAL FEES 31 °ai� vl COMMENTS I- rV 1 04 RECPT N0. n D- PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy