The URL can be used to link to this page

Home My WebLink About14586 CITY OF DIAMQND BAR —.� y - - ' -- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �-� � ai�a E.c�i�y rn;��s,�r�iga (909}8SQ-3245 Faac{904}861-3117 PRESS► ��A�°` BUILDA�tG PERMIT APPLICAT[ON FIRMLY � JQBSITE � ��y ,�/ � APPLlCATIdN ��j '�� PERMIT � , P/C d ADDRESSL'�C�k"1_w�'� N 7�t �'Ce!.—._— DATE_��L6z� �NUMBER � " F 7t � IS$UE TYPE OCC APN LOT_ TRACT DATE CONST. GROUP ,� � QWNER �.� rt � " A4DFiESS !� /L.� ZONING SE7BACKS ��'�"� CITY ZIP � TEL. 6 �Ar REAR RW--- � APP�ICAN �,. � T�� SiDElSIDE STREET fiW C) � CON7RACTOR_/� �� e<�y�'`— SIDE ❑ p� ADDRESS�2.��v PF2QPQSED USE U f/I � CITY� ZIP �� TEL,Fj � t,� ARCtilENG! � 17ESIGNER NC7.DWEL NO. NO. ADDRESS UNITS__ STdRiES BEdROdMS � CITY ZIP TEL. � DESCRIPTIQN SQ.FT. FACTOR PSF ADJ.AREANALt1ATION r» � OWNER-SUItDER DECLARATIpN SFR/ADRIREM �^y �IiBiEBY AFFlFid tRiO£R PENAITY OF aERAiRY THAT i Ahi EXEMPT FF�M THE WNtRACTqRs 11• �di9gelC8�pOCf � CENSELAWFriRTiEFOILCwYINOREASONISEC.7a71.5BU81NE5SAN�PROfESSIONS((%H�E:ANI'CI7YDF (n K.j CDUNTYWHICl4flEWIRF$NPERMITTOCONSTRUCT,ALTER,IMPROVE,pEA10115H2OqREPAIRANYSTfiUC- W patfo/�eck � TURE,AR10R TO iTS�SSU7INCE,A150 REflU1RE5 THE APPLrCANT FOR StlCN PERMI7 TO flLE A$ICat1E0 (� —Y STATEMENT 7HAT HE OR SME IS LICENSEO PURSUANT TO THE PROVIBIONS OF THE CANTRACTORS l,l- CENS£lAW 1CHAPTEfl 9(GOM#1ENCIMCi WITM SEC710N 70tl0)OF DIYI510N 3 pF THE 6VSINESS AND PRO• � PooUSpa FESBqNSCOOE�OpTHATMEORSHEISEXEMPTTNEREFROMANpTHEBM1SI9FORTHEALIEGEQE7(EIAR. (� TpN.ANV VMSLATNSN OF 3ECTICM/7037.6 B7 ANY�PPLICANT FOR�PEflM1T SU&lEC7S THE APPLICANT TO Z Re-Rooi � A CINI PEti+U.TY Of N6T M�RE THAN FIYE HUNDAEO DOI.i.11RS(5506}.): � q�,A54WNEROFTHF:PROpERri.ORMYEAiPLOVEESWITHWRGESASTHEtRSUIECOMPENSATiON, � Commerciat WILL CYD 7HE WORK,AND 1'HE STRUCTURE IS NOT INTENOE�OR OFFERED FOR SA4E(SEC.7014,BUSI• J HE55 AND PROPES5FON8 ibDE:T7iE t�NTPACTbRS IICENSE UW DOfS NQT ARPI.Y 70 fN�YNEfl f}F � PROPEfl�1'M/FpBIUILDSYJIiIMPROVE9THEREON,ANDWHQD06SSUCNWOqKHIMSELFOflHERSELFOR m fL TlNqU(iHHI30RHEPQWYEMAIOYEES,VFiOY1DEOTHATSUC1iIMPRqVEMEMSAqENOTWTENOEDOR t,�1 OFFERED WRSALE IF,tiQiMEVER TME 8Wi0�OR IMPROVEMENTt550tD WiTHM ONEY£AROFCOMPLE• � TION,THE OWNER�HUILpER W�LL HAVE THE 6UROEN OF PROYIHO TNAT HE OR SHE DID NOT BUIID OR � u�R6Vf FOR niE W fiPOSE 4�SALE}. ❑I,ASOYMEFOF TNE VRQVER7Y,+Ui E7(CLUSiVELYCONTMC7M6 Wt7}i tiCENSED CONTqACTOfl3 � TO CONSTRUCT TNE 7RQIECT(SEC,'i01�,BUSINE'SS ANLi PROFESSIONS COGE'.TME GONTRACTORS LI- V8IU0fiptl _ ADJ.AREA_ tlt CEt19EUWDOEBNOTAPPIYTpAN{ItVNER6GAPROPERTYWNQBUM,DSOFliMPftQVESTHEftEON.AND � WI%1CONTMCTSFORSUi:HPqOJECT5YN7HACONTMCTOR(S)UCENSEOPURSUMi77oTHEWNiRAG �UANTITY OESCR�PTION FEE �� TORS UCEN5E IAW.). �j/`� �j_�� O I M1 EXEMPT UNDfFl 56C. B.6 P,G FOR THIS REASpN � /"'" /l'"'"9 � j'�L� ` 'j� fL 2� f•^� �'1" DA7E OYYNER _ � � W � i � LICENSED CONTRACTOFIS DECLARATIDN w � 1 HEHEBY AFFIRM UNDER PENALTY 6i PERJURY TNAT I AM LICENSED UNDER PROVISIONS OF CHAPTER Ur (,� 4{L%MIMIENCW6 W�Ti1 SEG7KNV 7oro)OF DIVISION 3 OF THF BUSINESS AND PROFE55iON$COpE,AND Z ?f YY IICENSE IS�N FULL FORCE ANO EFFECT. � Lll //��, �63� 0 tlCENSf GUSS `�_,�s t-iC.NC1 � � OA7E CON7RACTOR ..... W 4- --.. W � \NORKERS'COMPENSATION DECLARA710N Q � V � I HERE AFFIRAI UNDEP PENALTY OF PERJURV QNE OF THE FqLLOWING PECURATIONS: � Z Q 0 I MAVEAND WIIL MAIN7NN ACERTIF�CATE OF C9NSEN7 TO SELF-�NSURE FOR WOflKER9' _ � , GdA1PEN3AT10N,AS RROVIOED BY SECTION 3�Do OFTNE UBOR CO[?E,FOR TME PERF6RMANCE W OF hiE NfORK Fq3i WNIGi TMIS PEFMiT iS i£SUEO. � 0 W �k NAVEANO WILL MAtNTANJ W{ti8SER5'COMPEN5ATtON INSUMNCE,AS REC]UIftED 9Y SEGTlON 4 376oOF7HElAEiORC4DE,FORTHEVERF-0RMANCEOFTHEWORKFORWFIICHTMISPERMiTt^u 0 t55UEA.MY WOIU(EyRS�'GyOMPENSATION IN/SURANCE CARRIER ANO POLICY NUMBEF ARE�. CONSTHUCTION _ ��"» c,�qqiEq�'' L r PLAN flEVIEW R� ...— ._ ' " ' } . .. ..�--...�� Q ._.L...'� .� .- � . � POIiCY NUAiBER L � � _`?��.—.._ E�ECTftiG t�'r"-'»—;,----. _. ��'-�r� o {i+�sEc¶oNr�t'-�»aT�ar�E'i'EgoFtNErEcatr�st�avE�a.rnr�ocaw�ry,wloac�ss) PLUMBING ,��. � .. - . .,._.�-.r— � 1 CERTIFY THAT IN THE PERFORMANCE bF THE WORK FOfl WHICH THIS PERMIT IS ISSUED,I MECHANICFiL� ' �� ,_ _ � SNAI:tqT EMFLOY ANY PEtiStX:IN At1Y MANNER 50 AS TO 9E�ME SU&lECT TO TH£ INSPECTION�EE^-,�� WORKEflS'CONI7EN5ATION LAW9 OF CALIFORNIA,AND AGREE THAT IF I SHOUIp BECOME SU&lECTTO IHE WORKEft5'COMPENSA710N FfiOY151QN5 OF SECTION 3740 OF THE L480R �� j COOE.1 SHALL r-os�rr�winv raF+ctr vnn+ P s s ISSURNGE �� + ��-- � SMIP p DATE: _,_ APPLiCANk . . —.— � �ENERGY P/C ,.._....—..—. � J WARNINO:FAILURE TO 5£CURE WORlCERS'COMPENSA710N ERAGE IS UNUWKUL AND SNALL BE LL SUBJECTAN EMPLOVER TC1 CRiMiNAl PENALTiES AND CiYt INES UPTOONE HUN6RE6 TtKH}SANQ ENERGY PEFiMIT Dq.LARS(f100,U00),IN MDI710NT0 THE COSTQF COMPENSA710N,DAMAGES AS PROVIpE�FOR IN - �� SECTpN 3T�{7F THE I.A$Ofl CODE,iNTEREST,AND AT70FW ETS FEES_ RETEMTION FEE: ._ � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: _ ...___„...—,. O � I NEREBV AFFIRM UNpI:R PENALTY OF P�P.JURV TMAT THERE IS A CONSTRUCTION LENpING AGENCY _ ,,, _,_ Ft)R TliE F�ERFQRMANCE 4F THE WOflK WR WHIGH TNIS PEqMt71S ISSUED(SEC.309],CN C.). Z W � LENQEP'S NtME_.., - ,_ F_ LENDER'SADDRESS_, ¢ ICERTIFYTHA7IHAVEPEAOTHISAVPLICATIONANDSTATETN�TTHEABOVEINFORMATIqNISCORRECT. T��A�FG��7 1 ' II j.� W i A(`s4EE T6 CAMPlY WITH AV.L CITY AN�CQUNTY ORDNiANOES AN�STATE UWS PELATING TO BI/ILDING -� � � CUNSTRUCTIIXJ.ANDHEREBYAUT}iOH¢EiiEPRESENTATIYESOF�iiiSCOUNTYT6ENTEHUP4NTH£ � A90 NTKkIED pIIOPE TY R INSPECTION PVRVOSES. COMMEN7S _ 0 J � aEflMITT N (P+NT) %/�/'J��'7yJ) ` ((Y • �"'J / ! :' �� • �'. � �/� �/j 5 F RM EE . DATE / � i ' = RECPT.NO��}__PAID BY _.. .......__ VALIDATION � � ~ ~ WHI7E—Depadment C opy,VELLOW--Finance Copy,PINK—Assessor Copy,60LDENROD--File Copy,6REEN—ApplicariYs Copy 9 f � �� +..'� .r, .-, �.a;�.�:'". a...r�`-'?�n`$ . ��'��€�� ,�� .�,. � . .� �. ,-_ � �� ,� �,.�. , . w b *TY ,4,x % h mry �! m�m ��.w +b '� � Y y �Y w„# ��,�§`€ 1 b F � � . �.i > :, . '. ' ' . �'k i . . .. . . . . . .h .. .. .... _.... ..... ...... .. .. . .... ......,_ .:. ....... ...... ..... . ...... .. �. . . _ . . , ._ . '.. . . � - .. ° ...' . .... .._.. .. .._ ..._.. t , .. ' "... . .... ... .__ _.. , .,_.,... .._.. '.. ��, , . E f^, : _ .. .. . . _..... �._.. _...._ . . ..... . , .,. � _ _.. .,. ,.._._. ...... ..... ..._.... t. , � � i . , . ' _ < , � __ ._. ...... . _....... ` �, , �, . , .., _. ._... .... .,_ . .. _ ..a/y� � . .__ .__. _.. __ ... � � � � � _ .._ . ..�_, y . _ .. ,._._ _.. �"��- ,..,,. . . ._. .. .. . . #`� I�� '� r�-�.n„ � M � . _- . �. , t — _ � _ _ _ . . __ .. s ,r... . .,�`3�. -`. „+,t b '�� . . . . . � . .�... ,... .....__ _._..�...�..,. ._._....._ ....._ .,...... ... . ._... ._... __... .._.. ..._,_ . _ ....... . ... .,. � i� E �..£ � . . . .. . _. . _. _i... . ...._ .. . _. _ ... �.. . . .._ .. . .. _ . .. '#r. _ .. �.. . . : ' ' � i_� . .. � .... . ....... C:e f . ; . .. . _. . . - _., _ < .. .. _. _ � _ . ,_ ... . . . �''1 ,�."'_�� t ' ' .. . ,_ _ ., _�-��..G"v . +�4�� . .. .. �. ... ' . . . .� _. ... .. � .. . ..,,ti�`� �-.s�,--.-. ., , �,..a _� � _ _ ,�-��,r � � � , ,.>•, �, � _ � ., ,�� , �,, �.� _ �r,��,.f��;�;�s�, _ �� _ �� _ _ _ _ __ . _ _ _ _. __ _ _ ._.. _ _ __ _ _ _ _ _ _ __ _ _ _ _ ` __ _. _ _ __ __ __ _ _ _ _ . _ �� 'I �8'�� }�.s'ii�s�2 `�� 'qj�F,� ....,.. ...... .... ... ....... . .. .... ..... ...... ...... . ..... ... .. ....... . ..... . .. ��. � " '� , it . �.: _ :u; ; �. .r � - �,.., . . . ��r. �h , ��. ...... ..... .. ...... . .... .. .. .. .. .. . . .... . .... . ... ... . ..... .. . ... .... .. .. �.. — � �y, � "Ir .xnP .. ... ...... ..... .... .. . ... ..... ....... ...... ...... ..... .. .... ........ . . � a,� �j`# � �� , , � k a � a. r°�� ',._.� _ _ _ ��µ �_' . �a�A� , �a _ _ _ __ _ i� .�` .� ,� £ __. ,. �k� �, � � � .„�",.b�`k�t ' +��Y, �, �.�. .,.� `�e�� . . .. .. . ADDRIESS� APN LOT TRACT OWNER ADDRESS CITY,[_ZIP TEL. APPLICAN TEL. CONTRACTOR/_ ADDRESS t o LIL CITY[L7 ZIP I 1 TEI.6. ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER-BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE:ANY CITY OR COUNTY WHICH REQUIRESAPERMITTO 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 HE 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 CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($500).): ^ 1,AS OWNER OF THE: PROPERTY,OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC. 7044,BUSI. NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY wFa BUILDS 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 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). ^ I,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 NOT APPLY TO AN 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.). ^ 1 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 EFFECT. LICENSE CLASS LIC. N0. '576-3 DATE CONTRACTOR WORKERS'COMPENSATION DECLARATION I HERE AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO ELF-INSURE FOR WORKERS' MPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR 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 WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER // POLICY NUMBER 7 OHS SECTION NEED NOT BE CCAP.ETEDOF THE%E MT IS FOR ONE HAORED 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 WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE,I SHALL FORTHWITH COMPLY WITH T PR S S DATE: APPLICANT. WARNING: FAILURE TO SECURE WORKERS'COMPENSATION ERAGE IS UNLAWFUL.AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVI INES 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 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 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 ASO ZONED PROPERTY R INSPECTION PURPOSES. ERMI N IP INTO S F RM EE DATE C6 0 ad LA Ca W cr LLj We W 2 W OF- ZO W W CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION PRESS FIRMLY APPLICATION PERMIT P/C / NUMBER 1- lt DATE-----,�--�- ISSUE TYPE OCC DATE CONST. 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.AREANALUATION SFR/ADD/REM W Garage/Carport W Patio/Deck L IJ LL Pool/Spa 0 Re-Root Z Commercial I', F Valuation ADJ.AREA QUANTITY DESCRIPTION FEE ac -z. W W 0 2 Z W CONSTRUCTION PLAN REVIEW ELECTRIC -�- PLUMBING MECHANICAL INSPECTlON FEE,-i . E ISSUANCE _ •t SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES COMMENTS -/'": "2 j LI-7 RECPT N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy,PINK-Assessor Copy,GOLDENROD--File Copy,GREEN-Applicant's Copy