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Home My WebLink About17851 ��; ,r-�� . CITY OF DIAMOND BAR �'W� DEPARTMENT OF COIvIlVIUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive � (909)860-3195 Fax(909)861-3117 PRESS �`T:�� BUILDING PERMIT APPLICATION FI RM LY o DDRIESS/� y� C� �� ' I /• DATE CATION � � NUMB R �� #`� � ISSUE� � ��'� TYPE OCC APN IAT �T��`CT _ DATE �� CONST. GROUP � OWNER C�i?�-V O o ADDRESS �„'l� ZONING SETBACKS Z CITY ZIP TE . � � FRONT RW ❑ � APPLICANT TEL. REAR ❑ � SIDE/SIDE STREET RW ❑ a CONTRACTOR � 4� SIDE ❑ . � ADDRES�.. � �tr� � PROPOSED USE � � �'<< 'ti � � � o CITY ✓�J�-, ZIP TEL. 7 ,� �1 w ARCH/ENG/ � y , �•i � � w DESIGNER NO.DWEL. NO. NO. a ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. cn � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR(ADD/REM O 0 I HEREBY AFFlRM UNDER PENALTV OF PERJURV THAT I AM E%EMPT FROM THE CONTRACTORS LI- GflfB(J0/C2fPOfI W CENSELAWFOHTHEFOLLOWINOREASON(SEC.]031.SBUSMESSAN�PROFESSIONSCODE:ANYCITYOR (/� U GOUNTYWHIGHREOUIRESAPEFMITTOCONSTRUGT,A�TER,IMPROVE,DEMOLISH,ORREPAIRANVSTRUC- W Patio/Deck Z TURE,PRIOR TO ITS ISSUANCE,AL50 REOUIRES TNE APPLiCANT FOR SUGH PERMIT TO FILE A SIGNED W w STATEMENT THAT HE OR SHE IS LICENSED PURSUANT 70 THE PFOVISIONS OF THE CONTRACTORS LI� � CENSE LAW(CHAVTER 9((:OMMENCING WITH SECTION 7o00)OF DNISION 3 Of THE BUSINESS AND PRO- � Pool/Spa � FESSIONSCODE)OflTHATHEOR5HE15E%EMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP- � TION.ANVVqLATIONOF5ECT10N]0315BVANVAPPLICANTFORAPERMITSJBJECTSTHEAPPLICANTTO Z Re-Root � A CIVIL PENALTV OF NOT NIORE THAN FIVE HUNDRED�OLLARS(f5oC).)� O ❑I,ASOWNEROFTH'�=PflOPERTV,ORMVEMPLOVFESWITHWAGESASTHEIRSOLECOMPENSATION, � COfi1R1BfC12I Z WILL DO THE WORK,AND iHE STRUCTURE IS NOT INTCN�ED OR OFFERED FOR SALE(SEC.]oa4,BUSI- J NE55 RND PROFESSIONS GODE'.THE GOFl�RACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF � PROPERTYNTIOBUIl�50RIMPROVESTHEREON,ANDNTiODOE55UGHWORNHIMSELFORMERSELFOFi � Q THROUGHHISIXiHEROWNEMPLOYEES,PflOVIDEOTHATSUGHIMPROVEMENTSARENOTINTENDEDOR m QOFFEREDFORSALE.IF,H0INEVER,THEBUILOINGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE Z TION.THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THA7 HE OR SHE DID NO7 6UIL�OR � IMPROVE FOR THE PURPOSE OF SALE). w ❑I,ASOWNEROFTHEPROPERTV,AMEXCLl.51VF.LYCONTRACTINGWiTHLICENSEOCONTflACTORS � TO CANSTRUCT THE PRO.IECT(SEC.1004,BUSINESS AND GROFESSIONS COOE�.THE CONTRACTOFS LI� VBIIJflIlOf1 ��' ADJ.AREA W CENSELAWDOESNOTAPPLVTOANOWNEROFAPROPEFITYWHOBUILDSORIMPROVESTHEREON,AND � WHOCONTRACTSFORSUCHPR0.IECTSWITHACONTRACTOFl�S�UCENSE�PUPSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE Y TOflS LICENSE LAW). Q J O ❑I AM EXEMPT UN�[F SEG. B.8 P.C.FOR THIS REASON Q � � 2 � OATE OWNER ~ Z U W � L.ICENSED CONTRACTORS DECLARATION w � I HEREBV AiFIqM UNOER PENPLTV OF PERJURV THAT 1 AM LICENSED UNDEA PROVISIONS OF CHAPTER � � 9(GOMMENdNGWITHSECTIONt000)OFDIYISION30FTHEBUSINESSANDPROFESSIONSCODE,AND Z X MV LIGENSE IS IN FULL FORCE ANp EFFECT. m /n 4 u Z-- � � LICENSE LASS `� �� LIQ NO. � �� J U DATE � ��2/ CONTFACTOR d W � N/ORKERS'COMPENSATION DECLARATION � � a � I HEREBV AFFIRM UNOEF��ENALTY OF PERJURV ONE OF THE FOLLOWING DECLARATIONS: U (/) Z Q � I��-H��AV[[[EANDWILLAAAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWORNERS' _ Z �PENSATION,I\S PpOVIDED BY SECTION�70o Of THE LABOR COOE,FORTHE PERFORMANCE U Q F THE WOFK FOR WMICM TMIS PERMR IS ISSUED. � � w IHAVEANDWILL�AAINTAINWOflKERS'COMPENSATION SURANCE.ASRE�UIREDBVSECTION / �I� Q 3'/OOOFTHE LABOP CODE,FORTHE PERF ANCE THE WORK FOR WHICH THIS PERMIT IS �I n. I y i ISSUED.MY WORK€RS' OMP�NSATION I ANCE ARRIERAND PO�ICV NUMBEFiARE: CONSTRUCTION �i 1..J �J `� �� PLAN REVIEW GARRIER_�J' "��- ''f � POLICV NUMBER Q�'� ELECTRIC Q � (iHISSECTKKJNE6JNOT8ENMPLEfEDOFTHEPERA�MISFORONEHUNDREDDIX.LAFlS(E100)ORLESS). PLUMBING w 1 CERTI-Y THq7��THE PERFORMANCE OF 1HE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL Z �J' SHALL NOT EMPIOY ANV PERSON IN ANY MANNER SO AS TO B[COM[SUBJECT TO THE � WORKERS'GOMPENSATION LHWS OF GALIFOFNIA,ANDAGREE THAT 1%I SHOULD BECOME INSPECTION FEE �� SUBJECTTO THE WOFKEHS'COMP=NSPTION PR ISIONS OF SEGTION 3]OOOFTHE LABOR COD�,I/SH�ALL FGqTHWITH COMPLV WITH THOS ROVISION(� ISSUANCE � �y � SMIP �� p DATE:��/' L._ APPLICANT: w ENERGY P/G J WFRNING:FAILVRETO SEGURE VdORKERS'GOMPENSHTIO�GOVERAGE IS UNLAWFUL,AN�SHALL6E J � SUBJECTANEMPLOVERI'OCRIMINALPENALTIESANDCIVRFlNESUPTOONEHUNDREDTHOUSAN� ENERGVPERMIT DOLLARS�Sl D0,000�,IN A[)DITION TO THE COST OF COMPENSATION,DAMAGES AS PilOVIDED FOH IN J SECTION 37aB OF h1E LABOfl CODE.�NTEREST.ANDATTOFNEY'S FEES. � � I_ � RETENTION FEE: a CONSTRUCTION LENDING AGENCV PRE-ALT FEE: O � IHEREBYAFFIRMUNDERPENALTYDFPERJURY'HATTHEREISAC�NSTRUCTIONLENOINGA6ENCY � iOR THE PERWRMANGE OF THE WORK FOflYJHICH THIS PENMIT IS ISSUE�(SEC.�09�,CIV.C.). Z w 2 LENDEF'S NFME � V— LENDER'SAf]DRESS � IGEFTIFYIMNTIHAVERf:ADTMISAPPUGATIONANDSTATETHATTHEABOVEINFOFMATIONISCORRECT TOTAL FEES i - w IAGFEE TO COMFLV WITH ALL CITY ANO COUNTY OHUINFNGESAND STATE LAWS flELATiNG TO BUILDING � CONSTR'JCTION,AND HERE6V AUTHORIZE REPiI�SENTATIVES OF THIS COUNTY TO ENTER UPON iHt Z ABOVE-MEN/�!pyNED PROPEFTY FOR INS ECTIOp PURPOSES. COMMENTS O �C�`��f' �I f'•f( .^ V � t m PERAAITTEENAMF(P N7) -/L.,/L _ Q �� .7`� .__.__.. ___. __. _" C!J �` ' � SIGNATU P MI ':_E DATE = RECPT.NQ PAID BY VALIDATION ~ WHITE—Department Copy,YELLOW—Finance Copy,PWK—Assessor Copy,GOLDENRO�File Copy,GREEN—ApplicanYs Copy �.c@�rc° 9� ��, , �,t�. > i } ',. t k y�'a,3 �'3 i :�U �aik t;r; .� i� - „ri'. � iml � rv�. � ��; �� . H.�. �'��` �€.�+�� .. . " i_ , m la. ��1�IE�?� 'id.,�� . - . . . .1";�a.� �'�. i . � .. .. .. ��.� ��_,__.,��_,� .: ,. ... .... .�.. .. . . ... ..... ��.��.. . . � � `'--�-- ��. q , . . 7� . . . . . ... .... ... ... ... .. . ... ... .... . .. .... : � : .��...... .. .... ...... _.._ ._. . .. � . .. � . ... .. . . � Mc. . °�b3-._ . � 9we .. .. ... .. .. .. . .... . . .. . . .. .. ... . . .. .... ..... .... .. aEi � f .i� a�,� � �.4 ��K , ��u � , � � , ,.r��;�� , ,s� ` , �� • �� ,, r�,� ,; � �. _ r'IuiJ .t: „"k�'.. 3 ` ��.. .rJ p � I .. '�.. T f II a r � . . . . _.. . . . .. .... . . . . .. .. .. . .. �r L Y 's.J1. —..... ._ . _.. � 1�X 3 g�i�. g'�,¢: .�� . �al �!:?9 ._ ' ' �. ... .. . . .. .. .. . .. . . . .. ... ... ... .... .. .... .. . . . k _ 1`(� � 'I ��. a I :i 4 a.,a'2 Ua �. '�..�i , i �k ; ... _ ... .. . ... .. . . . . .._. . . . . . .._ .... . ._. ._ ... . . � � i pIy'R. E�'.�� . { ��,��r� �+G �. F I a s :�. � .. . ��. . �� . . .. .. .. ._. ... ... . . . .. .. ._.. . ._ ...... ...._ . .... ...... .. .. . . . �� . ... ..... ... ..... . . ... . .. ..... ...... ... . . ....... . .. ... ...... ..._.. ..... ...... ...... ...... ...... CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION PRESS FIRMLY JOBSITE��JJ ADDRESS% L/ 1- APN LOT TRACT E OWNER�li�// ADDRESS Uy CITY ZIP TE APPLICANT TEL. CONTRACTOR .! ADDRE§j rq v e- �� CITY/��-ZIP'TEL '7 V• ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER-BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC 7031.5 BUSINESS AND PROFESSIONS CODE:ANY CITY OR COUNTY WHICH REQUIRES A PERMIT TO 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).): ^I,AS OWNER OF TH'E 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 WHO 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 CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE LAW DOES NOTAPPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S)LICENSED PURSUANTTOTHE 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 ANP EFFECT. � Q v2- NO LICE SE LASS LIC DATE CONTRACTOR 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' PENSATION, NSPROVIDED BY SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMANCE F THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION SURANCE'AS REQUIRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERF ANCE THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORK€RS'OMPBrJSATION I ANCE ARRIER AND POLICY NUMBER ARE: / /- 1 7-U ill CARRIER'/ 'L POLICY NUMBER(. (THIS SECTION NEED NOT BE COMPLETED 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 WORKERS'COMPENSATION PR ISIONS OF SECTION 3700 OF THE LABOR SSHALL FORTHWITH COMPLY WITH THOS ROVISION CODS,I ++/ Y L-APPLICANT: DATE: WARNING FAILURE TO SE CURE 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 LA130R CODE,INTEREST,AND ATTORNEY'S FEES. CONSTRUCTION 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 REPKSENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVJMEN„NEDPFtO PERTY FOR INS ECTIO PURPOSES. PERMITTEE NA ME(P N1)I/L_, rL 16L 3 SIGNATU P MI IFE DATE APPLICATION ERMIT P/C DATE-�}NUMBER # ISSUE TYPE OCC DAT 7 CONST GROUP CO NST. ZONING SETBACKS FRONT RW^ REAR^ SIDE/SIDE STREET RW^ SIDE^ PROPOSED USE � 7 N A 4'Yi7 N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREANALUATION SFR/ADD/REM CO Garage/Carport w Patio/Deck L.I LL PooVSpa 0 Z Re-Roof Commercial Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U 12 F- U W J W 0 a- ) U Z 2 U w CONSTRUCTION 7_• i 1/ PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES COMMENTS RECPT. N0. PAID BY IT&J VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy