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Home My WebLink About17998 �.�_ CITY OF DIAMOND BAR � DEPARTMENT OF COMMtJNI'['Y&L?EVELOPMENT SERVICES ,� � 21&25 E.Capley Drive (909)$60-3195 Fau(909)861-3117 PRESS ,'%4M'' BUILDING PERMIT APPLICATION FIRMLY JOBSITE �7 r �j Q ",/ '� /� APPLIGATION :/if PERMIT � PfC �a.� ADDRESS r✓�-� ./v /�-C�C- �'c �!JG� �F. ______,��G'�,.. �� DATE � NUMBER # � ISSUE TYPE OGC APN 1.4T TRAG7__ DATE CdNST.�_ GRdUP p OWNER �H!�C-A"f� ��I"l S__ p ADDRESS�L-��'��N l�'-rt/'Eyi 'I_. ZONING SETBACKS � CITY �t4�Y.�k'1 �1-+k= Z(P�t� ` TEL. '}L. �rti�� FRONT RW ❑ � APPLICANT TEL.__. S DEISICE STREET RW � O � CONTRACTOR_��--'9-.1�"��. T3"c+G„_ ._,^_ SIDE _ � � ADDRE S � �'4 �M� PROPOSEp USE c��v '. .,ti ,�•u�. zt� it��E�lr1 r �?c'�e 2't w ARCH/ENG/ Z dESIGNER Nb.DWEL. N(7. NO. � ADDRESS_.— UNITB STORIES BEDROOMS � CITY ZIP TEL. `'° dESCRIPTlON SQ.FL FACTdR PSF ADJ.AREANALUATtON rn � dWNER-BUILDER DEGLARATION gFR7RDDIREM (� I HEFiEBY AFFIRM UNDER pENALTY OF PERJURV TNAT'�.AAA EXEMPT FR4M THE CONTPACTORS LI� Gd10QB/CBfPOfI I.L} CENSELAWFORTNEFOLIOWMGREASQN{SEC.10.31.50USlNESSANDPRQFESSIONSCODE:ANYCi7YOR {J) � COUNTVWNiCNRECIU�RESAGERMiTTpCANSTRUCT,ALTERIMPROVE,pEMOL�SH,ORAEPAiRANYSTRUG W PBtip/OBCK TUPE,PRIOR TO ITS ISSUANCE,AL50 REOUIRES THE APPI.ICANT FO%SUCH PERMIT TO FILE A 51GNE0 W STA7EMEHT THAT IiE dft SHE IS IiCENSEO PURSUANT T67kE Pf>pYfSiONS OK THE CONTRACSOAS lI- � � CENSE LAW(CHAPTEH e(C73MMENCING WITH SECTION�01?O)OF DIVISI4N 3 OF THE BUSINESS AN�PRP POpUSD2 � FESSK7N5 CODE)Ofl THAT HE OR SHE I5 EXEMPT THEFEFROM ANd 7HE BA515 FOfl TNE ALLEGED E%EMP- � TA741.RNYVWI.kTiON4FSECTItN77631.98YANYAPPIlCANTFORAPERMiTSUBJECTSTHEAPP�ICANTTp Z Re-Raaf � ACIVILPENALTVOFNOTMORETHANFIVEHUNDREDDOLLARS(T500).): � ❑I,ASONTIEROETNEPROPERTY.ORMVEMPLQYEE5WITNWAGESASTNEIRS4lECOMPENSATION. � Gommerciai � WILt p0 THE WORK,AN6 TFtE STRUCTt7RE 78 NOT iNTENpED OA O�FEREO FOR SAIE(SEC.�aaa,BUSi� J i � NESS AND PROFESSIONS CODE:THE C:UNTRACTORS LICENSE LAW OOES Np7 APPLY TO AN OWNER OF � PROPERNWI�IOBUli,DStlftlMPflOVESi'HERGOk,ANDWNOQOeSSUCMWOftKHIMSEI�ORHEftS'eLE6fl m ,,.. [� TNROUGH NIS OP HER OWN EMPLOYECS,PROVIOED THAT SUCN IMPROVEMENTS ARE NOT INTEN�ED OR � OFFEREDFORSALE.IF,HOWEVER,THEBUILDINGOFIMPROVEMENTISSQLDWITNINONEYEFROFCOMPLE� ,,, y` Ti�l,THE OWNER�BUiiDEfi Will MRVE 7HE BURDEN ffF PROVING TNAi HE OR SHE D!D NOT BUII.D OR � IMPRPVEFOflTHEPURPO5EOF5ALE). _ ❑I,AS QWNER OF THE PROPERTV,AM EXCLUSNELY CONTRACTINCa WITH IICEN5ED CONTRACTORS � T6 fANSTRUCT THE PROJEGT{SEC.JOOa,BUSINESS AND PRflFFS510NS CO�E�THF CONTRACTORS li� VBIuBtiOli ADJ.ARER__,_. W GENSEIAWD�ESNOTAPPLVTOANOVJNEROFAPROPERTVWHOBUtLD50RIMPRQVESTHEREQN,ANp � WHOCON7RAGTSfORSUCHPRQIECTSW7THACONTRACTOR{S)LICENSEDPUftSUANTTOiN�CpNTMG� Q{)RIVTITY DESCRIPTION FEE � TORS I..IGEN$E UW.j. J � [:7 I AM EXEMPT UNDEFl SEC._, 6.8 P.C.F4R iH15 REAStIN U � ......_—_.. .. � . � DA7E .... oWNER V W � �ICENSED CflNTRAC70RS DECLARATION �j 4 CL (HERESYAFFIRM U4DER PF.NAITt OF PERJUHY TH0.T I AM I,ICENSED VNDER PF�VISIONS dF Ci{APTER � [L 4(COMMENCM}G W(TH SECTION�606j OF O�VIS�ON'n OF THE 8VS1Nf55 AND PROFES^a�ONS CODE,AND Z '-) .,�^ X MV LICENSE I5 IN FULL FO(iCE AND EfFECT. m f��f f-sG^� 'd�`��'rt;� +�� '"'� �f' �.j �j � /6 � UCEN5E CLASS C:,._�_""�._,— LIC.NO.% < � `pJ�'J � � DATE___�''��;• L-4� CONTRACTOR�L.—.—...— d . W � W6RKERS'COMPENSATIQN DEC�ARATION Q � 4 HEREBYAFF4flM UN6ER PENAI.TY OF FERJURY ONG OF TitiE FOI.IC+WlNG DECIAPAi lQNS: � f,1� Z Q 0 IHAVEANDWILLMAWTAINACERTIFICATE�FCONSENTTOSELF�INSUREFpR`NORKERS' S � �YCAMPENSATION,AS PROVIOEO BY SEGTION 3�06 t7F 7NE 1A86R CAPE,FOR iHE PEflFOiIMANCE �U OF THE WOqK FOR WHICM TMIu PERMIT IS ISSUEO. � a W I HAVE AND WILI MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOl11RED BV SECTION Q �37000F THE LABOFl CODE.FORTHE PERFOflMANCE OF THE WORK FOR WHICH TNI.S PERMIT IS _ ISSUED.hiV WORK€RS'COAiGENSATipN IttSURANCE CARRIER AND GOLICV NUMBER APE CONSTRI�CTIC}N _._,_.� ..�. ......_..__ •t cARRi�R_._�°'�� PLAN FEVIEW � ^ r.. L'� POLICVNUMBER_�W G �J��i ��v�,,,,,� . ELECTRIL' ._ � rSY Q (�HtSSECMNNEEUNOTBECJMFLETEDOFh1"e.PERMftISf-0RONENUPDIiEDD01.lARS(51oo)ORLESS). PLUMBING � w r�ECHnNicnc _ Z I CERTIFY 7HAT IN TNf PERFORMANCE aF THE W6RK FOR WHICH THIS pERMIT i5 ISSUEO,i -- (!S SNALL NOi EMPLOY ANY PERSON IN ANV MANNEP 50A5 TO BECOME 6UBJECT'O'fHE INSPECTIQN FEE {/� WORKEAS'COiiPENSATiQN LAWS OF CAUfORNIA.AND AGREE 7HAT if I SHOliLO BEGOME . � -�-- . �. SV&lECTTqTHEWORHCRS'CqMPENSATIONPROV�SfONSOFSECTION]1000FTHELABl7R I$SUANCE _ _. ��` � COOE.I SHALL FOHTHWITH COMPLV WITHTHQSE PROVISIONS. O ._r'�j -i.`�} ii/j" �" SMIP p DA7E: '�-APPLICANT: z-- �"'��-✓�� .�� ENERGY PJC J WpRNiNG�.fAiLURE TO SECURE NlORKERS GqMPENSATION COVCRAOE i5 UNLAWFU,ANO SHALL BE "—""' '�� y SUBJECTANEMPIOVCPTqCRIMINALPENAI.TIESANDCIVILFINESUPTf70NENUN6REDTHOUSAND ENERGYPERMIT ,,,,_. . — pOEiAflS{5100.'J�0}.iIN ApDiT10N TQ THE COST OF tATMPENSATiON,DAMAGES RS PROVIUED FOft IY '�?-7"`r�" � SECTN]N31q80FiHELABORGU�E.INfEREST.ANDATTORNEY'5FEES. RETENTIONFEE: __.... __ �' � W CONSTRUCTION LENDWG AGENCV PR6ALT FEE: Ct - � 3 HEfIEBY AFi�'iRM UNGER PENAITY OG PERJUftY 7HAT THEftE IS A CANSTRUGTION�ENDiNG AGEtiGY � FnA THC v[4�cpRMANCE OF THE WORK FOR WHICH TH15 7ERMI7IS ISuUED(uCC.3C.N],GIV.G.�. 2 W � LENDEP'S NAME_ ,.....� -. —' i. _ ,.,_,_ h CENDER'SADDNESS�___ —��-�-- � TOTAL FEES �, � '`' � ICEftTiFY?NATIHAVEP.EADTNISAPPUGATK>NANDSTATETHAT7HEABOVEiNF4RMA?10NISGORRECT. � 1 AGpEE TO COMPLV WITH ALL CITV AND COUM1TY OfiDINANCES AND STATE LAWS RELATING TO @UIIDING � CONSTRUC-ION,ANDHERENVAUTHORIZERE>RESENTAiIVESOFTHISCOUNTYTOENTENVPON7NE � ABOVE-MENTIONEOPaCiPERTYFORIN�PECTiUNPVHP45E5. � C4MMENTS _.. �— C� ' � �1"t _t��`2'h,v' � - .. � PEAM EE AME{PRINT 4 '} —�- � " ' ''•- _' l� {- �„ r �� ,� .. , r� � s� GNATUflEO RMITT c �.....-�TE ry. �J'''T�" F t � RGCPt NO.�,,.�r L PAID BY�� , VALIDATI4N .._. _ � WHfTE—Dzpartment Copy.YEILOW—�inance Gopy,PINK—Assessar Gopy.GOLDENROD—Pile Copy,GREEN—RpplicanCs Gapy � � P � �t} '� — � i� �i r , s .,.�G « �ii��, n �r'�: '� ...�t�.� m . . . `� e. � � � �'u'�t`;�°��'y` ��,�.�� a�i< ... . . . ... .. ... ... . ... ... . . ... .. .. .. .. . . . .... . . .. ... .. . . . ..... .: ... .. ... . .. . ... ... . .... . , _ �Y .. ... ... ... . . . . � .. .... . ... . . .. . . . . . ... . ... ... .... .. .. .... .... .. . ... . ... .. ..... _ . ... ..... i .u.. 2 �' ;� � ��1 �,P— �j � � "�� '� �p� y .. ... _... .. .. . .. . . .. ..... ... .... .. ... . . .. .. . __ .. r`�sp i��S ( '� i�j ..'�. _. ��t �'��-`"��'� t�� i s , ,�� •. � ��''��'�(w—��'.� �'"'�'a ' . . . . . .. . . .. .. . . .. .. . . .. .. . . � �� '�i��i��-�� . "�k� �r. r � - �� '��` fx 4. :� z�. � ti g� ,.!,.. , .... ... . ._ . .... .. . . . . . ... . ... . .... ..... .. .. . .._. ,. ht , �i ��"�!j��,��?� :, _ F; .. _. .. ._.. .. . ��,� �"4��` �� „�T'��a7,,u ," .. . .. .. . . . . . ... .. ... . . . .. .. . . . . .... . . �:- 7 ,.�t F t �� „`t .�^�:� F�.� p .,r ... .. ... . . . . . . . .. .. .. .._ _. . . . ��- � " h � ' y � £ � tlp7 A g � ,� ... .... ... .... .. . . .. .. ... .... .... .. .... ... .. ... . .. .. � rej � ? �� : .....: . . �eis'#,fA �,��., ,. CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION JOBSITE? ADDRESS 2-g/4-/ 10-OC n/I/C 7z OA APN_T_LOT TRACT OWNER' (-4- 1 ADDRESS 2.2 r IV uc f/i/€7 2. CITY O'4'-'I" 1511-ZIP S/TEL �I Cc,X 7 APPLICANT TEL. CONTRACTOR t,4 P_,q-f SG C ADDRE S j 114-K.1,Y d CITY. '_ff. 17 t w,"0 ZIP£rcW-TELYI�7 A Z'r ARCH/ENG/ D ESIGN ER 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 OWNEROFTHE 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 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 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 EFFECT. "'> LICENSE CLASS C+J ED LIC. N0./'7 t 4?J DATE S,_1 3� �.. CONTRACTOR AL 410 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 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 zIL F-J POLICY NUMBER_W C Z +t i/R1116 1 3 (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 PROVISIONS OF SECTION 3700 OF THE LABOR CODE.I SHALL FORTHWITH COMPLY WITH TH SE PROVISIONS. DATE:_L" PPLICANT:VmZ-I L/�I-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(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR 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 REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. U4-L 4724" PERMI EE AME(PRINT I SIGNATURE 01�7ERMITTE�E ATE APPLICATION PERMIT we P/C DATE 3 0'- NUMBER 7Q# ISSUE TYPE OCC DATE CONST GROUP ZONING SETBACKS FRONT REAR SIDE/SIDE STREET SIDE PROPOSED USE RW^ � RW^ PRESS FIRMLY N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SFR/ADD/REM Garage/Carport Patio/Deck Pool/Spa Re-Root Commercial SQ. Ff. FACTOR PSF Valuation ADJ.AREA QUANTITY L -J 0 Z 2 0 W 2 CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES COMMENTS ADJ.AREA/VALUATION FEE st% 1 RECPT. N0. PAID BY�-VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy fl DESCRIPTION �,�4�� i i� +��