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Home My WebLink About17885 C1TY OF D1AMCIND BA.R - - �''�`" - L7EPARTMENT OF COMMtJNITY&,DEVEL4PMENT SERViCES � 21825 E.Copley Drive (909)$60-3195 Parc(909)861-3117 PRESS "`%.v:�` BUILDING PERMiT APPLICATION FiRM1.Y dOBSITE Ci �" j`�� `��/ APPLICATION �' PERMIT C' �i,�Cry P/C ¢ ADDRESS�� .C.4Y�iJ�� /{1�'��I�� +�)t , QATE_ � � NUMBER � L' �°' # � ISSUE ��j U�,.+�ONST. GRdUP � APN �4T TRRGT DATE _. p OWNER 1r'�-/I✓t.�.�fi(J�_�� ZdN1NG SETBACKS `'" ADDRE S � FRl7NT RW C Z GITY • Z(P�T�TEL. REAR ❑_ g APPLICANT TEL.__ SIDEISIDE STREET F?W ❑ � CONTRACTOR � � � SIDE C7 � AODRE�S��, ' ' " �G" ,:�L -�''�--- PROPQSED USE Q e�Tv"��,�t.C`�ca+.�Xr.•-z�_ z�P TE 3�� z {}ES GNER/ �� ,�� ADDRESS NQ.DWEL. NO. NO. tlNITS STORtES BEpRO{?M3 � CITY ZIP_ TEL. � DESCRIPTIfJN SQ.FT. FACTOR PSF ADJ.AREANAIUATICtN cn � OWNER-BUILDER DECLARATION SFH/ADPlREM p I NERE6Y AFFIRM UNqER PENAL7Y oF PERJURY 7HAT I AM ExEMP7 FRqM TNE CONTRACT{1R5 LI� Gflf8g8/CBfpOfl W CENSEUtWFOHFNEFOLIOWMfREASON(SEC.t0.4/.58USlNESSANDPROFESSlON�CODE:ANYGTYOfl {f) � C6t1NTYWN{CHRE4U7RESAPERM�TTOCONSTRUCT.AITEfl.iMPROVE,DEMOtiSH,ORREPAIRANYSTRUG W Patio/Deck W TURE,PRIOR TO ITS ISSUANCE.AL50 RE�UIRES 7HE APPUCANT FOR SUGH PERMIT TO FILE A 51GNEQ w .� S7ATEMENS THAT I1E Ofl SHE IS UGENSED PURSUANT TO TME Pft4YiSiONB QF TME CONTRACTORS U- .�,�- CENSE LAW�CHAPTEF9(COMMENCING WITH SECTION�tl00)OF DIVISION 3Of THE BUSINESS AN�PRO• � PooVSpa � FESSIONSCO�E)OfiTHATHEOH5HEI5E%EMPTTHEFEFROMANDTHEBASISFORTHEAILEGEDExEMP• U T�ON.RNYVKKATIONffFSEGTiONTP31.58YANYAPP�iGANTfORAPERM�TSUBJECT57HEAPPIICANTTO Z R8-Ro61 � A CIVIL PENALTV OF NOT MDRE THAN FNE HUNDRED DOLLARS(f50a;.): � U�,ASOWNEROFTHEPROPERTYORMYEMPLOYEESWITNWAGESASTNEIRSOLECOMPENSATION, � GOttlRietCidl ,�„� WI�C pp TH6 W6RK.AND THE STRUCTURE IS NOT INTENDE6 OR OFFERED KOR SAtE(SEC.Io44,BUSi� J � NE55 ANO PqOFESSIONS CODE:THE CONTRACTOFS LICENSE LAW DOES NOTAPPLY TO AN OWNER OF � PAOPERNKMOBUI�DSbRfMPRQYES7HERGON,ANDWNODOESSUCHWORKHiMSEIFORFiEftSEI�OH m _ ['r THROUGH HIS OR HER OWN EMP40Y£ES,PRl7ViDED THAT S�CH IMPROVEMEYTSARE NOi MTENUEOOR QOFFERE�FORSAL[.IF,HOWEVEP,THEBUILDINGORIMPR4VEMENTISSOlOW11'NINONEYEAHOFCOMPLE� � T10N,THE{sWNEft�BUiLpER Will tiAVE 7HE BUROEN OF Pft4vWG THAT HE C7R SHE Di4 F%}T$UCt1l4R = IMPR4VEFOflTHEPUHP65EOF5ALE). W OI,ASONMEflOFTHEPROPERTV,AMEXCLU5NELYCONTRACT�,NGWITHIICENSE�GONTflACTORe [[ (O CONSTRUGT TNE PR0.7EGT tSEC.79aa,BUSiNES5 AMD PflOFE55pNS CObE�TNE f.ONTRAG70R5 L�� V3iU82ioR ADJ.AREA W CENSELAWDOESNOTAPPLYTOANOWNEF4FApflOPERTVWHOBl11LQ50pIMPROVESTHEREON,ANd � WHOG4NTRACTSFORSUGHPROJECiSWITNACONTRACTqR(5)LICE+ISEDPURSUANTTOTNECONTRAG� Q�ANTITY DESCRIPTION FEE TORS LiCENSE tAW.}. � � J _ p> (]1 AM EXEMPT UNOER SEC. ,,,,, ,. 8.&PC.FOft THIS REASOti Q > -..., � LL DA7E , 6WNER_.. -_- I- Z W � �ICENSED Ct7A7�TRACTdRS 4EClARATlON W ' 4 (� i NEREBY AFfIPM UNDER PF_NAL7Y OF FERJURY TNAT 1 AA1 LICEkSED UNOEft f'AQYISI4NS O�CHAPTER � [y 9(C6MME7JCMG WRN SECTION 7006�OK DIVISi6N 3 OF THE BUSINESS AN6 P%OFESS�ONS COOE,HND Z W 1.9V LICENSE�S IN FU4 FORCE AND EFFECT. m � � LICEh1SE CLASS�'3��r�`' ��:.No,.��.''��j � � W OATE. �I t�r�y.�. ._ CONTRACTOP Y'_""°'�'"+�c,��"'-`t: a r [� WORK£RS'COMPENSATION DECLARATtON � Q � U � i HEflE@YAFFIRM UN4ER PENAI.TY OF RERJURY ONE QF THE FOlIOiflNC.DEC:LARATIONS�- Z Q � IHAVEANOWILLMAINTAINACERTIFICATEOFCONS£NTTOSELF-INSUREFOPWOANERS' 2 � COMFENSAT�ON,AS FRpViDED 8Y SECTtON�lao 4F TNE 1A80R CODE.FOR THE YERFOFiMANCC �U OF THE WOFIK F4R WHICH THIS PERMIT IS ISSUE4 � � W IHAVEANDWILLMAINTAINWOHKEHS'COMpENSATIONMSURANCE,ASREQUIREDBYSECTION Q �3?00 OF TNE LA90P CODE.FOP THE PERFOFMANCE OF THE WORK FOR WHICH THIS PEPMIT IS -� _ ISSUED.MY WORKEiiS'o�e/p�p ENSATI()k fINSUftANC"E�C,A�flRiER/AN�D��OI�CY NUMBEP ARE: CONSTRUCTI(}N > caaR�ER ;J� , r�4- �/-v.�J�'- �\ PLAN REVfEW � POLICV NJMBER_`��!g! ��' �y7�G�.. ELECTRIC --..... .--�}�-- SL -i'--��. � �iHISSECTpnNEEIJNo7E#ECOMPLEfEDOFit1E�EpMrilS�oRONEF1uwF�EooCA.lnasl5�ao)oRLESS). PLUM8ING _,,..,_ w t CEflTiFV THAT IN T/iE PERF6RMANf,e 4F THE WORK FOR WNICN TNIS PERMii IS ISSUEO,i MEGHANICAL .--., � _"__' (�j SHA4L NCT EMPLO\'ANY PEfi50N IN.�1NV MANNEH SOAS TO OECOME SUBJECT TO THE ��SPECTION FEE � WOFiKERS'COMpENSAiION�AW50fCALifOftNiA,AN6AGREETMATifiSM4ULQ8ECOME ----- SU6JECT TO THE WORKERS'COMPENSATION PRpVISIONS OF SEGTI6N 3]00 OF THE LABOR �- � COOE.ISNALLFORTHWITHCOMPLVWIIHT'HOSEI'HOVIS�ONS. �SSUANCE __._.__ �_ O SMIP _ � OATE: __ APPLICANT: .. J ENERGY PIC .. � WARN�NG fAiLURE TO SfiCUFE WORKERS'COMPENSA110N COVEflAGE�5 UNIAWFUL,AND SHAI.L BE � SVBJECTANEMPLOVEflTOCRIMiNA4PENALTIESANDCIVIIFINESUPTOONENUNb%EDTHOUSAND ENERGYPERMIT � DO�tARS{51�.4'JO),INAODITIRYTOTfiEGOS74FG�MPF.NSATpN,QRMAGESASPNOV@7EDFORIN ' � �� SEGiION 3lotl OFTHE LRBaF CO�E,INIEHtST,FNDATTORNEV'5 FEES. RETENTION FEE: _. W CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � ._......— - O � i NEAEBYAffiRM UNDEft PFNAL.TY OF PeRJURY TNAT TNEftE IS R CONSTRVGTION�ENDINCa AGEY4Y ,,,, . FOR THE PERFORMANCE OL'THE WORK FOR WHICN THIS PERMI715ISSUED(SEC.3ti97,pV.G.�. � W � LENQER'S NpME_ ,,,T _�..-- _ ___ !- �ENDEfl5A60HES5__.,..__._._ -� --�-� ✓�^^� � i C£RTIFY TFtAT i NAVE REAG THISAPPUCATION ANR STATE THAT THE ABDYE INFORMATION IS COflRECT TOTAL FEES "� � 1 AGqEE TO COMPI.Y WITH ALL CITY AND COUNTV OROINANCES AND STATE LAWS ftE4ATING TO BUILOING � CONSTRUC ION,ANDMEREBYAVTHOHREREPRESENTATNESOFTHISCOUNTYTOENTERUPONTHE � A80VF_-M 1`KadEO PROPERSY F4R IN CT'IQN P PtJSES _ C6MMENTS._,..� n �ir�,. , t/'t►�� — _ , ; . m PE MITTEE �(kFINI' .�.- -- c$i� � J/ " J� p�`- _I�'�' !/""�� Jy SIGNA flE F P . DATE ��~I� � ^" ^ _ •` RECPT.NO. PAID BY !� VALIDATION ~ WNITE—Depanment Copy.YELLOW—Pinanes Copy,PINK—Assessor Copy,GqLDENROD—Pile Copy,GREEN—App�icanTs GORY �� ' - �u�� ;,�� o �',�! �� a ��,�� "� �a, �" > . � ,-. � , . . . . .. . . . . ,,'_� �'r=�`; m. ",-��.°;,-�� ` �..... .. . .. . ... .. .. . ... . .. ... .. . .... .... .. , •. � �, ��I�,-. . .. ... . ..... . .. ... .. ... . � i, _ , � s °."u �r� � ��,� i ,' i i� ,� 4 ��, � . " ; '��R :. .. . . ... . . . . .... . .. . .... . ... . . . .... . ,�. � �� 4� i� � ��` : 1re� ��u'��7��.h��". .. . . .. . . .. ...... . ._. . '� .3 �'� rv�.-, ..•, ..... .. .. . . . .. ._ .. . ¢�*z ;��+�5 ^_ �� '��. ( � '+S r� 4� . L a �r.,; �: 2g{I ... .... .. . . ._ .. ... . .... . . .... .. .. .... . . . . .. ... . . :I ; ;°�b �F �. . ... . _.. .��. . i � �Q �„rs ��k�; .. �'r `� �� '��. �"P �'-� . . . ..... ... ... ... � v � � � � . .. . .. .. . . . . . ... ... . . . . � ��e a i n` a � � _ � — — 5 '* % � ,� $as fl1 . �. _�.. ... ...... __. . . ..... . ... ...... ... . . ... � � ; � _ .. .. _ _.. . i � 1 ... . . . _... .. .. . . � .�i E � : ia ai; �: . „.� �4 ...,�; "� ;:�,7, 4�._'..' �.�v.^�.�^_ , .' :. . . .._.... . .... . ... . ... ..... . ... ._.. . _. . . .. .. ... . ... . .... ..�. CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION JOBSITE�}�/ ADDRESS f/-y APN LOT TRACT OWNER ADDRE,S /$ CITY 12, •ZIP 4(TEL. APPLICANT TEL. CONTRACTOR'IIiL ADDRESS CITY 41'�t�tJ,�u�,�I ZIP TE ARCH/ENG/ t� #V51 DESIGNER 7 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)): U 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 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.). 0 I AM EXEMPT UNDER SEC. B.8 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. LICENS fr I Z E CLASS LIC. N0. v _� I DATE CONTRACTOR/�! f 4. 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' ENSATIO N INSURANCE CARRIER/AN POLICY NUMBER ARE: ON CARRIER/ M/r(r I POLICY NUMBER-2 C,?/, -z (IRIS SECTION NEED NOT BE COMPLETED OF THE PERMIT IS FOR ONE HUNDRED DOLLARS(E100)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 THOSE PROVISIONS. DATE:APPLICANT. WARNING FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 15 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. 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-M TION ED PROPERTY FOR IN CTION P POSES. PE MITTEE(PRINT SIGNA fl F P DATE WHITE-Department Copy,YELLOW-Finance Copy, PIN APPLICATION qLj 11 i Sam/0"� PERMIT-� P� p/C DATE NUMBER ISSUE[0 TYPE OCC DATE CONST.GROUP ZONING SETBACKS FRONT RW^ REAR SIDE/SIDE STREET RW SIDE I] PROPOSED USE N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM Garage/Carport LU Patio/Deck LL PooI/Spa 0 Z Re-Roof Commercial Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U U W W Z M 3 a Z U W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING M ECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE- T OTAL FEES 15 COMMENTS 114, RECPT. N0. PAID BY VALIDATION PRESS FIRMLY