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Home My WebLink About16053 1�� CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 (909)860.3195 Fax(909)861-3117 PRESS �i%�'�� BUILDING PERNIIT APPLICATION FlR Y y JOBSITE ��Z� Q o�� -�r..�� 1 APPLICATION � � PERMIT �l P/C � ADDRESS DATE � NUMBER IJ � � ISSUE TYPE OCC APN-�OT TRACT DATE ' CONST. GROUP p OWNER 1 5�1 o ADDRESS 2 'Z �G ' ��'^�� ZONING SETBACKS Z CITY �h �M u"� y'� ZIP TEL�d ' �9 FRONT RW ❑ � APPLICANT � TEL. SIDE/SIDE STREET RW ❑ � CONTRACT(� I�C-• � c�A►1n~C-�. I G SIDE ❑ p� ADDRESS rL - 5• • �}V--�- � CI7Y L-��1�%�'t � ZIP�1`7� TEL.��_��j�f-/, PROPOSED USE wQ ARCHlENG! 2 DESIGNER � ADDRESS NO.DWEL. NO. NO. UNITS STORIES BEDROOMS �ii � CITY ZIP TEL. � tn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECL4RATION SFR/ADD/REM O I HEHEBY AFFIRM UNDER PENALTY OF PE0.ri1RY THAT I AM EXEMPT FROM THE CONTRAC70R5 LI- GafOge/CarpoR W CENSELAWFORTHEFOLLUMlINOREASON(SEC.7031.5BUSINESSANDPROFESSIONSCODE:ANYCITVOR (n Z COl/NTVNMIp1RE0U1RESAPERAARTOCON57RUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANVSTRUC- W Patio/Deck TURE,PRIOR TO ITS ISSUNNCE,A�SO REOUIRES THE APPIICM'T FOR SUCH PERMIT TO GILE A SIGNED W , � ST�TEMEM THAT HE OR EHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- � � � CENSE UW(CHAPTER B(C%7MMENCINO WITN SECTpN]000)OF DIVISION 3 OF THE BUSINESS RN�PRO- PDOVSpe FESSqNSCODE�ORTHATHEOR5HEISE%EMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP- (� TqN.ANYVIOLATIONOF5I-CTION7W1.5BVANYAPPLIGMlTFORRPERMITSU&lEGTSTHEAPPUCANTTO Z Re-Root � ACMI PENALiY OF NOT MOFiE 11ipN FIVE HUNDFEO�OLLAqS(SSDO).�'. � ❑I,ASOVMEROFTHEPROPERN,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSA710N, � �mmercial MALL DO THE WORK,AND'fHE SiRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.704a.BU51- J � NESS AN�VfiOFESSIONS IX�E THE CAN7RACTORS LICENSE lAW DOES NOT APPLV TO AN ONMEP OF � PROPENiY NM1i08UILD50R IMPROVES 7HEREON,AND VMU DOES Sl1CH WORK HIAASELF OR HERSELF OR Q iMqOU(3HHISORNEROWNEMPIOVEES,VROVIDEDTHATSUCHIMPROVEMENTSARENOTINTENDEDOR m QOFFEREDWRSALEIF,Vi05VEVERTHEBUILDINGORIMPROVEMEMISSOLDWITHINONEYEAROFCOMPLE Z TION,THE OWNER-BUILDER NALL.HAVE THE BUflOEN OF PROYING THAT HE OR SHE DI�NOT BUILD OR � IMPiqVE FORTHE PUPP05E OF SAIE�_ W Ll 1,A$OWNEROF THE PROPERTV,Mi E%CLUSIVELY CONTRACT�NG WITM LICENSED�NTMCTORS Q TO CONSTRUCT THE PROJECT(SEC.70�1,BUSINE55 AN�PROFESSIONS COUE:THE CONTMCTOFS LI- V8It18I10� ADJ.AREA � CENSEUWDOESNOTAPI'LVTOANOWNEROFAVROPERTYWH08UIWSORIMPROVESTMEREON,AND WMOCONTRACTSFORSUCMPROJECTSWITHACONTRACTOR(S�IICENSEDPURSUANTTOTHECONTRAG QUANTITV DESCRIPTION FEE Y TORS LICENSE UW.). � � J O ❑I AM EXEM�T UNOER SEC._, _ B.S P.C.FOR THIS REASON Q 3 -- � � � �ATE OWNER F' Z . —___—._-_ . _- .- - - _. W � LICENSED CONTRACTpRS DEi.LAFATION w � I HEREBY AFFIRAI UNOER F'ENALTV OF PERJURY TNAT I AM LICENSED UNDER PROVISIONS OF CHAPT'ER � d Y(COMMENCINO W17H SFCTION]000)OF�IVISION 9 OF THE BUSINESS AND Pf�FES510N5 GODE.ANO Z X AIV LICENSE IS IN FULL FOIiCEAND EFFECT. m lL (� W DATE SE CLA.SS� •' ��._ UC.NO � .. �.� 1 � O C. . , J V —�rLLi_L_-L��_Z_._ CONTRACTOR_ _ .� a .--^�� . ✓� V . � W'ORKERS'COMPENSATION CL ION + a 2 5 (J Q�r C�,.G � �HEREBY AFFIRM LINDER CENALN OF PERJUHV ONE OF THE FOLLOWING OEC�RATIONS: Z .� / �� F)Qa 0�� Q Cr [/ G � I HAYE AN�W�LL A�AINTpiN A CEATIFICATE�F CANSEM TO SELF�INSUHE FOH WORKERS' _ /'L-„ C.v� � �.y fry wt � COMPENSATION,ASPROV�DEC�BYSECTION37ooOFTHELABORfADE,FORTHE7ERFORMANCE U �� ' v� OF THE WORK FOFi WHICH THIS PER41T IS ISSUED. � jr � �j G+p� Q l� � w �I HAVEAND WILl1NAIMAIN WORKERS'COMPENSATION INSURANGE,AS REOl11PED BY SECTION Q 3700 OF THE IA00H CQDE,FOR TH[PEHF9flMANGE OF THE WORK wH WHICH THIS PEHMIT IS ISSUEG.MY WORKERS'COMPe.ryys RTION IN1SURANC`E'CAPRIER ANO POLICY NUMBER ARE' CONSTRUCTION j cnaaiEa_��W" `-�.C/\1.I 1 O•C"1 �~G...—� PLAN REVIEW Z apucvNUMBER._�1�� u � 'l7 �-��_ ELECTRIC _ _ � (iHi55ECMXJNEHINOTBE00hPLETmOFhiEPERMTISF{MCWEFAN�DfiED00tLAFi5�f100)IXiLESS} PLUMBING � W Z I CERTIfY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT i5 ISSUEO,I MECHANICAL �; - "+''� C�S SHALLNGTEMPLOYANYPERSONINANYMANNERSOASTOBECQMESUBJECTTOTHE '..'�� , ... _. . y WURNFRS'COMPENSATION l.AWS OF CALIFOR ,A D AGREE THAT IF I SHOULO BECOME INSPECT14N F�� _ __. SV&IECTTOTNEINORKERS'�MPENSATqN V IONSOFSECTION]]OOOFTHELABOR Ts,,� tr¢xTp ,/� ~ CO�E 1 SHALL FO THWITH COMP:V WITH T sE ovi ISSUANCE�C�g }�i�.t' �bF.�I��C�T�i U�D:i`ri' • CJLJ p UAfE: �� 1PPLICANT'. P�.��.'~!.. _ SMIP i..r!.I 11.��/��V�1 Y1�i-4i Si�r r`=~�i J WMNINO��URE TO SE�URE WORNERS'CO PENS ION fiAGE IS UNLAWFUL,AN�SHALL BE ENERGY P/C �y SV&IECTANEMPIOVERT✓JCRIMINALPENALTI SAN CIVILFI SUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOLURS(5100,000),IN A�DITION TO THE COS F � PENS ION,DAAIAGES AS PROVIDED FOR IN � SECTION J]0!OF 7HE LA80R CODE,INTEREST, D ATTORNEY'S FEES. FETENTION FEE: d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O � 1 HEREBV AFFIRAI UNDER PENALTY OF PERJURV TNATTHEfiE IS A CANSTRUCTION LENDING AGENCV FOR THE PERFORMANCE DFTNE WOPK FOR WHICH THIS PERIAIT IS ISSUED(SEC.30a1,CIV.C.�. Z W � LENDER'S NAME___ F-� IENDER'SADDPE55 ¢ I CERTIFY THAT I HAVE PEAD THIS APFLICATION AN�STATE THAT THE ABOVE INFORIAATqN IS CORRECT. TOTAL FEES �� w I AGHEE TO COMPLV WITH AlL CIiY AN�CAUNTY OROINANCES AND STA7E LAWS RELATING TO BUILDING � CONSTRUCTION,ANOHENEBYAUTHORIZEREPRESENTATIVESOFTHISCOVNTVTOENTERUPONTHE � ABOVEMENTIONEO PROPEAT'FOR MSPECTION PURPOSES. COMMENTS � � . � S A r-J m PERMITTEE NAME(P NT) � ¢ „i'- � ._ L� �� SIGN�TURE oF P qMITT DATE = RECPT.NO. PIUD BY VALIDATION ~ WHITE—Department Copy,VELLOW—Finence Copy.PINK—Assessa Copy.GOLDENROD—File Copy,GREEN—Applicant's opy .�"^4��"'�iY' �p F §i x ! � "�>': t`„ �p ' �" � � . �,a :�x,� u.�s�t$- ��:=.�;�� a��,t � � d.. r � � � �- ��.��,. . , ,��,�ro ,� �� a �� s » �� _ _, � _ _ . �. �, �� _ _-- -- - . _ _ . ____ _ � � �, , �� - � , � s ..� , r.,. � � �� s;� , � _ __ _..__ __ __ _ _ ��1�� _ '�`�I _- _ _ _ � _ _ , , _ � � � �� s��, ; �. °'�� _ -��e��."��,� .�._ . _. _ _ _. _ _ _ _ _ _ _ _ _ _ __ _ _ _ __ __ _ _ . __ _ _ _ _. _ _ _ _ _ _ _ __ _ _ � _ �' '� � r � - r�°,��'. = W � ns s;t'� ,��r'� ��"tr��.��'"w�y"�� _. . . ... . . .. _... . .. . . . .. .. .. .. . '+��,��"�R��a�.a.�r��'�� . . ...... . . ._ ... .. ...._. ...... . . .. .. �m �'�"�� .._. . _. __ ._ _. r. _. __ . .. . . . � � �� `� � • _. `� ��aa�;��e�� S ,��`�'� �` .. _.. .. ..... .. .... .... . _... .. .... . ... ... ...... .._. . .. . ,�" �� ^� a v,�r�� ,��' "t`��P�ra+�„( ��+P$� �� g"�.�",,��'��t"�' �'`��aty�` �r� `"'"„ .. . . .._ ._ . . . .. . . ... .. . .. . . �,.o-��;'� �r�� c� � � : �� w :.- c,�-�ts`��ke��'�.n_'�s+.. ��t� : ._ ___ _... _. . .. . _.. ...._ ..... ... . ... . ... .. _. . _ . . �,��'� �±'��°�ka�j�� -�'�� -:s� �� > h ��,�,,� � -� ULIHOSI)tRI: 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 JOBSITE�2' 1QD�IC 7r0, ADDRESS APN OT TRACT OWNER sim- 1 ADDRESS 2 2 OG��"" TELGO'd CITY h L� pr y�ZIP 4 AID APPLICANT 46-TEL. CONTRACTOR k4-C-• 1-i e c k,A-i C�I C�a ADDRESS 2 S•A- „-CITY LI�_ZIP JQ TELA 2-44J-6 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 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 B (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 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 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)- 0 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.). ^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. 4 " ' LIC. NO LICENSE CLAPS 40 E2 CONTRACTOR DAT WORKERS'COMPENSATION CL ION}, 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,A5 PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. jK_I HAVE AND WILL MAINTAIN WORKERS COMPENSATION INSURANCE,AS REQUIRED BY SECTION 3700 OF THE WOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED MY WORKERS'COMP ATION INNSSURANC CARRIER AND POLICY NUMBER ARE k G..��. �C_f/�._G•C�--c CARRIER W A POLICY NUMBER-If t•-/ 1 C (THE SECTION NEED NOT BE OOI.PLETED OFTHE PERMIT IS F< R ONE HUNDRED DOLLAR.,($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 CALIFOR,A D AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS'COMPENSATION V IONS OF SECTION 3700 OF THE LABOR CODE 1 NALL THWITH COMPLY WITH T SE OVI-' LPPLICANT. DATE: WARNINGURE TO SECURE WORKERS CO PENS ON RAGE IS UNLAWFUL,AND SHALL BE V SUBJECT AN EMPLOYER TO CRIMINAL PENALTVIL FI S UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN ADDITION TO THE COS ENS ION,DAMAGES AS PROVIDED FOR IN SECTION 3700 OF THE LABOR CODE.INTERESRNEY'S FEES. CONST RUCTION 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. 3087,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. C. S a r---I NT) PERMITTEE NAME(P SIGNATURE OF P RMITT DATE 7 APPLICATION f-PERMIT((�� p/ 1 DATE NUMBER V ii ISSUE TYPE OCC fl DATE AI .. 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 Garage/Carport LU Patio/Deck LL Pool/Spa 0 Re-Roof Z Commercial Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J h U w J w U z a :1,0 It a 5vaxeL"G a 2 G i^OoQ ec c�cs F'-Y�� )Z 1 G +� 2 OO OC2 CONSTRUCTION PLAN REVIEW ELECTRIC min PLUMBING MECHANICAL INSPECTI4N FFift', ••� - BAR,/� ISSUANCE_�I A Or I IAMOND BAC,00 SMIP IJTLD:AN 'ANA SAFETY ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES(0 COMMENTS RECPT N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy