The URL can be used to link to this page

Home My WebLink About17266 (10) CITY OF DIAMONL7 BAR ��"�W �-L� `� �"�`� I)EPARTMENT OF C4MMUNITY&.DEVELOPMENT SERVICES I 21825 E.Copley Dreve G ! �.-�� "z.��'`L�- (909)860-3195 Fa7c(909}861-3117 �r"',�l PRESS "'�.»wi' BUILDtNG FERMIT APPLICATION �— � FIRMLY � JOBSlTE �,{„ APPLICATi�N7��J� NUMBER t t L �-; #/_-l�.�ct� o ADDRESS_"�k'Z l DATE ,, � c� ISSUE TYPE OCC APN �QT TRACT dATE � � CONST.� GROUP p O W N E R ��. �L` Iyd� �4��.� _ � ADC3RESS ryqs,� _ ZONING SETBACKS �:14 z CITY ZIP TEL._._ FftONT RW ❑ � APPLICANT ��yy�'w �.y-�(�.� TEL. REAR ❑ � �' SIC}EtSiDE STF{EET RW C � CON7RACTOR ___ SIDE �J � A6DRESS PROPQSED U5E Y�LI� �'�� `'� ��, GIN ZIP TEL. -`T � p ��c' +� � �L5 i.i. w ARCH/ENG/ z RESIGNER�l' a�'Y�E��,�,t� Nd.DWEL. NO. NO. � ADDRESS ,��.�'� _ UNITS STORIES BEQRdOMS � CITY � ZI�P�� - ' -, 'TEL.� �y - dESCRIPTlON SQ.FL FACTQR PSF ADJ.AREANALUATiQN p� OWNER-BUILDEFi DECLARATION SFR(ADDlREM O I HEREBY AFFIRM UNOER VENALfY OF PERJURY THAT I AM E%EMPT FROAi THE CONTRACTORS LI. GBfaC]0/C8�0(I W CENSELAWFORTMEFOLLOWIN�RERSON(SEC.703t.58USMESSANDPPOFESSIONSCOOE:ANVCITYOR (� C.� GWN1YWritCHREWiRESAPERMtTTbC6NSTRUCT.AITER.iMPFOVE,0EAi0USH,ORREPAiRANYSTRVG W Patio/Deck W TURE.PRIOR TO ITS ISSUANCE.ALSO PEOLIIRES THE APPLICANT FOfl SUCN PERMIT TO FILE A SIGNE6 w v� STAT6MENT THAT HE Oft SHE I.S LICENSED PURSUANT'O THE PROVISIONS OF TNE CONTRrtGTORS U� .�r CENSE LAW(CHARTER 8(CAMMENCAJG W�TN SECTION 7000}OF D�V�SiON J OF THE BVSIN656 AND PqO� � POOUSP2 FESSIQNSCOOE)ORTHATHEORSHEISEXEMPTTI�EREFFipMANOTHEBA51SiOfliHEALLEGEDEXEMP� (� � TiflN.ANYV701A710lJOFuECTipN7031.58YANYAPPLiGANTFORAPEftMITSU&lECTSTHEAPPUCANTTQ Z Re-Raof � A CIVILPENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS�5500).): � pI,AS4WNEPOFTHEPROPERTY.ORMYEMP�_OYEESWITHWAGESASTHEIRSOLECQMPEN5A7ION. � (�'OmmBfCld! ,� Will p0 FME N1flRK.AND iHE SiRUCTURE IS N4T INTENDED 6R OFFERED F9R SAtE{SEC:.�o<a,BVSt� J � NE55 AND PROFESSIONS CODE THE CONTRACTORS LICENSE LAW�OFS NOT AVPLY TO AN OWNER OF � PROPEflTY WHO BUILDS OR IMVROVES THEREON,AN�NMQ�OES SUCH WORK NIMSEIF OR HERSELF OR � TNFb�UGH HtS QR HER 6WN EMPI.OYEES,AR6NOED THAT SUCH 1MPROVEtJ�ENTSAR£NOT WTEYDED OR � � OFFEREOFQRSALE.IF,HOWEVER,THEBUIL�INGORIMPROVEMENTISSOLDWITI�IINONEYEAROFCOMPLE� � TION,THE QWNER�9UILOEp WILI,HAYE THE BURDEN OF PR{JVING THAT H'c Qfl SHE D@ NQT BU.IQ O% = IMPRpYE FOp THE pUPGOSE OF SALE). W []I,ASOWNEpOFTHEPROPERN,AMEXCLUSNELVCONTRAGTNJOWITHUGENSEDCONTRACTORS ` [� TO CANSTRUCT TNE PRUJECT{9EG.T9da,BU5INESS AND�RQFESSIONS CODE:dl'IE CONTRACTQRS U- V3IU8FIDli �J - ADJ.AREA_._, W CENSEUWbOE3NOTAPPLYTbANOWNEFC1FAPqOPERTYWH40UILP50RIMPROVESTHEREON,AN� � WHOCANTRACTSFORSUCHPRt7JECT5WITHACONTRAC70R(5)UCENSEDPt;RSUANTTOTHECONTRAC- Q{�ANTITY DESGRIPTION FEE � TORSUGENSE�AW,}. .. � J Q ❑I AM E%EMPT UNDEA SEC. _,,. 8.8 P.C.FOR TN1S PEASON Q _"'S _ U � D '..., Q � ....._.. W � ItCEPI D C4N7 4RS DECLRRATION w � IHEREBYAFFIRMUNDERPENALTVOFPERJURVTHATIAMLICENSEDUNOERFROVI510NS4FCHAPTER � � S{Ct3MMENCittG WITH SECTI6N 7000)OF ONISION 3 QF THE BUStNESS AN6 PROFESSIONS COOE,ANO Z �X MV LICENSE IS IN FULL FOFiCE AND EFFECT. — � -�t, �� LICENSE CL'A`SS f_� LIC.NO., � T �� DATE�!_i�_cONTftAGTflR,_1' ""V" �__�� 1' ' a W T � � � W4RKGRS'COMPENSATI6N DEGlAftAT10N � Q � I HEREBY AFFIRM UNOER PENALTY OF PFflJUPV ONE OF THE FOLIOW'NG DEGLARqTIQNS: U Cn Q Cl IHAVEANDWILLMAINTAINACERTIFlCATEOFCONSENTTOSELF�INSVREFONWOflKERS' _ �^COMPEN5ATiON.RSPR(7VIDEDBYSEC71{]N3Toa4FTHElA$4flCOQE,FQRTHEPEflFOftMANGE C} � OF TNE WONK FDR WHICH THIS PERMIT IS 15SUEb. � n W I HpVE AND W�LL MAINTA�N WORKERS'COMPENSATiON INSURpNCE,AS RE�UIRED 6Y SEG710N /// Q �3�00 4F THE LABOR CODE,FOfl THE PERFORMANCE OF TNE WONK FOH WHICH THIS PERMIT IS 1��.Y� _ ISSUEp.MY WOftKER5 PENSA7ION INSUHANCE CAftR1E ANO PQUCY NUMBER AFE: �ONSTRUCTION ,,,^,�,_ t- _,,,,_ 4 ��'L- �`�..�_ -t-��-�-�-�-��`� , �, caaqita..,..._ PLAN REVIEW .��... L�� _,. � aoucvNUMaeR �.,_. ELECTRIC __,_. Q 0 (iHiS$ECTqNNEE6WT8ECOMPl.E7EDOFh{�p[q�iiSFt?RONEHUNDRf.DOq.i.ARS(LioO�ORLE55). PLUMBING _, w E CEftTiFY THAT 8i THE PEflFORMN+ICE 4F iHE WORK FbR WNICN THIS PERMIT tS t$SUE6,I MECHANICA� � _ ..�_..._ (,'3 SHnLINOtEMPLOVANYVER50NINANYMANNER60A5TOBECOMESUBJECTTO7NE � WORKERSGOMPENSATIONLAW50FGALIFORNIA,AN�AGREETHATIFISHC]ULDBEC�ME INSPECTIONFEE �,_,�_ __ � SUBJECTTOTHEWOf�(ERS'GOMPENSATIONPRbVtSIONSOFSECTiOh'3T66qFTHEIABOR ISSUANCE _,,, Y�� C COOE,I SHALL FOR711WITH COMPIV WITH THOSE PROVIS�ONS. p DATE: _ APPLICANT: ..., SMIP . ._ .. jj C. W ENERGY P1C � WARNING:FAiIUFE fOSECURE WQRKF.ftS'C6MPENSATION COVERAGE IS UNIAWAII,ANp SHA��8E � � �y SUBJECT AN EMPLOYER il7 CRIMINAL PENALTIES AND CIVIL FINES 11P TbONE NUNDRED TH4USAND ENERGY PERMIT DOLU%5{S7b0.009).IN PDOITION T�TH�COST QF COMPFN5ATIQN,DAMAGES AS PRQVIDED F�R IN � �-- -- � SECTION 3706OF THE LA86R COOE,INTERESf,ANO ATTOFAJEY'S FEES. RETENTION FEE: ._ ^ ��'"�Lj � C4NSTRUCTlON�ENpING AGENCY PRE-ALT FEE: ,,,,,_,,,,,, _ O � IMERE9VAFFIflMUN�EflPENA4TYOFPERJURYTHATTHEPEISACONSTRUCTIONLENDINGAGENCY . FaR1HE FERFORRtANCE OF THE WCRK FOA WNICH THIS PERMIT IS ISSUE6(SEC.309T,qV C.}. ' i—"'—��"' � w ,,,_� IEYDEfi'SNAME . __ .. — �.,^�. . 3 f�- IENOERSAC?(tRE55 � + � ICERTIFYTMATIHAVEREADTH15APPlICATIONAN�STATETHATTNEA@OVEINFnFMATiONi5C00.RECT TQTAL FEES �� '�� S � IAGREET6C�APlYWITHALLCl±YANOCAUNTYORDINANCFSAN65TATEtAWSRE�ATiN6T08Ui{.DIttG � GONSTRUCTIQN,AND HEHEBV AUTHORIZE RFPRESFNTATIVES OF THIS COUNTV T06NTER UPON 7HE _ � { � A80YE�MENT NED PROpEf3TY fQR INS ECTiON PURP�SES. COMM�EN^TS_� � � � t�y�L 47�'1. t/"ll l.�i t� .— `_.�� il� ' �i PE IttEE N E(PRINT) ._ �j,�?�� G Gn �. SIGN 7URE OF PERMITTEE DATE ) � = RECPT.�O. PAID B_Y_'--�� VAUDATION— . � HITE—L�epartment Copy,YEILOW—Finance Copy,PINK—Assessor Copy,60lDENR06—File Copy,GREEN—ApplicanYs Gopy � ��'�'� 7'S � 4 � � _�, �m�a�• �"�— �st� r�!�o-��9ii �� i��s°s�� } ` , ;a r . • ' �rc�s ° � , . . „ .. . . .. .. >t= , . . . . . .__ _. .. . �. ,.. �. ... .. . .. . � . � . . .�� .... . . .... ... . .. ... . .. t. .... . . .._. .. . ..�.. � �� .. . . .. . ... � . . ... .. ... . . .� ... � �... �� .... '' .. .. , /�!r'"._._�� ... .. . .. .. .. . .. l4.i�ey �y.`.�� 1�'�N. /(• " . ,� � .„: � ' y � _ � �N � a �; , s` , i� � � e . • __ ? vi �+�� °� a � . . . . - ' �, � � � a � ,� �p�� „��'�`��,3 �,. �,,, I _ � �� _ _ _, ! ' . ., r � = _ �� • �� ; . �� . �»� ��`'� �� - _ ,�;� ,� i��i,. , .. . . . . � � i � � ; - s _ .. . .. .._ _. .. ...... .. � ' ; � °' ..':�.:a � . . . . . .. . . . . . .. . .. . . .... � � � _�.< <�, .� _� .� . _. . ._ .. . ; _ �q � -, ,:: a ... .. .. . .. .. .._ .. — .._. .,.�. 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 APN LOT TRACT OWNER M r. lyd M (IJ W} ADDRESS CITY ZIP TEL. APPLICANT TEL. CONTRACTOR ADDRESS CITY ZIP TEL. ARCH/ENG/ DESIGNER DAWll 6W10 ADDRESS CITY ZIP=TEL. i 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($500).): ^I,AS OWNER OF THE PROPERTY. OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK.AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC. 7044,BUSI- NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE. IF, HOWEVER,THE BUILDING OR IMPROVEMENT IS SOLD W ITHIN ONE YEAR OFCOMPLE- TION.THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). C I.AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANTTOTHE CONTRAC- TORS LICENSE LAW.) . ^I AM EXEMPT UNDER SEC. B. 8 P.C. FOR THIS REASON LICENSED CONTR ORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORCE AND EFFECT LICENSE CLASS LIC. N0. DATE_.$CONTRACTOR hi 1114 l-f r o'T, 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'J;ENSATION RAN IEANDY NUMBER AR / G CARRIER Y Jf ��-31 POLICY NUMBER (THIS SECTION NEED NOT RE 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 THOSE PROVISIONS. DATE:APPLICANT: 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($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 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. 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-MENTNED PROPERTY FOR INS ECTION PURPOSES. LA PE ITTEE N E(PRINT) SIGN 'PURE OF PERMITTEE DATE '-WHITE-Department Copy,YELLOW-Finance Copy,PIN PRESS FIRMLY PERMIT P DATEIC TIQN NUMBER 1 7 L 1-#/C..J C J ISSUE �TYPE OCC // DATE V I CONST. GROUP ZONING SETBACKS FRONT RW^ REAR^ SIDE/SIDE STREET RW^ SIDE � yf PROPOSED USE 7(I �Tcs�c' Rir�ii �l. N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREANALUATION SFR/ADD/REM CO Garage/Carport LU Patio/Deck U_ Pool/Spa 0 Re-Roof Z Commercial Valuation S I-ADJ.AREA QUANTITY DESCRIPTION FEE J U U W W 0 z a Q U Z 2 0 w CONSTRUCTION PLAN REVIEW S 5 Z ELECTRIC PLUMBING M ECHANICAL INSPECTION FEE ISSUANCE Z.S'Cl L SMIP . 5 C ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES r> -5 COMMENTS �r7•�9 v RECPT N0. PAID BY VALIDATION 17>CJ5 /,;'0,/ALC