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Home My WebLink About17107 ✓ ` --��` — CITY OF DIAMOND BAR � DEPARTMENT OF COMMUNiTY&DEVELOPMENT SERVICES � � 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 Pf��$$ ��"%�� BUILDING PERMIT APPLICATION FIRMLY � JOBSITE ��9/2 ��/��/ ��0�� DATE CATION / / D NUMBER `'' #/C�• a ADDRESS_ J /'�J K� � .... � p' ISSUE TYPE OCC `A APN_�_ LOT� TRACT '�.�� DATE CONST. GROUP p OWNER F/'J��QOk/�j��f��"� p ADDRESS ZONING SEfBACKS z CITY /AMOA/��ZIP�1/7�,STEL. - � FRONT RW ❑ g APPLICANT TEL., REAR ❑ Z SIDE/SIDE STREET f{W ❑ ¢ CONTRACTOR.,I��P SIDE ❑ o CDDRESS � Z�P TEL. PROPOSED USE .� � � .� � O �0 � ARCH/ENG/ � ��!,Z�� z DESIGNER � �---E��"' �� '�� w � NO.DWEL. NO.�� NO. � ADDRESS � CITY ZIP TEL. UNITS STORIES 2 BEDROOMS � cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HEfiEBY AFFlRM UNDER PENALTV OF PERJl1RV THAT I AM EXEM7T FqOM THE CONTRACTORS LI- G8fege/C3fpOfS W CENSELAWFORTHEFOLLOWWGREASON(SEC703158USINESSAN�PPOFESSIONSCODEANYqTYOR (n U COUNTVWHICHREQUIRESAPERMITTOCONSTiiUCT,ALTER,IMPROVE,DEMOLISH,ORFEPAIRANYSTRUC- W pa110/DeCk W TURE.PRIOR TO ITS ISSUANGE,AL50 RE�UIRES THE APPIICANT FOR SUCH PERMIT TO FILE A SIGNED w STATEMENT THAY HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTflACTORS LI� � CENSE LAW(CHAPTEP 9(CANIMENCIN(:WITH SFCTIqN��o)�1F pIVISInN 3 OF THE Bl1SINF55 AN�Pq(1- LL PooVSpa � FESSIONS CODE)OR THAT HE OR 8HE IS EXEMPT THEREFflOM AND THE BASIS FOR THE RLLEOED EXEMP� TION ANYVIOLA710NOFSEC710N70315BVANVAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Roof A CIVII PENALN OF NOT MORE THAN FIVE HUN�flED DOLLARS(5500)) z ❑I,ASOWNEROFTHEPFOPERTV,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, � COR1R48fC12I WILL UO 7XE WDFK,ANO THE STRl1CTURE IS NOT INTEN�ED OF OFFERED FOR SALE(SEC 7044,BU51- J N NESS AND PROFE3310NS COOE THE CONTRACTOR9 UCENSE LAW�OES NOT APPLV TO AN OWNEfl OF � PROPERTV VhiO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR � THROUGHHISORHEROWNEMPLOVEES,PROVIDED7HATSUCHIMPROVEMENTSARENOTINTENDEDOR m QOFFEREOFORSALE IF,HOWEVERINEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCAMPLE Z T�ON.TME OWNER�9UILDER W�LL HAVE THE BUfiDEN OF PROVING THAT HE OF SHE DID NOT BUILD OR � IMPROVE FOR THE PUflPOSE OF SALE�. W OI,ASOWNEROFTHEPROPERTV,AMEXCWSIVELVCONTRACTINGWITHLICENSFDCONTRACTORS � TO GONSTRUCT iHE PROJECT(SEC.7004,BUSINESS AND PROFESSIIXJS CODE THE CONTRACTORS�I- V8II18110f1 A�J.AREA W CENSE LAW DOES NOTAPPLV TOAN OWNER OFAPROPERTV WHO BUILOS OR IMPFOVES THEREON,AN� � WMOCONTRACTSFORSUCHPFOJECTSWITMACONTRACTOR(5)LIGENSEDPURSUANTTOTHECANTRAC- QUANTITY DESCRIPTION FEE Y TORS LICENSE LAW� � ❑I AM EXEMPT UN�Efl SEC B 8 P,C FOR THIS REASON J o a � U tL � DATE OWNER _.._ V Z W � LICENSED CONTRACTORS DECLARATION W ¢ � I HEREBY AFFIRM UN�ER PENALN OF PERJURV THAT I AM LICENSED UN�ER PROVISIONS OF CHAPTER � � 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z w MV LICENSE IS W FULL FORCE ANO EFFECT m � LICENSE CLASS LIC NO j J U DATE CONTRACTOR n- W a� WORKERS'COMPENSATION DECLARATION a � U � IHEREBYAFFIRMUNOERPENALTYOFPERJURYONEOFTHEFOLLOWINGDECLARATIONS � Z Q � _IHAVEANDWILLMAINTAINACERTIFIC�TEOFCONSENTTOSELF�INSUREFOHWORKERS' _ CAMPENSATION,AS PROVIDED BV SECTION 3]o00FTHE LABOR CO�E,FOfI THE PERFORMANCE U � OFTHE WORK FOR WHICH THIS PEFMIT IS ISSUED � � w _IHAVEANDWILLMAINTAINWORKERS'COMPENSATIONINSUFANCE,ASflE0U1RE�BYSECTION ,�C�Y'� Q 3700 OF THE LA60R CO�E,FOR THE PERFORMANCE OF THE WORH FOF WHICH THIS PERMIT IS ISSUEDMVWORKERS'COMPENSATIONINSURANCECARRIERANDPOLICYNUMBEFARE CONSTRUCTION J � CARFIER PLAN REVIEW • • _. _ O. —6 Z PoucvNUMeea ELECTRIC ¢ � (IHISSECTIONNEmNOTBE�APLETEDOFIHEPEPMrtISFORONEHUWRE�D0�Wi5(510a)ORLESS) PLUMBING w MECHANICAL Z I CERTIFYTHAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I �J SHAlLNOT EMPLOV ANV PERSON IN ANV MANNER SO AS TO 6ECOME S�BJECT TO THE N WORKERS'C�MPENSATIONLAWSOFCALIFORNIA,ANDAGpEET ATIFISHOULD COME INSPECTION F�p � SU&IECTTOTHEWORKERS'COMPENSATIONPROVISIONSOF CTION37000F ELABOR ISSUANCE � CODE IS IA.f-0RITHWITHCOMPLYWITHTHOSEPROVISI � /� Y�'�/ ( SMIP p�(ArIV��2 �� p DATE,r_(�4 bV 1 _ APPUCANT: " W � TT ENERGY B!C� J WApNINGFAILURETOSECUREWORKERS'COMPENSATIONCOVERAGEISUNLAWFUL,ANDSFiALLBE —�— J � SUBIECTANEM7LOYERTOGRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT __ DOLLARS(51ao.0o0),IN ADDITION TO TNE COST OF COMPENSATION.DAMFGES AS PROVIDEO FOR IN J SECTION 3708 OF THE L490R CODE.INTEflEST,ANO ATTORNEY'S FEES RETENTION FEE: Q d CONSTRUCTION LENDING AGENCY pREALT FEE� � IHERE6VAFFlRMUN�ERPENAI.TYOFPERJUflVTHATTHEREISACONSTRUCTIONLENDMGAGENCV d FOF THE PERFORMANCE OFTHE WORK FOR WHICH THIS PEPMIT IS ISSUED(SEC 3097,CIV G) Z ._ W � LENDER'SNAME ___. F_— LENDER'SADDRESS — � I CERTIFY THAT I HAVE REAO THIS APPLICATION AND STATE THAT THEABOVE MFORMATION IS CORRECT TOTAL FEES O�A� W IqpflEETOCOMPLYWITHALLCITYANOCOUNTYORDWANCESANDSTATELAWSFELATINGTOBUILDING � CONSTRLICTION,ANDHEREBYAUTHORIZEFEPRESENTATNESOF7HISCOUNTYTOENTERUPONTHE � ZABOVE-MENTIONEO PflOPEflTV FOF INSPECTION PURPOSES COMMENTS � `� ' i�� S- � � - / m PERMI NAME(PRIN � J / -- Q �!� ��' L �� /) � � V (/ � nTuaEOFae irree DATE RECPTNO. PAIDBY VALIDATION _ ~ WHITE—Depaament Copy,YELLOW—Finance Copy.PINK—Assessor Copy,GOLDENROD—FIe Copy,GREEN—ApphcanPs Copy __ fd 2�-z.,.� :�,,�--..�._ ; _ _ .�� ,�-�,% �z , -�:�' , . � ' d� �� . ,� �, �<p�rv � . _ . .. �r 2'f� -�''�� .. � !.�� _ �� . ��r�� .� �a.��',�'�- . . �-��a� �n-c �a�,� �- � � �� .�+�a�e. ��s .r�c�t �.. ��_ P��.. F PRESS FIRMLY CITY OF DIAIVIOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E. Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION JOBSITE ADDRESS 21g/2..c-A/7-Ay 4.1,09, I 211—.2 I:3/11C' APN ......a,2 LOT /7 TRAGT.4,.. 2 .58, .....• .4,- OWNER" dc4.02/2 eircW 174ht&s,E.,l/4 ADDRESS 2113/2.5A---A,7127 CITY P/A/4/0/1/17 4914 ZIP 9/265TEL.,fO 7—96/-33/7, APPLICANT TEL. CONTRACTOye/4111W2.- ADDRESS CITY TEL. DESIGNER 12 fart_,ZIP ARCH/ENG/ .4 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 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)) O1,AS°INNER 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- MN,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) 0 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 LIC NO 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' 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 CARFIIER ! POLICY NUMBER I. (THIS SECTION NEED NOT BE COMPLETED OF THE PERMIT IS FOR ONE HUNDRED COLLARS($103)OR LESS) ! I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I i SHALL NOT EMpLOY ANY PERSON IN ANY MANNER SO As TO BECOME SUBJECT TO THE i WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE T AT IF I SHOULD COME SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF CTION 3700 OF E LABOR I SVALL FORTHWITH COMpLY WITH THOSE PROVISI ) CODE 4 DATE. APPLICANT: I 1 i WARNING. FAILUFIE 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 :I SECTION 370a OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES .-.1 CONSTRUCTION LENDING AGENCY .5. - 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) 5 LENDER'S NAME LENDER'S ADDRESS E I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT E 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 /"—4 c',thCii /-)"4---ii4.16-<-5-.1( 0 --.-..-7 PERM! NAME(PRIN - x 0...--.-e.- ,/,- '//7/_&2__]— o s ATURE OF PE ITTEE DATE E APPLICATION DATE .4/, / M PNEURMBIETR I 11 °I)MO I'..-. 9:13 ISSUE DATE TYPE OCC CONST. GROUP FRONT SEfBACKS ZONING REAR SIDE RW E D SIDE/SIDE STREET RW 0 0 N0. PROPOSED USE UNITS DWEL /'," • Jr 7 . - C-1 ,k,I JP 4 1_,I, ito iot. - - ..• .1 ,--410P/APra P•_n 77-I rr: ,c. . ^ i .. NO.NO. ..5 STORIES 2 BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREANALUATION SFR/ADD/REM 2 5 .e/ cn Garage/Carport LI w u- Patio/Deck (.1 z PooVSpa Re-Roof CT:1 I Commercial 5 co Valuation 0 0 0 ADJ.AREA QUANTITY /DESCRIPTION FEE < 0 E 1-- 96„SG 0 w J w 1 e)-00 fv- t�&461-- 0 z E m 1 a 1 a 0 2 a 0 w M CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FSEE ISSUANCE SMIP ,_. ENERGY P/- ENERGY PERMIT RETENTION FEE: PRE-ALT FEE. (AI,771t) ..1 1 -11 .11\ Lk 6•s:C G p L44441 s-c.),c 13 Flan ' o• ° r TOTAL FEES -50 A,90 COMMENTS RECPT N0. PAID BY VALIDATION WHITE—Department Copy, —mance Uopy,ITN1S—ASsessor Lopy, , (�-zo-i.i o(exo 9-6z3.000 ti.43.01 001 12z4kr rok_Foik&RECPf si464t. eat6S M:OT PK,4MP/W:0_AOS