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Home My WebLink About17524 .,,, _� CITY OF DIAMOND BAR ' y DEPARTMENT OF COMMUrTITY&DEVELOPIv1ENT SERVICES 21825 E.Copley Drive (909)860-3195 Pax(909)861-3117 PRESS "'%v�"� BUILDING PERMIT APPLICATION FIRMLY y JOBSITE �cL)/� � ��'f�.�,��/p �� APPLICATI N �} PERMIT J ,�-. P/C � ADDRESS r � - DATE �6-�(•-'.r�L`_%[�D �MBER 1 y� # 1SSUE TYPE OCC � APN � LOT��_ TRACT � DATE CONST. GROUP p OWNE ��j=�r�t,�.��?� .�`3 2�1s-�.� �` ADDRESS � ' � =� � � �1� ZONWG SETBACKS OCITY�j.✓�,3A�_��l? �:�t'"'ZIP�s/7�� TEL. L'/.- FRONT RW ❑ Z APPLICANT TEL. �!y 5'1 REAR ❑ SIDE/SIDE STREET RW ❑ Q CONTRACTOR L��i�'✓"� SIDE ❑ � ADDRESS � .: � PROPOSED USE /�Ls�1'��J [r'�_ �._z_ .�.. � CITY ZIP TEL. �-b.4L 21.�).".a w ARCH/ENG/ ,' /� iz pESIGNER ' '�'E-S�-'""`-"� C�-rG�i,' �r`'� NO.DWEL. NO. NO. a ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEI. � � DESCRIPTfON SQ.FT. FACTOR PSF ADJ.AREANALUATION OOWNER-BUILDER DECLARATION SFR/ADD/REM � 1 HEREBY AFFIRM UN�ER PENALTY OF PEFUURY THAT I AM EXEMPT FROM THE CONTRACTOpS LI- G8�896/C8fF101I W CENSELAWFORTHEFOLLOWINGREASON(SEC7o375BUSINESSAN�PROFESSIONSCO�EANYCITYOR (n C.� COUNTYWHICHREOUIRESAPERMITTOCONSTflUCT,ALT[R,IMPROVE,DEMOLISH,ORREPAIRANVSTRUC- `W P8I10/DBCK wTURE.PRIOA TO 1TS ISSUANCE.ALSO REWIRES THE APPLICANT FOR SUGH PERMIT TO FIIE A SIGNED � STATEMEM THAT HE Op SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTOFS LI� .� CErygE LAW(CHAPTER 9(COMMENCINO WITH SECTION 7000)OF DIVISION 30F THE BUSINESS AND PRO- LL POOVS(13 O FESSIONSCODE)ORTHATHEORSHEISEXEMP7THEREFFOMAN�THEBASISFORTHEALLEGEDEXEMP- � V TIONANVVIOIATIONOFSECTION70315BYANVAPPLICANTFOqAPERMITSU&IECTSTHEAPPLICAN7i0 Z pe-Root � A CIVIL PENALTV OF NOT MORETHAN FIVE HUNDRE�OOLIARS(S5o0)� Q ❑I,ASOWNEROFTHEPROPERTY,ORMYEMPLOYEESWIiHWAGESASTHE1flSOLECOMPENSATION, � COfllfflefCl81 Z WIIL 00 THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFEFEO FOR SALE(SEC 704d,BUSI- J NE55 AND PROFESSIONS CODE THE CONTRAC70RS LICENSE LAW DOES NOT APPLV TO AN OWNER OF N PROPEflTYWHOBUILDSOFIMPROYE5TF5EREON.ANDWFtODOE55UGHWORKHIMSEIFORHERSELFOR m � THROUGHHISORHEROWNEMPLOVEES,PROVI�EDTHATSl1CHIMPROVEMENTSARENOTINTENDE�OR QOFFEREDFORSNE.IF,HOWEVEFyh1EBU1LD1NGOflIMPROVEMEF7TfSSOLDWITHINONEYEAROFCOMPLE- � TION.THE OWNER-BUIL�ER W�LL NAVE THE BUROEN OF PROVING THAT HE Ofl SHE DIO NOT BUILD OR � IMPROVE FORTHE PURPOSEOF SALE). ❑I,AS OWNER OFTHE PROPERN,AM EXCIUSIVELY CONTRACTING WI7H LICENSED CONTRACTORS � TO CANSTRUCT THE PROJECT(SEC 7�44,BUSINESS AN�PROFESSIONS GODE THE CONTflACTOflS LI� V8IU8fI0f1 ADJ.AF7EA W CENSEWNOOFSNOTAPPLY70ANOWNEROFAPROPER7YWHOBUILDSORIMPROVESTHEREON,AN� � WHOGONTRACTSFOpSUCHPROJECT3WITHACONTRACTOR�S�LICENSEDPUflSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE TORSLICENSELAW) Y ' O ❑I AM EXEMPT UNDEti SEC B a P C GqR THIS REASON Q �0�C'�� d � 2 ., �:.� LL DA7E OWNER_ ~ a�f t�.1� �• "t S Z W � �f � � UCENSED CONTRACTORS DECLARATION W (� �.� �.f ` '�J ry � I HEREBVAFFIRM UNDER PENALTV OF PERJURY THAT I AM LICENSED 11NDER PROVISIONS OF CHAPTER � � 9(COMMENCMG WITH SECTbN 7000)OF DNISION 3 OF TNE BUSINESS AN�PROFESSIONS CODE,AND Z X MY LICENSE IS IN FULL FOHCEAND EFFECT m W � �{ 0 LICENSE CtASS LIC Nn .. .--- J rn C aV Q � � �� V pq7E CONTRACTOR � W � WORKERS'COMPENSATION DECLARATION -� U � IHEFEBYAFFIRMUNDER7ENALTYOFPERJURVONEOFTHEFOLLOWINGOECIAFFTIONS � Z Q � IHAVEANDWILLAIAINTAINACERTIFICATEOFCANSENTTOSELF-INSUREFORWOftNERS' 2 Q CAMPENSAT�pN,A3PROVIDEDBYSECTION3]OOOFTHEIABORCODE,FORTHEPEAFORMANCE W OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED � � W _IHAVEANDWILLMAMTAINWORKERS'COMPENSPiIONINSURANCE,A5RE0UIRE0BYSECiION Q 3700 OF THE UHOH CODE,FOR TH£PEHFORMANCE OF THE WORK F�R WHICH THIS PERMIT IS ISSUED.MV WORHERS'COMPENSA710N INSURANCE CARRIER AND POIIGY NUMBER AF7L CONSTRUCTION � CARRIER PLAN REVIEW � POLICYNUMBER ELECTRIC �� Z a � (IHISSECTIONNE�N�TBECCMPLEfEDOFTHEPERMfTISWRONEHUNDflEODOLLAflB(3100IORlESSj PLUMBING - � I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOA WNICH THIS PERMIT IS ISSUE�,I MECHANICAL F -_ — SHALL NOT EMGLOV ANV PERSON IN ANY MANNEP SO AS TO 6ECOME BJEGT TO THE � WORKERS'COMPENSATIONLAWSOFCALIFORNIA,ANDAGREETHAT ISHDUL�BEC ME INSPECTIONFEE ___ �•�� _ ` � SUBJ CTTO EWOFKERS'COMPENSATIONPPOVISIONSOF C N oOFTH BOR �SSUANCE �_1 �� C ISH FOfjjM`NiTHCOMPLVWI PROVISION � "-� V O SMIP 0 DATE � ��APPLICANT �� , _ _____ J ENERGY P!C - J WARNING FAIL�RETO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND 9HALL BE LL SU6JECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFMIESUPTODNEHUNDREDTHOUSAN� ENERGYPERMIT - DOLLARS(510o.000),INADDITIONTOTHECOST�FCOMPENSATION,DAMAGESASPROVIDEDFOFlIN fi � � J SECTION 37oB oFTHE LABOR CODE,INTEflEST.AND ATTORNEI"5 FEES RETENTION FEE � p � W CONSTRUCTION LENDING AGENGY PRE-ALT FEE: d � 1 HEREBV AFFIRM UNDER PENAL7Y OF PERJUfiY iHATiHEPE IS ACONSTRUCTION LENDING AGENCY d FOF THE PEPFORMANCE OFTH�WORK FOR WNICH THIS PEflM1T IS ISSUED(SEC 3097.CIV C� � W � I.ENDER'S NnME Fi LEN�ER'SA�DRESS 4�j, WICERTIFYTHATIHAVEREA�THISAPPLICATIONANDSTATETHATTHEABOVEINFORMATIONISCOFi3ECT TOTAL�EES v � IAGREETOCOMPLVWITHALICITVAN�COUNTVORO4NANCESPNDSTATElAWSRELATWGTOBUILDING � CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATNES OF THIS COl1NTY TO ENTEfl UPON THE z ABOVE-MENTIONEDPROPEFTYFORINSPECTIONP RPOSES COMMENTS o -� � ,^, !� .� _y--� � �� m P NAME(PRINT) � ^'� -. ¢ ;,�, , .�-- cn � ' � si UREOFGERMITT E ^TE � � VALIDATION RECPT N0. PAID BV � WHITE—Departmant Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—Fde Copy,GREEN—Appl�cant's Copy f I ��'� �l .?��y��-.�� PRESS FIRMLY CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY 8z. DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION JOBSITE :2.-/.•-.7.. i ADDRESS -7„ i_._fi,,;--/v,w Vii Mieiva 64-4 APN .6 LOT/7 TRACT I/7 513 OWNERLe,_... ADDRESS,Z V 3/Z ":=71 ,-,.#1,74-fy CITY/(.7 ,5._zZ,.,4ZIP 41,0 Ai TEL.rt...)(I-i Z 1 - APPLICANT TEL. -75. if-9/ CONTRACTOR 04-4•.-X.---',/,-'7.,. ADDRESS CITY ZIP TEL. ARCH/ENG/_, , l,e, 2. -- --........._� �--_�k� � 4„� -e DESIGNER -C---S' . eL I, 1..-, ADDRESS CITY ZIP TEL. OWNER-BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMpT FROM THE CONTRACTORS LI- CENSE LAW FORTHE FOLLOWING REASON(SEC 7031.5 BUSINESS AND PROFESSIONS CODE ANY CITY OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT,ALTER IMPROVE,DEMOLISH,OR REPAIRANY 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(COMMENCNG 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 70 A C/VIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($500)) 0 I,AS OVYNER 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 yEAROF 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) 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 7005)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORCE AND EFFECT LICENSE CLASS LIG NO DATE CONTRACTOFI 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 LABOFI CODE,FOR THE PEFIFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUmBER ARE CARRIER POLICY NUMBER is (TRSSECTION NEED NOT BECOMPLETEDOF THE PERMIT IS FORONE HUNDRED DOLLARS(5103)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 EJECT TO THE i WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT i SHOULD BEC ME .- SUBJ CT TO E WORKERS'COMpENSATION pROVISONS OF C N 0 OF TH BOR ) I SH FO HWITH COMPLY WI PROVISION ) �........1 DATE APPLICANT 1 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($100.000),IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN 3 SECTION 3700 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES 3 CONSTRUCTION LENDING AGENCY ) z 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) i -1-. LENDER'S NAME LENDER'S ADDRESS E. C I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATIoN IS CORRECT LI , 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 P RpOSES _ ......, ] " 4 5 lir al\-• i' _..., n NAME(PRINT) / 0 n SI URE OF PERMITT E 0 TE E AP DATE PLICATI9N ,.....) , --) PERMIT pi„-J,1 P/C /—,..t.-- L'.)I)e---NUMBER/v5,--r # ISSUE DATE TYPE OCC CONST. GROUP FRONT SEfBACKS ZONING REAR SIDE/SIDE SIDE RW 0 0 STREET RW 0 0 N0. PROPOSED UNITS USE DWEL. A Zi-121/-/-17.1.7/-1,4_ 7/e).-i — N0. N0. STORIES BEDROOMS DESCRIPTION _ FACTOR PSF ADJ.AREANALUATION SQ. Ff. SFR/ADD/REM cn Garage/Carport U-I Patio/Deck UJ u_ Pool/Spa CD Z a- -) 5 co Re-Roof Commercial Valuation ADJ.AREA QUANTITY DESCRIPTION FEE ,...1 E �-) L.LI LT; ,� -1 bk)f Lt 7 s ri q L.,ko tef z et-X"-,--oe_e s /6 4 0 a z EI n -) 0 /A I 04 t/1/1 I)/)-1 4c.4.--c 0 -J < 0 2 a x 0 u.i 2 CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE PRE-ALT FEE: 4,6 t5 0 j Pi. S .et) i .60 TOTAL FEES L.Sb COMMENTS RECPT N0. lit,7 PAID BY 3 VALIDATION WHITE--Department Copy,YEL W—mance Copy, —ssessor Uopy, — • sioz 2)TTPhyIA