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Home My WebLink About17964 CTI'Y OF DIAMOND BAR \ ( `�- ) � DEPARTMENT OF COMIvIUNITY&DEVELOPMENT SE ��..� �_� 21825 E.Copley Drive ��` (909)8603195 Fa�c(909)861-31 l7 �� (! PRESS �%�� BUILDING PERMIT APPLICATION � G��`�`��.�@.'1�� FIRMLY � DDRESS a'� �i Lv`�Z��—��""� �R, e DATE CATION� `� �� NUMBER + �` �I/ °�° APN LOT TRACT ISSUE � TYPE OCC DATE �� CONST. GROUP p OWNER -`tf_f1A1s�s�A, Q��i��'�. I,. o ADDRESS �1.1�(�xx.{ �i L-��i� ��y'i� Q��'•,,, ZONING SETBACKS z CITY��L�A�aJ1� ,��P�'i'f�` TEL.J�' S�-^�-a'�'�.- FRONT RW ❑ � APPLICANT TEL. REAR ❑ �� SIDE/S�DE STREET RW ❑ CONTRACTOR SIDE � � ADDRESS � � CITY ZIP TEL. PROPOSED USE nIl�YL- ��2Jf?! IO ZG�� Lj w ARCWENG/ ' � -- � z DESIGNER � �' a ADDRESS NO.DWEL. NO. NO. N CITY ZIP TEL. UNITS STORIES BEDROOMS N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLAFIATION p SF D /REM p I HEREBY AFFIRM UNDER PENALTV OF PERJURv THAT I AM EXEMP7 FROM THE CON7RAC70F5 LI- Ga298/CBfFIOrt W CENSEUIWFORTHEFOLLOWINGREASON(SEC70315B1151NE3SANOPflOFESSIONSGODEANYCITYOR (n U COUNTVWHICHREQUIRESAPERMITTOCONSTRUC7,ALTER,IMPROVE.DEMOLISH.ORREPAIRANYSTRUC- l w TURE,PRIOH TO RS ISSUANCE,ALSO RE�UIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W PaLo/Deck � STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF iHE CIXJTPACTORS ll� • � CENSE LAW(CHpPTER B�CAMMENCING WITH SEGTION 7W0)OF DIVISION 30F THE BUSINESS ANO PRO- � POOUSP2 O FESSIONSCODE)ORTHATHEORSHEISE%EMPTTIEREFROMANDTHEBASISFORTHEALLEGEDEXEMP- � U TION ANVVIOLATIONOFSECilON7037.5BVANVAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO Z R@-ROOf A CIVIL PENALTV OF NOT MORE THAN FNE HUNDRED DOLLARS(5500)) � ❑I,ASOWNEROFTHEPROPERTY,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, � Commercial Z WILL DO THE WOHK,AND THE STRUCTURE IS NOT INTENDED OR OFFEFED FOR SALE(SEC 704t,9U51- J N NE55 AND PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DDES NOT APPLV TO AN OWNER OF � PROPERTV WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR Q THROUGHHISORHEROWNEMPLOYEE9,PqOYIDEDTHATSUCHIMPHOVEMENTSARENOTINiENDE00R m � OFFEREDWRSILLEIF,HOWEVERTHEBUIL�INGORIMPPOVEMENTISSOLDWITHINONEYEAROFCOM7LE- Z TION,THF OWNF..q-BIIILDER WILL HAVE THE BUROEN OF PROVING THAT HE OR SHE DIO NOT BUILD OR � IMPflOVEFORTHEPURPOSEOFSALE) uJ ❑I,ASOWNEROFTHEPROPEFTY,AMEXCLUSIVELYCONTRACTINGWITHLICENSEDCANTRACTORS � TO CANSTRl1CT THE PROJECT(SEC 7044,BUSINESS AND PROFESSIONS CODE THE CaJTRACTORS LI� VaIUalI0f1 ADJ AREA W CEN6ELAWDOESNOTAPPLYTOANOWNEROFAPROPEflTVWHOBUILD30RIMPROVESTHEREON,qND = WHOCANTRACTSFORSUCHPHOJECTSWITHACONTflACTOR�S)LICENSEDPUflSUANTTOTHECONTRAC- ~ TORSLICENSELAW) QUANTITY DESCRIPTION FEE Y 0 ❑1 AM EXEMPT UNOER SEC OR THIS REASON Q ?� U � DATE ;�"eP+'0� OWN U 0 W LICENSED C T ACTO DECLARATIO -� Q W � I HEREBY AFFIRM UNDER PENALTV OF PERJURY THAT I A AI$E O IONS OF CHAPTER � � 9(COMMENCING WITH SECTION 7000�OF DIVISION 30F TH INESS AND P �'SSIONS CODE,AND Z �� MV LICENSE IS IN FULL FORCE AND EFFECT m � UCENSECLASS LIC NO j V DATE CONTRACTOR a W � WORKERS'COMPENSATION DECLARATION Q � IHEREBYAFFIRMUNDERPENALNOFPERJURYONEOFTHEFOLLOWINGDECLARATIONS Z Z _I HAVE AND WILL MAINTAINACERTIFlCATE OF CONSENTTO SELF-INSURE FOR WORKERS' _ Q COMPENSATION.ASPROVIDE�BYSEGTION37ooOFTHEIABORCODE.FORTHEPERFORMANCE w Q OFTHEWORKFORWHICHTHISPERMRISISSUE� � w 1 HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS RE�UIRED BV SECTION Q 370o OF THE LABOR CODE,FOR THE PERFORMANCE OFTHE WORK FOH WHICH THIS PERMIT IS ISSUED.MVWORKERS'COMPENSATIONINSURANCECARRIERANDPOLICVNUMBEFARE CONSTRUCTION J � CFRRIER PLAN REVIEW Z POLICV NLIMBER ELECTRIC Q � (iHISSECTIONNEmNOTBEQOMREfEDOFhIEPERMfTISFORONEHUNDREDOq1PAS(StDD)ORLES6) PLUMBING Z I CERTIFVTHAT INTFIE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL � SHALLNOTEMPLOYANYPERSONINANYMANNERSOAS70BECOMESUBJECTTOTHE [n WORKERS'COMPENSATIONLAWSOFCALIFORNIA,ANDFGREETHATIFISHOULDBECOME INSPECT�ONFEE � SUBJECTTO THE WOFKERS'CAAAPENSATION PROVISIONS OF SECTION 3]0o OF THE LA80R � CqDE,ISHALLFORTHWITHCOMPLVWITHTHOSEPROVI510N5 ISSUANCE _ 7 '- O �— �j � p DATE. APPLICANT c J WARNING.FAILUFIETOSECUREWOflKEHS'COMPENSATIONCOVERAGEISUNLAWFUL,ANOSHALLBE � f � SU&IECTANEMPLOVEqTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTMOUSAND - --�F--1T �OLLARS(f1oo,000�,IN ADOITION TOTHE COST OF COMPENSATION,DAMAGES AS PROVIDED FOH IN -'�`-''-' � SECTION 37oB OF THE LABOfl CODE,INTERESi,ANDATTORNEY'S FEES nrr�niTlrl__ N_�EE� d CONSTRUCTION LENDING AGENCY awP-:m�r��. O � 1 HEREBV AFFIRM UNDER PENALTY OF PERJURY THATTHERE IS A CONSTRUCTION�ENDING AGENCY FOR THE PERFORMANCE OFTHE WORK FOR WHICH 7HI3 PERMIT IS ISSUED(SEC 3097,GIV G� Z W � LEN�ER'S NAME F- LEN�ER'SA��RESS /) /1� � I CEFTIFV THAT I HAVE READ THIS APPLICATION AND STATE TNAT THEA90VE INFORMATION IS CORRECT TOTAL FEES {/� 3 �+� � I AGFEE TO COMPLY WITH AlL CITY AND CAUNTY OR�INANC D STATE LAWS RELATING TO BUILDING � � CONSTFUCTION,ANDHEFEBVAUTHORIZEflEPRESENTATI FTHISCOUNTYTOENTEFUPONTME Z ABOVE�MENTIONED PROPER P COMMENTS 0 J � m PEflMITT E�P Q C/J J� � SIGNATUREOF ERM EE OATE � = RECPT NO. PAID BY VALIDATION ~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—Fde Copy,GREEN—ApphcanPs opy �(22rr� l ._ �.. �^ CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SE 21825 E. Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION JOBSITE ADDRESS 0111(94 5 ti-Jerz,,..i---cni, r. APN LOT T RACT -1:'ri LoAA a 7....\b.. OWNER e:,P-ae 0 2-Z b. ADDRESS p...wc-x-Ii i 1-4 Q-12_C.: Lou,t> Vi^-. CITY I t-3X 3tiZzipqiltS"TEL5779---,1-30- APPLICANT TEL. CONTRACTOR ADDRESS CITY ZIP TEL. 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 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)) 0 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 ACONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW) 0 I AM EXEMPT UNDER SEC_.,.. ,• . THIS REASON DATE 5."ga-0 a owN • ,4areAFrialliM IENNi•X^^^^^ LICENSED C&... -ACTO'r DECLARATIF"PWLIP' I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I A '0 IONS OF CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF TH !NESS AND P1 SSIONS 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 CARRIER POLICY NUMBER (THLS SECTION NEED NOT BE COMPLETED OF THE PERMfT IS FOR ONE HUNDRED DOLLARS($150)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 3709 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 ORDINANC,•• D STATE LAWS RELATING TO BUILDING CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTAT if-• F THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPER • •?..,,zidAnau,P- ^(,)1011.111.11.7/1 fa I I I I Ik 10 A ei Ca. Win PERMITT EArI-MiIIF^quv SIGNATURE OF• ERM EE -"Mr4111111111.1111111..."DATE tht,eN ikra PRESS FIRMLY APPLICATION DATE (pr 31 ., PERMIT 1 # 04-- NUMBER 1 ISSUE DATE L„ TYPE OCC - CONST. GROUP FRONT SEfBACKS RW ZONING REAR SIDE 0 0 SIDE/S1DE STREET RW 0 0 PROPOSED USE N0. cmon---t-rexml 7e UNITS UV,-,..., DWEL. f ...A. • . • ilt ! 6'll' •• 'A ' • ..,17AMMTRIV "• -to.. ""Mt. 1 a T N0. N0. STORIES BEDROOMS CID W w DESCRIPTION SQ. FT. u- 0 Z FACTOR PSF ADJ.AREANALUATION sF79/REm 21? Garage/Carport Patro/Deck 03 Pool/Spa Re-Roof E Commercial 5 co Valuation ADJ AREA QUANTITY DESCRIPTION FEE -J < 0 CC I- 0 III -J iti 0 z Fa m n a_ -) < 0 2 a x c..) CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE Stottr— ENE.H.G34106 •ENC-MIT-PERKIIT RE.T.F.taJCZLEL;;,, PRLIft-ALTFEE,.. -3,5— 156/2" A A s. "'L TOTAL FEES 1. 3<03 COMMENTS RECPT N0. il PAID BY 1%3 VALIDATION WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy :41-2-2 oei/