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Home My WebLink About17985 ---1� --- CITY OF DIAMOND BAR ° � DEPARTMENT OF COMMLTNITY&DEVELOPMENT SERVICES 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 PRES� �-�%9«�" BUILDING PERMIT APPLICATION FIRMLY � JOBSITE APPLICATION _�� PERMIT P/C [ o ADDRESS ZZ-Z�� Sr"`1--�(.�L.E C_��",S� DATE —Z MBER�_ # O��J� T° APN LOT TRACT DA EE NPE OCC p OWNER �Tv1 G(•��i(C CONST. GROUP � ADDRESS ZONING SETBACKS 0 z C�T1' ZIP TEL. ��,� FRONT qyy � � APPLICANT ��',6�r/�' TS7'-�1/� TEL. a REAR n z SIDE/SIDE STREET RW ❑ 4 CONTRACTOR�y�3.,�/i��Se--,�J(, `v/{�? SIDE � p� ADDRESS . �.:` � —��_ ^ ,� o cirv/j�rbC- k�t'S ZIP�'/T l, . ,Z _ P ' PROPOSED USE F114+�� / /O A3 w ARCH/ENG! 0 z DESIGNER_��-ltfli `TSCs*�lL� NO. w � NO.DWEL. NO. � ADDRESS •- � l�" ,- l UNITS � STaRIES Z BEDROOMS� � CIN�i�-C h�TL ZIP EL. - � DESCRIPTION SQ.FT. F CTOR PSF DJ.AREANALUATION Q OWNER-BUILDER DECLAFlATION SFR/ADD/REM � � p I HEREBY AFFIHM UNDER PENALTY OF PERJURY TMAT I AM E%EMPT FflOM THE CONTiUCTORS LI- Gflfdge/CBfpOfl W CENSELAWFORTHEWLLOWINGREASON(SEC.7031.5BUSINESSANDPROFESSIONSCODE:ANYCITVDR (n U CAUNTIWHICHREQUIRESAPERMITTOCANS7RUCT,ALTER,IMPPOVE,DEMOLISH,ORREPAIRANYSTFUG w TUHE,PRIOR TO ITS ISSUANCE,AL50 REflUIRES THE APPLICAM FOR SUCH PERMIT TO FILE A SIGNE� W Patio/Deck � STATEMEN7 THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- � � CENSE LAW(CHAPTEft 9(CAMMENCING WITH SECTION]ooa)oF OIy1510N 3 OF THE BVSINE55 AND PRO- POOUSP2 � FESSIONSCqDE�ORTHATHEDR5HEI5EXEMPTTHEREFROMANDTHE8A515FORTHEALLEGEDE%EMP- (� V TION.ANYVIOLATIONOFSECTION7o31.5BVANVAGPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Raof � A CIVIL PENALT/OF NOT MORE THAN FNE HUNDRED DOLLARS(5500).): ❑I,q50YMEROFTHEPROPERTV,ORMYEMPLOYEESWITNWAGESASTHEIRSOLECOMPENSATION, ❑ COR1rt18fClal Z WILL DO THE WORK,AN�THE STRUCTURE IS NOT INTENDED OR OFFEflED FOR SALE(SEC.7044,BUSI- J � NESS ANO PqOFESSfONS COOE:THE CONTRACTORS LICENSE lAW DOES NOT APPLV i0 qN OWNER OF = PROPERTY WHO BUILOS OR IMPROVES THEREON,AND WHO DOES SUCH WOflK HIMSELF OF HERSELF OR wTHFOUGH HIS OR HER OWN EMDLOYEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m Q OFFEREDFORSALE.IF,HOWEVER,THEBUILDINGORIMPflOVEMENTISSOLDWITHINONEVEAROFCOMPLE- Z TION,T OWNEF�BUILDER WIL�HAVE THE BURDEN OF PROVING THAT HE OF SHE DI�NOT eUll��R � IMPR FORTHEPURPQSEOFSALE). W ASOWNEFOFTHEPROPER7Y,AMEXCLUSIVELYCONTRACTINGWITHLICENSEDCANTRACTOflS Q TO RUCT THE PROJECT(SEC.7044,BUSINESS AND PROFESSIONS COOE:THE CONTPACTORS LI- VdIUBflOf1 � ADJ.AREA W CENSELAWDOESNOTAPPLYTOANOWNEROFAPROPERTYWHOBUILDSORIMPROVESTHEREON,AND � WHOCONTRACT5FOR3UCHPROJECTSWITNACANTRACTOR(5)LIGENSEDPURSUANTTOTHECONTfiAC- QUANTITY DESCRIPTION FEE Y T�RSLICENSEIAW.). � ❑I AM EXEMPT UNDER SEC. 8.6 P.C.FOR THIS REASON Q �� Q . . U � onre oWNER ¢ { � s!'/�r A�R ��,o • 5-'�c> � W `.<+i� � L . �?e.a LICENSED CONTRACTORS DECLARATION � � W I HEREBY AFFIRM UNOER PENALTV OF PERJURY THAT I AM LICENSED UND6R PROVISIONS Of CHAPTER /� y( d 9(COMMENCING WITH SECTION�000)OF DIVISION a OF THE BUSINESS AND PROFESSIONS CODE,AND Z YJ�..1 � t'� (I' � MY LICENSE IS IN FULL FOFCE ANO EFFECT. � � � �`v�` � IICENSE CLASS LIC.NO. � , �(j �� V DATE CONTRACTOR n. � �;�r� " W �� WOFKERS'CDMPENSATION DECLARATION Q �, ,+l ` .�J 1 �e � I HEREBV AFFIRM UNDER PENALN OF GERJURV ONE OF THE FOLLOWING DECLARATIONS: Z Z IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' _ Q COMPENSA710N,ASPROVIDEDBYSEC710N3]OOOF7HELA80RCppE,F�RTHEPERFOHMANCE U OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. w � � QW _IHAVEANDWILLMAIMAINWORKERS'COMPENSATIONINSURANCE,ASREDUIRED6YSECTIDN //�� /� 37o00FTHELABORCODE,FORTHEPEfiFORMANCEOFTHEWORKFORWHICHTHISPERMITIS A.�O ISSUED.MY WORKERS'COMPENSATION INSUflANCE CARRIEF ANO POLICY NUMBER ARE: CONSTRUCTION J J � CARflIER PLAN REVIEW �� 0 POUCYNUMBER ELECTRIC I �� - � Z Q � (IFIISSECIIONNEmNOTBECOMPLEfEDOFTHEPERAHTISWFIXJEHIXJDREDDOLLARS(S10J)ORLESS�. PLUMBING �_£ (f ��,� Z I CERTIFY THAT IN THE PERFORMANGE OF THE WORK FOR WHICH THIS PERMIT IS ISSUE�,I MECHANICAL �� • �S� (�} SHALLNOTEMPLOYANYPERSONINANVMANNEFSOASTOBECOMESUBJECTTOTHE e � � � Vj WORKERS'COMPENSATIONLAWSOFCALIFORNIA,ANDAGFEETHATIFISHOULDBECOME INSPECTIONFEE K�� SUBJECTTOTHEWORKERS'COMPENSATIONPROVISIONSOFSECTION37000FTHELABOR - 1�PCJ�t <�� ' � CODE,i SHALL FORTHWlTH COMPLVWIiH THOSE PROVISIDNS. ISSUANCE / 1 � � SMIP � ... �f�.`J�� ,5`� p DATE: APPLICANi . J WARNING:FAILURE 70 SECUflE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C � ��--... � . � SUBJECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREOTHOUSAN� ENERGYPERMIT DOLLARS(5100.000),IN ADOITION TO THE COSTOF COMPENSATION,DAMAGES AS PFOVIDED FOR IN .r-1 SECTION3708OFTHEIABORCODE,MTFREST,ANDATTORNEY'SFEES. RETENTIONFEE: � a CONSTRUCTION LENDING AGENCY PRE-ALT FEE: O � � 1 HEREBV AFFIRM UNDER PENALN OF PERJURV THAT THERE IS A CONSTRUCTION LENOING AGENCY F4A TH�PERFORMANCE OF TH�WORK FOR W HICH THIS PERMIT IS ISSUE�(SEC_309],CIV C.). Z W j LENDER'S NFME _ � w LENOER'SAODRE55 O r� � ' � � TOTALFEES � I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. � I AGREE TO COMPLY WITH ALL q7yAND COUNTV OFOINANCES AND STATF IpWS PELATING TO BUILDING � � CONSTRUCTION,AND HEREBV AUTHORRE REPflESENTATNES OF THIS COUNTV TO ENTER UPON THE Z ABOVE-MEMIONE�PflOPERTYFORINSPECTIONPUFPOSES. 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' °�i �`�*�+9��"9�"a .....,_ .. .. . . _ _ .___ ��.�� ? �h{@I 6@F�i�id�e'M��'�d�N.�� ; nn ��a a�-�,: :.� �. " __.�.�? d�.,„�"�.':�f�r��u�a�;� _ ....... ........_. . _. .. .. ._�.._ ..,- .. ,.._. _ ..-- . -_ . . . . ....... � W'ALi\-L"I' VALLEY Gi�iIFIED SCHOOL D[5'I'R1CT ( 880 SOITTH LEMON AVENL� WALNiJT CA 91789 �-I J ' �� y CERTIFICATE OF COMPLIANCE �U�R✓lG�- �v�� With Fee Provisions of • Government Code Section 65996 DEVELOPER/OWNER John Chang ADDRESS 22205 Steeplechase Signature of Applicant CITY/ZIP Diamond Bar, 91865 The person signing represents that he/she is su;h�,rized TELEPHONE 626.827.8688 to sign on behalf of the owner/developer and thac che information provided is true and accurate ro the he��of his/her knowledge. 1VEW LOT ADDRESS USE OF BUILDIIYG TOTAL SQ. FT. ResidentiallCommerc ial/Industrial City ' HOME IMPROVEMENT OR REMODELII�IG PROJECT ADDRESS DESCRIPTION TOTAL 3Q. FT. 22205 Steeplechase t st � 2nd Floor Addition 2097 Diamond Bar Wainut (Bedroom, Family Rm., Kitchen, etc.) Signature of Superintendent of Buildings Date --�J�==-�'�� TO BE COMPLETED BY SCHOOL DISTRICT FEE SCHEDULE: The development fees levied by the Walnut Valley Unified TOTAL FEES DUE School District under provision of Government Code§65995 $ are: (EFF. 8/17/98) Residential Development $1.93/sq. ft. Receipt# Commercial/Industrial $0.31/sq. ft. Date Fees are assessed on TOTAL square footage "living space" of ALL new or remodeling construction projects OVER 500 sq. feet (eliminating garage or uncovered patio). This is to certify that all fees due to the Walnut Valley Unified School District under provision of Government Code Section 65995 have been received and a building permit may be issued. This is to certify that the above described development has been deternuned to be EXEMPT from the development fees of Government Code Section 65995 and a building permit may be issued. Exemption Justification: PROJECT IS 500 OR LESS SQUARE F'EET OTHER Vemon Medeiros Assistant Superintendent Fiscal and Facilities Management 1/87 Rev. 2/88; 6/88; 8/89; 1/9U; 8/90; 10/90; 8/92; 6/93; 11/93; 8194; 6/96; 1/97; 8198 PLEASE SEE NOTICE OF 90-DAY PERIOD FOR PROTEST OF F'EES ON REVERSE SIDE WALNUT VALLEY UNIFIED SCHOOL DISTRICT 880 SOUTH LEMON AVENUE WALNUT CA 91789 CERIII^ICATE OF COMPLIANCE With Fee Provisions of Government Code Section 65996 I-.)1 6vS DEVELOPER/OWNER John Chang ADDRESS 22205 Steeplechase CITY/ZIP Diamond Bar,91865 TELEPHONE 626 .827. 8688 Signature of Applicant The person signing represents that he/she is authorized to sign on behalf of the owner/developer and that the information provided is true and accurate to the heq of his/her Icnowledge. NEW LOT ADDRESS USE OF BUILDING TOTAL SQ. FT. Residential/Commercial/Industrial City HOME IMPROVEMENT OR REMODELING PROJECT ADDRESS DESCRIPTION TOTAL SQ. FT. 22205 Steeplechase lst&2nd Floor Addition 2097 Diamond Bar Walnut (Bedroom, Family Rm.,Kitchen,etc.) Signature of Superintendent of Buildings 0.' aAkt,_ Date c.'—'at'OQ--N, TO BE COMPLETED BY SCHOOL DISTRICT FEE SCHEDULE: The development fees levied by the Walnut Valley Unified TOTAL FEES DUE School District under provision of Govemment Code§65995 are: (EFF. 8/17/98) Residential Development $1.93/sq. ft. Receipt# Commercial/Industrial $0.31/sq. ft. Date Fees are assessed on TOTAL square footage"living space"of ALL new or remodeling construction projects OVER 500 sq. feet(elirninating garage or uncovered patio). This is to certify that all fees due to the Walnut Valley Unified School District under provision of Government Code Section 65995 have been received and a building permit may be issued. This is to certify that the above described development has been determined to be EXEMPT from the development fees of Govemment Code Section 65995 and a building permit may be issued. Exemption Justification: PROJECT IS 500 OR LESS SQUARE FEET OTHER Vernon Medeiros Assistant Superintendent Fiscal and Facilities Management 1/87 Rev. 2/88;6/88;8/89; 1/90;8/90; 10/90;8/92;6/93; 11/93;8/94;6/96; 1/97;8/98 PLEASE SEE NOTICE OF 90-DAY PERIOD FOR PROTEST OF FEES ON REVERSE SIDE DIAMOND BARI 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 2-Z--2-c.7-S,.. ...re-iel.;?Z. 6-CleytAls f- APN LOT TRACT OWNER LT) (4-0 c--(14./416 ADDRESS CITY ZIP TEL. 6;le APPLICANT A, ." • TEL --,e4 pi-- cp.? CONTRACTORI-„t,4-riii,"-7-3'• -714-:-/ e"..:?-,19e;? ADDRESS r., •--, fle.A.. ,(-72--C-: CITY t,k)rr P-#7.>I ZIP2_277f (L.4.7)7-chi-, ARCH/ENG/ DESIGNER .4R7740'1- �77.• C-Ali ADDRESS p, ,' 13.T,14: .—..0�)" +4C-i, cirof--/A-e frirt ZIP e ... ..-j-tior 7 12.--11-EL. 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 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(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,T OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPR FOR THE PURPOSE OF SALE). AS OWNER OF THE PROPERTy,AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO RUCT 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 8 PC 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 Moo)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 CARRIER POLICY NUMBER (THIS SECTiON NEED NOT BE COMPLETED OF THE PERMIT LS FOR CNE HUNDRED COLLARS($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 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 COUNT),TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES ----- 11 1Dyy ehqK-1 PERMITTEE NAME(PRINT) SIGNAT 6F PERMITTEE I DATE PRESF FIRMLY APPLICATION 2— ,PERMIT /..-1815-•• P/C 0 ..4.... 5.-g MBER i( # ISSUE DATE TYPE OCC CONST. GROUP FRONT SEfBACKS ZONING REAR SIDE RW CI 0 SIDE/SIDE STREET RW 0 c PROPOSED N0. UNITS USE DWEL A 13,O;i70 A-) N0. N0. i STORIES 2- BEDROOMS 4 (•/) Lu w DESCRIPTION SQ. FT. F,CTOR PSF 1•1- 0 Z • DJ.AREA/VALUATION SFR/ADD/REM ..Tatillin dE1:1111FISIMININIIIINI SIVA IrarMii^I Mill II i I Garage/Carport Patio/Deck PooVSpa Re-Roof EI -1 Commercial 5 co Valuation 0 1 I ADJ.AREA QUANTITY DESCRIPTION FEE < 0 E1— 'CO /la iA q�,G�7 i 5-#0.40.#fi AWL t(,10�0) 2. ". ?44 0 Z E 2. i 2 ( a a. 5 Ato..c.Art 2 re-4.,x 7-- gl,A° a a 0 2 a -i (--,3 1 i c.) L.Li 2 CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE. 1 r)N°6, 10 q 5-: O1 211,4.4' 42' I'e A0,�i 1 I OCk•q 1\ 1 ra-Ql.b), 0\)6\ L TOTAL FEES 1.)R, r10(1) 1—Q-1 1 1 6/1 IC COMMENTS RECPT NO 7 PAID BY VALIDATION il WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy Orlao /1-1?-0,tf, IeAI FI-00(2-900034 oft, z*oz--F4-9-5,1464Q-cc4ag eetc(442- 6..YTekt 54e4g-4,4-4-(4 Tr, izoyr-P&L Aft9Pot6c)Pc4-05 —• g--7° 5ttir4ez_4.41((f-fa 6,4/0 z_/el Ate-a-A 4vC._aim;sies,- 3-10-oz.To 0.41„ycatAte 4-- 1 lot bvs.;,, 2.4-"3 F(.004 c(t/tte.,c 17A1-4104C-6- +Igaltel /•,figi-,90/015C //,'ArE&09:;-&" 11, 1/7* n i-q4-(23 Noirna-d (riNAO