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Home My WebLink About15828 ��X�\�f�� _�� CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 �W (909)860-3195 Faz(909)861-3117 PRESS �^�'� BUILDING PERMIT APPLICATION FIRMLY o DDRIESS /S2. / S I��wi WI.U�� DATE CATION �l IT" NUMBER I�c!` #/C�'-Z c.� ISSUE TYPE OCC APN LOT� TRACT 3lC7lo Z DATE CONST. GROUP p OWNER �l�I L.OL " ADDRESS l� �, 13L � L.l�J ZONING SETBACKS �W CITY �C� ZIP L'�,�I TEL.�I�'�J �1�5��.,�',.,� FRONT RW ❑ APPLICANT TEL.�/ �/J='� REAR ❑ � SIDE/SIDE STREET RW ❑ � CONTRACTOR - SIDE p QCDDRESS Z�P TEL. ROPOSED USE /�11�I� I�UC)ivI ��12��%�( wo ARCH/ENG/ • z DESIGNER � ADDRESS NO.DWEL. NO. NO. � CITY ZIP TEL. UNITS STORIES BEDROOMS � cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECLARATION SFR/ADD/REM O I HERFBV AFFlRAI UNDER PENALTV OF PERIURV THAT I AM EXEMPT FROM TNE CONTRACTORS LI- G8I89B/CBfpOff W CENSELAWFOR7HEFOlLOWINGREASON(SEC.7o31.5BU51NES5ANDPROFESSIONSCODE:ANVCITVOR (n U COUMYNRiICHRC-0UIRESAPERMRTOCONSTRUCT,ALTERIMPROVE,DEMOLISH,ORREPAIRANYSTAUC- W P8110/DBCk Z NRE,PRIOR TO ITS ISSUANCE,ALSO RE�UIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W STATEMENT THAT HE OR SHE IS LICENSED PURSUAHT TO THE PROVISIONS OF THE CON7RACTORS LI• W � CENSE UW(CHAP7ER Y(COMMENCINO Wlhi SECTqN 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � POOVSPB FESSIONS COOE)OR THAT HE OR SHE IS El(EMPT THEREFROM AND 7HE BASIS FOR 7HE ALLEGED EXEMP• T10N.ANYVIOLATIONOFSECTION7031.SBVANVAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Ra-Roof � ACIVIL PENALTY OF NOT MORE THAN FNE HUNDRED DOLURS(f5o0).): � �ASOWNEROFTHEVROPERTV,ORMYEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, O COrtIf110lCIei � � WILL DO THE WOFi1C,AND THE STRUCRIRE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70a�,BUSI- J � NESS AND PROFESSIONS CODE:7HE CONTRACTORS LICENSE UW DOES NOT APPLV TO AN OWNER OF � PROPEHTY YVFIO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR Q iHROUGH HIS OR HER OMM EMPLOYEES,PROVIOED THA7 SUCH IMPFOVEMEHTS ARE NO71N7ENDED OR m QOFFEREDiORSALEIF,FiOWEVEiLMEBUILDINOORIMPROVEMFMISSOLDWfTHINONEVEAROFCOMPLE- Z �'TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUIID OR � IMPROVE FOR THE PURPOSE OF SALE). w ❑I,AS ONMER OF TME PROPEHTV,MI E%CIUSIVELY CAMMCTINO WITH LICENSED CONTMCTORS [[ TO CONSTRUCT THE PRQIECT(SEC.701t,BUSINE55 AND PROFESSIONS CODE:THE CANTRACTORS LI- 81U8110 ADJ.AREA W CENSEUWDOESNO7MPLYTOANONMEROFAPROPERTYWFIOBUILOSORIMPROVESTHEREON,AND � WFIOCONTRACTSFORSUCHPR0.IECTSWI7HACONTRACTOR(5)LICENSEDPURSUMITTOTHECONTRAG pUANTITY DESCRIPT N FEE � Y TORS LICENSE LAW.). � �I AA1 EXEMPT UNDER SEC. B.8 D,C.FOR THIS REASON Q 3 � � � Q DATE OWNER V Z w � LICENSED CONTRACTORS DECLARATION W � I HEREBV AFFIRAI UNDER PENKTV OF PERIURV THAT 1 AM LICENSED UNDER PROVISIONS OF CHAPTER � � 0(COAIMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z MY tACENSE IS IN NLL FORCE AND EFFECT. m L1J � LICENSE CLASS LIC.NO. j � � J V DATE CONTRACTOR a W � WORKERS'COMPENSATION DECLARATION Q NI HEREBV AFFIRM UNDER PENALTY OF PERIURV ONE OF THE FOILOWING DECUMTIONS: Z � _I HAVE AND WILL MAINTAIN A CEFiTIFICA7E OF CONSENT TO SELF•INSURE FOR WORKERS' 2 COMPENSATION,AS PROVIDED BV SECTION 37000F THE LABOR CODE.FOR THE PERFORMANCE w OF 7HE WORN FOR WHICH TNIS PEHMIT IS ISSUED. � � W I HAVE AND WILL MAIMAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SEC710N Q 37000F THE LABOFi CODE.FOfl THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS q O ISSUED.MV WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION /'1 I /I I/ _� jc�,qpiEp PLAN REVIEW I � Z POUCVNUMBER ELECTRIC �� Q � (IFUSSECIIONNE�NOTBEOOA�LEfIDOF7F�PERArfISFORONEM1NXiEDOqlAAS�it00)ORLESS� PLUMBING Z I CERTIFY THAT IN hIE PERFORMMICE Of THE WOHK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL (J SHAILNOTEMPLOYANVPEHSONINANVMANNERSOAST08ECOMESUBJECTTOTHE �,I(��r ) (� 7nrl� � WORKERS'CAMPENSATIONLAWSOFCALIFORNIA,ANDAGREE7HA71FISHOUL�BECOME INSPECTIONFEE vi�v i. S SU&IECi TO THE WORKERS'COMPENSA710N PROVISIONS OF SECTION 370o OF 7HE LABOR /� CADE,I SHALL FORTHWITH COMPLV WITH THOSE PROVISIONS. ISSUANCE �TT¢>.�.-r.�a n rt�nrT T A TT :t/� O �++L i iJJ'L1A10'LVl VL+/<an� � DATE: APPLICANT: SMIP nr+.,. �.. -.� .. e.�+.-.+m. "a � . vlJll. i1VLI H1V1J J!'iS'L'1 1 � J WARNINO:FAIWRE TO SECURE WORKERS'CAMPENSATION CAVERAGE IS UNUWFUL,AND SHALL BE ENERGY P/C LL SUBJECT Ml EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED 7HOUSAN� ENERGY PERMIT DOLLARS(f7o0.oao).IN AD�ITION TO7HE COST OF COM7ENSA710N,DAMAGES AS PROVIDED FOR IN ¢ SECTION 37oB OF iHE LABOR CODE,INTEREST,AND ATTOHNEY'S FEES. � RETENTION FEE: OCONSTRUCTION LENDING AGENCY pqE_p�T�r I � � I HEREBY AFFIRM UNDER PENAI.TV OF PERIURY THAT THERE IS A CANSTHUCTION LENDING AGENCY �jt► l�� FOR THE PERFORMANCE OF THE WORK FOR N?iICH THIS PERMIT IS ISSUEO(SEC.90G7,CIV.C.). Z W � LENDER'S NAME �� F- LENDER'SADDRESS � I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE TTiAT THE ABOVE INFORMATION IS CORRECT. TOTAL FE ES • W I AGREE TO CAM7LV N7TH ALL CIT/AND COUNTY ORDINANCES AND STATE UWS REUTING TO BUILDING /� Z CONSTRUCTION,AND HEREBV AUTMOHIZE REPRESEN7A71VE5 OF hIIS COUN7V 70 EMER UPON THE ��/� /� A�J� { �(�) / ��_ _ P i ABOVE�MENTIONED PROPERTY FOR INSPEC710N PURPOSES. COMMEN �Y rv (, � � t•"n••�� •�, v.,y... l/♦ � s' e ��C'.�Li m vewu r+u,�e . h� v�i �� O�0 D� � 510 R . ERMITTE A7E = RECPT.N0. PAID BY VALIDATION � ~ WHITE—DepaAmenl Copy,YELLOW--Finence Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—Applicant's Copy � . . . .� . . . .- . ., . ': .: . �_. . . . . .... � .. � .a.�. „ . . . �.;... . . . . . . . . ., � . , , . .. . , . ._ 5 .. . , . l�� C Y �� i.�''l�'�11Y1Vitl� �HII B�SB��CT80�! 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FlNAL - FlNA.L HEATING HEALTH DFPT. F!(VRL � FiNA�ELECTRIC ' DEV. FEES PAID '� �=�hlA,�PLUMBlNG � ENERGY . �=--- i � ,z o � � � }, _;:,�->- — 1,.,,� _ � �ONiiViER1TS , SEPTIC TANK SIZE `� SEEP PIT/U SIZE ___ - -- ----.._.____--------��. �___.__.____.--.--- ��'"`��,, � ,�H� �� ,�, � � r__ _ ___—.__ --------- +. F r!y'�'�r"�j# � 4 sQ. , �yd w4 5� S� `»c � � ° s. . ' ,-�� , rrt�� ___ �..---�— �-- � , �`�?��, ,� .� x s; y�, {��' e� �� ' a�, � . . . ---- — � s x� y,�, , ��1�• . -" x a � —__ — �� '� � �r � . t � � � � ' . � . � ' . .'� '.. ----- y� .�.:s.� . ... � d�' r� .� .�o '� � . � . . . � .