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Home My WebLink About18993 �,�'" �.��G� �--.� � CITY OF DIAMOND BAR � � DEPARTME;VT OF COMMIJNTfY&bEVELOPMENT SERVICES , �" 21825 E.Copley Drive / (909)860-3195 Pax(909)861-3117 PRESS ��%ti�� BUILDING PERMIT APPLICATION FIRMLY � JOBSITE a � d ADDRESS�� I (.l SQ C �, 6t..� ' � APPLICATION �/�� pERMIT P/C q o DATE V NUMBER�r�� #--�J�l� � ISSUE p TYPE OCC APN �I G'�G LOT C '� �ACT�C��___^ i � `�' D,ATE I CONS7. GROUP p OWNER C�(9t,K � c( � Gl1�i p ADDRESS 2- ��S�� CX�� CI ZONING SETBACKS z CITY it ZIP�� 7EL� o 0 0 � FRONT Ryy p � APPLICANT ` TEL. (b�� REAR ❑ aSIDE/SIDE STREET RW ❑ Q CONTRACTOR SIDE n ADDRESS � CITY ZIP TEL. PROPOSED USE w ARCH/ENG/ '"�' y— � z DESIGNER +1�`S 4�6'� ��_�� G' � ADDRESS � �/Y NO.DWEL. NO. NO. � CITY "� ZIP C-/� TE�. UNITS STOR�ES BEDpOOMS � cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER•BUILDER DECLARATION SFFUADD/REM O p I HE(7EBV AfFlRM UNDER PENALTV OF PERJURY THAT I AM EXEAIPT FROM THE CONTRAC7oqs LI- GafBge/CafpOR W CENSELAWFOHTHEFOLLOWINGpEA50N(SEC7o3158USINESSANDP90FESSIONSCODEANVQTYOR (f� U COUNTVWHICHREOUIRESAPERMITTOCONSTRUCT,ALTER,IMPPOVE,DEMOUSH,ORpEPAIRANVSTflUG w TURE.PfiIOR TO ITS ISSUANCE.AL50 REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SICNED w Paho/DBCk � STATFMENT THAT ME OF SHE IS LICENSED PURSUAMT TO THE PRpVISIONS OF THE CONTRACTOfiS LI- LL GENSE UW(CHAPTEA 9(COMMENCING WI7N SECTION 700�)OF DJYISIDN 3 0F TME BUSINESS AN�Pfl0- POOUSFI2 � FESSIONSCODE)ORTHATHEOf15HEISEXEMPTTHFpEFROMANDTHEBASISFORTHEALLEGEOEXEMP. (�J V TIONANVVIOLATIONOF6ECTION70315BYANVAPPUCAN�FORAPERMITSUBJEC�SfHEAPPLICANTTO Z Re-Roof � A CIVIL PENNITY OF NOT MORE TFIAN FIVE HUNDPED DOLLARS(SSoo�) � ❑I,ASOWNEROFTHEPROPERTV.ORAIVEM7LOVEESWITHWAGESASIHEIqSOLECOMPENSATiON, � COmR10fG121 Z WILL DO THE WORK,AND THE STRUCTURE IS NOT IN7ENOGD OR OFFEFED FOR SALE(SEC 7044,BUSI- J � NESS AND PROFESSIONS CODE THE CONTRACTORS UCENSE LAW DOES NO�APPLV TO FN OWNER OF � PpOPENTV NMO BUILDS OR IMPROVES THEREON,AND WHO OOES SUCH WORK HIMSELF Oq HERSELF OR � THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS AflE NOT INTEN�ED OR m w OFFEHEDFORSALEIF,MOWEVERTF7EBUILOINGORIMPROVEMENiI550LDWITHINONEVEAROFCOMPLE- � TION,THE OWNEREUILOER WILL HAVE THE 6URDEN OF PROVWG T�iA7 HE OR SHE DID NOT 9UILD OR Z IMPROVEFOqTHEPUflPOSEOFSALE) � ❑I,ASOWIrEROFTHEPROPERTV.AMEXCLUSNELVCONTRACTINGWII'HLICENSEOCONTqACTORS W � TO fANSTFUCT THE PROJECT(SEC.7064,Bl1SINESS ANO PROFESSIONS CA�E THF CONTRACTORS U- V31UaflOfl AD�AREA W CENSEUWDOESNOTAPPLYTOANONMEROFAPROPERTYWHOZUIIfJ50f11MPROVESTHEREON,AND � WHOCONTRACi5FOR5UCHPROJEGTSNNiHACONTRACTOfl(S�IICENSEOPUflSUAN7TOTHECONTRAC� QUANTITY DESCRIPTION FEE Y TORS LICENSE LAW) y,� � ❑I AM EXEMPT UNDER SEC - �8.8 P C FOR THIS REASON Q ��b�^"' L +{ �p � ' � ¢ �1 l�iT > D OWN E L F- pQ ^� ZO ' � w �,Y.��u".',>`7 ��'i� � LICENSED CONTRACTORS DECLARATION w ¢ � I HEREBY AFFIRM UNDEFi PENALTY OF PERJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTEq � "tII��1k'I (��,� � 9(COMMENCING WITH SECTION 7000)OF DIYISION 3 0F THE BUSINESS AND PPOFESSiONS GODE,hN0 z ��' v � uV `X MV LICENSE IS IN FULL FORCEAND EFFECT m �p,,1�� rs LICENSE CLASS LIC NO ~ DATE_ CONTRACTOF a �(��C U -- w � WORKERS'COMPENSATION DECLARATION Q � f HEFiEBV AFFIqM UN�ER PENALTY OF VERJURY ONE OF THE FOLLOWIN�OECUqATION$ Z � IHAVEANOWILIMAINTAINACERTIFICATEOFCONSENTiOSELF-INSUREFORWORNERS' a Z Q CAMPENSATION,AS PROVIOED BY SECTION 37000F THE LABOR CODE,FORTHE PERFORMANCE W Q OF THE WOPK FOF WHICN THIS PEPMI7 1S ISSUED � W I HAVEAND WILLMAINTAIN WORKERS'COMPENSATION INSl1pANCE.AS REOl11RED BV SFCTION Q 37oa OF THE LABOR CODE,iOR THE PERFORMANCE OF TH�WORK FOR WHICH THIS PERMIT IS 4 ISSUED MY WORKERS'COM7ENSATION INSURANCE CARRIEq AND POLICV NUMBERARE CONSTRUCSION � l� � CARRIER PLAN REVIEW ��_�_ Z POLICYNUMBER .. ELECTRIC ia Q � � (MISSEC"fiONNEmN�78E07HIN_E7EDOFTHEFEFAMISFORCUEHUrOPED�OLIARS(Slm)ORLESS) PLUMBING � �t� �� Z I CEFlTIFVTHAT MTHE PEFFORMANCE OF THE WORK FORWHICN THIS PEHMIT IS ISSUED,I MECHANICAL � � SHAIL NOT EMPLOV ANY PERSON IN ANY MANNEFi SO AS TO BECOME SUBJF/:T TO THE � WORKERS'COMPENSATIONLAWSOFCAUFORNIA,ANDAGREETMATIFISHOULDBECOME INS?ECTIONFEE � � Sl18JECTiOTHEWORKERS'COMPENSATIONPROVISIONSOFSECTION37000FTMELABOR �./ � COOE,I SHALL FORTHWITH COMPLV WITN THOSE PROVISIONS ISSUANCE � � SMIP p �ATE APPLICANT � J WARNMG FAILURE TO SECURE WORKERS'COMPENSATION COVEPAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C � SUBJEGTANEMPLOVERTOCRIMINALPENALTIESANDCIVIIFINESUPTOONEHUNOREDTHOU5AN0 ENERGYPERMIT DOLLARS(5700.000).IN AODITION TO THE COSTOF COMPENSATION,DAMAGES AS PRpVIpEO FOR IN J SECTION31080FTHELABORCODE,MTEREST,PNDATTORNEV'SFEES RETENTIONFEE. � d CONSTRUCTION LENDING AGENCY PRE-ALT FEE O � IHEpEBVAFciRMUNOERPENALTYOFPERJl1RYTHATTHEREISACONSTRUCTIONLENDINGAGENCY __ FOR THE PEFFOFiMANCE OF THE WORK FOR WNICH THIS PERMIT IS ISSUED(SEC 3D9],CIV C) Z � W � LEN�Efl'S NAME _ F- LENDER'SAD�RESS / w I CERTIFV TNAT I HAVE RFAO THIS AGPLICATION AND STATE THAT hIE ABOVE INFORMATION IS CORFECT TOTAL FEES��Q �,(� `�4 �� \'/ � Q IAGR[ETOCOMPLVWITHALLG'ryANDCOUNTYORDINANCESANDS�ATEL4WSRElATINGT09UILDING -N � CONSTRUGiION,AND HEREBY AUTHOPI2E REPRESENTATIVES OF THIS COUNTY TO ENTEfl UPON THE V�� ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES COMMENT$ �sl`� � - S'/' l�t % N� m PER EEN�M,Ej�WT�-•') Q - � �j� ��j..1 � � p �� DAT = RECPT NO PAID BY VALIDATION ~ WHITE—De artmentCo YELLOW—FinanceCo PINK—AssessorCo GOLDENRO�FIeCo GREEN— p py, py, py, py, ApphcanPs Copy , � . . . ,•r��° . . 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ARCH/ENG/.4.-% DESIGNER T-c t,to c ADDRESS _ IIVEL(2„A lr , .1rAN CITY ,"' MUM ZIP C-A TEL 5 (.;:a.m7w. cp-T---{z.- 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 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 AN),APPLICANT FOR A PERMIT SUBJEC rs f HE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS Ow)) 0 I,AS OWNER OF THE PROPERTY,OR MY EMPLOYEES WITH WAGES AS I HEIR 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 auit DS OR IMPROVES THEREON.AND WHO CONTRACTS FOR SUCH PROJECTS WITHACONTRACToR(Sji ICENSED PURSUANT TO THE CONTRAC. TORS LICENSE LAW) 0 I AM EXEMPT UNDER sec Et&P C FOR THIS REASON -- - ------- •, ... �•_��• -')CE.,..._D a2it-2„ OWN e- 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 PPOFESSONS CODE,AND MY LICENSE IS IN FULL FORCE AND EFFECT LICENSE CLASS LIC NO DATE CONTRACTOR WORKERS'COMPENSATION DECLARATION t HEREBY AFFiRm uNOER 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 PEFIMIT 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 NOTBECOMPLETEDOF THE PERMIT IS FORONE HUNDRED COLLARS($103)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 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 ft3'At4-0 lilt( e ry,.;4/d; PER EE NAME ealla).---) ...,.._...rpre��.e. /--/2—0-)- ..-/-'-'------ 0 DAT( PRESS FIRMLY APPLICATION DATE PERMIT 45.-k.X3 • NUMBER P/C OCC ISSUE TYPE DATE CONST. GROUP FRONT SEfBACKS ZONING REAR SIDE RW p 0 SIDE/SIDE STREET RW 0 ( CI PROPOSED N0. UNITS USE DWEL PMEMMillit kivk ivi. Pon rLwi N0. N0. STORIES BEDROOMS CO I-I-I LU DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION I-1- 0 z SFR/ADD/REM lit(o* Garage/Carport Patio/Deck Poo(/Spa Re-Roof E3 -) Commercial 5 co 1--141 1-lig• Valuation ADJ AREA QUANTITY DESCRIPTION FEE Q 1- 0 'id4S-- Tuthr w -J LIJ AT q ski...it-IC.4-V 1. tp-::0-ktori FAIJ (5 z E -ctitto(345�4 L D a� I 'ES AI A-Liz I g i/4 IC -J < 0 a x �•) Lu CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE tili, )0 ISSUANCE SMIP ENERGY P/C ENERGY PEFIMIT RETENTION FEE, PRE-ALT FEE IN 141 , --)) • -850 40,1a til._1')-- TOTAL FEES pfo Plowisz nJ° (91 G.6 2_. COMMENTS RECPT NO PAID BY VALIDATION WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy, e Copy, —pp ican s Copy ,1-14441� rir Devi_ c-o a Ijs A)67