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Home My WebLink About17396 (671) CTI'Y OF DIAMOND BAR — � — DEPAR"TMENT OF COMMUNITY&DEVELOPMENT SERVICES � � 21825 E.Copley Drive (909)860-3195 Fax(909)861-3117 - PRE$$ ''°%�»d'�' BUILDING PERMIT APPLICATION • FIRMLY � JOBSITE 23�22 �. �� (9P'➢tY'a10 R(�. APPLICATION ERMIT �`l Gln P/C �� o ADDRESS_ _ � DATE �MBER ` 1��`" # � ISSUE TYPE OCC ^° APN LOT TRACT DATE CONST. GROUP p OWNER Rarnona Rur�kel p ADDRESS ZONING SETBACKS z CITY ZIP TE�. 7943 7 01 FFiONT RW ❑ � APPLICANT TEL. REAR ❑ z SIDElSIDE STREET qy1J ❑ ¢ COf�?ACTOR Q�+►ner-�uilder SIDE � � ADDRESS � CITY ZIP TEL. PROPOSED USE � C � ARCHlENG/ ' w DESIGNER James Lindenber EI" NO.DWEL. NO. 4 NO. � ADDRESS ��JS��-S Illil� er UNITS STORIES BEDROOMS � cirr S�n uan apc�iP J�67�TEL. � 5 � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/AOD/REM O p I HERE6Y AFFIRM UNDER PENALTV OF PERJURV THAT I AM EXEMPT FROM THE CONTRACTOflS LI- GafB98/C.2fPOR W CENSELAWFORTHEFOLLOWMGREASON(SEC.7031.56USINESSANDPflOFESSIONSCODE:ANYCITYOR (n V COUNTY4YHICHREDUIRESAPERMITTOCONSTRl1CT,AL7ER,IMPROVE,OEMOLISH,ORREPAIRANYSTtiUG W TURE,PRIOR TO ITS ISSUANCE,AL50 REQUIflES TNE APPLICANi FOR SUCH PERMIT 70 FILE A SIGNED w Palio/Deck � STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CANTRACTORS LI- LL � CENSE LAW(CHAPTEq 9(COMMENCING WITH SECTION 700�)OF�NISION 3 OF THE BUSINESS AND PRO- POOUSpB � FESSIONSCADE)ORTHATHEORSHEISEXEMPTTHEREfROMANDTHE9ASISFORTHEALLEGEDE%EMP- TION.ANYVIOLl�TIONOFSECTION7o31.5BYANYAPPLICANTFORAPEHMITSU&lECTSTHEAPPLICANTTO Z Re-Roof � ACIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(ESoo).): � ❑I,ASOWNEHOFTHEPROPERTV,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, � CORIR78fC18I Z WILL DO THE WORK,ANO TF7E STRUCTURE IS NOT INTENOED oF OFFERED FOR SALE(SEC.7044,BU51- J � NESS AN�PROFESSIONS CO�E:7HE CON7pqCTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF � PROPERTV WHO BUIL�S OR IMPROVES THEREON,AND WHO�OES SUCH WORK HIMSELF OR MEFSELF OR � THROUGM HIS OR MER OWN EMPLOYEES,PROVI�E�THAT SUCH IMPROVEMENTS ARE NOT INTEN�ED OR m Q OFFEREOFOqSALE.IF,HOWEVER,THEBUIL�INGOPIMPROVEMENTI550LDWITHINONEVEAROFCOMPLE- Z TION,THE OWNER-Bl11LDER WILL HAVE THE BURDEN OF PROVWG THAT 11E OR SHE DID NOT BUILD OR � IMPqOVE FOR THE PURPOSE OF SALEJ. � w ❑I,ASOWNEROFTHEPROPERTY,AMEXCWSNELVCONTRACTINGWITHLICENSE�CONTRACTORS � TO CONSiRUCT 7HE PROJECT(SEC.7044,BUSMESS ANO PROFESSIONS CODE:THE CONTRACTORS LI- V8Ill8ll0� SPDJ.AFlEA � w CENSELAWDOESNOTAPPLYTOFNOWNEROFAPHOPERTVWHOBUILDSORIMPROVESTHEREON,AND � WHOCANTRACTSFOIiSUCHPROJECTSWITHACONTRACTOR(S)LICENSEDPUFSUANTTOTHECONTRAC- QUANTITY DESCRIPTION � TORSLICENSELAW.), FEE � ❑I AM EXEMPT UNDEF SEG � B.S P.C.FOR THIS REASON ¢ � U . � DATE OWNER R � � Z U � LICENSED CONTRACTO S DECLARATION W � I HEREBV AFFIRM UNDER PENALTV OF PERJl1RV THAT I AM LICENSED UNDER PFOVISIONS OF CHAPTER � d 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OFTHE 91151NE5S AND PROFESSIONS CADE,AND Z 'X MV LICENSE IS W FULL FOHCEAND EFFECT. m � LICENSE CLASS LIC.NO. � V DATE CONTRACTOR � W � WORKERS'COMPENSATION DECLARATION Q � U � I HEREBV AFFIRM UNDER PENALTV OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: Z 0 IHAVEAN�WILLMAINTAINACERTIFICATEOFCONSENT705ELFINSUREFORWORKERS' ¢ ¢ CAMPENSATION,ASPAOVlDEDBYSECTIINJ37000FTNELABORCODE.FORiHEPERFORMANCE U OF THE WORK FOR W HICH THIS PERMIT IS ISSUED. � � W _IHAVEAN�WILLMAINTAINWORKERS'COMPENSATIONINSUHANCE,ASREal11REDBYSECTION Q 370o OF THE IABOR CODE,FOR THE PERFOFMANCE OF TNE WORK FOR WHICN THIS PERMIT IS � ISSUED.MV WORKERS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE CONSTRUCTION ' �� j CARRIER PLAN REVIEW "'� �� Z POLICYNUMBER ELECTR(C Q 0 (�FiI55ECTKNJNEEDNOTBEOJMPLEfEDOFhEPERMITISFOROtJEHUNDREDDJLLAilS(§10o)ORLESSZ PLUMBING W Z I CERTIFY THAT IN THE PERFOFMANCE OF THE WORK FOR WHICH THIS PERAl1T IS ISSUED,I MECHANICAL CJ SHAIL NOi EMPLOV ANV PEHSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE (/� WORKERS'COMPENSATIONLAWSOFCALIFORNIA,AN�AGqEETHATIFISHOULOBECOME INSPECTIONFEE � SUBJECTTO7HEWORKERS'COMPF.NSATIONPROVISIONSOFSECTION3]ooOFTHELABOR � CODE,I SHALLFORTHWITH COMPLY WITHTHOSE PROVISIONS. ISSUANCE � p DATE: APPLICANT: SMIP W J WARNINGFAIWflETOSECUFEWORKERS'COMPENSATIONCOVERAGEISUNLAWFUL,ANDSHALLBE ENERGYP/C � SUOJECTANEMPLOVERIOCRIMINALPENALTIESANOCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT �OLLARS(5100,000),IN ADDITION TOTHE COST OF COMPENSFTION.DAMAGES AS PfiOVIDED FOR IN J SECTION37o80FTHELABORCODE,INTEREST,ANDATTORNEV'SFEES. w RETENTION FEE: O CONSTRUCTION LENDING AGENCY PFtE-ALT FEE: � IHEREBYAFFIqMUNDERPENALTYOFPERJURYTHATTHEREISACONSTRUCTIONLENDINGAGENCY FOR THE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.C.). �- WN�'r�,� � LENDEfl'S NAME �lt-'� ,� F— LEN�ER'SADDRESS � w ICERTIFYhIATIHAVEREADTHISAPPLICqTIONANDSTATETHATTHEABOVEMFOPMATIONISCORRECT. TOTAL FEES � I AGREE TO COMPLV WITH ALl CITV AND COUNTY ORDINANCES AN�STATE lAWS RELATING TO 6UIL�ING � CONSTflUCTIDN,ANDHEREBVAUTHORIZEREPRESENTATNE50FTHI5COUNTYTOENTERUPONTHE Z ABOVE�MENTIONED VROPEFiTV FOR INSPECTION PURPOSES. COMMENTS � = h�rr�, �, 1,��,n�� = m PEHMITTEF NP�M P T) p� y� e C/� 1 � �_T V 2 � SIpNATUflE O PE ITTE DATE � RECPT.NO. PAID BY VALIDATION WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOL�ENROD—File Copy,GREEN—Applicant's Copy �m...�M.. _.�w �u...w.�. ..,m��MM.�... _.��.�wm� . _._.w __ ven�a �� v.�m a.e.m._ _ . _ �_. _ ____- __ -_ __ .. _ ____ . .. _ __ .... .. __ _______ �.,......._ ��r �„� � "�h �` '� PRESS FIRMLY 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 23422 E. 1Nagontrail Rd. APN LOT TRACT OWNER Ramona Runkel ADDRESS CITY ZIP TEL. 7143967601 0\ APPLICANT TEL.tb COORACTOR Owner-Builder ADDRESS CITY ZIP TEL. ARCH/ENG/ DESIGNER James Lindenberger ADDRESS 25662 Spinnaker crry San Juan Capckip 9 2 6 7 5TEL. 9494967355 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 REQUIRESA 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 ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($500).): DI,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./F, 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). O1,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 AT/ DATE OWNER MIA t LICENSED CONTRACTO 'S DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH SECTION 70W)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORCE AND EFFECT. LICENSE CLASS LIC. N0. 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 (DISSECTION NEED NOT BE COMPLETED OF THE PERMIT IS FOR ONE HUNDRED DOLLARS(5100)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. CONSTRUCTlON 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. AL3A./A a....l.; .,\.. I LS t) F.-- Ka 1. e-r.:-..-R PERMITTEE NAM P T) SIGNATURE 0 TT5 DATE WHITE—Department Copy,YELLOW—Finance Copy, PIN APPLICATION DATE \_(I 0 eNoERMIT 0.-)..yo P/C a—a_[It UMBER I-J. * ISSUE DATE TYPE OCC CONST. GROUP FRONT SEfBACKS ZONING REAR SIDE RW 0 0 SIDE/SIDE STREET RW 0 0 PROPOSED N0. UNITS y.w. 4-0 St.VPArk. i:V Mei( USE DWEL. • + l.lr/WOAIERTIFI2 N0. N0. STORIES BEDROOMS cn I-u LLl DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION 1-1- CD z SFR/ADD/REM Garage/Carport Patio/Deck PooVSpa Re-Roof 5 J Commercial 5 m Valuation I\ XDJ.AREA QUANTITY DESCRIPTION FEE -J '6 Fc I- c.) iu 1 iii co Z EI 2 m -J EL -I < 0 2�� < I �••) L.1., 2 CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: . Oin ..- 7--- "'7 A L...,6 ) 1... TOTAL - COMMENTS FEES RECPT. N0, PAID BY VALIDATION -vPo 1\\\ 1\1' \ "7f'^\'\ld i.IcV 002,s1 iqrd ciAnd (rid Ss-110111D 114-cf41 "'.)619)1(1-1 -)iwij);;21-".q_. QQ--3A1 ;1_0 :(34Z.