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Home My WebLink About19087 --- - �'�'�r_f--� 1� CTfY OF DIAMOND BAR � ��`"� ` --- DEPARTMENT OF C�MMiJNITY dt DEVELOPMENT SERVICES � � . ais2s E.cop�ey nrn�e PRESS (909)860-3195 Fax(909)861-3117 """' BUD.DING PERMIT APPLICA'[TON FIRMLY JOBSI7E 1 APPLICATI�N `� r(�PERMIT Q�1 P/C a ADDRESS ��7� W a q jO ''�- �� I DATE � �'�/�V d��NUMBER 1" # c� ISSUE TYPE OCC APN LOT TRACT DA7E CONS7 GROUP p OWNER �:�C�i N��Ap "' ADDRESS —�—OV 1' ZONING SETBACKS z CITY ZIP TEL. FRONT RW ❑ � APPLICANT ��, REAR ❑ � SIDE/SIDE STREEf qW ❑ � CONTRACTOR SIDE p � ADDRESS ��_� L PROPOSED USE o✓ � GTY_ h. '� ��n�e TEL.�fF w ARCWEIVG/ �� ,,, � DESIGNER NO.DWEL. NO. NO. n. ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION N ' � OWNER-BUILDER DECLARATION SFR/ADD/REM O p 1 HEREB�AFFIRM UPNER PENALTY OF PEfiNRY hIAT I NA EXEMPT FROM THE CONTMCTORS LI- Qg�9�B�rt W CENSEUWFOHTHEFIX.IOWINOREA50N(SEC.7031.6BUSINE93ANDPROFESSIONSCODE:ANYCIT/OR (n U COUNfVNMICNREIXIIRES�PERMITTOCONSIRUCT.ALTER��.DEMOLJSH,ORREPAiPANY57RUG � petlO/DBCk � NRE,PRpH TO ITS ISSUANCE,ALSO HEW IRES THE MPLICANT FOH SUCH PEIiMIT TO FILE A SIGNED � STATEMENT THAT HE OR SHE IS LICENSED PURSUMIT TO THE PqOVI510N5 OF THE CONTiiACTORS LI- � CB13E UW(CHAPTER Y(COMMENCINO WITH SECTION 7000)OF DIVISION 3 Oi TME BU9INESS AND PRP �'�" Paa�Pe FESSIONS COD�OR 7HAT HE OR 9HE IS EXEMPT 7HEflEFROM ANDTHE BASIS FOA?HE ALLEOEU E%EMP- V 7pN.MIY VIDLATION OF SECTION 7IXi1.6 BY ANV APPLIGNT FOq A PERMIT SUBIECT9 iHE APPLICANi TO Z qe-Roof F A CIVIL PENAI.TY OF NOT MORE 7}iAN FIVE HUNDRED DOLURS(SSoq.�: � OI.ASONMEROFTFIEPROPERTY,ORMVEMPLUYEESWITHi�JA0ESA5THEIRSOIECOMPENSA7ION, � COf11111BfC181 = Z WILL W THE WORK ANO THE STRUCTURE IS NOT IPREN�ED dR OFFERED WR SALE(SEC.70N,BU51- J NE38 AND PROFE9910N8 CODE:THE CONTMCTORS LICENSE UW DOES NOT APPLY M AN ONTIEH OF � Pf10VEHTVNM1lOOUILD50RIMPROVE57HEREON,ANDNM1IODOESSUCHYYOfiKXIMSELFOqHEflSELFOq � � 711Fi0UGHH190HMERONMEMPLOYEES,PROVIOEDTHATSUCHIAWqOVEMENT6MENOTttiTENDEDOR m Q OFFEREUFOHBALEIf,HOWEVER,THEBUIIdNaOHIMPROVEMBJf1350LDNrtTMNONEYEAHOFCOMPLE• Z 71ON,THE OWNER-BUII➢ER WILL HAVE 7NE BURDEN OF PROVINQ TMAT HE OR SHE DID NOT BUILD OR = IMPqOVEFOflTHEWRPO5EOF51LL�. OI,ASOWNEROFTHEPROOENiV.AAA E%CLUSNELYCOMMCTINQ WITNLICBISEDCONTfUCTOHS � 70 CONSTRUCT TNE PRO.IECT(SEC.7oH.BU9INESS NiD PROFESSIONS CODE:THE CONiMCTORS LI- VfilUBfiOf1 ADJ.AREA W CENSEUWOOESNOTMPLVTOMIOWNEPOFAPROVERTYM6�OBUILA50RIMPROYESTHEREON,AND � WHOCONTMCT8WqSUCMPHOJEGTSWI7HACON�MGTOR(S)LICENSWPURSUANTTO7HECOHfiUC pUAN71TY DESCRIPTION FEE � TORSUCENSEUW.�. 0 ❑I AM EXEMPT UNDER 9EC. B.d P.C.FOR THI6 REIISON � � U � � OATE OWNEH V �¢ LICENSED CONTFACTORS DECLARATION W 2 I HEREBY AFFIHM UNDEH PENALTV OF PERJURY THA?IAM LICENSED UNDER PROVISIONS OF CHAPTEH � � Y(COMMENCINOWIIHSECTqN7000)OFDIVISKKJ30F7HEBUSINESSANDPpOFES510N5CODE,AND Z �� MY LICENSE IB IN FULL FORCE AND EFFECT. p m LICENSECLASS G �7 � �O �r � w DATE�;�CIONTMCTOR a / � WORKERS'COMPENSATION DECLAFATION � � I HERWV/1FFIqM UNDER PENALTV OF PERJURV ONEOFTHE WLLOYANO DECLARATIONS� U � � � _IHAVEMIDWILlMA1NTAINACEIiTIFICATEOFCONSENTTOSELFdNSUHEFORWORNERS' CI�MPENSATION,ASPROVIDEDBYSECTION37000F7HELABORCODE.FOR7MEVERiORMANCE U Q OFTHEWORKFORWHIpi7H157EHMITI5155UED. � 0 W �_I HAVE AND WILL MAINTAIN WORKERS'COAIPENSATION INSURANCE,AS REQUIRED BV SECTION Q 37ooOFTHEL4BORCO�E,FOR7HEPEPFORMANCEOFTHEWOPKWRWHICHIHISPERMITIS �� ISSl1ED.MY WOR/KyFAS�'COMPEN9ATION MSUflJANCE C�RqIER AND POLICY NUMBERME: CONSTRUCTION j GRRIER �1�'G�► p PUW REVIEW � PoLICVMIMBEN��/s�L ----- ELECTRIC Q � (I}ilSeECf10NNE�NDTBE00AREf�OF71EPHiMfISFaROfdEHlN7RE�DOL1AR48f0�ORLESS} PLUMBING W MECHANICAL Z ICEHTIFYTHATINTHEPERFOFiMANCEOF7HEWORKFOAWHICHTHISPERM1716163UED,1 (J 6HALLNOTEMPLOVANVPERSONNANYMPNNERSOMST09ECOMESIIBJECTTOTHE � WONI(ERS'COMPEN511TIONUWSOFCALIPoRNIA,ANDAOREETHATIFISFIOULDBECOME INSPECTIONFEE SUBJECT TO 1HE WORKERS'COMPR�ISATION PROVISIONS OF SECTION 970o DF 7HE LABOR � CODE,I SHALL FORTHIM7H COMPLY WITH THOSE PHOVISIONS. �SSUANCE � h � f.�,�.�wJ SMIP . � v p DATE: /�/�/V'=" APPLICAM: Dl�'V�/-,.�L � J � 1 ' �— ENERGY P/C WMNINO:FAILURE TO 6ECURE WORKERS'COMPENSRTION COYERAOE IS UNUWFUL,AND SHN.I BE � SU&IECTANEMPLOYERTOCRIMINAIPENAlT1ESAIJOCMLFINESUP700NEHUNOREUlHOU5AN0 ENERGYPERAHIT � DOlUR4(f7o0.000),INADDITIONTOTNECoSTOFGOMPENSATKKJ.DAMA0E5A5P�DEDFORIN J SEC710N37DlOFTHEU�ACODE,INTEREST,/WDATTORNEY'SFEES. FlETENTIONFEE: � Q W CONSTRUCTION LENDING AGENCV PRE-ALT FEE: o.. � I HEREBY AFflRM UNDEfl PENALTY OF PERJURY THAT THERE IS ACON5TRUCTION LEN�INO A/iENCV FOH iHE PERFDRMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SE0.�OW.qY.C.�. Z W � LENDEfYS NMIE 1� LENDEH'SAODRESS wICERTIFYTIMTIHAVEPEADTHISAPPIICATIONANDSTATETNATTiEABOVEINFOPMATIONISCORRECL TOTAL�EES � J� d I AAREE TO COMPLY WITH ALL CITV AND COUNT�'OROINANCES AND STA1E UWS RELATINO TO 9UILUINO CONSTHUCTION,AND HEREBY AUTFIOH2E REPRESENTATNES OF THIS COUNTV TO EMER UPON THE � ABOVE-MENTIONED PflOPERTY FOR INSP�CTION PURPOSES. COMMENTS � 7T►� N i�t� _ aPERMfiTEE NAME(PRIFIT) / /� Q� � � SIONA FPERMITT D TE � RECPT.N0. PAID BY VALIDATION WHITE—DepaRment Copy.YELLOW—Finence Copy,PINK—Assessor CoPY� OLDENRO ile Copy,GREEN—ApplicenPs Copy CITY OF DIAMOND BAR DEPARTMENT OF COMMUMTY&DEVE�OPMENT SERVICES 21825 E. Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION JOBSITE ADDRESS 1-.1)1+-) 1 wo..0„ APN LOT TRACT OWNER V:Ck j kle.n GI ADDRESS V „5"041".0 CITY ZIP TEL. 7..1131 6-f-0,64 APP�ICANT TEL.' CONTRACTOR priAA4.2.4 Aviv. ADDRESS)I/7:vo//2,- 1 � CITY 14/ A".i •&- li9/TEL.141.1 WE"p ARCH/M.iG/ , DESIGNER ADDRESS CITY ZIP TEL OWNER-BUI�DER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE�P,W FOR THE FOL�OWING REASON(SEC.7031.9 BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT,A�TER,IMPROVE, DEMO�ISH,OR REPAIR ANY STRUC, TURE, PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APP�ICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE IAW(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 A�LEGED EXEMP- TION.ANY VIOLATION OF SECTION 7031.9 BY ANY APP�ICANT FOR A PERMIT SUBJECTS THE APP�ICANT TO A CIVIL PENA�TY OF NOT MORE THAN FIVE HUNDRED DOL�ARS(9500).): 0 tAS OWNER OF THE PROPERTY,OR MY EMPLOYEES WITHWAGES AS THEIR SO�E COMPENSATION, WI�L DO THE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC. 7044. BUSI- NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE�AW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUI�DS 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 OFFEFIED FOR SALE. IF,HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE- TION,THE OWNER-BUI�DER WIL�HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUI�D OR IMPROVE FOR THE PURPOSE OF SALE). o I,AS OWNER OF THE PROPERTY,AM EXC�USIVE�Y CONTRACTING WITH LICENSED CONTRP,CTORS TO CONSTRUCT THE PROJECT(SEC. 7044,BUSINESS AND PROFESSIONS CODE:THE CONTRP,CTORS LI- CENSE t_AW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUI�DS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PRO)ECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS UCENSE�AW.). DI AM EXEMPT UNDER SEC. B. &P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DEClr4RATION I HEREBY AFFIRM UNDER PENA�TY OF PER7URY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY UCENSE IS IN FU�L FORCE AND EFFECT. LICENSE CLASS C 3 LIC. NO. i 0 J^^•• DATE O1/3/u L._ CONTRACTOR WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENA�TY OF PER]URY ONE OF THE FO�LOWING DECLARATIONS. I HAVE AND WIL�MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE t.ABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WIL�MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION 3700 OF THE�ABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER ,c4A4e. Ftod POLICY NUMBER /4 3,33 6 (THISSECTION NEEDNOT BE COMP�ETED OF RE PERWT IS FOR ONE HUNDRED DCUARS($100)OR�ESS), I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHAL�NOT EMPLOY ANY PERSON IN ANY MANNER 50 55 TO BECOME SUB]ECT 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(ABOR CODE,I SHAL�FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE:/ WO.2--APP�ICANT: pri.,fry.4 i WARNING FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UN�AWFUL,AND SHAL�BE SUBJECT AN EMPLOYER TO CRIMINA�PENALTIES AND CIVI�FINES UP TO ONE HUNDRED THOUSAND DOL�P,RS(SI00.000),IN ADDMON TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND AITORNEY'S FEES. i CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENA�TY OF PERIURY 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 I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. . I AGREE TO COMPLY WITH AL�CITY AND COUNTY ORDINANCES AND STATE LAWS RE�ATING TO BUILDING , CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE . ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. i i 1.144 et 1-042- 1 PERMIITEE NAME(PRINT) ) SIGNA PERMII"f' DATE PRESS FIRM�Y APP�ICATION DATE I elf I 3...LIERMIT I locri P/C 0---aUMBER # ISSUE OCC DATE TYPE CONST GROUP FRONT SETBACKS ZONING REAR SIDE RW 0 0 SIDEJSIDE STREET RW 0 0 N0. PROPOSED UNITS USE DWE�. :_ir It' • il_r7F,ArIiliEl ,• •INK4MEPl4*-111-111 m . . .42WWliliMr3r247, MINI N0. ,N0. STORIES BEDROOMS CO LI- i 11.1 DESCRIPTION SQ. FT. FACTOR PSF 11- {../ z ADJ.AREA/VALUATION SFR/ADD/REM GarageJCarport Patio/Deck Pool/Spa Re-Roof .2-a-- 5 -J Commercial 5 m Valuation # S4." ADIAREA QUANTITY DESCRIPTION FEE 4 0 Ea I- 0 Lo —I LU CJ Z CI) m -1 4 0 2 a x c.) w 2 CONSTRUCTION PLAN REVIEW E�ECTRIC P�UMBING MECHANICAL INSPECI'ION FEE ISSUANCE SMIP ENERGY P/C ENER6Y PERMIT RETENTION FEE- PRE-ALT FEE: t ft ,QO TOTAL FEES I I- , i COMMENTS • - • i ,••, RECPT NO. 111111111 PAID BY Slid VALIDATION Mir WHITE—Department Copy,YE�LOW—Finance Copy, PINK—Assessor Copy,OLDENRO le Copy,GREEN—AppiicanYs Copy