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Home My WebLink About18909 �� CITY OF DIAMOND BAR � � DEAARTMtE*'T OF COMMUNI"I'Y&DEVELOPMENT SERVICES 21825 E.Copiey Qrive (909)&60-3195 Fax(909)861-3117 PRESS �"%»�� BU[LDINGPERMITAPPLICATION FIRMLY � JOBSITE � ��R �A/_ ��J�J nl� pppLICATION r,`'� �,:. f,�yPERMIT .f �c� P/C /O Q, o ADDRESS �� c�� DATE ��.1� � + i��ti� 7VUMBER � � q_°�J t�.� � °-° APN LOT TR �T__ DATE ONST. GROUP p OWNER �- /� p ADDRESS � � � /"L4t` ZONING SETBACKS FRONT z CITY ' i ZIP 7EL.� RW ❑ � APPLICANT TEL. REAR � z SIDFJSIDE STREET RW p a CONTRACTOR E-��dn ��J SIDE � o ADDRESS�E_G�J t 1/Y .Bsl� pROPOSED USE o CITY,/�y.BNEI K7 ZIP �6 7�c�r] -.�i�Cw Q ARCH/ENG/ �z DESIGNER NO.DWEL. NO. NO. � ADORESS � CITY ZIP 7FL.___ UNITS S70RIES BEDROOMS � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANAI.UATION Q � OWNER-BUILDER DECLARATION SFR/ADD/REM O p I HEREBV pFFIRM UNOER PENALTY OF PERJUHv THAT I AM EXEMPi FROM TNE CONTRACTOqS LI� G81898/C2fPOA W CENSELAWFOqTHEFOLLOWINGFEASON(SEC.�031.5@USINESSANOPqOFE5510N5CODE:ANYCITVOR (n U CAUNTVWHICHREOUIRESAPFpM1TTOCONSTRUCT.AI.TEFl,IMPROVE.OEMOUSH,CpREPAIRANVSTRUC- w TURE,PRIOR TO iTS ISSUANCE,�L50 REOUIRES TNE APP�ICANT FOR SUCH PERMIT TO FIIE A SIGNED w Patiol�eck � STqTEMENT TMAT HE OR SME IS LICENSED PUflSUANT TO TNE PROVISIONS OF THE CONiRACTORS LI� � � CENSE LAW(CHAPTER 9�COMMENCING WITH SEC710N>000)OF OIVISION 3 OF THE BUSINESS AND PPO- POOUSEI3 � FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHFpEFflOMANDTHE0ASI5FORTHEALLEGEDEXEMP� (� V TION.ANY VIOLATION OF SECTION 7031.5 BY ANV APPLICAN�FOR A PERMIT SU9JEC(S 7HE APPLICANT T0 Z Re-Roo1 A CIVIL PENALTV OF NOT MORE THAN FIVE HUNORED DOLLARS{5500).):� ' � �� _ � p ❑�,ASONMEROFTHEPqOPERTY.ORMYEMPLOYEESWITHWAGESA5lHEIR50LEGOMPENSATiON, � CORIft78fCi87 Z WILI Do THE WORK.AN�THE STqUCTURE�S NOT IN'ENDE�OR OfFEREO FOfi SALE(SEC.7o4d,Bu56 _J � NESS ANO PROFESSIONS CO�E:THE CANTRACTpRS UCENSE LAW 00'e5 NO?APPIV i0 AN OWNER Of j PROPERTY WHO BUILOS OR IMPROVESTHEREON,AND VMODOES SUCM WORKHIMSELF Oq HENSELF OA C[ TNROUGH HIS OR HER OWN EMPLOYEES,PqOVI�EO 7HAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m Q OFFEREDFOASALE.IF,HOWEVERTHEBNLDINGORIMPROVEMENTISSOLAWITHINONEYEAqOFCOMPLE� � Z TION,THE OWNEfl-BUILDER W0.L HAYE THE BUROEN OF PROYING'NA7'HE OR SHE D1D NOT BUILD OR . � IMPHOV@ FOR THE PUqPOSE OF SALE). � t�^� �y,� OI,ASOWNEROFTHEPROPERiV,AMEXCLUSIVELVCONTRACTWGWITHLICENSEDCONTRACTORS Q 70 CONSTRUCT THE PAOJECT(SEG.70a4,9USINESS AND PAOFESSlONS GODE:THE CONTRAC70R5 LI� Vdlll3tlOn ay ' ADJ.AREA W CENSELAWDOESNOTAPPIYTOANOWNEROFRPROPEpTYWHOaUII.D50NIMPROVESTHEHEON,ANO � WHOCONTRACTSGORSVCHPR0.IECTSWITHACONTRACTOF�S�UCENSEDPURSUANTTOTHECONTRAC� QUANTITY DESCRIPTION FEE Y 70RSLICEN3EUW.). � O I AM E%EMPT UN�EF SF_C. B.8 P.C.FOR THIS REASON Q � Y�J - ! �'� � C� LL. � DATE OWNER �-' � O U ¢ LICENSED CONTRACTORS DECLARATION I W [C I HERE6V AFFlRM UNDER PENALN OF PENURV TMAT I AM LICENSED UNDER PROVi$IONS OF CHADTER � p� 9(COMMENCING WRH SECTION�000)OF DIVISION 3 oF 7HE BUSINE55 AND PP.OFESSiONS CODE,AND Z �'C btY IfCENSE IS M FULL FOflCE AN6 EFFEC7. � LL' 4`�S��D � � LIGENSE/C�LASS��y�O��v _ UG.NO. ' � U DATE '7��('S�� CONTRACTOR ��a ' �� LL! � WORKERS'GOMPENSATION DECLARATION ¢ � IHEREBVAFFIRMVNDENPENALTYOFPERJURYONEOFTHEFOLLOWWGDECURATIONS: Z Z _IHAVEANDWILIMAIN7AINACEHTIFICATFOFCON5EN770SELF-INSUREFOpWORKERS' _ ¢ CAMPENSATION,ASPROVIDEDBVSECTION37000FTHElABOHCOOE.FORTHEPERFORMANCE w O OF THE WORK FOR WHICHTMIS PERMIT IS ISSUE�. � � ��I MAVE AND WILLMAWTAIN WOflKEFS'GOMPENSATION INSURqNCE.AS REOUIPED BV SECTION ] V y(A Q 3700 OF THE LABOR CODE,FOR THE PER�ORMANCE OF THE WORN FOH WHICH TNIS PERMIT IS ! '++ \ � �,) ISSUED.MY WpRKERS'COMPwEN1SA3 ION INSURANGE GARRIER AND POUCV NUMBEFl ARE' CONSTRUCT�ON \...� �� ,t Y �• _�� j CARFIfiA �/"'�1 PLAN REVIEW --��—�-J ��-p . . z POLICYNUMBER C��,��.,�� ELEGTRIC _ " {.t.'�� ¢ � (1HISSEGTIONNEmNOTBECOMPLE7EDOFMEPEpMffiSFORONEHUhDRED00LLAR5(E700)ORLESS). PLUMBING Z 1 CER7IFY THAT W THE PEfiFORMANCE Of THE WOflK FOl7 WHICN TNIS PERMIT 15 ISSUED,1 MECHANICAL C,:3 SHALLNOTEMPLOYANYPERSONINPNYMANNERSOA T00E MESUqJ�C TOTHE (h WORNEFS'COMPENSATIONLAWSOFCALIFOHNIA.AN AGR ATIFI$NOIJDBECOME INS?ECTIONFEE ��+'�'� � � SUBJECT i0 iHE WOflKERS'COMPENSATION PRO�(i IONS SECTfO �]00 F THE LA80q � � C DE.I SH0.LL FORTHWITH COMPLY WITFi THOS� OVI ONS. ISSUANCE _ p �ATE:��/bz6�-APPLICA . � V SMIP '�— w ENERGY P/C '� WARMNG:FAIIURE TO SECURE WORKERS'C NSATION COVEAAGE IS UNLAWil1L,AND SHALI BE -� 9 �y SUBJECTANEMPLOVERTOCPIMINALPENAI.TIESANOCIVI�FINESUPTOONEHUN�REDTHOUSAND ENERGYPERMIT '1y_ ��. �OLLARS�5100,000),IN AODITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN - - ,q � SECilON:1708 0F THE LA80R COOE.MTEREST,ANDATTORNEY'S FEES. RETENTION FEE: -��-��--}�,�'-i� d CONSTRUCTION IENDING AGENCY PRE-A�T FEE: � j' �li O � 1 HEHE6VAFFlRM UNDER PENALTV OF PERJURV THATTH�RE IS ACONSTftl1CTION LENDING AGENCY _ FOP THF PERFORMANCE OFTHE WORI(FOR WMICH THIS PEftMIT IS ISSUEO ISEC.3097,CIV.L.�. Z w � IENDEH'S NAME F-- LENDER'SADDPE55 � ICERTIFYTHATINAVEREADTHISAPPLICATIONANOSTATETNATiHEABOVEINFORMATIONISCORFECT. TOTAL FEES ��. �� R � /f'�„�.� w IAGflEETOCOMPIYWRHAILCITYAN UNTVORDINANCESANDSTATEIAWSRFLATINGTOBUILDING � .�J►�`I"�J� � CANSTRUCT;ON,ANO HEREBYAUTHO IZ REPRESENTATIVES OP THIS COUNTY TO ENTER UGON THE � z ABOVE�MENTIONED PROPERTY FOR SP CTION PURPOSES. COMMENTS o � � U , _ ry • � � — _---.__— m PERMITTEENAME�PR � �---�'' 9 /��-- � � S;GNAT' �OF MI E DATE � = RECPT NO_ _ PAID BV VALIDATION ~ WH1TE-De anment Co YELLOW-Finance Coo,PINK-Assessor Co GOLDENROD-File Co GREEN-A IicanCs Co P PY. Y PY� PX PP PY , ., � �r_ CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E. Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION JOBSITE,..77,7 8 vqa)440,t)--i----,44/iii7" ADDRESS �---- APN LOT T.IVQT OWNER Z.-tY/ Z A y/A2 ADDRESS . .• .,: 9 14& f-i2.4/M) cm("P.i Ib . ZIP 9/7 6..EL.- APPLICANT TEL. CONTRACTOR --e',..4.-)4:9-, .41,e......,- ADDRESS 0. 6 E„ .e.-.4 ).,41.e'. !A ..01,-- cm(-414/A/Ei ii--7 ZIP•Q . :*e4f TEer,a 1-ct-/-..-W.C-tr ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. 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 PILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW(CHAPTERS(COMMENCING WITH SECTION 7500)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 703I .S BY ANY APPLICANT FOR A PERMIT SUBJEC t5 THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(BESS)): - 0 IRS OWNER OF THE PROPERTY,OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATOR, 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 BUILDS O11 IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). 0 I AM EXEMPT UNDER SFC B.X P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION ! I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT(AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISIONS OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORCE AND EFFECT /0-. ...<..> 4V 4%.r ao LICENSE CLASS LIC. N0. ' DATE q-457-61-1-- CONTRACTOR eZDA-la/V-.14.., WORKERS'COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE ANO 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 REOUIRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS'COMPENSAVON INSURANCE CARRIER AND POLICY NUMBER ARE CARRIER ,A114 POLICY NUMBER ,e,di-3-33_3 0 4' (THIS SECTION NEED NOT BE COMPLETED OFTHE PERMIT IS FOR ONE 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 A TOSS• ME su4atc TO THE WORKERS'COMPENSATION LAWS OF CALIFORNIA,AN AGR AT IF i AHOu D BECOME SUBJECT TO THE WORKERS'COMPENSATION PROVI :IONS SECTIO ' 750 F THE LABOR CODE,I SHALL FORTHWITH COMPLY WITH THOSE"OV,ONS. 4.----' DATE1""/"<5 ""APPLICA " ....6i 0 WARNING: FAILURE TO SECURE WORKERS'C•, •NSATION COVERAGE IS UNLAWFUL.AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($150.500),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. 3057,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 AN. "UNIT ORDINANCES AND STATE LAWS RELATING TO BUILDING , CONSTRUCTION.AND HEREBY AUTHO' REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVEMENTION ED PROPERTY FOR CTION PURPOSES. -----* 'C-3(17 PERMIT(EE NAME(PR 40 9'.*--AI 41-1- &GNAT OF •M DATE PRESS FIRMLY APPLICATION DATE 1 eff4;_fERMIT r Cc,qt. i q P/C(..y.:)..1 IAk.l NUMBER ' �-')I-I # . ISSUE DATE TYPE OCC CONST. GROUP FRONT SEfBACKS ZONING REAR SIDE RW 0 EI SIDE/SIDE STREET RW ID 0 PROPOSED N0. UNITS USE DWEL. el N0. N0. STORIES BEDROOMS CD III w DESCRIPTION SQ. FT. FACTOR PSF I-1- CD z ADJ.AREA/VALUATION SFFVADD/REM Garage/Carport Patio/Deck Pool/Spa Re-Root ED —J Commercial 5 op r Valuation . ",...) • ADJ.AREA QUANTITY DESCRIPTION FEE < 0 E 1- 1(' .cC) 0 w —I U.J / / fr21 7)- li•e, (.9 Z C73 m D —I a. -I "Cr 0 2- a 0 Lu M CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: IrSO\ 11) 1.1' •I ..-4 0„ .5-6) 1�...Z3- 0 C 5 .0---) ,..- L. :.-) J.t..)o TOTAL FEES-71.ts COMMENTS — 1 • ,.__A ,I .!..1 IRAK" IOrgo l0Y PAID BY VALIDATION RECPT. N0. WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy a on I fe_