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!' '� CITY OF DIAMOND BAR
� COMMUNTfY DEVELOPMENT DEPARTMENT
21660 E.Copley Drive Suite 190
(909)86Q3195 Fax(909)861-3117 PRESS
'""', BUILDING PERMIT APPLICATION FIRMLY
� JOBSITE APPLICATION'I/�� � PERMI � P/C ''� �j
o ADDRESS 2803 WATF.R COLTRSE DRTVE DATE V NUMBE �
g dSSUE 7yPE �C
APN LOT SO TRACT 47850 DATE CONST. GROUP.
p OWNER Di amond BAr WeGt, T..L•.G.
p ADDRESS 3480 Torrance BIVCl. St2. 3�� ZONING SETBACKS
"' cirv �orrance ziP 90503 rE�. 310-540-39 FRONT qyy ❑
� APPLICANT Richard Gould TEL. S3me abov SI�SIDE STREET qyy ❑
� CONTRACTOR .T. . .. .onG i inn SIDE p
� ADDRESS same as�owner
� CITY ZIP TEL. PROPOSED USE _ NF.W STN�T.F FAMILY RESIDENCE
w ARCWENG/
z DESIGNER R. Gould & Associates
� ADDRESS same 3S OWriOT UNITS EL 1 ,NO. 2 Np, 6
� CITY ZIP TEL.
'�STORIES �- BEDROOMS
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� DESCRIPTION S�.FL FACT08 PSF ADJ.AREANA UATI N
O OWNER•BCILDER DECLARATION SFR/ApD/REM 7�361. ' � - � �
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� STATENENT THAT HE OR SNE IS UCENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS lb �
� CENSE UW(CHAPTER B(COMMENqNO WITH SECTION 7000)OF DIVISqN J OF THE.BUSINESS AND PRP POOVSp9 , �`
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TION.AHY VqLAT10N OF SECTIOH 70J1.6 BV ANV APPIICANT FOR A PERAIIT SU61ECT9 7HE APPLICANT T0 Z RaRoof
A CML PENALTY OF NOT MORE T1iAN FNE NUNDRED DOLURS(i600).j: '
� ❑I,ASONMEROFTHEPROPERTV,ORMVEMPLOVEESWITHWADESASiHEIRSOLECOMPENSATION, � (�`pmTBfCIBI ' �
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� NESS AND PROFESSIONS COOE:THE CONTRACTORS UCENSE UW DOES NOT APPLV TO AN OWNER OF . 1 .
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w OFFE�RE�DFOR9ILEEF,HOWEVERTNEBURDINOOR�VEMEM�ISRSOLD�WRWNONEV�EAROFCOMPLE- 00 orch �213 �
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w ❑I,AS OWNER OF THE PqOPEHfV,AM EXCIUSNELV CON7MCTW0 M7TH LICENSED CONTMCTORS
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••"�`W CENSE UW OOES NOT MPLV TOAN OWNER OF A PROPERTV NM1p BUILDS OR IMPROVES THEREON,AND
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� UCENSED CONTRACTORS DECUIRATION W
� 1 HEREBV AFFIRAI UNDEH PENALTY OF PE0.1UfiV THAT I AN UCENSED UNDER PROVISqNS OF CHAPTER �
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�� MY LICENSE IS IN FULL FORCE AND EFFECT. m
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U DATE CONTRACTOR .T�� �.nllR YiI(`1'l j'( d
-- "-' . CIT'X OF DIAIVI
� WORKERS'COMPENSATION DECLARATION � �TM DIN —_� —�_
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� I HEREBV AFFIRM UNDER PENALTV OF PERJURY ONE OF THE FOLLOWINO DECLAfUT10NS: ' U �
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� _I MAVE ANO WILL MAIN7NN A CERTIFICA7E OF CONSENT 70 SELF-INSURE FOR NqqKERS' _
� COMPENSA710N,AS PROVIDED BV 9ECTION 37aa OF 7HE LABOR CODE,FOR TME PERf-0{UTAHCE U �
OF THE WORK FOR N?71p/7H19 PERMIT IS ISSUED. W
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� �I HAVE MID WILL MAINTAIN WORKERS'COMPENSATION INSUHANCE,AS REOUIRED BV SECTION � �, �
Q 7700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WOPo(FOR WHlp/THIS PERMR IS ' ,
ISSUED.MV WORKERS'COMPENSATION INSUFiANCE CAARIER AND POLICY NUMBER ARE: CONSTRUCTION
j CARRIER California Com en ati PLANqEVIEW n � 1
� POLICVNUMBER W97B S ELECTRIC �! � �
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Z I CERTIFV TMAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,1 MECHANICAL ��O w•V
C7 SHALL NOT EMPLOv ANY PERSON W ANY MANNER SO AS 70 BECOME SU&IECT TO 7HE
(!) MADRKERS'COMPENSATqN LAWS OF CALIFORNIti AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE -
SU&IECT TO THE WORNERS'COMPENSATION PROVISIONS OF SECTqN 3700 OF THE LABOR
_ O CODE.ISHALLFORTHWITHCOMPLVWITHhqSEPROVIS10N5. ISSUANCE '
p DATE: APPLICANE SMIP ��
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J WAANUKi:FAILURE TO SECURE WORI(ERS'COMPENSATqN COVERAQE IS UNLAVhl1L,AND SMALL BE ENERGY P/C
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� SUBJECTANEMPLOVERTOCRIMINALVENALTIESANDCNILFWESUFTOONEHUNDREDTFKKISAND ENERGYPERMIT �
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J SECTqN 37oe OF THE LABOR CODE,INTEREST,ANDA7TORNEY'S FEES. �
W REfENTION FEE:
O CONSTRUCTION LENDING AGENCY P -ALT FEE•
� 1 MEREBV AFFIPoA UNDER PEH�LTV OF PERHIHV THAT THERE IS A Cq�STRUCTION LENDWO A(3ENCV O '
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� LENDER'S NAME ` R � .
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� 1 CERTIFY THAT 1 MAVE READ THIS MPLICATqN AND STATE 7}UT 7HE ABOVE INf-0RMATION IS CORAECT. 'n'•'��GT Y
��' �1 AOREE TO COMPLV NATH'ALL GTV M1D COUNTY ORDWANCES MID STATE�UWS.REUTINO�TO BU0.01NU � V � V
CANSTRUCTION,AND HEREBY AUhqRIZE REPRESEN7ATIVES OF THIS CWNTY TO ENTER UPON.THE � �
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� `.' ��� CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY dt DEVELOPMENT SERVICES �
( W 21660 E.Copley Drive Suite 190 !
� (909)860-3195 Fax(909)861-3117 PRE$$
, �"*"� BUII.DING PERNIIT APPLICATION FIRMLY
� JOBSITE I-� / ` APPLICATION —�� PERMIT � /C
o ADDRESS 7�D7J ��'LT`fX C��10l6r �Q._. DATE NUMBER �
� ISSUE ' TYPE .00C
APN LOT � TRACT 4 Z DATE CONST. GROUP
°C OWNER �i 6{unn'✓1 _. i�[t r /_G1r G: .L L�_ —
`� ADDRESS +;'�/�K�'Tb R.�HAi C:� A�c v� ZONING SEfBACKS
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g APPLICANT TEL. SIDE/SIDE STREEf RW ❑
a� CONTRACTOR 1.r � i�C. SIDE ❑
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v� DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION
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STATEMEHT hiAT HE OR SHE IS LICENSED PURSUANT TO 7HE PROVISIONS OF THE CONTHACTORS Ll-
�ss CENSE UW(CMAPTER Y(COMMENCINO WI7H SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- LL- PooUSpa
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O ❑4ti^OWNEROFTHEPROPERTV,ORMVEMPLOYEESWITHWAOESASTHEIHSOLECAMPENSATION, � COrt1fi10fC18I �
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II � NESS MD PROFES570NS OODE:THE CONTRACTORS LICENSE Uw DOES NO7 MPLV TO Ml OWNER OF � �
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� THROU6H HIS OR HER OWN EMPLOYEE3,PHOVIDEO THA7 SUCH WPROVEMENTS ARE NOT IMENDED OR m
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700.5 4CENSE LAWJ.
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� _I HAVE AND WILL MAMTAIN A CERTIFlCATE OF CONSENT TO SELF-INSURE f-0R WORKERS' _
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Q OF THE WORK FOR NRiICH THIS PERAIIT IS ISSUED. �
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N WORNERS COMGEHSATqN UWS OF CALIFOqNIA,AND ACREE THAT IF I SHIXILD BECOME INSPECTION FEE
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�CODE,1 SHALI.FOR�HWITH COMPLV WITH THOSE PROVISIONS. ISSUANCE }I���R N • L �
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p DATE: � APRICANL SMIP '
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� SUBJECTANEMPLOVERTOCAIMINALPENALTIESANDCNILFWESUPTOONEMUNDREDTFKKISAND ENERGYPER � / ��4Q
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� I CERTIFV THAT I HAVE READ T115 APPLICATION M!D STATE THAT THE ABOVE INFORA/ATpN IS CORRECT. TOTAL FE ES
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COMMUNITY DEVELOPMENT DEPARTMENT �
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' DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES J
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(909)86Q3195 Faz(909)861-3117 � PRESS
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� _I MAVE AND WILL MAINTAIN A CERTIFICATE OF COfJSENT TO SELF•INSUFE FOfi WORKERS' a
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0 ISSUED.MY/WO�RK`EqS',CONPENSATION INSUHANCE GRHIER AND POLICV NUMBER ARE: CONSTRUCTION;�q/ �. "` ' � [,� ` I. �
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� I HEREBV AFFIRM UNDER PENALTV OF PERIUFV THAT THEFE IS A CONSTRUCTION LENDIN�AOENCY
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WALNUT VALLEY UNIFIED SCHOOL DISTRICT
880 SOUTH LEMON AVENUE WALNUT CA 91789
CERTIFICATE OF COMPLIA1�iCE
With Fee Provisions of
Government Code Section 65996 �
DEVELOPER/O WNER
ADDRESS Signature of Applicant R
CITY/ZIP The person signing represents that he/she is authorized
TELEPHONE ' to sign on behalf of the owner/developer and that the
information provided is true and accurate to the best of
his/her lmowledge.
NEW LOT ADDRESS- USF OF BUILDING TOTAL SQ. FT.
�.,.�...-— - -
ResidentiaUCommercial/lndustrial
City '
HOME IMPROVEMENT OR REMODELING PROJECT
ADDRESS DESCRiPTION TOT�S4.FT.
2 8�03 ����- Ca��-s-e �.�i��, �,�/���� 8�0
Diamond Bar�Walnut ��,B , ily Rm.,Kitchen, etc.)
• l /
Signature of Supermtendent of Buildings Date S� 2�/�J�
TO BE COMPLETED BY SCHOOL DISTRICT
FEE SCHEDULE: The development fees levied by the Walnut Valley Unified TOTAL FEES DiJE
School District under provision of Government Code §65995 $
are: (EFF. 12/1/08) Residential Development $2.97/sq.ft. Receipt #
CommerciaUlndustrial $0.47/sq. ft. Date
Fees are assessed on TOTAL square footage "living space" of ALL new or remodeling construction projects OVER 500 sq. feet
(eliminating garage or uncovered patio).
This is to certify that all fees due to the Walnut Valley Unified School District under provision of Government Code Section
65995 have been received and a building permit may be issued.
This is to certify that the above described development has been determined to be EXEMPT from the development fees of
Government Code Section 65995 and a building permit may be issued.
Exemption Justification: PROJECT IS 500 OR LESS SQUARE FEET
OTHER
Jack LeBrun
Assistant Superintendent
Business Services
1/87 Rev.2/88;6/88; 8/89; 1/90; 8/90; l0/90; 8/92;6/93; 11/93; 8/94; 6/96; 1/97; 8/98; 7/04;6/06;2/08' 12/08
WALNUT VALLEY U1v1FIED SCHOOL DISTRICT
880 SOUTH LEMON AVEI�TUE WALNUT CA 91789
CERTIF'ICATE OF COMPLIANCE
With Fee Provisions of
Government Code Section 65996
DEVELOPER/OWNER f,'Ilpv�
ADDRESS N Signature of Applican
" CTTY/ZTP l'�V,,,,� eG 9�'I�-� The person signing represents t at he/she is authorized
TELEPHONE �61G� c��rL��_ to sign on behalf of the owner/developer and that the
information provided is true and accurate to the best of
his/her Irnowledge.
NEW LOT ADDRESS- USF OF BUILDING , , TOTAL SQ. FT.
�----_,. ---•- -
Res i denti aUCommerciaUlndustri al
City
HOME IMPROVEMENT OR REMODELING PROJECT
ADDRESS DESCRIPTION TOTAL S /FT.
���3 lil/GL��� COr�s�S-e �'.�/2�i f �i�Ti�/'��=� ��CO
Diamond Bar�Walnut �(B , ily Rm.,Kitchen, etc.)
Signature of Superintendent of Build�ogs Date �S� ��2��J�
TO BE COIVIPLETED BY SCHOOL DISTRICT
FEE SCHEDLTI,E: The development fees levied by the Walnut Valley Unified TOTAL FEE DLTE
School District under provision of Government Code §65995 $ �
are: (EFF. 12/1/08) Residential Development $2.97/sq. ft. Receipt (/
CommerciaUlndustrial $0.47/sq.ft. Date .
Fees are assessed on TOTAL square footage "living space" of ALL new or remodeling construction projects OVER 500 sq. feet !
(eliminating garage or uncovered patio).
� This is to certify that all fees due to the Walnut Valley Unified School District under provision of Government Code Section
65995 have been received and a building perrnit may be issued.
This is to certify that the above described development has been determined to be EXEMPT from the development fees of
Government Code Section 65995 and a building permit may be issued.
Exemption Justification: PROJECT IS 500 OR LESS SQUARE FEET
OTHER
J ck LeB
Assistant Superintenderat
Business Services
1/87 Rev.2/88;6/88; 8/89; 1/90; 8/90; 10/90; 8/92; 6/93; I l/93; 8/94;6/96; 1/97; 8/98; 7/04;6/06;2/08' 12/08
NOTICE OF 90-DAY PERIOD FOR PROTEST OF FEES
Section 66020 of the Govemment Code enacted as Assembly Bill 3091, set forth as Chapter 549,
Statutes of the State of California, 1996 effective January l, 1997, requires that this school
district provide a written notice to the project applicant at the time of payment of school fees,
mitigation payments or other exactions. This notice is_to advise you that any protest in regard
to such amounts or the validity thereof in accordance with Section 66020 of the Government
Code and other applicable law, commences with such payment or performance of any other
requirement as described in Section 66020 of the Govemment Code.. Additionally, this notice
advises that the protest thereof must occur within 90 calendar days thereafter.
�