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Home My WebLink About18199 (9) CITY OF DIAMOND SAR � - � - DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � 21825 E.Copley Drive �` (909)860-3195 Fax(909)861-3117 PRESS "'"%��'� BUILDING PERMIT APPLICATION FIRMLY aJ08SfTE � a ' r APPLICATION ,-- �y PERMIT �':� P/C /� >�,, � ADDRESS_�� ✓4�i��i��e �IJi�� DATE_ =� ' O ^�L NUM6ER��. # C%Z- �.� I � ISSUE ry, � APN LOT TRACT DATE K,+ � � l.. � CO ST. GROUP p OWNER < <L � "��-a 1�� o � � --��y ZONING SETBACKS Z CITY'��L:vr.t�r.��jc� ZIP,_j�J�i TEL:]17')'� FRONT RW f� p APPLICANT TEL. " �y� SIDFJSI�ESTREET _ RW ❑ z m CONTRACTOR �,,,,U�t�.�wrnrnv�, ��i1��tZ�4�.v� SIDE U a ADDRE S �t °- ' p PROPOSED USE I f rt'��'. �-LN�L�uy.a:+��y Gn�vy (S ,� CITY 0� J IP��_ TEL. Z:� - 'S l.+av,r�i- w ARCHlENG/ ` � P�LD,i� z DESIGNER 1�``r`o 'v NO.DWEL. NO. NO. � ADDR SS t " � � ' � UNITS STORIES BEDROOMS � CI7Y ZIP�_ TEL. cn DESCRIPTION SQ.FT FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADD/REM ��j`', ) � O p I HEREBV AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRAC70fl5 LI- Gflf1 B/Ce OR 4��? W CENSELAWFORTHEFOLLOWINGREASON(SEC70315BUSINESSANDPROFESSIONSCODEANVCITVOH (n 9 � � `" � U COUNTYWHICHREWIRESAPERMITTOCANSTflUCT,ALTEF.IMPflOVE,DEMOUSH,ORREPA�RANVSTRUG W /,,i � w TURE,Pq10R TO�TS ISSUANCE,A�SO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w PatiolDeck t,()� � �/� 'j STATEMEM THAT HE OR SHE IS IICENSE�PURSl1AM TO THE PROVISIONS OF THE CONTflACTORS LI� � CENSE LAW(CNAPTER 9(COMMENCING WITH SECTION]000)OF DIVISION 3 OF THE BUSINESS AND Pfl0- u' POOUSPd � FESSIONSCODE)DRTHATHEORSHE�SE%EMPTTHEREFROMAN�THEBASISFORTHEALLEGEOEXEMP- (� V TION.ANYVIOLATIONOFSEGTION7o315BYANYAPPLICANTFORAPERMITSUBJECTSTHEAPPIICANTTO Z RB-RODf � AqVILPENALTYOFNOTMORETHANFIVEHUNDRE�DOLLARS�SSoo)7 � OI.ASOWNEROFTHEPROPERTV.ORMYEMPLOYEESWITHWAGESASTHEIRSOLEGOMPENSATION, � COlIIfI'1BfGel Z WILL DO THE WORK,AND THE STpUGTUHE IS NOT INTENOED OFl OFFEREO FOH SALE(SEC 7044,dUSI- J NESS AND PROFESSIONS CODE THE CONTRACTOR3 LICENSE LAW DOES NOT AGPLY TO AN OWNEF OF � PROPERTYWHOBUILDSORIMPROVESTHEHEON,ANDNTIODOESSUCMWORKHIMSELFORHERSELFOR � � THROUGHHISORHEROWNEMPLOVEES,PROVIDEDTHATSUCHIMPROVEMENTSARENOT�NTENDEDOR m Q OFFEREDFORSALE.IF,HOWENER.THEBUILDINGORIMPROVEMENiI550LDWITHINONEVEAROFCOMPLE Z TION,THE OWNER-BUILOER WILL HAVE THE BURDEN OF PROViNG THA7 H[OR SHE DID NOT BUILD Oq = 1MPROVE FOR THE Pl1RPO5E OF SALE) w ❑I,ASONMEROFTHEPFOPERTV,AMEXCWSNELYCONTRACTINO'MTHLICENSEDCONTRACTORS � TO CONSTqUCT THE PROJECT(SEC 1044,BUSINESS AND PiiOFESSIONS Cq�E THE CONTRACTOFS LI� V01U2110f1 1��4 ADJ.AREA W CENSELAWDOESNOTAPPLVTOANOVJNEROFAGROPEFTYWHOBUILDSOflIMPROVESTHEREON,AND � WHOCONTflACTSFORSUCHPR0.1ECT5WITHACANTRACTOR(S)UCENSEOPURSUANTTOTHECONTRAG QUANT�T' DESCRIPTION FEE Y 70RSLICENSELAW) ��yf�� ❑I AM EXEMPT UNDER SEC P 8 P C FOR THIS REASON Q A/$/ �' V� � U ` ' � � ¢ � � DA7E OWNER V Z W � LICENSED CONTRACTORS DECLARATION W � I HEREBY qFFIRM UNDER PENALTY Of PERJURY THAT I AM LICENSED UNDER PPOVISIONS�F CHAPiER p d e(COMMENCINGWITHSECTION�ooD)OFDIVISION30FTHEBUSINE55ANDPROFESSIONSCODE,AND Z � �Y t t � X MY LICENSE IS W FULL FOHCE AND EFFECT m � $Y� LL1 W ///�� LICENSE CLASS��•'�`' LIC NO ��`�\�'�� j V DATE_II-�'1�- d � CONTRACTDN 1'edY'+11l�VV� a W � � WORKERS'GOMPENSATION DECLAFATION Q ' � N IHEREBYAFFIRMUNDERPENALTyOFPERJURYONEOFTHEFOLLOWINGDECLARATIONS U � Z Q 0 IHAVEANDWILLMAMTAINACEFTIFICATEOFCONSENTTO5ELF�INSUFEWRWORKEFS' S CAMPENSATION,AS Pft�VIDEO BY SECTION 37000F THE LABOR CODE.FOf1T11E PERFORMAP7CE U . a OFTHEWORKFORWHICHTHISPERMI7ISISSUE� � � W _I HAVE AND WILL MAINTAIN WORKERS'GOMPENSATION INSURANCE,AS FE�UIRED BY SECTION Q 3TOOOFTHE LABOR CODE,FORTHE PEflFORMAI3CE OF THE WORi(FOR WHICHTHIS PERMIT IS �'��a� � ISSUED,MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBERARE CONSTRUCTION � � J j cqpqiEA PLANREVIEW __ Z POLICV NUMBEA .-_- ELECTRIC - ¢ 7 �. '�J _� r � (RIISSEGTIONNEmfJJTBEOJh1PLEfEDOFTHEPERMfr�SFORONEHUMREDDOLlPA9(S7C0)OR4E55) PLUMBING — w MECHANICAL � —' �� Z I CEFTIF�THAT IN THE GERFORMANCE OF THE WORK FOR WHICHTHIS PERMIT IS ISSUED,1 � (} SHALL NOT EMP�OY ANY PEFSON IN ANV MANNER 50 AS TO BECOME SUBJECT TD hiE � WORKERS'COMPENSATION LAWS OG C�LIFORNIA.AND AGREE THAT IF I SHOUID BECDME INS?ECTION FEE SUBJECT TO THE WORKEqS'COMPENSATION PHOVISIONS OF SECTION 3]Oa OF THE LABOR p ~ CO�E,I SHALL FORT�'M'�TH COMPLV WITH THOSE PROVISIONS ISSUANCE //^ � //q O DATE APPLICANT SMIP �, ' �� y� � _—— / W ENEPGY P/C J WARNINGFAILURETOSECUREWOflNEf15'COMPENSATIONCOVERAGEISUNIAWFUL,ANDSHALL6E ' �y SVBJ6CTANEMPLOVERTOCRIMINALPENALTIESAN�CIVIlFlNESUPTOONENUNDflED7�10U5AN0 ENERGYPERMIT DOLLARS(3100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN 1 � SECTION 3]OB OF THE LABOR CODE,MTEREST,AN�ATTORNEY'S FEES RETENTION FEE w CONSTRUCTION LENDING AGENCY PRE-ALT FEE. d O � IHEREBVAFFlRMUNDERPENALTYOFPERJURVTHATTHEREISACONSTR�CTIONLENDINGAGENCY FOR THE PERFORMANCE OFTHE WOFK FOR WHICHTHIS PERMIT IS ISSUEO(SEC 309],GIV C) Z W 2 LENDER'SNAME _ � F_ LENDER'SA�DRESS / r^J 9 Q ICERt�FYTHA7IHAVEREAD7HISAPPIICATIONAN�STATETHATTHEABOVEINFORMATKK`115CORRECT TOTAL FEES / �� '�'� ( ��j�I� � I AGflEE TO GOMPLY W�TH ALL GITY AN�COUNTY ORDINANCES AND STATE LAWS RELATMG TO BUIIDING 1/ !'�� CONSTRUCTION.ANDHEREBVAUTHORREREPRESENTATWESOFTHISCOUNTVTOENTEflUPONTHE Z ABOVE-MENTIONE�PROPER7Y FOR INSPECTION PURPOSES COMMENTS 0 � '�� L� �.T�, m PERMITTEE NAME(PRIM) M (� _I��:�D.�n/^ �'a?'�� —__ � 51 TURE PERMITTEE DATE `� � = RECPT.NO ✓ PAID BY VALIDATION ~ WHITE—Department Copy,VELLOW—F�nance Copy,PINK—Assessor Copy,GOLDENR06—File Copy.GfiEEN—ApphcanYs Copy � , , - ��3 �� 1��-03 ,4� ._., ,f /.�� ,�� .-�� '� _ -�_ ��3p�.�/� �J . , ,� , 1�� ' �� : y��,. r�`r' ,/': - �� .✓'°'� - � _ _ .- - - ✓ ap�G3 �. � -- - ;�' ��/ir��c� - -- ---- ___ ,�� .�:'�.� �-. � . . _�. -- - -__ � _ _ �� _ __._ � �''�r� � '� (u - - _ _ _ -_ .. � .;� `,�'t�� ' r /1'Sd" _ , `� �r��G Flr��/��rl�y �� 2�� "'� � f �� G��U��-� � -- —- 1l��-02 �=� ��%s� �r��/�/ � F�,�.-,�'��'/,� h,�`��M . .z !�l'f�'/C,�.�f�� -��-�'�- . ,�G��,,�G��2 ��C2> �i`,1�. s �,�� I��3' ��.� c �lC,. ��!t; - �'_�l�—p�� p.�. � C�ti��,r�-� , - � � �� o��:�c�t w cs�-� � ��,r � �� t�_�� : _w�� .� �2��u� - �a �ac- c-c��c� � ��7� �� - - . ... .. , . ,. , � ._�._... ... � � � . .. . PRESS FIRMI.Y CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVE�OPMENT SERVICES 21825 E. Copley Drive (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION JOBSITE ADDRESS q%D Ll/4),,,ki 5i�e p IOtt,e APN LOT TRACT OWNER-5-i4/...v 0_ et 7:-.)..O--A.,-le WI O-Vr- ADDRESS ' Os CITY IiAYaiticl, , , ( ZIP 1A,5 -.51ta 14.6.7 TfEEL APPL.ICANT L14110 CONTRACTOR 1..00.,,,,,,,, .,\ V,..e...vn tA2,\„ev, ADDRE S-— CITY O^ IP 4141.L TE�. 5-1 ARCH/ENG/% DESIGNER 1---riyv ti)0,\}* . ADDRcSS13A 0' .C.two en 4,e ""k *--)cra, CITY r,,,\-„Q\A-, ZIP C.. Px TEL. - A:kb' OWNER-BUI�DER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PER7URY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE IAW FOR THE FOL�OWING REASON(SEC 7031 5 BUSINESS AND PROFESSIONS CODE ANY CITY OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT,ALTER,IMPROVE. DEMO�ISH.OR REpAIRANY STRUC- TURE, PRIOR TO ITS ISSUANCE,A�SO REQUIRES THE APPLICANT FOR SUCH PERMIT To FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRP,CTORS LI- CENSE t_AW(CHAPTER 9(COMMENCING WITH SECTION 7900)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 5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APP�ICANT TO A CIVI�PENA�TY OF NOT MORE THAN FIVE HUNDRED DO�LARS($500)) 01,AS OWNER OF THE PROPERTY.OR MY EMP�OYEES WITH WAGES AS THEIR SO�E COMPENSATION, WI�L DO THE WORK,AND THE STRUCTURE IS NOT INTENDED on OFFERED FOR SALE(SEC 7044,BUSI- NESS AND PROFESSIONS CODE THE CONTRACTORS�ICENSE LAW DOES NOT APP�Y 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 OFFERED FOR SALE. IF, HOWEVER.THE BUI�DING OR IMPROVEMENT is SO�D 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 SA�E) 0 I,AS OWNER OF THE PROPERTY,AM EXC�USIVE�Y CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC 7044,BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LI- CENSE�P,W DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUI�DS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PRO)ECTS WITH ACONTRACTOR(S)LICENSED PURSUANT To THE CONTRAG TORS LICENSE�AW) 0 I AM EXEMPT UNDER SEC B&PC FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DEC�ARATION I HEREBY AFFIRM UNDER PENA�TY OF PER]URY THAT I AM LICENSED UNDER PROVISIONS OF CHARTER 9(COMMENCING WITH SECTION 7555)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND My�ICENSE Is IN FUL�FORCE AND EFFECT LICENSE C�P,SS EL,-1-I(L LIC NO 3t LA DATE li-116-0. \ CONTRACTOR 1-OOn, 1: 1 TY N Ixvy. WORKERS'COMPENSATION DECLARA,TION I HEREBY AFFIRM UNDER PENA�TY OF PER]URY ONE OF THE FOLLOWING DECLARATIONS I HAVE AND WIL�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 WI�L MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION 3700 OF THE IABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, MY WORKERS'COMPENSATION INSURANCE CARRIER AND PO�ICY NUMBER ARE CARRIER ! POLICY NUMBER L (THIS SECTION NEED NOT BE COMPLETED OFTHE PERMIT'S FOR ONE HUNDRED DOUARS($100)OR�ESS) ! I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I i SHAL�NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT To THE 1 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 SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS ) DATE APP�ICANT ) 1 1WARNING FAI�URE TO SECURE WORKERS'COMPENSATION COVERAGE IS UN�P,WFU�,AND SHAL�BE - SUBJECT AN EMPLOYER To CRIMINAL PENA�TIES AND CIVIL PINES UP To ONE HUNDRED THOUSAND DOL�ARS($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES As PROVIDED FOR IN ;:i SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATfORNEY'S FEES 71 CONSTRUCTION LENDING AGENCY - I HEREBY AFFIRM UNDER PENA�TY OF PER7URY THAT THERE is A CONSTRUCTION �ENDING AGENCY ,-- FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT Is ISSUED(SEC 3097,CIV C) EI Z LENDER'S NAME - LENDER'S ADDRESS 9 c I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT u I AGREE To COMP�Y WITH A��CITY AND COUNTY ORDINANCES AND STATE�AWS RE�ATING TO BUI�DING L .., CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY To ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES 5 J -Ve.,V-i.f. VI s - A,,, _,:�- . PERMIITEE NAME(PRINT) 17 C 4., 5-5g-0, „ S PERMII"I'EE DATE r AI APP�ICATION ,-. , DATE ( PJC -- PERMIT # CZ—IC(1 1-5-8,-,62--NUMBER ISSUE DATE „8., , ..... s V...,l'I I IL TYPE OCC . ;1-- CONST. GROUP FRONT SETBACKS RW ZONING REAR SIDE E 0 SIDE/SIDE STREET RW 0 0 N0. PROPOSED UNITS USE DWE�. i.i"$-A% I-Lao,.L-z,^)..k:..}t i E,A>el Fs`,,,i 2. n .S.- '5-Rcilotr\r- Le-i\ 1-thvy.A.l ti -v-bY-i N0. N0, STORIES BEDROOMS DESCRIPTION SQ. Ff FACTOR PSF ADJ.AREA/VALUATION i i W Otlo u) / w w u. 0 z i ciiy) 5 J 5 CO 1 Corn mBrcIa) Valuation I7,000-" AD�.AREA DESCRIPTION FEE IFIRRIMMILIMMIMENIIii ' QUANTITY IllgirvIVIIPI�P,IMMIIIII2, . •- jr i < 0 I-- w --I LL OD 0 z n a •tkv, n -1 EL i 1 MIMIE av,-. -J < 0 a I w n 1 k` • l, -/ i rk. CONSTRUCTION PLAN REVIEW E�ECTRIC P�UMBING MECHANICAL INSPECTION FEE MAL�_ ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE PRE-ALT FEE, q Zq 57 .l_,..•- •,-0 I CC,".--- II'7,-50 _13_3(e qV.._iii- TOTAL FEES 69?;6-3 pc(2., i 11 (0 71 i COMMENTS -ma RECPT, NOEMin HE VALIDATION U''71 PAID BY II WHITE—Department Copy,Y —Mance Copy, —ssessor AJopy, g13,102- ante,c6 1-21.03 A4 (ol v.91.1';7 /��Y/� J 1Il feei,m47-6u 4-43/9'14 / � -a !-03 . Firoltylow4104, ct Eetraue fffew/4-7 K6 Cox=/iks7 A //-,2 7-612 ac.g'). •ttagi lioer-riggk 640Je.-6,1 „k)t-r-e-liend, Ca) 7'-2'S a„4---i/4. 1,6-es/-io r-ov-a-3 exe,7ri iAT-V t51e)ote,ocA (JR,te46_ LZWL-tA)Uccs4) A5-L0543 60& b(r6