HomeMy WebLinkAbout18546 (32) CITY OF DIAMOND BAR %'" �� r�'!
-� -- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICE 'w �
21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 PRESS
�"'%�K��� BUILDING PERMIT APPLICATION FIRMLY
� JOBSITE APPLICATION 2 j(i�� � Q!;1�� p/C ('�"� '1�(�
� ADDRE55 3057 ti7INDMILT DRIV�: DATE `•f NUMBER��J_Iy�# �-�'�- r}�� �
� ISSUE TYPE OCC
-- APN LOT 1 TRACT 50314 DATE CONST. GROUP
0 owNeR Windmill Estates, LLC
" ADDRESS 3480 Torrance Blvd. Ste. 300 ZONING SETBACKS
z CITY Tnrran�a ziP q�5�3 Te�.'�1�-54(1-3A9 FRONT RW ❑
� APPLICANT Richard Gould TE�. same REAR p
a SIDE/SIDE STFiEET RW p
z
Q CONTRACTOR JCC Construction SIDE ❑
ADDRESS same aS owner
� CITY ZIP TEL. PROPOSEDUSE N2W S1rig12 Familv Residence
w ARCH/ENG/
z DESIGNER R. Gould & Assoc. NO.DWEL. 1 NO. 2 NO. 5
a ADDRESS same 3S owner UNITS STORIES BEDROOMS
� CITY ZIP TEL.
� DESCRIPTION SQ.FT. FACTOR PSF D .AREANALUATION
N
OOWNER-BUILDER DECLAFATION SFR/ADD/FEM H y 1 I.2 ��
p I HEREBY AFFIRM UNDER PENALiV OF PERJURY 7HAT 1 AIA EXEMPT FROM THE CONTRACTORS LI� � Garege/Carport �_�3[J 2 � �
W CENSELAWFORTHEFOLLOWINGREASON(SEC 70315BUSYJESSANDPROFESSIONSCODE ANVCITVOR
U CpUNTYWHIGHRE�UIRESqPERMITTOCONSTRUCT,ALTER,IMPFOVE,OEMOUSH,ORREPAIflANYSTPUG W patio/Deck
w TUFE,PRI�R TO ITS ISSUANCE,ALSO RE�l11RE5 THE APPLICANT FOR SUCH PERMIT TO FlLE A SIGNEO W
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI�
� CENSE LAW�CHAPTEF 9(COMMENCING WITH SECTION]OOo)OF DIVISION 3 OF TF1E BUSINE55 AND PR�- U' POOUSpB
FESSIONSCO�E)ORTHATHEORSHEISE%EMPTTHEREFflOMANDTHEBA5ISFORTHEALLEGEDEI(EMP� �
� TION ANVVIOUTIONOFSECTION70315BYANYAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO Z R2-RODf
� F CIVII PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(E5oD))
� ❑4ASOWNEROFTHEPROPEAIY,OPMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, � COmR�efCiel
WILL DO THE WOFiN,AND THE STRUCTURE IS NOT WTENDED OR OFFERED fOR SALE(SEC 7044,BUSI- J L -
� NE55 AN�PROFESSIONS CADE THE CONTRACTORS LICENSE LAW OOES NOT APPLV TO AN OWNEP OF � Ba 1 con 1 V 0
PROPERTYWHOBUILDSORIMPROVESTHERE�N,ANDWHODOE55UCHWORKHIMSEIFORHERSELFOR Y a" �
� THROVOH HIS OR HER OWN EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
W OFFEREDFORSALEIF,HOWEVER,THEBUILDINGORIMPROVEMENTISSOLDWRHINONEYEAROFCOMPLE- ETlt. POYC __ 13� _ _ � � )V�
0 TION,THE OWNER-BUILOER WILL HAVE THE 6UROEN OF PROVWG THA7 HE OR SHE DID NOT BUILD OR 7 �(
Z IMPROVEFORTHEPURPOSEOFSAL[) Din. POTC 114 �,1
_ ❑I,ASOVJNEHOFTHEPROPEflN,AMEXCLU5IVELYGONTRACTINGWITHLICENSEDCONTRACTOFS
� TO CANSTFUCT THE PRQIECT(SEC i044,HIJS WESS AND PROFESSIONS CODE THE CONTRACTORS LI- V2111dfi011 ADJ ARFA
W CENSELAW�OESNOTAPPLYTOANONMEROFAPROPERNWHOBUIL�SOPIMPROVESTHEREON,AND
= WHOfANTRACT5FOR5UGMPROJECT5WIh1ACONTRACTOR(5)UGENSEDPURSUANTTO7NEGON7FiAG QUANTITY DESCRIPTION FEE
~ TOflS LICENSE LAW)
Y J
� ❑IAMEXEMPTUNDEflSEC BBPCFORTHISREASON Q
� U
�
� DA7E OWNER U
Z w
� LICENSED CONTRACTORS DECLARATION �j
¢
� I HEREBY AFFIRM UNDEfl PENAIN OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER �
d 9(CAMMENGING WITH SECTION 7000)OF ONISION 3 OF THE BUSINESSAND PROFESSIONS CODE,AN� z
,X MY LICENSE IS IN FULL FORCE AN�EFFECT m
� LJCENSE CLASS � LIC NO 6 719 8 2 j
V DA7E GONTRACTOR JCC COIIS�CrUL��C1. IZ d
W
� WORKERS'COMPENSATION DECLARATION a
� U
� I HEREBY AFFIRM UNDER PENAITV OF PEFJURV ONE OFTHE FOLLOWMG DECLARATIONS Z
Q
� �IHAVEANDWILLMAINTAINACERTIFICATEOFCANSENTTOSELF-INSUREFORWORKERS' 2
¢ COMPENSATION,ASPROVIDEDBYSECTION3�o00FTHElABORCODE,FORTHEPERFORMANCE IU
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED �
�
W �IHAVEANDWILLMAINTAINWORKERS'COMPENSATIONINSUFANCE,ASREOUIREDBYSECTION R
Q 37DOOFTHELABORCODE,FORTHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMITIS �����
� ISSUEDMVWORKERS'COMPENSATIONINSURANCECAftRIERAN�P�LIGYNUMBERARE CONSTFiUCTION
j PLAN REVIEW -
CARRIER
0 POLICYNUMBER_ ELECTRIC � 4�
Z
Q �a
� (iF11SSEClIONNE�NDTBEOJ�h'LEf�OFhIEPERMRISFORONEHUnDRED�OlLMS(51a0�ORLE55) PLUMBING �
w I CERTIFYTHAT IN THE PERFORMANCE OF THE WOftK FOfl WHIGH 7HI5 PERMIT IS ISSUED,I MECHANICAL � �� �
Z
(,�} SHALL NOT EMPLOY ANV PERSON IN ANV MANNER SO AS TO BECOME Sl19JECT TO THE INSPECTION FEE ��>>
� WORKERS'COMPENSATION LAVJS OF CALIFORNIA,AND AGR[E THAT IF I SHOULD BECOME �
SU&IECT T0 THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LA80fl
� CADE,ISHALLFORTHWITHCOMPLVWITHTHOSEPROVISIONS ISSUANCE �
� SMIP �
p DATE. APPLICANT �
J ENERGY P/C
J WARNING FAILURE TO SECURE WOFKERS'COMPENSATION COVERAGE IS UNIAWFUL,AN�SHALL 9E �
� SUBJEGTANEMPLOYEHTOCRIMINALPENALTIESANOCIVILFMESUPTOONEHUNDRE�THOUSAND ENERGYPERMIT
DOLLARS(E100,00D).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOfl IN
J SECTION 3]OB OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES RETENTION FEE: ���'��
2
w CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
d
� 1 HEREBV AFF�PN UNOER GENALTY OF PERJURY THAT THEflE IS A CONSTFUCTION LENDING AGENCY
� FOR THE PERFOflMANCE OF THE WORK FOR WHICH THIS PEflAfIT IS ISSUED�SEC 3097.qV C)
Z
W
2 LEN�ER'S NAME __ _____
�
F— LENCIF.R'SA�DRESS .._ -
TOTAL FEES �fz" ``P �'"�'`"'`°�`1 �
� � .
¢ ICERTIFYTHATIHAVEREAOTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATIONISGOFRECT
W IAGREETOCOMPLVWITHALLCITVANDCOUNTYORDINANCESANDSTATEL4WSRELATINGTOBUILDING
� CANSTRUC710N,AND HERE61'AUTHOflIZE REPRESENTATNES OF THIS COUNTV TO ENTER UPON THE
� ABOVE-MENTIONED PflOPERN FOR INSPECTION PURPOSES
Z COMMENTS
O
� 3� u�' a i���. `�.e _ _
QPERMI AME�PRINT) ,p -s
(n f! � � �s L.17'�Jf a,. —_
� si�NnruReoFaenMinee" DATE RECPT NO PAID BY VAUDATION
2
� WHITE—Departmen�Copy.YE�LOW—Finance Copy,PINK—Assessor Copy.GOLDENROD—Fde Copy,GREEN—ApplicanYs Copy
. . . . ..,.. . . ,. .,.,, .,.. .
„ , � � .
„ , , � , � . � " � . ; .
.
,
,
. .._.. ..,, - ,
,
, �__ s � . __ - — ������ :-�. � ��� __ � � � - : -- ___ _ v ---_--�:-�:�:�—�t
_
a , .__:_,.: �
_ �. - . _ _________ _.__ . .._.
_ _ _ _ _ _.
.._. . �
� .
�
�
. /��- � -:i . .
, . . .
� _ . _ .
. _ . -.__ _
_ . . � � �, ; � _ ,
_ , .: ��, . " `,�' _ �
,
,.,�.
, "'
..i.r"- : . .. . '. �f' " ".. ..._., ..._�.�."_ " ...�.....,,....
.____,._ '__ _. .. . i. , - ,. ,,.� �
� t�.'-._._ . ,� . _ ; - ' . ._. _ _.._..._... ' _`."_^_,M�
____ ._ _.� „_ _ ' =T"�����*/�"�•�G�- �� � , `. � � -_ ..-.-, -..----- - I
,
_ ' " ,71�-��,'�� !�r - .. '_ . _.._ ._ _._.___. . . I
i' ._ - . - - � .
„ ..
,... � . , -." . .. .
� . .. . .-:.., . , .. . . . . . , ..- ----� --- --_'.----� . _ ..
. n
_._.� _ . ._. __ - - (�
..- , :.. .. . . � " , '
� F. �.. .. „ , t -.- .. .
�
,
�-,. • . .., - . -. . . , _. __�....._.
;
---"--. ._.... _.. _ . .
-• �.,.:-�� t--� r�,-:-; -�..- ,. ,
, ''S . . ' " ' ' . � " .. . ._.. ._. _... _ ....'"_ ' "__ ..
....._ _._._.. _ "
.,. . . . �• ,,y- , ..
. r �F,'—s ;�`: f ' L
. r.
J. . . . .... .............._.._
_. . �..' ' . . .
, ... 7 . <.. ,.. ,. "' _" " pp►� n , . .. ,
,
_ ... . .,, .. /l /� � _ . , i
. ...
�..,.- 7U` ��Iq�
� ... .,. _. �_ �:' Y . '"..,.. .._.' ' t ''"' ' '__._.__""" _'' "?
. ,_ ... � �'�V Q �/ �� � � . . , ...... _... _.._,._�_ i
S%' � /�
. ' F..m . M� _ ,(�' �"'� ., � " "' "'"_. .,... . _ , . - _- . �
• . � iL� `'
� �
. ..�
-- . - , �__.._--- --
; . . •' , a Z,�lgf�s . L . .,
... . -- --- - !
•-
_._�, ' .. _ .. ,. - . __._..__..'
� 1 �I-D� �� 6� - - - -
;: =�= � _ - � .
,� .
=��' C. � �� � � - _ - --_-� :� . . __�_�-_: ;
- , I � � ..._. . . .
. -r ; . � � � :�
�' _ . __ . . ___- ----
, - �- �. �`-�"N � ' ' .
-- �
U I C+� ..���1:j1 �(r'�'"G�' �/ !
�_ _., ._._.._.,..--' -
- . . . - - 1 _ _- - - �
� .
��y�'� ,� � � �'� � � /?�"� '��`" �i� �-� �
,,` . . Gy o,r� � , �. . ,G�..... _� ___. _ ����'.',�___..__..
� y � � % , r ,�- �
.�ir� � l�t-r5 �,�f r.� � �,`-�� �4,�'�;���•.�F /�,- ,,,� .
�
. - - - �- _
.
--- _ - -. .._ .__. _ _ _._ _. ..._ .----- -- - -- - ----_-;
; �.. _._. _. . . ._ ._ _ �
- -_ ___w.__.__.__.. -- �
' t
,_,.. .......__....._ _ .,..... . . . . ......._ ..
. �
� "
e . " w . , i
, . . , . , � , ._ , .. . _ _ , . ...._..._.._.. .'"'"""" }
. � a
CITY OF DIAMOND BAR ����"�� ��
- �'� DEPARTN[E?�;f OF C:OMMUN7"1'Y&DEVELOPMENT SERVICES
I
���� 21825 E.Copley Drive
(909)&60-3195 Fax(909)861-3117 � PRESS
"-���� BUILDING PERMIT APPL[CATION FIRMLY
y J03SITE n � ���� � l� jj�'� APPLICATION � � �� pERMIT �g/�
o ADDRESS_ y�� i�r► kr� DATE NUMBER (•�i
� ISSUE ' � Q� 7ypE OCC
APN__� LOT ` TRqCT �'�r _ DATE CONST. GROUP
p OWNER
o ADDRES � *r'" ZONING SETBACKS
Z CITY ���t� ZIP FRONT
,?tEL. RW ❑
� APPLICANT TEL. REAR p
� SIDE/SlDE STREET Ry/ p
z
¢ CONTRACTOR � SIDE �
ADDRESS
� CITY s C I T L. PROPOSED USE
oARCHlENGI ��
z DESIGNER
w — NO.DWEL. NO.
n, ADDRESS NO.
� CIN ZIP TEL. UNITS STORIES � BEDROOMS�_
� -
cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER•BUILDER DECLARATION
� SFWADD/FEM
p I HEREBV AFFIRM UNDER PENALTY OF PERJLIRY THAT I AM E%EMPT FROM THE CONTRACTORS LI- G8f39B/CBfPOfI
W CENSELAWFORTHEFOLLOWINGPEASON(SEC703158USMESSANDP90�ESSIONS:ODEANVCIfYOR (n
U COUNTYWHICHREOUIRESAPEflMITTOCONSTRUCT.ALTER,IMOROVEDEMOLISH.CRREPAIRANY5TRl1C
W TURE,PftIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FlLC A SIGNE� W Pa�lO/DBCK
� STATEMENT THAT HE OR St1E IS LICENSED PVRSUANT TO THE PROVISIONS OF THE CONTRhCTORS LI� LL
� CENSE LAW�CHAPTEP 9(COMMENCING WITH SECTION 7000)OF�IVISION 3[lF THF A'JSINESS AND PRO- POOVSpB
O FESSIONSCODE�ORTHATHEORSHEISEXEMPTTHEREFROMANOTHEBASISFORTHEALLEGEDEXEM?- (�
U TIONANYVIOLATIONOFSECTION7031.58YANYAPPLICAN�FORAPERMITSJ9JEGlSfHFAPVLIGHNiTO Z Re-RoOf
� A CIYIL PENALiY OF NOT MORE iHAN FNE HIINDRED DOLLARS(SSao);
� ❑I,ASOVlNEROFTIiEPROPERtt,OqMYEMPLOVEESW�THWAu^ESA57HEIFSOLECOMPENSATiON, � (�OmmCfClal
Z WILL DO THE WORK,AND THE STRUGTURE IS NOT IN i ENO�D OH OFFERED FON SALE(SEC 7044,BU51- J
� NESS AND PROFESSIONS CODE THF CONTRACTORS LICENSE LAW DO�S NO:APP�V TO Ah OWNER OF j
PqOPERTY NhiO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCIi WORK HIMSELF OR HERSELF Oq
� THROUGH HIS OR HER OWN EMVLOYEES,PROYIDED THhT�UCH IMPflOVEMENTS AflE NOT MTENDED OR m
� OFFEREDFORSALE.IF,HOWEVER,7HEP�1ILDINCOR��PRnVEMEN'�S�LOWITHWONEVEAROFCOAdPLE-
Z TION,THE OWNER�BUILDEfl WILI HAVE THE BURDEN OF PROVING'.HAT HE OR SHE DID NOT BVI�D OR
� IMPFDVE FOR THE PURPOSE OF SALE�.
w ❑I,ASOWNEROFTHEPROPERTV.AMEXCWSNELYCONTPACTMGWITHLICENSEDCONTRACTORS
� TO CANSTRUCT THE PROJECT�SEC 7044,Bl15WE5S AND PRO�[SSIONS CODE TNF CONTRACTORS ll- V81U3110f1 � ADJ AI�EA
= CENSEIAWDOESNOTAPP�YTOANOWNEROFAPROPERTYWHOaUIlA50RIMPROVESTNEREON,AND
� WFIOCONTRACTSFOPSUCNPROJECTSWITHACONTRACTOR(5)LICENSEDPl1RSUANTTOTHECONTRAC- OUANTITY DESCRIP710N FEE
Y TOftS LICENSE LAW j
� ❑I AM E%EMP7 UNDER SFC 8 8 PC FOR THIS REASON Q
O U
�' — ¢
LL' OATE OWNEft _ U
Z W
� LICENSED CONTRACTORS DEGLARATI0�4 W
¢
� I HEflEBY AFFIflfA UN�Eft PFNAITY OF PERJUFY THAT I AM LICENSED UNDER PPOVi51ON5 OF CHAPTEF �
d 9(COMMENCWG WITH SECTION]000�OF DIVISIQV 3 DF THE BUSINESS AND PPOfFSSiONS CODE,AND Z
X MY lIC[NSE IS M FULL F�CE AND EFFECT
� ` '��U LIG NO ���__ �
F LICENSE CLA55 �
~ +�_����� J
V DATE E CONTRACTOR�� t� l � d
W
� YJORKERS'COMPENSATION DECLARATION Q � ,7 �
4
� 1 H REB AFFIRM 11NDER PENALIY OF PERJURY ONE OF THE FOLLOWING DEGLAHATIONS Z �� l �
� �HqYE AND WILL MAINTAIN A CERTIFIGA7E OF CONSENT70 SELF-INSURE FOR WORKERS' _
Z COMPENSATION,AS PROVIDED BY SECTION 3]0o nF THE LABOR f.ODE,FOR THF PERFORMANCE U
a OF TME WORK FOR WHICH THIS PERMIT IS ISSUED � � e
O � t,r
� _. I NAVE AND WILL MAINTAIN WORKERS'COMPENSAi ION INSURANCE,AS REQUIRED BY SECTION
Q 370o OF THE LABOR CODE.FOR THE PERFORMANCE THC WORK FOR WHICH THIS PERMIT IS
ISSVED MYWORKERS'COMPE SATION SURANC ARRIEftANOPOLICYNUMBEflARE CONSTRUCTION
�
� CARRiER � .L � __ PLAN REVIEW .
� POLICV NUM6ER [LCCTf3IC
Q
� (iHISSECiIONNEmNOTBE�PIEfEDOFTHEPERMfTISFOFONEHUNDREDDOLLAR5�510C)ORLESS� PLUMBING
W I CCRTIFV THAT IN THE PERFORMANCE OF THE WOqK FOR WHICH THIS PEFMtT IS ISSUED,I MECHANICAL
Z �
(,'} SNqLLNGTEAAPLOYANYPEfl50NINANYMANNER50A5TOBEGOMESUBJEf,770THE � �T—�
� WORKERS'COMPENSATION LAWS OF CALIFORN10.AND AGREE lHAT IF I SHOUID BECOME INS�ECTION FEE
? SUBJECTTOTHE ORKERS'COIAPENSATIONF0.0VISIONSOFSECTION3]000FTHEIABOR �. '�a'
GODE,ISHALLF RTHWITHCOMPLYWITHT SEPROVISIONS �SSUANCE f.�. ,a
p DATE APPLICANT �t�,r.�, SMIP
w � ENEFGY P/C
� WHRNING FAILURET SECURE WOflKERS'COMPENSATION COV[�AG[IS UNiAWFUL,AND SHALLBE - --- ---
J SUOJECTANEMPLOYERTOCFIMINALPENAITIESAN�GNILFlNESUPIOONEHUNDHE�TMOUSAND
� DOLLARS�5100,000),IN ADDITION TOTHE COST OF COMPENSATION,DAMAGES AS PROYIDED FOR M ENERGY PERMIT
J SEGTION3]090FTHELABORCODE,INTEREST,ANDATTOHNEV'SFEES qETENTIONFEE� � -
�
� CONSTRUCTION LENDING AGENCY PRE-ALT FEE
� 1HEREBYA�FIRMl1NDERPENALTVOFPERJJRVTHATTHERE15.CONSTRUCTIONLENDINGAfENC.Y
� FON THE PEPFOflMANGE OF THE H'OFK FOR WHICN THIS PEftMIT IS ISSUED(SEC 309],CIV C)
Z
W
= LENDER'S NAM'
�
f= LENDER'SADDRESS -
w ICEftTIfYTHATIHAVEP.EADTH15APPLICATIONANDSTATETHATTHEABOVEWFOFFIAT1OtPISCnRRECT TOTAL FEES ��� � ��
� 1 SGREE l D COMPLY W1TH ALL CITY AND GOUNTY DRDINANCES AND STATE lAWS HELATING TO f3UILDING �r..� �
CDNSTRUCTION,AND MEREBYAU�HORIZE flEPRESENTATNES OF 1HIS GOUNTV TO ENTtR VPUN THE
ZABOVE�M NTIONED GROPERTV FOR INSPECTION PURPO.ES COMMENTS
� A'a,y��� ��f�'t� --
� MITT E NAME PRlMi)
Q Z
U) , _�.A� — f '
� SI N U FPERMITTEE T[ ��
= RECPT NO _ PAID BY VALIDATION
~ WHITE—Department Copy,YEU.OW—Finance Copy,PINK—Assessor Copy,UOI_DFNRO�FIe Copy,GREEN—ApphcanCs Copy
� ._ . . ,,:,r•��-i.
. . • . .. . . . .__��::,:.:,-C:�. �� � - - -
• ., '�.i�.; � ,. .:,•. �:. , , . . . . , _ 'i.. ,. • r• •��',::.•'
• , , • . , ..?Y • . . ' _,. . . .� -. . , . , ' . . . •d:i '."'.."I:�: �.c���,
. . . . :.t�n"':. . .. .
�' "" "2'ii". - ..., .� . �
> �_ �. , � � �
•ti . .." ''� , y. , . . , :'x� �
:�__.. ""_`_.� "_ '"_....�..._.. " "_. .. ., "_"_ _ _ " _'" "_ '�.. _ "" ___"_._.__'...."' '_ '" ' '_'"_.�.�_..�'_""__"_
�, . -� i� .. _ � R � - - � � �
_ � i
�.
. . � . .,:t'��':i, fti:�'_�.� ' ' � . �'t`' {�a��,1i:�4Y.') �
E �
, ,�,.., . . � ,
�
i - ' --. . .._..__----- - , .. ...._, _ ._.. . . - - -' � - — - -'- ^', -..�.�..--------- - ---- ---•
=! , �".r_:��r ti':1� ' � � ._ ' . ,- ^�i ���l� � �
,. ,,.�- „ ,.
�
. , ,�..-�,� . ,, � � , ,
, ,
. . �.,, , �
__ _ — _ - __.. _. _. ...-- � --_..�......_--- - ----
C<` `,. , ,.,.. :C. ; �• � i.��i. -t� .siJil;� �
-- - _ ---- _ ._._. . , . _ _ . _._._..._ . .. _...__.. ._._____..._..- - - - --______.__
,.. » - .,.. . �,._ ., .
.,..
; .,�._-','� ":�,;,� ��._ ��c! .�.t: ��.I��XJi.'��f�;i��
_..__..____.. - - --._..,_ — • ----.'__.. _.._ . _. '� _ ' .,. _ _ � _ ._.___._�__�..._..
`- - -- --- --_ .- --__.._
_ ..,.._ _.._.
.
` ,.,:,n,`"����t;tr-.a.,� , �, _ F- t�ili����C55�'r��Fi
� _._ -_ �.._ . ._ _ ._.. ' . ' _ __. ... _ . ._... . - "_" _. '
, _ � . , _ ._ . '_"' i'___.�._-__""...__ . . _____.___
_" `"�._ "'tN"iJ��t�� ' i ' t..ei S ..�'n� 1 ��{��.{{ 1
,i�.:. ,! .,. ._ i n
�r-
" '1 i
� �i
. �� x.,,. . � t
.:s . .,r�. � . . . , i
�.
" . . � , . . .._" _ ... _._..._. ._. _.__ ... ___._.v_.._'_"_".".__._�. _ _'_. ___.....
�'�. t^ :,-t� �� . � i
y
..',,..�.�•_ ,���_�k,t,-I�e.S.� 1 1`, . i. ' t�. ..:./�'.�'t{
.
� . ._,.'_' "'_[_ {� ' ` _' __" �}I-__ _ " ' .... . . .._..." ""_. ... .... .1 _ ..."'"" ._..._..__.....�..."' ' " _
£^* ^.�'lii�� -fJ[�SWFe"��S P`.iiV , t , i5 `\ . . �_. 'rt .�
. .,
"^� ro�ir`
� .:
..... ___._.._..� .. .�_.�_... _ ._. � . _ . _ ._..,v. _
� ._ . �_ �.. Sr... -� ' ' _"'""""""_"_'�_'___ ' '
_ i
; -E,-=._-: �.,`.�,r�s� -------�-.. t_ '��j�' . .. '�r`" . ... . - -- ---- -- �
.
;
,.,n� ,
_._..._. --._.._..----- w - -- - ---- - -- —
__... . .
_ .... . ,..-,.._,r - --
. � � '`'
. - `.' ,';,
' C.,.J'.:i:;f"f i';i.�F��il,'h � . -?'`•. '.,'-'.; , ,
i _
-_._.�_._.. ... "'_
: .,�-•�.s :�} `._i,.•y. � . ' ' "_..�.._�».�_,.,___
__ _....."'__ " "_...,_....._' _"""' ' '_�"` ' "'._ ._..__.__.___. ___...�___"_'__ _-
i ",.7r1 `i,-° , � , � •,
. .i.:��.. . _.. _ �����}�. ' � ':t� , ... . , , 'ti:::
' _. . ...__'_'__ ' ' '. _._ .' '_ '_' ' ' . . ..._, . ._'( ,. � �_..._. _ . .... ._"_"""_ "'_.""'_"_"_ . �
.r-, �,
�� S°�.� •��'"ir`J; �79v;s:���:! ; ..;j�;c����a�;'�rit.,:YL"0.a .�.� _._. _.
� _.. ....__._._ .' _......__ . . ... _. __ . ._ .... .. . .___'.._ ' _" _.__._ _ .
,. ._. ' ' ""___"___ �_�._..__._'�__.... '_
� .. ., o,._� ...� . • . . - , _"
_
r:
•_i'�. �l:'.F.�L� � �,,.:t:�T' {�i�.7._ ' '{� Yfi{�
....-, ....
. ;
;-.
., ... �- E.4 1
. , ` _
,.... . .. . - -,....._. - '- _ _- -"- '---- . ' , =..:.. _. .____T,__..... _ ....,__._----'--- "--- '--
.,. . ....�- ir.�7: ^
.,�_ • �
w � �
��'�' � •i^4� I�..a�..c� .. . a� "_ __"�___'__'_
r, `�" ,''��:i�4� µi�#C�� t+.a
."=_.._: .,____.:...'W.._ ._ : ..__ . .._. __ ._ _ .. _.�.. ' �N -- "--'. ' ` �-._ ---- --
, . . . '�.-.. . � -- --' '_..._�.,
... ,
.,.
'..
. ::;,, - � '�_;'s'i� �=i<>'�.'t. , . '.�i(�� � 'i�;i. -- I
, `• �.;
�-� - ---_�_.-__ - -..__.--�--....- -- -- - -_._. . _ .._-. . .- --. - . . . _�_-.}__._.._.`....�. .----
. .. ...; .:- �...,. .• ,��,�- -- - - ���. � ---'-----' -- ' '--�- -
� ' ' '-'' ' ��t'i � . �-�.rx.: `aFS�C. ( ' �
. , �
� �,rr,.: - _ ' '� . . .......� - - ' ... . . � . ...._. ., - i - , ' --- , ____....._.�__.._ _ t
� 1 ., , i 1,"' 'i, .. .. � 'i_'1.��.-. , :�..}IS�;
� :� ,
W �
. . ' "._. . . .. .. , .." ' _ ..� _ .. _ ' '
,
� ' .-.... __..__..._ . ' "
� ,.. ._. ._ . .r,� , "'___.. _—_ ................_.....""'".. '
:,� 6� " • :Y'�' . .��,�", � I �
" � i
v: i
i r
... . . , _ � ._ � - ` ' . _ """'' " " ..
:
.., . ; • � � � . � � - .. . . _ _'"'_.'__'"_.._..�_.......... ...' _
. ,- ,e.., r"..4.. . • :i,'7`.
. ...�_.. , � � � :_,,.. �1., pf
. . _" " "" " _ t ' "" . ' " __" ' _ ' '""....._.�.._�_...._«..v_
_. . � , i . . � ,,..
. . X-r' i�;.= I . �); . `�f-�F.' ',._ _._.. _... . . _. .�..._
� I�` !
, . ' ' .. , . . � b . " '.'. __'_v_._."""_'.
_ "" " ' 3�� '"' _'_' _ _...._..__.�..,.�
e... ' s� }. .l .�` '.. ' :. _ _ I _' " ""' �
.- a
t" i . 4��� _.. _.......,. : _.. __".... .. �__"__'
� ', �. _ __. .. .. ', , . +�I/"�i � '�__— �
. ._ .,. �:.�'Y � C- y 3r ,
r�'
. .. .. �=' , � . _ .. . . . __.,,�" _'----_.`-----
�
s
,. . , - _. , . � ';�,�' �... -- ----' -.' .-_ _�_.._..____-'
, . , � ,,.-.,, _ . _ � , y
, �. ,, �--.,�- a . ::,}�� . . .. . j
� . ..� ...w.. ... , . ... - - ' -" _ ' , � . .
....
._, -
. .,-"'- ' - ..--- - - _.�_.-" .._.__
' i'' t "- _ -- .. � � �. � ` , ,�� __..--_"I----' -. .. _ ., __ _-.-�1
,� ; , . ,..:� , , .,,�� �
_ .--� . _ . . __.�.._ _ _ :...-- ---_.�. � . . ' ;
� - . ._. _. .__.__�...._...,_-'___.._
, - . `, �;�.��;,-� _ � '---- - �. _ _.._
� ..
, ' `` . .
, �.. „ '.
., ___ . __._..._. .. .. -i' -"`--._. , ,.'_'-"-' ' � - -
- - - .-_ ._.... ._....._.___._.----
� -- ` -- -• ----- � i
_ ..__.. ,., . .� � .-- ' . ' --'-'- - � , i �
.A....._.._ !.Y ;�� y,.. .� * �a ,.
. . .......... . "----.� . _._. _.__...._ :..: :.:�,:•if{'<<...�,:�..h,�r:"���''sr�,.V.
. . ,... . ,r .. . i ,�.:3 f
. .-. .� : ..<.,_ .
_..---_... ..--.. .......... .__ _. _.,.,_.___
� -- --_. _... .. .__._v..._._,._.__.._.._..__.._.,�.._.._.__...---_._. ._.__.._.__.._.�_-_..�
- - . .. . . �._......_...__-- - -�-------
, _.,._._'-- - �-��-.
. �
; . _. _.___ _.....- ----- --- -� -- -_ . ,.....
- . . .____. .. . .- ---'-._,.._______._____���.._--� -
�
. ._... . . .. ... _.. .. _ ...__._..'-
� �
. . . . .. ... .----. .. _ _ . _.........._. _ .. .-----._..._..._
-----
' - - "'------
_ . _ .._.__..._--- � _. ._� _. . . ._. .. . .._ '.-- ' -..__.,._._�----`---------'------- - -� --' ---�
f
i � - . .._. . . ,_. .__..____'__"_" ' _ "'_'_""' " " _"'�'_
. .... . . .��. ,- � u.�_"�"'...___' ' "'"'_�_ "'
,
. ,
. . "'v_'_'_'__"".�...,."__'_'"'_._..__..'. " "" __'
...., _. .. , , � _ i
,
�
. . - - - - • . '.-- .' --""_"�--�-_"___._._.'— _��.._ _. ..- -- ';
.
.. , . . ,. .. . . . .._" -_ 4
, ' , -,--.�.�__.--_..._...__._,-___....----------_- -
. . . . � � ' - -- �
. ..
. . ...
.
. .. .�. .. ._. . _ ._--.. -- -" - - -- - -- - -----..___.__....._ ._
.. - -.-. '--...-'--
.,. ' � --' - -' I
_.--. -.-----.__.._.. ._ _ _
--- --�-- ---____--- �
. . _... ._ .. �- - .__._.........,...., ..�._.... ..
_...... ........... ........_. .,....... _,_ .._. i
�\t j,%}��� c�
`_--� -- CIT'Y OF DIAMOND BAR C— ��
I DEPARTMENT OF COMMUNTI'Y 8c DEVELOPMENT SERVICES
� . 21825 E.Copley Drive .� �
_ (909)860-3195 Fax(909)861-3117 PRESS
BUILDING PERMIT APPLICATION FIRMLY
o DDR�ESS ���� l���'y.��f,I� I DATEICATION t � �'�V NEMB R �" � p/C
� ISSUE TYPE OCC
APN LO `I TRACT ��=3 i� DATE CONST. GROUP
p OWNER � Jd3 1�.1/1 I ��T. LL�
p ADDRESS 'S 5F'X�r✓ %('✓j��/U�e-E �'�(.�le4� ZONING SETBACKS
z CITY"T(,+f��, Y�, ZIP��� TEL.'rll� ]..Zt'3�f03`� FRONT RW ❑
� APPLICANT TEL. REAR Q
� SIDE/SIDE STREET RW ❑
¢ CONTRACTOR �- � G SIDE ❑
� ADDRESS l3�- `L -
p c PROPOSED USE
o CITY +�i ZIP� � TEL.��� Li�"�� 7
w ARCH/ENG/ � /
z DESIGNER � C? D'���'?C
w NO.DWEL. NO. NO.
a ADDRESS �'�.l�l`'', �`iZ?�c /s�A.,�C�
N , --r- r— UNITS STORIES BEDROOMS
� CITY���.�� ZIP r��'�TEL.
rn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM j 1�Z.
O
p I HEHEBY AFFIRM UNDER PENPLTY OF PE{UUflY THAT I AM EXEMPT FFOM THE CONTRACTOHS LI• Gafege/C01pOA
W CENSEUWFOpTHEFOLLOWINGREASON(SEC7031.5BUSINESSANDPROFESSIONSCADE�ANYCITVOR (n
C-) COUMYWHfCHREUUIflESAPEfiMITTOCONSTfiUCT,ALTER,IMPROVE,OEMOU5H2ORflEPAIRANYSiRUG W patio/Deck
W TURE,PRIDR TO ITS ISSl1ANCE,ALSO RE�l11FE5 THE APPLICANT GOR Sl1CH PERMIT TO FILE A SIGNE� W
STATEMENT THAT HE OR SHE IS LICENSED PURSIIANT TO THE PqOVISIONS OF THE CONTMCTOHS ll�
gCENSE LAW(GiAPTEq B(COMMENCING NATN SECTION 7000)OF�IYISION 3 OF THE BUSINE55 AND PflP u' PooVSpa
O FESSIONSCODE)OfiTHATHEORSHEISE%EMPTTHEREFROMANDTHE6ASISFORTHEALLEGEDEXEM7• (�
U TIOM.ANYVIOLATKKIOFSECTiON7031.5BYANYAPPLtCANiFORAPERMITSU&/ECiSTHEAPPL7CANTTO Z Re-Roof
ACIVIL PENALTY OF NOT MOpE 1MAN FIYE HUNDRED DOLIARS(55uo)).
❑I,AS ONMEROFTHE PROPEHN,OR MV EMPLOYEES WITH WAGES AS 7HEIP SOLE COMPENSATION,
p 0 Commeraal
Z WILL DO THE WORK,ANO 7HE STRUCTURE IS NOT INTENDED OR OFFEREO FOR SALE(SEC 7oa4,BUSI• J
� NESSANO PROFESSION5 CADE THE CANTHACTORS LICENSE LAW DOES NOTAPPLY TO AN OWNER OF �
PROPEATY WHO BUILDS OR IMPROVES hIEREON,AND WHO DOES SUCH WORKHIMSELF Oq HERSELF Oq
� THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMFNTS ARE NOT INTENDED OR m
QOFFEREDWRSALEIF,HOWEVER,THEBUILOINGORIMPROVEMEMISSOIDWITHINONEYEqqOFCAMPLE-
Z TION,THE OWNER-B�ILOER WILi-HAVE THF Al1R0EN nF PROVM(;THaT NE OR SNF.�Ip NOT BUIL�OR
� IMPROVEFOflTHEPURPOSEOFSALE).
w ❑I,ASOWNEROF7HEPROPERTY,pMEXCLUSIVELYCANTRACTINGWITHIICENSEDCONTRACTORS
� TO CONSTRUCT THE PROJECT(SEC.7od4,9USINESS AND PROFESSIONS CA�E THE CONTflACTORS LI. V9IU3IlOf1 ADJ.AREA
W CENSEUW�OESNOTAPPLYTOANOWNEROFAPqOPERttWHOBU�LD50RIMPROVESTHEREON,AND
� WHOCANTRACTSFORSUCHPHOJECTSWITHACONfRACTOR(S)LICENSEDPUflSUANTTOTHECONTRAG QUANTIN DESCRIPTION FEE
Y TORS UCENSE LAW) j�
¢ ❑i AM E%EMPT LINOER SEC B.8 P C.FOR THIS REASON U �Q V 1K v j C� I
�
,� � 1 �a �;�� , � b
DATE OWNER U �
Z W
�Q LICENSE�CONTRACTORS DECLARATION w
CC 1 HEFiEBYAFFIRM UNDER PENALN OF PERJURV THAT IAM LIGENSED UNDER PROVISIONS OF CHAPTER �
� B(COMMENCING WITH SECTION 7000)OF DIV�SION 3 OFTHE BUSWESS AND PROFESSIONS CADE,lW� Z �
MY LICENSE IS IN FULL FOACEAN�EFFECT.
LLI /�,� m (`yfi '�. �'2'1�ESL',,!�i
� UCENSE CLASS '�r LIC.NO ����Z� �
V �ATE � GONTRAGTOR a /��e S �
[Lt �
� WORKEAS'COMPENSATION DEC ATION Q
= U
N I HEflEBY AFFIRM UNDEH PENALN OF PERJURY ONE OFTHE FOLLOWING DECLARATIONS�
(1J Q
� t IHAVEANDWILLMAINLAINACERTIFICATEOFCONSENTTOSELF-INSUREWHWORKERS' _
CAMPENSATION,AS PROVIDED BY SECTION 37000F THE LABOR CODE,FOF TH�PERFORMAN�E �
¢ FTHE WOPK FOR WHICH THIS PERMIT IS ISSUEO. �
�
W IHAVfANDWILLMAMTAINWORKEFS'COMPENSATIONINSURANCE.ASREQUIRE�BYSECTION
Q 3�o00FTHELABORCODE,FORTHEPERFORMANCEOFTHEWORKFORWHICNTNISPERMITIS
ISSUEO.MV WORKER.�S'yCA�. PENSAT,yIO�I INSURAhICE CARRIER AND POLICY NUM6ERARE' CONSTRUCTION
� CARRIER �1�"�q 1 ��\h.l PLAN REVIEW
Z POLICYNUMBER Z��r ��✓� �/�� � ELECTRIC
Q
� (n��sSEctaraNE�No7sEmFnaiFiEooFn+EaEa�ui�swaonENUNxa�oalnRS�Sicolat�5S1. PLUMBING _. . .. . --
w
Z �CEH7IFYTHATINTHEPERFORMANCEOFTHEWORKFOqWHICFITHISPERMITI5155UE0,1 MECHANICAL
C� SHALLNOT EMPLOY FNY PERSON IN ANV MANNER SOAS TO BEfAME SUBJECTTO THE
�j WORKERS'COMPENSATION LAWS OF CALIFORN10.AND AGflEE'fHAT IF I SHOULD BECDME INSPECTION FEE
? SUBJECT TO THE WONNERS'COMPENSATION PROVISIONS OF SECTIIXJ 37000F THE L4BOR —
CAOE,I SHALL FOflTHWITH COMPLV WI7H 7H0.5E VROVISIONS ISSUANCE
� SMlP
p DATE APPLICANi
J ENERGY P/C
WARNING FAILURE TO SEW RE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL.AND SHALL BE
�y SU&IECTANEMPLOYEflTOCRIMINAIPENALTIESANOCIVILFINESUPTOONEFAINDREDTFI0U5AND ENERGYPERMIT
DOLLAHS(5100.000),IN ADDITION TO THE COST OF CAMPENSATION,DAMAGES AS PROYIDE�FOR IN " -- (� —'�-'
J SECTION37ogOFTHELABORCODE,INTEREST.ANbA1"TORNEV'SFEES. RETENTIONFEE: � � v
�
d CANSTRUCTION LENDING AGENCV pRE-ALT FEE:
� IHEREBYAFFIRMUNDERPENALTYOFPERJURYTHATTHEHEISACONSTRUCTIONIENDINGAGENCY
a- FORTHEPERFORMANCEOFTHEWORKFORWHICHTHISPER�ITISISSUEb(SEC3o9],CIVC)
Z
W
� LENDER'SNAME
�—:-:
F— LENDEfl'SADDRESS__
� ICEHTIFYTHATIHAVEREADTHISAPPLICATIONANOSTATETHATTHEABOVEMFOFMATIONISCARPECT. TOTAL FEES �
w I AGRGE TO COMPLV WITH ALL CIN AND CAUNT/ORDINANCESAND STATE LAWS RELATING TO BIIIL�ING '
� CANSTRUCTION,AND HEREBYAUTHORRE REPRESENTATIVES OF THIS COUNTV TO ENTERUPON THE
zA90VE�MENTIONE�PROPEftTYFORINSPECTfONPURPO5E5 COMMENTS
� �_' �'
= c��� (y -�
�m PERMIITEE N E�7RINT) �, r� _
^YV-�/ !..-�f,' `� �
� SIGNA RE FPEHMITfEE �T
= RECPT.NO. PAID BY VALIDATION
~ ` WHITE—Depattmen[Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy
1
�.r��c`ta �"te"!.?�.;°��"E�,i'a"��� ��a�°$.
�n�����.�`����� �?'����ce�k.'�
, . . , � � . .. . .. . . ,.. ...t.
1 e���P,F4'.:i�, f ' ._ . j F-f_Ut'.��-;,�'.�'s�3 _-______--------j - - -- -- -----------
t��=�;�;��;�.%,�:�vE�.l�;?"F=�_ . __;___._.., .i...__._. ..._.�..___ _ F1�;���C`;Jt�S ----� �--• --_.__-
�--_ � -__;---�;--- -- ----- ------ - --.____ --- _�__ - ---�^. - - �`"
,. .
a C..``v����s�e.,,�Fi�f1��. �i � �ry � ui�1l��'','��"L�ILJ��'l.i�.i�...,..�._. ._.._. --___�__....
i__""____._,.�'.. .__ ___ _. . �—__._ __..._ .'__'..__ _._.__""'__.. "." m.r.
� `.a�iC'�i.i�•tC1•,�-.�.�`t'si'$F,,. ; tJPJI��i?��C.il)Fi£;C'ii�tCli!I`1 _____.._-- -- -- --.------
- E, �.? - ..--- - - _ _ �._
.,.. � .,. . ,
_'._..�._--......_- . 7_______. ._.".i_"_._.___"'""_ ' ._�_._.._._..._._�.i}`v_
�'�'__�.�- , �
� �f_^�.`„'i t�'\l�,i..�}� � 1."'_...,_.__`_'_"_.__ ! Y"�i�.��:^il,�� ��l�.J�����.,�1t� i
i..�.__.._...,...,.._"'_ ...��.__..�____ ..�..._.....__ _^-- �____ _"_.___ .T� _'. "_`______ �___"
'_ .'__.�.�'_
� m.-p...h.. . :i,k'�I� r,�.,- �
S i C..l'�:S's�.'"�.. . �� �";r�raL"3 3�t..C��✓' !`����:�iV� _.�--.�___.._. ....----.__.�"'�--- -
- i ._.'_�.'.'" ; _--__.'_____.__..'_.�"_......r_�._.._."____ _ _"�._ '_�_____'-
�__.__._,._..._._. � -
'___..,�_.....,_ ___.-..._.
¢ `�1¢�;,.�F' S;I�h�Lr�f'� { _ _ _ � _ � � �P�3L)1-�I�. ��!`t���.�(�__— -- t ---�-�-------
- -------- _.� � _ _ _..___._.. _ _________._.__
r . ..,.: � , ��.-s, �3��1C)i3E�(v� _ _�
�i°.:�C)r-a�:-€�.�tli=E€��:;;i � __-. --- _.._ �----.___
'___.__�V._ -- - -.-------- ____--.- - ..__._._.-_.-- -------__ � _
� FF��aB��i6s�'�:z;°."cd�E1`a(_?t��€�I;�es'�; ; ! � r�P,!µ?€�(7��!E) E�r::�iJ� _-- � _.._- -----
, �
• �-- --_____ .�,_.�__-- - -- ----�-� - -. __._----- -- -
� �`'��-Ca. '.., ti� �
--..__.�___..___._.�._..
: r �.,(w^, c.. ; , F?;e..,(�j t
a_:�{�,3�.� �t.,:tJs.,,.� . .__.__!__..�......._..,._b-...______,.__._._-_.__..,....�..�. ' -_-�-_.._— --."—�.._
i F�t�'�l�'S-S�?��?�1��t��; ' � �r[:,NC=�i��r �I — __
F�.�.._"—_ '__.._.....,..' "_.>».—.L...._._.......v..............v_,.._�_»_.._... ' ... ....___._,...,. �._ ..._J.{�.�
�.......�� ...
FiC� E�I"� "(_�t.e{�,�„ ; F2Ci�1Ca1'!{`'.��-?�C)ifV�'`a-----• � ----- - ---------
, , . -�__ ,..
� .�
.______._.__.._.—.�_- - - - --
-.-, ,.-�,E �-�,i t � ��,�� �- - ____�_�.___.__._..__.__ 7 �3�!f�i-i s`:�f���'s��?C�
, Ft�:��v:-s � �,fft,�. � ------....- ----- --- t �----_. �_._.� � _ _.�_____,._.
___��__..__.�
3 "' -'Ca;��,=�`s't"s t,%k"p��;_.�� �E.L�C�?��ilC � i
-.,f-. ,, -
� �. .. �. , , _ . �_�-.--___-_--- ----- -------- ----- ---- - .___-----
, �
.__.._._.__..__.._ ,_.�_w...___ ,, ._�.____ .
�
's c:y�i. � r:1 inl;.x("�i,�`,�r.? i _ _�____... � �C}i�L�-Ei�€CI�G �___ ' .__._,__ � _---
_. - __r.. �._
�.__.__. _____. .__ _,...
' ' �� L �'' L
a���.��.:��;:;.!i_�.` ;�_^-� - ___.._ ----__. _ - �E�C} ,�u�, _.__..._._--__ � __.____---- - --�___.__. _____
� , -
, , �
-----_�___._ . ...___._i_ .___.___,- ------____.___.. __- ----- �-�-- __ _ ._____ .�_
�--•--, -� _ _
; ,-�::.; :G.:, :r.,.;::�: , r-,r.� + � C3i�j=�+iT�(�t�?€��. �i
j �+i....:..::�w. . .. �w,r`�i..t . ._. _�....___... . .._-- _ _.----- � - --... .._._�. ____— -------.._.__
_.'--__..._
���
i'^��-'°'':.�.`-'.'. "s"�,1_�.'�Pi:: Y�v ��^���r°k��Ui��
. _
,�t'�� _ . . � ---_ ..__._.M�- — — — __.._ _�__ �._...__,.� _ --
�---'---....___..._. . ---------' -__..�_�
' �c�F,`:�i'Y ' � � ;"{�.E�+,� �fV.�'.R. -�-----'_._
��.___._._...._._.__,_. .. -- , -- ` ------- -__�___.__ _____--_�.. .___.___�_�.� _._______.__--__.�.
� :s���€(i; r,�,y>3s:: j i L.r����tii�"��-`��t�i��C'z.
------_.._. _,__..��._..._.._- ------'-- -------__._ �...._._- ------ ---- ----
- _._..__ _ __.___._�.___, __.._�
. .. i C�i� �i`("�iP��''�.
� �F���6' °s-'°!'::..�... ;
�.s�'�r't�a�`.lt4"i:;�.,�;�----- - �- --�.�__--- ___.i �=1t��tL;�C)���=(�,,��__-__---------- i--_-_._._ _. �,.�___._____._
, . .. � . , .
. .
, � . , .
�.
, . , � = � .
. . �
� '� '
._ r _ , .
?_�_._.---_`._.___.._._:.Y ____ ... � - .-�.;1_. .._�___ . _.�__.__ ___--- - _.______._ __._-----___ ___.___._--
-
_
_
_
� �:�s�,�[..��i�C"i'I�fi; �� � � C)�1I. ��vS r'I=��p� �
' � , � ___ - --- -- '-------
, � � �
€ I � I ( I -�_��____��___-_---
� . ;� ,;���:�r�,:..,� ..
+ �.. � • • ..:n: .'.X:�/�::.":'': '
�
.. ... .. :........�,_�».-.
-, . s�, i ....,
.��
EE ' 4 r`r""F..s , "'._�..w.._...._ _�.�_....._.
_'__"_'__.......__ _..__._.._....._.._.......r._�._.
g ,ta,„k���.� ...... «� "._"_' ______'"'__' _._'"""
3
�... ".,,.,..--� ......_.. _..._..... ... _ "'__" v..._._�.._..._�.�_..........__..._____"'_,....-_.._.__.........._�_____._....___ _...__.__ _ __.�.w...,�,_.._.""..�
:
� . .. . __ "'_"_"_'___'_ _'...._ _....._"'_�_......._.__. ...._.�._....._._...,_........._r.._._..___._._. _��_...__._,....___._,..__._,_.__....._.�___
�_,,...,.___.„_ ._..—_
�.,._.___..,_"""'.._.__. _ _ . __...__...._...-.._ ......,_.._.._—_..._.._.-. _ .._....__v....,..�.�.._.,_____�._.____._ __�...._..._�..._......."'_
e
=_'__'.______._..__________......._ _,.....„.__,..._.___..�.. __._._..��._.__ . .__ _..�.._...._. _..�.__.
3 '
5
i......__..._......_...___.._.__..... .,.._._.._._�_v�_"""" '.�_....�..........,...._. .. .__T..�_�._...._._�..'_'_'"""'_'" _.��..�__._._...,_.�__..-.._...__.�__�.,.
{
�
r�.._�._.___�....,...._...._ _...,_. ._. .� '"_"..._._._"__.._._.,....�.w_...,.__. ... . _.._����.._�...T_._._... .-.._�._.,....__.....y._...._.._._...._..�_._.____.._.__.._.._....
t
. �.�w_'.....v"..._. _._..._.._,._..._....."_�..�„_`."_._..____.__.__�_
•
i
..._..»._._..,. ......_..
�..............._..._ _ _.�_..._...�... . . �._......_..«...__�........_........___'...-._.�_..r..�.�.,..�,.... .._.,.__._.__.._._...__...�.._._..._.�___...._"..__`__.__'_____._...�._...___.
w^,�::'y i.i •. a.�t� i ..,3.,�f::
.. , ±C,§�=.:4�� "� .
u.,..., �. .�.e:..._
_....,.' ---_'_
..,,-• .,._.. -- —_.
� ,.,..�€� ��3�/��I�F __ ----- ---- -- _._ _._..__.�-------- -----_w._...,_____---------
� �a.��„ . , _.. -- -
� ' ' ' .____. _____,._._.__,.._.__��_____�._______ __�. _.__ ._,._.__._._�
� .� ;. � ,}�..
� � , � ; - ___---------______._.__ --.---------_..___--_.._ _ --------____---____------�
4 r� � �° �' '{'�.� � ��� _ �
. , .
,
,.
, ,.i.s , :, • ; __.___...... ._..__._.______.________. _.___�._..�..___---___
i r --- -- ---------
# .° '�3..
..
.
� -
, ,
� •� -�-------- - --_____ .-- -- ---- __..�__-------- - - ---- -
� . . --..______.---..�.._._._._.---_.__._.__..___.�____.___�_____ - --------�
, . _..__.______....�_�
i
.
, .
i --'----'---_ ., ...,-....�,.,.,....._.._...,.......___................_.._..._._...._�,.m..__._...._..__.,-.�_..�...m-...�.......�.T.,T.____._.�.,,.._...,......�...�..,....,....,......__w__
!�,_.:_. .. ..e...... . _ �...._.,.�.............. .... ...._. .._-- .... ._____...,... _.�.... ...�..,..,.�.,.-,_ _...._......_......:..�..._......_.._..�._..._..,.._.__..,...»...._.........._.....,....-....M ..y,.,...�..___._......_.........._.._.,___....._..__.._o
���-�c�����fi 1�`..� ��=� �e�c��y
� ct�aF n�orm s�x
I I , ' D£PARTIVYEE?VT OF COMMUNI"I-Y&�DEVELOPMENT SERVICES
21825 E.Copley Drive �— `
(909)&60-3 L95 Fax(909)861-3117 \ PRESS
��"-v»= BUILDING PERMIT APPLICATION FIRMLY
o ADDRIESS�lr�� � Wt;a'1(,IdVIY� ��'$'L'f DATECATION � - � NUMBER i'Y/! �� �/C �� '
W ISSUE Z t 7ypE OCC
APN LOT� TRACT S U;1�C-O,_ DATE � � CONST. GROUP
p OWNER tnit t+C1 rv�i I}�c�.'��` ��J�(�
� ADDRESS ��rl�(�1 �Tr.%vuv�C��"Q. SfP, i(?�/ ZONING SETBACKS
� Ut
FRONT
z CITY �^ nF (� ZIP C' >•• �TEL.�(:•� yl�'_':,�i� �. RW ❑
0 APPLICANT �C I7Ct VY7� Gylli���TEL. SP.w, e S DE SIDE STREET RW ❑
z
Q CONTRACTOR )�C. et�"�5�7•'�/e"�`ir,:`^ SIDE _
� ADDfiESS �aca rv�.P f%l S U.ul/1 r'�r
� CITY ZIP TEL. PROPOSED USE ��+/ �Ca I t7YL f,� C���''��SZ�,E '�� ;�
�w ARCH/ENG/ �y /; .._g�,, — � ..
z DESIGNER 1== C?C�:.!I(.� � lite.�l-�'��n.___��__�__P".t1 __ NO.
a ADDRESS �LLRi��11 t' P��`'� d"'•:�/��E'-�"' UNITS EL p S ORIES I BEDROOMS
� CITY ZIP TFL.
cn
cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION
� SFR/AD�/REM
I NEREBV AFFIRM UNDER PENALT'/OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- Gdle JBIC8fPOR
� �
W CENSELAWFORTHEFOLLOWMGREASON(SEC�a3t5BU5MES5ANDFAOFESSIONSr,pDEANYGI7VOF
U COUNTYWHICHREQUIRESAPERMITTOCONSTRUCT,AITER,IMOROVE.�EMOLISH.CRREPA1FtANYSTRUC-
w TURE,PRIOq TO ITS ISSUANCE,ALSO REOUIRES THE APGLICANT FOR SUCH PERMIT TO FlLE A SIGNED W Patio/Deck
STATEMENT THAT ME OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI�
� CENSE LAW(CHAPTER 9(COMAIENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AN�PRO� � PooUSpa
FESSIONSCADE)ORTHATHEORSHEISE%EMPTTHcqEFROMANDTNEBASISFORTHEALLEGEDEXEMV- (�
� TION ANYVIOLATIONOFSECTION70315BYANYAPPLICANi FOqAPERMITSUBJEGiS"fHFAP�UCANTTO Z Re-Roof
ACIVIL PENALTV OF NOT MOFE THAN FIVE HUN�RED DOLLARS(5500))
Z ❑I,ASOWNEROF7HEPROPERTY,OFIAYEMPLOVEESWITHWAGESASIHEIRSOLECOMPENSATiON, � Commercial
WILL DO THE WOqK,ANO THE STRUCTURE IS NOT IN i ENDED OH OFFERED FOR SaLE�SEC�a6a,BUSI�
� NE55 ANO�ROFESSIONS CODE THE CONTRACTORS LICENSE LAW GO'eS NO'APPLY TO AN OWNEF OF � ��5� ��� � e 5 . � �
PROPERN WHO 6UILDS OR IMPROVES THEREON,AND WHO DOES SUCH WOFiK HIMSELf OFl HGfISELf OR �'l
� THflOUGH HIS OH HEF OWN EMPLOYEES,FROYIDE�iHAT SUCH IMPflOVEMENTS ARE NOT INTENDEO OF m • ��C� �`� 4 �
QOFFEREL1FpR$pLE.IF,HOWEVER,TME9IJILDINGORIAIPROVFIAFNTIS501DWITHINONEVFARnE[:n61PIF- J (,r q
Z TION,TIfE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING'.HA1 HE OR SHE DID NOT BUILD OR
� IMPROVEFOHTHEPUFPOSEOFSALE)
w DI,ASOWNEROFTHEPfiOPEHTV,AME%CLUSIVELYCONTRACTINGWIfHLICENSE�CONTRACTORS
[= TO CONSTRUCT TFIE PROJECT(SEC 7oaa,BUSINESS AND PROFESSIONS CODE THF CONTRACTORS LI- Valua�i0n ADJ.AREA
W CENSEUWDOESNOTAPPLYTOANOWNEROFAPROPERTYWH07UII�SORIMPROVESTHEREON,AND
� WHDCANTRACTSFORSUCHVROJECTSWITHACONTRACTOR(S)IICENSEDPUiiSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE
� TORS LICENSE LAW)
� ❑I AA1 EXE�APT UNDER SFC 9 8 P C FOR THIS REASON Q
� _ U
� �
DATE OWNER , �
Z W
� LICENSEb CONTRACTORS DECLARATION W
Q
CC I HEftEBY AFFIHM UNDER PENALTY OF PERJUflV TMAT IAM LICENSED t1NDER PROViSIONS 0F GHAPTER �
d 9(CAMMENCING WITH SECTIDN 7000�OF DIVISION 3 UF THE BUSINE55 AND 7POFESSiOh'S CO�E,AND Z
X MV UCENSE IS IN FULL FORCE AND EFFECT —
W ,� � f f � --.. . _
� UGENSE CLA55�.___ LIC NO �� � 1� �
U DATE CONTRACTOR . �'l'� A'� C ll '7 d
w
� WORKEAS'COMPENSATION DECLARATION J
� 4
� I HEREBY AFFIAM UNOER PENAL7Y OF PERJURV DNE OFTHE FOLLOWING DECLARATIONS U
(n Z
Q
� IMAVEANDWILIMAWTAINACERTIFICATEDFCONSENTTOSELF-INSUREFORWORKERS' 2
Z ��CAMPENSATION.AS PROVIDED BYSECTION 37000FTHE LABOR CODE,FON iHE PERFORMANCE U
Q � /OF THE WORK FOR WHICH THIS PERMIT IS ISSUED �
O ��
I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BV SECTION . S �
Q 37000FTHELABORCODE,FOftTHEPERFORMANGEOFTHEWORKFORWnICHTHISPERM1T15 Sr ,
� ISSUED MV WORKERqqsss'COMP NSATION INSURANCE CARRIER AND POLICV NUMBERARE CONSTRUCTION
J � {{{ � '
j caaRiEA `aPr'i�� ��iVlrtYat'��";e ti, ^� j i�3-�} 'r ti i�a� '� U. g�'LAN REVIEW .
D poLICY NUMBER ��'�"��✓ p � � ELECTRIC F
� (i111S5ECTKKJNEmNOTBE�PLETEDOFIHEPERMfTiSFOFONEHUNDREDOq1J�RS(S10D�OFLESS) PLUMBING ��
W �
Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUE�,I MECHANICAL
(,'} 511AlLNOTEMPLOYANYPER50NINANYMANNER50A5TOBECOMESUBJCCTTOTHE INS?ECTIONFEE
� WORKERS'COMPENSATION LAWS Of CALIFORNIA,AND AGREE THAT IF 1 SHOUL�9ECOME ♦
� SUBJECTTOTNEWORKEflS'COMPENSATqNPPOVI510N50FSECT10N3]ooOFTHELABOR
CODE,I SHALL FOFTHWITH COMPLY WITHTHOSE PROVISIONS ISSUANCE
� SMIP � l.
p DATE APPLICANT y-..
w ENERGY P/C
J WAFiNINGFAILURETOSECUREWORKERS'COMPENSA710NCOVERAGEISUNIAWGUL,AN�SH4LLBE `
JUSAND � �
� " ` � ' � ' ENERGY PERMIT ti r _ - /
• , �• • • •• �FoaiN
� ' ' RETENTION FEE: r���k�
CC —
� CONSTRUCTION LENDING AGENCV PRE-ALT FEE• F � �'
O y
� IIIEREBVAFFIftMUNDERPENALTYOFPERJUR�TNATTNFRFISACANSTFUCTIDNLENDINGAGFN(.V �
d FOR THE PERFOqMANGE OF THE WOP,K FOR WHICH THIS PERMIT IS ISSUED(SEC 3091,CN C� '
Z �
w _
2 LENDER'S NAME
�
H LENDER'SADDRE55 .
� TOTAL FEES �'��``�'� �� (.�.UY��;_�.�a'(C r�'C �t��� �� ��.�
� ICERTIFVTHA7IHAVEREAOTHISAPPLICATIONANOSTATETHATTHEABOVEINFORMATIONISCORiiEGT
w IAGREETOCOMPLYWITHALLC17YANDCOUNTVORDINANCESANDSTATELAWSRELATINGT09UILDING
�
CONSTRUCTION,AND HEREBY AUTHORRE REPRESENTATIVES OF THIS COUNTY TO ENTER UPJN'HE
ZABOVE�MENTIONED PFOPERTV FOF INSPFCTION Pl1RPD5E5 COMMENTS
�
—' SNcNE �NL�E2S�t.�
�
m PERMITTEE 1 (PRINT) 1
4 � �� � Z�� i
Cn �'�^ _ - _ ._ —_.._ '1 P4
� SIGNATUREOFPERMIITEE °ATE RECPT NO PAIDBY � VALIDATION ""��
S
� WHITE—Department Copy.YELLOW—Rnance Copy,PINK—Assessor Gopy.GOLDENfiO�Frle Copy,GREEN—ApplicanYs Copy
� � � : � � � � _r:��
. � . . . � . . � . . . . ..,,, .
: .. �.q:. . :... . . • . . . ,, . ... . . :. r.� • '. .. .... .wri:m�`�,�`.,
. - �t.�"�F• ' � ' ' . , �
. �� :
._i .:... .. ._ . ,
.,, '_' ___'_."_ '' ' ' "'"" ' /�� ' ' , ._ . .. ...____.._..____—"' ' " _ '___..._`_____'
. , . �.y ..� ,-.,-�•r (� ' i
��,- . . ��..-,.'[} � t.. J . _
�
r , -, . . . �., ' ' . ti �
.
� ... 4• _ '.`.._.'"t.' _ _. . ._ . . . ._.. ' '; _ .+ _. _ . _ . ._ , _.___,.�___..__ ' __„""_�
=I_..,. 'ii , .. I /��� ., . �f 4 " "
� . ��� J �
�._'"'._', . . _... - . , . . ____.__.r.' _' '_ "___....i_.�...,_'__"""' _ .'._.
. �
' • ,. , � ,'. �� 'i ' „ _ �
�
� r . . . . �� , . _ . ,. . . ..... '�:..+ .I
, /f'
, �- �J
�
� ��. ... ,...__ (/ . _ ... ._ ..._,._.'""" "'.. _ ..._. . _""" "'
i., - ',�: � E,L � . , ";E ��x'?�'`�s�i
. , _ . „�. . '�
� , .
,
, ... , . �.;
._, _� '; ..: ^.^ ''�''
. ,-
��
r »
,� ,, _ �
_ - - -_.. .. _ ,.. _ ,._. _ , . __. . .. _... : ___.._ --- - - - _ _..._--
�. ,_ �
, _ ,
.. �u '.�(t' r�..
�:•r„ r ,.��_a-, - �_, _- . :i�•_ _ -�4:r� _
_ _ __. . . . . . ,. .. - .._ -- ...._-__ _ . -
• . ;C � '.". - , , ���{
. -"..S.Y .P ��E_i'�rt��,i.1ij... r ... . 1. . _ . - .�. "' "__"' ' " _ . _.. ._,.__.-,�__.__-_. ''"'_ "'_`"{
- P .,.•�U'\� �_ ...�I��, , �., �l,: . r. ` ' �
. .� .,. .�,,. �
;
-r.�.. � * ..
. , r..� .. ,...e' r
.. ... . __....:.. . ._... . , . .. _ _. _ . .. ...._.._. ._..�.,._'__'_'__...
f
, .. . .� .._ .. �
, ' .r e'_ ;. _'.7;"^.'? I ' " , `s
.
�.. .�,
i_..___' "'._............. ."""'...._. __v{._. . .. . _ . . ,.. . . . . .. . ""'"' _..��. _.._�_.__'_ _ ___.
. —�'}'tQ t•_t: �-: .ti''���a(�i . ! � � � .. • . . . 'i' S
- -
r„ _ .
. �
� , ,. -•
� �., ..
' .".'�T.'__' _. ___.._._"' . _ ___'_.._ _ ' .__ _�_ .___._ ' ' �
,._ . . ' __...____•._.___�'____'__;_.'' x
'r'�' �'.:.' S':! "". ,.. l.,�,. , .. . -. ._. . ..__�......,...�.�„'._"
_t•,; . �-" ,• : � � ��i� _ , , . � _ �
::�..;. .
.. ' . __ _'. . _ . .. _ ... ._.. .- . . - � � "" .. _ . _ . ..
. — �'eq ,..�._���Vi.:d � s '• . ...�, i . _..... _.... .'.... , ,_f
_j ' ', .
. � .
�... . . _. --'----� � - --..,_ . . . a _ . .. - -'-'-- �- - -. __.. - _....__..___.�._.__.
�1' " ,. , , . ; i i , , . .�l). • , _. i-:, ' �i �
., »„ .. ,�. ,.
> . .
, . .._. . .: _ . . - . _ , , . _ '- _"-"'- __--- - -- ---- _.__ .._
_ � . �_ , '�--'--
� ----- ----- -��
, ,, - ,
' �-"' :i ' . . ,`.�.
,
- ,�..,�. . ;-+ _
- . , . . . . _ . .
. . --- _...--.._..._... - ��--- - '� . .. .. ._. -----.-__--. '-' .. - - � --" '-..-
, . ( i
,. ;• - . ;
, . .
, . � .:,,;
,
.. ; , .
. �
.�
. . ._„ ,_.._._..--- _:._.. -- - . , _ -------_...�_._._�.----- ---- � -
• , ,.t:�• �� s
, . , : , _ _ :1: :Y ' , i . ' .
_ ""_ . � ,v . " .«."`__' " . _......"" " ""_ . . . ._ . "" " ' _'_ _" _.___.. ,._.." " ' '
� i - . �': �f._��it � �i. . ' .. ,. :�) �
;
, ." _ _ '" "_ .. � .. ... . . . � . ._ .. .._ . ._. . . . ' "
, ... .. � . ,.. "_".. . . ......... __�..... _. . .
� . __ ,�_ . � . ,. � .�. ' �
. " - -
I
� .
"_" , ' _" ' ' ' " � " " . . . _ __. _ , ._ . .____..._.._.'""' " '
,' .. . �ye.-.�. . . . .: • , . . . .
j_ �
.., ,
. �, i s
-- - - - ` - �- � - - ! �
; :.: , ; , , • , , - _. __----___—_-- - -- _ _... . .............
, , - '�'/^���y�'i!��•`' . .. � , .. _ ..,_ ...�_.�__. - -- - - -- ___._ _�
. . .
.
� ` "" , ' __--....- --- -. _-_ --_—_ -
. ,. .�. T,r.�,-.
.� ����' ��a � � - �-�- --�� -----�- }
� : , _
�
, :
� , . ..
_.. -..' - --.. _ . - ---�-- _�.._..v _ _ ..
-,
,. . .. , . . --Y.. __ . . .......�__`
�., . .
. . ` `� . .._ 1 . . .S.
� � �
. _. . i � . ' i 1
� �
. ... . .. . _. �.._ ._ ... _ . . . _ ' ' " ""__�__..' " " "" `"." ' '
. -, � ��,� - . , � i � �
�� i Y
<
�
_"4_'.....»..."' " ' '_._. ........ _ . '_""' ". . .._.. _ .. � _. . ..'"__""""_'_
. ..... . .,.. . .. .'"__ _ """_` _ — ;
c� c�Qa ��.
u�_ ._.... e�-. . - --- }_�: � --- , . --- ----. _.. � �
� .- --- - . .. _ �.s;::�r;�#�� -�
— - .._� ..- � - .. .. . , . . . ,.., ..
. :,,.-,�_ . . .- ..���.�����r,�� �{,`�'���'� �'��- c"�1� Q �' _ ._ f
.� . -. 1l l� � �� / _1�%-- - l�/!�'�..�.�___�d�,
� �
__ __---- ------_—___m______ .
-- -;
� �. _ -- - - - -. - - -----______—_------- .... �
- -- -, - -,____
�
f
,.. . "_ ' . ..' ..___ '_. ..... . .. . . .. . . .
'____..�...—___............__.._.._....___'__'�__.,_"'".._.. _..,_�-!
. �
-.. .." '" " "'..""'.... .' " """'"_ '_ " . . .. . _... . . ... . t
.__........____.'_"'_..._.�._....__.__..,..._ . _ _ ..._ __�
. �
s..''" ' .,.,._ -...,..._. .._. _. .� ._' " ' "'''""'_ . ._, . .
'_____'_.__'_"'_"_`___" _,.�_""_"
'_ ._�
' _ ' " ' _ . . _. . . ...._ . . "'""" " "' "....."'
_ "__"'_" ''""'"�
. . .. , . . ... .. . ' "".... .... . . . . :
" " _""""'__'"____._._._._."_""_
''_'"_"'i
. . . . . _' "" '._.' "_. .._ .. . . (t`
""'_"'_�'___.._.�........""_._...__,..__..__""' " '_"'._".!
5 . �, w..' .�,�.
f
. .,
,- �.
._ . . . . ' ' ""'_ _ _.�._.�...."""""_"""' _'_ _ __'_'"..i
-';:.i"' . . _4. . ..
_ " _ i
- _' _' .. .. .
. . """',_.'_""".....�..._.__,._._'_'"'"" "
"�
. . . . i
' ' - -- .'"_ '-- - - . . ' -., - -''_'.-" __-"—. - -- 3
... ._�.__...------�
, �
' � ' ' ---- . .. . _ _ ... _ ---'---., _.�.___�..�.___. . _ . i
4
. • �
CITY OF DIAMOND BAR �� ,
� DEPARTMENT OF COMMUMTY&DEVELOPMENT SERVICES � (
21825 E.Copley Drive � (��
(9Q9)860-3195 Fax(909)86L-3117 � ���' Y �PRESS
`%��� BUILDINGPERMITAPPLICATION FIRMLY
� JOBSITE �yry�� `�j���;F� j �12 APPLICATION � ]6 �JL�PERMIT P/C
o ADDRESS_. !s' f/ DATE Q V NUMBER p
� ISSUE TYPE OCC
r° APN LOTn� TRACT �.S 0,�f� DATE � CONST. GROUP
°C OWNER c-�`✓
0
o ADDRES,�,���'P�1 %G��Z2/'�KJG6� 5��''t ZONING SETBACKS
Z CITY_!'�2r2lZA/VG�6r ZIP�TEL«f> C/�L��� FRONT Ryy p
� APPLICANT TEL. REAR p
z SIDE/SIQE STREET RW ❑
m CONTRACTOR �S�.e%��l�n'� � /7/�f�'�'�/�y� SIDE p
¢ ADDRESS —� -'—�
� CITY��/.j1.�t9 ZIP TEL. 7 �� PROPOSED USE
o ARCH/ENG/ -
z DESIGNER
a ADDRESS — NO.DWEL. NO. NO.
c� --- UNITS _ STORIES BEDROOMS
� , CITY ZIP TEL.
cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDER DECLARATION SFR/ADD/REM
O
p I HEREBY FFFIRM UNDER PENALTY O'r PERJ�RY TNAT 1 AM EXEMPT FROM TNE CONTRACTORS LI� GdfdJEJC2fPOf[
W CENSELAWFORTHEFOLLOWINGRFASDN�SEC7a315BL151NE55AN�PROFESSIONSCODEANYCITVOR (n
U COUNTYWHICHREOUIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC- W Pabo/Deck
w TURE,PRIOR TO ITS ISSUANCE,AL50 REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNEO W
STATEAAENT THAT HE DR SHE IS LICENSED PURSl1ANT TO THF PROVISIONS DF THE CONTRACTORS LI-
� CENSE LAW(CHAPTEfi 9(COMM�NCIN6 WITH SECTION 7000)OF OIVISION 3 OF THE BUSINESS AN�PRO- � POOVSpB
FESSIONSCADE)OFTHATHEORSHEISEXEMPTTHEREfROMAN�THE8A515FOHTHEALLEGEDEXEMP- (�
� TION.ANVVIOLATIONOFSECTION7D3158VANYAPPf.ICANTFOFAPERMITSIJBJECTSTHEAPPLICANTTO z RB-R00(
� A CIVIL PENALTY OF NOT MOflE THAN FIVE HUNDPED OOLLARS(f50o))�
Z ❑I,ASOWNEROFTHEPROPERTY,ORMYEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, � Commeraal
WILL 00 THE WORK,AND THE S7RUCTURE IS NOT INTENDED OR OFFEREO FOR SALE(SEC 7o4a,BU51-
� NE55 AND PROFESSIONS CODE THE CONTRACTORS LICENSE lAW DOES NOT APPLV TO AN OWNER OF �
PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF Oq
CL THROl1GHHISORHEROWNEMPLOVEES,PROVIDEDTHAT5UCF11MPR�VEMENTSARENOTINTENDEDOR C�
w OFFEflEDFORSALE.fF,HOWEVER,hiEBU1LDINGOAIMPAOVEMENTI550LDWITHiNONEYEAFOFCDMPLE-
� TION,THE OWNER�BUILDER WILL HAVE�fHE tlUHDEN OF PROVING THAT HE UR SFIE DIO NOT BUILD OF --------'�'-' ""-`--�--'-'
z IMPFOVE FORTHE PURPOSE OF SALE)
_ ❑I,ASOWNEAOFTHEPROPERTV,AMEXCIUSIVELYCONTRACTINGWITHUCENSEDCONTRACTORS
W
Q TO CONSTRUCT iHE Pfl0.1ECT(SEC.7044,BUSWE55 AND PROFESSIONS CODE THE CONTRACTORS LI- V811Jef1ofl ADJ.AREA
W CENSELAWDOESNOTAPPLYT�ANOWNEROFAPROGFRTYWHOBUILDSORIMPROVESTHEFEON,AND
� WHOCANTRACTSFORSUCHPR0.IECTSWITHACONTflACTOR(57LICENSEDPURSUANTTOTHECONT(iAP QUANTITY DESCRIP FEE
Y TORS'LICENSELAW) �a+
¢ ❑I AM E%EMpT UNDER SEC B 8 PC FOFi THIS fiEA50N Q !/J�`.a'" � J � ��
� U
,� � �'' � 'z t 7���
DATE OWNER U .�-^�
Z J '.S I
� LICENSED CONTRACTORS DECLARATION W - ¢,f/L� �
¢
� I HEREOV AFFIFM 11NDER PENALN OF PERJUfiV 7HAT I AM I ICFNSF�UN[]ER PROVISbNS Of CHAPTER � �ry:G�
d 9(COMMENCING WITH SECTION 7000)OF 01VI510N 30F THE BUSINE55 AND PROFE5510NS CODE,AND Z � L>'` /�
X MY LICENSE IS M FULL FO/R/C E AN�EFFECT � �
� LICENSE CLASS C.� � J C�9 LIC NO l � J
F-- a � f /l�. �O
U DATE CONTRACTOR ���� a- �
W ` . �. 'e
� WORKERS'COMPENSATION DECLAFATION ¢ �' �,
� U l� r7sa-iv � f°/�
I HEREBV AFFIRM 11NDEF PENALTV OF PEftJUftV ONE OF THE FOLLOWING DECLFRATIONS Z
0 IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELFdNSUflEFOPWOfl1(ERS' _ � l /l
WMPENSATION,ASPROVID[D�VS[CTION370DOFIHELABORCOOE,FORTHEPERFORMANCE U � '� �� GF !�` �`
¢ OF THE WORK FOq WHICHTHIS PERMIT IS ISSUED � /f. ' � � , �j�}
0 �
W IHAVEANOWILLMAINTAINWORKEFS'GOMPENSATIONINSURANGE,ASREQUIREDBYSECTION /��')^!y
4 a]oo OF THE LABOq COOE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS .E(�jJ's L�
� ISSt/E�IAY WORKERS'CAMPENSATION MSURANCE CARRIER AND POLIG NUMBEflAFE CONSTRUCTION 7" -7
j caaaiEa ��p.-y't� y L � PLAN REVIEW
� POLICY NUMBEfl �L-Y G � ''� � ELECTRIC
Q
� (IHISSECTIONNEmN�TBE(Ah1FLEfE�OFTIIEPERMIT6FORQYEHUNDREDD�LLARS(5100)ORlE55� PLUMBING
W
L I CEFTIFY THAT IN TNE PEflFORMANGE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
(� SHA1 L NOT EMPLOY ANV PERSON IN ANY MANNER 50 AS TD BECOME SUBJECT TO THE
� WORKERS'COMPENSATIONLAWSOFCALIFORNIA,ANOAGREETHATIFISHOULDBECOME INSPECTIONFEE ._
� SUBJECTTOTHEWORKERS'GOMPENSATIONPROVISIONSOFSECTION3]OOOFTH[1A80R �
� CA�E,ISHALLFORTHWITHCOMPLYWITHTHf�SEPROV�IJSIONS / ISSUANCE
p �ATE� APPLICANT. /'��'�K� `�����G9� SMIP
W ENERGY P/C
WARNING FAILUflE TO SEGUHE WORNEftS'GOMPENSATIDN COVERAGE IS UNLAWFUL,AND SHALLBE
� SUBJECTANEMPLOYER70CRIt/{MAIPENAIT{ESAN�CIVILFINESUPTOONEHUNDREDTHOUSAND ENEAGYPERMIT � (��
DOLLARS(5100.00D),IN ADDRION TO THE COSTOF COMPLNSATION,DAMAGES AS PROVIDED FOR IN
J SECTION37080FTHELABORCODE.INTEflEST,AN�ATTORNEY'SFEES RETENTIONFEE:
2
� CONSTRUCiION LENDING AGENCY PAEA�T FEE.
O
� I HEREBY AFFIRM UNOER PENALTY OF PERJURY THAT THERE IS A CONSTRUGTION L'cNDiNG AGENCY
�-- FOR THE PERFORMANCE Of THE WDRK fOR WHICH THIS PEHMIT IS ISSUE�(SEC 3097,GIV c�
Z
W
S LENDER'SNAME
�
I— LENDER'SADORESS ^]
wIGERTIFYTHATIMAVEREADTHISAPPLIGATIONANDSTATETMATTHEABOVEINFORMATIONISCDfifi[CT 1 O�AL FEES ��{"^��
� I AGREE TO COMPIY WITH ALL CITV AND COUNTV ORDINANCES AND STATE lAWS PELATING TO BUILDING
CONSTRUCTION,AND HEREBV AUTHORI2E R=PPESENTATIVES OF THIS COUNTY TO FNTER UPON THE
ZPBOVE-MENTIONED PROPEflTY FOR INSPEGTION PUFIPOSES COMMENTS
� rC.f�/�.rt'S1 d7�9`f/�CJ�_._
m !P MITTEE RINT) ,y
Q !/�
� � ..�,cer--`-.—
Uj SIGNATUREOFPERMI E � OATE
= RECPT.NO PAID BY __ ____VALIDATION__ __
~ WHITE—De arimentCo YELLOW—FinanceCo PWK—AssessorCo GOLDENRO FileCo GAEEN—A lican['sCo
P PY, PX PY� PY, PP PY
; - . � .. _ .
�
. . ,
� M � �� � -- _... __._.__..----_-
� �� ., ��::w�. . _ ,��f�G-���" � =..:__'� � , -,,,,_._ � -•--_._.__-___ _ _m��I
.� ,, . .,
,. . .
� ���� �� . _ _- _ �.=�
' _ '3' � ` ' ..
GZ �
:. ,. _ >> _. . .. .. ___.-__
"� .f �
- : ' ti .,, ��I; , � . t
,...,. �._.. ` ..._...,..__.._ ....._._.-. , . - .. , _...... ' .. . - . ..... . . _ ,., _._..._.....,_..__.....__. .....____..�...��
. i .
t,_ . -
. , ;. .. �� ' . ; , ..
. .
-�- , _ � . . ; . _
, T-�..�
; '„" �':J,.,,.... ' - - __.._.. . _._ _ ..____....._ .'__. . .._..___._'
. . .,.. . '. ,_ _. . . , .
. ;,
.__ : ",. " . . , ' .i�, . � . ' "' _'........v__.___._._. . ___...,.�...._1
... � , .. �. -
. �� _
' ,.._._ 7_ - . �-, - - � . ..... �
..,
.. , . ._ ....._,. i. , _ , .,, •'�_' � . _..__�._..__ �. .
t.� �. .. � . . .. .. .. ___ . , . . _._ ,
.. _ __ . .. . , s , � � !
,_�,.,, , .:, ,,, . ,, , , . . - . . �__.�__.... . .
� � .. ..
� . ..
_.__.. -
..._.. '- - _'_ '. "
,. �
,c. ,: ti_:_�a,_ ... ..�. ... ..�. ._, _ . . . ... ..
`--'. _..�._.,-". . .- . .
' .. . . .... .... .. .
: -.. ...,.. , _ , �.. _ . -- -'..._...._._--"____�-'
_. .
�.
`F'.�. �� .�,., � ...:. - --_. �____ . ,.. _. ___ . __..�_�. ------ . � -
, __...,....w... _. _ . . .__,_ . , �
�-..�.s:r+..! . . . . _...�....�._.-�__ ___,_._ .._.._.._- �
'E
�4� . _ . _ .. . . . . __. . .
_,._.. -. -'`__ . _- ,
.. . . .., . . ,. . , .
r .� .. , . , � . . ..., . ,', ,. . . .... . . .._ .,,._�_...._.,..___._.,._._ �
� .. '.i s, �.�
. _ . _ .. , -. _..."'" . _ _
,..__ . _ _ " ' � �
r
. . ._ . _,. ., ' �{ ' .
t'
. _.
. ;-� . .�.., �l . 1, / _._�. .._._.._ "
3
e. . o- . . . .... ..._._._. . � .
.....->, ' """`" - '
�_ , �.-.> r,- . � -� '
- • :..
�.
. .. � �
-� t. . � �A
t..., . , . . .....__..�_
y_ -. . . �.'� '.. :` '� : , . ," '"" "" "..�...� ..."'_"",.._.__. ' ' "' _ ' " ".. .r
_ ... . , . . .. . - rv . . �. .- �
. .._ . .... . . .
�. ,
. �
, ... ..
„ : . ' ' '_ "_...._.� ._,.." "�" ' "" ' " _.._....__.;
f
. _.
. . .. ,,, \ . .
.,, , .
�.., .,.. ... . .. . . . . . __.,.. _..___ , ___ . . _ _ __ _"___._
,..._._ _ __ _ ' . . '_ _ . ..
� _.. .�� � - ,
, '_• .-�:, .:,. . .. ,s , .,, . ... _ - _ _. __...._..._... .. .. ._ . . .....�.,..... _
.i�,r_
. ......... .. . .. .. _ . .., .
..
,
' _ . .p. '-=,_.r, : � ..tr � 'i,. _ .
, ,. .. �.. 1� _ . � _ .
_. ,.. .�/ � _. ., _ ._� _.._ ..._...._.____._.___.. _.. _, __. _._
�"`�i;�'•� _. .. _ _ _. _ ttY z �t
.� ..
--�....��.� , �
_ .:� -. ., �... _
, , _
_ �
, . .._. _.. . . � .�.�_ � _ ... .._ ... - - ' • --,"--..,...w.��.---�--..�- '
; . _, _.___.. . ,
�____.__ . _. . ....._—— — ��'i 1 � ___,.__I
._.�
i
. ,
. .... ., „
`;`s- .'..°�_ '_ y � . _.. _____,_.___r_____..�t._ .__. ., _._.a.�_�__
. . _ , � __ , _.�.. _ _ . _ _ . �
._..�, . .»__..._ .. ___ __...__,..�.._._ __--- . . ,. . ______v._._,.. i
i
;
___... -- � -- _.._._--_--_____ _.__.,..__ — ---... . . ,___�._._i
;
4
,._.,._.._. �.._., ...,, . _._ _. _ " __,..« . " _"__ .. _.. .,_ _. �..._��.._..a...�._-�...�....-.�_..��._. ._ "�_�...._�
.. ,.�._ . _ , . . . _.. . . . _ . ............ . . . ._.. . , - .......__... ..__ ..__..._—._._ __ _. _._.7
�
�«_. ..�_.... _ .. . ._,.,.., . . . ._' '" " ._...... . _..,"__ .__... _ ...._._""___.�.... ....._.._�-...'_"'..__. . ._ . _.....,._.a
� �
"_"..._ .. ._ . . .__. .. _ _ _ .. .. ___.. _ . ..__.......�_..._.._.........��__""""___.... _ .. _" '"�
.. � ,.�..,...... �
�
_-'"'" . . ""
.,.... ... ._._.._.. .__.__ �...._._...�.._...__..�._....._..... .. ' '"".e.."'.,,
.... ....... M _ . - .
• _.;. ,. . . . .. `
.:.....-'. ,. ,. . : , - . .' . .. _ ___.._.1
_ . _._....__ .._�...._..._..,.,�._.. __.
. . ' .a . _. _ _ - . .. _ _ i
, , , . . � . .. , g
: ... , . � .. . _ . ... ..._ . ."' ' _ . . �_......._.__�____._,.....___�_._. -
. ., . �
. , � . , . '�� . , ' , . . , _,.. . . . _'_ _ �__ -_��� . ____ i
-----1�'r.�--- CTTY OF'DIAMOND BAR
I DEPARTMENT OF COMMiJN1TY&DEVELdPMENT SERVICES
,e . 21825 E.Copley Drive
(909)860-3145 Fax(909)861-311'7 ;.�,�� P�ESS
�""'" BUILDING PERMIT APPLICAT'ION ` FIRMI_Y
,
� JOBSITE �p �/ p�. • APPLICATION PERMIT }
¢ ADDRESS �Gn� f i �'l��r�� �� !�� �� I�t C'^t` � P!C
t
o DATE �2� � t�'= Z NUMBER;sK� I" # OCC G `�' � •
� � ISSUE . r ' TYPE
APN LOT TRACT DATE y
°rp O W N E R `p 3'•r"v' a CONST. GROUP
� ADDRESS , w r' i�� �
o �-� � '�.� l:`� a iU �E f� i r�--t vf•a• ZONIN ETBACKS
oCITY '•t„a sa,a�.i_ `�R.�ZfP � T�L. FRQNT Ryy p
o APPIICANT� )'!'� :n�,a!__ hJ," TEL. REAR �
z '
�� SIDE/SIDE STREET pyy p
m CONTRACTOR '��`� �C� i f,�" f.,�,t.y '3-�-r ,r. ' �- SIDE �
� ADDRE ? , � , . ,K, ..;•9,f,, i � '- � � f !�'1���'�.�\�vKl�._ `�,.J l�F'—
o CITY �° 41 y M � 21P�'')TE����1'',.F���g PROPOSED USE
wo ARCWENG/ � � �.r �I �r S�o,� °- '��'E:'�'�'
z DESIGNER
w NO.DWEL. NO.
a ADDRE55 N�•
� CITY Z�p -�� UNITS STOR►ES BEDROOMS
�
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/AOD/REM
O
p I HEREBV AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM IXEMPT FROM THE CONTRACTOR6 LF GaragelCa�port
W CENSELAWFORTHEFOLLOWINGREASON(SEC.7037.5BUSINESSANOPROFESSIONSCODE.ANYqttOR (n
U WUNiYWHICHREOUIRESAPEFlMRTOCONSTRUCT,ALTER,IMPF�VE,DEMOLISH,ORREPAIRANY57RUG
w TURE,GRIOR TO ITS ISSUANCE.ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FlLE A SIGNED W PaI10/OBCk
� STATEMENT THpT HE OR SF1E IS LICENSED PURSUANT TO THE PROVISIDNS OF 7HE GONTRACTORS LI• �
g CENSE LAW(CHAPTER 9(COMMENCWG WITH SECTION 700U)OF DNLSIDN 3 OF THE BIISWESS ANO PRO- PODUSpB
� FESSIONSCODE)ORTHATHEORSHEISE%EMPTTHEREFROMANDTHE6ASISFORTHEAILEGEDEXEMP- (�
V TION.ANYYIOLqT10NOF5ECTION7031.5BYAN7APPlICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Ra-Raof
A CNIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(SSao�.)
� ❑I.ASOWNEROFTHEPROPERTV,ORMYEMPLOYEESN7THYJAGESASTHEIRSOLECOMPENSATION, � COfllmBfClel �
Z WILL DO TME WORK,AND THE STRUCTURE IS NOT INTENDED OR OFfEflE�FOR SALE(SEC 704/,BUSI- J
� NESSAND PROFESSIONS CADE THE CANTRACTORS IICENSE LAW DOES NOT APPLV TO AN OWNER OF � �,��
PHOPER7VWFIOBUILDSORIMPROVESTHEREON,ANDWHODOESSUCHWORKHIMSELFORHERSELFOR � �
CC THROUGN HIS OR HER OWN EMPLOYEES,PHOVIOED THAT SUCH IMPqOVEMENB ARE NOT INTENDED Op m � �
W OFFEFEDFORSAIEIF,HDWEVERII�EBUILOINGORIMPROVEIAENiIS50lDWRHINONEYFJ�ROFCAMPLE-
� TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
Z IMPROVEFORTHEPUPPOSEOFSALE).
_ ❑I,ASOWNEROFTHEPROPERN,AME%CWSIVELYCOMRACTINGWIiHLICENSEDCONTRACTORS
W
� TO CANSTRUCT THE PROJECT(SEC.7a44,BUSINE55 AND PqOFESSIONS CODE:111E CANTRACNRS U- V3I1Je�lOf1 ' ADJ.AREA
W CENSELAWDOESNOTAPPLYTOANOWNEflOFAPROPERTYWFpBUILD50RIMPROVESTHEfiEON,AND
� WHOCANTRACTSFORSIICHPRCLECTSWITHACONTRACTOP(5)LICENSEOPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION FEE
� TORSLICENSELAW).
Q ❑t AM EXEMPT IINDER S�C B.&P C.FOq THIS REASON Q
� U
� �
DATE OWNER �
� W
� LICENSED CONTRACTORS DECLARATION W
� I HEREBYAFFIRM UNDEfl PENALTY OF PERJURY THAT I AM LICENSEO UNDER PROVISIONS OF CHAPTEH �
d 9(COMMENqNGWITHSECT10N70oo)OFDNISION30FTHE9l/51NES5ANDPROFESSbNSCA�E,ANO Z
X 1AY UCENSE IS IN FULL fORCE AND EFFECT.
LtJ .-d.� � � [�
� I,ICENSE GLq55 �' � �LIG NO � � � � J
V DATE � "� �' `S CONTRACTOR } f ;..-V�'"_,. d
W � .� ... ;;, +,..
� WORKERS'COMPENSATION DECLARATION Q
� I HEREBY AFFIRM UNDEH PENALTY OF 7ERJURY ONE OFTHE FOLLOWING DEGURnTIONS: Z
O ,_�ryqyEAND WILL MpINTAiN A CERT�FICATE OF CONSEM TO SELF-INSURE FOq WORKERS' _
a COMPENSATION,AS PROVIDED 9V SFCTION 87oa OF THE LA80R CO�E,FOR THE PERWRMANCE �U
Q OF THE WOpK FOR WHICH THIS PERMIT IS ISSUED �
w _IHAVEANDWILLMAINTAINWORKERS'COMPENSATIONINSURANCE,ASREQUIREDBYSECTION
Q 37ooOFTHEIABORCODE.FORTHEPERWAMANCEOFTHEWOHKFORWHICH7H15PEFM1T15 �� �/t_•ry �.�
ISSVED MV WORKE(R�S'�CAMPENSATION INSURANCE CARRIE AND POLICY NUMBER Aq-RE CONSTRUCTION T L �7 �
j cARalEq -'S r t�`, ' �-'V�L� li � pLAN REVIEW (�( . ��
� POLICYNUMBER���'"�°�F- � ELECTRIC ' '
Q � .. E ar �
o �ni�ssEcrrovnE�noroEoa.wi.erEooF�a�rwns�oaa�rn�wr�Eooa.w�s siao�oa�Fss� � PLUMBING
Z I CERTIFYTHAT IN THE PERFORMANCE OF THE WOHK FOR WHICH THIS PERMIT IS ISSUED,I t MECHANICAL
(,`} SHALLNOTEMPLOYANYPERSONINANYMANNERSOASTOBECAMESU&IEG'iTOTME •
� WORNERS'COM7ENSATION UWS DF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPEGTION FEE
� SU&IECTTOTHEWORKERS'COMPENSATIONVROVi510N50FSECTION3loDOFTHEL4BON �^-f �,� G
� CADE,I SHALL FORTHWITM COMPLY WITH THOSE P OVISIONS > , SSUANC � L-
� 4y r �` 7 �
p )
p DATE: Li i x .k' l APPLICANT "� ,. �-^''L-^"�•'r', r �' �•��
v y � .
J WARNINO FAI UFE TO SECURE WORKERS'COM�ENSATION COVERAGE IS UNUWfuL,AND SHALL BE ENEflGY P!C
� SU0lECTANEMPIOYEflTOGHIMINAIPENALTIESANDCIVILFMESUPTOONEHUNDRED.TMWSAND r`_�
UOLURS(SIOo,oCo).IN ADDITION TO THE COST OF CAIAPENSATION,�AMAGES AS PROVIDm FOR IN �� �
� SEGTWN3T080FT11ElA60RCODE,INTEREST,ANOATfORNEY'SFEES. MhIENT10NFEE• � ��O�
a CONSTRUCTIONLENDINGAGENCY PR - FEE:
O
� IHEREBYAFFlPMUNDERPENALTVOfPERJURVTHATTHEREISACONSTPUCTIONLENDINGAGENCY
FOR iHE PEflWRMANCE OFTME WORK FOfl WMICIi THIS PERMIT IS ISSUED(SEC 3ov'!,CIV G).
Z
W
� LENDER'S NAME
1
F_ IENOER'SADDRE55
� 1 CERTIFY THAT I HAVE READTHIS APPLICATION AN�STA7E THAT TNEABOVE INFORMATION IS CARRECT TOTAL FEES �
w IAGREETOCOMPLYWITHALlC1TYANDCAUNTYOflpINANGE5ANO5TATELAWSREIATINOTOBUILDING
� CONSTRUCTION.ANDHEREBYAUTHORIZEREPftESENTATIVESOFTHISCOUNTYTOENTERUPONTHE '
J •
ABOVE-MENTIONED PROPEHTY FOR INSPECTION PURPOSES. �'�h � � ' l 4�G�
Z COMMENTS - (.^ ? � �-j '�y
� i � i, '�'-1 �t..��.s _---
m PERMITiEE NMAE�PRINT)
Q 5 � =s' �
� �i f � � l�i � -
� SIGNATUREOFPERMITTEE """"`"'" '.,, � ' �AT� �'
= REGPT.NO. PAID BY __ VALIDATION_�=.
~ WHITE—DepaAmerif Copy,YELLOW--Finance Copy,PINN—Assessor Copy,GOLDENRO�Fde Copy,GREEN—Appticant's Copy
�
�m S p�KK k� b��' swr°�d'��'#`..�.`3�w,���Sn.P k,AB�i g .
�������'.��"��.°��»� t��.����
, r ;J, ., ,. • � . .. ;,;
' , " ' ' a � � ��. - . . . � ... . . ..... . " , i�'3�'i . � . . . ��.�
,,. . .� �, . . ., 1��.... ��+ `,. �
-. , �, � ',� .��"i.i�- . , . . ' ' ��
E�s�..���'.tt�r�.���.���ui�`.��" �1�.����r��`� ��u �.., (�
�. , . ' '_ t '� _ "' ' ' --' -- �<� , ' ,.. .���i.��� �' � ° -- - ' ' - , - —""— €
;- �`�L)��'��11�
� - - - - -- - . . __ . . -- - :-- - -- - - - -
TEi'�E�!�C?'r�lEi� '�iE'.EI'��tC�E �'C��vL}c�EA���
_ __ .. .... .__ d _ _• - � � _-.-
. _ _ . _ ° ._... _ °_ _ � _• __ __ __ ._._. _'___
�'fa611"F(=�e�EHVEC� ;Pd[I(3 FIT,i-3{�P�1f3 l���t�di
----- - - - - - - - - _ _.
1-�C���S�-4Ei�TFilt�i{� _.`._�----.__�._�_�______.�__._____.._� ,i�'�l�C71Vt3 t�3Fr�1l�' ____ _��--- --- -
r=�r1l�!(`�C?ltr=l�3l`I�t�'?"�(�fv �t=�Nl�,i E;t;)I�1)}3f=lzt:�i
�tC�t�t CC�`J6"�3 -_.__ — ._ _�� -��"'-L�Ri-;f�El�{� �- --_�._______ _
--__-_ ���______------ __-.___, ._-._—_-- ----
�h?�}�iG�r i-9�ilTli�ii� •---- -- -__. ,t3�[vC:h(N�
� ------ - ---- - - - ---- -- - __ -__.__ _ - - . . __ � - - - - - --
�F?vu}!:H CLI�C:1`f�i� .._ '�C)I;GH Ci-?:��.DlPiG
--- -- ------ --- - - -- -- - .. --- - - --- - � -- - . __--- - -- -- - ' -- _ - -- -- ----
�C}U�=<H �!til���lC�ti� �1�1lS!f��dA��iv�
------ ---.---- - --- -- .. _ _� _ .--.-- --- __. _�_.__ .. .. ____. _.__
a1-1C31�J��?t�i"l3�T��i Pn�L EL�CT�I� __ ._�. ._. __.___._____�_ .__�______�_ �.___ _
- - -- - - - -- - - - - - -•- -- - -
�:XT.LAT3-1?SlLiEI�� --- 't�t3L F�€�CI�JG
- - . . . , . _ : _ _
��VY�4�...�,ll���'3��..r3�3{��i� �i�'���.�"3�1`�i.. ' ' ' ' ' ' ' _
�Cs��.11.,?I�� I���st)1.`1�'(!`?(� ._ _ < . �F��j(T� 3(tl(','1. , . . . .
I�I?YlE1'At_!3�as�1?E?�� ��U�C;�T!C3tv:;
1�t~'v^�f�€'4' :f''.l>:! 1=�Ci.
�5;�1=�IC ����i i "�,€�a(=�:C�11>t:%iE�[�;{�;. .
_._____------_____._�__--------- ---------__.._._ __ _ -----_---- —— — --------.._�___---.__�___..-- .--- - ----. _.._____.__._.__�_______�_�___�_�.._._.
�;if'�="r'�=�?"!f ,t. �,it.3;YIT� (Cf91'S.
_r___� �_'y.-�_^-_C_�-�_^_---------- --------------•-__ __ __._.-_ _---�.._ _ W ,.--- -�-- - -7�--{-�- --------- ------- � ------_____-.____�
��t�si rlir5�L..J 3 YWi4'iYt�.����Yt�Y�.9
___..�"__..__'_."_'�....._...."_v_._..�._'_....._._......�"'"._.. ""'"""""!\_.�. ..,- ...... .._.......... �.___._...__..__....� ....._....._�. _. _ .�._..____W_....._._.�..`._._......_.__..._.."'"_"_._�_,.
����1€I��..vi����'°..�. � '�i��iJ�C'I Y ;���_
__ ._. .. ____ ___ _ _ _ _
€t�I�il��.��fS.�i��M P��f�l�.�� C��.��.�1i1�l��_ - ..
�- - '--------_ _ _ . � . , . . - --- -- --- - - -
:s'=I�AL CC.C£;'CFiiC ��='�.F"�'Eu i�l�i�
p �_- - ------ -- - ----�-- ---- -- -- - -- - , � _ . � ----- - - - --
��"2R!r,l_PLi1�=:clll�l� . _ . . :'=:��F�,��! . - - - - - _ ,
� - - �-- , � , - - -- - - - �
� . . ' _ �
�t.����t���`���� ��'��
� /,�-f/�,.� �' � c��d'� _�'J� �������'��?� 1i1��� ���� ��/`4�
�
�
� - - --- - - - - - -
�
�--- _ _ . __- - - _ . _ . - -
;
� - E
� �
�_ . __ _ . _ .. _ . _ . __ . .. ' ' _ "'""_ ""' " _'. �
�
3 ' ' '" ' " ' ' ' ' ' ' '
jj
i
.... _ __ . . _ _ _ _ `
� "'___
� :'��������3Y�Yi���C � ' _ . ' " ___
� w�t-.�5�" t�"3�t.''L.�aSIJF__ _ __ ' _ _ _ _ _ " _.
� . ' ' _
� . , ' - __ _ - _
� ' r!0� ��i , "' ' '_ " ___"' ' '_ ' ' ' ' ' ' ' ' " . �
� . , ,, • ' ' _ ' _ '�4
� (
� �� ' ' � ' .. ' - €
� #
. ^ (
?.......................__..�...._.,_..,....,..,.._w,..._...............,_....
. . .. ... . ... . .... .., .. .....,..,...., ...... , .. ...., .
. ......... .....___,�__-___._._...,,...._..._.....,. .,..
CITY OF DIAMOND BAR
� DEPARTMENT OF COMMi7N1TY&DEVELOPMEN'I'SERVICES
c; . 21825 E.Copley Drive .(�
(909)860.3195 Fa�c(909}861-3117 `� PRESS
�'""� BI)ILDINGPERMITAPPLICATIOl�i FIRMLY
� JOBSITE APPLICATIO PERMIT , P/C d.....�-
o ADDRESS �C�� tVA F`V1��� �9/�� DqTE � ��c= �l.- NUMBER`�_���
o� ISSUE TYPE OCC
APN LOT . � T CT S y� � DATE GONST. GROUP
°C OWNEF7 K�6'+� S' �
O A�DRESS_3�y 7� �M �� �✓' ' ZONING SEl'BACKS
Z CITY ZIP TEL. FRONT RW O
p REAR p
o APPLICANT TEL StDE/SIDE STREET RW p
z
¢ CONTRACTOR L- �.-% t G._ SIDE ❑
ADDRE�S s '
� CITY d[�'1 t ZIP` 1� TEL.Z 1 fS`�if7 5 7 PROPOSED USE x`� L L��%d.
o ARCWENG/ �j � 'c� "'�C 'r� 1 �c i
z DESiGNER i�._ ��*e��.I� E� AS�<-- NO.DWEL. NO. NO.
a ADDRESS % . &� UNITS STOAIES BEDROOMS
a CITY"'�� '' ZtP`�� TEL. �
�
u� DESCRIPT{ON SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DEC4ARATION SFRIADD)REM
O
1 HERE6YAFFIiW UN�Efl PENALT'OF PERNRY THAT I AM EXEMPT FHOM THE CONTRACT00.S t4 (�`afage/Cefpolt
W CENSEUWFORTHEFCLLO'NIN6REA5011(SEC.�oa1.56U51NESSANOPROFE55KXJ5CWEFNYCRYOfi (n
U COUHIYWHICFiqEOUIqESAPERMRTOCONSTqUCT,PLTER.iMPflOVE.OEMOUSH.oqREWURANYSTfiUG W pafiD/Deck
W NpE,PRIOR TO RS ISSUANCE,q�,50 REOUIRES THE APPtIChN7 FOA SUpi PERMIT TO FllE A SIGNEO �
� SiATENENi THR7 HE OR SHE IS LICENSEU PUi15UANT 10 THE PROVISIOryS OF 7HE CONifuGTORS LL
� CENSE LAW(CHAP7EN 9(�A�ENCWC.NAT{SE�T�ON 7000)OF DIVISION 3 OF THE 9USNESS AN�PRO � PooVSpa
FESSi0N3 CODE}OR 7HAT HE OR SHE IS IXEMPT THEREfROM AND iHE BASIS FOR THE/LLLEGm E%EMP-
V TKMI.ANYVIOI.A71oNOF5EC710N7o31.5BYANYAPPLICAMWRAPERMIiSU&IECTS7HEAPPLICnN�TO Z qe-qppf
ACML VENI�TV OF NDT 670RE 11iAN FNE NUNDAEO DGLLAf15�S5o0)):
OlA50WNEFlOFTHEPRpPENTY.ORMYEMPLDYEE5WIh7.WAGESASTHEIRSOLECOMPENSATp�J, Q
p Commercial -
Z N7LL 001ME WOHIC,AHO THE STRUCTURE IS NOT INTENDED OR OFFERED FOH SAI,E(SEG 1oee,BUSL J
� N�5$MIO PROFESSION9 OOOE:iHE GONfRACTOpS LIGENSE LAW DOES Nai A7PLY TO AN OWNEfl OF �
PROPERTYWl106UILDSOP6AVROVESTHEHEON.ANDNMD�OESSUCHWORNHIAISELFOIiHERSELFOR �
� 7HRW6HHISOpNERONMEh5P�0YEE9,PppVIDEDSHATSUGiIMPROVEMENTSMENOTWTEN0E00R
OOFFEPEDWqSALE1F,HOWEVEfL7HE8U1LDINGOHWPROYEMFNTI550LpWfTNINONEYFAROFCOMPLE�
Z TqN,iHE OWN�P-9t11WER Wll;HAVE THE 911RDB7 OF PAOVIN6 THAT HE OR SHE�ID NOT BURD OR
� IMpRpVEFORTHEPURPO5EOF5ALE}
D 4�OWNER OFTHE PqOPEHTY,AM EXClA1SNELYCOMRAGTING NATH LICENSFD COMMCTOpS
� TO CON5iRUCT THE PROJEC7(SEC.70aa.BUSMESS AND PROFESSIONS CODE THE CONTMCTORS LF VdWdGOr1 ADJ.AREA
W CENSEUWDDESNOiAPPIVTOANOWNEROFAPROPER7YWHOBURO50RIMPflWE3THEREON.AND
� LNi00DMRACTSFOPSUtNGAWECT5WITHACONTMCTOR(S7LICENSEDPURSUANfTOTNECONTRAG QUANTITY DESCRIPT�ON FEE
� TORSLIGENSELAW) �y�.�{
❑f AM EXEMPT UNDEfi SEC B 8 P.0 FOR THIS HEASON Q V'i./ �./Y � ^.�✓'C�..
� ¢ � Lr�G.
Z once ONMER �— � ���
w
� LICENSED CONTRACTORS DECLARATION �j � �
� I HEqEBYAFFIMI UNDER PENq�,7y OF 7EiWRY THNT IAM LIGENSED 11NDER FFOVU^�IN'!8 DF GHAPTEfl I J��p�
d 9(COEIMENGNG WffH SECTION J000)OF DMSIOIA 30F iHE BUSINE55 NJD PROFESS10N5 CqOE.OND Z Q�/ �'
X MY UCENSE 15 M FULL FOflCE AND EFFEGT m
L11 �/C y'J
� LICENSE CLASfS �,�_�(� LIG NO. 7 /�ly�`"?��^/�� �
V DATE_�/z�s' q,L CONTRACIOR .1 L� L.�^u-C��L �
�
� WOqKERS'COMPENSATION DECLARATION ¢
� U
� I HEREBV AFFIRM I11iDER PENAL7V OF PERJURY ONE OF TNE fOLLOW WG DECLAMTI�NS:
�j Z
Q
� IFUVEANOWILLMAINTAWACERTIFICATEOF('ANSENTTOSELFiNSVRcFORWORKEflS T
Z �cAMPEAt5AT1Ofi,ASPAOVtDED9Y5ECTlONaTOaOFTHELA90RCADE,FORTMEPERFOflMPNCE U
¢ 7HEWORICFORWHICHTHISPERMITISISSUED. �
W
1 HAYE ANO WILI MAINTAIN WQFIKERS'GOMPENSATION INSUPANGE,AS REWIqED BY SECTION
Q3�o00Fh1ELABORCODE,FORTHEPEflFORMiANCEOF7HEWOqKFONWNICHTHISPEFlMRIS
¢ ISSUEDMYWORNF��VFjN5A71DN1yBV��GE'C(�RA�ERANDPOIICYNUNlBERAAE CONSTRUCTION
7 GARR�ER ��J �L..-q��.�L �9 d PLAN REVIEW
0 POLICY NUMBER '��._=_�V 7 FJ� ELECTRIC ' "'��v
Z
4
� (n��ss[cnaur+�IDwo7eEco�IDOFn�caa.si�swr�o`giamnr+mocr-inAsR+mlotit�sy PLUMBING --
W .. � MECNANICAL
� . . . :tin�v•ti:�� �t• � � '. '
� ,,. . , ' , , •��r.� • s INSPEC710NFEE
.��', ' ,,1� r••' ,, ,Fa '•,'�•.I:, 'I,••.,•,�•' � � . ,� i �S L;'s'�,.
� CODE,ISHAI.LFORTFIWI7HCORIPLVWITH7HObEPROVISIONS ISSUANCE
0 SMIP
� DATE. APPLICANT.
w ENEAGY PIC
� WARNIN6.FAIW0.ETOSEWREWORKERS'COMPENSATIONGOVEflA6EI5UNLAWFUL,M'DSHALl6E
� SUBJEC7ANFJAPLOYfR70CRiMINALPENALTIE6AtJUCMLFINESUPTOONENUN�pLDT11qJ5AND ENERGYPERMIT
DOLLAA:(5100,000),IN ADDIT7qiS0 THE CAST OF GOMPENSA710N,DNAPGES AS PflOVIDED WR IN
� SECilON9'loaOFTHELA90RCOD�INTEqEST.MlDATTbNNEVSFEES. RETENTIONFEE' � �
pw,. CONSTRUCTION LENDMG AGENCY PRE-ALT FEE:
O
� IMEIiEBYAFFIRMUNDERPENAL7YDFCEpJUAYS}UTSHERE55ACON5TRUGTIONIENDINGNGENCY
FOR THE PERPoflMANCE OF 7HE WOFiK FOfl WMICH THIS PEflMR IS ISSUED(SEG 9De],qV C).
Z
w
� LENOER'S NAlAE ._ ,
F— IENOER'SAOpRE55 �
� ICERTIFYTHATIHAVEAEAORXSPPPIACATIONANDSTATETMATTHEABOVEMFORMATpNISCARAECT. T07AL FEES \:i� ' ��
W IAOREETOCOMPLYWIiHALLCITYANOCOUNIYORDINANCE5MJ�5TATFUWSRElATINGTOBUI�0ING
� CpNSTAVCTION.ANPHEREBYAUT110PiZEPEPRESENTATIVE50FTMSCWNIYTOFNTERUPO.`7TFIE
ZABOVEJ.IEPfIIONED CROPERTY FOR IIJSPECTION Pl1RPOSES, GOMMENTS
Q er j �y
� � VY��rJ L.�: I ���✓
m PEwartr nMEIPwrJ�
Q .�_�^"'. �L� r,.
t!! �/
� 51 EPAit7iEE E A
RECPT.NO_ ` PAID BY ���� VALYDA710N
_
~' WHITE-0epaAment CoDY.YELLOW—Fnance Copy.PINK—Assessor Copy,GOLDENROD�--File Copy.GpEEN--Applicanl's Copy
(
�nd'� $ � �� ��$`������ �.G��v �
�������� t��� ������
; ��:.., ,, , ,, .
� ,:�, :°' �� .�W�.. �?�1 � 'Y 1� "6 �fr k'. ,!',`
. , , . . . . .ti , '"R P i
,' . ,.,,� . . ��„ , ... ..� ^", , .� .., .•�i.. ... . .... .. . . . ,. , .,.. . .
. ., , .:__���._� ..,.. ... �._.�.. � . k� . . .. .,,,,, „�.
j S�T�S�GK __ "..—� : �`I.CIt��at3,ST _.._�. ..�..___-----
;�l"`�S`f=,�,��,iSISTE�� � FP-If��Ct,�t��s�{`S �
__v__p_S�w�+�-y `tp�y � _.._�_______�_ _ _.__ ,_ t�qg t�r�^
frk` p__�_^_�,_�_^.,_� _�
;'=�����'itv ViT.{�IUR�IJ kJiY.��t"�t Lt,.+�i':LJs1S✓# 3 .
'"" ___""" ' _ ' _° "'"' " '_ ' " "_"' ""_" '_'_ '"" " ""' '_ _"'
_ _ ' '' _'__ _ _ _'_"""""�'_ ._"_
;t�s��€,��,�J���.��t'3���.F".x " ---- ��'��:�=�i���i�1,������ � -- --'- - - - -
('- --- - ------ " '-.-` —'•--------- ^ -- - - "-'-- - -------�-- °---" ' ' -- --- _--•"
._. _
:LF1E3 t�l�iAL�'i� C-1R�F��le`,E YC�Il�1P�C3f�.T1C}1, t
-- --- ._ ,_.. ...- - - - ---�-- ---- - - - ---- ------- - -- -- - --- --- - ----- - - -- - - - --
`y --- -- --- - --- - ---- ---------- �
1-Ett�1�F'C7t���� '�>REPLi;'�k B�hlC)HEf�f�� } `
- -- - - -• ------ •- - -- — --- --- - - - --- - --�- --......:.._ _ ._..._.__
E::`4#i�T il?SEF'sVEC;E (t!(fCa�-(T.BG�3'�[�t3�l�Fv`� '
--------_ .._-�----------- ---_.—_-- --
____ : --------------__- ---------_
_-__--- -------
!?�C'£�!=�i~3E.AT�fIhfG ���';Bi�i����E,��i �
f.—_-------------____—_._ .�—____�.___--------- --- -------------------------r------____�----------------------
E=f�AA�IF�CNE;ti1'IL�1i lt'��! Fi�I�L i�C}3�[�B�t��� � ;
�_-----------------_�_—____--_._--------------_- ___�_-- - ----�_._�---' -.-- .__.------------
I�?C�t���C?LF�R �i�F��-i��?A'�['�� �—
;_._---___----____----�_.____:��_�---:-------___-------------,__- ----------_ ____..__.__�_.________.�_-----------------__._�_
�3it�UG�-11-{E1�1 I�L"x �3E'�'�H1f1� �
��t"�t3G;-i�L�CTRi� � �?C)l,u?-1 u?��lhl� ;
;;��?UG;-��L?:,�iF��P�IU Fl�"iS�-I�(�A�#'�ta j
'SI-Ir—�4,�dE--i"5r`Tlf�'"EST P�C7L�LEt�1"�It� `'
__}..______ �
��=X'T.LATI-f'�I�iIf�G --- �—�"_---_�___�__.__-� P"�..°C7t,wE�lGI��:C, _..___ __�.... _
- -_�__ -� -- ----_____ .�_�, �.�._.___�� .--.� _
i`ctJALt�iRSi.IL�iTECt(ef Pi�(Jt��i;��it. �� !
�--------------_ ____—__—��----__._-----._.__� .—_—_------------�.�__._.�.._�..--___--
�i,�lLII�G lt�SG3l_�1T��7�f i�I�"�1TE)f�i�S. 1 --
_------_.. ,_ -------------------�------�-------_._____...�
�(�.P��r����,l.L�l,�ti!(_Ii�E'v� � � C3Ei?I��l`It�}'�.�"-, _._ � � __ � _ ..� ._�
'-- ---- --�-- -- __ - -
- --- - , ,
-- }- - -- - --- -
SEt�:��R F��!riL E1�az. � �
-- -- ------- - -----. . .----- ------ - - - --- , >. ------ - - --- ---� --' - - --- - - -- -- - - - --
��PTIC 1�:�4K L:�f�lt�SCF�?�!Ei�Ri�. �- - ----- �--
_ __ ' ""_" '___ "_ ' " ' '" " _' "__".__. """i' __ " " __ "" _"_"'__"'-,_.
'" """_'" ' `_ '" "" ` "'-_'_ ' " '"' __ '
��EP PI�?�..�. � {JN S1T�EUP�. I ;
----- - ------- ------- - -- ------- ------ - ------ ----- - ------ - - - - ---- - - ----- --- - - - --- -
- ---, ,._ ._ �_
i Ga�S Ai?T�ST ; .Fih�A�ZOI�!t�i� '
[�AL��YvST. � ' —_�___�..�----; :�€(iE,�EF�"T� i Itvr'�L --------�__�---- ____�_---_-----____—�_
T----__ _ - _ _ ��.--------------------- ____--__ _�_�..__._-----------
�
,=I��iL FtEAT�!€� , � .v � �__�_�___—_ --------__° .h�Efi[�C}i��f'`C.F(�lF�_ 1
•�, .. , --s-------- . -------------
, . .•.,� ' �C�EL'.r"-EcS F'4!t? �
' ' �EV�h�GY � '
� � �
. :
�.... ....,, . _ .- -
,, .. .
, •:•,.,, ,..
. ,,. �
.� ,„ ,.. :,.,;e;<,', i <;x;;
���I�E�I�T� ____.._ .__.._____r.__._.__.�. ___. ______.._..___�_.___._�____ �_..�_______�_--
- ------------- -- -- ---------- -- ------ ---- - --- --- --- -- -- --
-- - - - --------- ---- - -- - - --- ----
- -- - -- ---
�_�^ � �___�-��__ ---------------___-_--- -------z-- --
- - --
��PTiC TA(�f�SfZE
S��F'P[T!€1 SiZE
• ' '•'.: �i-.,.'�:�,�q�"'�'F'_ �"�� •.';� � — -- --_--'------ -----
' ,�r; '�i+'.,,; t
�, :,,,`� ,,,�,"''A.':,'I �S�SR,;,i,a�;'��y.., ,,E
A�,'ry�;+�xyy`�,,;'.�p '";,• ;�'�'",�„Y^a,,'•, :;'���#i�'� , ______��.._ - —
,.
.� ,
� .
��'�,.,� { . � -- -- - -- - � __. ---- ---' ----- --- "---'- -'— `— ----.........__._ .__
.
, ,�p, ' x�`+xN�*�`.e�'� , �----- -- - ----
_N � � '1 �,,,� .
� , p
� '�'0 �Y 4� , ��� y .�h ____ . ____ ._"'_-__' '_ ___ __'___ '_" "' ' ____" _ ____ _ _ __'__ ' . ..._,
a� F � b �„;
��,� , y;`�f���� - - -""--'- '--------
. �
• n
.,�� � .ti^. iF: �7';k .
�
' r:. y •'
.,���Il,�i�.it �„,f1�� �yp'yq�lu,'A� . _' _" '__
.
� � �n�
. " .
�
�,��,1'�;••',i'''���'i�'�' ,,�ii'���� : _ __ '_'"_""" "' __ ' __- ' __'___ _ "_ __ "'_"'"_"_
fW��•�,Y "�l1���� 1''�7' � ___ "_ ____
,�����^,',���i� I�A', ti°,I _ _______'_"'_________
y,�z:;l•�'•uM�.�Yro-��,.'�„°�;m�J'A��A,',"�5'„��,'Mi,� :,�,c — �.�.__.._._._._ _—_____ .___�_.--._—
, �����o�{ir�ry".�"�"��, t�^"!-':�;�.�M�"�,.'le.�,.,��",
„
,
• .. � ;,,r,,
,'
,.
. .. � ,� .
. } • • ,
i,«.»..,_...»... ..� ....... � .... .. � ..,«...........@�,.....................,.,.,.,..,.._,_.,.,.o�.�... n...�,....,...�.,.,--_w..�m..........,�.m...�_.��-�-�—_,........_.w._...�.�._......--....m.......,............._...
_ �� CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY 8c DEVELOPMENT SERVICES �
� , 21660 E.Copley Drive Suite 190
(909)860-3195 Fax(909)861-3117 � � PRESS
�"9�" BUILDING PERMIT APPLICATION FIRMLY
oJOBSITE ��r–y � �w u�i L� A��. DATEICAT�I.QN • PERMIT p/C ,Y.,_
¢ ADDRE55 1 c� � E'3 NUMBER `���r:#
$ ISSUE TYPE OCC
� APN �OT—l � TRACT � �_ DATE CONST. GROUP
p OWNER t vtn T /?/S�! N�/r=11[
p ADDRESS_'�d!"� e,.l i�N-�-�• 4 l 4 /�— ZONING SETBACKS
Z CITY I�. 1�M. o w s�F��jW TEL. FRONT RW ❑
g APPLICANT TEL. REAR p
� _ � SIDE/SIDE STREET RW p
CONTRACTOR 'Z " : I�t...rt �.a� SIDE �
o ADDRESS 't �� � PROPOSED USE ��-���"�' �
o CITY G� O ZIP 7/7/OT'EL.�__2 G S
o ARCHlENG/
z DESIGNER
tu NO.DWEL, NO. NO.
a ADDRESS
� CITY ZIP TEL. UN4TS STORIES BEDROOMS
�
cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREFWALUATION
� �WfIER-BUILDER DECLAflATION SFR/ADD/REM
O
I HEHE9Y AFFlRM UNDER PENALT/OF PER1UflY THAT I AM EXEMPT FpOM THE CANTRACTORS LI- Gd�39B/CefpOfl
W CENSELAWFOPTHEFOLLOWINGREASON(SEC7o315BU5MESSANOPROFES510N5CODEANYCITYOR (n
U CWHT`(WF5{G/REWVRESAPEqMITTOCONSlAUCT,AL7ER,IMPAOVE,DEMOWSH,ORAEPAIAANYSTRUG
W iURE.PRbR TO RS ISSUAh10E,ALSO REOIJIRES THE APPIJCANT FOR SIICH PERMIT TO FILE A SIGNED W Patio/Dack
STATEMENT THAT HE Oq SHE IS LICENSED PURSUANT TO THE PROVISIONS OF TNE GONTRACTOfiS LI-
�g CENSE LAW(CHAPTER 9(COMMENCINO WITH SECTION 70Da)OF OIVISION 3 OF THE BUSINE55 pN0 PRO- � PooUSpa
FESSI�NSCADE)ORTHATHEORSNEISEXFIAPTTHEREFRaMpNOTHE6ASISFORTHEALLEGEDEXEMP- (�
U TION.ANVVIOUTIONOFSECTION7031.6BVANVAPPLICANTFORAPERMITSUBJECTSTHEAPPUCANTTO Z Re-Roof
� A CINL PENALTY OF NOT MOHE 7HAN FNE HUNDRED DOLtARS(f5oo)�.
� ❑I,ASOWNEROFTHEPFOpERTY,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECAMPENSATION, 0 COIi1fI1BfC12I
WILL 00 THE WORK+WD THE STPoJCTURE IS NOT INTENDED OFi OFFERED FOR SALE(SEC.704d,B1151- J
N NESS M70 PROFESSIONS WDE THE CAPl�MCTORS LICENSE LAW WES NOT APPLY 70 AN OWNEfl OF �
PqOPERTY WHO Bl11LD5 OR IMPqpVES TiEflEON.ANO WHO W ES SUCH WORK NIMSELF OR HERSELF OR
[r THROUGHHISORHEROWNEMPLOVEES,PROVIDE�THATSUCHIMPROVEMENTSAFENOTINTENDEDOR m
QOFFEflEDFORSALEIF,HOWEVER7MEBUILDINGORIMPqOVEMENiiSSOLDWITHINONEYEAROFCOMPIE�
� TION,THE OWNER-BUILDEp WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE OID NOT BUILD OR
� IMPROVEF-0R7HEPURPOSEOFSALE�.
W ❑I,ASOWNEROFTHEPROpEHTY,AMEXCLU5IVELYCONTRACTINGWfrNUCENSEDCONTFACTOFS
[[ TO CONSTAUCT THE PRQIECT(SEC.704d,BUSMESS AND PROFESgION£CODE THF.CONTRACTORS LI� VeIUBIInn ADJ.AREA
LU CENSE LAW OOES F10T APPLY TO AN OWNEfl OF APAOPEPT/WHO BUILDS Ofl IMPROVES THEREON.AND
= WFIOCOMRACTSFORSUGMPppJECTSWIiHACONTRACTOR(S)LICENSEDPURSUPPITTOTHECOPIrRAG QUANTITY DESCRIPTION FEE
Y roasuc�sEuw.>
O6 I AM E%EMPT UNDER SEC 8 6 P C.fORTH15 REA30N / V� �D� .�`
� /I-7 /'�'�
� DATE OWNER !��� �,�0
S LICENSED CONTRACTORS DEClRRATION � � Q
� 1 HEREBYAFFIPM UNDER PENA�',Y OF PERIURV THAT I AM LICENSED UND[R PROVISIONS OF CHAPTEfl � /
� 6(COMMENCINf3 WITM SEGTqiV 7aDD)OF DIVISION]OF 7HE BUSINE55 ANC.PFOFESSIONS CODE,AND Z �
�� MY UCENSE IS IN FULL FO CEAND EFFECT �/ m
� UCENSECLASS�LIC NO ��f�� j
V DATE CONTRACTOR
W
� WORKERS'COMPENSATION DECIAr'1ATIUN
�
� IHEREBYAFFIRMUNOERP.NALNOFPERIUFlVONEOFTHEFOLLOWINGDECLARATIONS
�
C� IHAVEANDWILLMAMTAINACERTIFICATEDFCONSENTTOSELF�INbUAEFORWORKFRS' .
� CAMPENSATION,ASPROVI�EDBY�ECTION370oO�THELADOFCOUE,FORTHEPFRFOHMANCE
OF7HE W�JRK FOR WHICH THIS PEAMIT IS ISSUEO
Q
� �IHAVEANDWILLMAINTAINWORKERS'COMPENSATIONINSURlNCE,ASRE�UIREDBVSECTION � '
Q 3�oa OF THE LA90R COOE,�ORYHE PeRFORMANCE CF 7HE WORK FOR WHICH THIS PERMIT IS �
i5SUE0 MYWOPKE MPENS�A.i{Iq�t�INSURANC RIE9ANDP0 Nl1M9Ff7ARE CONSTRUCTION
� CAFRIFH�!/+ �""� PIAN REVVEW
� ��—
� PouCYNUMBEa��7 .L v ,+-.-�rL— ELECTRIC
Q
� (iHISSECTJiJNEB�NOTBE07F�LEiEDCF1HFPEMNTl.4i�ACNEhlkAFim�lAAS(S�o�)oRlEss) PLUM8ING ��- ���
w I CERTIFY TNAT IN THE PEFFOPMANCE OF THF_WORK FCft WHICH THIS PERMIT IS ISSUED,I MECHANICAL
Z
(,'3 SHAl4 NOT Ck1FLOV ANY PERSON IN ANY MANNEP SO AS TO BECCME SUBJECT TO THE
(J� WORKERS'C6MPENSq710NLAW50fCAL{FORNIA,PNDAGREETliATIFISNOUlDBEC/JME INSPECTIQNFEE
Sl1fl1ECT TO TNE WOANERS'COMPENSATION PflOVI510NS OF SECTION 3700 OF THE LABOR
� CODE.ISHALLFOfiTHWITNCOMPLYWI7HT FPROVISiONS �SSUANCE �`- `�
� ��y ,�;iv�
p UATE. APPLfCANT �_ SMIP
� ENERGY P/C
J WAFNING FAILURE TO SECUPE WORKERS'C0IAPENSATION COVEf7AGE IS UNLAWFUL,AND SHALL BE
� SUBJECT AN EMPLOYEfl TO CqIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNORED THDUSAND ENERGY PERMIT �i ��
DOLlARS(570�.000).IN Ad101TlON TO THE COST OF COMPENS0.TION,�AMAGES AS PROVIOED FOft IN
� SECTION3]OBOFTHELABORCODE,INTEREST,ANDATTORNEV'SFEES. RETENTIONFEE.
� CONSTRUCTION LENDING AGENCY pRE-ALT F�E•
� I HEREBV AFFiRN UN�EA PEN4lT'4F p�RJURV THAT THERE IS A CONSTRUCTION LENDING AGENCY
n- FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC 3oel,CIV C)
Z
W
� LEN�EF1'S NAME __._
� LENDEF'SADDRE55 . — - — �I�P��
� ICERTIFYTHATIHAVEREADTHISAPPLICATIONANOSTATETHATTHEABOVEWFORM.4710NISCORftECT TOTAL FEES
w I AGREE TO GOMPLY WITH AlL CIN AND COUNTY ORDMANCES AND STATE�-4WS RELATING TO BNLDING
� CONSTHUGiION,FND HERE6V AVTHORIZE PF.PRESENTATNES oF THIS COUNTY TO ENTER UPON THE
ZABOVE�MENTIONED PROPEflTY FOR INSPECTIDN PURPOSES COMMENTS
� � � 7 �
�
m PEAMI EE NA1 RINT)
Q
� ' � Z
� SIO ATURE OF P[RM17TE% DATE J`� �1,�.�
_ / RECPT.NO. PAID BY°� �I�'E� VAUDATION ■ �
~ WHITE—De admentCo YELLOW--FinaoceCo PWK—AssessorCo GOLDENFOD�—PileCo GREEN—A hcanYsCo
P PY, PY. PY� PY� PP PY
���"�a� ��= u,����:�4���:���� ������
���������"��°M��� ��°:�.������
. � . . • ::.��;�:�,,•.. .. ,�v�;.��r�..
� � ' • . , ' • � ' � • , .. .. ' - ;t . ' ' . ��'��;�'„v�:p,.y
.�4r'��'.$�'r
� . .. . . � . . . . . . ... . . n . ..xn.� i. •. •�. �a.. r�.A�1e. .^pY•.:4xh:IFe'n�`T.�'.�'.
.
- -�-� �-�;� � ' �i S�Ci� 's'��T� . €
: _' , ,,,�'; _.. ... , I
�,. •_
- .._..._.._""__ __�'_ _ '�""'__ ' _ __' _ .._.._ '.d "___ �.__�'_
_' _..._" � _ _' _ -. _ '.�-'- .1_.� � ,
� . �:�r���, ;:��;��-=. , —�� �,�;, �,�:��,U�3:� � �..�
� ,, ,
..: .
.
_..._.__ . _._._. _ --- ---- -- - . __ __.____ . } _ _—^q('� - --!�`�' ---- --.___._.-- . ._.________�_.._------- --
t��£____._' _'_"'__sl,��'�_� .."' """ i-_�_. ._... I_....... . .....__�»._.� .I ll�\iuL��-S(-�';,5�'s.j�� �L14.1h Y ___.__ � + __���_._. .. �
y✓''�'��i.. .-
... s'�1 i._. � ' _ ;-�-�...
. f_r�r•����;-� .�i � `ti�i� ' rt " :,T..� ij� � � .� , � .
�`�=_....... _'�'�` �' ��,��,��i� � �
-. ,., .. s > . .
.. ..... : .. .
:'_
. �.. ::f: � , �
._,_�_. _ ' _� "_' '"_ _ ..__�...._...�"'. .. _ _. . —...-.......�._' " __" ....._ ...-•- ___.. ........... _..._
,
. -+,
_,
� ''� Xdr; ;,,�'r,r4t^t ' !;�r"" _ :�L..I�S E�'�
._ � �... � �a
u.. .
�+
.
- i
- �.': �. � ' . . . �
,...._._,_ . __..._....._.,... . .__.�..'""" �.,_- '"'_ .___...� _ i . .. ._. ' . _.. _. .._.. ' .,� _�_.__ . .._....
.... ...._,. _ . ,.
' • _�.-�i,.; 1,',r � ,: ;; �.:�rs��:. G{(}Ti�,f a[S�"Fi(.f �
,^,.,
:.
-�._....:.._: . '_.._. ___ .. i � - --_��-_•-_ "-- - '--'-_'----_�. __.__._.._-- -' -- _..��------_ _._,_- --'..""
' ��. --,-•, . i
,., _'.�^ „;�_s.;:: �'-- t , 'i�i;i�� .{'� �€� ��ai{
. a<z".;.. � � -
...
�:_ l
�-- _ ; �C3 '�3�` ��
---=- — . _�:=w... . _,._- - -_ _. _,___._____ --- __-_____._. _ - -- —- --- - --- --.�,._--__. -----------
. ,_, �,.. ., ... ;;:; , E � �;:),�!�} �� •
, �.: : . �
. s :- . - y _`". �
. . _.µ- . ,. - . , ___ � _
—.�
..
;_. .. . ---- ----_'...^ -- . _�_.W.. ___.___ _--- ---- --._.___...___ -- -- — _ _ _._z ____ . _.----.— __ __._
! �;� Y�, �
�r — t: ;,"�,t +_ .1 �.. _�,�R� 1 `�
' .".:`rtiiit4 �� ��: Irv ' _
. .
_.. .S_i.." .... '......�.�n
3.iTx.t
...._ . .__.�___ _._�----- --___. _ ._- - - --._— __..— -- . '--______�__._ .__.__-----._..__----------- - —- -- ---------_____..__.----
� i ;1-d�� .� r ��5 = �
�, ,,,. ,, , i _: ��;�,-s
. _. . :
...� ..:` __ . ..
. ,"` __
:___. ____.__-._____-,---... �....._ _._ .._._._..__.____.------ ---__.._---.- ----- ---------_. , ..----.___._---7----._.__._.______ _
_�
; .., ..„ � �
-�.�..�... .,_, .
�_ ":-
, }
, . _, .-i� i`1e4- � ����jke�'; c{,.A
. . ... .... ..�.. . _ _ Yµ :�
' .__._._......___..,_..;.._....._ . _........._.._ ..._.--._�.___....__.. ,.� . ____... -_ __(_' ' _"""'"_...,..____. ._..._...... _.u..._..�.._._-,._.r_�....._�_
, 'r's1 ri.,?"i p:�''�•�t�„ � � ........_i..�.� .�r..r'�'.�3'i'(»2�'-,p,�S_ye7��`r�• -�—�' I
� �' �a , t
r ....;.,� ..__.. �� �
_ . _._..'"_".__. .._ . . -.___"' " "..�.�"__' '... ..""_�_.......... _.___ . _ ...�.__"'__ .. _______._.""'_...""_" '_"_'_'"�.._ _"�"'____.____.__'__._"'""'._.
;'FF ^ � �
r}; . •-, . r74 `,:'^. � . � I '2`�^';,;�i�''Jli� i
i "'s�;. � � °.I`,�.'u'�4 .;.' , _ L.-. 1 T ;
...
�
�.�i
,._.,- . .__,.«,..___" "" "_'"""..__._ . .. '-"_....__"""__"__ '_"".________"____...""____"____._"" _"_"' _'__ ....r._......_.._.......__'-"_"__'_""_' _"___ -__.—_._„�.,._....___._'___"-_
'_ . " ' _ "_.' � � riliC.�: ��Y��i °��I.,aµ � i �1
� :_e. ':",.�t :=_.j � � i
j.r
. a., .,.. . : . � ..
...;... _ _..__..... ..r_. _ .. ......�..............'_ _._.' ___.,..._.. ."._.-,___._ _ .r_"_ ___ __—___."_ __w_ ___._._...�.._..___ ___-..._.._._....,...._ _'.._____.__�_. '
' .. . . �.. � . ` _
� ,--_ , > ikM;-tt.:`�_`.•:<': � F'i.�fi iiwi�id�.'s _"—i-
_ _ ��_ � I
�r..._. . " ` ""'.._,. . _ ' "'"... .. .....__"''' ' "'.�....._.,.... __.� >._....[_ �"_'_' '_......_._ _r._.-..___ _..�...__ .. _�...._
• �Fi . . . �._�. �_4^^ }i"Ii ?{ti�fc�l. ^,� ' i
. . ..•• . ...� .
. .. .�., . � . .
......,... ....,.._.,4.._...._ .. ...........""' "' " �._".... _. ._..«_..�... �._ ' '" .._._ _"�,.".__'__ ' " "..__ _ ...,-,_"__"__..�a._..,,....,..,....,..,�.,...,....,�_.......,._'__" " '"_
� t� . .�, ..~"i e I� T��"`..r,� " 4�1. ,t�ir".�. �
. . � .. , ., �,.. .,,
. .,:, �.;_ : „. -:. . , �
, ;�
_ .. _ , _ ,
, -.
-,-- -- ----- --- �._____. ____.�,___- — - -__. �._.__ _ ..___._.. . . ....__�_.________.i__------- ----- ; _ _. -- ----— -----____.__---
. -. , .. , ,. . ' �..r'�._, .. •!ii,:if�.ie"k �- -f
, .-.__.....,, . . , ,
.,y,�
, � . , � , ,
.
� . .
_ .
�""�..._ __ . _. _ _ .._._.. � '__...__'__ i _"_ ___.__..__ _ ' -' ' ." "_ __ _ '_'_"'...�....___„'__'_ '_- "_''"" _"_""... _ .___.�_�..._.�__..._.
, ' � r,t` , °'t:.�. � 2 ..#
,._.
•.._....__. . _ .._ ..""'_ '" "'""'".,... """ "_..__._....._.... .._.. � - ' _ ..,_....""�'_ ..._._.."'"""_""" _"' ". _ . . ..._._....__....v,___,_i
. ...
< .. ., .u. ', " , _ i
,
� '� ;,��g":. i � � .� . . . , . , - � a
�� i4�"
:t
____....._ _......_`..."__ ... . . . " .. _. _ _..`___._..�..... _____'._.-....___.._ _......,.._.___ . . ` " _._._... _._.'_._._ ....................._._.., .._.d....�..._...�.�..._ " .._.. "__
- „ ....�.....
.. .. ... - . . ' y_
- ...v-• � . .. ., � " '��/S9. _
. I �
, i.._.�. . .W..,... _ «.._ . .,....... _.... 1 , . �.' . . ._........_..._.�. �__."_` - '___________._. ___"'".__'__. 1
._._._.._ . _.... . ,. .... ., " " """" " "" "' .._.......... .... " " ...�"_ ` '". ,_.
i =. ,- � ,ri� . 1 :.3: r . . 4
.w"i "ia- '. . � . .t'_
. . � '"'
_
,.
..�_... ... _ ..._..___. .... ,. " "�.._.-..____ _ '_-__.�__,___`" '" _'__��. ' ' __' "' " " ' _"'......_..,.___....__""""'_" "'_ '
: .. .^..'�.n it.�..
.
:-�. � ,
._., ., .,s.,�. � �E
, , �
� � , ...... . ' - . . � .'�..... .W . .. . . ,. t
�,.ti . , x . ...
..__.._- '--_...._._. __. ,....,_._..+.. - --._.._..,,...,.o------ -�- -_�_........_._..,.__._: . _._, . ..._.. .�..� - �--`-. ._,.-- -......,_._...__.___.....-'"-`-'--. . __., j
. �. . . _. , . .
._ 1,�
.. , ,,2."C;a, _ ,� . � - ;l: - i�.��c, ._. .
_ , . . _.wlw.... i,.... ,� � ' ._. . � . . . ._
•....._.... ___ _ - _ ..,._._.. .___._ __. _._.._.„._,......__.._. _ _ .. . ._ _.. .._.._....._.. .._�_...._._.�.__..__�.. . .... __._. _
, . . '�i=��"}` �� I '����� ���� ' � '� ,_�_... .. . . !i� � � }
. . , . .f .. �i
_ ry-�
, � 11 . ; . i
r �
. . . ,.. .. ,.
i
,. .
.. . . �
,- - .*� .�'a... , a
, • . __.._ .. .__ .._.�__..., __._........._..___..""""'__"
_ .�.. .__,.... "'..... .. _ __'___'_.____._...____..""_'__..�__'__�"_'___"
_ ' _ ' "._ ._.. _._..._.�._..
-__ .. . ." ",... . _... .. ' ' ".._.._.._...Y _. _. .._ _______.._.._....._...
' _ ._.._...._._'"__' _" ". ..._
" " ' '`_"'_"_�'_'____..._'_' _'_
t
�
2
.................__ ,..-__'_'_ _.._ ._""..'___'_" `__'_�"'"�._'"�. ._. •
, " " ... . .... '""""' . _»_._...."_,.�"__.�_'....__...._.�_..��..�._."_.'" "
__.....____-4
F__ ., ,_.�.�......... _ . _... .. .._ _ . _.__.'__....�..._.... ._' ` . �
.�.., . . .. . .... .... __._"._..___'_.__ .. . . _ ......�___-`__
,_�.... _ .._�.�...__.. . , �
4 _. .'" "'__""_._ �...__�__......_�...,._,.
'_.'._"._ .
r �
.._..�« ..�.".._.....__...�._...._ __.. . .. _ _.�................_,."_'_.__ . ......... .__'_ " '
�
_. __...._.�...__ . . _.. ..__�......._....,__...
'` .._ ._•_•___._._.._v_�..._�-_____W._._.-___._"
_ �
t
�•___ . _._. _ ....._.... '_ "_._. _ ....._.._ .. .. .__.__....._.� .. ...... . . _... � _ , ._.__.._.�.'_""_.�_...�....�._�_____ '_ _."
_.".. . . ._. ''_.__'"_......�.... . -....,...� ;
� �
.
.." .,_�.�..... - _.. . . . ... ... . ........_"_. . .."_.,.. _ ....__._...._._....__ ' _ __" .
V . . _...�.,_..._. ' _" .... _.__�..'"_`�_'_.___._._'__.`.--___........ ..... ..
p ....� <. ; S .
..,Q�.v.-Y i
� , � �.. `�\�. . ..
.' . '� �'
^' - _ .._.
.
.,...n.... :ro ._.�� � �• .. .
� . _..._ .._ �. . _".'__.__.__..._' ..�.__. .._�_.._..............� '_"_ #
_. ,_ _. __". . ... .. .. .� .. __...__. .. -_._'__..____'�'__. s
3
i
, ._..�.._ .. . _......""" '__..... ....... . .. .._...._ _.................. .._.. ._.._ . ..__ .._._ . °
..__.._______�
,
; __...---__..____. � _-- — - — - — -- - '
--._ __.__-----------_ -. -- _._._�_____--I
4
' ` '"' ""'"_"......""" " ' ' .. ....�__.......�..._ ....._...._......».................._._ '
. _ _ ' """'""�.____'�
_____ _�r ___ CTTY OF DIAMOND BAR
DEPARTMENT OF COMMLTNITY&DEVELOPMENT SERVICES
�. 21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 � PRESS
"""" BUILDING PERNIIT APPLICATION FIRMLY
d ADDRIESS ��`'��� �U f����L�L �� APPUCATION � ,Y, e'�� PERMIT �I,, p/C
o DATE �-� NUMBER ��p
`-° APN LOT�_ TRACT_ fU��.�-- ISSUE TYPE OCC
DATE CONST.__ GRQI�P
o OWNER ��j4.i � Ca�.I`f�i-J
0
ADDRESS'�if:'��% (3 �€3t._.L 20NING SETBACKS
oCITY��t� '� ZIP TEL. REORT RW ❑
APPLICANT' i„' E� L �U�--( TEL, l� ❑
z SIDE/SIDE STREET Ryy p
¢ CONTRACTOR .. �i:.' G.��l`{�TF�-k�"(`(,�� SIDE �
� ADDRESS `� �C.J. � 'C���Q ri G �'�7j,�' �y�
p CITY��-= �f`�t� ZIP_C�L�.i_ TEL:�iv�'� C-7j`�c� PROPOSED USE � '{�
w ARCH/ENG!
z DESIGNER l"c�f�
w —� NO.DWEL. NO.
� ADDRESS NO.
cn UNITS STORIES BEDROOMS
� CITY ZIP TEI.
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION
p SFRlADD/REM
p I HEREBY AFFIflM UNDER PENALTY OF PERJl1RY THAT I AM EXEMPT FROM THE CONTRACTORS LI- GafBgB/C2IPOR
W CENSEUWFORTHEf-0ILOWINGR�ON(SEC.7037.58USMESSANDPROFESSIONSCODE:ANYCIT'Oq (n
V CDUNTYWHICHRE�UIflESAPEFMITTOGONSTRUCLALTER,IMPROVE,DEMDUSM,OqREPAIRANYSTRUC- pd1i0/DBCK
W TUHE.PRIOR TO ITS ISSUANCE,ALSO RE�UIqES THE APPLICANT FOR SUCH PERMI7 TO FILE A SIGNED w
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF hIE CONTRACTORS LI�
� CENSE LAW(GHAPTEA e(COMMENCING WITM SECTION 7000)OF�1VISION 3 OF THE BUSINESS AN�PRO- V' POOUSP2
O FESSIONSCO�EJOIiTHATHEOflSHEISIXEMPTTHEREFROMANDTHEBA515FORTHEALLEGE�E%EMP- (�
V TION.ANVVIOIATIONOFSECTON7031.6BYANYAPPLICANTFORAPEflMIT5U8JECT5TMEAPPLICANTTO z Re-Root
� AqVIL PENAL7YOF NOT MOFE TFlqry FIVE MUNDRED DOLUflS(5500�)
� ❑I,ASOWNEROFTHEPROPERTY,OflMYEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, 0 CpmmBfCl81
Z WILL DO THE WORK,AND THE STqUCTURE IS NOT INTENDEO OR OFFERED FOR SALE(SEC 7Dq4,BU51- J
� NESS AND PROFE5510NS CO�E:THE CON7RACTOPS LICEN5E LAW DOES NOT APPLY TO AN OWNER oF
VPOPERNWHDBUILDSORIMPROVESTHEREON,ANDWHODOESSUCHWORNHIMSELFORHERSELFOR � �`_
WTNRWGH HIS OR 55ER OWN EMPLOYEES,PROYIDED THAT SUCH IMPROVEMENTS ARE NOT 1NTENDED OR m
0 OFFEREOFORSALEIF,HOWEVER7MEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE-
Z TION,THE OWNER�Bl/ILOER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUIID OR
� IMPROVEFORTHCPURP0.SCOf9A�E).
W ❑I.ASOWNEROFTHEPROPEH7Y,AMEXCLUSIVEIYCDNTRACTINGWI7HLICENSEDCONTRACTOHS
� TO CONSTRUCT THE PROJECT�3EC 7Ued,BUSINESS AND PROFESSIONS CODE:THE CONTMCTORS LI- VdIUd1fOf1 ADJ.AREA
W CENSELAWDOESNOTAPPLYTOANOWNEqOFAPROPERNWHOBUILD50RIMPROVESTIIEREON,AND
� WHDCANTRACTSFORSUCMPROJECTSWITHACANTRACTOfl(S)LICENSEDPURSUANTTOTHECONTRAP QUANTITY DESCRIPTION FEE
Y TORSLICENSELAW.).
0 ❑I RM E%EMPT UNDER SEC _ B.8 PC FOR THIS REASON Q
� U
� �
DATE OWNER 1—
Z W
� LICENSED CONTRACTORS DECLARATION w
� I HEFEBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
� e(COMMENCINO WITM SECTION 700D)OF DNISION J OF THE BUSINESSAND PROFESSIONS CODE,AN� z
��� AIV LICENSE IS IN FIRL FORCE AND EFFECT /� m
� UCENSECLASS � �IC NO l.V� ` {'�" � �
V OATE CONTRACTOR a
W
� WORKERS'COMPENSATION DECLARATION Q
� I NEflEBV AFFlRM UNDER PENALN OF PERJURY ONEOF THE FOILOWING DECURATION3. Z
Z __IHAVEANDWILLMAINTAMIACEHTIFlCATEOFCONSENTTOSELF-INSUREFORWORKERS' a
2
¢ COMPENSATION,AS PROVIDED 9Y SECTION 370o OF THE LABOR CODE,FOR THE PERFORMANCE W
Q OF THE WORK FOR WHICH THIS PEHMIT IS ISSUED �
� ^I HAVE AND WILL MAMTAIN WOPKERS'COMPENSATION INSURANCE,AS RE�UIRFD BY SECTION �
QQ 3�oa OFTHE LABOR CODE,FOF THE PEflFOPMANCE OF THE WORK FOR WMICHTHIS PERMIT IS � ��*y `�
ISSUED.MV WORKERS'COMFENS�ATI^O�N INSURANCE CAHRIER AND VOLICV NUMBER ARE- CONSTRUCTION t�..l
� CAqRIER � �7 1t��� �h�� PLAN REVIEW
0 POLICY NUMBER +l e7 L� �� t:j �
Z � �� C ELECTRIC
¢
� (IHISSECTIXJNE�NOT9ECOMPI.EIEDOF'fHEPEWJIT�SWRONEHUNDPEDDIXIAAS(ftaD)ORLESS) PLUMBING
Z ICERTIFVTHATINTHEPERFORMANCEOFTHEWORKFOqWHICHTHISPERMITISISSl1E0,1 MECHANICAL
� SHALL NOT EMPLOY ANY pERSON{N ANY MANNEH SO AS TO 9EC01l�E SUBJECT TO TNE
� WORKERS'COMPENSATION LAWS OF CAUFORNIA,pND AGREE THAT IF I SHOULD BECOME INSPECTION FEE
� SU&IECTTOTHEWORKERS'COMPENSATIONPROVISIONSOFSECTION3iooOFTHELABOH ,�"y`�
� CADE,ISHALLFORTHWITHCOMPLYWITHTHOSEPPOVISIONS �SSUANCE �._!
� SMIP • ��!
p DATE� APPLICANT
� WARNING FAILURETO SECURE WORKEAS'COMPENSATION C-0VERAGE IS UNIAWFUL,AND SHALL BE EIdERGY P/C
� SU&IECi AN EMPLOYEft TO CRIMINAL PENALTIES AN�CIVIL FINES UP TO ONE HUNDRED THOUSAND ENERGY PEpMIT
O�LURS(f700.000).M ADOITIONTO THE COST OF COMPENSATIDN,DAMAGES AS PfiOVIDED FOR IN
J SECTIDN370BOFTHELABORCODE,WTEREST,ANDATfORNE1"SFEES RETENTIONFEE: � (�
�
a CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
O
� I HERE6Y AFFIPM UNDER PENALTV OF PERJURV THAT THERE IS ACONSTRUCTION LENDING AGENCY
FOA TNE PERFORMANCEOF TNE WOAK WR WHICHTHIS PERMf�IS fSSUE�(SEC 9097,CIV,C)
Z
W
� LENDER'S NAME _—__
F— LENDER'SADDRESS
� I CERT�FY THAT 1 HAVE READ THIS APPLICATI�N AND STpTE TNAT THE ABOVE MFORMATION IS COflflECT TOTAL FEES
W I AGREE TO COMPLY WITH ALL CRY AND COUNTV ORDINANCES ANO STATE LAWS RELATING TO BUILOING +
� CONSTRUCTION,AND HEREBYAUTHDH�ZE REPRESENTATNES OF 7HIS COUMY TO ENTEfl UPON THE
ZABOVE�MENTIONE�7ROPERN FOR INSPECTION PURPOSES GOMMENTS
� �-1�i�l�FL—C3 [,—�C ;� a�-p
� PEPMITTE rPRIN �r„6 F�n f� 9�� / �
1/''l�..<.'✓"�f � lA f �^.� O
� SIGNATURE 6F PERMf� DATE � Y
= RECPT.NO. PAID BY VALIDATION
~ WHITE—Department Copy,YELLOW--Finance Copy,PINK—Assessor Copy,GOLDENROD—FJe Copy,GREEN—ApplicanPs Copy
r�"��'�� ���° ����r�r�g���;:� ��&'�
�������'����k�"��� �'��=�'"��';:�
�_-------__.---.-_._.__.__ _�_ _._----- ��-- - - - .._�,.-
. . . . .-� . , , . -----�-:,::,:.<_
. • . .,. . . . . . . . .� . • � , . . . .. ,,�v. :,�"y.+'�'p`!��i
. " � � ' . � ' . . . � . .. ... ... � . ........:�.'+":.�s:
E ,-, ,-�;';,l;4 � �
' ��' _ � ------- ---__ __�-- �- - — -- -- ----�---- -------- -----
_ _ __.._ __-�----__ ---
� f-LC��Jt-e 1C)i.`a!
_. _ �
� ,�,<"C-'s:Is=';���''.i��l�"3�twr_ � ; i r�-4�1�E�'s"�ST� _.........------........__.._--._..---.._._.__.
� �
' ------- .. __._�......�_�.._�........ - -------..... .. � {
�.�.,_.... _. .___ .....
' �%_E?�?"F?IC:�C2[=ikJ:�f�!Cj ._.. � _�_______--__ ! l P�,��� �L�G�-i CC'�i�i�1i"
_ _ � .__.___ - � __- -.---
`" --- --- - - - -- -- --------__.. _.._ __.- - �-- - -
�� _ �. .
r�l:�>Ff`, " +€- >.r.
� .�`�,�'.vi.�tg: F�S.�t�€k,3�3'�lx f__—_-_ __'
f_,.._____..__�:" . .-_. _ __' .__ ._ �----'_"._ �'* '__'.___.._..' ' _"_._.._.'__
I �sR..d'fC:.�:�=si�@��_ - --- 1 �- '------------ - ---- � L�=1�E�i_1'tC��{�[.i�C�4"6"tC��l -- ------_ ----
i
__.._ - -------- �
� ��:�',�,`� r'(e�LF�� ' � � �i�6'��.r�li���i��1����vA[ � _
yY ._._._�.� �___.. --T-�--- �-----�----- y ----�-
.__.._.._ . -- ------ � __�/_^�p�.F_(��p-}[.-y � -- --------
i���$_�`J�f"'��i����- � ��i���. ��e�� ����_ �
t"�E.14J1"' J�'._'�7 i'I&t�5{�. � ,f3 �. �..%`JIVLJ F>t�!':�VI -�-'�..�.._,___
�Ymy��m _'"....,._,,.____ �._..... "_'_- "T � � '-.__._.,
~ �..i.� -i_-
� �r-�:�F�,[�1:{�^lG:/�t�t�(TiLkd�,Tii�t'i I �. �',l�f��...�'sC'I�it1 ��t?it�i--�._.._ �
--__ __...________._�.. �..�._-.- -----._.__. . _...__._____.__ _ _
---------
�`�����-�'°a`�� .____`__�__._i __._�� I 4'RE-��'�A,G(i'�lCa '
RG1��r"-=€-i '.-!EI�;�.''s'.�C� � 1 �EC�f:F-f@t�(� __---___. ,
Ra°.C;6� �L�C"��'lU__ .��______ .._� ...___.µ_,.___ _._______-i E�C�tiG�C;��[Ji��!U------�� ----- -__
� `�$'4 c'`��ir:a°�2,�R'��'��."s � � �E�����'1 i:i�i�`+�7�{�ta _.
C"'i4�tii;. � �_..��__...__.._---
_'____.__________.._... .__�"._�___ __�.�.. "__:_
� 5k-157°�'�;'frT``�ia�'�:`�.�� ; ; F'CJfJ9_.E;LEGTRIC;
_ +- -- ----
���.��.F�t"a�?�:�,!���F�____,- __ _ �_ `_'"'___ �,OC��.I=ENCII�C� __ _._ I
�.�� _.
.
�;��[_�._�t�lSt��_,�->=;C}� �` _..__._. _- — --- - - ------ ---- -------__ _ _ ----_
1---,w.-- ----- - - _r-....._. -- --•---_-___------ F�JC��.F 1(t?¢�I -- —
' (----_____._� ___ �_�__._._�
��I� ft`-F�: e�i`"€.;_rt!�Js`� ! � c.:i�ui�`::IP,HF'�. _ �
.�_..�--__�. _� .`_.--- - -- --'_-----� ----
Ci�l'��r�`._l.�'�:�`tiS.;t��cx ; C,cC�1�#kTiC)I�S
�_ ` ------ -- - -
�� `" �
___. _ ...__
_______._-----._. . � _._.___.__,_______
---______.__.
:z�`ltr�.�,r.; � k=Pf�ir�,E...E-6�lf�.
�e,�--��r----- -�.. _____.._.._____ ---- .._....._..----- � - --- ._....._._.____---___ ___.._.... .._._ ---
e'-~� 4.:�!�1C?�i€..Af=�/f�r"�i�. -----
S�E€' . �l[_�.. I r c � �-
........___.___.. �--_. ._.___------------ ----_...--___ -------�------_
,.��4-�°s;C:��'.�It,.., I
! � CJP+� SITE iIJ��S.
___._... .__.�_- - -- ---,..__ .�._�. ____._.--_____� _______------- -_____..
� ;����;E�w �:.�-� , i �-�d1�A.(..:��."t��EE`'�;
� ., . �- � .. . � .� ' • �
:,. . - -- � _ . . • � . . . . .. . . .- - - �
. ._. :. . ., .• , .
...,.� :�..�.._ .. .
�
...�...._�___.._. ___...-�------- �--- -.�._._._._-;-� ---_--__.��__- - -.._._._.__---
,�,>> � �
. .g��.,y.y,.,
r���!,�t.�a_C�.,i��„=�:� I ' � � �-;vER`;'Y -- __._
-------- ------._._.��__�_,__._._ i____.�___ —.._� x_.�_._,��_�__ - --------
, � ,
. . . :•6r.:''?'' . I
. .. . � '. . . � . ..z a3.Y.f.''� .
�
� '�.�5..��L�ka�it���a�`�� t�;` _
.__,.,_.__..�_.___...,_.-.-__��...,._.�...,..._'___.�_
"""""�..._._.�._....._.._.._.._..
�,,.._.„.�...,...__.____....,...__......._"__.-`__'__—_--'-_____.'__"__�_____'_'__-___"'_.-__'_TT.__ �'
i _ '__—_�. -__.._._..�
k
"" ""_"__""'"_"' ""�__""___..,..._.._�_._ ._ �.,..._...__.�___
�___,.-�..._..,,_'"'�_„_. -_ ___""'...__......_"_'"_
�g
f
�
.0 ._....,..�.. __ .� __.�___.... _.. _�. .__ . . �w.........� _ �
y' _.___.._._.. .. ..__m___.,.._..____. ""��"'..____._...._._.�_,v......._....�_.....�,.�.___ �_
(_�..e_..,_' _.�""w..._.__'__""__
t
1
7-.__._..__..�..._"—__._"_w"_"'.._.,._. .......__e.._ _.�...."_�_.�.' �_""_-_ —____"'_'_'___
� �_�
4
;_,_,_..._....�___._.___T_'_'�.'__""�__.�__....._.___. ...."__"__._...__,.._.__.. .�______ ._...._ .__"_..�_�..._.__�..__._.�__._�.__.�___._�__'�.._...�
r ��:`.�"'!t� �ra:i�:.�:rY�k.._ _e_.._.....,._,.
� ». r.. . .._.��__.�._.�.___....._..�_"__"_"'_'
"_'. _....._ '_'__' �_'_"_�._..�""'
c- t'
� �.�.Ec�u� �"d .(:,'v.�.t',` __._... --------.-__
� " ' � . _�___..._""'"'_"'. ........_...�..,....._............... .....�_....._.,....�.....
� . . ' �'"r..__..____�_,_.�_"
.
g ' ` . . . . ; � ._..._._...._......___._..._......_......�_...,.�'_'""'____ _......_._...�._ �__.�_._._._._.�.._
. . .
E . .�.� ,�. .
� • • . __.�._.._.._..._�_'_ "_n �_...�_.........__........._�_.__"_.____ �.� _'_
� . . , • ...............................�..�.�.._........._....,.,....� .._.._ ._"'_"�......_..__._..._...__���_- �"' "'"�
� � ' " '"
S . _ . __..._„�.._._..._.__._ _._....�..___.�_..,,..,_._.......__�.. _ .._ __.�_"'..___....�_____._..w.____........._�_ �__..._.._.____
4 ' - .
��`_ CTI'I'OF DIAMOND BAR
� DEPARTMENI'OF COMMUNTI'Y&DEVEJAPMENT SERVICES
,� . 21$25 E.Copley Drive
(909)860.3195 Fax(909)8613117 PRESS
�"'"' BilILDINGPERMITAYPLICATION FIRMLY
� JOBSITE � ���^� . ` APPLICATION PERMIT P/C
o ADDRESS_�7 v 7� W'����'� DATE tdUMBER #
� ISSUE 7YPE
APN LOT;�--- TRACT DATE CONST. GROUP
p OWNER �111,� I�G LliV1 � �G�IJI Fi" �
ADDRESS c iL ZONING SETBACKS
Z CITY b��oa�Y�1,�z�P TEL. FRON7
RW [J
o APPLICANT TEL S pE/SIDE STqEET RW p
z
Q CONTRACTOR �L�� +U��� �/� JJ , SIDE ❑
� ADDRESS � PROPOSED USE � 7
� CIN ZIP TEL
i)
w ARCH/EN 1
z DESIGNER_�v!t,� ,� G� 2Sr� ��e .
W NO.DWEL. NO. NO.
a ADDRESS '�o��_� C S/1[ �f��� UNITS STORIES SEDROOMS
� CIiY�Il.�^ ZIP �T
u� DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION
� OWNER-BUIIDER DECLARATION SFR/ADD/REM
O
I MEREBY AFFIHM UNDER PENALTY OF PEIWqY THAT I AM E%EMPT FflOM THE fAMHACTOqS LF Garaga/Carport
W CENSEUWFDA7HEFW,LOVJIN[ipE790H�SEC.'1031.50US1NESSAHDPqOFES510N5CObE:NflC4tYOR (n
U COUNfyWHICHflC-0UIRESAPERMITTOCONSTRUCT,AITER�A�'EDEMOLJSH,ORREPqIRANY57RUG W patio/Deck
Z TUR�Pq10R TD ITS 1SSl1ANCE,ALSD qEpU1RE5 7HE APPiIOANi FOR SUdi PEAfAIT TO RLE A SiGHEU
W STATEMENT iHAT HE OR SHE IS UCENSED PURSUANT TO 7HE PROVISIq45 OF THE COMMCTopS l4 W
� CENSE LAW(GNAPTEq B�COMMENCING WI7H SEC710N 7000)OF DIVISIDN 9 OF THE BUSttJE55 AND PRa u- PooUSpa
FESSIONSODD�OR7NATHEORSHEISIXEMPTTHEREFROMMIDTHEBASISFOR7HEf�.IEGEDE%FJA7- �
UTION.ANVVpLAT10T70F5EGT10N7o31bBYANYMP11GN7FORAPERMITSU&IECTSSHEAPPLICANTlO Z pe.ppp�
A CML pENALTY OF N�T LIOPE 7FIAN FNE HUNDqED OOLLARS(SSaoJ.):
0 D4�D�EROFTHEPROPEHTY,OPMYEMPLOYEESWI7NYJAGESASiHE1pSOLECOMPEN5AT10N, 0 COmfllBfCial --
Z H7LL�O 7HE WORK AND TNE STHUCNRE IS NO�IMENDED OR OFFERED FDR SAI,E(SEG 7041,BUSF �,J
� NESS qND VROFESSIONS CO�E lHE CONTi1ACTOflS LCENSE LAW DOES NDT AFPLY TO AN DWNER OF � 1 y� �( ..y� . /!� /�.d�� �
PqOPEpTYWHOBUILDSORIMPqOVE57HEREON,ANDWHODOE55UGiWORKHIMSELFORHEf154FOH eY ^' �. "'7' �•
Q 7Hfid16H HI5 OH HEq ONM EMPLOVEES,PFOV��E�TXAT SUpi IMPPWEMENTS APE NOT M77ENDED OA m
QOFFEf1EDPD1iSALEIF,HOWEVEFtTiEBU1LDINGORIMPROVEMENTI550tDWrtHINONEYFAROFCOMPLE L �O�i � ---� �({�U L
Z TION,THE OWNER�BUI(�EH N7LL HpVE TNE BURDEN OF PROVIN(i INPT HE OP SHE D1D D70T BUItD OA _ -
W PAOVE FOR 7HE PURPOSE oF SAL�.
W ❑I,ASOWNEflOFTHEPflOPERN,AMIXClUSNE�YCOMRACTINGVfiIiLICENSEDCAMfiACSOAS � �—
('L TO CONSTRUCTiHE Pq0.1ECT(SEC.70�1.BUSINESS ANO PROFESSIONS CWE THE CONTMCTOflS U� VeluaGOn AD.I.AREA
W CENSEUWODESNOTAPPLVTOANOLIR�EROFAPROPERTVWHOBU1lDSOA1MPPOVESTHEREON.AND
F ItRIOCONTMCT5FOX5UCHPROJECTSWITHACONTRAC70R(S�ULENSEDPURSUANTTOTHECONTMG QUANTITY DESCRIPTION FEE
Y 7oliSUCENSELAw.�_ ,
� ❑1 AA1 EXEMPT UNDFA SEC. H E PG FOR TMS HEASON U
�
�
LL OPTE OWNER U
Z W
� LICENSED GONTRACTORS DECLAflATION �j
� IHEREBYAFFIRIAUNDERPENALT'OFPERAURY7HATIAMUCENSEOUNDERPAOVISpNSOFCHAPTER �
p_ 9��MMENGNGWRNSECTIaJ70Co�OFDMSION3OFTHEBUSINE55ANDPROLESSIONSCOOE,AM Z
�X� U'(UCQiSE IS W FULL'^FOflLEAND EFF . (� m
� LICENSE CIASS '/� !''� LIG NO ��I� " j
V �ATE — CONTHAGTOR� a
lll
� WORKERS'COMPENSA710N DECLARATION Q
� U
� INEREBYAFFIRMUNOERPFNA[IYOFPp0.1URYONEOFTNEFOL40WINGDECUMTIONS:
N Z
Q
C1 ,_IHRVENJDW111MAIMANiACERTIFlCATEOFCONSENTTOS0.F-INSUflEFORWORKEFS' _
COMPENSA710N,A&PROVIDEDBYSECTON3]ODOFTHELABORCOOE,FORTHEPERFOHMPNCE U
Q OFTHE�YOP1(FORWHICHTHSPEqMITi5fS5UED �
�
� ,_�HpVE AND W�LL NNNTA�N WORKER5 COMPENSATION INSURANCE,AS REOUIRfO BY SECTION
Q 3]ooUGTNELABOPCODE,FOqTHEPERFOHMANCEOFTHEWOPI(FORWFiIdi7HI5PEflMIT15
p ISSUED.MYWOPKERS'CDMP�EsN�SA(TIONIN5U-/flPNGECAflR1E/R_ANQPOLICYNUMBEqARE� CONSTRUCTION
� CARRIEFl --�7�T��_["" �v"�� EVIEV�(
Z Poucrr+uMeen �''�_d�B ��- ELECTRIC _�._
`� mnssEcnor+�rioreEmngtFrmoFn�r�srswnarvEri.xoaEoocxinas�s�omoniFssl PLUMBiNG
0
w ICERTIFYTHATIN7HEPEflFOPMANCEOFTHEYJDRKFOflWHICHTHISPEHMITI5155UED,1 MECHAIJ{CA
(Z�} SNnIL NOT EMPLOY ANY PEHSON IN ANV MANNEH SO AS TO BECOME SUBJECT TO THE
� WORI(Efl5'COMPENSATIONUVISOFGN.IFORNI0.N7DAGREETMATIFISIiWIABECOME NSPECTIOI3FEE
SU&IECT TO THE WDRKEPS'COMPENSATION PROVISIONS OF SECTION J700 OF THE LABOR
� GODE,I SHNy FORiHYATM COMPLY WI7HT}!CB!'PRb01i E7�RL' C "' /J ISSUAt�10E
W ' r� APPLICA C_ �� SMiP
OATE: _��
—� WARNINO.FAILURE TO SECURE WOflKERs'COMPENSATION ERAOE iS UNUWFlIL.AND SNALL 8E ENEflGY P/C
� SUBJEC�ANEMPLDYERlOCPoMINALPE73ALT1FSANC1qVILFIHE6UPTOONEHUNOHEATHWSAND ENERGYPERMIT
DOL Wi5(Stao,aon),IN ADDITION 70 THE C�ST OF COMPENSATION,DAMAGES AS PRONDED WR IN
� SEC�IDN 3708 OF THE LABOA COOE,INTEREST,ANL1 AT(ORHE'f5 FEES. RETEMION FEE'
� CONS7RUCTlON LENDING AGENCY PAE•AI.T FEE:
0. --
�
� IHEREBYAFFIRMUNDEflPENALTYOFPEfUUqVTMATTHEREISAGONSTRUGTIONtEN��NGAGENCY
� fOq7FiEPERFORAIANCEOFTHEWOpNFORWHICHTHISDEHMITISISSUED(SEC3o97,tIVC)
Z
W
� LENDEflSNAME
F— LENDER'SA��RESS
� ICEATIFYTHATIHAyFREADT+ISAPPLICATIONANDSTATETHATTNEA80VEMFOflMATpNISCORNECT. TOTAL FEES
w IAGREETOCAMPLYWITHAIIG[iVANUCOUNTYORDINANCE3ANUSTATElAW5FEI.ATINGTOBUILDING
� CONSTRUCTION,ANO HEREBV AUTHOFiIZE REPRESENTATIVES OF 1MI5�'�UNTY 70 EMER UPONTIIE
� A90VE-MEM�EO PR�PERTYfOH IN6PECTION GUpPO5E5. ��`
Z COMMENTS 1 _� � ��� `- ���� �
� ,�7]�r6�t L _ G�{�� �
m PEqNI `I
a ,�°�✓��� r �
� ���� �- ��---
� C�51 NATURE_O�� 1 E DPTE
= FECPT.NO. PAlO BY VALIOAT70N_
�' WHITE—Depflrtment Copy.YELLOW--Finence Copy,PINK—Assessor Copy.GOIDENflOD--File Gopy,GREEN—ApplicaM's Copy
���'� �� �������3 ���
[������'°Q�°�� ������
�,�m ' �..,.: . 'ti�. . ���. ': , .����.��:eo,- ��r� . .��,,,, . .' , f •ir���. .a��� .r... 'j. ,r�y� .. nsy.a. � ., .
�. . � * r• �'' �" ,`-0 4 ..
,. „ '�� ., �w i�: ;J..\^. x" u� �4r,.2.,,�; r '",; ,y�' ,: `.�
�� .4�'i; ��a ^' �;'i'� a �;'e „L'x,� � `.'�. ' -'' �..� � � : r"�'';&.s,"�j �.�.. � M; "'Vw�r� .
Y ` .,. .
V i �,�,4�� '�.,•ur
,., ' ` .. . ' �n..:a°•'..� , ,
� '. "� •,�Jw. . ,, . . � '' u". , � � .. .. ,� �,.. . .... . • ).:�.n...",.k'4 ' • , , �, . r,.�
. , .
� T,A,,..�, •.
: t, ' ., , . �.;
, _ , , . ,..� � �r . .�. . , ....„ .. ... . ,.. . .
�������� ' ' ���{�������� �
��a.���?��l:�t�'1�3�G'—�i_ - � � ���-{���.Q��w�+ �,_ �
�-��GTr"{IC CF�C3t1�D � t.��t�ER�L�(?$�C3SIC`,1"
-- ------------- ------ ------•--- --- --•---- --- - ------ -- -- - --- ------- --- -- ------------->- ------- ---------------- --..
GF��t1�r`[1 fzLUt+RE3E�i� Uf�[::1�R FL.(�C3('�(;C�N�U(T
--- ------ - - ---- ------- ------ - -- - --•----- --- -- ------- -- - �-- --------- - -- ------ --•- - - - -- ---- - ---
- - -------- �
SLRS CaF�R�E --°-------- - - • - ----- - -�- ---- , �FIR�P�AC:E;=C}�1RtC}/�TIC3�- ----- -- -- ---- ------- - ---- - _ _
3
_......- - ---- - --- -- - - - � - -- --- - _._ -- - -- ------
TE€t�P PCJ�`J�R FIR�PLRG��{JNE�EiER�t, .
--- - - - -- -• - - - ---• - --- --- -- -- - -- - :_ _ -- -- ------- --- --- -�- ---- --• - --------- --- - - --
4�lRTER SERV€�:E ` , 2�5lD�i7:�OI�G B�AM �
FiC}C?F SNEAT@-iER(G --- - ------- ,8 F��ON��EA�J! �-------
�=C'�A[t�if4lC�lE+EA3T?L�3kCJf'�� ��— ___ -- ---' �i�tAL BON[3 BER� -- --Y--
FdC1{}�C:C1V�E� ; PF�E-�RAt�I�(a
ifi�?liGl�FiEATI�;� -� _ ___ ����H(N�
P.QUG��LECT�IG ` : .�C3�i f-f G�AC1ihlG
f�QUGFf PLUMB[�tG � 'Fit�iS�-E GRf�C3I��
>FI£31�i1ERtTUB TEST � PC,�C�L�LE�T�lC ! —
EX�:LATHlS(E31f�G �R(?C3t_r-ENCI�.�'�� �
�£VALL!l�SU€.ATiC�t�t � _�: PC}C3�r�I�AL � ; �
CEIL1l�G IhtSULATit}N � {�F�SET�I�PS. �_.�
C)RYV�dALL N{?(LINC`a - � --- � � ;DFC3(CA7'IC.71�S '
-- ----- ---- �- -_ ._t - - - - • � ---- - - --- -- -- - -- - - - , _ ..
_
5�8+t1��; ' � ,f�iN�L��G.
-- --�-- ----------_ ._------'--------------------------- ---- -• -- - - ------ - --- - - - - �- - ------- -----------
SEPTIC TAt�K ° L,�i�D:C1��E!IF�RIi�.
�- --------- ------------ --; - - ------: --------- _-_ _ ---- - � � -- -- -------------------- ----------- --- ----_�-- -------------------
SEEP�17!�.L. � C)t��v'ITE I��iP�.
----- - -------- - -- - - - -------- ---- -- - - �- - - - --- ----- -- -- -- --- - -- - - --- --�- -- -------
GA�AlR TEST' � FEP�AL ZU�llhlf� _
FI�ALCC3�ST. ------; `F€t�E�EP3 �INAL �}- --- �
F(t�AL I�EATENC � �. :NEALT H DE€'T.F;�1�� I ----�------
�I�R��tL�IEC�F3':C � ---A ---- -------'. ;LEtt.FEES F'�11f�_ ��_�______.—----------
FI�?RL PLUY+�E31N� ,�E�EF3�Y '
� � ,
���{����� _� ______� _��._
SEPTlG TA€�K SI�E
S�EP PITi��3�E
;��. - . �: , (''r, — —_
',t��.: ",„��'.,��,��..• Y�, ,;5� `,n'.;� ,_.....�.__'._ _"�'�_
i u� , 'A.'Y..
�:���..�,r��
,,
: ,:,i��"�i�� � ,
°�i'� . ' ..:��..�, .. �,.,. . L,�
i;iv . . .;�, �, .
, �. . . � .
i�� �� . .� , a� �. :'t _ _ _'_ _"' ' ' ' " "_"_ "___ "'_ ""_ ` __"_ '_' ._ .._....
.
,, .
,' y l
, �� ' .
.� f.i.'�,,��
,• ..i ,.;� ���
.
..•. �x
. ..
't •
�.�•• . t �Tt �. �:1: �'�.
��i'
!"��1.�i ..!M1 .. ___ ____ __ _ _ _ _ _'"__________ " _ ""_ '_'_ _ ___.,._"'" _'_'_ _ __ __"' _ ____' ___
t�•' +, .,',n�
t.
ii�����+rv,. . , ,
•.:. '
� f.'��s"��.
� �•r1����,��� �•,,f r� n;
,�',. �,w,,, � �� k��.,
.�.,L` i ,��
.��ji��i'����� ...,�ii.��' M A "�
1.r i I i. _ _ _ _
�•�,�� � �� ..._ ' _ .. __ _ __ ___ _ _______ _
. :i�r . � �, _�_'__.__. __ _ _____ _.____'____.___ _ __ ____ _______ __
' '.'�u ����i. �^•�a'•�t�J . . �
�i A�� � 1rM ,��. i.��
�.� .� , i . .....,..........«......<....«..,.«.«.».�....«�.....�.�.....m._..a....e�e..e.......�..+........Y..�.......___ .e.A.e...�m..e.....�...o..T................�............«.m.. �t
_�� CITY OF DIAMOND BAR
I I � DEPAR'fMENT OF COMRMTTJNITY&DEVELOPMENT SERVICBS
21825 E.Copley Drive
�wj (909)860-3195 Fax(909)861-3117 PRESS
`""", BLTILDING PERMIT APPLICATION FIRMLY
� JQBSITE �), • APPLICATION ��`���- ��PERMIT P/C
o ADDRESS_ -.1- � 'J DATE ") ��NUMBER #
o � ISSUE TYPE OCC
`r APN_____�_ LOT TRACT DATE CONST. GROUP
p OWNER ���� �
p ADDRESS ZONfNG SETBACKS
Z CIT1' ZIP TEL. FRONT RW ❑
o APPLICANT TEL. S DE/SIDE STREET RW ❑
z
� CONTRACTOR SIDE ❑
� ADDftESS PROPOSED USE
� CITY ZIP TEL.
o ARCH/ENG/
�z pE51GNER NO.DWEL. NO. NO.
n,_ ADDRESS UNITS S70RIES BEDROOMS
� CI'fY ZIP TEL.
cn
cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
� OWNER-BUfLDER DECLARATION SFR/ApD/REM
O
INEREBVAFFIRM UNOEF PENALT/OF PERJURYTHATIAM EXEMPTFROM THE CONTRACTORS U- GefA99/CdlPOR
W CEI�EUWFORTHEFOLLOWINGflEASON(SEC70315BUSINESSR47DPROFESSIONSG�OEANYGIIYOft (n
U CqUNTYWHICHRE�UIRESAPERMITTOCANSTRUCT,ALTER,IMPROVE.OEMOUSH,ORREPAIPANVSTRUC- W P8h0/D6Ck
� TURE,PRIOR TO ITS ISSUANCE,AL50 RE�UIqES 7HE APPllGANS FOR SUGH PERMIT LO FILE A SIGNED
� STATEMEM THAT HE OP SHE IS LICENSEO PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- �
� CENSE LAW(CHAPTER 9(fAMMENCING WITH SECTION�000)OF pIVISION 3 OF lNE BUSINE55 AND Pfl0- V'" POOI(SPd
0 FESSIONSCODE�Of1THATHEOR5HEI5EXEMPTTHEREFHOMANOTHE9A515FORTHEALLEGEDEXEMP- (�
V TIONANYVIOLATIONOGSECTION7091.SBYANYAPPUGANTFORAPERMITSU9JEGTSTHEAPPLICANTTO z Re-Roof
A CiVIL PENALT!aF N�T MORE THAN FNE HUN�RED OOLLARS(SSaO)j
� ❑I.ASOWNER�FTHEPRDPERTY.ORMYEMPLOYEESWITHWAGESASTHEIRSOLEGOMPENSATION, � COfI11118fG1e1
z WILL D�THE�'70RK,AND THE STflUCTURE IS NOT INTENDEO OR OFFERED FOR SALE(SEC 7W1,BU51- J
� NESSPND PROFESSIONS CADE•THE CONTRACTORS LICENSE LAW UOES NOT APPLY TO AN OWNER OF �
PROPEFTtV NMO HUIt,DS OR UAPitOVES SFIEpEON,AND WHO DOES SUCfi WpRK HIMSEIF�R HERSEI.F�R
� THROUGH HIS OR HER OWN EMPLDYEES,PFOVI�EU THAT SUCH IMPROVEMEPIB ARE NOT INTENDED OR �
� OFFEPEDFORSALEIF,HOWEVER,iIiEBUI�DINCORIMPAOVEMENTISSDLDWITHINONEYEAROFCAMRLE�
� TION,7NE OWNER-OUILDER W�LL HAVE THE BUR�EN OF PROVING THAT HE OR SHE DID NOT BUILD OR
IMPFOVE FOR TNE PURPo&E OF SALE)
w ❑I,ASOWNEROFTHEPflOPERTY.AME%GLUSIVELYCONTRACTINGWITHLICENSEDCONTflACTORS
�[ TO CONSTRUCT iHE PROJECT(SEC 7o4d,pU51NES5 AND PROFESSIONS CODE THE CONTRACTORS LI- VdlUaliOfl ADJ ARER
W CENSELAWDOESNOTAPPLYTOANOWNER�FAPROPEqTYWH06UILD5�RIMPROVESTHEREON,AND
� WHOCONTRACTSFORSUCHPqOJECTSWITHACONTPACTOR(S)IICENSEDPtJRSUANTTOTNECONTHAC- QUANTITY DESCRIPTION FEE
Y TORSLICENSELAW)
p ❑I AM E%EMPT UNDEfl SEC _ B&P G F�RTHIS REASON U
-�i �
� DAIE OWNER ~
Z _ V
W
� LICENSED CONTRACTORS DECIARATION W
� I HEREBYAFFIRM UYJDER PENALTY OF PERJURY THAT I AM LICENSEO UNDER PROVISIONS OF CHAPTER �
� g(COMMENG�NG WITH SECTION 7000)OF DIV1S10N 30FTHE BUSlNESS AND PROFESSIONS CO�E,AND Z
LLL MV IICENSE IS M FlJLL FORCE AND EFFECT m
O �
� UCENSE CL4S5 LIC.NO �
� DATE COMfIACTOR a
W
� WORKENS'COMPENSATION DECLARATION --�
= U
� IHEHEBYAFFlRMUNDERPENALiYOFP�HJURVONEOFTHEFOLLAWINGDECLARATIDNS �
Cf> Z
Q —
� �IHAVEANDWILLMAINTAINACFRTIFICATEOFCONS`cNTTOSELF-INSUREFORWOHKERS' _
CAMPENSATION,ASPqOVIOEDBY5EGT10N3]o00FTHELABOqCODE,FORTH[PERI'ORMANCE U
Q OFSHE WDRK FOR WHICHTNIS PERMIT IS ISSUED �
� ` .._
� ,I HAVE AND W�LLMAINTAIN WOAKERS COMPENSATION VNSURANCE,AS REQUIRED BY SECTION ;i
Q 3�0o OF THE LABOR COOE,FOR TNE PER WRMANCE OF THE WOPK FOR WHICH THIS PERMIT IS ��
ISSUE�.MY WORKERS'COMPENSATION INSURANCE CAflRIER AND POLICY NUMBER ARE CONS7RUCTION �
J
j CAHRIER_ PLAN REVIEW
� POLICY NUM6ER ELECTRIC
Z
Q
Q (THISSECIrJNNttUNUI'HE(DMF;EIt�OFhIEPEFUNi'ISFONONEHUNOHEDDOLIAf1S(5100)ORLESS) PLUMBING
Z 1 CER7IFY THAT INTHE PER'rORMANCE OF TNE WOFK FOF WHICH THIS PEftMIT IS ISSUED.I MECHANICAL f �
°Lj' SHALL NOT EMPLOY AN7 PERSON IN ANY MANNER SO AS TO BELOME SU�,1ECi TUTHE �
� WOR%ERS'GOMPENS0.TlONLAWSOFCALIFOflNIA,ANDAGREETHATIFISHWLD'dECOME INSPCCTIONFEE `
� SUBJECTTOTHEWORKERS'COMPENSATIONPHOVISIONSOFSECTION3]000FTHELABOR
� CADE,154A4LFOfliHWITNCOMPIYWITHTH�SEPR�VISIONS. ISSUANCE
0 SMIP
p DATE. APPLICANT.
'� ENERGY P/C
J WARNING FAILUflETOSEGURE WORKERS'COMPEN3ATION COVERAGE IS UNLAWFUL,AND SHALLHE
� SUSJECT AN EMFIOYERTO CRIMINAL PENAlTIES AND CIVIL FINES UP TO ONE MUNDRE�THOUSAND ��yERGY PERMIT
�OLLARS(St W.oao�,IN ADOITIpry TO THE COST OF COMPENSpTION,DAMAGES AS PROVIDEO FOR IN
� SE��ON 7)OB OFTNE LABOR CODE,INTER55T,ANO ATT�RNEV'S FEES. �{ETENTION FEE:
d CONSTRUCTION LENDING AGENCY pRE•ALT FEE:
O
OC IHEFEBVAFFIRMUNOEHPE LTYOFPERJURYTHATTH REISACONSTRUCTIONLENDINRAGENCY
a- fOPTHE�'ERF9RMANCEOF HEWORNFORWHICHTHI EqMI7151SSUE�(SEC3o97,CIVC)
� _._._.—� —_
I�J
= LENDER'SNAME �-���--
�
f— LENDEfl'SADDRE
� , d . • • � . - •.-. ----- TOTAL FEES
� � � .
� ABOVE�MENTIONE`�iP OPERTYFORIN5PECTIONPURP•SE5
� COMMENTS - - .
a a --
_ ` , —
m PERMITfEENAME(Pfl�IJT} -'� V — -
Q
� _�
� S�GNATUF,EOFCERMITfE& OP�E
� RECPT.NO. PAID BY VALIDATION
r` �T��� WHITE—DepaAment Copy,`�ELLOW--F+nance Gopy,PINK—Assessor Copy,GOLDENR06—File Copy,GREEN—ApplicanYs Copy
�,���,v�6 �"�.�,"� ��b"".C�d���€f�;�,o-�' ��"kb'2
Ym�s,_G�`���r�°�gd"�'�-�,T e��":,5*'�t'�"�,`?y,"��'�
§
� . . . . . ' ' . , �. . .� . � . .. • ' -'.'�.
' . . . . . .. _ _ , ...,..... . ..s.
i c_._i-� .._� 'i.CS<).-��t�l�,"t '
, - c- I
r .a�� G r � � � _ __.- ' -- ---+ ---------
�. _��� ^ ,..`_RJ�_. ` ._._�__ „" _"_."' " """...._._._�._ '___�_
� ���., � �^�sV�..�.�.':�a t.:..�,�---- � . .._ . � t�t i��i��'.1�llt(."".. � l..__. _-----
__ ..._.._.._�-� . ..._�.._.�.._.._. .......» _
f„__ _., f ,....._ .. . _.__.�.. �_._�
v �i�d��h� `"�_r�`�i"� ��'ti.��`#
[1 ' F I
�n
��%=�v 4�ii�w l.f�i`.Jt,1��''
_.,.__.___���-- -"-'—
,
���,_._....__ ..__�_.�__. ��-'--- - ---
�G,Fi '.�,^t-�ri=v_�Jl�:ir�}i'!E: 'mm _ } ,.�_---- -_.__i i_ Ut�4�7[:ii i�'•_.:J�}�t<�.1i�i��>Jf�-�� _�-_— ---- —-------
. � , ____� - --
-- _.____.._..----
r---- , � t!`�
� ::��.�i.i�:.'',G� � _ _— , -f-?=?���-- -._�_ .__—_ _. - -.__._�__ _—
-r� - � —_�._�. � 1 : . �. _r��:�: t�UCVE? �lC}� �
---------- ----------- _.._.__�_.__. __.___
!��•��� �t'..i�L'C'�i � � ( 11�=i��"t,_r�����IVC:����,�__ ,_�' - - _.__._
_ _ -- - ---- - � __---- - __.._..�...:._;_`_.�_.�. �� -
� s i �,t?if.�H�T'. E�t��c`�FICI-�I'tirl __
-� -------- ����
���1`,�"�W�2 u"r'h�t�:C;L= � _--- __ — ._
- --- -_.`.___-- - �-- �.._—---- - -----� , _ ..____
{'Si f�`c.::s�"i�r'�r�_�'Fi°'tia �_ �_. � i ���?. `rt�.S'�ih'�����`:.�1; �
�- ._...�._� -' - -- .____—_ ---- ------- ---- ---- �
------
"'"3
� r=�I�I��Y��i'�r�t��tia�''LE�`�;i di�i�i ' � �F€P��� �;G1'�C��'i�,`-t�� ------_- __.�
� --------- -- ..�_ �] �''yJt {[`'
,..M___.__--- ( ._� L
��_.....,.._... - � ; F rT�_'\..ii"F14�.114'J1..h ..
P��,.,��J�"�M�`1�f'"'r's � ' ._..---'-._.._. �_.___.�
_ �...... .__--'- -' --'
�'S�'V��2i'��'1�i?.i€�'�J� _..__ � t��?��������.� ���_. �
W., �� �
�, _.__�.,_.._.__. _ —.�_..___ � __..._... ______
_._—�-.___�
+"�{�i.�t�e"��.��{„a��;i� , i ���!�$'i��i1�t���ti{�.`,
—___-- - - ' - --__-- ------ - -------
___..�.__
------ - -----
�,^��r��,.� r E i i�tf%;�;�v�1 � � �,�v€SF C��-��U(�Ca
� i
_ __(_-------� �_...�._--- — --__..... � _.__.___.__. _____----
[��_p.^_�.___.__+
"��'�-���t�b�"t`i!}E?r"',?i-C" I ��../�. �w�..�t./�i�il� �
�------------- --- � -- - — --------__ _.___ -- -- --------- ----
� �'t�s s1��4 rjG':t���d�F"..: � i �"{�t;%������C,���� � i
._ .�.__ _..'-.—'--'�--- ----- ---- '-- --- ------ -- ------- --- ---- -- -'-
. . -�,..
�
: ,._
�,��5_f.6i'�u�,%i_t��?�'r��i i . .
.__..._�____r__.�_ __"..._,._.....� _......___..�._. .,.__---------- - - ------ ---- � -- ---- ----------._--- -- --------
1 � ��'J{i� `"��,��..
r
, ct.s�14!r'8u� !��=�L�S_��i€�r'��t ( �� � 1 .�''/t'F'��"lti�1= fr�}`o1�'s�. � _ �
� � � � u;;���l0 3 2_�.• ���►�;�s Ee���----�---� ' - -- _____
� �.r._� � ; �-, <«�. -----�
� ��.Y���� I I s �;�?��.�:��c�,
_ _ . _. _-- --- - --------- --- --- ---__.�
4�+����� f�.����be� ' � s ��sn,c.f�.��fi���� __.. �
.�_.__ � �__ _._._____ _.�
___---��_ _._ __ _. .�.._. � , __ __ _ ___ . _ _._�_
_--
a s���Fe:�,3..a, i � ��I�� (�`v'��"�
�
3 �7rLi� n_f�"� :.F.:.�.�. ��,a�c[:'• �
_......._.._.___. ...__......._ .._ .. _.._.......__._._._... .__. __�__ .._._.__ _._."' _ '._.... _.,_ " _'
�"r<-r � � �Yi�ta��,,c�.�..� 'n4t"�
}w..__...,�,_................. ._..."_��_.� «.._. ' _�.__.._.____'._.�,„._....._'.___�_� �_ '_ "__ '_'._._....�... _ ______ _'_'_'___...._._�.,.
(" � ; �"'���i'���i�'�. i�iC��+.`r T -I—
e 3"��U.f13_�.:�i a6�i��.
�._..
.._._..___..._._..__..._. .. . _ ._ _-..�.. _ -- �-�___-- _. ...��_ __... _.._ ._._..._ ...--_—____
'_... ___.._.
; �E?�3o�ri��a�;[��� : � , �-IEI�t �H C��€��r �'•Et��,t3 �
,_.___._.._ __..._..�..___._._.�__. . _�._.___.�_ __._. ._.._ __.____�_ _ __._ _____ ___ . _._ _ _--- --
f .. .-- r.-.���,�., . .._�
�
f F!?�I_I_C:t„:,.���.ft.
_____ ______._..------ -._._. ___ . _ __.._.___.___. ----------------- ------- --
_. ._� 6��V �4 '
��,i ;"I ' �y. i:^�°` �_�_��_�_ `PET�-�C's
• F'�i(:} �
. .., , r
� .�.1..3:;%..^.,:, , �..r�: � � �--{____
a__..._._.._..�---- - . ____,......_._.,__..., ._______._�_. ._- ---_.,__.__ ._- -;--_...__._�_� ___ I
� . { ' .____.._.._ � � ---
..�����`�;'��k==., . � � ._.._._._____.________�____.___---_._.___.__.____��_________. __..__..._�__�__...._._ �_
i �-
---- ---- - --- ____.---- --------- ---------.________--- ------ - - ....�--- -- ---------
�_______._..___, _.-- _____..__.__�_---_._..____.M.__._..-------___�_._..-.- .-- ---.._..___._ . .___._.__--
� -----
�...._ .__._..._----.-, ---------------- ------______-. _ _ ..___..._�____m_.__..�._�._ _�_._.____'-------_ .___.
� -- ----�---_...__�
i
. __ __.__.......�.W.._.��W�._......_._... ._.....__... .._w __....�._.m.__.._..._.__........�.._ .�.___........_W._....�__�
�-�------•----_____�__-- -�- -�-- - -___—___.___-----. .. -�---�v__._._._-- ---- -----
_.. __.__-----__-_---- —
- - -__.___...___.�.---.._._...,.. ...._ __�____._..__--- --T—.,._..�__.._.___---------- -__..__
�
�.._.�.___�_.._._ .. ........._,_,__.�.�.._..__.... _._.._... .._��.._. ........... . _._....�____�.__,_._..A.... ....__. ��-----__._._._W._._...._-- _-____----
�
� _____�.._.._..__-----__ - ------�--------�--- - -- ---- --- ------ ----_._�_�_
� �.r'4`s"`4;.,"t" ��.`";'= ---'- ----- -----
�aw.. :f .f's�\1SL. �.a=�..._.
"�"7 z-L''{�!' i.•"'t::: ---__'�'.."._._.���___________ ""'_"___.._..._........__
.� , -"---.__._.._.._.�.� -----------
� , ?�.P:".€' . 81r'.3 c..�i,._. ___. _
� � . , .
� . .. ___._._._'"______�___'_—
�{ _..._,...,_... ' "'��.,.,..._.�._.."'_"'_'_'__'___ ""'
1 .. ' . ""_' ._ __'.......__-__._..._._.
� , ��______�"_ _._"._._'�._`_".._,_�_' __'___'_—�___.� _._...__
� .
E ' ___.. ,.._....._ _..W_.�.__..._._.._._.___��_._._,_....__-___._._'_�_.._.___.___._._'____.__—_..»„,.,..»._,.....,..�_.._.
S
._.�,_...__.......�.........._., _.�......._.....,,.._....._..._._.... ___..__�__._...............».....�_..._,.,,,..,...�
.._�._...�._—'___'__..__�,,,.�g
_ e, .. .. .. „ ,.,.......'""..-... _._ , . ._..... �...........ma.......,...,�.,�.......... .. ...d...«»... ..._.,.,. ��_.............r........-.,.�«,..M,�...,»,._«..,,...,......,.,...,...>...,e.....,.,rm.«.,...�w..»........e»...,............,.,.._.3
WALMJ'�'VALL�Y iJNIFrEp SCHOOL D[STRICT
S80 SOUTH LEMON AVENUE WAi..NUT CA 91789
CERTI�CATE OF C�MPLIANCF
With Fee Provisions af
Govemtne�t Code Seciion 65996 =
DEVELOPER/OWNER ���LL E�aTATE5, LLC
�
ADDRESS 34$0 T01�RANCE BL STE 300 Signacure af Applicant �
CITY/ZIP TOR�tANCE 90503 The petsan signing represents that hefshe is au�hoti�-:
T�LEPHQNE310.540.3990 to sign on behaif of rhe owner/developer and tha� d;c
information pzovided is ttue and accurate rn che he�c nt
his/her knowledge.
IVEW LOT ADDRESS USE O�BUILDING TOTAL SQ. FT.
0 WINDMI�.L DRZVE _ NSFIi _ 81Z2 _
Resideatial/Cvmmerc ial/Industrial
City �
HOME[MPI20VEMENT OR REMODEI.ING PRO]ECT
ADDRESS DESCRIPTIOI�I TOTAL 5Q, FI".
Diamond Baz � Waluut (Bedroom, Family Rm., TCitchen, etc.)
Signetare of Superintendent of�uiidings ��XY�A � �✓ Date � ` l�`J _r�-��
TO BE COMPLETED SY SCHOOL DI5TRICT
FE�SCI-iEDULE: The development fees levied by the Waluut Valiey Unified TOTAL FEES DUE
Scho01 Distria under pravision of Governrcxent Code§65995 $ ,f .,
are: (EPF. 8/17198) Residential Development $1.93/sq. fr. Receipz ����--�
CommerciallIndustrial $0.311sq. ft. Date�„20
Fees are assessed on TOTAL square footage "Iiving space" of ALL new or remodeling con5[ruction prajects OVER 500 sq, feet
(eliminating parage ar uncovered patio).
x This is to cenify that ail fees due ta the Wainut V�iley Usufied 5chool pistrict under pzovision of Government Code 5ection
�7~~65995 have been received and a building pemut may be issued.
This is to csrtify that the above described developmen[has been detenz�ined to be EXEMl'T from clie clevelopment fees of
Government Cade Section 65995 and a building perznit may be issued.
Ezemption Justiftcation: PROJECT IS 500 OR LESS SQUA.RE F'EET
QTH�R
—��-- -� (//�
Ni!i`�J � ��t-e/`.'-v�i"'^��F"�ti�
Assistant Superintendent
�iscal and Facilities Management
1l87 Rev. 2/88; 6/88; 8/89; 1190: 8i9�; 1Q/94; 8/92: 6/93; 11(93; 8/94; 6/96; 1/97; 8/9$
PLEA5E 5EE NOTIC�O�90-DAY PERIOD FOIx PROTEST OF FEES ON RE'V�R5E SIDE
�eg puowetQ �Q F�t7
esb �0i Z� D� ���
96trL-96E-6�6 ---- .— -
� � - -------------��-._--- --
WATER
RECLAPAATION
SOLI�WkSTE MANAGEMENT C�U N T 6 �/11 V I T�T I O 1 \9 �I S T�I C T�
OF LOS ANGELES COUNTY
1955 Workman Mill Road,Whittier, CA 90601-1400
Mailing Address: P.O. Box 4998,Whittier,CA 90607-4998 JAMES F. STAHL
Telephone• (562� 699-741 1, FAX: (562)699-5422 Chief Engineer and General Manager
Counfe°rTi'ou°i�: 7:00 a.m.- 4:00 p.m.Mon.-Thurs.
7:00 a.m.- 3:00 p.m. Fri. — — - --- ��-- I
:lccuunt \c�.: O�II(i707
SEWERAGE SYSTEM CONNECTION FEE . �'�'"�"� �"�� �� I
-- -� - -- -
Date: August 20, 2002
Properry Owner: WINDMILL ESTATES
Address of Property: 3057 WINDMILL DRIVE
DIAMOND BAR, CA
Thomas Guide Page: 0679J7
Contact: JON CAMERON
Phone: 310-540-3990
Mailing Address: 3480 TORRANCE BL, #300
TORRANCE, CA 90503
County Assessor Map Book,Page,and Parcel Number: 8713-021-031
Structure is Proposed.
User Category and Units of Usage:
Category: OlA
Number of Units: 1
Square Footage:
CONNECTION FEE CALCULATION
1.00 X $1,290.00 = $1,290.00
Number of Units of Usage Connection Fee Per Unit of Usage Connection Fee
COMMENTS:
�A-21-646 , $1,290.00
Connection Fee Due
� �-- —----- - --
� i
i I�cr P�i�in��:u R�•u:i�r�l i•rcnn: I'iuc�����:�1 h�: 1\'I'Y Sqry(�'ATION DIBTP.SGT5
' \1'I\D��111.1. I:ti I�r•\I I:S .\��,_•. �: OFLOSANGEI..ESCOt1NN
.1uu�uw: ti!,��)U.i)(� ('k. N�.�.:��lU:il �,./.'�/��//��.1/�� . __. .
� : ,�.�� : � ��.�,�.: ,��,_�,.� ,��. ,,,;,,- �-- � APPROlIE
APPLICANT COPY ' . JI���F.S F.STf.:��
='F�AIf'i:N�'i:i?tC'!' �! •r
� _.�__._...�_. •—
$g0 Flecycled Paper
� � �a, ,t, ,,
t4�� .
�� ��'�. . � .
PRESS FIRMLY
CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICE 21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117
BUILDING PERMIT APPLICATION
JOBSITE
ADDRESS 3057 WINDMILL DRIVE
APN LOT 1 TRACT 50314
OWNER Windmill Estates, LLC
ADDRESS 3480 Torrance Blvd. Ste. 300
CITY TorrancP ZIP 9050 3 TEL110-540-199C
APPLICANT Richard Gould TEL. same
CONTRACTOR JCC Construction
ADDRESS same as owner
CITY ZIP TEL.
ARCH/ENG/
DESIGNER R.Gould&Assoc.
ADDRESS same as owner
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 REPAIFIANY 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))
DIES 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. 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)
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 ACONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC-
TORS LICENSE LAW)
0 I AM EXEMPT UNDER SEC B A,PC FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER
9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND
MY LICENSE IS IN FULL FORCE AND EFFECT
LICENSE CLASS B LIC NO 671982
DATE CONTRACTOR JCC Constructici
WORKERS'COMPENSATION DECLARATION
, I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS
I 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.
I X 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
I ISSUED MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE
i -
CARRIER • o asRtiOn Tnguranop Fund
POLICY NUMBER •I • a
(THIS SECTION NEED NOT BE COMPLETED OF THE PERMIT IS FOR ONE HUNDRED DOLLARS(DI CO)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
3 CODE,I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS
)
I DATE. APPLICANT
J
1 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 W 00,000). IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN
7.I SECTION 3708 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES
C
J
CONSTRUCTION LENDING AGENCY
'5
C I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY
I- FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC 3097,CIV C)
CI
LENDER'S NAME
C..
- LENDER'S ADDRESS
C I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION Is CORRECT
u
, 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
7.
5
I
5 iv e AN"ie.(1....5. c,i.,l
n FERMI AME(PRINT) i
2
n 1 --&-'A.o-a)-4,,.
D SIGNATURE OF PERMITTEE" DATE
f
APPLICATION
DATE
Ilit ),.. I ISLI(' P/C m
NUMBER 1 w# ...-e.....:.'CI\cj 1
ISSUE
DATE
TYPE OCC
CONST. GROUP
FRONT SEfBACKS
ZONING REAR
SIDE/SIDE
SIDE RW 0
E
STREET RW 0
0
N0. PROPOSED
UNITS
DWEL. USE New Single Family Residence
1
N0. 2 N0.
STORIES BEDROOMS 5
DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREANALUATION
SFR/ADD/REM 8,112 ritt '46 . (9 0
4if
CO Garage/Carport 1,382 -1 (*30'ZO
I-1-1 Patio/Deck
W
I-1- PooVSpa
CD Re-Roof
Z
13
) Commercial
5
Balcony 160 ,,,):36 0 6
m Ent. Porct 138 1 0
15
Din. Porcl- 114 1-/
Valuation 1.! I Ib Lp ADJ AREA
QUANTITY i
DESCRIPTION FEE
1
<
0
E
I--
0
w
I
u.i
0
9
2
n
1
a
i
a
0
E
a
x
0
w
2
CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
SMIP
ENERGY P/C
ENERGY PERMITPERMIT
RETENTION FEE:
PRE-ALT FEE:
.s.
1111111
• )11141111M , �i c�i�.. �oi
137C9• °)%fl
5 0. ,11,
D."
.2..:< `1 \i
ZAtI 1
'3 46/45
e)..., s. k10
A ,ik
i
TOTAL .ca
COMMENTS i . .4',-vr•-='rc"A
FEESt 1 41.0.4 0
RECPT NO PAID BY VALIDATION
WHITE—Department Copy,YELLOW—Finance Copy, PINK—Assessor eopy, , —
�•�
�� '
�
016., f0,6
Otl* 4.
I 1
..1./1"(7,
0664„•;:exi.,e,
t
DIAMOND BAK I
PRESS FIRM
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 5 I'* -1 hirvA m .64 AK'
APN LOT TRACT
-----?1 fr9'
OWNER j
ADDRESS_39d7 7/Ar4i
cm( 1 atntiw-- ZIP le;rEL.
APPLICANT TEL.
CONTRACTOR id i 4 4WANIF.
ADDRESS �;1147Ir .
CITY .0, TL.
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 PERMITTO 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 SOBJEC IS CHF APPLICANT TO
A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(5 5W))
0 LAS OWNER OF THE PROPERTY. OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATON.
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 THAI HE OR SHE DID NOT BUILD OR
IMPROVE FOR THE PURPOSE OF SALE).
DI,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&PC FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER
9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PPOFESStONS CODE,AND
MY LICENSE IS IN FULL FQ15CE AND EFFECT
ti
LICENSE CLASS -2,-0 LIC NO 3-72-774,-7
DATE (24'74 CONTRACTOR
/43
WORKERS'COMPENSATION DECLARATION
I H REB 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 THE WORK FOR WHICH THIS PERMIT IS
ISSUED MY WORKERS'COMPE SATION SURANC ARRIER AND POLICY NUMBER ARE
CARRIER I- P
id
POLICY NUMBER
(THIS SECTOR NEED NOT BE COMPLETED OFTHE 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 ORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR
CODE, 1 SHALL,F RTHWITH COMPLY WITH T SE PROVISIONS
DATE APPLICANT
1 WARNING FAILURE T SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE
• SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP 10 ONE HUNDRED THOUSAND
DOLLARS(5100,1900),IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
i SECTION 3708 OF THE LABOR CODE.INTEREST.AND ATTORNEY'S FEES
CONSTRUCTION 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-M NTIONED PROPERTY FOR INSPECTION PURPO ES
A44--- .0 A. ri
E NAME FONT)
SI'. N' LH F PERMITTEE"YE
APPLICATION 1 05 PERMIT
DATE NUMBER
ISSUE OCC
DATE 1 &:..5 CC)PNEST GROUP
FRONT SEfBACKS
ZONING REAR
SIDE RW CI
0
SIDE/SIDE STREET
RW 0
0
N0. PROPOSED
UNITS
USE
DWEL /
/e-...
N0. N0. a_
STORIES Z.- BEDROOMS
u)
W
w DESCRIPTION FACTOR PSF
1-1-
0
z SQ. FT. ADJ.AREANALUATION
SFR/ADD/REM
Garage/Carport
Patio/Deck
Pool/Spa
Re-Roof
-6
I Commercial
5
co
Valuatton ' ADJ AREA
QUANTITY DESCRIPTION FEE
C.)
E
I-
0
w
I
w
0
z
co
2
D
..,
f%
-.1 0 ---
C.) ---i(2) —
E
< gyfit-375-,4,,,
I
�•�
w
2
"-VOA.—9.24Pitzv
,' .11111MMES" L.-
CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
M ECHANICAL
INSPECTION FEE
ISSUANCE
SMIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE'
PRE-ALT FEE
344. 50
1 -
TOTAL FEES .0
COMMENTS 370„�
RECPT NO =SF PAID BY illirliall VALIDATION
WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy, e Copy, pp !cant s
FCAP:-,11:ATION
CND BP'AM rty:,
CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117
BUILDING PERMIT APPLICATION
0
JOBSITE ,, 1
ADDRESS 301 iti 11 1
5 /VI ti-d
APN LOT I TRAGT 5-C3 i 4
OWNER LAJ) 1.4 dtut; ( 1 ET L. L.e..
ADDRESS 3 4 Ire "rc?-grotitie-- 1-3(-1/1:7
crrv-reagektte zipiev-,-,TEL31/2.1011
APPLICANT TEL.
CONTRACTOR"'IL,T4--e" filyt 4--
ADDRESS i O1. -
ti` a-t-.
CITY 5/.1.4. L)r4440,4 ziPqi-/73,TEL-Zen/../Cg 7
ARCH/ENG/-7.,
DESIGNER r•-•i/-. 1,111 8 A!-----)t-'
ADDRESSy.Re--„--7-r izpiirliCE
CITYI-CMI-6,1<::: ---- ZIP'fitEL.
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 P ERMIT 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(CHAPTERS(COMMENCING WITH SECTION 7000 OF DIVISIONS OF THE BUSINESS AND PRO-
FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP-
TION.ANY V/OLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO
A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(5555)).
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 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).
DI,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 t AM EXEMPT UNDER SEC B.&PC. FOR TI-US REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER
9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND
MY LICENSE IS IN FULL FORCE AND EFFECT.
LICENSE CLASS ---( LIC. NO It -;<" 7_7
DATE °Z- CONTRACTOR
WORKERS'COMPENSATION DEC ATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS.
(b 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
F THE WORK FOR WHICH THIS PERMIT IS ISSUED.
V°
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'COMP ENSATLON INS.U1/410E CARRIER AND POLICY NUMBER ARE-
CARRIER 5-1--"4-4,.., in)...
POLICY NUMBER 2---7-41 --e Z- "13 tie 1
^ (11-lIS SECTION NEED NOT BE COMPLETED OF THE PERMIT IS FOR ONE HUNDRED COLLARS(5100)OR LESS),
! I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I
i SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE
i WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME
z SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR
9 CODE,I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS
)
DATE APPLICANT
3
I
1 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(5100,000),IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
:I SECTION 3700 OF THE LABOR CODE,INTEREST.AND ATTORNEYS FEES,
3
CONSTRUCTION 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)
J
LENDER'S NAME
LENDER'S ADDRESS
E
I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
J 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
, .... .,,,•
4 j ek hiv--5 L-. I- et le-5
C3 PERMITTEE N E(PRINT) .
L
i
0 1444 ,i t.-4117-41-fra—
0 SIGNA
E PERMITTEE
APPLICATION
DATE
:,-.] P/C
\1 )(0,.0-1.p.gRMIT i 0, b )
N MBER I I #
ISSUE OCC
DATE
TYPE
CONST. GROUP
FRONT SEfBACKS
ZONING REAR
SIDE/SIDE
SIDE RW o
0
STREET RW o
0
N0. PROPOSED
UNITS
USE
D W EL.
N0. N0.
STORIES BEDROOMS
DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION
SFR/ADD/REM
CO Garage/Carport
LIJ Patio/Deck
W
U- PooVSpa
0 Re-Roof
z
15 Commercial
5
CO
Valuation ADJ.AREA
QUANTITY DESCRIPTION FEE
-J NM!
C./ t, Vice—
EE 4.LOMPRIMINIIIMIS
,-- 4400 WIMMILM1111111111111111
0 MENNEMZIZIUMI
Ili MIIMMI11111111111111111111
-J
L11
rti
1 0 1
(.../
z
�Z
2
ZS
2
a
x
0
iii
2
M EM"D
WNW
IIME4WAII
CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
SMIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE:
PRE-ALT FEE:
rii 4-
64
.7414-.e,3 0
t^to
111,.^
TOTAL FEES iit",Ali
COMMENTS
RECPT. N0. PAID BYmiiA. ..).2.1 VALIDATION
WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy, e Lopy,UN FI—AppIIcarOrsopy
DIAMOND BAR i
PRESS FIRMLY
CT"rAP DiAR;qONO. BAR iq.SPECTiON RE-7CORD
S.E.T RACK
1 FT GP:iFOR.MS/STFL• ELECTRIC,'GROUND GROO;qD PLUM.,!rtRADF TEMP PC;VvER
LYVATFR SERV/CE_
ROOF SI-IEAT RING
FRAMINGNENT;LIATION ;
; ROOF COVER _
ROUGH HEATING
ROUGH ELECTRIC
ROUGH PLUMBING
SHOWEFFFUS EST
EFT,/JO H/SIDING
WALL;,ISUI...ATIC..)N
OLFCON L_
'SEWER SEPTI:1';
:EP i-TI'L.AS AIRTcr
' FLOOR
FHA REOMTS
UNDER FLOOR DUCT
UNDER FLOOR CONDUIT
I-
I FIREPLACE FOUNDATION
'I FIREPI ACE BOND BEAM
MID HI-. BOND BEAM
8 Ff BOND BEAM
I r FINAL eoNo BEAM
PRE-GRADING
BENCHING
ROUGH GRADING i FINISH GRADING POOL ELECTRIC POOL FENCING POOL FINAL
OFF SITE IMPS, DEDICATIONS
FINAL FNG, LANDSC;APE/IRRIG. ON SITE IMPS, FINAL 70NINC:i
FFI.NATIIL EC-lyd C
SEPTIC TANK t'iL.,-"1"
SEEP Prl/U SIZE
t
I•,
..��
i..'
tt, REV. FEES PAID
�
DIAMOND BARI
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 .7,...--, 7-v.) •
ADDRESS D(....-' PI'/ W L ki ci eriii 1 b vi tie
APN LOT I TRACT 0 71 1 e,-/
OWNER et CI V^
ADDRESS 344is7Q Tr,ze r et"e e 8 fid ho. -ICY)
CITY rc,',c..-.srst in.c e ZIP C,- .. TEL. 3 it).-Vie% --Y?
APPLICANT V:. ; (h 0 vrA CTYcuIcF TEL S tt, 1/4-1 -e
i
CONTRACTOR JCL, IC CI PA-5 fro(tie) ...",
ADDRESS (a cl iel".. IP CA c 0,v ki e
CITY ZIP ZIP TEL.
ARCH/ENG/
DESIGNER it .
Q. . c;e3 Le,t tt-1"4-#1� 044r7C4. rkl-e4
ADDRESS 4 A YlA. f el..ez. r„w-ner
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 REOUIRES A PERMIT TO CONSTRUCT,ALTER,IMPROVE, DEMOLISH,OR REPAIRANY 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(CHAPTERS(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 00-10 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)
O1.AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTING WI LH 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 BUII DS OR IMPROVES THEREON,AND
WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S)I ICENSED PURSUANT TO THE CONTRAC-
TORS LICENSE LAW)
CI I AM EXEMPT UNDER SEC B&P C FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER
9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND
MY LICENSE IS IN FULL FORCE AND EFFECT
�
����� do����
LICENSE CLASS I--) LIC NO (-11 47 1 el 0 ,e
DATE CONTRACTOR S tic (t3-1.4itel,kite
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
14 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 WORKEV COMPINSATION INSURANCE CARRIER AND POLICY NUMBER ARE
J •
e... IO i .., n AI .
CARRIER -Jeer, I a.,,9,10e I'i S 1-4-I t t-., '1, fin 5. 4,:r C 1 PI ge t'
POLICY NUMBER
_l l,'>q-i'.4:)-t
(11-lIS SECTION NEED NOT BE COMPLETED OFTHE PERMIT IS FOR ONE HUNDRED CaLARS(SICO)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
• ' . - )USAND
1 1 • 1• " • • 1 FOR IN
i 1 1
I
CONSTRUCTION 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)
LENDERS 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
-C1.4 co.le A5
PERMIT-TEE
) (PRINT) .516L....... 5 -'3 " -?....,,,,
SIGNATURE OF PERMITTEE DATE
U)
CO
CC
LL LEI
0
sQ CL
0
414
021
a
U)
Cr
0 Lu
Lu
C.)
0
CO
CL
F—
CL
CC
a-
>< Lu
LIJ
(.0
-trc
.tct
APPLICATION PERMIT 1-- -s
DATE 0 NUMBER 1C6i PICQ r I
ISSUE TYPE OCC
DATE 6'2 d CONST. GROUP
FRONT SEfBACKS
ZONING REAR
SIDE RW 0
0
SIDE/SIDE STREET RW 0
IF
NO PROPOSED
UNITS
USE
DWEL (C4 i (1 et-
i e 1 ,..)
P 4
NO N0.
STORIES I BEDROOMS
U)
W
w DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION
u-
CD
Z
SFR/ADD/REM
Garage/Carport
Patio/Deck
PooVSpa
Re-Roof
13
I Commercta(
5
co
i2e,01 ee, ' ) '°
)-•U —
'ar ', 30 19111111111111LVAt.
Valuation ii C^I C...sICi ADJ.AREA
QUANTITY DESCRIPTION FEE
-J
<
0
E
I-
0
w
I
i.0
cp
z
473
2
D
-J
I3.
1
<
0
2
a
I
ci
w
2
rt.,,,, CONSTRUCTION
&LAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INS2ECTION FEE • 1
ISSUANCE ^C)&4c,' 0
SMIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE:
PRE-ALT FEE*
Ii il Y6s-3 0).9 S\-',/
Lk 1,.<.pj,
li Cit\.Scp
4 f*. *us'
'-9
li
– – .5 ..,,.... 1—
t
s,l
0(
irli-111
TOTAL FEES 16i=1Q-- IS Cyrr-i'LL•,(Ct t,-,' kt„s,',A.\•.,, .1,64 :3
COMMENTS
G���....,
PAID BY U"', VALIDATION (4)
RECPT NO
WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy, e Copy,(JIIGCFY—AppeCanrS Copy
.g .g�. . _ . . , ;,,4i;•'.'.. .
g . •vg..-
;-';-....-. ; -.���t_,•;',•:::•.•��. i ; .
1 .. . .
. -.,f� �:� H �� .�-•7::�'„1�' • '-� '•'�'�'��'�'�t'•���
+
.. .�
Fs;;.
;,r-.4;-;•;,;;-47;•4 1-s;
. r T'TCN
+
9
� � �
Y.,
6/11_04-770_-_IL
41FIgli;
t
1-,
CITY OF DIAMOND BAR IN)9 Ftz.
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E. Copley Drive
(909)860-3195 Fax(909)861-3117
BUILDING PERMIT APPLICATION
I ON 11/1PRESS FIRMLY
r
JOBSITE
ADRESS
D ,1/ 2 N
.7
/7 ai/A/PM/ /
.3e9c
AP N LOT TRACT .,.5 CI 57 4c
OWNER
ADDRES � z Z/Z 4....) z ,4„J----
cm, 1,0,2 P_AVIX;(7.-c_.7-.--,t-_, „•,,,,,,
ZIP 1,9:,e.../...,TEL.71",cio 3 y'.;
APPLICANT TEL.
CONTRACTORr57-4/0 1Z,A brfr 4 ./74--' '1-'67
ADDRESS//A-2,y cfr,-
crry L..74/./,t,e) ZIP TEL. 762Z 5
ARCH/ENG/
DESIGNER
ADDRESS
CITY ZIP TEL.
OWNER-BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PEFUURY 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 PERMITTO 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 7005)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(5500)).
0 I,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. 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)
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 AcONTRACTOR(S)LICENSED pURSUANTTO THE CONTRAC-
TORS LICENSE LAW)
0 I AM EXEMPT UNDER SEC B&PC FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER
9(COMMENCING WITH SECTION 7050)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND
MY LICENSE IS IN FULL FOR E AND EFFECT
LICENSE CLASS --..17'. L IC NO K.; fV,e7 7
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 ANDe11104_, NUMBER ARE
7-'4. 7�;/1 •„L,
CARRIER
,•/
� POLICY NUMBER /7-47 4. e....., ......:......)
(THIS sEcnasi NEED NOT BE COMPLETED or THE PERMIT IS FOR ONE HUNDRED DOLLARS(EI CO)OR LESS)
i
I
' I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I
i SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE
i 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 TI-I SE PROVISIONS
I DATE- APPLICANT. .,-/ZR;--/7e,e7
1
i 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
71 SECTION 3709 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES
71
CONSTRUCTION LENDING AGENCY
5
- 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,cly C)
E:1
.-.. LENDER'S NAME
LENDER'S ADDRESS
E--
5 I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION is CORRECT
LI 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
5'.. ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES
5
1 een/Z/Z,',4 '))/J
o P MITTEE RINT)
0 Z.
n SIGNATURE OF PERM I, E DATE
E
APPLICATION i i I PERMIT P/C
DATE 1 NUMBER #
ISSUE TYPE OCC
DATE I b 02-- TYCONST. GROUP
611
FRO NT
ZONING REAR SETBACKS
SIDE/SIDE RW o
SIDE
0
STREET RW o
ID
N0. PROPOSED
UNITS
USE
D W EL.
N0. N0.
STORIES BEDROOMS
DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION
SFFVADD/REM
co Garage/Carport
Lu
lil
IL Patio/Deck
(5
Z
Pool/Spa
Re-Roof
Ei Commercial
D
CO
Valuation ADJ.AREA
QUANTITY DES_CRILTI' 1;)A2 FEE
0
E
I-- 76 16
-J
W
2474 14. 2 VT g 7. Zo
5.-
A WV. ee, ,eee ..co
i37 .e%s
CD
z
Co- ..e.: ..... -
2
a
Ar APPISMINIPIIIP,M21111111'1-r 4::5,-CZ)
.. -,... r.lall.e• /e..9, 0
1111, 6.. -
<
0
2 ,;,-„W".WNIIMP-P7A111=11-?:
a AML,RMIA. !AVEMMEMIIlir77e9
x A,,,,,r v- - ,,,A?,..2._ '
c.) 11/F
L11 /c..)
IIIIIVI •'. %�"'
CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE 454f: U
ISSUANCE
SMIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE:
PRE-ALT FEE,
2-5-•°a
I e 07:;',)
TOTAL FEES Wt., 20
COMMENTS
.1.
WM"Mt WOOF r
RECPT. NO MN ---- PAID BY VALIDATION ..,
WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy, e Uopy,II'IIrIzN'-AppIICant S Uopy
�
m
CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION
JOBSITE il ff^ 1 •
ADDRESS -7:. C' / ' ill d Iii I )-'
APN LOT TRACT
OWNER it,G,A_ i-AI' ,I,
ADDRET ' - 1 ( .0 9 1 ( 11.7—'---1"'-i-lis-v
7
, . .. - ..
CITY .
I ,'ii SIP e t,- ,K ZIP TEL.
APPLIC.ANt- - AI :h.vi.t? A.,),6: TEL.
CONTRACTOR ,er', p e rli ve, 1;e2.444-}c-e '...)1.-
ADDRESS 2 r•Ay Pa Sy-,4' 94,,,&.7)
my 11,(4 I It ZIP lk't.
tEL.
i . . _741')
ARCH/ENG/ t i /'-"'
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 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(0500).)
0 I,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. 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).
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.&PC. FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER
B(COMMENCING WITH SECTION 7000)OF DIVISIONS OF THE BUSINESS AND PROFESSIONS CODE,AND
MY LICENSE IS IN FULL FORCE AND EFFECT.
,,,c_,I, 7
LICENSE CLASS g .1 ki. 'I c"'..s"--1 1.
- , 1.10 NO
DATE 1 1 1 "'?) I(-2' S CONTRACTOR .::: 4-7 r,......, 14,,,,v,..-e_
—i 1 - ,
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 REWIRED BY SECTION
3700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED MY WORKERS-COMPENSATION INSURANCE CARRIEtD POLICY NUMBER ARE *1„
C.,,. ----„L,oe'
CARRIER 551-6 -1
POLICY NUMBER . i ('ll- 1,- C>,iciNt:
t
(THIS SECTIC8INEED NOT I5E CCMPLETED OF D-IE PERMIT IS FOR C81E HUINOREDDOLLARS$100)ORLES4
1
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 I
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, 1 SHALL FORTHWITH COMPLY WITH THOSE PpiOVISIONS .,
1
'7 11 - .,c
k DATE: 11,1. 5..e 1,-' k APPLICANT 1' ,I "...--A......,,-- .-
1 Iv )"
. WARNING FAILURE TO SECURE WORKERS'COMIENSATION COVERAGE IS UNLAWFUL AND SHALL BE
- SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED.THOUSAND
DOLLARS(meow).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
i SECTION 3708 OF THE LABOR CODE. INTEREST,AND ATTORNEY'S FEES.
i
CONSTRUCTION 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.
AITR iAjA k)(Z,-
) PERMITTEE NAME(PRINT)
C I,,
0 .. ..7'
,-) SIGNATURE OF PERMITTEE J, ..
DAT'E
�f ..
PRESS FIRMLY
1
APPLICATION
DATE
,_ PERMIT
i 1_I . 5 ':-Z..., NUMBER # e
.,t
ISSUE
DATE
. TYPE OCC
—CONST. GROUP
Tilifialllll. ETBACKS
FRO NT
ZONIN REAR
L SIDE
RW 0
0
SIDE/SIDE STREET RW 0
0
N0. PROPOSED
UNITS
USE
DWEL ..)) F r P, i-i)e--tA..t..���_�t��--Lk._ \��_�I-A--
—12.0 _rx-i_. )5—
N0. N0.
STORIES BEDROOMS
CI)
W
w DESCRIPTION SQ. FT. FACTOR PSF
Li-
0
Z ADJ.AREA/VALUATION
SFR/ADD/REM
Garage/Carport
Patio/Deck
Pool/Spa
Re-Root
E Commercial
2 .,..)4c-t-L\(..7 Z.-S F-r UV.
-,- rl"
Valuation IO tctc-N ADJ.AREA
QUANTITY DESCRIPTION FEE
s
0
E
I-
LL
-J
LII
21.1." 501r4..11'
0
z
E
2
D INVID...—WW/1.1111
idIIIMP IMF
kV
--I
C.)
2
a
x
0
ILI
r,,.57Y-E_Aurse MIT
CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
SSUANC
----sm
ENERGY P/C 4
ENTION FEE' ,
il I Li . 0
fj, ),CO,CD.
IT,--2_cz,
PR- FEE:
TOTAL FEES � 3/:,,,i.l.-- - - ...0.._d-d
COMMENTS 76-1,-, 09,-/
RECPT. N0. 1 I Ot. 1„PAID BY ilt-71 VALIDATION
.6Xy)
WHITE—DefiartmenT Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy
CITY°DIAnO 1\1 D n
SPCTO CORD
GROUND PLUMBING SLAB GRADE
TEMP POWER
WATER SHAME ROOF SHEATHING FRAMING/VENT!!ATON ROOF COVER
ROUGH HEATING ROUGH ELECTRIC-ROUGH PLUMBING
SHOWER/TUB TEST_EXT LATH/SIDING WALL INSULATION CEILING INSULATION DRYWALL NAILING SFWEH
SFEFIC TANK SEEP PIT/1
GAS AIR TEST FINAL CON ST. FINAL HEATING FINAL ELECTRIC FINAL PLUMBING
UNDER FLOOR CONDUIT FIREPLACE FOUNDATION FIREPLACE BOND BEAM
MID HT BOND BFAM
FT. BOND BEAM FINN BOND BFAIVi PRE-GRADING,BENCHINC3
ROUGH-GRADING FINISH GRADING
POOL ELEGTRIC POOL FENCING
. POOL FINAL
,OFF SITE IMPS. DEDICATIONS
FNG,
I ANDSCAPEARRiG,
ON SITE IMPS,
70NING FIRE DEPT FINAL HEALTH DEPT,FINAL DEW,FEES PAID,; ENERGY
COMMENTS
SEPTIC TAIC SIZE SEEP PIT.,LI SIZE
cVr7M/ 47/77-t/ti&7e kileS Pral•(Yat/b/ii
CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY 8c. DEVELOPMENT SERVICES 21825 E.Copley Drive
(909)860-3195 Fax(909)861-3111
BUILDING PERMIT APPLICATION
APPLICATION-
DATE
D4e..... , t.,l FZFZErR.,, ./c:c.)47C
ISSUE
DATE
TYPE OCC
CONST. GROUP
FRONT SEfBACKS
ZONING REAR
SIDE RW 0
0
SIDE/SIDE STREET RW 0
0
N0. PROPOSED
UNITS
USE
DWEL ..1"-- ..-- -
N0, N0.
STORIES BEDROOMS
DESCRIPTION S0. FT. FACTOR PSF ADJ.AREANALUATION
SFR/ADD/REM
a) Garage/Carport
U-I
U_I Patio/Deck
1-1-
Pool/Spa
(5 Re-Roof
Z
CI
-.I Commercial
co
Valuation ADIAREA
QUANTITY DESCRIPTION FEE
-4
c(--- co bj
Ui
/ z_.fel 1.,•-1.74
'7 pi o 6
i
'7 1 5 i...k. ,txu3.
z / 8i,.,, eA ittioct---fekAA
si
0
z
c.)
CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
SWF,
ENERGY P/C
ENERGY PERMIT
RETENTION FEE-
PRE-ALT FEE:
4'° . •5.:..-3
4-4.5 ---:,-----
I.Z....c
TOTAL FEES CC')-1 .
COMMENTS
RECPT. N0. 1 1 ...;'<":-.1 r.°; PAID BY_I Q ike.....!9_VALIDATION --.1\ell
WHITE--Deparlment Copy.YELLOW—Finance Copy, PINK—Assessor Copy,GOLDENROD—File Copy. GREEN—Applicant's Copy
PERMFTT AmE(PRINT)
JOBSITE.3051 Wtvid iv(I Dv.
ADDRESS
CONTRACTOR :SLR C--7 I&— ADORE/Q2'75 fil,e4)-t-e..
CITY.. e4s4 tA Wiz> DPI i 7 73 TEL 2 10•-11,
ARCH/ENG/ , i I
DESIGNER R 4...0.2,1'134
ADDRESS .-:' ....0 1 11.Lisill
......-,
CITY Or, :..,:iA. ZIP 47662.33 TEL
APN LOT I T ACT 663 i
OWNER evl A,giti
ADDRESS 30—.7(/tit yid 14411 126"
CITY ZIP TEL
APPLICANT TEL.
OWNER-BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I MI EXEMPT FROM THE CONTRACTORS LICENSE LAW FORTHE
FOLLOWING REASON (SECJ039.5 BUSINESS AND PROFESSIONS CoDE.ANY CITY OR COUNTY WHICH REOUIRESA PERMIT
TOCONSTRUCT,ALTER.IMPROVE DEMOUSH,oR REPAIRANY STRUCTURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE
APPLICANT FOR SUCH PERMIT TO FILE P.SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS
OF THE CONTRACTORS LICENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 7030)OF DIVISIONS OF THE BUSINESS AND
PROFESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMPTION.ANY
VIOLATION OF SECTION 70313 BY ANY APPLICANT FORA PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE
THAN FIVE HUNDRED DOLLARS(3500));
L AS OWNER OF THE PROpERTY.OR MY EMPLOYEES WITHAVAGES AS THEIR SOLE COMPENSATION,WILL DO THE WORK,AND
THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC. 7944, BUSINESS 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 ISSOLD WITHIN ONE YEAR OF
COMPLETION.THE OWNER-BUILDER Wal HAVE THE BURDEN OF PROVING THAT HE OR SHE MD NOT BUILD oFt IMPROVE FOR
THE PURPOSE OF SALE).
0 LAS OWNER OF THE PROPERTY AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE
PRCMECT(SEC. MA,BUSINESS AND PROFESSIONS CODE.THE CONTRACTORS LICENSE LAW DOES NOTAPPLY TO AN OWNER
OFA PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTSFOR SUCH PROJECTS WID4A cONTRACTOR(S)
LICENSED PURSUANT TOIRE CONTRAO TONS UCENSE LAW)
IIIAMEXEMPTUNOEIASEC B&PC FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAN LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH
SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE.AND MY LICENSE is IN FULL FORCE AND EFFECT
LICENSE CLASS LIC N0. 171112
DATE 3/z. 4.10-4 CONTRACTOR L._15 ete-efy,
WORKERS'COMPENSATION DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATKNS:
!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 THE WORK FOR WHICH THIS PERMIT IS ISSUED.
I HAVE AND WILL MAINTAIN WORKERS. COMPENSATION INSURANCE,As REWIRED BY SECTION 37130 OF THE LABOR CODE.
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED MY WORKERE7SeA RoN 1MBURANCE CIARRIER
AND POLICY NUMBER ARE
CARF9ERt---09/%6 POL1Cy NUMBER Z
(THISSECTION NEED NOT BE COWLETED OF THE FERMAT IS FOR ONE FIUNDAED DOLLARS(SICO)OR LESS).
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($100,5os).IN ADDMOH TO THE COST
OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3709 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE
OF 714E WORK FOR WHICH THIS PERMIT IS ISSUED(SEC 3097,CIV CI.
LENDERS NAME LENDERS ADDRESS
I CERTIFY THAT I HAVE READ THIS APPLIcAIioN 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,
-ve6
ERM/17
PRESS FIRMLY
CITY OF DIAMOND BAR INSPECTION RECORD
SET BACK , 'FLOOR JO,ST .
IT- :FHA REQMTS
-TGS/FOR MS/STEE_ .
' — — — �
ELECTRIC GROUND___ , _ _ UNDER FLOOR DUCT
GROUND PIOMBING -
, UNDER fl OOP CONDUIT •
SLAB GRADE:
TEM P POWER , . • FIREPLACE,--OUNDATION,
WATER SERVICE . .
-'FIREPLACE BOND BEAM !
-MID HT BOND BEAM
ROOF SHEATHING 8 F", BOND BEAM
1 -
" FINAL BOND BEAM ,
:--RAN/INGNENTILATION
ROOFCOVER . .
ROUGH HEATING • PRE-GRADING -
� BENCHING
ROUGH ELECTRIC . ROUGH GRADING
ROUGH PLUMBING : . FINISH GRADING
SHOWER/TUB TEST , POOL ELECTRIC i
EXT. LATH/SIDING - i POOL,---ENCI\G I ,
WALL INSULATION . .
: POOL FINAL i
CEILING INSULAT:ON • . OFF SITE IMPS, -
DRYWALLNAILING • DEDICATIONS
SEWER _ , .
SEPTIC TANK FINAL ENG.
SEEP PITILL . LANDSCAPEIRRia•
. . 'ON SITE IMPS.
i-GAS AIR TEST . ; ! .
- -,FINAL ZONING .,
, :7\ ' 'FIRE DEPT. FINAL '
FINAL CONST. .4: • ', --i
'--INAL HEAPNG . --------I-73-„i . , , .
• . : • HEALTH DEPT. F NA L
..•
DEV. FEES PAID
. ENERGY
.. . �
. ... . .. . „ . ,.- .
COMMENTS
SEPTIC TANK SIZE
SEEP MTN SIZE
, •...- • .: •7:••_f,' .
.
- ';'• ..
�•�� .. s.
_ . ... ,
WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy
DATE
ATURE OF PERMITT7
SIG
CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21660 E.Copley Drive Suite 190
(909)860-3195 Fax(909)861-3117
BUILDING PERMIT APPLICATION
APPLICA
DATE
T NUMBER a/ i_r_ PERMIT, , P/C„-.-._
......t, "'( --1&-)C-l.e."#
ISSUE
DATE
TYPE OCC
CONST. GROUP
FRONT SEfBACKS
ZONING REAR
SIDE/SIDE
SIDE RW rj
0
STREET RW 0
0
N0. PROPOSED
UNITS P\ -cB
USE
D W EL.
N0. N0.
STORIES BEDROOMS
DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION
SFR/ADD/REM
(4 Garage/Carport
U-1
tu Patio/Deck
LL
PooVSpa
0 Re-Roof
Z
5 Commercial
5
co
Valuation ADJ.AREA
QUANTITY DESCRIPTION FEE
I
z 1*,I-Pil7' /e�
Ed ,_.e..i.' /2.4. $
2 /
i i .4Pt7'
/ :diolies 44.0 iEt Z ZeP.I.e,
le."4-'74
A-24AtbC/2. rf9. 1G
II 6eff^ 174'X- .7'-c ,09e'
v..;
I
CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE . ,
ISSUANCE -5613q=-61=
SMIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE.
PRE-ALT FEE'
5-1--S'----
c'D,t:::'�•_�
TOTAL FEES e1..50
COMMENTS
E.TE'rE INK'-TI'V.,--e/
1 ' _PAID BY'I' '-',-"" 140 VALIDATION • V-1(1
JOBSITE-2
ADDRESS (-14"/1e41/Pt?" 144 7C)12•if
APN OWNER
ADDRESS 7.".r7
CITY Di*"yk.. 1/04. TEL.
APPLICANT TEL.
CONTRACTOR
ADDRESS jir, 5." "I or-4"
CITY afrii 4. 0 ARCH/ENG/
DESIGNER
ADDRESS
CITY ZIP
OWNER-BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LICENSE LAW FOR THE
FOLLOWING REASON (SEC 7031 5 BUSINESS AND PROFESSIONS CODE.ANY CITY OR COUNTY WHICH REQUIRES A PEEWIT TO
CONSTRUCT,ALTER,IMPROVE, DEMOLISH,OR REPAIR ANy STRUCTURE, 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 LICENSE LAW(CHAPTER(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND
PROFESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMPTION.ANY
VIOLATION OF SECTION 7031.6 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,BUSINESS 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
COMPLETION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR
THE PURPOSE OF SALE).
DI,AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE
PROJECT(SEC. 7044,BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER
OF A PROpERTI WHO BUILDS OR IMPROVES THEREON.AND MO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)
LICENSED PURSUANT TO THE CONTRACTORS UCENSE LAW.)
DI AM EXEMPT UNDER SEC B PC. FOR THIS REASON
TEL.
LICENSED CONTRACTORS DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 0(COMMENCING WITH
SECTION 7003)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FOZCE AND EFFECT
LICENSE CLASS 744 LIC NO Vffle7
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 370000 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 WORKE90-DOMPENSAII INSURAN5EARRIER
AND PO NUMBER ARE
CARRIER -S
POLICY NUMBER/2. 7". a. 7 "7
(THIS SECTION NEEDNOT BE OZNPLETEDCF THE KEW FORONEHUNORED COLLARS($100)O11 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 3750 OF THE LABOR CODE,I SHALL
FORTHWITH COMPLY WITH T E PROVISIONS
DATE. APPLICANT 7'/6/-141P414)
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 3750 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
CONSTRUCTION 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 3007,cIV C)
LENDERS 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
X/1/2,5-'
PERIM EE N RINT)
PRESS FIRMLY
ZIP 7//OrELIe,C2
DATE
OWNER
rATY OF DiAMOND BAR INspFc,;TvIN P,ECOSD
•FLOOR,IOIST
Fil2.:',XvITS
UNDER FLOOR DUCT
UM) E: 17 LOC o(tiUiT
— I '
ACIF FOUNDATION 7:REFILACE BOND SEAM
' MID T. SOND BEAM
� 8 F. 1•30ID BEAM FJAL LII)ND BEAM I'-'1••=-IF•R=I3RAUI:.\;G
. ?UGH
CTflC I (4t-I•IADING
i ; P00: ELECTRIC
POOL I"E\ICING
Rory,
-^-
' 1,-,r.:,-, ��-, -•-'-',vc
- -- - ^ - - -- --- - ----
.. ...... ...... ....... , ............,,......, ...... . .......
. „ .. .....�.���„ ....,,..
.
^ ' f-r.,',', .i k?�� '
.• .
:),.-
4
CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E. Copley Drive
(909)860-3195 Fax(909)861-3117
BUILDING PERMIT APPLICATION
PRESS
JOBSITE .
. b91 WI NIP t----1(1., L.-D(-2_,
ADDRESS
APN LOT t TRACT C.--)TI, A--
OWNER H it,I NI C-/LI-I i--4
ADDRESS'1, CR-%y..i-tot-
crry-P-67 gAivr- ZIP TEL.
APPLICANT 1Z. 1 Ci-iiNp:, 61 te:),---it.--0 TEL t CD c-40,-g-rt.,,
CONTRACTOR J C,C., C..O 1-4 1-1?-4-(C-v-r(ut--1
ADDRESS"' 4-c --tviaiLArd 6.- pL-411
CITY 1-07-*.A r-i-c_el ZIP 4, TEL"?'t c--54-e-7100
ARCH/ENG/ .
DESIGNER hi-AA
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,DEMOUSH. 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 7031.6 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO
A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS P00))
O1,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 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).
DI,AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTING WITH UCENSED 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.&PC FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER
9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND
MY LICENSE IS IN FULL FORCE AND EFFECT
LICENSE CLASS LIC NO Co 1 11 0 4-
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 4101411=Ff 417'. \V--6or1 r
POLICY NUMBER (to 13 kikef-/00
(THIS SECTION NEED NOT BE COMPLETED OFR-IE PERMIT IS FOR ONE HUNDREDMI I ARS($100)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 ATTORNEYS FEES
CONSTRUCTION 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,CM 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 CiT(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
' k c-t-0,12---0
IL L.---Ic 0 i- 12
PERMITTE 4pRiz
(p----144/ Ve h) ".
SIGNATURE OF PERM! E ,,,,- DATE i
APPLICATION \-------
DATE V NUMBER 03 PERMIT ottc-tt P/C
I 1.- #
ISSUE
DATE
TYPE OCC
CONST. GROUP
FRONT SEfBACKS
ZONING REAR
SIDE RW 0
0
SIDE/SIDE STREET RW 0
0
N PROPOSED , Oft
UNITS —Da-rLc. .0- LI Mr 1 r•i, AMA
USE
.a 1Pt'IMPI
wilin...——— —
u)
W
w DESCRIPTION SQ. FT. FACTOR PSF
u-
0
Z
SFR/ADD/REM
Garage/Carport
Patio/Deck
Pool/Spa
Re-Roof
15
.../ Commercial
5
m (----^
D\0(>
1
Valuation 'Q,) ADJ.AREA
QUANTITY
DESCRIPTION FEE
. J
<
0
-lt-
I-
0
U.1
I
LIJ
0
Z
E
2
m
i
CL
--I
<
c.)
-2
a
m
c)
ui
2
CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
SMIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE:
PRE-ALT FEE: i ^IC),Y3
- -)c,C 2)
,aISO
C.)6
TOTAL FEES
COMMENTS
RECPT. N0. PAID BY VALIDATION Ii'
WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy
4-
SET SACK
FIGS/FORMS/ST ELECTRIC GROUND GROUND FLUi,./IBING SLAI3 GRADE
TEMP '-'0\NER
WATER SERVICE ROOF SHEATHING RAMING/VENTILIATION ROOF COVER ROUGH HEATING ROUGH ELECTRIC FICIUC;11
PLUMRT4G
SHOWER/TUB JEST E XT. LATHIS i7;G h-WALL INSULATO-.-M CEILING, INSI DRYWALL
N:-
SEWER
"EPTiC TANK SEEP P;T/I,L.
GA
I-LCOR JUIS I
FHA REQMTS
UNDER FLOOR DUCT UNDER FLOOR CONDUIT FIREPLACE FOUNDATION FIRE--.PLACE BOND BEAM
ID HT, BOND BEAM FT. BOND BEAM
FINAL BOND BEAM PRE-GRADING BENCHING ROUGH GRADING FINISH GRADING POOL ELECTRIC POOL FENCING POOL
FI NAL
'...'FF SITE IMPS. 'DICATIONS
FINAL ENG. .4NDSCAPEJIR'IG.ON SITE IMPS. FiNAL
FINAL PLUME...NG
, ENERGY
PTIC TAN:(1:::=AZE EP Pri/U SITE:
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 0 .*-1 kA 11'.1bAn i Li...-
APN LOT TRACT
A. 1,61
OWNER OA,k A KA A ,) 11
ADDRESS '31;4 1 �Ai t NOVI I Li-.
CITY VI44A 04 PIY4)00--ZIP TEL.
APPLICANT TEL
CONTRACTOR tit 2-It--6cl IV r" 1--A4P4'ork o ri I i41 C.
f
ADDRESSir i?r..(_0 po p 1._(Z-,
CITY in/LA)14 T ZIP TEL
ARCH/EN/
DESIGNER 1.,V I P A pap-e-i_
ADDRESS Z-o >7 1 ittlats , - 1417Z--I
crry jl/4 I, f3, . ZIP
OWNER-BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI-
CENSE IAWFORTHE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE ANy CITY OR
COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT:ALTER IMPROVE. DEMOUSH,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 UCENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI-
CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 7005)OF DIVISIONS 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 70.31.6 BY ANT APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO
A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(Ma).):
0 L AS OWNER OF THE pROPERTY.OR MY EMPLOYEES WITHWAGES 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 MHO 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).
O1,AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTING Will4 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 BUIU)S OR IMPROVES THERE-ON.AND
WHO coNTRACTS FOR SUCH PROJECTS WITH A CONTRACToR(S)LICENSED PURSUANT TO THE CONTRAC-
TORS LICENSE LAW.)
O1 AM EXEMPT UNDER SEC. B a PC FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER
9(COMMENCING WITH SECTION 7500)OF DIVISIONS OF THE BUSINESS NID PROFESSIONS CODE,AND
MY LICENSE IS IN FULL FORCE AND EFFE .
2,C. 7- 6etI5 ?/
LICENSE CLASS LIC NO
DATE t i--1--D)7 CONTRACTOR eIlIZ4rbeliV._tr_
I
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'
coMPENSAlION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMANCE
OF THE WoRK FOR WHICH THIS PERMIT IS ISSUED
i-
I i HAVE AND YELL MAINTAIN WORKERS COMPENSATION INSURANCE,As REQUIRED By SECTION
. 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
I ISSUED. MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE
i
. CARRIER 414-1 -E— 'r("..<10
! POLicy NuMBER i 4 1-6704FL
i (THIS SECTON NEED NOT BE COMPLETED OE THE PERMIT is FOR ONE HUNDRED CCXIARS(alma%Las).
/
- I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT is IsSUED,l
i SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE
5WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME
.- SUBJECT TO THE WORKERS COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR
3 CODE.I SHALL FORTHWITH COMPLY WITH I-•s -•••, 41.
)
DATE: 1 I" e-0.. 'APPLICA .O.l l l l leiks
)
i ,--
1 WARNING. FAILURE To SECURE WORKERS COMPENSATION .. ERAGE IS UNLAWFUL,AND SHALL BE
- SUBJECT AN EMPLOYERIO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
- DOLLARS 0100,000,IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
,-..1 SECTION 37oe OF THE LABOR CODE INTEREST,AND ATTORNEY'S FEES.
3 CONSTRUCTION LENDING AGENCY
3
C I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY
L. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC 3097,Civ C)
5
LENDER'S NAME
C.
LENDERS ADDRESS
E
(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 RELAT/NG TO BUILDING
, CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
-, AS30VE-MENTIoNED PROPERTY FOR INSPECTION PURPOSES.
Z
5
5 p ic-1.1.t_— C t-/-VI...)
33 PERM!
< i k"' /
A GRATUREoF, DATE
L -
APPLICATION
DATE
PERMIT P/C
NUMBER II
ISSUE
DATE
TYPE OCC
CONST. GROUP
FRONT SEfBACKS
ZONING REAR
SIDE/SIDE
SIDE RW 0
0
STREET RW 0
0
N0. PROPOSED
UNITS �1..ALJ-i\--
DWEL USE .lArifl-C�W
�
- vw-- •iir--- • .1 r
N0, STORIES
N0,
BEDROOMS
DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION
SFR/ADD/REM
U) Garage/Carport
LIJ Patio/Deck
U.
0 Pool/Spa
Z
Re-Root
5
-) Commercial ..
D
CO
rtj_Mi Viz_ J1," 14.4.... . 4_0,
, 7.4...e._ -
gifir tr&-id-.OA-1.-L ,-;-Loit 1-f6 . -- .-.06, LT-
.:Ireikii?..4
Vaivation '5 r<1..."C"-.
ADIAREA
QUANTITY )
DESCRIPTION ,FEE -
...i
.rC
0
EC-
Lu
-J
Lu
0
z
ro
M
D
-J
12-
-J
<
0
2
a
x
0
t.0
M
RUCTION -.-
EvIEW
ELECTRIC
PLUMBING
MECHANICAL
O.lISPECTION FEE D
ISSUANCE
SMIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE:
PRE-ALT FEE:
TOTAL FEES
COMMENTS -12-' -)—A. ---,Affk 0
11ECPT. N0. PAID BY VALIDATION
WHITE--Department Copy,YE mance Copy, —ssessor COpY. —
CITY OF DIAMOND BAR INSPECTION RECORD
��,�
1 "11
' 1 FLOOR JOIST
SET BACK , .
, • -FHA REOMTS
FTGS!FORMS/STEEL
ELECTRIC GROUND: . UNDER FLOOR DUCT t -
GROUND PLUMBING UNDER-FLOOR CONDUIT
-SIAB-GRADE . ,FIREPLACE FOUNDATION
TEMP POWER. , FIREPLACE BOND BEAM
WATER SERVICE -- . . . MID HT,BOND BEAM
ROOF SHEATHING * : r 8 FT,BOND BEAM
FRAMINGNENTILATION . . : .FINAL BOND BEAM
ROOF COVER , . PRE-GRADING
ROUGH HEATING I BENCHING
ROUGH ELECTRIC * ' 1 . ROUGH GRADING
ROUGH PLUMBING : ; FINISH GRADING •
SHOWER/TUB TEST• -POOL ELECTRIC
EXT. LATH/SIDING , - . : POOL FENCING .
ALL INSULATION ; POOL FINAL
. • OFF SITE IMPS. .
CEILING INSULATION . : ,
; DEDICATIONS
, ,,FINAL ENG. I
DRYWALL NAILING _,.. ,
. . . . LANDSCAPEIIRRIG. '
SEWER . ON SITE IMPS.
. FINAL ZONING
-S-E-P-T-IC TANK i .
i .
SEEP PITILL,
GA--S--A I R T- E ST-- • ---i----z--_,.._ -
FINAL CONST -.4111111111111v ilhk ; ' FIRE DEPT. FINAL .
FINAL HEATING 1, . : HEALT H DEPT. FINAL .
F NA ELECTRIC • • i DEV, FEES PAID
FINAL PLUMBING . , ENERGY
. ,
. ,.,.. ., .
COMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
�� � .�_� . � ��. ..
• I�I..'�..r r-r �rrr•� r rrr••• •
� � � �� ��. .',',1,•>::".';.:,..,A:
� --- ----- ----- --- -- ---- -
�� �i ,": • . ;','..,. . � �I �� �� –—
f������$.il,•,. ":.7..,:.
„� � •'� '���� • •� •�� ���
CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 E. Copley Drive
(909)860-3195 Fax(909)861-3117
BUILDING PERMIT APPLICATION
PRESS FIRMLY
ui
>--ec
clt
—APN LOT i TRACT
co
0
OWNER '1 C-c..
CC 7-
Li-
0 ADDRESS
al
z CITY ZIP TEL.
0 APPLICANT TEL.
n
z
..0
co CONTRACTOR
..=c
cc ADDRESS
0 CITY ZIP TEL,
w ARCH/ENG/
z DESIGNER
LU
ADDRESS
CD
CITY ZIP TEL.
CC OWNER-BUILDER DECLARATION
0
ca I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI-
LL CENTS LAW FOR THE FOLLOWING REASON(SEC 7031 5 BUSINESS AND PROFESSIONS CODE ANY CITY OR COUNTYWHICH
REOUIRESA PERMIT°CONSTRUCT.ALTER,IMPROVE, DEMOLISH,OR REPAIR ANY STRUC-
=TURE, PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED CU
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 PROFESSIONS CODE)OR
THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMPTION 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))
0 IAS 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,BUSINESS 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
CC THROUGH HIS OR HER OWN EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR
CU OFFERED FOR SALE.IF, HOWEVER:IHE BUILDING OR IMPROVEMENT IS SOLDWITHIN ONEYEAROF COMPLETION,THE
OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR. IMPROVE FOR THE PURPOSE OF
SALE)
1.1.1 CI,AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS cC TO CONSTRUCT
THE PROJECT(SEC 7044,BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LILL! 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 CONTRACh—TORS LICENSE
LAW)
CC
0 I AM EXEMPT UNDER SEC B&P C FoR THIS REASON
u
DATE OWNER
0 LICENSED CONTRACTORS DECLARATION
02 I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING
WITH SECTION 7050)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORCE AND
EFFECT
LICENSE CLASS LIC. NO
DATE CONTRACTOR
Lu
2 WORKERS'COMPENSATION DECLARATION
CO
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
LU
F— 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
w<C
CARRIER
POLICY NUMBER
(THISSECRON NEED NOT BE COMPLETED OF THE PERMST IS FORONE HUNDRED DOLLARS(SIR OR LESS)
LU
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 CO WORKERS'COMPENSATION
LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME
SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR
1-7
CODE,I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS,
DATE APPLICANT,
LU
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
EtT
CONSTRUCTION LENDING AGENCY
Cr.'y SIGNATURE OF PERMITTEE DATEAPPLICATION) -0"AERMIT
DATE UMBER
ISSUE TYPE
DATE CONST.
FRONT SEfBACKS
ZONING REAR
SIDE/SIDE
SIDE RW 0
0
STREET RW 0
D
N0, PROPOSED
UNITS
DWEL, USE
N0, N0,
STORIES BEDROOMS
DESCRIPTION SQ. FT, FACTOR PSF ADJ,AREA/VALUATION
SFFVADD/REM
(1) Garage/Carport
III Patio/Deck
w
IL Pool/Spa
0 Re-Roof
z
5
--I Commercial
5
co
Valuation ADJ AREA
QUANTITY DESCRIPTION FEE
-1
<
0
CT
I-
0
LU
-I
04
0
Z
513
D
-1
CL
7.71
.L
0
2
�
s
Q
LU
A^A 4170111111 a
CONSTRUCTION v , 1
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
SMIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE:
PRE-ALT FEE:
--ookairt.--:,,.a
TOTAL FEES
COMMENTS
/
PAID BY —1 ) 13 VALIDATION
DOLLARS($100,000),IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FoR IN SECTION 3700 OF THE
LABOR CODE.INTEREST.AND ATTORNEY'S FEES,
CC Lil CL.
CCI HEREBY AFFIRM UNDER PEFIALTY OF PERJURY THAT TH RE IS A CONSTRUCTION LENDING AGENCY FOR THE
PERFORMANCE OF filE WORK FOR WHICH THI ERMIT IS ISSUED(SEC 3097,CIV C)
LU
2 LENDER'S NAME
LENDERS ADDRE
a
ABOVE.MENTION bC).1.R,&ERTY FOR INSPECTION PURP SEs
f=1
PERMITTEE NAME(PRINT)
CO
P/C
OCC
GROUP
RECPT. N0.
JOBSITE ADDRESS
n ^AN\
WHITE—Department Copy,VELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy
CITY C:xti" C)BAR.,STfrg\t'
SET ,, FTGSI1:O;iMSISTE ELECTRIC GROUND GROUND FLU .!(_,SLA
_TEt,nP POWER
WATER Sr-+IVICr: LRoo F.'SHBATHft,IG FRAMING,VENTILATION ROOF COVER OUGH HEATING OUGIi ELECTRIC FtOIi%J1-1
PLUM,;;::%1G
SH OWi:.--R -EST 1 EXT LAT i-ik.,iD
INsuu-,-,-[oN
P� ' iNCC.:...!-"i c,,.....t..../
EEP P;
FINAL HEATVO
I FINAL--
1-
I FLOOR,jOIS I EI IA REQM
UNDER FLOOR DUCT
UNDER FLOOR CONDUIT
ACE FOUNDATION_PLACE BOND BEAM HT,BOND BEAM FT BOND BEAM F-FINAL BOND BEAM PRE-GRADING
ENCHING
ROUGH GRADING FINISI i GRADING POOL ELECTRIC POOL FENCING
POOL FINAL
OFF SITE IMPS. DEDICATIONS INAL ENG,
_ANDSCAPE/IFIRIG.
SITE IMPS.
FIRE DEPT flNAI HEALTH DEPT FINAL
DEV, FEES PAID IEFIGY
ER
WALNUT VALLEY UNIFIED SCHOOL DISTRICT 880 SOUTH LEMON AVENUE WALNUT CA 91789
CERTIFICATE OF COMPLIANCE With Fee Provisions of
Government Code Section 65996
DEVELOPER/OWNER WINDMILL ESTATES,LLC ADDRESS 3480 TORRANCE EL STE 300
CITY/ZIP TORRANCE 90503
TELEPHONE3 1 0.5 4 0 .399 0
Signature of Applicant
The person signing represents that he/she is auihoriz.:..to sign on behalf of the owner/developer and that the information provided
is true and accurate,o the het his/her know/edge.
NEW LOT ADDRESS
05L WINDMILL DRIVE
- City
USE OF BUILDING
NS FR Residential/Commercial/Industrial
TOTAL SQ. FT.
8112
HOME IMPROVEMENT OR REMODELING PROJECT
TO BE COMPLETED BY SCHOOL DISTRICT
FEE SCHEDULE: The development fees levied by the Walnut Valley Unified TOTAL FEES DUE
School District under provision of Government Code§65995
are: (EFF. 8/17/98) Residential Development 51.93/sq.ft. Receipt' 3 0
Commercial/Industrial $0.31/sq. ft. Datee e--)v,
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).
ADDRESS
DESCRIPTION
TOTAL SQ,FT.
Diamond Bar
Walnut
(Bedroom, Family Rill,Kitchen,etc.)
Signature of Superintendent of Buildings
Date
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
VuenetrMeeloir.
Assistant Superintendent
Fiscal and Facilities Management
1187 Rev. 2188;6/88;8/89; 1/90;8/90; 10/90;8/92;6/93; 11/93;8/94;6196; 1197;8/98
PLEASE SEE NOTICE OF 90-DAY PERIOD FOR PROTEST OF'FEES ON REVERSE SIDE
- 91317L-966-606 -tea puoweTa sI.TO eS:Cli 20 02 2nti
COUNTY SANITATION DISTRICTS
OF LOS ANGELES COUNTY
1955 Workman Mill Road,Whither,CA 90601-1400 Mailing Address: P.O. Box 4998,Whither,CA 90607-4998 Telephone. (562)699-
7411,FAX: (562)699-5422
eorvinfeFITIMca: 7:00 a.m. -4:00 p.m. Mon. -Thurs. 7:00 a.m. -3:00 p.m. Fri.
JAMES F. STAHL Chief Engineer and General Manager
•---
Account No.: 0406707
SEWERAGE SYSTEM CONNECTION FEE District No.: 11
Date: August 20, 2002
Property Owner: WINDMILL ESTATES
Address of Property: 3057 WINDMILL DRIVE DIAMOND BAR,CA
Thomas Guide Page: 0679J7
Contact: JON CAMERON
Phone: 310-540-3990
Mailing Address: 3480 TORRANCE BL,#300 TORRANCE,CA 90503
County Assessor Map Book, Page,and Parcel Number: 8713-021-031 Structure is Proposed.
User Category and Units of Usage:
Category: OlA
Number of Units: 1
Square Footage:
CONNECTION FEE CALCULATION
1.00
Number of Units of Usage
X $1,290.00 Connection Fee Per Unit of Usage
$1,290.00
Connection Fee
COMMENTS: *A-21-646
$1,290.00
Connection Fee Due
[cc Pa)mimi Itecen. c...l From: \VINI)N111.I. ES FA I 1:..5
S!,290.O11APPLICANT COPY
Plocei...(111^.:
\
Ck. No.: 103!
?:,). 2(02
SANITATION DISTRICTS
OF LOS ANGELES COUNTY
4)APPROVE
JAMES F.STA: 'L E-NCL'NFIFIX• •ft' !'mr•
0 Recycled Paper