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Home My WebLink About17833 (10) CITY OF DIAMOND BAR �'�`'"� DEPARTMENT OF C�MMUI+iITY&DEVELt}PIviENT SERVICES . � t . 21825 E.Cogley Drive �909�s6o-�i9s F��9ov�sbi-3�i� PRESS "`;�µ�' BUILDit'�G PERMIT APPLICATION FIRMLY � JOB5ITE �� 1i aAPEICATION �. �..��N��gE {"1 #!C a ADDRESS � � � ISSUE TYPE OGC APN �OT RGT __ DATE CC3NST. GRdUP p OWNER �Y�G�—*�""_"_—U p ADpRESS •�' . _._ ZdNING SETBACKS Z CITY �`�- ZIP _ TEL.��?�-~� FR4NT RW O g APPUCANT TEL. �p�SfDE STREET RW CJ _. „da�,� GONTRACTOR SIpE L.I _ ADDRESS pROPOSED USE � CITY I1S# �V@.TE�.� � ARCWENG/ Lakewood,CA. 9p712 � DESIGNER NO.DWEL. NO. NO. � ADDRESS UNITS STORtES BEDROpMS � CiTY ZIP TEL. `� DESCRIPTION SQ.FL FACTdR PSF AdJ.AREANALUATION tn � OWNER-BUILDER DECLARATION SPRIADQIREM O � I HEREBV AFFIRM UNbEP PENALiV OF PEWURV THAt I AM EXEMPT FROM THE CONTMCT4R5 LI� � Garage/Carport W CENSfLAWFORTMEFOLIOWMGREASON(SE�.7031.SBVSINESSAMDPftOFES510NSCODE:A.NYGTYOR � CX7UNiYWH�CNAEfJU�PESAPEpMITTOC6NSTflUCT,ALTEP,�MPROVE,pEMOI�SH,ORREPAiRANVSTRUG W PHiiO/DeGk , � 7URE.PRIOR TO ITS ISSUANCE,AL50 REQUIRES THE APPUGANT FOR SUCH PEFMIi TO FILE A SIGNEp (L .,�,.- STATEMENT THAT HE OR SHE IS IiGENSEQ PURSUtMT T(?THE PftOViSiONS OF THE CON7flAGTQftS U• .L,s- CENSE LAW�CHAPTER 9(COMMENCING WITH SECTION 7pp0)OF DIVISION 3 0F THE BUSINESS AND PRO� � POOVSpB � � FESSIONSGODE�OflTNAT'HEORSHEISEXEMPTTHEREFflC1MAN�THEBASISFORTHEAILEGEDE%EMP. (� � TKKJ,ANYVi6)iAT�ONOFSECTION703t.58YANYAPPIFCAMFOftAPfftMiTSU&lEC7S7µEApPti(:ANTTO Z Re-�toof_ � A CIVIL PENAL7V OF NO7 MORE 7HAN FIVE�fUNDREb DOLLARS(S5oo).): p fJI,ASOWNEROFTHEPROPERTYaRMYEMPl.OYEESWITHWAGESASTNE10.50LECOMPENSATION, � �OPI17119CC18I � WILI CXS THE WORK,ANO fHE 5TRUCTURE iS NOT INTENOED OR OGFERE6 Fqft SAIE{SEC.]64a,BUSI- J NESS ANO PpOFE5SIONS CODE:TNE CdNTRACTO%9 LICENSL LAW DOES NQT APPL1'TO AN OWNER OF � PR6PERTYWFIOBUlIDSOHMAPPOVESTHEFieON,ANDWNODOfiSSUCHWORKMIM5E�F4flHEftSELFOH m [,� THROUGH HI$OR HER OWN EMP40YEES,PROVIDED THAT SUCH IMPRC}VEMENTS A%E NOT INTENDED OR LL1 pFFERE�FORSALE.IF,HOWEVER,THEBUILDINGORIMPROVEMENTIS50L�WITMINONEYEAROFCOMPLE� - � TI�Fl,THE 4WNER�BV€tDER Wq.t tiAtE THt BURDEN VF PFiOVING THAT HE t?R SHE DID NOT 9UIlD OR � IMPR6VEFDRTHEPURPOSEOF5ALE). W LII,ASQWNEflOFTHEPRpPERTy,AMEXCWSNELYCONTRACTINGWITNLICENSEDCfYMRAfTOqS ('� TO CQNSTRUCT TNE PftOJECT iSEC.T04a,BUSINESS AND RR�FESSIONS CODE�.TNE CONTRACTORS�I� VeiUBtio� ADJ.AAEA_,._.,,., W CEN55UWDOESNOTAPPlYT1JANOWNERDFAPpOPERTVWHqBU1LpSOflIMPROVES?HEREON.AND � WF10CbNTRACTSfORSUCHGRfL1ECTSWITHAGONTRACTQA{SJUCEMSEDPUft6UANiTOTNECONTRAG Q�ANTITY C}ESCRIPTION FEE Y TORS IiCENSF.tAW}. � ❑I AM EXEMPT 11N6GR SEC. .�..B.8 P.C.FQR THiS REASON � �i __.. "__" ..� � � OATE DWNER� . ~ — W —��- �iCENSED CONTRACTORB DECLARATI6N �j d � i HEAEBY AFFIPM UNQEH PENAIXY OF PER.IURY THAT 1 AM IICEN6ED UNREft PAOYISIONS Of GHAPTER � � �� . [L 6(COMAAENCINGWITHSECTION7000)l7F�IVIGION.?OFTHEBUSiNESSANDPROFESSIONSGODE,ANO Z W MVUCENSE I5 W FUL Fb CEAND EFFECT. ` 1 C1 m t � L�cENs c Y✓ ._ ur..No. .,!,�V� � J U onTE , � _conrrancTo, a W �-F`�71 u''� � W4RKEftS'COMPENSATION DECLARATIO � ¢ � U � I HEREBYAFFIftM UYDER PENAITY OF PER3JflY ONE OF THe FO�tOW4NG DECIAftA`IONS: Z Q � _I HAYE AND WILL MAINTAIN A CERTIFICATE OF CON5ENTTQ SElF�MSURE FOfi WORKFRS' 2 ^ COMpENSATK3N,AS 7RQVIOED BY SECTION 3�6o PF THE 1A80R CODE,FOR THE PERF6RMANCE `U OF THE WORN FOR WHIGH THIS PERMIT IS ISSUED. � � W I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,A&REOUIRED BY SECTION � 370a pF THE LABOR CODE,FOR TNE PERF MRYGE OFTHF VlORK FQP WHiCH FHIS PEpM1T IS � ISSUED.MY S'. SAT I RANC€CAftRiER ARID POLICV NUMBER ARE: CONSTRUC.TION � cnAaiEa . PLAN F1EVIEW _. .. — � POIICYNUMBER � �— ELECTFIIG — ..__._ � _�?_=... � (THISBECPCMJNEQ7N0T6E�Mf'LEfEC]aFTNc'FERM14TISFORONEHUMREDOOI.I.APS(S10o)ORLE5.4). PLUMBING � i CEflTtFv TNAT M THE PERFOti4.SANCE OF THE WORK F6R WMCH THIS PERMIT IS iSSUEO,t MECHANICAL ..— � _' ..._,... („�J SHALLNOTEMPLOYANYPERSONINhNVMANNERSOAS'OBECOMESUBJECTTO'fHE ��SPECTIONFEE � VvK)�?NERS'GOMPENSATION LAWS OF CAlii'ORNIA.AN�AGREE 7HAT tF I SNOVLO BEGOME —�-� �` SU&JECT TO THE WORKERS'COMPENSATION PROVi510N5 0f SEGTIGIJ J10 OF TH�LAHUR � �� ISSUANGE �,I SH l FOftTMWITH CpMPLV WIT HOSE PR VI$10 . � � SMIP p DATE��APPLIGANT: �� ENERGY P1C ,_ - — � WpRNiNG�.FA�LURE TO SECURE WORKCRS'COMPENSA710N COVERAOE�5 UNLAWFV4,AND SHRLL BE � SUBJECTANEMPLQVERTCICRIMINALPENALTIESANDCIVII.FINESUPTGONENUNDREOTHOUSAND ENEFIGYPEAMIT „ ., r bOIIARS(St W,OdOj.tN AOD�TION T4THE GOST OF COMPEPlSATN7N,DAMAGESAS PflWIDECS FOR IN "- J SEGTpN 3l'JBOF THE LPBOR COUE,IN7EREST,ANpA�TORNEY'S FEES. RETENTION FEE: � — _ � d CONSTRUCTION LENDING AGENCV PRE-ALT FEE: _ �.. �- i HEAEBY AFFiftbi UNDER PENAI.T`f flF FEftJUftY TNAT THGRE IS A GON5TftUCT�ON IENDtNG At3EV(:;Y d- FOR THE{'C(iFORMANCE OF THE WOflN FOR WHICH THIS PERMIT IS iSSUE��uEG.31�3],GIV.G.). � W � LENDER'S NAME ,,,,,,,__ -- . I_ IENDEN'SAU(7FiESS _ '_._....._ /'''' � ICERitFYTNATiHAYEPEAOTHISAPPi.iCAT�NANDSTATETHASTHERHOVEINFORMATiDN15COt{REGt. I�TALF�E� �. L,J� W I AGRCE TO COMP_Y W1TH ALL GITY AND COUNTV pRDINANGES AND SiPTE tAWS flEI.AI ING 7D BUILDING � CONSTRUCT'ION,ANDHEREBYAUTFqHIZEREPRESENTATNE50FTHI5COUNTYTOENTERUPONTHE _�� ftOPtRTY FOR t PECE N Pt7RPOSES. � GOMMENTS_.._.___.._ ...— -.—.. ABaYE;MENi NEOP � ,� .�� ,��, _. m PFA1Nl�NP,�1 {VRIN. ,,t,.��1��/�,f �1 � lh^__ ... . ___ K„ '�/� ; �- ,_, . - _ _ �.-= � SIGNA Ufl F PEHMITTf£ � OA E = RECPt R'O... .. � PAID BY _.�' ...—VALIDATION� ~ WHITE—Dep3rimzni Gopy,YE�LOW—Finance Copy,PINK—Assessor Gopy,GOLQENROD---Pile Copy,GREEN—ApplicanYs Gopy ��,t,g � i � i �� s� �� .a� �ti p „,��'„�" c `��i�' � '� � - a .�� w,��r`G�� ,�'��_ .,�,�e�4�"�� `� �� ..,. �m� . . _ . � . _.. .. .. .... ... .. .. . . . .... e �: �� ,. ... ... _.. ._ .. . .. . ', a � .. . . .: ,.. �g��,��e�a� .. .... .. . _.. .. .._ . ._.. ..... . ...... .. ._ . _.. ..�; i, '.� '' .. .. ..... . .... .-.. .. ... .. .... .. e F t W � i � �-��a° � ��s � ��, �.a ��y,� _� .. .. . .. . .... . .. .... "� , �pr��,��ac�'�'��M��" � _ ��' `'� ��,��n'�,'�'��""�" .� a� . ._. � j. �� i�`„I� � "fiy� � I" �' _ .. .. . . . ..... ... . . .. . .._.. _.. _ . ... ...... ..._ ,^^"'4 s 4f� s. � E �4 " . ^ " ' ti_ -y.,' �'g � d ��n f . .. . . . . .. . .. __ ... : a� a w�� . .... _... . ... . . . _ . .._. a �+� �—h a�q"i � �46 p, n .y - � .<�� "�� " �I:. ... .. . .. .. . . - .. .. �� d �N E'aI A �. «i .. . .. .. .. . . c L „ m :� ,=& 'n " .... . . ... . . .. .... ... .. . . . � 4_ m. � ' ... ... ... . . . .. . ... .. . .. . . .... . s _ , � i .._.. . .._ .. . � � � �i � �i .i t •V §�si , :. .. ,gai; i _��. . +�d'm��J� . m, „ : .._. . ... .... . . . .. .. . .. ... ... ... .. . .... ... . _.... ... .. . .... . .._. , ��' 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 JOBSITE CJ ADDRESS APN LOT ACT OWNER ina L n ADDRESS' CITY ZIP TEL._ APPLICANT TEL. CONTRACTOR ADDRESS CITY uS1AVe.TEL -3W ARCH/ENG/Lakewood,CA.90712 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 LT 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).). U 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). U I,AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC. 7044, BUSINESS AND PROFESSIONS CODE.THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). U T 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 FUL FO CE AND EFFECT. ff� ur L1 LICENS C LIC. N0. DATE,CONTRACTO• WORKERS'COMPENSATION DECLARATIONJ..{ 1 J{(.111 I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: -1 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 PERF RMANCE OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED. MY S'SAT RANCE CARRIER AND POLICY NUMBER ARE: CARRIER POLICY NUMBER (THIS SECTION NEED NOT BE COMPLETED OF THE PERMIT IS FOR ONE HUNDRED DOLLARS($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 370 OF THE LABOR D I H FORT2WITH COMPLY WIT HOSE PR VI510�. 9 P i DATE: AP LICANT: 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 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 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT 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-MENTT&PROPERTY FOR I PE f[WP SES. t P BE NAyI(PRIN �� / jl ��)� ]�K'-/�� SIGNA UR FF PERMITTEE DA E APPLICATION °3�PERMIT P/C �p 1 � DATE II J NUMBER 1 3 ISSUE TYPE OCC DATE CONST.GROUP ZONING SETBACKS FRONT RW^ REAR^ SIDE/SIDE STREET RW^ SIDE^ PROPOSED USE N0. DWEL. N0. N0. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREAIVALUATION SFR/ADD/REM Garage/Carport W Patio/Deck LL PooUSpa Z Re-Roof Commercial m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J H-U w W Z A Ip W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES V-50 COMMENTS RECPT. N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy