The URL can be used to link to this page

Home My WebLink About7842U1�1�IO�ll 11111 CITY OF DIAMOND BAR COMMUNITY DEVELOPMENT DEPARTMENT 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION ADDRIESS APN LOT TRACT OWNER i 1W 41.94c 1 � ,t�/�,S' A --,I ADDRESS CITY ZIP TEL. APPLICANT TEL. CONTRACTOR - ADDRE S CITY - f 4. , ~ ZIP TELE li 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 REOUIRESA PERMITTO CONSTRUCT, ALTER, IMPROVE, DEMOLISH, OR REPAIRANY STRUC- TURE, PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE 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) ORTHAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THEALLEGED 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).): ❑ 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 ONEYEAROF 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). ❑ 1, 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 NOTAPPLYTO AN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S) LICENSED PURSUANTTO THE CONTRAC- TORS LICENSE LAW.). ❑ 1 AM EXEMPT UNDER SEC. B. & P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM 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 CLA S _ _3 LIC. NO. DATE 2 Se -)l 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. MYW KEE_�q�MPENSATIOnINSURAA,NC7E CARRIER AND POLICY NUMBER ARE: CARRIER MOP - P POLICY NUMBER (THIS SECTION NEED N'OTSE CON PLETEDOFTHE PERMIT IS FORCNE HUNDRED DOLLARS ($100)08 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 BOAS 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.,/Y DATE:/ L - APPLICANT: �,_%• rd�=Y 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 1 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 AUTHORIZEREPRESENT ES OF THIS COUNTY TO ENTER UPON THE ABOVE -M IONED PROPERTY,�FOR.. ION P ( C PERMITTEENNai (P�I ) ` STIBNATOREORPERMITT £ :%'- DATE ,3' `t` �;i.f APPLICATION5 3_Vj` PERMIT ^� A• P/C DATE / NUMBER CO # ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ Ll SIDE ❑ PROPOSED USE NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREANALUATION SFR/ADD/REM Garage/Carport W Patio/Deck L- PooVSpa C) Z Re -Roof A19j " f, Commercial m Valuation % ��G� ADJ.AREA QUANTITY DESCRIPTION FEE J Q U tr E5 U W J W 0 Z CD a J Q U_ Z a 2 U W � CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL -� INSPECTION FEE yy��' ISSUANCE 4:5, I/ SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: TOTAL FEES y COMMENTS r v y y 9 / LO ��10 RECPT. NO. PAID BY VALIDATION WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD—File Copy, GREEN—Applicant's Copy 6-l' 111 A F? A "I"13ACK FHA 1`11HOM-1-S UNDI-HR L1.001-1 DUG -11- - - -------- ll I, I I\J D 11 1, 1 N/1 13, 1 N G UNIDL-JI [J001-11 GONDULT - ------------ -`A-AB GH'/Wt, FOUNDATION POW1,11-1 FIH[.[)I.AGF [-,',ON[) GLIAM ---- ---- ------ WM Fl -I FT-lVI('J]- Mir) IT. IF OND HFAM FIO0I II`,Af`HINCi 8 FTBOND BI AM FINAL BOND BF -AM HOOF I"I"IF-GFIADING I -lot IGH I II/V1INGA 13 FEN C 1 -11 N G HC)11 F, I - F, GIT lilt ROUGH CiflADING --- — ------- - 1101)(-�H P1 UMBIN(I'll FINISH GRADING 8I1OW[-.1H/1 UH JT -'.81 POOL. ELEG TRIG, L:'X I" (,A' I I- W,1 I D I N Cq POO1- FENCING WA 1, IN,`31-IL-AT ION POOL FINAL_ GUI-ING 11\!'M-ATION OFF SITE DHYWAI 1 NAZI-ING DEDICATIONS 0 FINAI- ENG, SFVIGTANK LANDSCAPE/IFIRIG. SI EI' ON SITE IMPS. GAS A111111"ST FINAL. ZONING I"I N A 1. G 0 N,"51, FIRE DEPT. FINAL FINAL. 11 FKHNG HEAFTH DEPT, FINAL- FINAI- F -,( TRIG DEV. FEES PAID FINAL. L!I-tJM13IN(-1 IENEHGY CC) M M I NT ---------- -- — -------- - --------- - ------- ---- ------------------------ - ------- -------- ------- 81-4YI �-TKI Y - --- --------