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Home My WebLink About12-505 (16)Cc W a� Z W TJJ z Y O LL z O E.L.I U W Cl? d Q Cl Q a 4 ca- LL.I co O LLL.J l.L cc 0 O W Q W 2 H LU W fl (J a m [n Y t— CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 (909) 839-7020 Fax (909) 861-3117 Building Inspection Hotline (909) 839-7027 BUILDING PERMIT APPLICATION JOBSITADDREE }� 1J� ADDRESS � �`� � '�'--'+ r l y 1J APN. LOT TRACT OWNER g ADDRESS ,e Y1 CITY ZIP TEL, APPLICANT TEL, CONTRACTOR ADDRESS CITY ZIP TEL. ARCH/ENG/ f 0 DESIGNERV 14 h L'f ' ADDRESS CITY ZIP TER. 71 _ � 7/7Al OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNbEFI PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS Lr- CENSE LAW FORTHE FOLLOWING REASON (SEC 7D31.5 OUSINESSAND PROFESSIONS CODE; ANY CITYOR COUNTY WHICH REQUIR.ESA PERMITTO CONSTRUCT ALTER, IMPROVE, OEMOLI$N, OR REPAIRANY STRUC- TURE. PRIOR TO ITS ISSUANCE, ALSO REGUIRF$ THE APPLICANT FOR SUCH PERMIT TO FILE A STONED STATEMENT THAT HE OR SITE IS LICENSED PURSUANT TO THE PROVWONS OF THE CONTRACTORS (P CENSE LAW (CHAPTER 9 (COMMENCING WITH SECTION 70W)OF DIVISION OF THE RUSiNESSAND PRO, FESSID.S CODE) ORTHATHE ORSHEFS EXEMPTTHEREFROM AND THE BAS% FORTHEALLEGED EXEMP- T1ON.ANYVIOLAFM OF SECTION 7031.58YANYAPPUCANT FOR APERMIT SUBJECTS THE APPLICANT TO ACIVILPENALTYOF NOT MORE THAN FIVE HUNDRED DOLLARS (3800),); - ❑ I,AS OWNEROFTHE PROPERTY, OR MY EMPLOYEES WITH WAGfSAS THEIR SOLE COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. Im, BUST• NESS AND PROFESSIONS CODE: THE cownACTORS LICENSELAW DOES NOTAPPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO DOES SUCFtMRK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIOEO THAT SUCH IMPROVEMENTS ART: NOTINTENOED OR OFFERED FORSAL£, KHOWEYER THEBUILDINGOR IMPROVEME NTIS SOLD WITHINONEYEAROFCOMPLE- TION. YHE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING' HAT HE OR SHE DID NOT SU3LD OR IMPROVE FOR THE PURPOSEOF SALO. " ❑ 1. AS OWNER OF THE PROPERTY, AM EXCkUSNF-LY CONTRACTING WITH LICENSES CONTRACTORS TU CONSTRUCT THE PROTECT (SEC, 7044. BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS U_ CENSE LAW DOES NOTAPPLYTO AN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WaHACOWMCTOR(S)LICENSED PURSUANT T6THE WNTmm TORS LICENSE LAW.). I tAM EXEMPT UNDER SE;C, B. E P.C. FOR THIS REASON GATE LICENSED CONTRACTORS DECLARATION I HSOE6 AFFIRM UNDER PENALTY OF PERJURYTHAT IAJA LICENSED UNTJER PwAtfONSOF CHAPTER 9 (COMMENCING WITH SECTION 7ODD) OF OFAS" 3 OF THE BUSINESS AND PROFESSIONS COOS, AND MY LICENSE IS IN FLkL FORCEAND EFFECT. LICENSE CLASS LTC. NO. DATE CONTRACTOR WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AHD WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERSF COMPENSATION, AS PROVIDED 9Y SECTION 370D OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR"41CH THIS PERMIT €S ISSUED. J HAVE AND WILL MAINTAIN WOPKFHS' COMPENSATION INSURANCE, AS REQUIRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WOhK FOR WHICH THLS PERMIT IS €SSUJYJ. MY WORKERS` COMPENSATION 114SUFIMGE CARRIER AtJO POLICY NUMBER ARE: CARRIER POLICY NUMBER (IRIS SEC IONNE£ONOTBE CCMR-ETED OF THE PERMIT IS FOROIEHU DREDOOUARS (5100)6RU--4 F CERTIFY THAT IN THE PERFORMANCE OFTHE WORK. FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SOAS 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 FOITEHWITH COMPLY WITH THOSE PROVISIONS. DATE; ' APPLICANT: WARNING: FAILURE TO SECURE WOFIKEEIV COMPENSATiON COVERAGE €S UNLAWFUL, ANU.SHALL BE SU8JECTAN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($10D.W), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3700OF THE LABOR CODE, INTEREST, ANOAnonn Y'S FEES. „I CONSTRUCTION LENDING AGENCY II• I HEREBY AFFIRM UNDER PENALTY OF PETLOURY THAT 7HEFIE IS ACONSTRUCTION LENDING AGENCY FOR THE PE RFORM:r THE W��O77RK FOR WHI THIS PERMIT IS ISSUED (SEC, 3097, CIV. C.). LENDER'S NAME 1i .G�- LENDER'SADDRESS f �'T I CERTIFY THAT I HAVE AM THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT I AGREE TO COMPLY WITH ALL CRY AND COUNTY ORDINANCES AND STATE TAWS RELATING TO BUILDING CONSTRUCHON, AND HEREBY AUTHORIZE REPRESENTAT€VES OF THIS COUNTY TO ENTER UPON THE ABOV - ENTIONEOPROPERTY FOVW9PfbTJON PURPOSES. i PEHMI�Ef�T61.i Rl`NTj SIGNATUR ERMFiiE ' DATE PRESS Ie1oal11i V APPLICATON PERMIT ff � P/C ...•..l• DATE NUMBER � #�^~ ISSUE C TYPE 9 OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET' ( j SIDE PROPOSED USE C�.r� v^1� % c ��►� NO. DWEL, NO. NO, UNITS STORIES BEDROOMS DESCRIPTIO SQ. FT. FACTOR PSF ADJ. AREANALUATION SFRlADD/REM� co Garage/Carport W Patfo/Deck D- 0 Poo!lSpa Z Re -Roof Commercial m Valvalion C ADJ.AREA - QUANTITY DESCRIPTION FEE Q U F w C7 EA J (i J d U_ w CONSTRUCTION PLAN REVIEW — ELECTRIC PLUMBING _ MECHANICAL INSPECTION FEE ISSUANCE C �] SMIP ENI=RGY P/C ENERGY PERMIT RETENTION FEE:, PRE-ALT FEE: TOTALFEES COMMENTS RECPT, NO, AID BY VALIDATION WHITE —Department Copy, YELLOWS€nanco Copy, PINK —Assessor Copy, GOLDENROD —File Copy, GREEN—Appl oant' Copy AN "-. =ORMS/STEEL .- -- 'RIC GROOM] _ }ND PLUMBING GRADE P POWER ER aFRVICE JF SHEATHING AMING/VENTILATION )OF COVER JUGH HEATING_ OUG1-I ELF4..TRIC MGI1 PLOWING SHOWER/TUB TEST EXT, LATH/SIDING WALL INSULA-I10N CFILING INSULATION DRYWALL NAILING SEWER- SEPTICTAN_K_ SEEP PITH-L. GAS AIR TFST FINAL CONST.— _ FINAL HEATING FINAL ELECTRIC FINAL PLUMBING FINAL PLANING FINAL ENGINEERING —� COMMENTS SEPTIC TANK SIZE SEEP PIT/U SIZE FLOOR)OIST - FHA REQfATS _ UNDER FLOOR DUCT UNDFR FLOOR CONDUIT FIREPLACE FOUNDATION FIREPLACE BOND REAM _MID T. (BOND BEAM 8 FT. BOND BEAM FINAL BOND SEAM -PRE-GRADING BENCHING ROUGH GRADING FINISH GRADING POOL ELECTRIC POOL FENCING POOL FINAL OFF SITE [MPS. DEDICATIONS FINAL ENG. LANDSCAPE/IRRIG. ON SITE IMPS. FINAL ZONING FIRE DEPT, FINAL HEALTH DEPT. FINAL DEV. FEES PAID ENERGY