The URL can be used to link to this page

Home My WebLink About12-11330 ro C) €l in LLI z 0 Cl z Cc O w 0 z Lu d rn cn U3 cc O d LiJ C.0 l�E.1 C) 0 CO 111 d Z LL! fC LLJ EY]—[ CG Il.. z O Qx� W O U W C3 d B LLL Co O Lu LLL LL J cc LLI s1 6 1= LLI d CZ 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 JOBSITE ADDRESS Isa NI!I 0 APN LOT TRACT OWNER ADDRESS CITY ZIP TEL.- APPLICANT TELI Le ' j o CONTRACTOR ��- y /�C ADDRESS a Ni 1 CITY �Jo,T4!ll {-� ZIP (-jl— TEL� ARGW GI DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PMMPIY TNAY I AM EXEMPT FROM THE CONTRACTORS tl- CENSE LAW FORTHE FOLLOWING RF150N (SEC. 7031.6 BUSINESSAND PROFESSIONS CODE: ANY CRV OR COUNTY WHICH REOUIRESAPERI.IITTOCONSTRUCT,ALTER, IMPROVE. DEMO€ISH, OR REPAIRANY STRUC' TUBE, PRIORTO ITS ISSUANCE, ALSO REWIRES 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) OFDIVISKIN 3 OF THE BUSINESS AND PRO- FESSIONS000E)ORTHATHEORSHE 15 EXEMPTTHEREFROMAND THE BASIS FORTHEALLEOEDEXE)AP- TIOA ANY VIOLATION OF SECTION 7031.5 BY ANYAPPLICANT FOR APERMIT SUBJECTS THE APPLICANTTO ACIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DCLIARS ($son).); k,ASOWNER OFTHE PROPERTY, ORMYEMPLOYEES WITH WAGESAS THEIR SOLECOMPENSATION, WILL DO THE WORK, AND THE STRUCTURE 15 NOT INTENDER OR OFFERED FOR SALE (S£C.7044, BU51-. NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO SUILDS OR IMPROVES THEREON, AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFEHEDFOR SALE. IF HOWEVER,THE BUILDING OR IMPROVEMENT IS SOLD Wrl ONEYEAROF COMPLE- TION, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE), O1,AS OWNER OFTHE PROPERTY, AM EXCLUSIVELY CONTRACTING WHTI LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC, 7044, SUSINESSAND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE LAW DOES NOTAPPLY TORN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES'HEREON, AND WHOOONTRAOTS FORSUCH PROJECTSWITHACOWRACTOR(SSLICENSED PURSUAHTTOTHEOONTRAG, TORS LICENSE LAW.). €7 JAM EXEMPTUNDER SEC. B. A P.C. FOR THIS REASON DATE OWNER - LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION 70l OF DIVISION 3OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT, LICENSE CLASS J — LIC. NO. DATE CONTRACTOR WORKERS' COMPENSATION DECLARATION I HEREBYAFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING OECLAHATC)l �I HAVEAND WILL MAINTAIN ACERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION 37000F THE LABOR CODE, FOR THE PERFORMANCE Or THE WORK FOR WHICH THIS PERMIT IS ISSUED. —I HAVE AND WILLMAINTAIN WORKERS'COMPENSATION INSURANCE; AS REQUIRED BY SECTION 37000F THE LABOR CODE, FORTHE PERFORMANCE OF THE WORK FOR WHICH THIS PERMITIS ISSUED. MY WORKE/�RS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER AR6: CARRIEfln POLICY NUMBERgait .11 -' (IHSSECTION NE®NOT BECOMPLET W OFTHE Pull F0RCVLHUNDMl3WJARS ($IW)ORL645p I CERTIFY THAT IOTHE PERFORMANCE OF THE WORK FOR WHICH TH€5 PERMIT IS ISSUED, I SHALLNOT EMPLOYANY PERSON INA14Y MANNERSO AS TO BECOME SUBJECTTO THE WORKERS' COMPENSATION LAW30F CAL€FORNIA.AND AGREll IF SHOULD BECOME SOBJECTTO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 37000F THE LABOR COOE,I SHALL FDflrHSYITN COMPLY WITH THOS R VISIONS APPLICANT, ✓� WAR€41JIG FAILURETO SECURE WORKERS NSAT COVERAGE IS UNLAWFUL, AND SHALL BE SUBJECT AN WPLOYERTO CRIMINAL PENAL S AND CIVIL FINES UP TOONE HUNOREDTHOUSAND DOLLARS (5700,000), 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 THATTHERE €S ACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMITIS ISSUED (SEC. 3097, CIV. 0.1. LENDER'S NAME LENDE€TSAODRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THATHE TABOVE WFORMATION IS CORRECT. IAGPEETO COMPLY WITH ALL CITY AND COUNTY ORDINAN C ES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE -MENTIONED PROPERTY FOR INSPECTION PURPOSES. L` C PERIATTEEN (PRI - R 510NA7S1 O P EE DATE PRESS FIRMLY APPLICATION ,d- PERMIT 1133 P/C DATE NUMBED NUMBER # ISSUE �' TYPE OCC DATE , CONST.= +)GROUP ZONING SETBACKS FRONT RW Li REAR 0 SIDE/SIDE STREET RW 0 SIDE ❑ PROPOSED USE v e-IA101? NO. DWEL. UNITS NO. NO. STORIES d— _ , BEDROOM$ DESCRIPTION SQ. FT, FACTOR PSF ADJ, AREAIVALUATION SFRIADDIREM U) Gal/Carpolt W PaIWDeck LL Pool/Spa tD Z FW Rl 0 Commercial - In wwwlon il 00 ADJ.AREA QUANTITY DESCRIPTION FEE J Q U 4 C.) LIJ LU EiJ . z J eL U_ [ULI CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES COMMENTS RECPT: NO. l PAID BY VALIDATION pr WHITE—DepartmonE Copy, YELLOW —Finance Cop PINK —Assessor Copy, GOLDENROD —File Copy, GREEN —Al Copy CITY OF DIAMONDBAR INSPECTION RECORD SETBACK FLOOR JOIST FTGS/FORMS/5 rrEL FHA REQmTS UNDER FLOOR DUCT ELFC:1'RfC GROUND GROUND PLUMBING UNDER FLOOR CONDUIT SLAB GRADE f _ FIREPLACE FOUNDATION -_--- TEMP _POWER - FIREPLACE BOND BEAM WAFER SERVICE ; MID HT. BOND BEAM --- ROOF SHEATHING 18 FT. BOND BEAM -- FRAMING/VENTILATION FINAL BOND BEAM - ROOF COVER PRE-GRADIPIG ROUGH HEATING ( BENCHING ROUGH ELECTRIC I ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWER/TUBTEST POOL ELECTRIC EXT, LATH/SIDING € POOL FENCING WALL INSULATION i POOL FINAL CEILING INSULATION i OFF SITE IMPS. DRYWALL NAILING SEWER _ _ SEPTICTANK -- DEDICATIONS -. ENG. -FINAL LANDSCAPE/1RRIG. SEEP PIT/L,L, ON SITE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST. _ FIRF DEPT. FINAL _FINAL HEATING HEALTH DEPT, FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY _FINAL PLANING —f FINAL ENGINEERING MEN "1819FAmiliffinim_ I COMMENTS SEPT#C TANK SIZE 5EEP PIT/U SIZE