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Home My WebLink AboutPR 12-451CITY 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 ADDRESSxI _ _ ._ G C Z C,PG S APN LOT RACT OWNER L ADDR SS C C 1 wl i / CITY P D-74, -TEL APPLICANT 4 'JJ A g 1 j .GL TEL (1 CONTRACTOR ADDRESS CITY ZIP TEL ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS L4 CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.6 BUSINESS AND PROFESSIONS CODE ANY CITY OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT, ALTER IMPROVE, DEMOUSH, OR REPAIR ANY STRUC• TURF, PRIOR TO 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 U. CENSE LAW (CHAPTER a (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 CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (6500).): - L AS OWNER OF THE PROPERTY OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORT( 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 YEAROF 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). I, AS OWNER OF THE PROPERTY AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS I.I. CENSE LAW DOES NOT APPLY TO AN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S) LICENSED PURSUANT TO THE ODNTMO TORS LICENSE UAW.). 1 AM EXEMPT UNDER SEC. B. 8 - . FOR THIS REASON DATE% OWNER LICENSED CONTRACTORS DEC T I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT JAM LICENS U DER PROVISIONS OF CHAPTER 7 (COMMENCING WITH SECTION 7000) OF DIVISION a OF THE BUSINE MUD PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT. LICENSE CLASS LIC. NO. DATE CONTRACTOR WORKERS' COMPENSATION DECLARATION 1 HEREBY AFFIRM UNDER PENALTY.OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELFANSURE 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 CARRIER AND POLICY NUMBER ARE CARRIER POLICY NUMBER OHS SECTION NEED NOT BE CCK"OFTFE PERMIT IS FOR ONE HUDRED CUARS($10D)OR LESS)_ I CERTIFY. THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT S ISSUED, 1 SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME' ECT TO THE WORKERS* COMPENSATION LAWS OF CALIFORNIA, AND GREE THAT I DBBECOME SUBJECT TO THE WORI(ER5 COMPENSATION PROM SOFSECT oo OF THE LABOR CODE, I SHALL FORTHWITH COMPLY WITH THOS O IONS. DATE: N)4& 4///Ir// APPLICANT: WARNING, FAILURE TO SECURE WORKERS COMPS ATION CO GUNLAWFUL. AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FIN TO ONE HUNDRED THOUSAND DOLLARS (S1o0,ODD), IN ADDITION TO THE COST OF CDMPENSAT , DAMAGES AS PROVIDED FOR IN SECTION 37060E THE LABOR CODE, INTEREST, AND ATTORNE EES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE S A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3077, CIV O), LENDER'S NAME LENDER'S ADDRESS I CERTIFY THAT IHAVE 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. FORIN CTION PURPOSES 1 G PERMI_ ENAME( X SIGNA R F DATE r 0 . v PRESS FIRMLY APPLICATION PERMIT P/C DATE ' O J\a, NUMBER it ISSUETYPE OCC41DATECONST. GROUP ZONING SETBACKS FRONT RW REAR El SIDE/SIDE STREET RW 0 - SIDE PROPOSED USE L IS 121 -G32, - I`t1- NO. DWEL UNITS y q STORIES BEDROOMS DESCRIPTION SO. FT FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM U) Garage/Carpon W Patio/Deck IL 0 Pool/Spa Z Re -Roof 0 Commercial M Valuation aoo. — ADJ.AREA QUANTITY DESCRIPTION FEE U w 0Z m a U QZ 2UW CONSTRUCTION- 3' L2j ' O PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP DO ENERGY P/C ENERGY. PERMIT RETENTION FEE: OCj PRE -ALT FEE: Ocs TOTAL FEES 4tAa • COMMENTS ' RECPT.NO. PAID BY J O J J j VALIDATION I—' I --,,,,n,,, -Py, T IM"U mance L,Opy, nNK—Assessor Copy, GOLDENROD—Rla CDpy, GREEN—Applicant's Copy tg we SET BACK FTGS/FORMS/STEEL ELECTRIC GROUND GROUND PLUMBING SLAB GRADE TEMP POWER WATER SERVICE CITY OF DIAMOND BAR INSPECTION RECORD FLOOR JOIST FHA REQMTS UNDER FLOOR DUCT UNDER FLOORCONDUIT FIREPLACE FOUNDATION FIREPLACE BOND BEAM MID HT. BOND BEAM ROOF SHEATHING 8 FT BOND BEAM FRAMING/VENTILATION FINAL BOND BEAM ROOF COVER PRE-GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWER/TUBTEST POOL ELECTRIC EXT. LATH/SIDING POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER FINAL ENG. SEPTIC TANK LANDSCAPEARRIG. SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST. FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY FINAL PLANING FINAL ENGINEERING COMMENTS m ce w w SEPTIC TANK SIZE SEEP PIT/U SIZE