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Home My WebLink AboutPR 13 1304.pdfCITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPME RVICES ( J O INUM21810CopleyDrive, Diamond Bar, CA 91765 909) 839-7020 Fax(909)861-3117 Building Inspection Hotline (909) 839-44 SS BUILDING PERMIT APPLICATION FIRMLY JOBSITE 74ADDRESSz36oS O LJoA SPI° I M 4s n R. APN LOT TRACT d OWNER 5 ADDRESSEVl SPWr lr5 i2u. CITY 10/Art +cl if -m ZIP TEL. APPLICANT Asn '?" L -72K- TEL. 9 2-3 62--7--V3'2 CONTRACTOR ADDRESS & & CITY ZIP ck- TEL ARCWENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS U. CENSE LAW FOR THE FOLLOW W G REASON (SEC. 70.71.8 BUSINESS AND PROFESSIONS CODE ANY QTY OR COUNTY WHICH REOUIRESA PERMITTO CONSTRUCT ALTER, IMPROVE DEMOLISH, OR REPAIR ANY STRUC- TURE. PRIOR TO ITS ISSUANCE, ALSO REWIRES THE APPLICANT FOR SUCH PERMIT TO RLE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LF CENSE LAW (CHAPTER B (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 7031.8 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (11500).r C]1, AS OWNER OFTHE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WALL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 70N, 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). O I, AS OWNER OF THE PROPERTY AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS U. 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.). 1 AM EXEMPT UNDER SEC. B. 8 P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER Y (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS ODDE, AND MY LICENSE IS IN FURL FORCE AND EFFECT. LICENSE CLASS LIC. NO. DATE CONTRACTOR— 1 L WORKERS' COMPENSATION DECLARATION 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 0-80R CODE FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. 1 HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE AS REWIRED BY SECTION 37M OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' COMPENSATIIONN(INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER 51-%N-Tt- 4q• AJ POLICY NUMBER I' y J 4G —2-4013 THIS SECTION NEED NOT BE COMPLETEDGF THE PEWM 5 FOR ONE HUNDRED DOLLARS ($10MOR LESS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. 1 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 3700 OF THE LABOR CODE. I SHALL FORTHWITH COMPLY WITH THOSE PROVISK) DATE 40-z rO APPLICANT. WARNING: FAILURE TO SECURE WORKERS' CC PPNSATCOVERAGE IS UNLAWFUL,ANDSHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CAVIL FINES UP TOONE HUNDRED THOUSAND DOLLARS ($700,000), IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 370E OF THE LABOR CODE INTEREST, AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS ACONSTAUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 30W, CIV. C), LENDERS NAME LENDERS ADDRESS I CERTIFY THAT I HAVE 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-MEWIONED PROPERTY FOR INSPECTION PURPOSES. Tbyxv, PERMITTEE NAME (PRIITT) I SKMTURE OF PERMrTTEE DATE APPLICATIQN PERMIT 13 P/C DATE (af s \3 NUMBER \ 1- # ISSUDATEE TYPE OCC CONST. GROUP ZONING SETBACKS FRONT RW REAR SIDE/SIDE STREET RW O SIDE PROPOSED USE NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT FACTOR PSF ADJ.-AREA/VALUATION SFR/ADD/REM U) Garage/Carport WPatio/Deck LL PooUSpa 0 Z Re -Roof QCommercial M Valuation ADJ.AREA QUANTITY DESCRIPTION FEE JQU W w C:) Z DO d ZQ 2UW CONSTRUCTION PLAN REVIEW " ELECTRIC S(o 33 PLUMBING MECHANICAL g INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: TOTAL FEES Asia ' -121 e COMMENTS RECPT NO. PAID BY 018 VALIDATION WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD—File Copy, GREEN—Applicant's Copy r CITY OF DIAMOND BAR INSPECTION RECORD m SET BACK_ FLOOR JOIST FTG_S/FORNtS/STEEL --- I FHA REOMTS ELECTRIC GROUND I UNDER FLOOR DUCT____ i GROUND PLUMBING UNDER FLOOR CONDUIT SLAB GRADE FIREPLACE FOUNDATION TEMP POWER, FIREPLACE BOND BEAM WATER SERVICE I MID HT. BOND BEAM ROOF SHEATHING 18 FT. BOND BEAM FRAMING/VENTILATION FINAL BOND_ ROOF COVER PRE -GRADING --- - ROUGH HEATING r _ BENCHING ROUGH ELECTRIC P,OUGf !GRADING ROUGH PLUMBING FINISH GRADING SHOWER/TUB TEST POOL ELECTRIC EXT. LATH/SIDING POOL FENCING I POOL FINALWALLINSULATION CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS- II LANDSCAPEARRIG__ SEWER__----__ SEPTIC TANK 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 SEPTICTANK SIZE SEEP PIT/U SIZE