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Home My WebLink About12-867.pdfN1)IIIJ MIAR i 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) BUILDING PERMIT APPLICATION JOBSITE ADDRESS £'A ORCA%S APN LOTTRACT OWNER M I ADDRESS S -K CITYM29 ZIP TEL. APPLICANT ' TEL. 3Z3 62'T-3)32 CONTRACTOR ADDRESS CITYR- ZIP TEL ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PENURY THAT I AM EXEMPT FROM THE CONTRACTORS U. 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 ST_ TUBE, PRIOR TO ITS ISSUANCE, ALSO REWIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS UCENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS U, CENSE LAW (CHAPTER 9 (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 ACML PENALTY OF NOT MORE THAN. FIVE HUNDRED DOLLARS I, AS OWNER OFTHE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK, AND THE STRICTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, BUSI- NESS USHNESSMIDPROFESSIONSCODE: 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). 0 L AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WrTH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS U - CENSE LAW DOES NOTAPPLY70 AN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH A ODWRACTOR(S) LICENSED PURSUANTTOTHE CONTRAC- TORS LICENSE LAW.). O 1 AM EXEMPT UNDER SEC. B. A P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION 1 HERESY AFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER .PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 30F TILE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULLFFORCEAND EFFECT. LICENSE CLASS e--2-0 LIC. NO.. DATE 3' 51ZI L}CONTRACTOR WORKERS' COMPENSATION DEC RATION 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 37000E 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 BV SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMMCE'OF THE WORKFOR WHICH THIS PERMIT IS ISSUED. MY WORKEW COMPENSATION INSURANCE CARRIERANDPOLICY NUMBER ARE: CARRIER grkTr' F 11il.y POLICYNUMBER __1 2`Z R99 SECTION NEED NOT BE COMFLETEDOF THE PERMIT IS FOR ONE HLIDREDDOWAtS (SIM On LESSI. I CERTIFY THAT IN THE PERFORMANCE OF THE. WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECAME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS COMPENSATION PROVISIONS OF TION 3700 OF THE LABOR CODE, I/S WLLL FORTHWITH COMEETI'-']i ROVISIONS. DATE ! -Z APPLIC WARNING: FAILURE TO SECURE NIORXECOVERAGE IS UNLAWFUL, AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS (SI D,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3700 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. CONSTRUCTIONLENDING AGENCY I HEREBY AFFIRM UNDERPENALTY OF PENURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3097, CIV. C.). LENDERS NAME LENDERS ADDRESS 1 CERTIFY THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. 1 AGREE 70 COMPLY Y TH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY 70 ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. S 61 ZAj64?% Nq PERMITTEE NAME (PRINT) - I. 4 SIGNATURE OF PERMITTEE DATE 0 l V AWSeit1iQY APPLICATIO PERMIT P/CI ' DATE \ _ NUMBER X a-aio= #t ISSUE -7 / TYPE OCC1y \aDATEl CONST. GROUP ZONING SETBACKS FRONT RW p REAR SIDE/SIDE STREET RW SIDE PROPOSED USE NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM A Garaga/Carport WPatimVeck LL. Pool/Spa 0 Z Re -Roof 0 Commercial - M Valuation ADJ.AREA. QUANTITY DESCRIPTION FEE MG i5C_ cc wwF- Jw UZ m a U ti ' z UW CONSTRUCTION PLAN REVIEW ELECTRIC Jr 40 J PLUMBING MECHANICAL S C1 \ \ INSPECTION FEE ISSUANCE S-!- SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES COMMENTS RECPT. NO. \ 1 2 PAID BY VALIDATION _ WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD—File Copy; GREEN—Applicant'e'Copy A" o"'.. g = ypY yy .,, SET BACK FTGS/FORMS/STEEL ELECTRIC GROUND GROUND PLUMBING SLAB GRADE TEMP POWER WATER SERVICE ROOF SHEATHING FRAMING/VENTILATION CITY OF DIAMOND BAR INSPECTION RECORD FLOOR JOIST FHA REQMTS UNDER FLOOR DUCT UNDER FLOOR CONDUIT FIREPLACE FOUNDATION FIREPLACE BOND BEAM MID HT. BOND BEAM 8 FT. BOND BEAM 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. SEPTICTANK 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 SEPTIC TANK SIZE SEEP PIT/U SIZE