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Home My WebLink AboutPR 13 634.pdfCn 0 m DIAMIND D1111 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) 839-7027 BUILDING PERMIT APPLICATION JOBSITE II ADDRESS APN LOT TRACT OWNER ADDRESS V ,Aou p a „al CITY ZIP ,/-JGi TEL.4020 .'I <jPQOO APPLICANT TEL CONTRACTOR ADDR SS/ z _q CITY ZIP 4/? 1TEL 40 O DESIGNER ADDRESS J A4A(}J_e f C ZIP 5A TEL fr o OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS L4 CENSE LAW FOR THE FOLLOWING REASON (SEC. 7071.s BUSINESS AND PROFESSIONS CODE ANYCITY OR COUNTY WHICH REQUIRES A PERMITTO CONSTRUCT. ALTER IMPROVE, DEMOUSK OR REPAIR ANY 9TRUC TURF, PRIOR TO ITS ISSUANCE. ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SKIVED STATEMENT THAT HE OR SHE 0 LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS L4 CENSE LAW (CHAPTER I (COMMENCING WITH SECTION 7000) OF DMSION 3 OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OR SHE LR EXEMPT THEREFROM AND THE BASIS FOR THEALLEGED EXEMP- TION. ANY VIOLIOATN OF SECTION 7131.5 BY ANY APPLICANT FOR A PERMIT Ski WECT S THE APPLICANT TOACMLPENALTYOFNOTMORETHANFIVEHUNDREDDOLLARS (3300).}. L AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7644. 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 ORTHROUGHHISORHEROWNEMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE IF, HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD VIf) W ONE YEAR OF COM PLE. TION. THE OWNER-BUBDER WILL HAVE THE BURDEN OF. PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SX -4 O L AS OWNER OF THE PROPERTY, AM EXCLUSNVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 704. BUSINESS AND PROFESSIONS COOS THE CONTRACTORS U. CENSE LAW DOES NOT APPLY To AN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON, ANDW40CONTRACTSFORSUCHPROJECTSWTHACONTRACTORNS) LICE ,SED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). B 1WEXEMPT UNDER SEC, a. i P.C. FOR THIS REASON c F DATE / 9K Z4 /A.i A.A Ln / Awe 7 LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERIIRY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION I OF THE BUSINESS AND PROFESSIONS CODE, ANDMYLICENSEUINFULLFORCEANDEFFECT. LICENSE CLASS LIC. NO. DATE T CONTRACTOR WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECEARATIONS: I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SEL -INSURE FOR WORKERS COMPENSATION, AS PROVIDED BY SECTICIJ WOO OF THE LABOR CODE, FOR THE PERFORMANCEOFTHEWORKFORWHICHTHISPERMITISISSUED. ANO WILL MAINTAIN WORKERS COMPENSATION INSURANCE; AS, REQUIRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS COMPENSATION INWRANCI.0 €R AND POLICY NUMBER ARE: CARRIER (Z fit/` 2( THIPOLICY NUMBER 8-2402— THISS SECTION NEED NOT BE CO PLETI DOFTHE PERMIT IS FOR ONE HLI DREDDOLLARS (fim)OR LESS) 1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 6 ISSUED, 1 SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS BECOME SME TO THE WORKERS COMPENSATION LAWS OF CALIFORNIA. AN EE THAT IF I BECOMESUBJECTTOTHEWORKERS' COMPENSATION PRO F SECTION 3 THE LABOR CODE. TH COMPLY WITH THOS DATE APPLICANT. WARNING:FAIUIRETOSECUREWORKERSCCMPENSATION IS NLAWRIL. AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINE E HUNDRED THOUSAND DOLLARS 0I 00.000L IN ADDITION TO THE COST OF COMPENS GES AS PROVIDED FOR INSECTION3708OFTHELABORCODE, INTEREST. AND A S S CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE 6 A CONSTRUCT1oN LENDING AGENCYFORTHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMITISISSUED (SEC. 7097, CN. C.), LENDERS KAME LENDERS ADDRESS I CERTIFY THAT'I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT: 1 ADREE TO COMPLY WITH ALL CRY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATN S OF THIS COIMTYTO ENTER UPON THEABOVE-MEHfTDNED PROP TY FORINSPECTION / t f PERMITTEE As ASIGEPEDATE WHITE--DePwIlnent Copy, YELLOW—FIRa noe COpy, PINP PRESS FIRMI V APPLICATION/ PERMIT DATE AXII3_ NUMBER 7 #O'T G ISSUE TYPE OCCate' i \ 3DATE CONST. GROUP ZONING SETBACKS FRONT RW REAR 0 SIDE/SIDE STREET RW O SIDE PROPOSED USE o _C if t c Z - NO. DWEL NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ_ AREANALUATION SFR/ADD/REM IV Cir b !V\d LC C to Garage/ Carport W PatWD.* LL Q) Poompa Z Re -Roof 0 Commercial CQY m Valuallon p fj BO ADJ.AREA QUANTITY DESCRIPTION FEE . U CU L w 0Z m Jd Z U onW CONSTRUCTION q 4 , 9S PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMTP ENERGY P/C ENERGY PERMIT RETENTION FEE Ol Qp PRE•ALT FEE: IF3sA'F \ Cn TOTAL FEES \ 3 8 . R aM r COMMENTS RECPT. NO. PAID BY 16111 VALIDATION C—Aaeeaen. r( Py. OD --File Copy, GREEN—Appl{cant'a Copy 7- SET BACK FT(-,SlFORMS1STFEL ELECTI`IC GROUND ROUND PLU(vl.BIf,IG SLAB GRADI: TEMP POWER 1 --51 icy-;..iUKZLP FLOOR JOIST FH.", REQMTS UNDER FLOOR DUCT UNDER FLOOR CONDUIT FOUNDATION FIREPLACE BOND BEAM MID HT. BOND BEAM 8 FT. BOND BEAM j FINAL BOND BEAM iFE NG ROUGH GRADING W WATER SERVICE ROOF SHEATHING FRAMING/VENTILATION IROOFCOVERPRE-GRADING ROUGH HEATING ROUGH ELECTRIC ROUGH PLUMBING I I FINISH GRADING SHOWER/TUSTEST I POOL ELECTRIC EXT. LATH/SIDING POOL FENCING WALL INSULATIONPOOL CEILING INSULATION FINAL OFF SITE IMPS. DRYVIALL NAILING EWER SEPTICTANK SEEP PIT/L.L. GAS AIR TEST DEDICATIONS FINAL ENG. LANDSCAPEARRIG. ON SITE IMPS. I FINAL ZONING FINAL CONST. I FIRE DEPT. FINAL FINAL HEAT ING 4L HEALTH DEPT. FINAL FINAL ELECTRIC FINAL PLUMBING ni r on k DEV. FEES PAID ENERGY FINAL PLANING 41 I FINAL ENGINEERING 5e COMMENTS 4 4 SEPTICTANK SIZE SEEP PIT/U SIZE