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Home My WebLink About9302 (21).pdfCITY OF DIAMOND BAR COMMUNITY DEVELOPMENT DEPARTMENT 216601- Copley Drive Suite 190 909) 860.3195 Fax (909) 861-3117 h' ^" BUILDING PERMIT APPLICATION ADDRESS APN _ LOT TRACT OWNER 1-4,-4 ADDRESS X -e- CITY ZIP TE APPLICANT TEL. I CONTRACTO ADDRESS CIN iC! vi` ZI Fi1. 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 LI. CENSE LAW FOR THE FOLLOWING REASON ISEC.7031.6 BUSINESSAND PROFESSIONS CODE: ANY CITYOR COUNTY WHICH RECUIRESA PERMIT TO CONSTRUCT, ALTER. IMPROVE, DEMOUSR OR REPAIRANY STRUC. TORE, PRIOR TO ITS ISSUANCE. ALSO REQUIRES 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 U(CWHAPTER 6 (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 FINE HUNDRED DOLLARS (000).): 0 LAS OWNER OFTHE PROPERTY, OR MY EMPLOYEES MTN WAGESAS THEIR SOLECOMPENSATION, WILL DO THE WORK AND THE STRUCTURE IS NOT NTENDEOOR OFFERED FOR SALE (SEC.70u, BUSI- NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE UW DOES NOT APPLY TO AN OWNER OF PROPERTY V410 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 MENDED OR OFFERED FOR SALE. IF. HOWEVER THE BUILDING OR IMPROVEMENTS SOLD WITHIN ONE YEAR OF COMPLE• TIOFI, THE OWNER.BUI'GER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). O L AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 70". BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS U. CENSE UW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND W HO CONTRACTS FOR SUCH PROJECTS WITHA CONTRACTOR(S) LICENSED PURSUANT TOTHE CONTRAC- TORS LICENSE LAW.). O IAM EXEMPT TINDER SEC. B. t P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION ' I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCNG WITH SECTION 70001 OF DIVISION I OF THE BUSINESS AND PROFESSIONS ODOE, AND MY LICENSE IS N FULL FORCE AND EFFECT. LICENSE CUSS LIC. NO, DATEIrl/1- 21 CONTRACTOR WORKERS' COMPENSATION DECLARATION` 1 r I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONI v I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELFHNSURE 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 WALL 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. MYW'ORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER POLICY NUMBER THIS SECTION NEEDNOTBE COM LETEDOF THE PERMIT 15 FOR ONE HINOHEDDOLIARS aIIJSOR LESSL I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON N ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF 1 SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 37000E THE LA13OR COCDE, I FOR)HWITH COMPLY WITH PROJ S. LATE: ,N LPPLICAFR: _,,C C WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL BE SUaJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLtAR3 (S100,000)• N ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE. INTEREST, AND ATTORNEY'S FE ES. CONSTRUCTION LENDING AGENCY 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED (SEC. 3057, CIV C.). LENDERS NAME LENDERSADDRESS ICERTIFY THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. 1 ACREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCT.AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE.MENTIONED PROPERTY FOR INSPECTION PURPOSES. aPfRMITTE /]Q/ • . SIG;SIGNVD;PERMIrrEE V DATEE !/ Y exp % 0 PRESS FIRMLY APPLICATION L / PERMIT MODATEl U NUMBER ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW REAR SIDEISIDE STREET RW Ll SIDE PROPOSED USE .rif NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREWALUATION SFRIADDIREM ' n Garage/Carport W PatkVDWk LL PooVSpa _ Z Re -Fool 0 Commercial 5 m Valuation ADJ.AREA QUANTITY DESCRIPTICN FEE J4U cc wU Jw 0Z r• c L U 2 Q2UW CONSTRUCTION PLAN REVIEW ELECTRIC ev MECHANICAL INSPECTION FEE ISSUANCE SMIP LA ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: INclreUrNv. I 3 L IN NI ar ,•L H I TOTAL FEES tPmw COMMENTS RECPT PAID BY VALIDATION WHITE—Department Copy. YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD—file Copy, GREEN—AppllcenYa Copy j7 CITY OF DlAfvlOND;BA'R INSPECTION RECORD"! 614 9... OP SET BACK FLOOR JOIST - FTGS/FORMSISTEEL- 'FHA nEQMTS ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING' UNDER-FLOOR CONDUIT t's SLAB GRADE FIREPLACE FOUNDATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICE I'MID HT. BOND BEAM ROOF SHEATHING 8 Fr. BOND BEAM FRAMINGNENTILIATION FINAL BOND BEAM ROOF COVER PRE-GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC -ROUGH GRADING . I -2. ROUGH PLUMBING FINISH GRADING SHOWER/TUB-TEST 7 POOL ELECTRIC POOL FENCINGEXT. LATHISIDING WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS.-.':, DRYWALL NAILING DEDICATIONS SEWER.. FINAL ENG. 7SEPTICTANK LANDSCAPE/IRRIG. SEEP__PITlL.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 COMMENTS A SEPTIC TANK SIZE' SEEP PIT/U SIZE Vw.