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Home My WebLink About27557.pdfl 1A)10. D IURt ji CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21825 Copley Drive, Diamond Bar, CA 91765 909) 839-7020 Fax (909) 861-3117 Building Inspection Hotline (909) 839-70 g/ `Il' , J BUILDING PERMIT APPLICATION ADDRJOBSESS z544 5e9-II GS CT APN LOT TRACT OWNER g:^ (^iT' ADDRESS P-0' QX (1Z A 1 7h Q CITY. ZIP PAII& TEL. 0 APPLICANT "lli --nom TEL. CON TRACTORZJ4B('%fB-}-` IA- ADDRESS • - fit] V CITY)W ip ZIP TEL. 3 ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CDDE: ANY CITY OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT, ALTER, IMPROVE, DEMOLISH, OR REPAIR ANY STRUC- TURE, 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 U - CENSE LAW (CHAPTER 8 (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 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO MACL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS ($500).): EDI, 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. 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 W ITHIN 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). L AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WRH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI. CENSE LAW DOES NOT AP PLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND M40 CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTORS) LICENSED PURSUANTTO THE CONTRAC- TORS LICENSE LAW.). 1 AM EXEMPT UNDER SEC. B. $ 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 Y (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS N FULL FORCE AND EEFFECT. LICENSE CLASS Ceiwo C-2(9 LIC. NO. /5 - DATE CONTRACTOR WORKERS' COMPENSATION DECLARATION 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 37M OF THE LABOR CODE, FOR THE PERFORMANC OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE. AS REWIRED BY SECTK)N 3700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS'COMPENSATION INSURAANCC (Q,ARRIER AND POLICY NUMBER ARE: JCARRIER 7*' --1 F"G. POLICY NUMBER L% q 99 2GbS DHS SECTION NEED NOT BE COMPLETED OF THE PERMIT IS FOR ONE HL DRED COLLARS ($100) OR 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 37W OF THE LABOR CODE. I SHALL FORTHWITH COMPLY WITH THOS - ROVISIONS. DATE: 9 _J —C)rl APPLICANT; WARNING: FAILURE TO SECURE WORKERS' COMPENSAT CO RAGE IS UNLAWFUL, AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATKNJ, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE. INTEREST, AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3N7, CIV. C.). LENDER'S NAME LENDER'S ADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL CRY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. zy k h I" A17h, PrRMITTEE NAME (PRINT) SIGNATURE OF PERMITTEE DATE PRESS FIRMLY APPLICATION. ff PERMIT p/C DATE_ t$ 1 sQ NUMBER ol"[SS"T # ISSUE"V=,/ TYPE OCC DATE CONST. GROUP ZONING SETBACKS r FRONT RW REAR J 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 U) Garage/Carport LwL.I Patio/Dock LL 0 Pool/Spa Z Re -Roof Commercial m Valuation ADJ.AREA OUANTITY DESCRIPTION FEE JQU HUW 0Z_ m a ZQSUW CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING CHANICAC Sv INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: TOTAL FEES Zo COMMENTS RECPT NO. SOS PAID BY VALIDATION TTrn 1 r=—unpunmem uopry, TtLLuw—mnance L;opy, rINK—Assessor Copy, GOLDENROD—File Copy, GREEN—Applicant's Copy CITY OF DIAMOND BAR INSPECTION RECORD . FLOOR JOISTSETBACK FTGS/FORMS/STEEL FHA REQMTS ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR CONDUIT SLAB GRADE FIREPLACE FOUNDATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICE MID HT. BOND BEAM ROOF SHEATHING 8 FT. BOND BEAM FRAMINGIVENTILATION FINAL BOND BEAM ROOF COVER PRE -GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWER/TUB TEST POOL ELECTRIC EXT. LATH/SIDING POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER FINAL ENG. SEPTIC TANK LANDSCAPE/IRRIG. 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 Fif COMMENTS SEPTIC TANK SIZE SEEP PIT/U SIZE a