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Home My WebLink AboutPR 13 631.pdfUI.I III D DN11d i G w,p\max-aA—ecad.l wJ IeL\\may J b'c- t G..-.••,oi\ CITY OF DIAMOND BAR \ a^QDEPARTMENTOFCOMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 ' )7909) 839-7020 Fax (909) 861-3117 Building Inspection Hotline (909) 839-77 BUILDING PERMIT APPLICATION E ADDRESS C (5C /FADDRESS (j! ,, 7_ APN LOT RAIUOWNERAV S,(mL ADDRESS 3 V D..,.F CITY bZA".N.'r) (RaeZIP T OCA APPLICANT CONTRACTOR (L ADDRESS M%_ CITY ZIP 4 TEL ARC W ENG/ DESIGNER ADDRFwS CITY _ 1 ZIP&J TELO OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PFJLAURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC 7001.5 BUSINESS AND PROFESSIONS CODE: AIlY CRY ORCOUNTYWHICHREQUIRESAPERWTTOCONSTRUCT,ALTM SAPROVE DEMOLISH, OR REpA- ANY ITTy/C. TURF, PRIOR TO ITS ISSUANCE ALSO REOUIRES THE APPLICANT FOR SUCH PERMn" TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LJ - CENSE LAW (CHAPTER Y (COMMENCING WITH SECTION 7000) OF DIVISION 3 O 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 TOACIVILPENALTYOFNOTMORETHANFIVEHUNDREDDOLLARS (M00).): D 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. 7044. BLISA 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 ORTHIMGHHISORHEROWNEMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FORSALE IF, HOWEVER. THE BUJDNG 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 ORIMPROVEFORTHEPURPOSEOFSALE). O L AS OWNER OF THE PROPERTY, AM EXCLUS VELY CONTRACTING WITH LICENSED CONTRACTORSTOCONSTRUCTTHEPROJECT (SEC. AN70"- BUSINESS O PROFESSIONS CODE: THE CONTRACTORS U_ CENSE LAW DOES NOTAPPLY TOAN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOA(S) LICENSED PURSUANT TO THE OONTRAOTORSUCENSELAW.). 1 AN EXEMPT EA SEC. B. 8 P.0 FOR THIS REASON P warp DATE 0 OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM LICENSED UNDER PROVISIONS OF CHAPTER Y (COMMENCING WITH SECTION 70W) OF DIVISION D OF THE BUSINESS AND PROFESSIONS CODE, ANDMYLICENSEISINFULLFORCEANDEFFECT LICENSE CLASS UC. NO. DATE CONTRACTOR WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERNRY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AILD WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WgfIXERW COMPENSATION. AS PROVIDED BY SECTION WOO OF THE LABOR CODE FOR THE PERFORMANCEOFTHEWORKFORWHICHTHISPERMITISISSUED. I HAVE AND WILL MAINTAIN WORKERS COMPENSATION INSURANCE; AS MOURRED BY SECTION 7700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHIN THIS PERMTT IS ISSUED. MY WORKERS' COMPENSATION INSURANCE C' p POLICY NUMBER ARE- CARRIER RECARRIER POLICY NUMBER - ?•• IT -IS SECTION NEE) NOT BECOMQLETEDOFTHE PEFMT IS FORONE H NDR®DOLIARS (S1COICR Las} I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHIC7T THIS PERMIT 19 LSSUED, 1 SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF + ArMMF.ES. AND ME THAT IFI BECOME SUBJECT TO THE WORKERS COMPENS OF SECTION OF THE LABOR CODE. RTHWITH COMPLY WSK)NS. DATE APPLICANT. WARNING: FAILURE TO SECURE WORKERS CORAGE IS UNLAWFUL, AND SHALL BE SUBJECT ANEMPLOYER TO CRIMINAL PENALTIL E UP TO ONE HUNDRED THOUSANDDOLLARS (7100.000), IN ADDITION TO THE COST. DAMAGES AS PROVIDED FOR INSECTION370! OF THE LABOR CODE NTERESTFEES. CONSTRUCTION LENDING AGENCY 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCYFORTHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMITISISSUED (SEC 70A, CN. C), LENDER'S MALE LENDER'S ADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. 1 AGREE TO COMPLY WITH ALL CRY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BULGING CONSTAUCTION,Nm HEREBY AUTHORIZE REP SEWATIVES OF THIS COUNTY TO EWER UPON THEABOVE-MENTIONED PROPERTY FOR IN PURPOSES. B L% C-ef P (PRINT) - t ai EOATS WHITE—OepartmOnt COPY, YELLOW—Finance COpy, PIN P V PRESS FIRMLY APPLICATIONI L PERMIT p y/ DATE A049 NUMBER <O3\ fr lLo3 ISSUE TYPE OCCIdie- `13DATE CONST. OCC GROUP ZONING SETBACKS FRONT RW REAR 0 SIDE/SIDE STREET RW SIDE 0 PROPOSED USE [ 7yt,4 M 'IF7 De c.f S n NO. DWEL NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT FACTOR PSF ADJ. AREA/VALUATION SFRIADD/REM U3 Garage/ Carport WPatiatDeclI LL 0 POoVSPa Z Re -Roof 0 Commercial m Valuation i' "'— ADJAREA QUANTITY DESCRIPTION FEE U 2 O O IT WJW ZZ m ZJCL U 09; R — LIJ9 CONSTRUCTION 3 a Ja a PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE --1 4} —1, SMIP ENERGY PIC ENERGY PERMIT RETENTION FEE C) PRE -ALT FEE.- EETOTALTOTALFEES COMMENTS RECPT NO. SSS PAID BY ak_> 1, VALIDATION S'Yl Acenaw r py. ENROD--FRe Copy, GREEN—Apptkwra COW SET BACK FT(_,S/rF0Rf\AS!STFEL ELECTRIC GROUND GROUND P L U f,!! P, I f,.I-G SLAB GRADC TEMP POWER j I FLOOR JOIST FHA REOMTS UNDERVLOOR DUCT UNDER FLOOR CONDUIT FI i- LACE FOUNDATION FIREPLACE BOND BEAM MID HT. BOND BEAM 8 FT. BOND BEAM FINAL BOND BEAM PRE GRADING I SEN ING i ROUGH GRADING WATER SERVICE ROOF SHEATHING FRAMING/VENTILATION ROOF COVER I ROUGH HEATING ROUGH ELEc,rpic ROUGH PLUMBING FINISH GRADING SHOWER[TUBTEST I POOL ELECTRIC EXT. LATH/SIDING POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS. DR'04YALL NAILING SEPTIC i DEDICATIONS FINAL ENG. LANDSCAPEARRIG. ONSITE IMPS. TANK SEEP PIT/L.L. GAS AIR TEST If FINAL ZONING FINAL CONST. FIRE DEPT. FINAL FINAL HEATINq,;..HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING. I ENERGY FINAL PLANING FINAL ENGINEERING COMMENTS SEPTICTANK SIZE SEEP PIT/U SIZE