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Home My WebLink AboutPR 13-1034.pdfQ 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 B IL,DING PERMIT APPLICAT] JOBSITE ADDRESS DATE p l NUMBER 3-M APN LOT TRAC OWNER ADDRES CITY ZIP TEL. APPLICANT TEL if1L- 3 -01Cj CONTRACTOR N- ADDRESSAj CITY Lr — ZIP _ TEL.?0 `Ll 2-3rDD % ARCFI/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 (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE ANY CITY OR COUNTY WHICH REQUIRES A PERMITTO CONSTRUCT, ALTER. IMPROVE, DEMOLISH, OR REPAIR ANY STRUC- TRUGTURE, TURE,PRIOR TO ITS ISSUANCE, ALSO REWIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS L6 CENSE UW (CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 7 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 FORA PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (11500).r I, 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. 70", 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 WITHIN ONE YEAR OF COMPILE. TION, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE} I, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 70N, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI. CENSE LAW DOES NOT APPLY TO AN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S) LICENSED PURSUANT TO THE CDNTRAP TORS LICENSE LAW.). O 1 AM EXEMPT UNDER SEC. B. 6 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 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT. LICENSE CLAS LIC. NO. 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 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. g I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE AS REWIRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF T E WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS-}-MP ATION IN 1/1/py,WCE CAR ER AND POLICY NUMBER ARE: CARRIER ` 0 ( %% 1 POLICY NUMBER LILAS SECTION NEEDNDT BENI.iiETEDOFT E PERMIT 6 FOR CNE HUNDREDDQ _ARS(f1001ORNESSI 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 ANDA EE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROMS Fa: 101 OF THE LABOR COO 1S FORTHWITH COMPLY WI SE PROpr DATE: APPLICANT. I i WARNING: FAILURE TO SECURE WORKERS' COMPENSATIONCAVE RAD E6 UIU FAL, AND SHALL BE MSUBJECTANEMPLOYERTOCRIMINALPENALTIESANDCL FINES UP TO 01 7IlINDRED THOUSAND DOLLARS (3 100,000). IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN I SECTION 3708 OF THE LABOR CODE. INTEREST. AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY i 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. 3097. CW. C.). I LENDERS NAME LENDERS ADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. 1 AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING 3 CONSTRUCTION, AND HEREBY RIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE.MENTIOVEDPROPEFITY OR INSPECTION PURPOSES. Valuation n P E NAN 9 3 S TORE OF PEAMITME DA E ON P SS IRMLY APPLIPERMITCATIO rL 1, 1(- P DATE p l NUMBER 3-M Ii/ C ISSUETYPE 1A OCC DATE ( CONST. GROUP ZONING SETBACKS FRONT RW REAR SIDE/SIDE STREET RW SIDE PROPOSED USE NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREAIVALUATION SFR/ADD/REM U) Garage/Carpon WPatio/Dock LL Pool/Spa ZRe Root 0 Commercial m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE JQU Q 0UW W 17Z_ m Ja JQU_ 2QS W i I2E p CONSTRUCTION 1 PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE r Z SMIP ENERGY P/C ENERGY PERMIT 7 RETENTION FEE: Z Q2 P ALT FEE nn TOTAL FEES, 3 COMMENTS RECPT. NO. jq11T PAID BY 144 VALIDATION WHITE -Department Copy, YELLOW—Finance Copy. PINK—Assessor Copy, GOLDENROD --File Copy: GREEN—Applkanfs Copy crry OF DIANION D GAP, INSPECTION RECORD e I FLOOR.IOIST S ------ -- SET BACK FTGS,FORMS/STEEL ---- A FHAREQfy1TS --- —_ -- UNDERELECTRICGROUND FLOOR DUCT GROUND PLUMBING UNDER FLOOR CONDUIT SLAB GRADE FIREPLACE FOUNDATION TEMP POkVER FIREPLACE BOND BEAM WATER SERVICE MID HT. BOND BEAM ROOF SHEATHING 18 FT. BOND BEAM FRAMING/VENTILATION FINAL BOND BEAM —_ ROOF COVER ----- PRE- GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC I — ROUGH GRADING ROUGH PLUMBING I FINISH GRADING SHOWER/TUBTEST POOL ELECTRIC EXF. LATH/SIDING POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS, DRYWALL NAILING DEDICATIONS SEWER SEPTIC TANK FINAL ENG _ LANDSCAPEARRIG. SEEP PITA.L. ON SITE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST. l I FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING JENERGY FINAL PLANING_______ FINAL ENGINEERING- COMMENTS __w r+v-hor — yr1 AD o __--- ---------------_----- 4"c Xrlcke4f ra`^_ Pa -- SEPTIC TANK SIZE SEEP PIT/U SIZE f