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Home My WebLink About18946 - 22628 E GOLDEN SPRINGS.?� CITY OF DIAMOND BAR F DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES :.c 21825 E. Copley Drive (909) 860-3195 Fax (909) 861-3117 '• ''` BUILDING PERMIT APPLICATION JOBSITE ADDRESS kAs APN LOT TRACT OWNER ADDRESS CITY %U_ w &,(t_ 71Pql7czoq TE T APPLICANT TE CONTRACTOR ADDRESS CITY ZIP TEL ARCK ENG/ DESIGNER 76 C4 ASSD6 ADDRESS CITY ZIP TEL OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS L4 CENSE LAW FOR THE FCLLOWNO REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE: ANY CRY OR COUNTY WHIC H REQUIRESAPERMTTTO CONSTFIUCT.ALTER. IMPROVE, DEMOLISH. OR REPIURANY STRUCG TURF, PF OR 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 LAW (CHAPTER t (COMMENCING WITH SECTION 7000) OF DIVISION 0 OF THE BUSINESS AND PRO - SESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP• TION. ANY VIOLATION OF SECTION MIA BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (t5001.} D LAS 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 TWO" HIS OR HER ONTO EMPLOYEES, PROVIDED THAT SUCH IMPROYEMENTSARE NOT INTENDED OR OFFERED FOR SALE IF.HOWEVEWITHINIONRTHE BUILDINOOR IMPROVEMENT IS SOLD WITHIN ONE YEAROF COMPLE- TION. THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR I�THE PURPOSE OF 8ALEI. AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO THE PROJECT (SEC. 70u. BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS U- CE ELA ES NOT APPLY TO AN OWNER OFA PROPEFITYWHD BUILDS OR IMPROVES THEREON. AND CONTRACTS FOR SUCH PROIECTSWITHACONTRACTOR(SILL ED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). D1AM EX MPTUNDERSEC, ORTHIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER P (COMMENCING WITH SECTION 70001 OF OMSION S OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS N FULL FORCE AND EFFECT. LICENSE CLASS LIC. NO. DATE CONTRACTOR WORKERS' COMPENSATION DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PER.NRY ONE OF THE FOLLOWING DECLARATIONS. _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION 0700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT S ISSUED. I HAVE AND WILL MAINTAIN WORKERT COMPENSATION INSURANCE. AS REQUIRED BY SECTION 5700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT isISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER POLICY NUMBER (THIS SECTION NEFDNOTEECOLPLETEDOFTIE PETMIT S FORONE HJFDREDDOL TARS (5100)ORLES% 1 CERTIFYTHAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I SHALLNOT EMPLOYANY PERSON INANY MANNER SO AS TO BECOME SUBJECTTO THE WORKERT COMPENSATION LAWS OF CALIFORNIA.AID AGREE THAT IF 1 SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 77000E THE LABOR CODE.1 SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE: APPLICANT. WARNING: FAAURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (3100.1)00). N ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 0708 OFTHE LABOR CODE, INTEREST, AND ATTORNEYS 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 S ISSUED (SEC. 3007, CIV. Oj. LENDER'S NAME LENDERSADDRESS I CERTIFY THAT 1 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 CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON T}IE ABOVEME ED vILOVERTYj9R NSPFFCT/KXI PURPOSES. .\LV\ P SIGNATURE OF PERMITTEE I DATE PRESS FIRMLY PERMIT APPLICATION I I -13' o`- NUMBER N� / I ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW p SIDE p PROPOSED USE NO. DWEL NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREANALUATION SFRNADD/REM CO Garage/Carport W Patio/Deck U- POoVSpa Z Re -Root 0 Commercial m Valuation ADJ.AREA QUANTITY DESCRIPTION I FEE _U L) U C) Z ED J�J O 4 U_ Q2 2 W CONSTRUCTION ELECTRIC t:_T1 PLUMBING MECHANICAL INREF ON FEE ISSUANCE ENERGY P/C ENERGY PERMIT RETENTION FEE: RE-ALT FEE: � • r TOTAL FEES fL L COMMENTS +`�`�•. Roy 2- m C r RECPT. NO.+ PAID BY ✓ VALIDATION WHITE —Department Copy, YELLOW —Finance Copy, PINK—Asseew Copy, GOLDENROD —File Copy, GREEN —Applicant's Copy CITY OF DIAMOND BAR INSPECTION RECORD SETBACK r FLOOR JOIST FIGS/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 6 FT. BOND BEAM FRAMINGNENTILIATION 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. _d %� FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC ��! 1. DEV. FEES PAID FINAL PLUMBING ENERGY ;r �,PI c : io ear:-� ��• COMMENTS SEPTIC TANK SIZE SEEP PITIU SIZE vv. j