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Home My WebLink About10915 - 2139 EVERGREEN SPRINGSCITY OF DIAMOND BAR 1 COMMUNITY DEVELOPMENT DEPARTMENT ' 21660 E.Copley Drive Suite 190 909)860.3195 Fax(909)861-3117 ' J PRESS BUILDING PERMIT APPLICATION J / FIRMLY C13 JOBSITE . if APPLICATION.p PERMIT PIC ADDRESS K ffN J /" DATE / _ NUMBER I, c ISSUE TYPE OCC. APN LOT TRACT DATE CONST.GROUP, O OWNER f O o p ADDRESSZONINGS SETBACKS z CITY ? ZIP EL FRONT RW 0 O APPLIbAff REAR 0 SIDE/SIDE STREET RW O CONTRACTOR t -r SIDE n 0 ADDRESS /!z PROPOSED USE_Fc MsV( (ji ao p S CITYT IP a u r TEL. LU ARC 1,•' t Y 1 w DESIGNER NO.DWEL. cn ADDRESScnUNITS -- STORIES BEDROOMS rn CITY ZIP TEL. En- DESCRIPTION SO.FT. FACTOR PSF " ADJ.AREAIVALUATION C OWN[R•Bl ILDER DECLARATION SFR/ADD/REM O p1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LF Garage/Carport - W CENSE LAWFOR THE FOLLOWING REASON(SEC.7031.6 BUSINESS AND PROFESSIONS CODE ANYCIT'OR (0 C) COUNTY WHICH REQUIRESAPERMITTOCONSTRUCT,ALTER.IMPROVE.DEMOLISH,ORREPAIRANYSTRUC• W Patio/DeckaMTURE.PRIOR TO ITS ISSUANCE.ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W STATEMENT THAT HE OR SHE 15 LICENSED PURSUANT To THE PROVISIONS OF THE CONTRAC70RS LI- CENSE UW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 30F THE BUSINESS AND PRO. LL" Pool/SpaFESSIONSCOCE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP. 0 IOVTION.ANYVI04ATNOFSECTION7031.5BYANYAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO Z Re-Roof r A CPnL PENALTY CF NOT MORE THAN FIVE HUNDRED DOLLARS(7500).): Z 4ASOYMEROFTHEPROPERTY,ORMYEMPLOYEES WITH WAGES ASTHEM SOLE COMPENSATION.Commercial WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENOED OR OFFERED FOR SALE(SEC.7044,BUST- J NESSAND PROFESSIONS CODE:THE CONTRACTORS LICENSE UW DOES NOT APPLY TO AN OWNER OF ? PROPERTY YA108UM1D5 OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR Cr THROUGHHISORHER OWNEMPLOYEES.PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR M OOFFERED FOR SALE.IF,HOWEVEI'L THE BUILDING OR IMPROVEMENTIS SOLD WITHIN ONE YEAROFCOMPLE. Z TION.THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD ORIMPROVEFORTHEPURPOSEOFSALE). yJ - O L AS OWNER OF THE PROPERTY.AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS Q TO CONSTRUCT THE PROJECT(SEC 7040.BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI.Valuation ADJ.AREA - W CENSE UW DOES NOT APPLY TOAN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON.AND V6TORS FOR SUCH PROJECTS WITHACONTRACTOR(S)LICENSED PURSUANTTOTHE CONTRAG QUANTITY DESCRIPTION FEE Y TORS LICENSE LAW.). OIAMEXEMPT UNDER SEC. B.a P.C.FOR THIS REASONCCd U DATE OWNER F= LICENSED CONTRACTORS DECLARATION W I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER d 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE.AND z X MY LICENSE IS W FULL FORCE AND EFFECT. rn LICENSE CUSS P LIC.NO.—A_I-3VZ U DATE J_ CONTRACTORVV_ l/7i,,1__ d O- W 2 WORKERS'COMPENSATION DECLARATION a wI HEREBYAFFIRM UNDERPENALTYOF PERJURYCNEOFTHE FOLLOW:NGDECURATIONS: Z I HAVE AND WILL MAINTAINA CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' y COMPENSATION.AS PROVIDED BY SECTION 37000FTHE LABOR CODE,FOR THE PERFORMANCE WOFTHEWORKFORWHICHTHISPERMITISISSUED. I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE.AS REQUIRED BY SECTION 0 3700 OF THE LABOR CODE.FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.MY WORKELRS'COMPENSAT NSURANCE CARRER AND POLICY NUMBER ARE: - CONSTRUCTION tT TCARRIERA7 MeV PLAN REVIEW POLICY NUMBER ELECTRIC 0 ([F9SSECTION NEEDDNNOTTBECOMPLETEDDOFTHE 44TISFORONTRAIMDOLLARS(f100)ORLESSl PLUMBING ... Z 1 CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I MECHANICAL SHALL NOT EMPLOY ANY PERSON IN ANY MANNER 50 AS TO BECOME SUBJECT TO THE N WORK ERS'COMP ENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BE COME INSPECTION FEE SUBJECT TO THE WORKERS•COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE,1 "ALL FORTHWITH COMPLY WITH THOSE PROVISIONS. ISSUANCE Ip DATE: 0 Q JAPPLICANT: t4V SMIP J.. 1 WARNING:FAI URE OSECURE TMDRNERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL BE ENERGY P/C - y„ SUB.JECTAN MPLOYERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGY PERMITDOLLARS($100,000),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3701 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. RETENTION FEE: OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: ji )y.py CI= 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY BUJ lA/J FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEG 3097,CIV.C). W LENDER'S NAME 1— LENDERSADDRESS W (CERTIFY iHATIHAYE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORR[CT.TOTAL FEES 7'd.S Ll I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION.AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTE R UPON THE Z ABOVE-MENTIONEDPROPERTVFORINSPECTION PURPOSES. COMMENTS DJ IK4— Ca PERMUE j C SQ rI n 51GNATU L7 T1MI E I ./ RECPT NO. 2 PAID BY VALIDATION WHITE-0epartment Copy.YELLOW—Finance Copy,PINK—Assessor Copy.GOLDENROD--Filo Copy.GREEN—Applicant's Copy CITY.OF DIAMOND BAR. INSPECTION RECORD INSPECTION DATE INSPECTOR INSPECTION DATE INSPECTOR SET BACK FLOOR JOIST FTGS/FORMS/STEEL FHA REQMTS ELECTRIC GROUND UNDER FLOOR QUCT1,:": r r• GROUND PLUMBING UNDER FL A`CONDUITt SLAB GRADE - FIREPLACE FOUNDATION TEMP POWER FIREPLACE BOND BEAM I i WATER SERVICE. MID HT.,BOND;BEAM ROOF SHEATHING 8 FT. BOND BEAM FRAMINGIVENTICIAT16N 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 7.;, POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER.... _..FINAL ENG. SEPTIC TANK n LANDS CAPE/I R RIG. 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 COMMENTS a s `. SEPTIC TANK SIZE SEEP PIT/Ll SIZE ' f1 : r• I