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Home My WebLink About2_19_02 - 21700 LAURELRIM DRJ CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21825 E. Copley Drive 909) 860-3195 Fax (909) 861-3117 BUILDING PERMIT AP/P L ICATION JOBSITE ADDRESS_.) -19O0 Lq\grektl t'7 r di APNLOT TRACT OWNER ADDRESS CITY t^ ZI TEL. APPLICANT TEL CONTRACT ADDRESS CITY ZI TEL ARCWENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LI- CENSE UW FOR THE FOLLOWING REASON (SEC.7031.6 BUSINESSAND PROFESSIONS CODE:ANY CITY OR COUNTY WHICH REQUIRES A PEFMITTOCONSTRUCT,ALTER. IMPROVE, DEMOUSH,CR 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 LI- CENSE LAW (CHAPTER P (COMMENCING WITH SECTION 7000( OF DIVISION S OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OR SHE 15 EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7071.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS is500).T O L ASOWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATKN, WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7041. SUSF 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 HIMSELFOR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR $ALE F IN , HOWEVER. THE BUILDING ORIMPROVEMENT IS SOLD WITHIN ONEYEAR OFCOMPLE- T. THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALEL E3 L AS OWNER OFTHE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 70". BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LJ - CENSE CENSE UW DOES NOTAPPLY TO AN OWNER OFAPROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS UCENSE LAW ). D I AM EXEMPT UNDER SEC. B, a P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION 1 HEREBYAFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER 0 (COMMENCING WITH SECTION 7000)OF DIVISION 0 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FLLL FORCE AND EFFECT. LICE NSECLAS1y.. LIC. NO. DATE 4 fi, CONTRACTORCc 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 7700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. 1 HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY BECTON 770D OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKER-CQLIPE ATION IN§y1RANCE CARRIER AND POLICY NUMSER ARE: CARRIER C'•`l/1'[ ii /V POLICY NUMBER D-USSECTKDN NEEDN.OT BE O DIMP ETEDOF THE PERMIT IS FORONE HUMDREDC0LLARS(%100)ORU= 1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER 50 AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA. AND AGREE THAT F 1 SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 5700 OF THE LABOR LLTH CMPLY WITHT DATEAPPLICANT WARNING: FAILURE TO SECURE WORKERS COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL BE SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,0WX IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 7706 OF THE LABOR CODE, INTEREST. AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I 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. 7007. CIV C). LENDERS NAME LENDERS ADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THATTHE ABOVE INFORMATION IS CORRECT. 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 ENTER UPON THE ABOVE -ME EO PROPERTY FOR IN PURPOSES. L4 PERMITTEE (PRI I_ Goa' pyIq 1u - SIGNATURE OF PERMITTEE DATE PRESS FIRMLY APPLICATION I O PERMIT 7 P/C DATE l NUMBERy k ISSUEv/1 TYPE OCC DATE C CONST. GROUP ZONING SETBACKS FRONT RW REAR SIDEISIDE STREET RW SIDE PROPOSED USE NO. DWEL NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION SFR/ADD/REM C/) Garapa/Carport WPalio/Deck U- Pool/Spa ZRB Roof OJ Commercial - D il Valuation ADJ.AREA OUANTITY DESCRIPTION FEE JQU_ L) UWJw UZ m J a a U ZQ2UW CONSTRUCTION l •2 . PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT r RETENTION FEE: PRE -ALT FEE: TOTAL FEES COMMENTS RECPT. NO. PAID BY VALIDATION WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD—File Copy, GREEN—Applicant's Copy CITY OF DIAMOND BAR INSPECTION RECORD SET BACK It Z l - . 7 ii7ATE 5) FLOOR JOIST, FIGS/FORMS/STEEL FHA REGMTS ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR CONDUIT SLAB GRADE I FIREPLACE FOUNDATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICE ROOF SHEATHING FRAMINGNENTILIATION ROOF COVER ROUGH HEATING L MID HT. BOND BEAM 8 FF. BOND BEAM. FINAL BOND BEAM PRE -GRADING I BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWERITUB TEST POOL ELECTRIC EXT. LATH/SIDING POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION j OFF SITE IMPS. DRYWALL NAILING j DEDICATIONS SEWER FINAL ENG. SEPTIC TANK j j LANDSCAPE/IRRIG. SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST j FINAL ZONING FINAL CONST. I FIRE DEPT FINAL FINAL HEATING j HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING j ENERGY COMMENTS SEPTIC TANK SIZE SEEP PIT/U SIZE