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Home My WebLink About6_17_02 - 21700 LAURELRIM CCITY OF DIAMOND BAR DEPARTMENT OF COMMUMTY & DEVELOPMENT SERVICES c 21825 E. Copley Drive 909) 860-3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION JOBSITE f) IDDADDRESStdY'r!`Ml— APN LOT TRA T OWNER ADDRESS CITY ZI TEL. T_ APPLICANT Za TEL CONTRACTOR ADDR SS jaECITY ZIP jbz37_TEL. 3 zali ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LF CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.6 BUSINESSAND PROFESSIONS CODE: ANY CITY OR COUNTYWHICH REQUIRESAPERMITTO CONSTRUCT.ALTER IMPROVE, DEMOLISH,OR REPAIRANYSTRuC- TURF, PRIOR TO ITS ISSUANCE. ALSO REWIRES THE APPLICANT FOR SUCH PERMIT 70 RLE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW (CHAPTER 9 (COMMENCING WITH SECTION TWO) OF DIVISION S OF THE BUSINESS AND PRO- FESSIONSCOOE)OR THAT He OR SHE IS EXEMPT THERE FROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7031.613Y ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF= MORE THAN FINE HUNDRED DOLLARS (3500).1: O 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 BALE (SEC. 7011, BUSI- NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOTAPPLY TO AN OWNER OF PNKOPERTY WHO BULDS 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 BULDNG OR IMPROVEMENT IS SOLD WITHIN ONE YEAROF COMPLE- TION, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVNG THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALEL O L AS OWNER OF THE PROPERTY. AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR MPROVES THEREON, AND WHIOCONTRACTS FOR SUCH PROJECTS WITHACONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.), O I AM EXEMPT UNDER SEC. B. 3 PC, FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 O THE BUSINESS AND PROFESSIONS COOE,AND MY LICENSE IS IN FULL FORCE AND EFFECT. LICENSE CUSS1__ LIC. NO- 0— DATE fZ7 -If -'%%_ CONTRACTOR WORKERS' COMPENSATION DECLARATION I HEREBYAFFIRM UNDER PENALTY OF PERJURY ONE OFTHE FOLLOWING DECLARATIONS: HAVE AND WILLMAINTAN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION 3700 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 REWIRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS LSSUED. MY WOf]LcERS' RS- COMPENSATION IN FIANCE _ AkCARRIER AND POLICY NUMBER ARE: L n-lL-, f 14CARRIER POLICY NUMBER DISSECTION NEED NOT BEOOLI x7moFTHE PERMIT B FOROhEMAZAIED DOLLARS ($1001 ORLESSL 1 CERTIFY THAT LATHE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I 1 SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE j WORKERS' COMPENSATION LAWS OF CALIFORNIA AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR E.I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. 1 DATE: APPLICANT: 1 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL BE SUBJECT AN EMPLOYER MTOCRIMINALPENALTIESANDCL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (3100.000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR N i SECTION 37060F THE LIBOR CODE, INTEREST, AND ATTORNEYS FEES. J CONSTRUCTION LENDING AGENCY i I HERESY 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, CIV C.L. J LENDERS NAME LENOERSADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL CIT' AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. PERMINAME (PRINT) ry SIGNA EGF PERMITTEE ••^ C RESS FIRMLY APPLICATION .441 PEn,mrrR P/CAftj,, DATE UMBER ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW REAR SIDE/SIDESTREET RW 11 SIDE PROPOSED USE NO. DWEL NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADDIREM Garape/Carpon WPatio/Dock LL PooVSpa ZRe Roof 0 Commercial m Valuation AMAREA QUANTITY DESCRIPTION FEE U F— UWJw T.7Z m J CL r U 2 Q2UW CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING 143MECHANICAL y INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: TOTAL FEES COMMENTS RECPL NO. PAID BY VALIDATION WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor COPY. UOLLIENHLLJ—rue wpy, LJHr;tN—APPIcam 3 L opy CITY OF DIAMOND BAR INSPECTION RECORD SET BACK FLOOR JOST FTGS/FORMSISTEEL I1 FHA nEQMT ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR CONDUIT - SLAB GRADE FIREPLAdE,FOONDATION TEMP POWER WATER SERVICE FIREPLACE BoND"BLAM I t MID HT. BOND BEAM ROOF SHEATHING 8 Fr. BOND BEAM,. FRAMING/VENTILIATION 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 j LANDSCAPE/IRRIG. SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST. FIRE DEPT. FINAL FINAL HEATING FINAL ELECTRIC HEALTH DEPT. FINAL DEV. FEES PAID FINAL PLUMBING ENERGY COMMENTS SEPTIC TANK SIZE SEEP PIT /U SIZE