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Home My WebLink About18165 (26)i CITY OF DIAMOND BAR )� t DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES G% 21825 E. Copley Drive (909) 860-3195 Fax(909) 861-3117 PRESS BUILDING PERMIT APPLICATION FIRMLY JOBSITE VC 400 ADDRESS �5 1I IfgdO IZ.L APN LOT TRACT OWNER ADDRESS_ CITY a r)ZIFt A� TEL APPLICANT TEL. CONTRACTOR ADDRESS CITY ZIP TEL. ARCFVENG1 DESIGNER ADDRESS CITY ZIP TEL OWNER -BUILDER DECLARATION I 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 CRY OR COUNTY WHICH REOUIRESA PERMRTO CONSTRUCT•ALTER. IMPROVE. DEMOLISH. OR REPAIR ANY STAUC- TURE. PRIOR TO ITS ISSUANCE. ALSO RECUIRES 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 8 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OR SHE IS EXEMPTTHEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- 70N.ANY VICLATIN OF SECTION 7031.5 BY ANY APPOCANT FORA PERMIT SUBJECTS THE APPLICANT TO ACML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS ($500t): ❑ L AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL 00 THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044. 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 COMPLE- TION, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FORTHE PURPOSEOF SALE} ❑ 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 NOTAPPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S) LICENSED PURSUANTTOTHE CONTRAC- TORS LICENSE LAW). O 1 AM EXEMPT UNDER SEC. B. 3 P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER S (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE. AND MY LICENSE IS IN FULL FORCE AND EFFECT. UCENSE CUSS LIC. NO. DATE CONTRACTOR WORKERS' COMPENSATION DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWNG DECLARATIONS: I HAVE AND WILL MAINTAIN 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. _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE.AS REWIRED BY SECTION '700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBERARE: CARRIER POLICY NUMBER (THISSECTION NEEDNOT BEOOMPLETEDOFTIE PERMIT IS FOR ONE 1MOREDDCLLARS (1100) OR LESS) I CERTIFY THAT INTHE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I SHALLNOT EMPLOYANY PERSON IN ANY MANNER SOAS TO BECOME SUBJECTTO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISONS OF SECTION 3700 OF THE LABOR CODE.1 SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. I DATE: APPLICANT. 1 WARNING: FAILURE 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 (11100.000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN 1 SECTION 3708 OF THE LABOR CODE. INTEREST. AND ATTORNEYS FEES. 1 CONSTRUCTION LENDING AGENCY i I HEREBY AFFIRM UNDER PENALTY OFPERJURY THAT THERE ISACONSLENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUEDUED(SEC. 3P97, CIV. C.). j LENDER'S NAME LENDERSADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELA7 WG TO BUILDING CONSTRUCTION. AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS TO ENTER UPON THE ENTIONED PROPERTY FOR INSPECTION PURPOSES. - J i P MITT E NAME (PRINT) C I NATUREOFPERMITTEE DATE APPLICATION / 1 () 02 NPERM UMBER 9 :� 0 v� DATE �j ISSUE D - TYPE OCC 1 DATE 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. AREA/VALUATION SFR(ADD/REM Garage/Carport WPatio/Deck LL PooVSpa ZRe -Roof D Commercial IIl Valuation ADJ.AREA QUANTITY DES IPTION FEE J U `11 I- U w J W 0 2 m J IL a _U Z Q 2 U W PC CONSTRUCTION v PLAN REVIEW _ELECTRIC Q PLUMBING MECH NICAL N ECTION FEE rY^ I SUA D !� 6�t � SMI ENERGY PIC �NERGrPE RETFMYIfTN FFF• PRE•A TOTAL FEES COMMENTS i RECPT. NO. PAID BY VALIDATION WHITE —Department Copy, YELLOW —Finance Copy. PINK —Assessor t;OPY, Livwewnuu—raB t OPY, UhtLN—nppacant 3 L.opy CIT'i' OF DIAMOI�D BAR I NI S P F_ C':-ICJ[ R E C 01131 D 14, c SET BACK FLOOR JOIST FTGS/FORMS/STEEL FHA REGMTS ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR CONDUIT SLAB GRADE l FIREPLACE FOUNDATION TEMP POWER WATER SERVICE i I FIREPLACE BOND BEAM 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 I I FINISH GRADING SHOWER/TUB TEST POOL ELECTRIC EXT. LATH/SIDING i 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 -- Ar FINAL ZONING FINAL CONST, FIRE DEPT. FINAL HEALTH DEPT. FINAL FINAL HEATING j FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING I I ENERGY 00 COMMENTS SEPTIC TANK SIZE SEEP PIT/U SIZE