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Home My WebLink About18232CITY OF DIAMOND BAR cb DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21825 E. Copley Drive "Mc (909) 860-3195 Fax (909) 861-3117 PRESS BUILDING PERMIT APPLICATION FIRMLY JOBSITE ADDRESS _ Z APN LOT TRACT OWNER% i Kr2-1=112ir ADDRESS 21 o I S PA-T� f uQ;>c n CITY 7Dfn/a00Nl? VAL ZIP 9 tal TEL. APPLICANT TEL. CONTRACTOR ADDRESS 10 CITY M ZIP TEL. 7-7 '57S5/ ARCRENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS Ll• CENSE LAW FORTHE FOLLOWING REASON (SEC. 7031 5 BUSINESS AND PROFESSIONS CODE. ANY CITYOR COUNTY VMICH REQUIRES A PERMITTO CONSTRUCT, ALTER. IMPROVE, DEMOLISH, OR 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 9 (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- TON. ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FINE HUNDRED DOLLARS ISSM) ): ' D L AS OWNER OF THE PROPERTY. OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATAN. WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044. BUST. NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY VhO BUILDS OR IMPROVES THCREON, AND WHO DOES SUCH WORK HIMSELF OR HERSELFOR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE IF. HOWEVEKTHE BUILDINGOR IMPROVEMENT IS SOLD WITHIN ONE YEAROFCOMPLE- TION, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DO NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). ❑ L AS OWNEROF THE PROPERTY. AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 70", BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI. CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO a'JI1.DS OR IMPROVES THEREON, AND WINO CONTRACTS FOR SUCH PROJECTS WITHA CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS UCENSE LAW ). O IAM EXEMPT UNDER SEC. B, A P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I 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 PP.OFESSKONS CODE, AND MY LICENSE IS N FULL FORCE AND EFF ECT. C o/ LICENSE C/U✓SS 10 LIC. NO. DATE h CoNTRAcToR �yn .I13?91" , 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 SELFNNSURE FOR WORKERS' COMPENSATION, AS PROWGEDSY SECTION)7000FTHELABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. _I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE. AS REQUIRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER LA ~ 0 POLICY NUMBER /Io (THIS SEC'T10NNEED NOT BE COMPLETED OFTHE PERMIT 6 RDRONE HUIDREDOCLLArS(F100IORLESS) 1 CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 37000E THE LABOR COODE, I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE:-6 CK,(7 7APPLICJINT WARNING: FAILURETO SECURE WORKERS'COMPENSATON COVERAGE IS UNLAWM, AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TOONE HUNDRED THOUSAND DOLLARS (3100,000). IN ADDITION TO THE COST CF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 3703 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. i 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 IS ISSUED (SEC. 3097. C W. C.). I LENDERS NAME LENDERSADDRESS I CERTIFY THAT 1 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 RELATING TO BUILDING CONSTRUCTION. AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE -MENTIONED PROPERTY FOR INSPECTION PURPOSES. i 1 i PERMII[T E (PRIrNNT) / SIGNATU -OF PERMITTEE ATE APPLICATION 6 O PERMIT P/C DATE NUMBER 1 Ss 23 2 p ISSUE TYPE OCC DATE CONST, GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW D SIDE ❑ PROPOSED USE Off- SOS A ev" NO. DWEL, NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION SFR/ADD/REM fn Garage/Carport WPatio/Deck LL Pool/Spa 0 Z Re -Roof Commercial m Valuation ADLI.AREA QUANTITY DESCRIPTION FEE Q 0 LJV U H- U W J w CD Z Ri a J L) _U Z U W �F- CONSTRUCTION d ELECTRIC L A*TO PLUMBING MECHANICAL INS?ECTION FEE ISSUANCE • d SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: 1.40 PRE-ALT FEE: TOTAL FEES z' 1- b COMMENTS RECPT NO. PAID BY VALIDATION ' WHITE —Department Copy. YELLOW —Finance Copy, PINK —Assessor Copy. GULULNHULF— Ile LJOpy, UHttN—ApplICanTS L:Cpy Cff�," OF DIAWiOND BAR iNISPECT10r� RECORD ilc SET BACK FLOOR JO(ST' FIGS/FORMS/STEEL FHA REQrvlTS UNDER FLOOR DUCT (-� ELECTRIC GROUND GROUND PLUMBING SLAB GRADE UNDER FLOOR CONDUIT FIREPLACE FOUNDATION FIREPLACE BOND BEAM MID HT. BOND BEAM _ TEMP POWER WATER SERVICE ROOF SHEATHING 8 FF. BONDBEAM FINAL Bat J 0. S E A MI PRE -GRADING BENCHING _ROUGH GRADING FINISH GRADING ..POOL ELECTRIC POOL FENCING I POOL FINAL FRAMING,IVENTILIATION ROOF COVER ROUGH HEATING ROUGH ELECTRIC ROUGH PLUMBING SHOWERTFUD TEST EXT. LATH/SIDING WALL INSULATION CEILING INSULATION --()FF SITE IMPS. DRYWALL NAILING SEWER -DEDICATIONS FINAL ENG. SEPTICTA14K LANDSCAPEARRIG. SEEP PIT/L.L. GAS AIR TEST FINAL CONST. FINAL HEATING I c't-l't j ON SITE IMPS. FINAL ZONING FIRE DEPT. FINAL I HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING i i1 ENERGY COMMENTS SEPTIC TANK SIZE SEEP PIT/U SIZE