The URL can be used to link to this page

Home My WebLink About18547 (11)\ CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21825 E. Copley Drive (909) 860-3195 Fax (909) $61-3117 .. BUILDING PERMIT APPLICATION JOBSITE /S y� �Qer-�Ool'� ADDRESS APN LOT TR CT OWNER '� h C e- r S ADDRESS CITY Owl 6 IP TEL APPLICAN f� A ,% Cam_ TEL. CONTRACT 60 P ADDR S CITY ZIP TEL ARCHIENG/ 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. ANYCITYOR COUNTY WHICH REOUIRESA PERMIT TO CONSTRUCT, ALTER IMPROVE, DEMOLISH, OR REPAIR ANY STRUC• TUBE. 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 U• CENSE LAW (CHAPTER 9 (COMMENCING PATH SECTION 7000) OF DMSCN 3OF THE BUSINESS AND PRO• FESSIONSCODE) OR THATHEORSHE IS EXEMPT THCRE FROM AND THE BASIS FOR THE ALLEGEDEXEMP• T)ON. ANY VIOLATION OF SECTION 7031.5 BY ANYAPPLICANT FORA PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (SS00) ), D L AS 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 SALE (SEC. 7044, BUST- NESSAND 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 CR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FORSALE IF, HOWEVER THE BUILD'NO OR IMPROVEMENT IS SOLO WITHIN ONE YEAR OF COMPLE- TON, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE), 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 NOTAPPLY TO AN OWNER OF A PROPERTY WHO aVILDS OR IMPROVES THEREON. AND LV)O CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTORS) LICENSED PURSUANT TO THE CONTRAC- TORS UCENSE LAW). O IAM EXEMPT UNDER SEC. 6. L P.C. 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 7N10) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE. AND MY LICENSE 19IN ML FORCE AAyN1 O EFFECT. LICENSE CLASS 3 / LIC. NO. DATE n CONTRACTOR 3 �11� KERS' COMPENSATION DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: —1 HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION 37M OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. 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 ISSUED. MY WOpLER3' COM^ENSATIDN BNSUCARRIEp AND POLICY NUMBER ARE: CARRIER S �GJ� POLICY NUMBER RHISSECTION NEED NOT BE COMPLETEDOF TIE PERLLTIS FORONE HIPDRED OCl1ARS (FI00) OR LESS) I CERTIFYTHAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED, 1 SHALLNOTEMPLOY ANY PERSON IN ANY MANNER SOAS TOBECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA. AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE. I SHALL FORTHWITH COMPLY WITH HO PROVISO DATE: �ro APPLICANT WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP 10 ONE HUNDRED THOUSAND DOLLARS (S 100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37050F THE LABOR CODE. INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY 1 HEREBYAFF WM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3007, CIV. C.). LENDER'S NAME LENDER'S ADDRESS 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 PEPRESENTATNES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENT EDPROPERTY ORINSPECT0NPLF4.VSES. � PERM(/Iy�Ep/fA��ME: (PAINTy3 ) SIGNA,URE OF PER TEES- OPRESS FIRMLY APPLICATION - 3-u� PERMIT P/C DATE NUMBER q ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE p PROPOSED USE ^ ti"2 NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION SFR/ADD/REM CD Garage/Carport WPatio7Deck LL Pool/Spa ZRe -Root a QA Commercial 5 m Valuation _ ADJ.AREA QUANTITY DESCRIPTION FEE J d U CC h U W -J W 2 m a 4 U a d W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE T SMIP V ENERGY P/C ENERGY PERMIT V RETENTION FEE: PRE-ALT FEE: ' TOTAL FEES S O COMMENTS RECPT. NO. PAID BY VALIDATION WHITE —Department Copy. YELLOW —Finance Copy, PINK —Assessor Gopy, GVwtNHVu—tne wpy uhttN—Appit ;ant s copy CITY OF DIAf&OND BAR INISPECTION RECORD - �iF`�T'^^�:a'.I�l„+��':.�c�C'�"c ..I��,y� »�_ �'�,��. ..1,�1��6�:1`�� _-�. SET BACK ' + _ (� u j l FLOOR JOIST m�'��,,��i-•.. •f e FTGSIFORMS/STEEL--_ - � I FHA REOC�ITS - _ �— - - ELECTRIC GROUND UNDER FLOOR -DUCT. �.. _; GROUND PLUMBING i -- -- SLAB GRADE `^ _ _ UNDER FLOOR CONDUIT - — FIREPLACE FOUNDATION i TEMP POWER i I J FIREPLACE BOND BEAM _ WATER SERVICE _ 1 _- ROOF SHEATHING CaU FRAMINGNENTILIATION ROOF COVER �D d Z ROUGH HEATING ROUGH ELECTRIC ROUGH PLUMBING _ SHOWER/TUB TEST 1 _ EXT. LATH/SIDING l _ _ _ I MID HT. BOND BEACH ! 8 FT BOND BEAM 1 FINAL BOND BEAM PRE-GRADIN_ G BENCHING ROUGH GRADIt- _FINISH GRADING i POOL ELECTRIC j { POOL FENCING — ! _ WALL INSULATION) _ 1 POOL FINAL i CEILING INSULATION DRYWALL NAILINJG SEWER - �- _ FF SITE IMPS. �-'DEDI CATIONJS FINAL ENG. SEPTIC TANK 1 LANDSCAPE/IRRIG. j SEEP PIT/L.L. GAS AIR TEST 1- ! TON SITE IMPS. -- 1 FINAL ZONING FINAL CONST. FINAL HEATING 1 FIRE DEPT. FINAL HEALTH DEPT. FINAL FINAL ELECTRIC fbEV. FEES PAID FINAL PLUMBING I ENERGY COMMENTS SEPTIC TANK SIZE SEEP PITH SIZE — i -