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Home My WebLink About15725 (20)CITY OF DIAMOND BAR (fir j DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION ADDRESS lt�V NIT iDrn i 02 , APN LOT TRACT OWNER ADDRESS CITY ZIP TEL. APPLICANT TE CONTRACTOR _Nk ADDRESS CITY ZIP`14EL,S42 O ARCWENG! X On (O DESIGNER ADDRESS CITY ZIP TEL OWNER -BUILDER DECLARATION 1 HEREBYAFFAM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FORE FOLLOWING REASON (SEC. 7031.6 BUSINESS AND PROFESSIONS CODE: ANY CITY OR WINTY YW4W REOIJIRESAPEWrTTOCONSTRUCT,ALTER IMPROVE. DEMOLISH, OR REPAIRANY STRUC, TURF PRIOR TO TITS 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. LENSE LAW (CHAPTER I (COMMENCING WITH SECTION 7WO) OF DIVISION 3 OF THE BUSINESS AND PRO. FESSKONSCODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP. O TN.ANY VIDUITION OF SECTION 7071.E BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS ($5OOM: O LAS OWNER OFTHE PROPERTY, OR MY EMPLOYE ES WITH WAGES AS THEIR SOLE COMPENSATION, WALL DO THE WORK AND THE STRUCTURE S NOT INTENDED OR OFFERED FOR BALE (SEC. 70M. BUS4 INS SS 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 EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT MENDED OR OFFEREDFORSALE IF,HOWEVERTiEBUWNGOR*APROWNENTS" DYMMNONEYEAROFOOMPLE TION, THE OWNERTIADER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). 0 L AS OWNER OF THE PROPERTY. AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. TOM, BUSINESS AND PROFESSIONS CODE THE CONTRACTORS U. CENSE LAW DOES NOTAPPLY TORN OVMER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON. AND WHO CONTRACTS FOR SUCH PROJECTS WITHACONTRACTOR(S) LICENSED PVRSUANTTOTHE CONTRAC- TORS LICENSE LAW.} 01 AM EXEMPT UNDER SEC. B. a P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION IHEREBYAFFiRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER (COMMENCING WITH SECTION 7000) OF DIVISION S OF THE BUSINESS AND PROFESSIONS CODE. AND MY LICENSE S N FULL FORCE AND EFFECT. LICENSE 1,p�/SS LIC. NO. DATE ✓ CONTRACTOR YY11I�1= WORKERS' COMPENSATION DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MANTAN A CERTIFICATE OF CONSENT TO SELFNNSURE FOR WORKERS' OOMPENSATON, AS PROVIDED BY SECTION 37000F THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT S ISSUED. _I HAVE AND W.U.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 ERS COMPIN/S1ATKK�/ W,SUF(�ANCE/C�JRVI�ER AND POLICYNUMBERARE: CARFUERC(�t \..T•1�^^/ \./T'S POLICYNLIMBER I O�Gi'nLJ (Ri5 SECTION WED NOT BECLhRETED OF THE PERMIT 6 FOR ONE HUNDRED DOLLARS 41001 OR LESSL 1 CERTIFY THAT LATHE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON N ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA. AND AGREE THAT IF I SHOULD BE SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3T00 OF THC•1SieOR COOS I SHALL FORTHWITH COMPLY WITH THOSEP ONSKN DATE: ftj_APPLICANT: WARNING: f TO SECURE WORKERS` COMPENSATION COVERAGE IS UNLAWFUL AND SHALL BE SUBJECT AN EMPLOYERTO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (3100.0M), N ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 370E OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDPO AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3007, CIV. C.). LENDER'S NAME LENDERSADORESS I CERTIFY THAT IHAVE READ THIS APPLICATION AND 3TAT TWITTME ABOVE INFORMATION SCORRECT. I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDIN CES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, AND HEREBYAUTHORIZE REPRESENTA VES OF INS COUNTY TO ENTER UPON THE ABOVE -MENTIONED PROPERTY FOR INSPECTION PURPO S. PER I FE E (PRO ) Si P RMNTEE DATE PRESS FIRMLY APPLICATION I I 3 PERMIT �7 �f Pic—_, ' DATE NUMBER / * •�� ISSUE 11 I l TYPE OCC DATE 1 V V CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE E 1 NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREANALUATION SFR/ADD/REM 07 Garage/Carport WPatio/Dock U- PooVSpa ZRe -Root Commercial m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U F- U W J w l7 2 CO J _U a 2 U W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES CQ�T COMMENTS RECPT. NO. PAID BY VALIDATION WHITE —Department Copy, YELLO nance Copy. PINK —Assessor Copy, GOLDENROD --File Copy. GREEN —Applicant's Copy CITY OF DIAMOND BAR, 7114SPECTION'RECORD lam FLOOR JOISTr SET BACK FTGS/FORMS/STEEL FHA REWTS 'ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR CONDUIT 'SLAB GRADE FIREPLACE FOUNDATION TEMP POWER FIREPLACE -BOND BEAM'. - ,WATER SERVICE MID HT. BOND BEAM I ROOF SHEATHING 8 FF. BOND BEAM lFRAMINGNENTILIATION FINAL -BOND BEAM 'ROOF COVER PRE -GRADING :ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING -ROUGH PLUMBING FINISH GRADING SHOWERrrUB TEST POOL ELECTRIC EXT.-L-ATH!SIDING POOL FENCING 'WALL INSULATION - POOL FINAL CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS !SEWER FINALIENG. 'SEPTIC TANK LANDSCAPE/IRRIG. ,SEEP PIT/L.L. ON SITE IMPS. .GAS AIR TEST FINAUZONING FINAL CONST. FIRE DEPT. FINAL .FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY. COMMENTS L !SEPTIC TANK SIZE ;SEEP PITIU SIZE h V