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Home My WebLink About15149 - 21865 E COPLEY DR\ CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 ^� BUILDING PERMIT APPLICATION 1 , JOBSITE ADDRESS ADDRESS APN LOT TRAC OWNER Sr Cn•'�5f' c,cA t ADDRESS CITY ZIP Q)2L--5EL.9 3�14�1ZSr� APPLICANT TEL. CONTRACTOR nN ADDRESS CITY ZIP TEL Z ARCWENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION 1 HEREBYAFFWW UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.6 BUSINESS AND PROFESSIONS WOE: ANY CITY OR COUNTY WIaCH/ REQUIRES A PERMIT TO WNSTRUCT,ALTER IMPROVE.DEMOUSK OR REPAIRANY STRUC- TURE. PRIOR TO R9 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 LF CENSE LAW (CHAPTER P (COMMENCING WITH SECTION 7000) OF DIVISION S OF THE BUSINESS AND PAO- FESSIONS ODDE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FORTHE ALLEGED EXEMP- TON. ANY VIOLATION OF SECTION 7071.E BY ANYAPPUCANT FORA PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS IK00).1: O LAS OVANER 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. 7D44. BUST. NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY VMO BUILDS OR IMPROVES THEREON. AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH NS OR HER OVM EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFEREDFOR SALE IF, HOWEVER THE eIJEDNG OR PAPAOVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE- TICK THE OWNER-WLDER 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 WTTH 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 BURRS OR BA PROVES THEREON. AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAG TORS LICENSE LAW.). O 1 AM EXEMPT UNDER SEC. B. 6 P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBYAFFLAM UNDER PENALTY OF PERJURY THAT 1 AM LICENSED UNDER PROVISIONS OF CHAPTER P (COMMENCING WITH SECTION 7000) OF D:VISKJN 7 OF THE BUSINESS AND PROFESSIONS CW E, AND MY LICENSE IS IN FULL FORCE AND EFFECT. � LICENSE CLASS 8 [ LIC. NO. C 7—`•O L ZZi DATE GPI 1Z d>e3 CONTRACTOR F WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS. I HAVE AND WILL MAINTAIN A CERTIRCATE OF CONSENTTO SELF4NSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SEC71ON 7700 OF THE LABOR CODE, FOR THE PERFORMANCE CIFTHE WORK FOR WHICH THIS PERMIT IS ISSUED. �I HAYE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE. AS RECNRED BY SECTION 57000E THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS WUED. MY WORKERS'COMPENSATION AND N INSURANCE CARRIER APOLICY NUMBER ARE: CARRJER�CE POLICY NUMBERQQT+d�� (,ri (HIS SEC IoN NEED NOT BE CONFI ETEDOr THE PERMIT Is FOR ONE HUNDRED DOLLARS I61001 OR LCM I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, 1 SHALL NOT EMPLOY ANY PERSON N ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS'CXXAPENSATK1f1LA AND AGREE THAT F 15HCUL0 BECOME SUBJECT TO THE WORKERS' ENSMXJNP ISKkJS OFSEOF THE LABOR COO ,ISH FORTHWTH COMPLY TH PROVISIONS. APR 7 I GATE- Z �i OANT: CT I WARNING FAILURE TO SECUREWORKERS'COM .NSATION COVERAGEIS UL.AN HALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIE Z50AL FIVES UPTOONEHUNDREDT SAND DOLLARS (SI00.OW), IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN t SECTION37DS OF THE LABOR CODE. INTEREST. AND ATTORNEYS FEES. I CONSTRUCTION LENDING AGENCY i FOR THE ERFO UNDER PENALTY OFPENURYTHAT THERE ISACONSTRUCTION LENO7O AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 7007, pV. C.). I LENDER'S NAME IENDERSADORESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. 1 AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING SCONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE.MENTIONED PROPERTY FOR INSPECTION PURPOSES. t t PERwIrrEE N E (PRINT) O_ SIG RE OF PERMITTEE ErE (y) PRESS FIRMLY APPLICATION �/,� PERMIT P/C DATE NUMBER N ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREANALUATION SFR/ADD/REM In Gara9a/Carport WPatio/Deck V- PooUSpa ZRe -Root OJ Commercial m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE a '��C�i / D !ti cr v 5 L W J W U Z (D J IL U A 140 2 / 2 U W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C — 1 ENERGY PERMIT l)1'1J!fLi tVL'rLiL+.•� REfENTIONFEE13L PRE•ALT FEE: TOTAL FEES - COMMENTS RECPT. NO. PAID BY VALIDATION WHITE —Department CM1. YELLOW —Franca Copy. PINK—ASSOSSor GM. UULULNHQLF—rNe t,opy, U11ttN—wpglCanTS UOpy CITY OF DIAKriOND.BAR IIvqSPECTION RECORD �"- I�+!:+:��.�: I'leI'`! �. !�l'�til`= 41-7��.��,��'�'1'$. — ,•I��'1;-i:,�:� �,��lr"_'�" �s �_�++.._._ _.,_ N ISET6AG!'.+_._....,_....._..._j._.._.___..__.I---•------.-.. FLOOR JOIST �._._...___ I ��...,_.___..........._._......_....._._,...._-.. ,.. FTGS!1-OR,"1S' STEEL I -- 1 FHA REQ`,1TS —� ELECTRIC GROUND UNDER FLOOR DUCT. _ - G9OU,ND PLU!•."B!!JG I I UNDER FLOOR CONDUIT— SLARGRADE I I I FIREPLACE.F.OUNDATION-- ,I T TEMP POWER i i FIREPLACE BOND BEAM WATER SERVICE ' l PJ1!D HT. BOND BEAM ;ROOF ONEATHING _ I _ f 8 FT. FOND ,�" FnA-!'tJGIVEtJTILIATION �— FINAL B ND BEAM f; )OF COVER _R;.UGH N_EATINa_ L I i_1BENCHING I PRE -GRADING ROUGH GRADING _ PO UGH ELECTRIC ) fa I —`�� ROUGI-1 PLU!...BIND --- . ! I FINISH GRADING '; 'P"vER,TUBTEST PO_CL ELECTRIC Er:T. LATHSIDING ( POOL FENCINu MALL INSULATION �'''' I POOL FINAL ---1 —T ( CEILING INSULATION ( — OFF SITE Ih."PS. 1.DRWv'ALLNAILING I _ r I ( DEDICATIONS -- i -- I;sc E-v ER I FINAL ENG. ;SEPTIC TANK —r � LANDSCAPE/IRR!G. ( --_v SEEP PIT/L.L. - ON SITE IMPS. �— - I:C AS AIR TEST -- FINAL ZONING CONST. NAL HEAT ING ( IG _ j • �' 01 FIRE DEFT. FINAL HEALTH DEPT. FINAL —' -i.' ",L. ' - DEV. FEES PAID, J Ei!EP,GY ----- -�- - -- SEPTIC TANK SIZE =�=P PITM SIZE --- ----- - -- — i. -