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Home My WebLink About17912J� CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21825 E. Copley Drive (909) 860-3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION JOBSITE ADDRESSIL �) APN LOT TRACT OWNER 6 yr ADDRE S)1 _ CITY TEL -0 t APPLICANT IP 1 TEL. r n CONTRACTOR fo c ADDRESS CITY 44,ZL» j4e,v ZI TEL ! � ARCHI/ENG/ u� DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 NM EXEMPT FROM THE CONTRACTORS LL CENSE LAW FOR THE FOLLOWING REASON (SEC. 7001.5 BUSINESS AND PROFESSIONS OCDE: ANY CITY OR COUNTY WHICH REQUIRES A PERMITTO CONSTRUCT. ALTER IMPROVE, DEMOLISH. OR RE-- PRIOR TO ITS ISSUANCE, ALSO REOUIRES 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 PRO- FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE eASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7001.5 BY ANY APPLICANT FORA PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (SS00).): O 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, 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 FORSALE IF, HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OFOOMPLE- 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. 70". BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LJ- CENSE LAW DOES NOT APPLY TO AN OWNER OF APROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITHACONTRACTOR(S) LICENSED PURSUANT 70 THE CONTRAC- TORS LICENSE LAW.]. O JAM 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 • (COMMENCING WITH SECTION 7000) OF DIVISION 0 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT. LICENSE CLA S _ LIC. NO. 15 i DATE CONTRACTOR f_ WORKERS'C OMPENSATION DECLARATIO N J7 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELFINSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION 0700 OF THE LABOR CODE, FOR THE PERFORMANCE THE WORK FOR WHICH THIS PERMIT IS ISSUED. 1 HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY SECTION 070001 THE LABOR CODE. FOR THE PERFORMAN EOFTHE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WON(t�q�S.'C{Q.MPENSATIONI NSUR E CARRIER AND POLICY NUMBER ARE: CARRIER — A `r /'� 1—'L/ /) C POLICY NUMBER (THIS SECTION NEEDNOTBE OOMPLErEDOFTLE PERMIT IS FOR ONE HUNDRED DOLLARS(S'0O)ORLESS) 1 CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUEO,1 SHALL NOT EMPLOY ANY PERSON N ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA. AND AGREE 7HATF15 DBEOOME SUBJEC TO THF=TH=LY ERS'COMPENSATION PROVISIONS OF SECT R 1 HALLWITH THOS RO •DATE: AP WARNING:FAILURETOSECUREWORKERS'COIPENSATION COVERAGE ISUNUWFUI. ALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDR SAND DOLLARS(5100.000). NADDITION TO THE COST OF COMPENSATION, DAMAGES AS PR FOR IN SECTION 0700 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS ACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 7097, CIV. C.). LENDER'S NAME LENDERS ADDRESS 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 RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE -MENTIONED 0 ERTY FOR INSPECTION P POSE . A PERMITTEE NAME (PRINT _ #!?,NATIJRr,OF►E ITTE DATE OFSS FIRMLY APPLICATION PERMIT f P/C Z DATE !� ?a l� �- NUMBER t ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR p SIDEISIDESTREET RW ❑ SIDE ❑ PROPOSED USE r NO. DWEL. NO. u NO. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREAIVALUATION SFR/ADD/REM Cn Garage/Carport WPatic/Deck LL Pool/Spa ZRe -Roof Commercial co Valuation Ar i2v. 11 ADJ.AREA QUANTITY DESCRIPTION FEE J Q U cc F- U ltl LU W C7 Z m J IL 6 U z a W ya CONSTRUCTION �Op PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE _ ISSUANCE PDO SMIP t c A ENERGY P/C ENERGY PERMIT -L. �'- RETENTION FEE: A PRE•ALT FEE: TOTAL FEES, COMMENTS 1 ' �' RECPT. NO. PAID BY VALIDATION WHITE—Depaftfnent Copy. YELLOW —Finance Copy. PINK —Assessor Copy, GOLDENROD —File Copy, GREEN —Applicant's Copy CITY OF DIAPfOND BAR II4SPECT[OFl RECORD 1►�k-��'�.�,.r.C�;l►�I �1�'��':�,. I�I•'� a�f. t'fa�t SET BACK [►`.E-'�:�-•�:~r.Cci►�6 i�y,`�;�� II►`f-��3��rr��, T FLOOR JOIST , FTGS/FORMS/STEEL ! FHA REOMTS ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING I UNDER FLOOR CONDUIT SLAB GRADE FIREPLACE FOUNDATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICE MID HT. BOND BEAM ROOF SHEATHING _ ��' �f�Zj- I _ Q�� 8 FT. BOND BEAM FRAMINGNENTILIATION ROOF COVER I FINAL BOND BEAM PRE -GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWER/TUB TEST POOL ELECTRIC EXT. LATH/SIDING 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 FINAL ZONING FINAL CONST, FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY COMMENTS SEPTIC TANK SIZE SEEP PIT/U SIZE 1� C i