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Home My WebLink About19085 (264)CITY OF DIAMOND BAR DEPART N1ENT OF COMMUNITY & DEVELOPMENT SERVICES 21925 E. Copley Drive (909) 960-3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION JOBSITE ADDRESS ! ��`� S•VQ lQ U F APN�r LOB TRACT ' OWNER rF ADDRESS - CITY] ' roDjRc,r. ZI TEL n %r APPLICANT TEL. CONTRACTOR ADDRESS CITY ZIP TEL ARCKENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS U. CENSE LAW FOR THE FOLLOWING REASON (SEC 7031.E BUSINESS AND PROFESSIONS CODE: ANYCTTYOR COUNTY WHICH REQUIRES APERMrTTO CONSTRUCT,ALTETL IMPROVE, DEMOLISH. OR RE PAIR ANY STRLIO• TURF_ PRIOR TO ITS ISSUANCE, ALSO REWIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LH CENSE LAW (CHAPTER a (COMMENCING WITH SECTION 7000) OF DIVISION 3 Of THE BUSINESS AND PRO• FESSONS CODE) OR THAT HE OR SHE LS EXEMPT THEREFROM AND THE BASIS FORTHE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7031.E BY ANY APPLICANT FORAPERMIT SUBJECTS THE APPLICANT TO ACIVILPENALTY OF NOTMORE THAN FIVE HUNDRED DOLLARS (1500)* O L AS OWNER OFTHE PROPERTY, OR MY EMPLOYEES WITH WAGESAS THEIR SOLE COMPENSATION, WILL DO THE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, SU56 NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTYYa1D BUILDS OR IM PROVES THEREOK AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE IF. HOWEYEILTHE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE- TION, THE OWNERNRUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SHALL ❑ L AS OWNER OF 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 BUILDS OR IMPROVES THEREON. AND WNOCONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S) LICENSED PURSUANTTO THE CONTRAG TORS LICENSE LAW.). O I AM EXEMPT UNDER SEC, • O. a P.C. FOR THIS REASON DATE Oa OWNER MOr LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION PF THE BUSINESS AND PROFESSIONS CODE AND MY LICENSE IS IN FULL FORCE AND EFF LICENSE CUSS LI47. DATE C WORKERS' COMPENSATION DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION 3700 OF THE LABOR CODE FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WLL MAINTAIN WORKERS COMPENSATION INSURANCE AS REQUIRED BY BECTON 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: I CARRIER POLICY NUMBER (naS SECTON NEED NOT BE ¢7dlETEDOFTFE PEFW IS WRCNE H)CFCDDCUAF:S (SIOD)OFtUZS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT tS ISSUED. I 1 SHALL NOT EMPLOY ANY PERSON N ANY MANNER 30 AS TO BECOME SUBJECT TO THE j WORKERS' COMPENSATION LAWS OF CALIFORNIA. AND AGREE THAT ff I SHOULD BECOME SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE I SHALL FOTTMMTH COMPLY WITH THOSE PROVISIONS. I I DATE APPLICANT: iBE WARNING: N EMPLOYER YE SECURE WORKERS COMPENSATION COVERAGE IS ONE HUNDRED L. AND SHALL D SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (S100.00o), IN ADDITION TO THE COSTOF COMPENSATION, DAMAGES AS PROVIDED FOR IN i SECTION 37060F THE LABOR CODE INTEREST. AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY i FOR THE AFFIRMUNDER PENALTY OFK FOR PERJURY THAT THERE ISACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC, 3097, (N. G). 3 LENDERS NAME LENDERS ADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATETHAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL CRY AND COUNTY ORDINANCES AND STATE LAWS REWIND TO BUILDING CONSTRUCTION. AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE -MENTIONED PROPERTY/ FOR' INSPECTION PURPOSES. D (y�4 "A Q Q, r) SIGNA E f PERMITTEE DATE C rl PRESS FIRMLY APPLICATION ( I 6L PERMIT 1 S P/C DATE 1 NUMBER #� 1 D TEE 1 1 , CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDESTREET RW ❑ SIDE O PROPOSED USE NO. DWEL NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREANALUATION SFR/ADD/REM Cj) Garage/Carport U PatwDe& LL- P001/spa ZRe -Roof Commercial O Valuation k A ADJ.AREA OUANTITY DESCRIPTION FEE _U I J w C3 Z on J o_ U Z W ' CONSTRUCTION PLAN REVIEW - ELECTRIC PLUMBING MECHANICAL INSPECTION FEE 7n� ISSUANCE •�� SMIP '/ ENERGY P/C ENERGY PERMIT RETENTION FEE: u J PRE-ALT FEE: TOTAL FEES COMMENTS ' / RECPT. NO. PAID BY VALIDATION WHITE —Department Copy, YELLOW —Finance Copy, PINK—AS"6601' UOPy, LiULutNHULP- 10 LAW. uMM= —PQP�l 5 w" CITY OF DIAMOND BAR INSPECTION RECORD SETBACK I FLOOR JOIST 1 FTGS/FORMS/STEEL FHA REOMTS 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 ROOF SHEATHING 8 FT. BOND BEAM FRAMINGNENTILIATION FINAL BOND BEAM ROOF COVER 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 fl`DEDICATIONS SEWER FINAL ENG. SEPTIC TANK ; ,, LANDSCAPEIIRRIG. SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST. �2- .U' �� , FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY COMMENTS SEPTIC TANK SIZE SEEP PIT/U SIZE