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Home My WebLink About15152F— C C% 2 LL u CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 ' BUQ.DING PERMIT APPLICATION JOBStTE ADDRESS APN LOT TFIACT OWNER e.-A a v C 3C,Ke Al ADDRESS If CITY ZIP TEL APPLICANT TEL. CONTRACT R w ADDRES u CITY ZIPq�C TEL ARC NG/ PI _ DESIGNER ADDRESS F3�Ac %Zrr ,.13L O CITY ,I N'�h � ZIPW TEL OWNER -BUILDER DECLARATION I HEREBY AFFIRM LNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LF CENSE LAW FOR THE FOLLOWING REASON (SEC.7031.5 BUSINESS AND PROFESSIONS CODE: ANY CTYOR COUNTY WHICH REOUIRE3APERMTT70 CONSTRUCT,ALTER IMPROVE, DEMOLISH. ORREPAIRANY 3TRUG TURL PRIOR TO ITS ISSUANCE. ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE S LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LF CENSE LAW (CHAPTER I (COMMENCING WITH SECTION 7000)OF DIVISION S OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OR SHE ISIOHEXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- T. ANY VKXATION OF SECTION 7031.6 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (S50D)J: OL AS OWNEROFTHE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WOFK AND THE STRUCTURE S NOT INTENDED OR OFFERED FOR BALE (SEC. 70U. BUSI- NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPRDVESTHEREON. ADD WHO DOES SUCH WON( HIMSELFOR HERSELF OR THRO K64 MS OA HER OWN EMPLOYEES, PROVIDED THAT SUCH MPROVEMENTS ARE NOT INTENDED OR ER OFFED FOR SALE IF. HOVEVER.THE BUILDING OR IMPROVEMENT S SOLD WRHIN ONE YEAR OF COMPLE- TION, THE OWNER-0URDER WILL KAYE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE1 O L ASOMNER OF THE PROPERTY. AM EXCLUSIVELY CONTRACTING WITH LICENSED CONrFLACTOR3 TO CONSTRUCT THE PROJECT (SEC. 70". BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LF CENSE LAW DOES NOTAPPLY TO AN OWNER OF A PROPERTY WHO BULBS OR IMPROVES THEREON, AND WHO CONTMCTSFOR SUCH PROJECTS WITH ACONTMCTOR(5) LICENSED PURSUANT TOTHE COMRAG TORS LICENSE LAW.). O I AM EXEMPT UNDER SEC. B. A P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER I (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND ICY LICENSE S N FULL FORCE AND EFFECT. LICENSE CLASS G A2 ,LIC. NO. 4oC F / DATE 12-3)-7-606 CONTRACTOR 'i c c WORKERS' COMPENSATION DECLARATI C� I HEREBY AFFIRM UNDER PENALTY OF PERRIRY ONE OF THE FOLLOWING / (^/X1`n(/ WILL -I HAVE AND LL (MAINTAIN A CERTIFICATE OF CONSENT TO S FMNSU WURK�RS' ✓ COMPONSATION.AS PROVIDED BY SECTION 37000FTHE R CODE. FOR THE PERFORMANC OF THE WORK FORWNeCH THIS PERMIT S ISSUED. I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSLI . REWIRED 3700 OF THE LABOR COOL FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' COMPENSATION INSURANCE TIER AND POLICY NUMBER ARE CARRIER POLICY NUMBER VASE M NNEEDNOr BECOLLETEDCFTKPV*ATEFCRONEHUDCMIF.D I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHIpG THIS PERMI S'SUE SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SOAS TO BE SUBJE OTHE WORKERYCOMPENSATIO" LAWS OF CALIFORNIAANDAGREE THAT IF SHOULD COME 6UBJECTTOTHEWORKERS'COMPENSATI=,. 50�37000F�E R COOL I SNAIL FORMWRH COMPLY W11H TNO 15 1 .. DATE: APPLICANT: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE S UNLAWFU. AND SHALL SE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVILFINES UP TOONE HUNDRED THOUSAND DOLLARS (6100.000). IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION3708 OF THE LABOR CODE. INTEREST AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE S A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED (SEC. 3W7, CIV. C.I. LENDERS NAME LENDER'SADORESS I 1 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THATTHE 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-MENT)ONED PROPERTY FOR INSPECTION EURPOSES. r R h / R PERA,TTEE ( WIlT) SIG PE EE DATE PRESS FIRMLY APPLICATION PERMIT P/C P/C DATE NUMBER ✓ R ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR 0— SIDE/SIDE STREET L-1 RW ❑ SIDE ❑ PROPOSED USE NO. DWEL NO. NO. UNITS STORIES - BEDROOMS DESCRIPTION SO- FT. ! FACTOR'PSF ADJ. AREA/VALUATION SFRIADDIREM C0 Garage/Carport W Patio/Dock LL POOVSpa 0 Z Re -Root 0 Commercial m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE lout-,1 IiAe F U w J w F,7 Z Do S U CONSTRUCTION PLAN REVI EIF RIC LU BI�I H I IN PECTION F E SMIP t7- vi T � ENERGY P/C r ENERGY PERMIT RETENTION FEE: 1 �) PRE-ALT FEE: C-- - - .a -^ ^ J_ L--Jll V s..J IJ 1V `F lfS�L J/ Mom. TOTAL FEES ri COMMENTS RECPT. NO. PAID BY VALIDATION WHITE —Department Copy, YELLOW —Finance Copy. PINK —Assessor Copy, GOLDENROD— Ile COW GREEN—Applicanl'a Copy V CITY OF DIAMOND,BAll INSPECTION (RECORD @�x'F!wif SET BACK �'FLOOR JCIST(j., IFTC-SIFORMS/STEELFHA REQMT5.___*,"l_-___ JELECTRIC GROUND__ C UNDER FLOORDUCT- lGR_5UND PLUMBING UNDER FLOOR C6NNblt"' SLAB GRADE-- FIREPLACE FOUNDATION TEMPPOWER77 - - FIREPLACE BOND BEAM' WATER SERVICE - POOF SHEATHING 1.8 FT. BOND -BEAM . -7 Q FRAMINGIVENTILIATION FINAL iJbrb BEAM, [ 5�obFCbVF__rf PRE -GRADING - i 1 ROUGH HEATING f3OUGH'ELECTRI( 6 KV 5i\ R0UGWdAADItiG ROUGH 1.ROUGH PLUMBING --: 1_:2 GRADING SHOWER/TUB TEST POOL ELECTRIC I EXT. LATH!---IDING POOL FENCING' WALL -INSULATION - POOL FINAL - CEILING -INSULATION OFF SITE IMPS. DRYWALUNAiLING DEDICATIONS 'SEWER FINAL ENG_ SEPTIC TANK i, LANDSCAPE/IR91G. SEEP-PIT/L.L.-.-. ON SITE !MPS. G-ASAIR TEST FINAL ZONING FINAL,CONST._; FIRE DEPT. FINAL-_ FINALHEATING HEALTH DEPT. FINAL DEV. FEES PAID FINA! ELECTRIC— Fi-NAL PLUMBING /o ENERGY t T, '%Z'0 M V1 N T S E SEPTIC TANK SIZE SEEP PITIU SIZE 7_ _7 7� v�y