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Home My WebLink About18091CITY OF DIAMOND BAR ' DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21825 E. Copley Drive (909) 860-3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION JOBSITE ADDRESS_�gHM-LaIA DIZ APN LOT TRACT OWNER ADDRESS •=E-A2#3 }" o L_L_n iZ) biz CITY DI�?•�1[]wl'b �b ZIP�� TEL. APPLICANT TEL. CONTRACTOR - R�211 E �1�1 ADDRESS !;V75� a 4P_12 1 MR CITY 41-= 1►jnlJCTp2_1[ ZIP441QIM TEL.gpQ��q ARCFUENG! , ` DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LL CENSE LAW FOR THE FOLLOW74G REASON (SEC. 7031.6 BUSINESS AND PROFESSIONS CODE:ANYCITYOR COUNTY WHICH REOUIRESAPERMITTO CONSTRUCT, ALTER IMPROVE, DEMOLISH, OR REPAIRANY STRUC- 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 U- CENSE LAW (CHAPTER a (COMMENCING WITH SECTON 7000) OF D VISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7071.E BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO ACML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS ❑ 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. 70U, 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 FOR SALE IF, HOWEVER THE BUILD W G OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE- TION, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). E3 L AS OWNER OF THE PROPERTY. AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 704, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI. CENSE LAW DOES NOTAPPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON. AND WHO CONTRACTS FOR SUCH PROJECTS WITHA CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW ). 01 AM EXEMPT UNDER SEC.. B. IS P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM LICENSED UNDER PROVISIONS OF CHAPTER I (COMMENCING WITH SECTION 7000) OF DIVISION S OF THE BUSINESS AND PROFESSIONS CODE, AND FULL MY LICENSE IS IN FORCE AND EFFECT. A LICENSE CLASS Gla LIC. NO. DATE CONTRACTOR 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 370D OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REOUIRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED. MY WORKERS COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER POLICY NUMBER�C'TL7.Gl_ UMSECTK)NNEEDNDTBEOd UIMOFTHEPERMTMFORCNEWCREDDOUAAS(SIOD)ORLESS) I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SOAS TO BECOME SUBJECT TO THE j WORKERT COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF I SHOULD BECOME 6�� TH WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OFT HE LABOR L RTHWITH COMPLY WITH T PROVISIONS. DATEAPPLICANT: WARO SECURE WORKERS' COMPENSATION COVERAGE ISUNLAWFUL,StJB.IYER TO CRIMINAL PENALTES ANO CMLFINES UP TOONE HUNDRED THOUSAND DOLLIN ADDITION T07HE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN i SECTION 3708 OF THE LABOR CODE. INTEREST, AND ATTORNEYS FEES. R CONSTRUCTION LENDING AGENCY i 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDWG AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED (SEC. 3097. CIV. C.). 1 - LENDER'S NAME LENDERS ADDRESS I CERTIFY THAT I HAVE READ THIS APPUCATKON AND STATE THATTHE ABOVE INFORMATION IS CORRECT. I AGREE To COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING sCONSTR TION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVEM TKONED PROPERTY FOR INSPECTION PURPOSES. .4 NAME(PflINT) 2ME�E E OF PERMITTEE DATE C PRESS FIRMLY APPLICATION PERMIT P/C DATE 2 d2 NUMBER bg r N ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW 0 REAR ❑ SIDEISIDE STREET RW ❑ SIDE ❑ PROPOSED USE f ` NO. DWEL NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREANALUATION SFR/ADD/REM Cl) Garage/Carport WPatio/Deck LL Pool/Spa ZRe -Roof Commercial m Valuation 0D0 ADJ.AREA OUANTITY DESCRIPTION FEE J U F- U W J w 0 Z m J a J a U 2 a U W �• �� CONSTRUCTION / PLAN REVIEW ELECTRIC PLUMBING--.'�-----•____ MECHANICAL INSPECTION FEE AAA ISSUANCE V Jr SMIP • ENERGY P/C _-T -- ENERGY PERMIT RETENTION FEE: �• �' PRE-ALT FEE: TOTAL FEES COMMENTS RECPT.. NO. PAID BY VALIDATION WHITE—Dep , YELLOW —Finance Copy, PINK—ASsessor copy, LiULUtNHUL�nIe L Upy, um—N—rppi—rR 5 a py CITY OF DIANIOND BAR INSPECT 1011 RUCOR D j SET BACK FLOOR JOIST FTGS/FORMS!STEEL I FHA REQMTS ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING SLAB GRADE FIREPLACE FOUNDATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICE ROOF SHEATHIN MID HT. BOND BEAM 8 Fr. BOND,BEAM FRAMINGNENTILIATION ROOF COVER ROUGH HEATING FINAL BOND BEAM PRE -GRADING 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