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Home My WebLink About16443EXPIRED CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES JUN 1 g ZOO2 e 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 PRESS BUILDING PERMIT APPLICATION FIRMLY ADDRESS S7Z /(l DI11 M ONO 13� 2 LGJD APN — LOT TRACT OWNER SG J ADDRESS -T7 N r. G10+ C6injr_ ZIP V17L5- TEL. 9XI--044 APPLICANT TEL. CONTRACTOR ADORE S JSi 9 �a $� S P Cff17 fj?tj WI = ZIP '11 2t i TE ` 0'1J ARCFVENG/ DESIGNER ADDRESS CITY ZIP TEL OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS U. CENSE LAW FOR THE FOLLOWING REASON (SEC.7031.5 BUSINESS AND PROFESSIONS CODE:ANY CITY OR COUNTY WHICH REOUIRES A PEAARTTO CONSTRUCT,ALTER. IMPROVE, DEMOUSK OR REPAIR ANYSTRUC- TURE. PRIOR TO ITS ISSUANCE. ALSO REWIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE 6 LICENSED PURSUANT ID THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW (CHAPTER I (COMMENCING WITH SECTION IWO) OF DIVISION S 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 7031.5 BY ANY APPLICANT FORA PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (3500).X O L AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WADES AS THEIR SOLE ODMPENSATION. WILL DO THE WORK AND THE STRUCTURE 6 NOT INTENDED OR OFFERED FOR SALE (SEC. 70N, BUSI- NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY VOID BUILDS OR IMPROVES THEREON. AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OVNN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT MENDED OR OFFERED FORSN.E IF.HOWEVER THE BUILDINGOR IMPROVEMENT 6 SOLD WITHIN ONEYEAR OFODMPLE- TION. THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE E} PURPOSE OF BAL ❑ L AS OWNER OF THE PROPERTY, AM EXCLI6NNT ELY CORACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044. BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS U- CENBE LAW DOES NOTAPPLY TO AN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHOCONTRACTS FOR SUCH PROJECTS WITH AC IFTRACTOR(S)LIOENSE'DPURSUANTTOTHECONTRAC- TORS LICENSE LAW.), O 1 AM EXEMPT UNDER SEC. S. a P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PCRJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 5 lCOMMENCNG WITH SECTION 70(0) OF ONISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE 6 IN FLU /FORCE AND EFFECT. LICENSE CLASS �•, LIC. 110. 7q/y -7 S DATE - - - Z CEO ( CONTrucron C-SA r E l i; 7/* C WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWNG DECLARATIONS: _ I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELFaNSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION 37W 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 RE WIRED BY SECTION 3700 OF THE LABOR COOS. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMT IS ISSUED. MY WCNLERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER POLICY NUMBER I'M SECTION NEED NOT BE COMPLETED OF THE PERMIT IS FOR ONE HNIXED DOLLARS MOO) ORLESSL I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 6 ISSUED. I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE i WORKERS' COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE.I SHALL FOnTWNITH COMPLY WITH THOSE PROVISIONS. I L DATE: APPLICANT: i L WARNING: FAILURE TO SECURE WORKERS' CDM P ENSATION COVE RAGE IS UNUWFUI., AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL PINES UP TO ONE HUNDRED THOUSAND DOLLARS (III OO.WO). IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN i SECTION 31050F THE LABOR CODE. INTEREST. AND ATTORNEYS FEES. N CONSTRUCTION LENDING AGENCY i 1 OR THE AFFIRM UNDER PENALTY OF PERJURY THAT THERE 6 A CONSTRUCTION LENDING AGENCY FIXiTHE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 9007, CIV C.). LENDER'S NAME LENDERS ADDRESS 3 I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. 1 AGREE TO COMPLY NTH ALL CRY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING 3 CONSTRUCTION. AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE AP.OVET.IENTIONED PROPERTY FOR INSPECTION PURPOSES. i CPER 47AME(PRIINT) O W rD UR FPERML I OATE WHITE—DeparlmentCopy. YELLOW —Finance COPY, PINK —Assessor Copy. GOLDENROD --File Copy. GREEN—Applicant'5CGPy APPLICATION }, PERMIT P/C DATE v NUMBER 1�{� A ISSUE Al TYPE OCC DATE (J CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ Lj SIDE ❑ PROPOSED USE NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION SFR/ADD/REM Cal . Garaae/Carport WPBtiolDeck LL POOVSPa :j Z Re -Root 0 Commercial E5 m Valuation ADJ.AREA QUANTITY DESCRIPTION G/ FEE a zoo ry U¢_ F U LU C7 Z E J a J a U Z a x W ZE CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE ` SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: g-• TOTAL FEES COMMENTS RECPT. NO. PAID BY VALIDATION CITY OF DIAMOND,.BAR , . INSPECTIOIV'RECORD — - ;SETBACK � �. FLOORJ01 T �� FTGSIFORMS/STEEL �- FHA RECMTS 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 iROOF SHEATHING 8 FT. BOND BEAM FRAMINGIVENTILIATION - FINAL BOND BEAM ,ROOF COVER .c PRE -GRADING - 'ROUGH HEATING BENCHING TROUGH ELECTRIC_ ROUGH GRADING ROUGH PLUMBING -- --- FINISH GRADING iSHO'NERITUB 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_PITIL.L _ ON SITE IMPS. ;GAS AIR_TEST ` FINAL ZONING 'FIN.I,L-CONST. FIRE DEPT. FINAL FINAL.HEATING __ _ _' HEALTH DEPT. FINAL - iFINAL ELECTRIC -- -- DEV. FEES PAID -- - , PLUMBING - — — - - - - ENERGY i ' L UAMENTS I . 'SEPTIC TANK SIZE- i ,SEEP PITIU SIZE I