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Home My WebLink About18052U i iz r C] W 0 CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21M E. Copley Drive (909) 860-3195 Fax (909) 861-3117 "- BUILDING PERMIT APPLICATION JOBSITE ADDRESS1-3� ��-✓L�Y�i..1 APN—�� _ LPT TRACT OWNER ►'IfWIG I I flLllvli kei'f i—'— ADDRESS -L �-jCITY (o TELAPPLICANT TEL. CONTRACTOR ADDRESS CITY ZIP TEL ARCH/ENG! Vj DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS L4 CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.9 BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REQUIRES PERMIT TO CONSTRUCT, ALTER, IMPROVE, DEMOLISH. OR REPAIRANY STRU6 TURF. PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LF CENSE LAW (CHAPTER9 (COMMENCING WITH SECTION 7000) 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 VIOLATKNN OF SECTION 7031.6 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A P NALTY OF NOT MORE THAN FNE MINDRED DOLLARS (f 5001.t S OVMEROFTHE PRODER7Y.ORMYEMPIOYEES WITH WAGES AS THEW SOLE COMPENSATION. WILL E WORK AND THE STRUCTURE LS 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 WTrHINCNE YEAR OFCOMPLE- TION. 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. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE LAW DOES NOTAPPLYTO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON. AND WHO CONTRACTS FOR SUCH PROJECTS WITHACONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). D IAA EXEMPT UNDER SEC. B. S P.C. FOR THIS REASON DATE -1-0 -C 1— OWNER LICENsEDCONTR CT RS DECLARATION 1 HEREBYAFFIRM UNDER PENALTY OF PERJURY THAT LAM LICENSED UNDER PROVISIONS OF CHAPTER MYE IN FULL (COMMENCING SECTIONORCE 7D O) OF DIVISION S OF THE BUSINESS AND PROFESSIONS CODE, AND T. LICENSE CUSS LIC. NO. DATE CONTRACTOR WORKERS' COMPENSATION DECLARATION 1 HEREBYAFFIRM UNDER PENALTY OF PERJURY ONE OFTHE 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 OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED. _I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REWIRED BY SECTION 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: CARRIER POLICY NUMBER (INS SECTION NEEDNOT SE COAPLETEDOFTHE PERMT IS FORCNEMINCREDOd1AFIS (SICO)OR LESS). 1 CERTIFYTHAT 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 WORKERS' COMPENSATION LAWS OF CALIFORNIA. AND AGREE THAT IF 1 SHOULD BECOME SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3100 OF THE LIBOR CODE I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE: APPLICANT: j WARNING: FAILURE EMPLOYER TOSECURECRIMINAL PEN COMPENSATION COVERAGE 13 ONE HUNDRED THOUSLLBE AND SUBJECT AN EMPLOYER 70 CRIMINAL, PENALTIES AND CIVIL FINES UP TO ONE HUNDRED TIIOUSANO DOLLARS isIO0.000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN i SECTION 37DS OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY i IORTHE ERFO MANCE OF THEE OFPERJURY THAT THERE U"ACONSTRUCTION 097. CIO AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC.30P7, pV. Q). i LENDER'S NAME LENDEITSADDRESS 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 BUDDING 3 CONSTRUCTION. AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE•MENTKXNED PROPERTY Fork INSPECTION PURPOSES. i Mark L,, ,(I ITTEE NAME (P I SK:NATU EOF PERMITI E DATE PRESS FIRMLY a �-L PERMIT �r P/C APPLICATION 5' z&O Z DATE NUMBER 0 J If ISSUE ^ 2p 0-L TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDEISIDE STREET RW SIDE ❑ PROPOSED USE �� E-1� ^% Per'-1 NO. DWEL NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ.AREANALUATION SFR/ADD/REM U) Garage/Carport W Patio/Dock LL- Pool/Spa 0 Z Re -Roof 0 Commercial 5 m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE Q U_ L) U W J W z Je fi 2. op co zi J a J _U 2 4 U W CONSTRUCTION PLAN REVIEW ELECTRIC (• S� PLUMBING MECHANICAL INSPECTION FEE I- ISSUANCE SMIP IVIAK 1 1_ ENERGY P/C ENERGYPERMIT ��• "-- I '0 0 RETENTION FEE: PRE-ALT FEE: TOTAL FEES COMMENTS RECPT. NO. PAID BY C L VALIDATION WHITE —Department Copy, YELLOW —Finance Copy, PINK —Assessor Copy, GOLOLNHUD—t-ae wpy, OrteeN—ADpNcanrs L:opy --;1 —7- — ll�Z nT •w,>'•'It 7 ,,A CITY OF DIAMOND BAR INSPECTiON RECORD N V. SET BACK Y y Off FLOOR JOIST FTGSIFORMS/STEEL FHA REOMTS ELECTRIC GROUND j UNDER FLOOR DUCT GROUND PLUMBING I UNDER FLOOR CONDUIT SLAB GRADE FIREPLACE FOUNDATION TEMP POWER I FIREPLACE BOND BEAM WATER SERVICE MID HT. BOND BEAM ROOF SHEATHING FT. BOND BEAM FRAMINGNENTILIATION _48 FINAL BOND BEAM ROOF COVER PRE -GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWER/TUBTEST POOL ELECTRIC EXT. LATH/SIDING I POOL FENCING WALL INSULATION I POOL FINAL CEILING INSULATION 1 OFF SITE IMPS, DRYWALL NAILING pqi/ DEDICATIONS SEWER --FiNAL.F;!4G, SEPTIC TANK LANDSCAPE/IRRIG. SEEP PIT/L.L. ON SITE IMPS._ GAS AIR TEST j FINAL ZONING FINAL CONST. j FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT., FINAL FINAL ELECTRIC I j DEV. FEES PAID FINAL PLUMBING j j ENERGY COMMENTS SEPTIC TANK SIZE SEEP PIT/LI SIZE 7