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Home My WebLink About15129 (17)J� CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-31 l7 BUILDING PERMIT APPLICATION JOBSITE nn ADDRESS, APN LOT TRACT OWNER �' ADDRESS b CITY ZIP C %f TEL.KQCq &I • APPLICANT TEL. 1-7 CONTRACTOR ADDRESS VQ - CITY ZIP 219 TEL. ARCFVENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC 7031.5 BUSINESS AND PROFESSIONS CODE:ANY CITY OR COUNTY WHICH REQUIRES APERMRTO CONSTRUCT.ALTER IMPROVE.DEM GUSH, OR REPAIR ANY STRUC- TURE. PRIOR TO ITS ISSUANCE. ALSO REWIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE 15 LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI. CENSE LAW tCHAPTER P (COMMENCING WITH SECTION 7000) OF DIVISION S OF THE BUSINESS AND PIIO- FESSIONSCODE) 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 FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (SSW)J' 0 LAS OWNER OFTHE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK. AND THE STRUCTURE IS 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 HS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE F. HOWEVER THESULDINGOR IMPROVEMENT IS SOLD WITHNONE YEAR OF COMPLE- TION. THE OWNERIUILDER WILL IUVE THE BURDEN OF PROVING THAT HE OR SHE OO 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 LF CENSE LAW DOES NOT APPLY TO AN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CDNTRAC- TORS LICENSE LAW } O IAM EXEMPT UNDER SEC S. S PC FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION 1 EBYAFFVMA UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER P( MENCNO WITH SECTION 7000) OF DIVISION S OF THE BUSINESS AND PROFESSIONS CODE. AND MY ENSE LS N FULL FORCE AND EFFECT. p+L E S !c I-j1 LIC. NO. 1 D CONTRACTOR A WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELFaNSURE 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 W MAINTAIN MAINTAWORKERS' COMPENSATION INSURANCE. AS REQUIRED BY SECTION 3700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' Cg1+PENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: ER �gjL/I :4 w<• Lis, \\ ICY NUMBER G C -Ci v VVfn4S SECTION NEED NOTBE COIF =0FTEPER.IT 6 FOR ONE HIFDRLDDQIM6(SIgOR LESS), 1 CERTSYTHAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I SHALL NOT EMPLOY ANY PERSON N ANY MMINER SO AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS Of CALIFORNIA. AND AGREE THAT IF SHOULD BECOME SUBJECT TO THE WDRIERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE SHALL ORTHVRTH COMPLr WI THOSE PROVISIONS. DATE , APPLICANT: = l �S Cam% WARNING' FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. AND SWILL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS (I100.000). N TO TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3705 OF THE LABOR CODE. INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY 1 HEREBYAFFIRM UNDER PENALTY OF PERJURY THAT THERE M A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC 30F7, OV C). LENDERS NAME LENDER'SADDRESS 1 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. 1 AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTIaICTION. AND HERE BY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE4AENTIONEO PROPERTY FOR INSPECTION PURPOSES. PERMITTEE NAME ( GNAT HE OF E ITTE DAT PRESS FIRMLY APPLICATION PERMIT 1 tq P/C d ` U DATE NUMBER_ i a • ISSUE C TYPE OCC DATE — I J ` &y CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR p SIDEISIDE STREET RW ❑ SIDE ❑ PROPOSED US 4 ' 1 c NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT FACTOR PSF ADJ. AREANALUATION SFR/ADD/REM 03 Garagwrarport WPatio/Oeck LL ool/Spa 9-Root f J Commercial - In Valuati —� ADJ.AREA OUAl,fiITY DESCRIPTION FEE U EL U u3 LU w 0 Z TO J a J U_ 2 ¢ 2 U W CONSTRUCTION / PLAN REVIEW ELECTRIC PLUMBING�- MECHANICAL INSPECTION FEE ISSUANCE >� " A y 1 ^ - 5.1t SMIP u 1 nr` .. uLN( / S L ENERGY P/C 11•�){, '1f1 •(1L. ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES COMMENTS RECPT. NO. _ PAID BY VALIDATION WHITE —Department Copy, YELLOW --Finance Copy, PINK —Assessor Copy, GOLDENROD —File Copy, GREEN —Applicant's Copy CITY OF DIAMOND.13AR..., 'INSPECTION RECORD ;SET BACK FLOOR JOIST Ilk iFTGSIFORIMS/STE�L FHA REQMTS !ELECTRIC GROUND UNDER FLOOR DUCT ,GROUND PLUMBING UNDER FLOOR CONDUIT :SLAB GRADE FIREPL"ACE-MUt4DATION 1TEMP POWER FIR EPLftE' YON'O'BEAM WATER SERVICE - •ROOF SHEATHING AA2 t l''.''I :� '.' "' ' ~ ;-: \171 MID HT. BOND 8 F-T. BOND DEANI bb NAL. �iiDUEAM I NEtJTILI ilia FRAM NG ;ROOF 'COVER PRE -GRADING ,ROUGH HEATING BENCHING !ROUGH ELECTRIC ROUGH GRADING !ROUGH PLUMBING FINISH GRADING :SHOWER/TUB TEST POOL ELECTRIC -EXT. LATWSIDING POOL -FENCING iWALL-fNSULATION POOL FINAL .CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS !SEWER FINAL ENG. -:SEPTIC TANK LANDSCAPEARRIG. .SEEP PIT/L.L. ON SITE IMPS. 'GAS AIR TEST FINAL ZONING FINAL -1 �2 FIRE DEPT. FINAL HEALTH DEPT. FINAL !FINAL �FINAL HEATING :FINAL ELECTRIC DEV. FEES PAID .FINAL PLUMBING ENERGY ;COMMENTS iSEPTIC TANK SIZE rSEEP PIT/U SIZE 'A"