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Home My WebLink About17610 (19)CITY OF DIAMOND BAR 1 DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES I 21825 E. Copley Drive (909) 860-3195 Fax (909) 861-3117 PRESS %» BUILDING PERMIT APPLICATION FIRMLY JOBSITE ADDRESS APN LOT TRACT OWNER ADDRESS cIT�A PSA� ZIP TEL. ; APPLICANT 4— TEL. CONTRACT ADDRESS CITY - ZI TEL. 3 ARCF/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS L4 CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE ANYCRY OR COUNTY WHICH REQUIRESAPERMITTOOONSTRUCT.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 L4 CENSE LAW (CHAPTER 0 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT ME OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP. TION. ANY VIOLATION OF SECTION 7031.E BY ANY APPLICANT FORA PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FINE HUNDRED DOLLARS (LSOOD: ❑ L AS OWNER OFTHE PROPERTY.OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL OO THE WORK, AND 7HE 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 IMPROVESTHEREON. AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH MIS OR HER OWN EMPLOYEES. PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE IF HOYIEVER.THE BUILDTIOR 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). O L AS OWNER OF THE PROPERTY; AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7061, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI. CENSE LAW DOES NOTAPPLYTO AN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FORSUCH PROJECTS WITH A CONTRACTOR(S)LCENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). ❑ 1 AM EXEMPT UNDER SEG B. L P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER a (COMMENCING WITH SECTION T0001 OF DIVISION 3OF THE BUSINESS AND PROFESSIONS COOS, AND MY LICENSE IS N FULL FORCE AND EFFECT LICENSE CUSS 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 3700 OF THE LABOR COOE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WILLMAINTAIN 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 WORK�COMPENS )ON INSURA�L yE CARRIER AND POLICY NUMBER ARE: CARRIER l X5;� T !'L�LMAf POLICY NUMBER (masEC110N NEEDNOTBE CMIETEDOF7)E PEFAC ISFCRCNEKtOFtEDWLLARs (S1O0)CRLESS) I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I SHALL NOT EMPLOY ANY PERSON N ANY MANNER SO AS 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 3700 OF THE LABOR CODE.1 SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. I DATE: APPLICANT.j WARNING: FAILURE TO BECUREWORKERS'COMPENSATKN COVERAGE ISUNLAWFUL.AND SHALLBE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (7100,000), N ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN i SECTIONS70B OF THE LABOR CODE. INTEREST, AND ATTORNEYS FEES. 1 CONSTRUCTION LENDING AGENCY i I OA AFFIRM UNDER PENALTY' OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 7097, CN C.). 1 LENDERS NAME LENDER'SADDRESS 1 I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THA7THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL CRY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION. ND EREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE.MENrI N D P PEATY FOR INSPECTION PURPOSES. J PERMITTEE E( NT 2 swNAruREOF`ftF41nEIi DAT APPLICATION 14 ^ ly_PERMIT DATE UMBER /C # ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW O REAR ❑ SIDEISIDE STREET RW ❑ SIDE ❑ PROPOSED DWEL. T` N . NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION SFR/ADD(REM U) Garage/Carport WPatio/Deck LL PooVSpa ZRe -Roof Commercial - 5 m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J 6 _U U w Lu W E7 2 TD .G J n. J Q U ' z a x W r2 CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP 7T1 l/ ENERGY PIC ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES COMMENTS RECPT. NO. ' rV PAID BY VALIDATION WHITE —Department Copy. YELLOW —Finance Copy, PINK —Assessor Copy, IJQLULNHULu— 118 Loopy, L;ntrN—Applcan7s copy CITY OF DIAMOND BAR INSPECTION RECORD SETBACK RVI FLOOR JOIST FTGSIFORMS/STEEL FHA REOMTS ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR CONDUIT SLAB GRADE FIREPLACE FOUNDATION TEMP POWER i FIREPLACE BOND BEAM WATER SERVICE ROOF SHEATHING /z � MID HT. BOND BEAM - 8 FT. BOND,BEAM FRAMING/VENTILIATION FINAL'BOND BEAM ROOF COVER PRE -GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWER/TUB TEST POOL ELECTRIC EXT. LATH/SIDING POOL FENCING WALL INSULATION 1 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 CONING FINAL CONST. I FIRE DEPT. FINAL FINAL HEATING j HEALTH DEPT. FINAL FINAL ELECTRIC I DEV. FEES PAID FINAL PLUMBING ENERGY COMMENTS SEPTIC TANK SIZE SEEP PITIU SIZE