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Home My WebLink About18684 (19)CITY OF DIAMOND BAR DEPARTMENT OF COMMUNHY & DEVELOPMENT SERVICES 21825 E. Copley Drive (909) 860-3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION JOBSITE r ADDRESSAj.2)Pi APN LO TRACT OWNER ADDRESS CITY ZI TEL. APPLICANT TEL. CONTRACTO ADDRESS CITY ZI TEL. ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL, OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I 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 A PERMIT TO CONSTRUCT, ALTER, IMPROVE, DEMOLISH, OR REPAIR ANY STRUC. TURE. PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW (CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 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 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS 0I, AS OWNER OF THE PROPERTY. OR MY EMPLOYEES WITH WAGES AS T HEIR SOLE COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044. BUSI. NESS AND PROFESSIONS CCOE: 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 BUILDING 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). ❑ I, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 70". BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI. CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO aUII.DS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). ❑ 1 AM EXEMPT UNDER SEC, B. A 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 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PPOFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT. LICENSE CLASS LIC. NO. T r DATE ~ 1/0 A] i CONTRACTOR 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 SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION 37M OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WILL MAINTAIN WORKERSCOMPENSATION INSURANCE, AS REQUIRED BY SECTION 37U0 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' COMPENSATION INS E CARRIER AND POLICY NUMBER ARE: CARRIER POLICY NUMBER 0HIS SECTION NEED NOT BE COMPLETED OF THE PERMIT IS FOR ONE HUNDRED DOLLARS (S100) OR LESS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 37M OF THE LABOR COD , I SHALL FORTHWITH COMPLY WITH THOSE r—MIONS. DATE: APPLICANT: WARNING: ILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS NLAWFUL, AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3709 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY I HEREBYAFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3097, CIV. C.). LENDER'S NAME LENDER'S ADDRESS 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 BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE -MENTIONED PROPERTY FOR INSPECTION PURPOSES. PERMIT -TEE N EE A. `L SIGNATURE Ck2g9htrr EE DATE WHITE —Department Copy, YELLOW —Finance Copy, IN I ®r PRESS FIRMLY APPLICATION PERMIT �(� /C DATE—� NUMBER O # ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED US { ZX s� NO. DWEL. "-'NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM C/) Garage/Carport Patio/Deck LULU LL Pool/Spa 0 Z Re -Roof 0 Commercial fI] Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U Cr H U w W 0 2 m a _U Z Q U w CONSTRUCTION PLAN REVIEW - ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: , v� PRE-ALT FEE: ' TOTAL FEES ✓ v COMMENTS RECPT NO. PAID BY VALIDATIO t, Py, l ULULNMUU—r09 copy, UHLLN—Applicant's Copy CITY CAE DIAMOND BAR INSPECTION RECORD SET BACK �_ FLOOR JOIST- FTGS/FORMS/STEEL I FHA REOMTS ELECTRIC GROUND --_��.._....._UNDER j v FLOOR DUCT _ GROUND PLUMBING UNDER FLOOR CONDUIT SLAB GRADE FIREPLACE FOUNDATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICE_ *�-. _ MID HT. BOND BEAM ROOF SHEATHING ~ /p(o 8 FT. BOND BEAM FRAMINGNENTILIATIONTFINAL ROOF COVER ROUGH HEATING b Z�v2� �- BOND BEAM _ PRE -GRADING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING _ FINISH GRADING ~ — SHOWER/TUB TEST POOL ELECTRIC EXT LATH/SIDING j POOL FENCING WALL INSULATION _ POOL FINAL CEILING INSULATION OFF SITE IMPS. — DRYWALL NAILING — DEDICATIONS SEWER FINAL ENG.__ SEPTIC TANK — _ LAND_SCAPE/IRRIG.— SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST FINAL CONST. �J� FINAL ZONING FIRE DEPT FINAL —� HEALTH DEPT. FINAL FINAL HEATING l FINAL ELECTRIC ! DEV. FEES PAID FINAL PLUMBING ! ENERGY COMMENTS SEPTIC TANK SIZE SEEP PIT/U SIZE