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Home My WebLink About18684 (21)` CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & bEVELOPMENT SERVICES 21825 E. Copley Drive (909) 860-3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION JOBSITE ADDRESS APN LO TRACT OWNER AJ� ADDRESS CITY ZI TEL APPLICANT TEL CONTRAC_ ADDRESSTO CITY ZI TEL. ARCRENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS Ll- CENSE LAW FOR THE FOLLOWING REASON (SEC. 7001.5 BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REOUIRESAPERMIT TO CONSTRUCT, ALTER, IMPROVE, DEMOLISH, OR REPAIR ANY STRU'C- TUBE. PRIOR TO ITS ISSUANCE. ALSO REOUIRES THE APPLIGNT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE 6 LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS L4 CENSE LAW (CHAPTER 0 (COMMENCING WITH SECTION TODD) OF DIVISION 0 OF THE BUSINESS AND PRO. FESSONS CODE) OR THAT HE OR SHE IS EXEMPT THSREFROM AND THE BASIS FOR THE ALLEGED EXEMP. TION. ANY VKAATION OF SECTION 7001.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOTMORE THAN FIVE HUNDRED DOLLARS (SS00) ): 0 L AS OWNEROF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS 114E:R SOLE COMPENSATION. WILL DO THE WORK. AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044. BUSb NESS AND PROFESSIONS CODE. THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BULDS 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 BUILO'NG OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPILE. TION, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT SUILO OR IMPROVE FOR THE PURPOSE OF SAAEL O L AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 70N, aUSINESS AND PROFESSIONS CODE: THE CONTRACTORS Lt. CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO a' -'It DS OR IMPROVES THEREON. AND W'HO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAO TORS LICENSE LAW). O 1 AM EXEMPT UNDER SEC. 8 d P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBYAFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 0 (COMMENCING WITH SECTION 70001 OF DIVISION S OF THE BUSINESS AND PP.OrESS1ONS CODE. AND MY LICENSE IS IN FULL FORCE AND EFFECT. LICENSE CLASS LIC. NO. �L— =.'_'(�� .�• D. CONTRACTORa/ TES i r<I. WORKERS' COMPENSATION DECLARATION I HEREBYAFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: _ I HAVE AND WILL MAINTAIN A CERTIFICATE Of CONSENT TO SELF4NSURE FOR WORKERS' COMPENSATION. AS PROVIDED SY SECTION 7700 OF THE LA80R CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT ISISSUED —I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE. AS REWIRED BY SECTION 57000E THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED. MY WORKERS' COMPENSATION IN CE CARRIER AND POLICY NUMBER ARE: CARRIER J w POLICY NUMBER'1sI s MtSSEC ION NEED NOT BE OOt.OIETED OFTHE PERMIT IS FOR ONEKI DIED DOLLARS ($1001OR LESS) I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. 1 SHALLNOT EMPLOYANY PERSON IN ANY MANNER SOAS TO BECOME SUBJECT T07HE WORKERS' COMPENSATION LAWS OF CALIFORNIA. AND AGREE THAT IF 1 SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 07M OF THE LABOR ��CODE. I SHALL FORTHWITH COMPLY WITH THOSE ROVISION$. DATE :(J�.C�A PPLICANT: WARNING: RURE TO SECURE WORKERS' COMPENSATION COVERAGE IS JNLAWFUL, AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO CNE HUNDRED THOUSAND DOLLARS ($100.000). IN TO TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 3/00 OF THE LABOR CODE. INTEREST AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 50P7, CIV. C.). LENDERS NAME LENDERSADORESS 1 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT I AGREE TO COMPLY WITH ALL CRY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION. AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY 70 ENTER UPON THE ABOVE MENTONED PROPERTY FOR INSPECTION PURPOSES. A14, ItIIU s=L_� PERMITTEE NA � INT) A �r_ SIGNATURE dIZLwfffEE1 DA PRESS FIRMLY APPLICATION �� PERMIT �j�„�t/C DATE NUMBER, Q �O ISSUE TYPE OCC DATE CONST, GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDEISIDESTREET RW ❑ SIDE ❑ PROPOSED US ie Talf STj91� 1 NO. DWEL. ..-*'NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM CY) Garage/Carport - W Patio/Deck U- PooUSpa Z Re -Roof , 0 Commercial 5 m Valuation JV 5 tF3D ADJ-AREA QUANTITY DESCRIPTION FEE J _¢U F U W Lu W C7 Z m a Q U Z Q 2 W CONSTRUCTION 13 I 1 PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE (� 6 SMIP . �O ENERGY P/C ENERGY PERMIT RETENTION FEE: vuv PRE-ALT FEE: TOTAL FEES COMMENTS NN RECPT NO. PAID BY VALIDATIO WHITE —Department Copy, YELLOW —Finance Copy. PINK —Assessor Copy, GOLDENROD —File Copy, GREEN —Applicant's Copy Ci T Y OF DIAMOND BAR INSPECTION' PECOi3D .-'I�►�..!`IQi.�i1i..�+f n�_'�.�A.�.afrFp� �rYl�,�_�li�)_�.._...... D'_:...F(.:�� SET BACK i _ i ' FLOOR JOIST-- FTGS/FORMSISTEEL �_-_— I FHA REQMTS _I I I UNDER FLOOR DUCT _UNDER FLOOR CONDUIT �� _ I FIREPLACE FOUNDATION i FIREPLACE BOND BEAM ^ _ MID HT. BOND BEAM FT• 60ND EE_F,(V1 J t — -- _)) _ `` FINAL BOND BEAM b zL/a7�� / I PRE -GRADING BENCHING 1 ROUGH GRADING _ _ _FINISH GRADING POOL ELECTRIC POOL FENCING ELECTRIC GROUND GROUND PLUMBING SLAB GRADE TEMP POWER WATER SERVICE ROOF SHEATHING. _ _ _ - _ FRA6111NGlVENTILIATION ROOF COVER ROUGH HEATING ROUGH ELECTRIC ROUGH PLUMBING SHOWER/TUB TEST EXT. LATH/SIDING WALL INSULATION POOL FINAL _ CEILING INSULATION -_ I OFF SITE IMPS. DRYWALL NAILING SEINER SEPTIC TANK SEEP PIT/L.L. GAS AIR TEST FINAL CONST. FINAL HEATING ( _ _ _ _ _ Z I 1 _ _ _� - DEDICATIONS I_FINAL EN_G. I LANDSCAPE/IRRIG. OtJ SITE IMPS. FINAL ZONING I FIRE DEPT. FINAL _ �HEALTH DEPT. FINAL FiNAL ELECTRIC I DEV. FEES PAID FINAL PLUMBING ENERGY — --- i — — — COMMENTS SEPTIC TANK SIZE SEEP PIT/U SIZE — a I I i — -- — —