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Home My WebLink About13605 (644)11.1MIND Ii:11: CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION JOBSITE f 1 A ADDRESS V 1 APN ' TRA T OWNER37) ADDR S CITY ZIP TEL. APPLICANT TEL CONTRACTOM( ADD ASS C ZIP TEL ARCFVENG/ /,lO DESIGNER V 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 7HE FOLLOWING REASON (SEC. 70 1.5 BUSINESSAHO PROFESSIONS CODE: ANY CRYOR COUNTY VO4CH REQUIRES &PERMIT TO CONSTRUCE ALTER MPROVEOEMOUSH. OR REPAIRANYSTRUC• TUBE- PRIOR TO ITS ISSUANCE. ALSO REOUIPES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE M LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS U- CENSE LAW (CHAPTER I (COMMENCING WITH SECTION 7000) OF DIVISIONS OF THE BUSINESS AND PRO• FES31ONS CODE) OR THAT HE OR SHE IS EXEMPTTHEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7051.E BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (1500).): O L AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORD AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 70". BUSI- NESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY IWIO BUILDS OR IMPROVES THEREON -AND WHO DOES SUCH WORKHIMSELF OR HERSELFOR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT NYE14DED OR OFFERED FOR SALE IF, HOWEVER.THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE- TION. THE OWNER'BUILDER WALL HAVE THE BURDEN OF PROVING THAT HE OR SHE DI) NOT BUILD OR WPROVEFOR THE PURPOSE OF SALE). O LAS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROTECT (SEC, 70". BUSINESS AND PROFESSIONS COCC THE CONTRACTORS LL CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON AND W HO CONTRACTS FOR SUCH PROJECTS WITH AOONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). D 1 AM EXEMPT UNDER SEC 8 A P.C. FOR THIS PEASON DATE OWNER LICENSED CONTRACTORS DECLARATION I KEREBYAFFIRMUFDERPENALTY OFPE RY THAT IAILICENSED TINDER PROVISIONS OF CHAPTER I(COLIMENCING WITH SECTION 7000)OF f 5AN305EPE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS N FULL FORCE AND EFF T LICENSE CLASS TIC. NO.-_C DATE CONTRACTOR WORKERS' COMPENSATION DECLARATION I NEREBYAFFIRM UNDER PENALTY OF PERJURYONE OF THE FOLLOWING DECLARATIONS I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELFHNSURE FOR WORKERS' COMPENSATION. AS PROVIDED BY SECTION 170D OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REWIRED BY SECTION 3700 OF THE LABOR COCE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' OOMPENSAT)ON INSURANCE CARRIER AND POLICY NUMBER ARE CARRIER POLICY NUMBER (I/iS SECTION NEED NOTBE COMPLETED OFTHE PERLAT IS FCLCNE MXEDCOLIARS 0100) OR LESS} 1 CERTIFY THAT W THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON W ANY MANNER 50 AS TO BECOME SUBJECT TO THE j WOAKERV COMPENSATION LAWS OF CALIFORNIA AND AGREE THAT IF I SHOULD BECOME - SUBJECT TO THE WORKERS COMPENSATION PROVISIONS OF SECTION 5700 OF THE LABOR CODE.I SHALL FORTHWITH COMPLY WITH THOSE PLWYISCNS. I I DATE: APPLICANT. WARNINGI SECURE WORKERS'COMPENSATION COVERAGE 13 SK4LL BE ONE HUNIA,AND OUSAND SUBJECTANEMPLOYERTO AND FlNESUPTOONEASPRVI THOUSAND $MECTANEM L YE IN DDCRMWAILPENALTIES PEN DOLLARS (t100.000L N ADDITION i0 THE COST OF COMPENSATA7N, DAMAGES AS PROVIDED FOR W L SECTION3708 OF THE LABOR CODE. INTEREST. AND ATTORNEYS FEES. L CONSTRUCTION LENDING AGENCY i I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS ACONSD LENDING AGENCY JSEN PERFORMANCE THE PERFORMCE OF 7ME WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. ]OPT- CV. C,). LENDER'S NAME LENDERSADORESS (CERTIFY THAT IRA E i THIS APPLICATION AND STATE THAT 7HE TION IS CORRECT. I AGREE TO WI ALL CRY AND COUNTY ORDINANCES ANO ST RELATING TO BUILDING 3 CONSTR .AND REBY AUTHORIZE REPRESENTATIVES OFT C TY TO ENTER UPp A80YE ERTYF W EC P RPOSES. - PERMIiI ENAM HTj D O SIGNATURE OF PERMITTEE DATE "(�J �� n PRESS FIRMLY APPLICATION PE ff; P/C 137 , h DATE NUMBER .M ISSUE TYPE OCC 5_� DATE. � I 1 CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDEISIDE STREET RW ❑ SIDE ❑ PROPOSED USE 41 O.OWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM fA Garage/Carport WPallo/Deck LL POOI/Spa ZRe -Roof OJ Commercial - m Valuetio / ADJ.AREA QUANTITY DESCRIPTION FEE -U Q U it 1- U w C7 2 m J o_ K U lLI CONSTRUCTION ll• - PLAN REVIEW ELECTRIC l PLUMBING A.1 J`l v, MECHANICAL INSPECTION FEE I / 7•E'� ISSUANCE � � L'`,' ~ 1 SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL F ES COMMENT V RECPT. NO. PAID BY VALIDATION WHITE—Depanment Copy. YELLOW—FLnanoo Copy. PINK —Assessor Copy. GOLutNHUL)--+Ile UOPY. LjH LLN--ApplcanrS L;GPy .. .. Y+ .. .. .. � �n i .f• 0•1• � Nr.., -s�• • - '1• +� r s >. IK. 4.\'. t� � . � f.'M; ♦1: :`• w\ � +•.faq J�..f_ CITY OF DIAMOND.BAR .INSPECTION RECORD �f•1.1-�1 �.1i��it .SET BACK �_ln��. �1.��X'�,.a'J�►!l�Ift'�,.� ��... .1��. �.��r. ! T�►a ��' FLOOR JOIST,_) ! J j �! \ % -� !;� • _ 'FTGSIFORPv'SSTEEL ---- FHA REOMTS 'ELECTRIC GROUND J UNDER FLOOR DUCT, - :GROUND PLUFJIBING UNDER FLOOR CONDUIT.!, :SLAB GRADE - FIREPLACE FOUNDATION -• ! : • ! '. TEMIP POWER FIREPLACE BOND BEAM =' t WATER SERVICE - - MID HT. -BOND BEAM •) ' ; � - - i ROOF SHEATHING; r -i 8 FT. BOND BEAM FRAF.I1NG�llENTI0ATION FINAL BOND BEAM !ROOF COVER .: PR&GRADING ;- ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING - FINISH GRADING :SHOWER.TUB TEST POOL ELECTRIC .EXT. LATH/SIDING - POOL FENCING .^:ALL INSULATION POOL FINAL CEILING -INSULATION OFF SITE IMPS. ,DRYWALL NAILING DEDICATIONS " .SEWER FINAL ENG. ,SEPTIC TANK �. - - -` LANDSCAPE/IRRIG. SEEP_PITIL.L. `- - '' I - t' ON SITE IMPS. !GAS AIR TEST ! FINAL ZONING ,FIIJAL CONST. FIRE DEPT. FINAL EiNAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC -- - ' !NAL PLUMBING - DEV. FEES PAID- ENERGY COi'JiMENTS __Dpw�_S�O� SEPTIC TANK SIZE SEEP PIT/U SIZE -