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Home My WebLink About13606CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 216601- Copley Drive Suite 190 r BUILDING 860 NG Fax MI 861-3117 PPLI BUILDING PERMIT APPLICATION JoosITE ADDRESS V t G APN LO TRAC OWNER ADDRES Z CITY P TEL APPLICANT TEL. CONTRACT ADDjt6fSS C ZIP TEL ARCWENG/ DESIGNER ADDRESS CITY ZIP TEL OWNER -BUILDER DECLARATION I HEREBY AFFIFMI UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LI. CENSE LAW FOR THE FOLLOWING REASON (SEC. 7671.E BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTY WMCH REQUIRES TO CONSTRUCT. ALT E R. IMPROVE, DEMOUSK OR REPAIR ANYSTRUC- TURF. PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT 70 THE PROVISIONS OF THE CONTRACTORS U. CENSE LAW (CHAPTER I (COMMENCLYG WITH SECTION 7DD0) OF DIVISION 3OF 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 7031.6 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO ACRnt. PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS ($Sao).): O L AS CWMER OFTHE PROPERTY. OR MY EMPLOYEES WITH WAGESAS THEIR SOLE COMPENSATION. W61 DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. TON, BU51• NESS AND PROFESSKXMS OCOE: 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 TT640RJOH 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 OOLIPLE- TION. THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALEl ❑ L AS OWNER OF THE PROPERTY. AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT 70".(SEC. 70. BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS U- CENSE LAW DOES NOT APPLY TOAN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WRHA CON7RACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW). 01 AM EXEMPT UNDER SEC. B. 6 P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION 1 HERESYAFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER e(COMMENCING WITH SECTION 70001 DIVISKN 70 EBUSNESSAND PROFESSIONS CODE, AND MY LICENSE S N FULL FORCE AND T. 4/ LICENSE CLASS LIC. NO. DATE CONTRACTOR WORKERS' COMPENSATION DECLARATION 1 HEREBY AFFIRM LNDER 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 3TWOF THE LABOR CODE, FOR THE PERFORMANCE OF THE WOFOL FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE. AS REQUIRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED. MY WORKERS COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER POLICY NUMBER (1F16SECTICN NEEDNOT BEOCA `UETEDOFTHEPEAMITIS FOR ONE HLA1M WWUb(LICOORLESS) 1 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 70 THE WORKERS COMPENSATION LAWS OF CALIFORNIA. AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE. I SMALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE: APPLICANT: WARNING FAILURE TO SECURE WORKERS COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (L 100.000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 370E OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES CONSTRUCTION LENDING AGENCY I HERESY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 000. CIV. C.). LEM7ER'S MAME LENDERSAODRESS :CERTIFY TFATI ERE THIS APPLICATION AND STATE THATTHE EINF IWATION IS CORRECT. I AGREE TO CO LY ALLCRY AND CdJNTYORDINANCES AND -LAWS REUTWO TO LARDING CONST AND REBYAUTHORIZEREPRESENTATIVES H TOE ME ABOVE• ROPERTYi�PUR PERMrrTEENAME(P ` T) SIGNATURE OF PERMRTEE DATE PRESS FIRMLY APPLICATION PERMI ��rJ p/C DATE NUMBER ISSUE / n OCC 2 DATE. CONTYP -J '-�1 G CONST. GROUP ZONING SETBACKS FRONT - - RW ❑ REAR 0- SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREA/VALUATION SFWADD/REM to Garage/Carport WPatio/Deck LL POOVSpa i� Z Re -Roof Commercial - m Valuat' ADJ.AREA OUAN1ITY DESCRIPTION FEE \_ 4 U_ U W Lu W C7 Z m 0- a a U 2 a S v W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL A (? INSPECTION FEE ► ". �•Y 1. tl L� ` • T7 ISSUANCE r " L• ' _' -r c/ �� SMIP - ENERGY P/C. ENERGY PERMIT RETENTION FEE: PRE -AST FEE: j TOTAL F S QQ COMMENTS RECF'T. N0. PAID BY VALIDATION WHITE —Department Copy, YELLOW —Finance Copy. PINK —Assessor Copy- GOLDENROD —File Copy, GREEN —Applicant's Copy ... rU .,. �. .. ,.y�ry..� .. � . -•: �.- � -.P .� 'r•;,,-_,• y�. .. Vt ��.. r.. 1•. k' :'1.'N' ,.w •N`i CITY OF DIAMOND BAR INSPECTION'RECORD `\y _ i,►��C.7.�>.3�-T�C��,t�, ��=� �1.��E-��?.�c' �.�� (►' :1` �1.c1�P�1�_�S[� - -.._ o.- SET BACK FLOOF3JOIST�,' i 1 ,FTGS!FORI .S/STEEL FHA REMITS. ELECTRIC -GROUND • UNDER FLOOR DUCT,-, GROUND PLUMBING t UNDER FLOOR'CONDUIT '• SLAB GRADE- ' ---- FIREPLACE FOUNDATION .TEMP POWER , FIREPLACE BOND BEAM ' WATER SERVICE MID HL.BOND BEAM,-., i :ROOF SHEATHING 8 FT. BOND BEAM •FRAMINGAIENTILIATION = FINAL.BONb 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 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 ZONING 'FINAL CONST..:_ - _. FIRE DEPT. FINAL F;,,NAL HEATING . __.____.. HEALTH DEPT. FINAL +F;NF.L ELECTRIC-DEV. FEES PAID �i=INAL PLUMBING ENERGY ,COMIMENTS )SEPTIC TANK SIZE ,SEEP PIT/U SIZE I; Ar.0 _ _.