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Home My WebLink About16845CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES �`• 21825 E. Copley Drive (909) (909) 860-3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION C LL Zi Q c i C a C LL 7 L U JOBSrrEADDRESS •Z 1 O S A y UCIPi Iry �L � APN LOT _ TRACT OWNER it - C ADDRESS - S' `h- Lf VCA-T'A IJ CITY Jji"e)I ib RAI _ IP A I7GC' TEL. APPLICANT TEL. CONTRACTOR ADDRESS CITY ZIP TEL ARCFVENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS U- DENSE LAW FORTHE FOLLOWING REASON (SEC. 70315 BUSINESS AND PROFESSIONS CODE: ANY CITY OR COl1NTYWIIIC/I REWIRES A PERMITTO 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 i (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OR SHE IS EXEMPTTHERE FROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7031.6 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (SWO .' O L AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, TALL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7DN, BUSI- NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON. AND WHO DOES SUCH WORN HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT W TENDED 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 SAAEL O l AS OWNER O - THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 70u, BUSINESS AND PROFESSIONS CODE: THE CONT/WCTOFIS LI. CENSE LAW DOES NOTAPPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHOCONTRACTS FOR SUCH PROJECTS W THACCNTRACTONS) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). ❑ I AM EXE�M7PT UNDER SEC. B. 6 P.C. FOR THIS REASON DATE _ OWNER LICENSED CONTRACTOR DE RATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER i (COMMENCING WITH SECTION 7") OF DIVISION 3OF THE BUSINESS AND PROFESSIONS CODE. AND MY LICENSE IS N FULL FORCE AND EFFECT. LICENSE CUSS LIC. NO. DATE CONTRACTOR WORKERS' COMPENSATION DECLARATION 1 HEREBYAFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS. —I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORK[ RS' COMPENSATION, AS PROVIDED BY SECTION 3700 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 REQUIRED BY SECTION 37000F THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH iH PERMITIS ISSUED, MY WORKEPTCOMPENSATIO� INSRANCE RFIER AND NUMBER RE: CARRIER POLICY NUMBER CM SECRDN LASED NOT BE ODAOUnD OF TFE PERMR IS FORCNE RN)REDDOUArLS (MOD) OR LESS) I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL N07 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 3700 OF THE LABOR E,1 ALL FORTHWITH COMPLY WITH O�SE PROLV')ISNTVS. %27-4 DATE: IO �l i.� L - 'WARNISHALL 2.��FAj [ T S ..ERE WORKEnS'C0 PENSATION COVERAGE IS UNLAWFUL AND BE SUBJEM DYER TOCRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND li DOLLARS is I W,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION3709 OF THE LABOR COOE, INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED (SEC. 3097. CIV. C.). I LENDERS NAME LENDERS ADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. 1 AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING UCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE MENTIONED PROPERTY FOR INSPECTION PURPOSES. ABOVE. 1 N 1 PERMrTTEE NAME(PRI O SKiNATVRE OF PERMITTEE DATE PRESS FIRMLY APPLICATION PERMIT P/C �+ DATE NUMBER # ISSUE TYPE OCC DATE' CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREANALUATION SFR/ADD/REM Garage/Carport W Patio/Deck u- PooVSpa Z Re -Roo( JO Commercial D Cal Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J Q U d: U J W 'L LD J a J Q U_ Z Q S U W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE _ _ Tr ISSUANCE ,- �"� �"E� � 5 — SMIP ENERGY P/C JULA 2 n of I ENERGY PERMIT RETENTION FEE: 0"_„��_ PRE•ALT FEE: TOTAL FEES A 5 U r COMMENTS RECPT NO. PAID BY _VALIDATION WHITE —Department Copy, YELLOW —Finance Copy, PINK —Assessor Copy, GOLDENROD —File COPY. GREEN —Applicant's Copy 9& . so. - CIT , 'OF DIAL'IOND F:,A-t,.' !M-1,ECTIO'' P-Ef."(Di-D SET BACK FTGS,'FORrvIS,'STEEL I ELECTRIC GROUND FLOOR JOIST I I FHA RE-Q',-.TS UN D GROUND PLUMBING UNDER FLOOR M111DUll SLAB GRADE --L[_FIRF--PLACE FOUNDATION' TEtAP POWER BOND BEAM FIREPLACE M,:D HT. BOND BEAMI WINTER SERVICE ROOF SHEATHING 8FT. BOND BEAM FRAMING/VENTILIATION1 I FIiJAL BOND BEAM ROOF COVER I I I PRE -GRADING- ROUGH HEATING I BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUIM.131i.,lu- FINISH GRADING SHOWER/TUB TEST POOL ELECTRIC EXT. ILATWSIDING V,'ALL INSULAT ION I POOL IFFNCING I I POOL FINAL CEILING INSULATION j OFF SITE IMP-S. DRYWALL NAILING DEDICATIONS SEkAJER I FINAL ENG. SEPTIC TANK I LANDSCAPE/IRRIG. SEEP PIT/L.L. I I ON SITE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST. I I i�-FIRE DEPT. FINAL FINAL HEATING FINAL ELECTRIC FINAL PLUMBING tj HEALTH DEPT. FINAL I DEV. FEES PAID ENERGY COMIMENTS SEPTIC TANK SIZE SEEP PiTJU SIZE