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Home My WebLink About16680 (37)01,10IIIND BAR CITY OF DIAMOND BAR DEPARTMENT OF COMMLNITY & DEVELOPMENT SERVICES 21825 E. Copley Drive (909) 860-3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION TE ADDRIESS/d-M lf!�ZUA Vic% 1,1W( APNJ:� J OaOTV_(_1_ TRACT OWNER ADDRE S d'. CITY PJAILIVA4 641" ZIP 15)VS TEL.VII -i C(' APPLICANT CONTRACTOR ADDRESS CITY ZIP TEL. ARCFVENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION 1 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 REOUIRESA PERMIT TO CONSTRUCT•ALTER, IMPROVE, DEMOUSH.OR REPAIR ANY STRUC- TURF. 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 700D) 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- TaN. ANY VIOLA71ON OF SECTION 7031.5 BYANYAPPLICANT FORA PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS ISSW).): It AS OWMEROF THE PROPERTY, On MY EMPLOYEES WITH WAGESAS THEIR SOLE COMPENSATION, WILL �D THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7D44, BUSI. NESS AND PROFESSKNNS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THE REON. AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS On HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE. T. HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD W THIN 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). ❑ LAS OANEROF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WRHUCENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 70N. BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE LAW DOES NOTAPPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS W THA CONTRACTORS) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). �D 1 AM'EXXEEMPT UNDER SEC. B. IS P.C. FCR THIS REASON DATE �/ ZV VI OW7NER LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PE BURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION 70001 OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE. AND MY LICENSE IS N FULL FORCE AND EFFECT. LICENSE CUSS LIC. NO. DATE CONTRACTOR WORKERS' COMPENSATION DECLARATION 1 NEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARAMONS: I HAVE ANO WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKS RS' COMPENSATION, AS PROVIDED BY SECTION 3700CFTHE LABOR CODE. FORTHEPERFORMANCE DFTHE WORK FORYNICHTHIS PERMITIS ISSUED. _I HAVE AND W LLMAINTAIN WORKERS' COMPENSAII)N INSURANCE. AS REOUIRED BY SECTION 37000F THE LABOR CODE. FOR THE PERFORMANCE OF THE WORIO FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMDER ARE: CARRIER POLICY NUMBER fn-r, SECTION FEED NOT BE DDIAIETEDOF TIE PEFFAT 6 FOR ONE H NDFIEDD0.URS (1100) ORLFS% I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, 1 SHALL NOT EMPLOY ANY PERSON N ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA. AND AGREE THAT IF I SHOVLD BECOME SUBJECT TO THE W ORKERT COMPENSATION PROVISIONS OF SECTION 37000F THE LABOR CODE.1 SHALLFORTHWITH COMPLY WITH THOSE PROVISIONS. DATE: APPLICANT: WARNING: FAILURE TO SECURE WORKERS' COMPENSATON COVERAGE IS UNLAWFUL. AND SHALL BE SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS 13100,000). N ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 3705 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 ISEC. 3097, CIV. G.I. LENDERS NAME LENDERS ADDRESS 1 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ML CM AND COUNTY ORDINANCES ANO STATE LAWS RELATING TO BUILDING CONSTRUCTION, ANO HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE MENTIONED PROPERTY FOR INSPECTION PURPOSES. i' E rev PER I;r (PRIM) SIGNATURE OF PERMITTEE DATE Z_f PRESS FIRMLY APPLICATION -Q PERMIT /C DATE NUMBER ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDESTREET RW ❑ SIDE ❑ PROPOSED USE Ato re_h-,C NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREANALUATION SFR/ADDIREM CIO Garage/CarpoR WPatio/Deck u- PooUSPa 0 Z Re -Roof 0 Commercial m Valuation ADJ,AREA QUANTITY DESCRIPTION FEE J Q U fFL U W W Z m a a C U Z S U W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERRLIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES COMMENTS RECPT NO. PAID BY VALIDATION WHITE —Department Copy, YELLOW —Finance Copy, PINK —Assessor Copy, GOLDENROD —File Copy, GREEN —Applicant's Copy I CITY OF DIALT,01�P, BAR 1 0 710 i I" R E C (D i-a D =c, r(c) SETBACK F LCOR j'-)IST FTGS!FORMS/STEEL j I I f I "A R E 0'., T S ELECTRIC GROUNID UNDER FLOOR DUCT' GROUND PLU.'vl-qING Ur.ID-Fi FLOOR CONDUIT SLAB GRADE FIJREPL c.,E,mur-lDATI0r., FIREPLACE BOND BEAV. TEMP POWER WATER SERVICE ROOF SHEATHING FRAMING/VENTILIATION ROOF COVER 17 ROUGH HEATING M.ID 111'. [13NID BEAM FINAL BOND EEAM PRE GRADING_ BEN-CHHNIG ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING I I l i FINISH GRADING SHOWER/TUB TEST POOL ELECTRIC EXT. LATH!SIDING POOL FENCHN'G WALL INSULATION j rk)OL FINAL CEILING INSULATION L OFF SITE MIPS. DRYWALL NAILING DEDICATIONS SEWER FINAL ENG. SEPTIC TANK J j 1 LANDSCAPE/IRRIG. SEEP PIT/L.L. I j ON SITE IMPS. GAS AIR TEST FINAL CONST. FINAL ZONING FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL t FINAL ELECTRIC , DEV. FEES PAID i FINAL PLUMBING t I ENERGY COMMENTS 1., r SEPTIC TANK SIZE SEEP PIT/U SIZE