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Home My WebLink About143201)1,1!111 TmIt'll CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax.(909) 861-3117 & DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION JOBSITE ADESS APN LOT TRACT OWNER r/ / /' ! ADDRESS L . .� AI ,Ir i 1 0rAaC CITY ,.Z�IP�, ��,T��" TEL 3 6 APPLICANT !=„a=,crt.r a+b� �6�� TEL. CONTRACTOR ADDRESS CITY ZIP TEL. ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LN CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.6 BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REOUIRESA PERMIT TO CONSTRUCT. ALTER IMPROVE, DEMOLISH, OR REPAIR ANY STRUC- TURE. PRIOR TO ITS ISSUANCE ALSO REWIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LN CENSE LAW (CHAPTER Y (COMMENCING WITH SECTION 7000) 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- TION. ANY VIOLATION OF SECTION 7031.E BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS ($600).): ❑ L AS OWN ER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK. AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, BUSI- NESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WIND BUILDS 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 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 SALE). ❑ L AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND M 40 CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S)LICENSEDPU UANT TO THE CONTRAG TORS LICENSE LAW.). ❑ 1 AM EXEMPT UNDER SEC. - B. & P.C. FOR THIS REASON DATE �' OWNER I ' LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRIA UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER , a (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT. �j LICENSE CLASS . ,LIC. NO. 15- 6 R 6 3 61 DATE CONTRACTOR �O,A'Jii/C77 . . d WORKERS' COMPENSATION DECLARATION ..1 HEREBY AFFIRM UNDER 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 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 REWIRED BY SECTION 3700 OF THE LABOR CODE FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' COMPENSATION WSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER POLICY NUMBER (nHLS SECTION NEED NOT BE OOAPLET®oFTNE Pew IS FORONE M1rmm DOLLRs (i100)OR LESS) I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT 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 CODE. I SHALL 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 CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 370E OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS ACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3077. CIV C.). LENDERS NAME LENDERS ADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION ANDS T E ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL CITY AND COUNTY O I CES STATE YAWS RELATING TO BUILDING AND D HEREBY AUTHORIZE REP E ATWES THIS COUNTY TO ENTER UPON THE ABOVE -MENTIONED PROPERTY FOR INSPECT POSES. PERMITT E (PN " f SIGNATURE)RF PE DATE EGG PRESS j FIRMLY APPLICATION' — + Q , PERMIT P/ q -39'� DATE I oo NUMBER it 1 �J ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS . FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE NO. DWEL. NO.. NO. UNITS STORIES BEDROOMS DESCRIPTION 'SO. FT. FACTOR P$F ADJ. AREAIVALUATION SFR/ADD/REM Garage/Carport UPatio/Deck LI_ Pool/Spa Z Re -Roof 0 CommercialI q0 m Valuatlon ADJ.AREA QUANTITY DESCRIPTION FEE - To- 0r� ,wt�-�� ,3Z) J W 1 ,l Z^ L_" - l WY, l z D 2 W CONSTRUCTION PLAN REVIEW ELECTRIC n. 3 PLUMBING, Li Sy MECHANICAL INSPECTION FEE' . ISSUANCE u^ 6/0 SMIP 71) Trrm e14) ENERGY P/C T iy ENERGY PERMIT RETENTION E: �0 9 29 V 'C"T Y OF DIAMOND BAR ' ENG AND SAF TY 17 TOTAL FEES COWAENTS RECPT NO. PAID BY VALIDATION WHITE-0epartrnent Copy, YELLOW —Finance copy: N•INK—As8eS8Gr Copy, GOLDENROD —File Copy, GREEN —Applicant's Copy - CITY OF DIAMOND BAR INSPECTION RECORD SET BACK FLOOR JOIST FTGS/FORMSJSTEEL FHA REQMTS ELECTRIC GROUND / UNDER FLOOR DUCT GROUND PLUMBING -(�_ D ' UNDERFLOOR CONDUIT SLAB GRADE FIREPLACE FOUNDATION _ TEMP POWER FIREPLACE BOND BEAM WATER SERVICE MID HT BOND BEAM ROOF SHEATHING l 8 FT. BOND BEAM FRAMINGNENTILIATION FINAL BOND BEAM ROOF COVER PRE -GRADING ROUGH HEATING -Zo--00 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 _/,Do DEDICATIONS SEWER FINAL ENG. SEPTIC TANK _ -_ LANDSCAPE/IRRIG. SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST _ Zo - ap FINAL ZONING FINAL CONST _ 8 FIRE DEPT. FINAL _ 1 -40 FINAL HEATING HEALTH DEPT. FINAL �' ' - -Z FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY C COMMENTS GbL- l• Y c• ^1 \ z G 1f po J�}--✓ -� $ s� Jl� '� t -F vv eo SEPTIC TANK SIZE SEEP PIT/U SIZE � a f