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Home My WebLink About14247CITY OF DIAMOND BAR EXPIRED DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 111A,110NII IIAI 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION JOBSITE ADDRESS APN LOT TRACT OWNER L 6--c- e, -,-) ll ADDRESS 2IJI l -k—Ve b 0' CITY 0 , - ZIP-- J,)d TEL.t'bi APPLICANT _ L. CONTRACTOR ADDRE S CITY L 6ti 4tQGN ZIP Q/V TEL. 3 9 - Nc ARCFVENG/ DESIGNER 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 THE FOLLOWING REASON (SEC. 70.71.E BUSINESS AND PROFESSKNNS CODE: ANY CITY OR COUNTYWHICH REWIRESA PERMIT TO 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 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 THEALLEGED 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 (i600).): ❑ I, AS OWNER 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 WHO 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 OFOOMPIE. TXMN, THE OWNERAUILDER 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. 70", BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S) LICENSED PURSUANTTO THE CONTRAG TORS LICENSE LAW.). O I AM EXEMPT UNDER SEC. B. & P.C. FOR THIS R DATE U — O LICENSED CONTRACTORS bEdLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER Y (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND T. �D EFFECT p LICENSE CUSS ` 1 L(C. NQ. 6 Z / o IF DATE �o�L.o/S5 CONTRACTOR �/1/T'Neo✓I S/S� 1 WORKERS' COMPENSATION DECLARATION I 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 REQUIRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WOR�COMPENNSATiIOO1N INSURANCE CARRIER AND POLICY NUMBER ARE : CARRIER +ll ; Kn✓�/L1 POLICY NUMBER - (n-US SECTION NEED NOT BE COMPLETED IOFTFE PERMIT IS FOR ONE HUNDRED DOI ARS($100) OR LESS) I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I SHALLNOT 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 S�jCTIO N 37M OF THE LABOR CODE, I SHALL FORTHWITH COMPLY WI THOSE PROVISIp DATE: j.jjAPPLICANT. �- WARNING: FAILURE TO SECURE WORKERV COMPENSATION COVE, GE IS UNLAWFUL, AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 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 (SEC. 3071, CIV. C.). LENDERS NAME LENDER'S ADDRESS I CERTIFY THAT I HAVE REAL? 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 CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE -MENTIONED PROPERTY FOR INSPECTION PURPOSES. PERMITTEE NAME (PRINT) SIGNATURE OF PERMITTEE DATE WHITE —Department Copy, YELLOW —Finance Copy, PINK MAY 0 9 2003 PRESS FIRMLY APPLICATION PERMIT L/1(f'1 P/C III LAO- DATE 1 NUMBER # ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE O /" Z iQ f Q /` e /tG� 3 ® NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM 4 Garaga/Carport p LwLI Patio/Deck u- POOI/Spa 0 Z Re•Rool CI Commercial m atlon 0 ADJ.ARFA QUANTITY DESCRIPTION FEE �S d d v U W J W Z_ mNnv In C a 9 U r �rA U QA Z Q u 2 U W CONSTRUCTION I j ta Id PLAN REVIEW \ ELECTRICV EA Q C7 PLUMBING MECHANICAL INSPECTION FEE Q ISSUANCE SMIP I ENERGY P/C ENERGY PERMIT RETENTION FEE: - 00 6 PR FE TOTAL FEES COMMENTS RECPT. N PAID BY VALIDAT �7- DOPY, t;HthIN—Applicant's Copy r � CITY OF DOAMOND FAIR INSPECTION RECORD .. WW a d- Q • #F,'... SET BACK FLOOR JOIST; . , • _ . , , FTGS/FORMS/STEEL FHA REQMTS ELECTRIC GROUND UNDER FLOOR DUCT ' GROUND PLUMBING UNDER FLOOR CONQ IT;,.,. i. ," ;' r-`_ SLAB GRADE FIREPL:ACF_:+0JjNDATION ; I" TEMP POWER FIREPLACE BOND BEAM WATER SERVICE MID HT. BOND BEAM ROOF•SHEATHING '• .. ' ; .. 3 :. %, ! . 8 FT. BOND BEAM, FRAMING/VENTiUATIpN,' ; " ''' FINAL BOND BEAM ROOF COVER PRE -GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWERITUB 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. r� i A!R TEST FENAL CONST.. - 71 _ ON SITE IMPS. FINAL ZONING FIRE DEPT. FINAL HEATING_ HEALTH DEPT. FINAL- 1 '-�'`• �, ELECTRIC DEV. FEES PAID '.. PLUMBING ENERGY COMMENTS SEPTIC TANK SIZE SEEP PIT/U SIZE