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Home My WebLink About13-917cri 0 w U1,1�IO�D�U,11i i CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 (909) 839-7020 Fax (909) 861-3117 ]Building Inspection Hotline (909) 839-7027 BUILDING PERMIT APPLICATION JOBSITE / A a . rvLw ADDRESSX2D71%Y E. G2.r:-Si / kwil-, G� A_h_ gj7B9 APN LOT TRACT OWNER %V11 c, I�lnn/n�trl�dc�o��D ' vl 1) . �AA ADDRESS ZJV q 4 t . C.f� <+y ma c' CITY.niiaA&' 4 BiNg ZlpC?j7Bq TEL.C65514-Veob APPLICANT TEL. CONTRACTOR ADDRESS CITY ZIP TEL ARCH/ENG/ 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. 7D31.5 BUSINESSAND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REQUIRES A PERMIT70 CONSTRUCT ALTER, IMPROVE. DEMOLISH, OR REPA:R ANY STRUC- TURE, PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR 5HE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW (CHAPTER Y (COMMENCING WITH SECTION 7DOO) 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 7031.5 BY ANY APPLICANT FORA PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS ($5OD).): ❑ 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 YEAROF 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): ❑ 1, 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 OFA PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). p I AM EXEMPT UNDER SEC. B. A P.C. FOR THIS REASON DATER Y -?.- � L OWNERVY ✓}`'�i+-�"�� n LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM 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 EFFECT. LICENSE CLASS LIC. NO. DATE CONTRACTOR WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: _IHAA��YYE 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 1 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 WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: I CARRIER POLICY NUMBER 9MISSECilONNEEDNOTSEODMI LETEDOFTHE PE3MT IS FOR CNEHNNORED DCU_ARS(SiW)ORLESS1 1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I 3 SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE j 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: X 4•L( 1w713 APPLICAM:/, 1 j WARNING: FARLRE 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 t150o,000), IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR 1" J SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY 1 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. 3097, CIV O). 3 LENDERS NAME LENDER'S ADDRESS C I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. LJ I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING L CONSTRUCTION. AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE 7 .ABBOOVVEE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. j A lit FV !'1 � _ T PE fTTEE NAME (PRINT) X y.:.I(9L3 n Y 1 rV1� n SIGNATURSOF PERMITTEE DATE L WHITE —Department Copy, YELLOW --Finance Copy, PINK —assessor L opy, uuwtn"Uu Ile wpy, unccOv Vvl cagn a a vy PRESS FIRMLY APPLICATION {{ PERMIT P/C DATE 44 \ ZAyf S3 NUMB1 ER R ' #ISSUE -� DATE�q 1 CONTYPOCC CONST. GROUP ZONING SETBACKS FRONT ❑ REAR ❑ SIDEISIDE STREET RW ❑ SIDE ❑ PROPOSED USE jFff LAC-w C"ary^ T W IA L. I.0 i nlJ1 NO. DWEL. NO. NO. UNITS STORIES Z BEDROOMS 2- DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREAIVALUATION SFR/ADD/REM to Garaga/Carport LU Patio/Deck LL PooUSpa 0 Z Re -Roof Commercial m ValuationY_'39Cyn•dD ADJ.AREA QUANTITY DESCRIPTION FEE J Q U CC F U W w 0 Z m J a J ' U Z Q W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SV SMIP ' ENERGY P/C ENERGY PERMIT RETENTION FEE: I PRE-ALT FEE: sS S TOTAL FEES COMMENTS RECPT. NO. 14 CU .� PAID BY 45Sa, VALIDATION 40 crry OF DIAIMOND GAR � %il S P E i"I'l T 10 IN RE -%-." 0 R D R . . . . .@ -XV ;.AL7% 51,10 SET BACK LOOR JOIST FTGS ;FORM (STEEL S. -------- - ----- ------- 'FHA REON1TS, ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUN18ING UNDER FLOOR CONDUIT SLAB GRADE i FIREPLACE FOUNDATION FIREPLACE BOND BEAN( TEMP POWER WATER SERVICE LAID HT BOND BEAM 18FT. BOND BEAM ROOF SHEAl'HING FINAL BOND BEAM FRAMING/VENTILATION ROOF COVER PRE -GRADING ROUGH HEATIN.G_________ i F_ 1 BENCHING ROUGH ELECTRIC ROUGH PLUMBING ROUGH GRADING FINISH GRADING SHOWER/TUBTEST POOL ELECTRIC EXT LATH/SIDING POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER L FINAL ENO. SEPTICTANK I LANDSCAPE/IRRIG. SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST [Fl EJALZZONING FINAL CONST. FIRF. DEPT. FINAI_ FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC I DEV. FEES PAID FINAL PLUMBING FINAL PLANING iENERGY FINAL ENGINEERING COMMENTS SEPTIC TANK SIZE SEEP PIT/U SIZE