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Home My WebLink About17790CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21825 E. Copley Drive (909) 860-3195 Fax (909) 861-3117 j BUI�IN�',( PERMIT APPLICATION J ' i r5 r JOBSITE ADDRESS' APN LOT TRACT j OWNER ''C7ier -�Z'EVAI ADDRESS�!,tIA7 w1 IDYL _ CITY 17 %'6M2- ZIP TEL -$ 3 APPLICANT TEL. CONTRACTOR ' ADDRESSL3U Z LtrCl- OITYSAAj ram: �LJ1�xx� U' IP y1Q TEL 1� u ARCFVENG/ s DESIGNER i ADDRESS CITY ZIP TEL. n n = OWNER -BUILDER DECLARATION � I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LL L CENSE LAW FORTHE FOLLOWING REASON (SEC.70.T1.S BUSINESS AND PROFESSIONS CODE: ANY CITY OR -i COUNTY WHICH REOUIRESAPERMITTO CONSTRUCT ALTER IMPROVE, DEMOLISN.OR REPAIR ANYSTRUC. TUBE. 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 LH rr CENSE LAW (CHAPTER 6 (COMMENCING WITH SECTION 7000) OF DIVISION S 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 T031.6 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS IS600).): O L AS OWN EA OF THE PROPERTY. OR MY EMPLOYEES WITH WAG ESAS THEIR SOLE COMPENSATION. Z WILL DD THE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. TON, BUSI- NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO SURDS OR IMPROVES THEREON. AND WHO DOES SUCH WORK HIMSELFOR HERSELF OR i THROUGH HIS on HER OWN EMPLOYEES. PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR 1J OFFERED FOR SALE IF. HOWEVEFLTHE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE- TION. THE OWNER-8UILTIER WILL HAVE THE BURDEN OF FROVING THAT HE OR SHE DID NOT BUILD OR Z IMPROVE FOR THE PURPOSE OF 6ALEI. O I. AS OWNER OFTHEPROPERTY.AMEXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. TGu• BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS U- CENSE LAW DOES NOTAPPLYTOAN OWNER OF A PROPERTY WHO BUILDSOR IMPROVES THEREON. AND S W40 CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LOENSEDPURSUANT TOTHE CONTRAC- TORSUCENSELAWJ. " O O 1 AM EXEMPT UNDER SEC. B. i P.C. FOR THIS REASON V" DATE OWNER Z 4� LICENSED CONTRACTORS DECLARATION CC I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER CL 6 (COMMENCING WITH SECTION ?Goo) OF DIVISION S OF THE BUSINESS AND PROFESSIONS CODE. AND !G MY LICENSE IS N FULL FORCE AND EFFECT. l101 LICENSE CUSS ir' !L �+ LIC. NO. ��L./ 190 U DATE Dgrf - Ua. A CONTRACTOR?!h! Alf f CC) w .. WORKERS' COMPENSATION DECLARATION In I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: to C] I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-NSURE FOR WOPJ(ERS' QZ COMPENSATION. AS PROVIDED BY SECTION]700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FORWHICH THIS PERMIT IS ISSUED. =1 HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE. AS REOUIRED BY SECTION ST00 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FDA WHICH THIS PERMIT IS ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER POLICY NUMBER PHIS SECTION NEEDNOT SECOMPLETEDOFTHE PERMIT S FORONE HUNDRED DOLLARS (S100)OR LE55). 1LJ Z 1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. 1 53 SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE w WORKERS' COMPENSATION LAWS OF CALIFORNIA. AND AGREE THAT IF I SHOULD BECOME S SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE.1 SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. CD OATE:O 3—V4Ion APPLICANT. �� CD WARNING! FAILURE TO SECURECRIMINAL PEN COMPENSATION COVERAGE IS ONE HUNDRL. ED T OUSASHALD � BE SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (5100.000). IN ADDITION TO THE COSTOF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 3 70a OF THE LABOR CODE, NTEREST.AND ATTORNEYS FEES. d CONSTRUCTION LENDING AGENCY I HEREBYAFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY d FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3067, CW. C.). Hi gi LENDERS NAME I- LENDERSADDRESS WI ON CERTIFY THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. Q IAGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATNES OF THIS COUNTY TO ENTER UPON THE y ABOVE MENTIONED PROPERTY FOR INSPECTION `PURPOSES- 9 v O m PERMITTEEN HT) N r� SIGNATURE F PERMITTEE DATE WHITE —Department Copy, YELLOW —Finance Copy, PI PRESS FIRMLY APPLICATIO DATE �v2— PERMIT P/C NUMBER,/7�9a ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS RW ❑ REAR ❑ LiFRONT SIDE(SIDE STREET RW ❑ SIDE ❑ PROPOSED USE �arL oft 2 CE+ -_5_� -7 —n S+ t6 NO. DWEL. NO. NO.' G�iO UNITS STORIES BEDROOMS DESCRIPTION Q. FT. FACTOR PSF ADJ. AREANALUATION SFR/ADD/REM D) Garaga/Carport WPatio/Deck LL PooVSpa u Z Re -Roo( , E5Commercial m Valuation ADJ.AREA OUANTITY DESCRIPTION FEE Q U_ U W W a Z m J a. U Z 4 S W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE f �- SMIP ENERGY P/C _ ENERGY PERMIT iLL.� RETENTION FEE: PRE-ALT FEE: TOTAL FEES COMMENTS RECPT. NO. PAID BY VfftVALIDATION NK—ASSaSSOr L:Opy, UULLItNhULI rR ,Opy, aancc pP--- a —pry �. � .. .. .... �.y. 1' ...A „ ..•.�... v . .'f.r. •� .. v br"i'1• a.. �.'"� Y.. . ,.• ^tR' :;! ,: _ _ ,.. - .. � cr . r. CITY OF DIAMOND BAR INSPECTION RECORD -- SET BACK FTGS/FORMS/STEEL ELECTRIC GROUND GROUND PLUMBING SLAB GRADE ' TEMP POWER WATER SERVICE ROOF SHEATHING FRAMINGNENTILIATION ROOF COVER I ROUGH HEATING ROUGH ELECTRIC ROUGH PLUMBING SHOWER/TUB TEST EXT. LATH/SIDING WALL INSULATION CEILING INSULATION DRYWALL NAILING SEWER SEPTIC TANK SEEP PIT/L.L. GAS AI R TEST FINAL CONST. FINAL HEATING FINAL ELECTRIC FINAL PLUMBING COMMENTS SEPTIC TANK SIZE SEEP PIT/U SIZE - FLOOR JOIST FHA REOMTS _ UNDER FLOOR DUCT UNDER FLOOR CONDUIT I FIREPLACE FOUNDATION FIREPLACE BOND BEAM MID HT. BOND BEAM 3� Z��• 8 FT. BOND BEAM I FINAL BOND BEAM 17P-1aPRE-GRADING BENCHING ROUGH GRADING FINISH GRADING -j POOL ELECTRIC j POOL FENCING I POOL FINAL j OFF SITE IMPS. -� DEDICATIONS FINAL ENG. j LANDSCAPE/IRRIG. I ON SITE IMPS. FINAL ZONING FIRE DEPT, FINAL j HEALTH DEPT. FINAL DEV. FEES PAID ENERGY