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Home My WebLink AboutPR 11-1636nr;��io�na�Kl, p(M R -F D CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY c� DEVELOPMENT SERVICES 21825 Co le Drip D' d B CA 9176- p .7 e, Iamon ar, (909) 839-7020 Fax (909) 861-3117 Building Inspection Hotline (909) 839-70 BUILDING PERMIT APPLICATION JOBSITE J D ADDRESS ��%ODoZ HDI �i l ]/T AY �%GJIilrTr(//Fi7✓ APN LOT TRACT i OWNER ADDRESS DO CITY - ZIP 5?? i TEL. CIDP- XJ-Zy APPLICANT O TEL. . C,4+ve s95 A� 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 U. CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT, ALTER IMPROVE, DEMOLISH, OR REPAIR ANY STRVO 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 LAY! (CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PRO. FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROMAND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECT S THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (SS00).): WIL❑ I. AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH LVAGES AS THEIR SOL COMPENSATION, NES DO THE WORK. AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE tSEC. 7044, BUST. 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 DAPROVEMENTS 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) I, AS OWNER OF THE PROPERTY. AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS 70 CONSTRUCT THE PROJECT (SEC. 704, BUSINESS AND PROFESSIONS CODE THE CONTRACTORS U. CENSE LAW DOES NOT APPLY TO AN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTORS) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW). �AM EXEMPT UNDER SEC. B. d PC FOR THIS REASON DATE /1-5L I / OWNER /r LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AA LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 O 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: 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 REDUIRED BY SECTION 3700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR YMICH THIS PERMIT IS ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE CARRIER POLICY NUMBER (NNIS SECT)ON NE® NOT BE COYPLETED OF TF=_ PEFU.YT LS FOR ONLF Rk&RED DQULAR.S (SILO) OR LESS) I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT LS 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 37M OF THE LABOR CODE. I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE: APPLICANT: WARNING: FAILURE TO SECURE YORKERS COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL BE SUBJECT AN EMPLOYER TO CM -ANAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($10D,000), IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 3705 OF THE LABOR CODE, INTEREST ANDATTOR/NEYS FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORIAANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED ISEC. 3097, CIV. C.). LENDER'S NAME LENDER'S ADDRESS 1 CERTIFY THAT I HAVE READ 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 ASOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. '140 iN 1..0v PERMITTE NAM RIN71 i� /r N / O ERMNTEE DATE VVHI I E --Department Copy, YELLOW—Finance Copy, PINN PRESS FIR LY APPLICATION PERMIT DATE NUMBER ISSUE 0 DATE TYPE OCC �� CONST. GROUP ZONING SETBACKS FRONT RW REAR SIDE/SIDE STREET RW SIDE PROPOSED USE Iw Ci ✓LA n (t -y G, NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREANALUATION SFR/ADD/REM U) Garage/Carport WPatio/Deck G' LL PooUSpa Z Re -Root 0 Commercial m Valuation QUANTITY DESCRIPTION ADJ AREA FEE Q U RE I.- 0 U W J W C) Z_ m OL OL J Q _U Z Q 2 U W CONSTRUCTION PLAN REVIEW= jt iS- ELECTRIC r PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP 4 ENERGY P/C T ENERGY PERMIT RETENTION FEE: ..d P�-AyT FEE TOTAL FEES COMMENTS RECPT. NO.PAID BY VALIDATION '.+Py- wpy. UHEEN—Applicant's Copy CITY OF DIAMOND BAR INSPECTION RECORD SET BACK FLOOR JOIST FTGS/FORMS/STEEL ELECTRIC GROUND FHA REOMTS UNDER FLOOR DUCT �- GROUND PLUMBING UNDER FLOOR CONDUIT SLAB GRADE FIREPLACE FOUNDATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICE MID HT. BOND BEAM ROOF SHEATHINGI FRAMIi Iw/VENTILATION ROOF COVER 11 �l Lk A -- SFT. BOND BEAM � 1 FINAL BOND BEAM PRE -GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC _ ROUGHGRADING ROUGH PLUMBING FINISH GRADING SHO`,N_R/-1 UB TEST POOL ELECTRIC EXT. LATH/SIDING � POLL FENCING WALL INSULATION CEILING INSULATION --- POOL FINAL �- DOFF SITE IMPS. - DRYWALL NAILING DEDICATIONS SEWER FINAL ENG. SEPTIC TANK _ LANDSCAPE/IRRIG, SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST _ FINAL ZONING FINAL CONST FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC - - - ----------------`----- DEV. FEES PAID --- FINAL PLUMBING_ COMMENTS ------------------- -- =-- ---------- - - .----- - _-- - SEPTIC TANK SIZE SEEP PIT/U SIZE - ------ --