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Home My WebLink About25595vi 0 O LL 0 U.1 z O z M cc O 0 w 0 w a U3 cn 52 Q O 0 w U Z W O U H O Z Q W O Z W Q W I— ]C 13C 9 LL CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21825 Copley Drive, Diamond Bar, CA 91765_ (909) 839-7020 Fax (909) 861-3117 Building Inspection Hotline (909) 83 7027 PRESS BUILDING PERMIT APPLICATION FIRMLY JOBSITE ADDRESS APN LOT TRACT OWNER Zla ogej T RJBA./ Stisire t 13LoSa ADDRESS ne ROC E ✓ -d - CITY'Dian,rb.3 13a#t_ ZIP i/o TEL." 0'/3&57 APPLICANT le, , F'iE.C&yfa+'-' TEL.7/1777 boVO CONTRACTOR H A 14 -Ck �ia7G� ADDRESS 1 A.Aq ita-)COCk st o 7 CITY ALP -1 a 9.111 i tl ZIP 9929V 7 TEL.7/q 7.775/0 O ARCH1/ENG/ /V DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE UW FOR THE FOLLOWING REASON (SEC.7031.5 BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REOUIRESA PERMIT TO CONSTRUCT, ALTER, IMPROVE, DEMOLISH, OR REPAIRANY 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 OROVISIONS OF THE CONTRACTORS LI- CENSE LAW (CHAPTER 6 (COMMENCING WITH SECTION)000) 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 FOR A PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (SSW).): 0I, 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 ANDPROFESSIONS 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 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). 0 I, 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 NOTAPPLY TOAN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). 0 1 AM EXEMPT UNDER SEC. B. & P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT (AM LICENSED UNDER PROVISIONS OF CHAPTER 6 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT. 7 LICENSE CLASS e 3 9 3 � LIC. NO.61f�3 + DATE 0 2IQ57D 7 CONTRACTOR /CLO /e M1 IOC � 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 jJJF 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 WORKERS COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER S % i4TE Pu, .� POLICY NUMBER / toy 7 y 3 ITHIS SECTION NEED NOT BE COA6LETEDOFTFE PEFW IS FOR ONE HLP.DRED DOL ARS (5100) OR LESS} I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, 1 SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SOAS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA AND AGREE THAT IF 1 SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR E. I SHALL F RTHWITH COMPLY WITH THOSE+PROVISIONS. DATE: D O O APPLICANT: (_GLS/ Fle �• 6'L6 S� WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL BE SUBJECT AN EMPLOYER 70 CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (3100.000). IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 3703 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. 3067, CIV. C.). LENDER'S NAME LENDER'S ADDRESS 1 CERTIFY THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL CT' 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. PER TT E (PRINT) 0340&.0-2 SIGNATURE OF PERMITTEE DAI E APPLICATION PERMITC�jGi— P/C DATE NUMBER J 1 gISSU TYPE OCC ` DA EE 2 enE!�(-GROUP CONST ZONING SETBACKS FRONT RW 0 REAR 0 SIDE/SIDE STREET RW 0 SIDE 0 PROPOSED USE % tsSe �J1 ST iG G .c Fe taJGA� a .viw..TG O NO. DWEL. NO. NO. _ UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREANALUATION SFR/ADD/REM In Garage/Carport WPatio/Deck LL Pool/Spa 0 Z Re -Root 0 Commercial - 3 m Valuation iaa''r% ADJ.AREA QUANTITY DESCRIPTION FEE Q U Q F U w w 0 _Z m Q _U Z Q U W 7 �V CONSTRUCTION p • PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE • 00 SMIP !� ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE -ALT FE I(�•DU TOTAL FEES to -cam COMMENTS C' RECPT. NO. 3SZ PAID BY - VALIDATION WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD --File Copy, GREEN—Applicant's Copy INSPECTION RECORD SET BACKFLOOR --- --- -- --- ---......._..__.._.._._._..------------- _....- --- -_ ..._......_.__....__... - JOIST __..._._......_._....--..._.._..-- --- -------._.._...----.-....._..._.._.._.._._.._._..-------------- - FTGS/FORMS/STEEL . -....---._..........---....._._.._.._.__................:..._._.....__.._._.___.....__...,_.._..-----------._.......__.......__......_...... -- _._... FHA REQMTS -- ----- ...-.._._.._..__...._.....____._...._................_..._.. --- -_-----._...-------.._.. - ---...- ELECTRIC GROUND _..._.._..... _- ....__....... ---...__.._....._._.-..;......_..._.._.._._..__._......._....._........._.__....---.._..........__....._......._._........_.._._._.._...._..._--- ' UNDER FLOOR DUCT ..._._._........_............_........__._.._...__..._....._.................:.....__.__...- ,.._.. - -= --- -- ...---._..._.__...--.._.....__._.__.........- - GROUND PLUMBING .................. ... ._. ... ... ._._ _._.. ; UNDER FLOOR CQNDUIT ...._ ._._...... ._. SLABGRAD . - _ _..__.. .._.. _.. .. ._... ... .............. ..... ......... __.._.. TEMP POWER FIREP WATER SERVICE , t . _..... ...... - _.......................... ....... -- MID HT, BOND BEAM _ ROOF SHEATHING /,� 8 FT. BOUD BEAM ` FINAL BOND BEAM_ FRAMING/VENTILATION ROOF COVER ;PRE GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC I ROUGH GRADING ROUGH PLUMBING ._._..-.... ... ----...---- - - .... _ ...__._.. --- ........__..._. FINISH GRADING _._..._......_._...._..............------......_..----......_...__..__..........__....._...._._.._,_._._..__..._..------------ ---------------- SHOWERi7UBTESTPO ...... ............._..__..._.._..... ... ..... -- ... -- ..................... _.......... _._.__........... - -...__.._._..._-.......... .._.... __....... --------- EXT. LATH/SIDING _...._.---.___.._..._..._.............._............___.....______...._.__.._..__.._..._....._...........___._..,-_--._..._.-._._.._.._._....----.._.___.__......_............----_.__ POOL FENCING. _-- ._..._.....__.._...._..--------_-...__._.____.__..._........_.__.._..-- WALL INSULATION ,..._..__...._....._...._._..__.........___.._...._._......._._._.._.------.._ POOL FINAL _._._...._-..__.._.........................._.__..__.._...----......__._.._..._...._.._..._.........._.._..._.._....._....._............._.....__.....__._._.........._...--......._.._...__.._......__._.., CEILINGINSULATION- __....._................._.._._._.. --......._......_............_...._............. _..._._..._..........._....._.. ..._.._................_....................._....--_.___._..._........._.._..__...._.....L......._.....__..._....._........_..__............................................_........._...-_-.._............_...__.._......._........ __........_......._..._.................._.........__._._......._..... ............ ... ... ......_..... _...... ..__._..._......_......_._._......_... _.__._.:.._...__......_.. DRYWALL NAILING -- DEDICATIONS SEWER _ _ _ _ FINAL ENG, SEPTIC TANK i LANDSCAPE/IRRIG. SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST I FINAL ZONING FINAL CONST, FIRE DEPT: FINAL FINAL HEATING 'HEALTH DEPT. FINAL FINAL .......... FINAL PLUMBING !ENERGY ENERGY rCOMMEINTS SEPTIC TANK SIZE SEEP PIT/U SIZE