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Home My WebLink AboutPR11-912CITY 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) 839-7020 BUILDING PERMIT APPLICATION '40PSITE I AIDDREtX,, APN LOT d TRACT OwNEOA_" ADDRESS'...11;n!5 501- CITY 1 a TEL. APPLICANT TEL. 1 CONTRACTOR X P.. Ir -0 g=0 t -7'f V ADDRESS I S-rl Al 6 01N -U;= CITY i KS�JA' GAP Z10 '1177 TEL-.' b -bZ2 ARCH/ENG/ A DESIGNER - y_ NE —ptAj ADbRESSI , 2-;7ak 5-/,/jV6t_rZ_ E7 -- CITY, /Z.V91EiL4Ifi_A-s:7' zip 2/77C TEL. kLjnk-_-5 7,— OWNER-16UILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS Ll CENSE LAW FOR THE FOLLOWING REASON (SEC. 7*31.5 BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REOU InREBA PERMIT TO CONSTRUCT, ALTER, IMPROVE. DEMOLISH, OR REPAIR ANY STRUC. TORE, 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 U - CENSE LAW (CHAPTER 9 (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 THE ALLEGED EXEMP. TION. ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (SSW).): 0 L AS OWNER OFTHE 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. 70", SUSI. 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 WFTHNONEYEAROFOOMPLE. TIM, THE OWNER'OUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE 00 NOT BUILD on IMPROVE FOR THE PURPOSE OF SALE). 0 LAS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS To CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS ODDS. THE CONTRACTORS LI. CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY VIM BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH A OOINTRACTOA(S) LICENSED PURSUANT TO THE OONTRAC. TORS LICENSE LAW.). OIAMEXEMPT UNDER SEG B. &P.C. FOR THIS REASON if DATE OWNER LICENSED CONTRACTORS DECLARATION HERESY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS Or CHAPTER C WITH H . (COMMENCING SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE is IN FULL FORCE AND EFFECT. CENSE CLASS 49 LIC. NO. j< TE_ sa 7 1 liz, CONTRACTOR WORKERS' COMPENSATION DECLAR w1 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 37000E THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 13 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 Alf) PoLrCYNUMsER noo mm sEq.noN NEED NOT BE COMPLETED OF THE PERMIT IS FOR ONE HLINDRED DOLLARS (SIOD) OR LESS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS 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 WORXSRS* COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE, I SHALL FORTHWITH COMPLY MRN THOSE PROVISIONS. DATE: — APPLICANT., WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP 70 ONE HUNDRED THOUSAND DOLLARS (3100.000), 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. 3007. CIV. C,). LENDERS NAME LENDERS ADDRESS CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT 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 (PRI 4 . . x SIONATUREC7ERM DATE/ PRESS C110111,11111 V APPLICATION PERMIT P/C DATE NUMBER ISSUE TYPE OCC R% DATE CONST GROUP ZONING SETBACKS FRONT RW 0 REAR 0- SIDE/SIDE STREET RW 0 SIDE 0 PROPOSED I USLX NO. DWEL. NO. NO UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATIOW SFWXD-D')REM #1Z GaragatCarport W W Pallo0eck LL 0 Poot/Spa Z Re -Roof Commercial Ib Vafuafion)(_!!�� '6fC:ot� ADJ.AREA_ QUANTITY DESCRIPTION FEE IM J, Z 00 Z CONSTRUCTION PLAN REVIEW es. zos ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C as ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: oQ. F -w. TOTAL FEES 4-a 4. COMMENTS PI N�7 7 LRECPT NO. PA-, BY 1 5 VALIDATION I —Ijy. , -"VYY—rMwme "Opy, ritmR—Assessor copy. GOLDENROD—File Copy, GREEN --Applicant's Copy �'• � I 1 II i�, ,i CITY OF DIAMOND BAR INSPECTION RECORD coa SET BAC :'' FLOOR JOIST I 'f ,TGS/FORMS/STEEL y. FHA REQMTS _. tLiEbTRIG GROUND UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR CONDUIT SLAB, GRApE' • ' FIREPLACE FOUNDATION "TEMP POWER,i I' (FIREPLACE BOND'BEAM, .WATER. SERVICE MID HT BOND BEAM ROOF SHEATHING .'8 FT. BOND BEAM FRAMINGNENTILATION •� l� "'� !FINAL BOND BEAM ROOF COVER i ', 'PRE -GRADING ROUGH HEATING BENCHING :ROUGH; ELECTRIC ROUGH GRADING ROUGH'PLUMBING " ; ' FINISH GRADING, bHOWER/TUB TEST' ,POOL ELECTRIC(. EXT. LATH/SIDING `POOL FENCING ' v ALL INSULATION POOL FINAL CEILING INSULATION DRYWALL NAILING ' SEWER 1 OFF SITE IMPS. DEDICATIONS FINAL ENG. SEPTIC TANK LANDSCAPE/IRRIG. ;SEEP PIT/L.L..• ON SITE IMPS. GAS TEST FINAL ZONING,Wu 'FINAL CONST FIRE DEPT. FINAL FINAL HEATING HEALTH, DEPT., FINAL 'FINAL ELECTRIC DEV. FEES PAID `FINAL PLUMBING ENERGY COIVIMEIVTS (� 'L • — 4zko:,r,�-tet ,�x�•.tr ��+�• AN ' f ' •'t�pl F/@C f f3�6 OiE�' !"-�{/ '0 IdfdO�! '4z C.IKJ V ilpl o�r3 �A f gntd aqc i'�i G7/ "gid f ` z• 28/_3 (� SEPTIC TANK SIZE SEEP PIT/U SIZE (XGA/ <57*