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Home My WebLink About12-2183C 0 Cr O W 0 LU z O 0 z DID 4 Cr O 0 ILL! 0 z LU a cnCnCn Cn cc O 0 W U Z w O U O Z Cc W CI Z LU W Lu W 2 rr Y O W Z O a - W O U W cn za Q C W a C C Z C LL C: U C C LL LL a u ❑ C ❑ CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES I 21810 Copley Drive, Diamond Bar,,CA 91765 L (909) 839-7020 Fax (909) 861-3117 Building Inspection Hotline (909) 839-7027 PRESS BUILDING PERMIT APPLICATION FIRMLY JOBSITE ADDRESS APN�� LO �— TRACT OWNER (•�T 22E ADDRESSL CITY [� 45�iVJr 13t'4� ZIP TEL APPLICANT �! TEL. CONTRALTO _ 7 ADDRESS CITY ZIP 3 TEL. ARCFVENG/ 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 C.00E: ANY CITY OR COUNTY WHICH REWIRES A PERMITTO CONSTRUCT, ALTER IMPROVE, DEMOLISH, OR REPAJR ANY 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 PROVISIONS OF THE CONTRACTORS LI- CENSE LAW (CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PRO. FESSIONSCODE) 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 ACIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (SSW).): 111, 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. 70a , 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). ❑ 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 NOT APPLY TO AN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAG TORS LICENSE LAW.). ❑ 1 AM EXEMPT UNDER SEC. B. & P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION TOM) OF DIVISION 3 O THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT. LICENSE CLASS �� LIC. NO. v �� DATE ZZ'�2 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 REQUIRED BY SECTION 3 700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY ,WORKERS' COMP SAT/I�j�,NS,U.R/A�CE CHARIERAND POLICY NUMBER ARE: CARRIER ff��C/ /L -y,/! I�a7I/[L�G G% L/�Li� •CCS POLICYNUMBER To�d7^/LA� (THIS SECTION NEED NOT BEOOhPLETmCFTHE POW IS FOR ONE HUNDRED DCUARS ($10MOR LESS 1 I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, 1 { SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE j WORKERSCOMPENSATION LAWS OF CALIFORNIA. AND AGREE THAT IF 1 SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE, IS FORTHWITH COMPLY WITH THOSE' iL0 IONS. /�/lf DATE �` r APPLICANT: J J WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL BE J _ SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CNIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN J SECTION 3709 OF THE LABOR CODE INTEREST. AND ATTORNEY'S FEES. J CONSTRUCTION LENDING AGENCY - I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS ACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORT( FOR WHICH THIS PERMIT IS ISSUED (SEC. 3097, CIV. C.). J - LENDERS NAME LENDER'S ADDRESS C 1 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. U I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION. AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO EWER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES i PEAMITT AME (PRINT) , �jPMNATURE OF P RMRTEE DATE L APPLICATION l 2 PERMIT I Z , Z193 P/C DATE NUMBERS # ISSUE TYPE ��,� OCC DATE � � CONST I.rL�=,C7 t GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USENO. DWEL. NO. ) NO. UNITS STORIES 6 BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION SFR/ADO/REM U) Garage /Carport W Patio/Deck LL Pool/Spa 0 Z Re -Roof 0 Commercial M Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J Q U Q F -- U W J W L1 Z Go M 0 J D- Q U_ Z Q x W ✓ ' CONSTRUCTION ` PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE Z, �� ISSUANCE ✓ SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: - �PRE E--A.LTT FELE: TOTAL FEES 3 COMMENTS f RECPT NO. PAID BY VALIDATION WHITE—Department Copy, YELLOW—Finance Copy. PINK—Assessor Copy, GOLDENROD --File Copy, GREEN—AppllpnCs Copy P E Fi E C OFID' h, SE1 BACK -K, ELi �2 LOOK GIST 'FHA REQ,,,ATS la i_ML ;ULM ;_LEC IRIC GROUINID GRC)UND PLU'VIBING SLA B GRA DE UNDER FLOOR DUCT -- - ------- -" - -- UNDER FLOOR CONOUIT FIREPLACE FOUNDATION FENIP POliVEfl, v,j/vrE.R SERVICE ---- ROOF SHEATHING - - _ -- FIREPLACE BOND 6EAM vlID HT. BOND BEAM 8 FT. BOND BEAM FRAMING/VENTILATION FINAL BOND BEAM ROOF COVER PRE -GRADING ROUGH HEATING ROUGH ELECTRIC BENCI41'NG I - ROUGH GRADING ROUGH PLUMBING SHOWER/TUBTEST _EXT LATH SIDING FINISH GRADING POOL ELECTRIC POOL FENCING WALL INSULATION POOL FINAL CEII-IiNG INSULATION OFF SITE IMPS. DRYWALL NAILING IF i DEDICATIONS SEWER SEPTICTAN-K FINAL ENG. FCil�D S C AFEJ'l Ii R I G. SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST. FIRE DEPT F!NAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY FINAL PLANING FINAL ENGINEERING 6 MINE 4 M-Iffliftim MINE, 2 COMMENTS SEPTICTANKSIZE SEEP PIT/U SIZE