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Home My WebLink About12-2038AP C Z Q C LL F a C a C 2 C LL L U F C u u CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 (909) 839-7020 Fax (909) 861-3117 Building Inspection Hotline (909) 839-7027 BUIL.DING PERMIT APPLICATION JOBSITE ADDRESS P/C APN LOT TRACT OWNER ADDR S CITYU1 P50K ZIP TEL. afij APPLICANT TEL. CONTRACTOR ADDRESS CITY ZIP TEL- ARCH/ENG/ DESIGNER ADDRESS TY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE ANY CITY OR COUNTY WHICH REQUIRES A PERMITTO CONSTRUCT, ALTER IMPROVE. DEMOLISH, OR REPAIRANY STRUG TORE. PRIOR TO RS 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 L CENSE LAW (CHAPTER 4 (COMMENCING WITH SECTION 7000) OF DIVISION 7 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 7071.5 BY ANY APPLICANT FORA PERMIT SUBJECTS THE APPLICANT TO A CIVIL,ENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (1500).): AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL E WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, BUSI- NESS D PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PRO RTY 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} ❑ 1, 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 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.). , ❑ 1 AM EXEMPT UND SEC.B. 8 P,C, FORT 'ISR DATE OWNER / LICENSED CONTRACTORS DECLARAT115N I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER Y (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS ODDS, AND MY LICENSE IS IN FULL FORCE AND EFFECT. LICENSE CLASS LIC. NO. DATE CONTRACTOR WORKERS' COMPENSATION DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: 1 HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPETNSATION, AS PROVIDED BY SECTION 7700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. i IHAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE AS REWIRED BY SECTION ' 37M OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT NS ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: ! CARRIER POLICY NUMBER (THIS SECTION NEED NOT BE COP LETEDOF THE PERMIT 6 FOR ONE HJPOREDOOLLALS(511M)OR LES% J 1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED. 1 f SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE j 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. 0 � DATE APPLICANT: 1 J WARNING: FAILURE TO SECURE WORKERSCOMPENSATION COVERAGE IS UNLAWFUL, AND SHALL BE J -_ SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($700,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN J SECTION 3708 OF THE LABOR CODE. INTEREST. AND ATTORNEY'S FEES. J CONSTRUCTION LENDING AGENCY m - 1 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. 3047. CIV. C.). C LENDER'S NAME LENDER'S ADDRESS C I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. LI 1 AGREE TO COMPLY WITH ALL CRY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING L CONSTRUCTION,ANDHEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE 0VE-M EDPROPERTY INNSP�EC-TIIONNPPURPOSES. dFOR 38 ADJ.AREA iPE EE NJAE (PRINT) n_ O SI RE OF PERMITTEE DATE (5).RESS FIRMLY APPLICATION u n y � Z PERMIT'�j�g 2D3 P/C DATE G' ( NUMBE # ISSUE ?/ 7i- TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE n n 11/71 NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ-AREA/VALUATION SFR/ADD/REM Garage/Carport WPatio 6 ooUSpa Z Re -Root 0 Commercial m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE Q U_ Q U W J W 0 z_ m J EL J Q U_ z Q 2 W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE -ALT FEE:If ^^�� V TOTAL FEES COMMENTS 12 RECPT NO. r10PAID B�ri VALIDATIW WHITE -Department Copy, YELLOW --Finance Copy, PINK—Assessor Copy, GOLDENROD—File Copy, GREEN—Applicant's Copy SET BACK - --------- FTC,'; W "FOR/STEEL - E LECTRIC GROUNID GRfj-Ijt,.ID FLUfviBING SLAB GRADE--------- TEMP POWER WY ."ER SERVICE ROOF SHEATHING FRAMING/VENTILATION ROOF COVER 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 AIR TEST FINAL CONST. 1 1-4 FINAL HEATING FINAL ELECTRIC FINAL PLUMBING FINAL PLANING FINAL ENGINEERING COMMENTS SEPTIC TANK SIZE SEEP PIT/U SIZE UF F'Y G F Di P.,� IV,! 0 N D GAEa JFLOORJOIST FHA REQMTS UNDER FLOOR DUCT UNDER FLOOR CONDUIT FIREPLACE FOUNDATION jFIREPLACE BOND BEAM j,vlID HT. BOND BEAM 18 FT BOND BEAM FINAL BOND BEAM PRE -GRADING BENCHING ROUGH GRADING FINISH GRADING POOL ELECTRIC POOL FENCING POOL FINAL OFF SITE IMPS. DEDICATIONS -- FINAL ENG LANDSCAPE/IRRIG. ON SITE IMPS. FINAL ZONING FIRE DEPT. FINAL FHEALTH DEPT. FINAL I DEV. FEES PAID !ENERGY