The URL can be used to link to this page

Home My WebLink AboutPR12-2031LL O U 0 C O O `U 2 F C L C DIAMOND 'BAR i 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 BUILDING PERMIT APPLICATION JOBSITE ADDRESS C 1 /p� �S1 S�q Ow C/-�1, APN LOT TRACT OWNER ADDRESS CITY ZIP TEL. APPLICANT TEL. CONTRACTOR +� ADDRESS L` CITY 1416% I -le., ZIP I/ 0 -C TEL. ARCWENG DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FORTHE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REWIRES A PERMITTO CONSTRUCT, ALTER. IMPROVE. DEMOLISH, OR REPAIRANY STRUC- TURE. TRUGTURE. 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- 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 ($500).): 01, 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. 7044, 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- TON, THE OWNER -BUILDER WALL RAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). ... 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 A CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS UCENSE LAW.). 0 1 AM EXEMPT UNDER SEC. B. & P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT. n LICENSE CLASS 41-1/0 LIC. NO. Cy DATE /I-.�G - /.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 PEP.FCHMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. 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 p� �� gI L,ie l, -Ac F /� POLICY NUMBER IT ro - Jr.* fr;, 70 i (THIS SECTION NES NOT BE COMPETED OF THE PERMT IS FOR ONE HUNDRED DC/.IARS WWI OR LESS) I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH TNIS PERMIT 15 ISSUED, 1 { 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 3700 OF THE LABOR I CODE.I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. 1 1 DATE: APPLICANT: 1 j WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN i SECTION 3708 OF THE LABOR CODE INTEREST. AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY i_ I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS ACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3097, CIV. C.). i_ LENDER'S NAME LENDER'S ADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. 1 AGREE TO COMPLY WITH ALL CIN AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS,CW NTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. J PERMITTEE VAr(psi" o O SIGNATURE OF PERMITTEE DATE PRESS FIRMLY APPLICATION PERMIT 'Pi2 P/C DATE NUMBERta ^ TQC \ It ISSUE �l !� TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE i NO. DWEL NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION SFR/ADD/REM U) Garage/Carport WPatio/Deck LL Pool/Spa Z Re -Roof Commercial - m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE . J Q U cc H w W J w 0 Z_ V I An if - CO 7 J d 04 1 J U_ Z Q 2 1 51 W CONSTRUCTION PLAN REVIEW ELECTRIC SB • 4� PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMTP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: TOTAL FEES qs • a COMMENTS RECPT. NO. 1353 -1 PAID BY S VALIDATION WHITE—Department Copy, YELLOW --Finance Copy, PINK—ASSBSSor Copy, GOLDENROD—File Copy, GREEN—Applicant's Copy b� y F .. J* SET BACK FTGS/FORf,ASlSTFEL ELECTRIC GROUND GIROUND Pt,Ufv!BING SLAB GRADE TEMP POWER WATER SERVICE ROOF SHEATHING FRAMING/VENTILATION ROOF COVER ROUGH HEATING I ROUGH ELECTRIC zz, ....... ... I ----- ------ .... . ..... FLOOR JOIST FHA REQMTS ...... ...... UNDER FLOOR DUCT UNDER FLOOR CONDUIT FIREPLACE FOUNDATION FIREPLACE BOND BEAM MID HT BOND BEAM 8 FT BOND BEAM . . . . . . . . . . FINAL BOND BEAM I PRE -GRADING BENCHING 1 ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWERITUBTEST POOL ELECTRIC EXT. LATH ' !SIDING POOL FENCING WALL INSULATIONPOOL CEILING INSULATION FINAL DOFF SITE IMPS. DEDICATIONS DRYWALL NAILING SEWER--.-. SEPTICTANK SEEP PIT/L.L. GAS AIR TEST FINAL CONST. FINAL HEATING FINAL ELECTRIC Q FINAL ENG. I LANDSCAPEARRIG. ON SITE IMPS. -FINAL ZONING j FIRE DEPT. FINAL HEALTH DEPT. FINAL j DEV. FEES PAID FINAL PLUMBING ENERGY FINAL PLANING FINAL ENGINEERING COMMENTS L SEPTIC TANK SIZE SEEP PIT/Ll SIZE F If i 1:11:11IL;