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Home My WebLink About11751DIAMIND HAK!1 CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICE 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 BUILDINQ PERMIT APPLICATION JOBSITE ? ,! ADDRESS eG. 3 Y2 % 4M 4C wick APN LOT TRACT OWNER L tw ADDRESSF �A 4a f��" CITY ® ZIPaf71f-- TEL APPLICANT Fr' -E'- TEL l� CONTRACTO a ADDRESS CITY ZIP TEL. ARCH/ENG/ DESIGNER ADDRESS CIN ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERIURY THAT I AM EXEMPT FROM THE CONTRACTORS U G85E LAW FOR THE FOLLOWNO REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE ANYCITYOR COUNTY YA#CH P£OIARESA POUHTTo CONSTRUCT, ALTER IMPROVE, DFAOUSK OR REPAIR ANY STRUF TURF. 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 I.I. CFNSE LAW (CHAPTER i (COMMENCING WITH SECTION 7=) OF DIVISION 3 OF THE BUSINESS AND PRO FESSIONS OODE)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 TYEAPPLICART TO A CMl PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (fsoD)-k ❑ L ASOWNEROFTHE PROPERTY OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK AND THE STRUCTURE 15 NOT INTENDED OR OFFERED FOR SALE (SEC 70M, BUSI- NESS AND PROFESSION$ CAGE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTYINq WNL" OR IMPROVES THEREON, AND WHO DOES SUCH WORK HR/SELFOR HERSELF OR THROUQH MS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE F. HOWEVER THE BUILDMgOR IMPROVEMENT IS SOLD WRMNONEYEAROF COMPLE. TON, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT MAID OR IMPROVE FOR THE PURPOSE OF SALEIL LASOMNEROFTHE PROPERTY. AM EXCLUSIVELYCONTRACTNG WITH LICENSED CONTRACTORS To CONSTRICT THE PROJECT (SEC. 70M, BUSINESS AND PROFESSIONS COOS THE CONTRACTORS LI CENSE LAW DOES NOTAPPLYTOAN OWNER OF A PROPERTY WHD BUILDS OR IMPROVES THEREON, AND W OCONTRACTS FOR SUCH PROJECTS WITHACONTRACTOR(S) UCENSEDPURSUANTTOTHE CONTRAC- TORS ONTRAGTORS LICENSE LAW)_ ❑ 1 AM EXEMPT UNDER SEC. B- A P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HERESY AFFIRM DOER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER P (COMMENCING WITH SECTION 7000) OF DIVISION 3 O THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IR N FULL /FORCE AND EFFECT. n LICENSE CLASS L..` LIC. NO. 0,P-2- Z� DATE T (.CONTRACTOR /i 1A 44 -AM t6,P WORKERS' COMPENSATION DECLARATION I HERREEMi`BYAFFTRUNDER PENALTY OF PERAGRY ONE OFTHE FOLLOWING DECLARATIONS: -_�FHAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COLPEN$ATON, AS PROVIDED BY SECTION 3700 OF THE LABOR CODE FOR THE PERFORMANCE OFTHE WOR( FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WILL MAINTAIN WORION (ERS' COMPENSATION INSURANCE, AS REQUIRED BY SECTON 3700 OF THE LABOR COOS, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 1$ ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER APE: DARKER S ./tF- Al FOLIOYNUMBER (M1M63ECtIDN NE®NOTBECUFLETm0F n-P67MiB FOR CNE HAN]HED DCUARSDI(10i OR LESS] I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I SHALL NOT EMPLOYANY PERSON N ANY MANNER SO AS TO BECOME SUBJECT TO THE YORKERS' COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF 1 SHOULD BECOME SUBJECT TO THE MORKEAS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE,--,�� TH CO*PL Y VATH THOS�E�PROVISIONS. DATE- APRNCAM_ V(L! __. WAFNINO: F RE TO CURE WORKERS COMPENSATION COVERAGE IS UrtAWF� AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS (5100,ODD), N ADDITION TO THE COSTOF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 970E OF THE LABOR CODE. INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY 1 HERFBYAFFIRM ODER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORM FOR WFICH THIS PERMIT 15 ISSUED (SEC. 3 7, GV C.). LENDERS NAME LENDERS ADDRESS _ I CERTIFY THAT 1 HAVE READ T141S APPLICATION AND STATE THATTHE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS PELITNG TO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTFR UPON THE ABOVEJAENTONFD P dEeTY FOR INSPECTION PURPOSES. f Y� PERM E NAIJE (PRINT) DATE PRESS FIRMLY APPLICATt N DATE !- p/C PERMIT 117 NUMBER � # ISSUE MDATE t�� TYPE OCC S CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE p PROPOSED USE ; ztl'P- teff D I,%e-C- L NO. DWEL NO. NO. �� UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM co GaragaiCarpon W, Patio/Deck LL PooL'Spa Z Re -Roof Commercial - m Valuation ADJ.AREA OUANTITY DESCRIPTION FEE Q U IS I— U w W 0 Z m a. a Q U_ Z Q 2 W CONSTRUCTION 6 152 PLAN REVIEW ELECTRIC PLUMBING MECHANICAL _ INSPECTION FEE ISSUANCE SMIP L S b ENERGY PIC ENERGY PERMIT RETENTION FEE: PRE -ALT FEE- TOTAL FEES COMMENTS RECPT. NO. PAID BYC-^ VALIDATION 1,/ WHITE--Dapertment Copy, YELLOW—Finenw COW PINK—A$aeasor Copy, GOLDENROD --File Cary, GREEN—AppficeWs Copy CITY OF DIAMOND BAR INSPECTION RECORD * lot0 SET BACK II + a . . * D + . FLOOR JOIST FIGS/FORMS/STEEL FHA REQMTS ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR CONDUIT SLAB GRADE FIREPLACE FOUNDATION -- - TEMP POWER FIREPLACE BOND BEAM- - WATER SERVICE - MID HT, BOND BEAM - - ROOF SHEATHING / fS 8 FT. BOND BEAM FRAMING.NENTILIATtO FINAL BOND BEAM ROOF COVER l' PRE -GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWERTTUB TEST POOL ELECTRIC EXT. LATH/SIDING POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER.. FINAL ENG. SEPTIC TANK LANDSCAPE/IRRIG. SEEP PIT/L.L. - ON SITE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST, y FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY COMMENTS SEPTIC TANK SIZE SEEP PITA) SIZE