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Home My WebLink About17007CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21825E. Copley Drive (909) 860-3195 Fax (909) 861-3117 -� BUILDING PER1bIIT APPLICATION JOBSITE M�-�(-� ADDRESS W N IV\ APN�L T� J 5 OWNER —t1 1— I. ADDRESS k– CITY ZIP ZIP TEL. APPLICANT TEL. CONTRACTOR ADDRESS CITY ZIP TEL. ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM LNDER PENALTY OF PER."RY THAT 1 AM EXEMPT FROM THE CONTRACTORS LI. CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REWIRESA PERMIT TO CONSTRUCT,A'_TE0.1MPROVE. DEMOLISH. OR REPAIRANV STRUC• LURE, PRIOR TO ITS ISSUANCE. ALSO REWIRES 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 TRAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7031.5 BY ANYAPPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO ACML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(SSOO).)- 1 O LAS OWNER OF THE 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. 7011 BUSI- NESS AND PROFESSIONS CODE. THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON. AND WHODOES SUCH WORK HIMSELFOR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE. IF,1gW EVER THE BUILDING OR IMPROVEMENT IS SOLD W'THIN ONE YEAROF COMPLE• TION, THE OWN E R43UILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE), O L AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7011, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI. CENSE LAW DOES NOT APPLY TO AN OWNER OFA PRCPERTY WHO BUILDS OR IMPROVES THEREON. AVD WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC• Tons LICENSE LAW.). O IAM EXEMPT UNDER SEC. B d 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. G �/ LICENSE C�1 [y�SS LIC. NO. DATE // 4 CONTRACTOR�f�C['�r✓ •C('1'� WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF RERJURY 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 RE W IRED BY SECTION 3700 OFTHE LABOR CODE, FOR THE PERFORIAANCE OF TME WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKEF1�S COMpENSATgN I 'SURANCE CARRIER AND POLICY NUMBER ARE: CARRIER + t�y�� tl0 — POLICY NUMBER D S~O I 00066;-T5 (TILOS SECTION NEED NOT BE COMPLETED OF THE PERMIT IS FOR ONE RRM-D DOLLARS ISI OCI OR LESS} I CERTIFYT14AT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I SHAT EMPLOY ANY PERSON W ANY MANNER SO AS TO BECOME SUBJECTTO THE WORKERS' COMPENSA71ON LAWS OF CALIFORNIA AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE, I SHALL FORTHWITH COMPLY WI�T-H.'�`..p��ROVISIONS. DATE: 27 "b L APPLICANT.: �, 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 13100,D00). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3705 OFTHE LABOR CODE, INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY I HEREBYAFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3097, CIV. C.). LENDER'S NAME LENDER'S ADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. IAGREE 70 COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAYS RELATING TO BUILDING CONSTRUCTION. AND HEREBYAUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE MENTIONED PROPERTY FOR INSPECTION PURPOSES, 1 n ✓✓_ ��q,/ Cv PFAI+IT7 E TINT)SI UR eHMITTf - �... DATE Of PRESS FIRMLY APPLICATION �/- 1,� PERMIT I P/C DATE 0 '�J NUMBER N ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE I' O NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION SFR(ADDIREM Cl) Garage/Carport W Patio/Deck LL POOI/Spa 0 Z Re -Roof Commercial M Valuation ADJ.AREA QUANTITY DESCRIPTION FEE Q U U 0 W LU LU l7 Z Rl J LL C _U Z Q U W 1 CONSTRUCTION { E PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP • V' 0 ENERGY PIC ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: TOTAL FEES COMMENTS RECPT NO. PAID BY VALIDATION WHITE—Department Copy. YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENHOo--Fue copy, GHttN—Applicant's copy SET BACK FTGSFORMS;STEELFHA -------.- ELF--CTF-'.I-- GROUIND j GROUND PLU.,',D!f,,IG SLAB� GRADE TEMP POWER WATER SERVICE ROOF SHEATH N c FRAMIl .G,IVENTILIATIONI ROOF COVER j R 0 U G H HEATING il-)!,--,-,. RLMITS UNDER FLOOR DUCT ---UNlD'--R 1- 0 01, CUNDUIT FIR - 11 I'll EPLA',-,�: FOUND,' 'I'Y',' UIREP'-AGE BC),,! D EH7A%', '.11D HT. E30; ID BEA�,' 15 FF. UY'diD FINAL F-,lY,D-EEA%1 i PRE-GRADIINIG I — ROUGH ELECTRIC ROUGH G R A ri I Fi:.,IIF-H ROUGH FLIJIMEII`��lc SHOWER.,`TUBTES T -_ EXT. UJH/SIDINIG PUC L ELECT H I POOL FEN --1,N3 -f 00_L HINAl WALL INSULATI0,',l CEILING INSIJLP,T I OFF SITE IMPS. PEDI,-ATIONS — DRYV.1ALL NlAILING SEVVER F NAL U,13 SEPTIC TANK LANDS CA P E:/I R R I G. 0 SITE It., PS. SEEP PIT/L.L. GAS AIR TEST FINAL ZONI-1,13 FINAL CONST. FINAL HEATING FINAL ELECTRIC HINAL PLUMBING COM,MiENTS EIRE DEPT FII`T,'.'- JHEALTH DEP]. -FINAL j DEV. FI -ES P, -'0D ENERGY SEPTIC TANK SIZE SEEP PIT/U SIZE