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Home My WebLink About17785f� CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES x--- 21825 E. Copley Drive (909) 8 60-3 195 Fax (909) 861-3117 PRESS BUILDING PERMIT APPLICATION FIRMLY JOBSITE ADDRESS 21522 Barbi Land APN LOT TRACT OWNER -Hey&Aidaorgia ADDRESS 21622 CITY } IiltOlY�—BciY ZIP � STEL. _ 6 1 APPL A TEL. -C,ONTRACTOR ROYALTY Al mh NaarA /—.., - ADDRESS CITY P 9 22TEL��B E ARCH/E DESIGNER ADDRESS CITY ZIP TEL OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS IJ - CENSE LAW FOR THE FOLLOWING REASON (SEC.7031.5 BUSINESS AND PROFESSIONS COOS ANY CITYOR COUNTY WHICH REQUIRES A PERMITTO CONSTRUCT,ALTER IMPROVE, DEMOUSH, DR REPAIRANYSTRIIC- TURE PRIOR TO ITS ISSUANCE ALSO REQUIRES THE APPLICANT FOR SUCH PERMITTO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISICNS OF THE CONTRACTORS U - CENSE LAW (CHAPTER a (COMMENCING WITH SECTION 7000) OF DIVISION S OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VKX_AnQN OF SECTION 70313 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (5500).): O L AS OWN ER 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 (SEG 7014, BUSI- NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE UW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDSOR IMPROVES THEREOMAND WHO DOES SUCH WORK HIMSELF OR HERSELFOR THROUGH HIS OR HER OWN EMPLOYEES. PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE IF. THE BUDDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OFGOMPLE- TION, THE ER -BUILDER WILLHAVE THE BURDEN OF PROVING THAT HE CR SHE DID NOT BUILD OR IMPPO OR THE PURPOSE OF SAIF} AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO STRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS U. CENSE LAW DOES NOTAPPLY TORN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON. AND M40 M CONTRACTS FOR SUCH PROJECTS WITH ACORACTOR(S) LICENSED PURSUANTTO THE CONTRAC- TORSUCENSELAW). O 1 AM EXEMPT UNDER SEC. B. a P.C. FOR THIS REASON DATE WNER LICENSED tONTRACTORZ&CLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER a (COMMENdNO WffHSECTXN 7000) OF DIVISION ] OF THE BUSINESS AND PROFESSIONS CODE. AND MY LICENSE LS N FULL FORCE AND EFFECT ,�/ LICENSE CUSS C20 HIC CL161D. 1x772177 DATE 3.13 4 4' CONTRACTOR ' uu� ..,, -}n 1 n l— b WORKERS' COMPENSATION DECIytR7 -Pot & A 1 C 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF4NSUi1E 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 REWIRED BY SECTION 37DO OF THE LABOR COOE FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER C: tit -FR t -a rnRln--Tnc! �'• 1�Tnd POLICY NUMBER - 1610815 —02 (TFSSECTION NEED NOTBEODMREfEDCFT E PERMIT IB FOR ONE MJFDREDOOl1ARS (STOO)OR LESS) I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF 1 SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF ME LABOR CODE, 1 SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE: :)APPLK;ANTROYALTY P1mh Heat & 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 is 100,D00). IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 5705 OF THE LABOR CODE INTEREST. AND ATTORNEY'S FEES. C RUCTION LENDING AGENCY IHEREBYAFF�EMiclhael__P NALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PER THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 5007• CR C.). LENDER JunaPrG LDERS ADDRESS I I CERTIFYTHATI HAVE RE THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT I AGREE TO COMPLY WITH LL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, ANDHE 13YAUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONEDP PITY R INSPECTION PURPOSES. { i I ITT NAME (P NT) E PERM E DATE APPLICATION 1 5 PERMIT 1 %8 P/C 1 DATE NUMBER f ISSUE t� 1 TYPE OCC DATE U CONST. GROUP ZONING SETBACKS FRONT RW ❑ 4 REAR ❑ SIDE/SIDESTREET RW O SIDE ❑ PROPOSED USE 67 NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREANALUATION SFR/ADD/REM Cn Garage/Carpon WPatio/Deck IL- POOVSpa ZRe -Root 0 Commercial M Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J Q U_ U W J W C7 Z ib 7 eL 7 �. 100,000 bb, 2-StAga- U 2 U S L 13 r CONSTRUCTION unit. , PLAN REVIEW ELECTRIO PLUMBING MECHANICAL $ rk _ i 9 i n INSPECTION FEE ISSUANCE �• L / SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: TOTAL FEES —70-56 COMMENTS RECPT. NO. PAID BY C'.k _ W C n VALIDATION WHITE—Department Copy, YELLOW --Finance Copy, PINK—Assessor Copy, GOLDENROD --File Copy. GREEN—Applicant's Copy CITY OF DIAMOND BAR INSPECT IOtq RECORD toN SET BACK FLOOR JOIST FTGS/FORtvIS/STEEL FHA REOMTS ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR CONDUIT SLAB GRADE FIREPLACE FOUNDATION TEMP POWER I FIREPLACE BOND BEAM WATER SERVICE i MID HT. BOND BEAM ROOF SHEATHING I 18 Fr. BOND BEAM FRAMINGNENTILIATION I FINAL BOND BEAM ROOF COVER I PRE -GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC I ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWERITUB TEST POOL ELECTRIC EXT. LATHISIDING POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER I I FINAL ENG. SEPTIC TANK LANDSCAPE/IRRIG. SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST. FIRE DEPT. FINAL FINAL HEATING FINAL ELECTRIC HEALTH DEPT. FINAL DEV. FEES PAID FINAL PLUMBING ENERGY 5 MRT 0 _-T �m COMMENTS SEPTIC TANK SIZE SEEP PIT/U SIZE