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Home My WebLink About14968E 'll-wI)11N11I CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 PRESS (909) 860-3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION FIRMLY JOBSITE ADDRESS APN LOT q TRACT OWNER ADDRESSt-v^(n i 151c�11 CITY1.1 (7, ZIP _ TEL _&ZfA_%Crr APPLICANT Alefih 13,12 TEL CONTRACTOR L1 ADDRESSZF -1 I e CITY �(-1 I V �� ZIP TEL ARCMIENG/ DESIGNER ADDRESS CITY ZIP TEL OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC 7031.5 BUSNFSS ANO PROFFSSKwS CODE ANY CITY OR OI COUNTYW4IRFOUIRESA PERMIT TO CONSTRUCT. ALTER IMPROVE DEMOLISH. OR FEPAIR ANYSTRUC- TURE PRIOR TO RS 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 LL CENSE LAW (CHAPTER F (COMMENCING W TH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONSCODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED fXEMP. AN. ANY VIOLATION TOF SECTION 7031.5 BY ANY APPLICANT F09 A PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS O L AS OWNEROFTHE 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 COOS 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 APE NOT INTENDED OR OFFERED FOR SALE K, HOWEVER THE BUILDING OR MPROVFMENT IS SOLD WITHIN ONE YEAR OF COMPLE- TION, THE OWNER-OURDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DO NOT BUILD OR IMPROVE FOR THE PURPOSE OF Mn ❑ LAS OYMER OF THE PROPERTY. AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC 7044. BUSINESS AND PROFESSIONS CODE: WE CONTRACTORS U - CENSE LAW DOES NOTAPPLY TO AN OWNFR OF A PROPERTY WHO BUILDS 09 IMPROVES THEREON, AND YNIgOONTRACTS FOR SUCH PROTECTS WTHACCNTRACTOR(S) LICENSED PURSUANT TO THE CONTRA(, TORS UCENSE LAW } O IAM EXEMPT LANDER SEC, B. L P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I EHY HERAFFIRM UNDER PENALTY OF PER.0 RY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER I (NMMENCNG WITH SECTION 7000) OF DIVISION 3 O THE BUSINESS AND PROFESSIONS CODE, AND WY LICENSE IS N FULL FORCE AND EFFECT. LICENSE CL,A/SS�'S -c3Le LIC. NO. �/� J� / - DATE DAT CONTRACTOR? Lx-�A M411b WORKERS' COMPENSATION DECLARATION - I REAM AFFIRM UNDER PENALTY OF PERAIRY ONE OF THE FOLLOW NG DECLARATION& I HAVE AND WALL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS COMPENSATION, AS PROVIDED BY SECTION TIM OF THE URCIR (MODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH TMS PERMIT IS ISSUED. __I HAVE AND WILL MAINTAIN WORKERS' COUPENSATXN INSURANCE. AS RECURRED BY SECTYN - 3700CF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY W ORK S COMPETNSATIJN INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIERe u POLICY NUMBER (Lias %%7M NEEGNOT BE COFLETEDOF THE PERMIT IS FORCNE/AIOREDOOLURS ($TOM OR LES% I CERTIFY THAT LATHE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I SHALL NOT EMPLOY ANY PERSON INANY MANNER SOAS TO BECOME SUBJECT TO THE woRKERSCO.IPENSATI)N LAWS OF CALIFORNIA AND AGREE THAT IF I SHOAD BEC ME SUBJECTTOTHE WORKERS COMPENSATION PROVISIONS OF SECTION 37000E THE l 90R C.ODDEE. I`SHALL FORTHWITH COMPLY WITH THOSE PREMSKNs. 1 DATE' APPLICANT: t�/ F V ) / - WARNING:FARU E TO SECURE WORKERSCOMPENSATION COVERAGE IS UNLAWFUL AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS Is 100.(=), N ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN 1 SECTION 3701 OF THE LABOR CODE. INTEREST. AND ATTORNEY'S FEES. I CONSTRUCTION LENDING AGENCY i FOR THE ERFO AWE PENALTY OFK FOR YICH TH-SPE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH TH'S PERMIT IS ISSUED (SEC 3f197, OV. C.). S lEN0fR9 NAME LENDER'SADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL CRY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING sCONSTRUCTION. AND HERESY AUTHORIZE REPRESENT TINES OF THIS COUNTY TO ENTER UPON THE ABOVE.MENTIONED PROPERTY FOR INSPECTION PUR SES. �-1�-tie -S a C PE LTTE AMEIPRI ] E PE TE DATE APPLICATIO PERMITPIC DATE NUMBER # ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDElSIDE STREET RW O [:: SIDE ❑ PROPOSED USE NO. DWEL NO. NO. UNITS STORIES BEDROOMS DESCRIPTION " SO. FT. FACTOR PSF ADJ. AREANALUATION SFR/ADD/REM co Garage/Cerport WPatio/Dock - (= PooVSpa ZRe -Roof OJ Commercial - D� Valuation ADJ.AREA OUANTITY DESCRIPTION FEE U F– Lu Lu w w z Z m a 4-1 a Z Q S W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING ( - MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGYPERMILI RETENTION FEE$I JU PRE -ALT FEE: TOTAL FEES COMMENTS RECPT. N PAID BY VALIDATION WHITE—Department Copy. YELLOW—Finance Copy, P NK—ASSRSSOF L:apy, uvwcrvnvtr`rlre T.v(ry, aanccr.--np(nicarn a 117 CITY OF DIAMOND BAR INSPECTION RECORD ' SET BACK WEIMMIR INSPECTION DATE INSPECTOR FLOOR JOIST FTGS/FORMS/STEEL FHA REQMTS ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR CONDUIT SLAB GRADE FIREPLACE FOUNDATIONy'- =' TEMP POWER FIREPLACE-130ND BEAM WATER SERVICE - MID HT. BOND BEAM ROOF SHEATHING - 8 FT. BOND BEAM':-. FRAMINGNENTILIATION FINAL BOND BEAM ROOF COVER _ PRE -GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWER/TUB 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 PITIL.L:- - ON SITE IMPS. GAS AIR TEST - FINAL ZONING FINAL CONST. - FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINALPLUMBING I ENERGY COMMENTS 77 ------ SEPTIC TANK SIZE SEEP PIT/U SIZE 1,- 1 \ ',1. , Imo- _} . .,, . ,• _. �-_!-` -- ._ _ __-. -^... .-