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Home My WebLink About11393- JFK CITY OF DIAMOND BAR COMMUNITY DEVELOPMENT DEPARTMENT !,..0 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION JOBStTE ADDRESS APN LOT TR CT OWNER ' 'J Co. ADDRESS. CITY amanA IP �f2(, TEL APPLICANT TEL. CONTRACTOR ADDRESS CITY ZIP TEL. ARCWENG/---� DESIGNER� ADDRESS (O uCq y CITY ZIP OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LL CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031,5 BUSINESSAND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH RECUIRESA PERMITTO CONSTRUCT, ALTER, IMPROVE, DEMOLISH,OR REPAIR ANY STRUC TUBE, PRIOR TO ITS ISSUANCE. ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAI, HG On SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS U CENSE UW (CHAPTER 9 (COMMENCING WITH 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 EXEMP- TION. ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CNIL PENALTY OF NOT MORE THAN FINE HUNDRED DOLLARS (FS00).): O L AS OWNER OFTHE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WALL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 70N. BUSI. NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNFR OF PROPERTY WHO BUILDS OR IMPROVES THEREON, AND VINO 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. H—R.THEBUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE- TION, THE OWNER BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE 010 NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). C L AS OWNEROF THE PROPERTY,AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRICT THE PROJECT (SEC. 7014 BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI. CENSE LAW DOES 140T APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHDOONTRACTS FOR SUCH PROJECTS WITH A CONTRACTORS) UCENSED PURSUANT TO THE CONTRAG TORS LICENSE LAW.). O 1 AM EXEMPT UNDER SEC. B. A P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 O THE BUSINESS AND PROFESSIONS CODE, AND LAV LICENSE 6 1I-N-yFULL FORCE �AND �E-FF1ECT. LICENSE CIASG �—`� ` LIC.NO. DATE CONTRACTOR WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING CECURATIONS:�/1'�'6 I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKE14 RS' CDMPENSATION.AS PROVIDED BY SECTION37DO OF THE LABOR CODE, FORTHE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT M ISSUED. HAVE AND WILLMAINTAIN 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 WORK1ERST CO PENSA`TION INSURANCE C RIERAND POLICY NUMBER ARE: CARRIER �^ \ POLICY NUMBE (MSSECTICN NEED NOT BE COMPLETEDOFTME KIM ONE HUDPEDOOLUR>(SI0010RL 1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK OR MICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO T EOOME SUBJECT TO THE WORKERS'COMPENSATION LAWS O—A.AN AGR "THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS' COMPEN„ KKJ PR 'S SOF ECTION37000FTHELABOR CODE, 1 SHALL FOR TM COMPLY WITH OSE P W S. DA� �� PLICANT: WARNNG: FAILURE TO SECURE WORKERTOOMPENSATION COVERAGE IS U%"IN' SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONDT USANDDOLLARS(1100.000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGEVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY 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.). LENDERS NAME LENDERS ADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION ANO STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BURDING CONSTRUCTION, AND HEREBY AUTHOR ZE REPRESENIATNES OF THIS COUNTY TO ENTER UPON THE VEMENTIO PERTY FOR INSPECTION PURPOSES. ERMITTE AME(PRI !� 3 L�� SIGN U _OF MITTEEDATE PRESS FIRMLY APPLICATION / Z9� PERMIT G NUMB R _ A/CEJ DATE 7 U ISSUE TYPE OCC _ DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE of ' r NO. DWEL. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREANALUATION SFRIADDIREM Garage/Carport LLLI Pa!iolDeck LL Pool/Spa 0 Z Re -Root OJ Commercial TD O] Valuation _C-X:I0 ADJ.AREA QUANTITY DESCRIPTION FEE J Q U UJ LU LU z rYi J a a V z x U W CONSTRUCTION - F N REUI W _ EL NIC LUMBING MECHANICAL INSPECTION FEE �qe SSUANCE ISMIP ENERGY PIC ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: TOTAL FEES 1 COMMENTS l Z RECPT. NO. 7 PAID BY VALIDATION WriLIE—Department Copy, YELLOW—Finance Copy. PINK—Assessor Copy, G04EWOD-File Copy, GREEN-Appplicant's Copy V CITY OF.DIAMOND BAR INSPECTION RECORD SET BACK FLOOR JOIST FIGS/FORMS/STEEL FHA REQMTS ELECTRIC GROUND UNDER FLOOR;DUCT GROUND PLUMBING UNDER FLOOR CONDUIT - SLAB GRADE FIREP CE �OUNbATION TEMP POWER - FIREPLACE BOND 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 PIT/L.L. ON SITE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST. B �— - FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY _ COMMENTS I ell I f � SEPTIC TANK SIZE SEEP PIT/U SIZE 1� 1