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Home My WebLink About15120 (8)CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICESP 21660 E. Copley hive Suite 190 (909) 860.3195 Fax (909) 861-3117 PRESS BUILDING PERMIT APPLICATION FIRMLY JOBSITE ADDRESS APN LOT TRACT OWNER rjle %/17 x S- 14r / ADDRESS CITY ZIP TEL. APPLICANT C.vm PF%L'YieAJ I7F4TEL. CONTRACTOR ADDRESS CITY�� —ZIP Z�Z TEL ARCWENG/ DESIGNER ADDRESS CITY ZIP TEL OWNER -BUILDER DECLARATION 1 HEREBY AFFWY UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE CENSE UW FOR iNE fOLLO.Y:NO REASON (SEG 7051.1 BlU5WE55 AND PROFESSIONSCOOS: ANYGTYOR COtUNTYVVHICN REOUtAUAPERMITTO CONSTFUJCTALTER IMPROVE. DEMOUSN,OR REPAiRANY STRUC- TURE 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 LL CENSE UW (CHAPTER "(COMMENCING WITH SECTION 7000) OF DIVISION 5 OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 70.71.6 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS O L AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH RAGES AS THEIR SOLE COMPENSATION, WILL DO THE WW1, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, BUSI- NESS AND PROFESSIONS CODE. THE CONTRACTORS LICENSE UW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO SULDS OR IMPROVES THEREON, AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR T1i40UGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPRCVEMENTSAR'e NOT INTENDED OR OFFEREDFORSALE. IR HOWEV A.THEBULDWGORIMPROVEMENT15SOLDWITHINONEYEAROFCOMPLE- TION. THE OWNER-OUIDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD 09 IMPROVE FOR THE PURPOSE OF SALE) O L AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WHTH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AN PROFESSIONS COLE: THE CONTRACTORS LJ - CENSE UW DOES NOT APPLY TO AN OMER OF A PROPERTY WHO BUILDS OR MPRDVES THEREON. AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAG TORSUCENSELAW) O 1 AM EXEMPT U NDER SEG B. E P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION 1 REBYAFFIRMUIOERPENALTY OFPERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHiAPTEfl COU MFNCWO O WITH SECTION TOOO) OF D VISION S OF THE BUSINESS AND PROFESSIONS CODE, AND LICENSE IS IN FULL FORCE AND EFFECT. (CENSE CLASS c 3y LIC.NO. TE .6'— ! 4 -- CONTRACTOR WORKERS' COMPENSATION DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: Y I HAVED WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF NSURE FOR AN COMPENSATION, AS PROVIDED BY SECTION 57W OF THE LABOR CADS. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED. I HAVE AND WILL MA24TAJN WOTKERS' COMPENSATON INSURANCE. AS REQUIRED BY SECTION 1700 OF THE LABOR CODE- FOR THE PERFORMM:CE OFTHE WORK FOR WRICH THIS PERMIT 15 ISSUED. MY YORKERS COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE CARRIER POLICYHAIMSER UMSWWNNEED NOT BEooKumOFTHE PERMIT SFOR ONE HUNDRED MULARS (SIGO) OR LESSL 1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECAME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF 1 SHOULD BECOME SMECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE 4 - l oma APPLICANT: 1::;e—✓ WARNING: FAILURE TO SECURE WOFIKERV COMPENSATION COVERAGE IS UNLAWFUL AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS (1100.000). IN ADDITION TO THE COSY OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 5701 OF THE LABOR CODE. INTEREST. AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY 1 HEREBY AFFIRM WADE"P ENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PE W7 IS ISSUED (SEC. 3007, CIV. O). LENDERS NAME LENDERSAODRESS I CERTIFY THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUDORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVEJAENTIONED PROPERTY FOR INSPECTION PURPOSES. 0- L_L.0 t - PERMITTEE NAME:Pr SIGNA TUREOF PERMITTEE DATE APPLICATION PERMR� P/C DATE ! — / ii r �—� NUMBER L# ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDESTREET RW ❑ SIDE ❑ PROPOSED USE � •2��t5' : sc e 6 NO. DWELL N NO. UNITS STORIES DEDROOMS DESCRIPTION SO. FT FACTOR PSF ADJ. AREA(VALUATION SFRIADDiREM to Garage/Carport WPat*/Deck LL goovspa Z Re -Roof Commercial m Valuation 6 4 0— ADJ.AREA QUANTITY DESCRIPTION FEE U cc I— U w LU LU C� Z A J _U Z 4 2 U W If CONSTRUCTION / L I PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMTP ENERGYP/C HIT U ENERGY PERMIT ��,� RETENTION FEE: C1 f I 0'1: i)I/1 T,h(")1?Tl T'A — PRE-ALTFEE. $IJi►.T)IATr: TA C`AY,-f-T17 -- TOTAL FEES COMMENTS RECPT. NO. PAID BY VALIDATION WHITE—Department Copy, YELLOW—Finance Copy, PINK--ASSOSM Copy. VULnENHUL)--r•Ile Copy, UKEEN—AppHlcanCS L:opy CITY OF DIAMOND BAR INSPECTION'RECORD ��d'�-,�rl P.I.,_J_�.� .. -. ..�-�-.. t'1�-, ��.►,�.1�i1 ��_•.lL} -- - ( -- --- SET BACK I I,� �J �'1�� li LIJ,I RJOIST FLOOR FTGSIFORMS/STEEL - - .. FHA REOMTS ELECTRIC GROUND - _ _ .._ UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR COi,,)JIT SLAB GRADE-- -- - FIREPLACE FOUNDATION " TEMP POWER FIREPLACE BOND BEAM I WATER SERVICE _ - _ 'ROOF SHEATHING -• �l�-' _ FRAMING/VENTILIATlON MID HT. BOND BEAM ; 8 FT. BOND BEAM `- FINAL BOND BEAM ROOF COVER PRE -GRADING ROUGH HEATING' - BENCHING ROUGH ELECTRIC " ROUGH GRADING 'ROUGH PLUMBING -- - - -- FINISH GRADING SHGW- RrUB TEST POOL ELECTRIC -X''T: LATH/SIDING POOL FENCING l:4"/ALL INSULATION - POOL FINAL { CEILING INSULATION- OFF SITE IMPS. _ DRT01ALL NAILING DEDICATIONS SEWER FINAL ENG. SEPTIC TANK LANDSCAPE/iRRIG. SEEP P! T/L L.. a ON SITE IMPS. TQ ST ., FINAL ZONING FIRE DEPT. FINAL IEATING HEALTH DEPT. FINAL - - ` `-_ELECTRIC - DEV. FEES PAID - -- PLUMBING- ENERGY ';C;"ruiMENTS SEPTIC TANK SIZE SEEP PIT/U SIZE T i. t __ '