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Home My WebLink About15047 (17)CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 BUELDI NG PERMIT APPLICATION JOBSITE ADDRESS CA I b0 V rr► Q r' APN LOT TRACT OWNER Re cc i_ - ADDRESS a AYLF3ddr-s cG Dy- CITY YCITY DIAL.. ,I l,.,r ZIP Si� TEL 909 .'79 Y3,U APPLICANT-)AyFBr A.,e@yyd?_ TEL $167015'03'7 CONTRACTOR A- Q r,& I e R_e>r j 'tom ADDRESS CITY 0 Or"ci D•,s- R ZIP _[/k TEL $TS 70ISOJ7 ARCH/ENG/ 'iI3 -q DESIGNER ADDRESS CITY ZIP TEL OWNER -BUILDER DECLARATION I HEREBY AFF04 UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC. 7071.5 BUSINESS ANO PROFESSIONS O OG:ANY CITYOR COUNTY VI4KN REQUIRES APERIM TO CONSTRUCT,ALTER. IMPROVEDEMOUSR OR REPAIR ANY STROP TU1RE PRIOR TO ITS ISSUANCE ALSO RECUIRES THE APPLICANT FOR SUCH PERMIT TO FEE A SIGNED STATEMENT TWAT HE OR SHE /S LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LF CENSE LAW (CHAPTER 6 (COMMENCING WITH SECTION 7000) OF DIVISION S OF THE BUSINESS AND PRO• FUSION$CODE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEIEMP- ..ANY VIOLATION OF SECTION 7041,6 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO ACRALPENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (25W).} U 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. 7044, BUST. NESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUU M OR IMPROVES THEREON, AND WHO DOES SUCH WORK HIMSELF OR HERSELFOR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED CR OFFERED FOR SAE IF, HMVEVEFL THE BUNDLING OR IMPROVEMENT LS SOLO WTTONONE YEAR OFCOAIPLE- TDN, THE OWNERAUILDER WILL HAYE THE BURDEN OF PROVP/O THAT HE OR SHE 00 NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE} O L AS OWNER OF THE PROPERTY, AM E%CLUSNELY CONTRACTNO WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEG 7044, BUSINESS AND PROFESSKY+S CODE: THE CONTRACTORS U - CENSE LAW DOESNOTAPPLY To AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON. AND W HOCONTRACrS FOR SUCH PACUECTS WITNA CONTRACTOR(S) LICENSED PURSUANT TOTHE CONTRAC- TORS LICENSE LAW.). O 1 AM D(EMPT UNDER SEC B. I 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 I (COAMEHCING WITH SECTICN 7000) OF DIVISION S OF THE BUSINESS AND PROFESSIONS CODE. AND MY LICENSE IS N FULL FORCE AND EFFECT. LICENSE CLASS c 9 LIC. NO. v DATE I I 1 CONTRACTOR WORKERS' COMPENSATION DECLARATION 1 HERESY AFFTM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DE a _I HAVE AND WELMANTANACERTIFICATE OF CONSENTTO SELF-INFFRS' COMPENSATION. AS PROVIDED BY SECTION 4700 OF THE LABOR CODE, FFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. _I NAVE AND WILMANTAN WORKERS, COMPENSATION INSURANCEAS RECUR YSECTON/ 37000E THE LABOR COLE FOR THE PERFORMANCE OFTHE WORK FOR THISPERMITIS ISSUED, MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLI ' NUMBER ARE: CARRIER POLICY NUMBER O S / a1 O (IFLSSECIONFEEDNOTBE07AEiETEDCF71HE POW S FOR on£W (SIODIOiL I CERTIFY THAT N THE PERFORMANCE OF THE WORK FCR LVIIICHTHIS SISSUED.I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SOAS TO BECOME SUBJE WORKERS' COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF I SHmAD BECOME SUBJECT TOTHE WORKERS' COMPENSATION PROVISIONS OF SECTION 47000E THE LABOR CODE I SHALL FORTHWITH COMPLY WITH THOSE PP S DATE: �' / o O APPUCAM: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. AND SHAT BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ({700,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 4706 OF THE LABOR COOS INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A OONSTRU1CrKON LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 4097, CIV. C). LENDER'S NAME LENDER'S ADDRESS 1 CERTIFY THAT I HAVE READ THIS APPLICATOR AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTOR AND HEREBY AUTHORIZE REPRESENTATIVE OF THIS COUNTY 70 ENTER UPON THE ABOVE.MENTIONrD PROPERTY FOR INSPECTION PURPOSES. J A,/1 c -x '45,cArrv,-' � NAME P PPGE SONArUNATUREO ERMIREE DATE PRESS FIRMLY APPLICATION l PERMIT 5011 P/C DATE NUMBER J U # ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDESTREET RW ❑ SIDE ❑ PROPOSED USE J NO. DWEL NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT FACTOR PSF ADJ. AREANALUATION SFR/ADD/REM to Garage/Carport WPatioiDeck LL- PooVSpa 0 Z Re -Roof 0 Commercial - m Valuation o ADJ.AREA QUANTITY DESCRIPTION FEE J U EL H U w LU LU C7 Z O] CL Q 2 Lu CSTRUCT, N -SO REVIEW jE'UCG C HANICALL INSPECTION FEE ISSUANCE SMIP CITY nF 1AAM �- ENERGY P/C T2I �;�, T)TrTr: AMID SA-- FL Iy ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: TOTAL FEES 3 0 COMMENTS I . .! RECPT. NO, PAID BY _ VALIDATION WHITE—Department Copy, YELLOW--FnanCe Copy, PINK—ASsessor Copy, GOLDENROD—File Copy, GREEN—AppliCant'S Copy CITY OF DIAMOND BAR INSPECTION RECORD - ti • a. t _o �I 'Vtl:.: �_(zyw _ Il'►�-'i �r ala' i _ -- I'Dy ' il�� -y•t � reit --- SET BACK FLOOR JOIST, FTGS/FORMS/STEEL FHA REOMTS ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR CONDUIT SLAB GRADE --- FIREPLACE FOUNDATION! - TEMP POWER FIREPLACE BOND BEAM WATER SERVICE ROOF SHEATHING., MID HT. BOND BEAM B FT. BOND BEAM FRAMINGNENTILIATION ' ' ". " ` FINAL BOND BEAM !ROOFCOVER PRE -GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING - ROUGH PLUMBING FINISH GRADING SHOWER/TUB TEST POOL ELECTRIC EXT. LATHISIDING POOL FENCING .WALL INSULATION POOL FINAL CEILING INSULATION -" OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER FINAL ENG. SEPTIC TANK_ LANDS CAPE/IRRIG. SEEP PIT/L.L. " " '' ="; ON SITE IMPS. GAS AIR TEST FINAL CONST. _ _ FINAL ZONING FIRE DEPT FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY COMMENTS , 1 ` -d.yY.1�ij� ..Nll 'SEPTIC TANK SIZE SEEP PIT/U SIZE jS]