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Home My WebLink About14932CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES C • 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION JOBSITE ADDRESS 13J > CM kLA R-�vC' �R" APN LOT TRACT OWNER J t� ADDRESS5---/k(2L /a,-- CITY a,SCITY 13 ZIP TEL. APPLICANT - TEL. CONTRACTOR 3 iL In ADDRESS�(v(P CITY :D ( (?j ZIP TEL.C30 ARCH MNG/ DESIGNER ADDRESS CIN ZIP TEL OWNER.BUILDER DECLARATION - I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE UW FOR THE FOLLOWING REASON (SEC, 7031.5 BUS.'NESS AND PROFESSIONS CODE: ANY CITY OR CO NTY WHICH REQUIRES APERMrF TO CONSTRUCT, ALTER IMPROVE. DEMOLISH, OR REPA'RANY STRING. TUPE, PRIOR TO ITS ISSUANCE, ALSO PEOUIP.ES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PRCMSIONS OF THE CONTRACTORS U• CENSE UW (CHAPTER Y (COMMENCING WITH SECT" 7rool OF DIVISION 3 O THE BUSNESS AND PPO- FESSIONS COOEI OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE P.AS!%FOR THE ALLEGED EXEMP- TION, ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CML. PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS "500))! ❑LAS OWNEROF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION. WILL DO THE WON(ND AM THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC 7041, BUSI- NESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DOES NOTAPPLT TO AN OWNER OF PROPERrY WHo BULDS OR IMPROVES THEREON, AND VM0 DOES SUCH WORK H'MSELF OR HERSELF OR THROUGH MS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NCT INTENDED OR OFFERED FOR SALE 6, HOWEVER THE SUKDNOCR IMPFROVEM-n IS SCUD YITIIIN ONE YEAROFCOMPLE- TON, THE OW'NFRAUILDER VAILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT RUII D OR PAPROVE FOR THE PURPOSE OF SALE). 0 4 AS OWNER OF THE PROPERTY, AM EXCLUSNMY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEG 704. BUSINESS AND PROFESSIONS CODE THE CONTRACTORS U - CENSE LAW DOES NOTAPPLYTOAN OWNER OFA PROPERTY WHO RUILDS OR IMPROVES THEREON, AND WIOCONTRACTS FOR SUCH PMLUFCTS WITH A CtWTRACTOWS)LICENSED PURSUANT TO THE COW RAG - TORS LICENSE LAW). D I AM EXFMPT UNDER SEC. 8. L P C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION 1 HERE'BYAMMA UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER i (COMMENCING WTrH SECTION 7000) OF DMSION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT. Q p LICENSE CLASS _C39 LIC. 1,10._Q3D DATE C;1 9 I /`D A CON!RACTOR-4(_/ -L__,— WORKERS' COMPENSATION DECLARATION HERFBYAFTIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS. _I HAVE AMD WILL MANTAN A CERTIFICATE OF CONSENT TO SFIF-INSURE FOR WORKERS COMPENSATION, AS PROVIDED BY SECTION Sr00 OF THE LAPOR CODE, FOR THE PFPFOPMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. _I HAVE AND WA_L M44ftAN WORKERS COMPENSATION NSVRANCE. AS REOVIRED SY SECTION 3700 OF THE IAROR COLE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NIP.i.j7/too E: CARRIER 9POLICY NUMBERO (THIS SEL'IXIN NEED NOT BE W.RETEDOF nE PMATIS FORONE HUEi ED=1AR5 flIr CA LESS) CERTIFY THAT IN THE PERFORMANCE OF THE WOPK FOR WHICH THIS PERMIT IS I<_SUFD, SHALL HOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SVSUECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA AND ACPEE THAT IF I SHOULD PFCOME SUBJECTTO THE WORKERS COMPENSATION PROVISIONS OF 5ECTION 3707 OF THE LABOR CODE, I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS.^� DATE:,,D APPLICANT: _� 1G �' I WARNING: FAILURE TO SECURE VAORKERS'COMPENSAiON COVERAGE`S UNLAWFUL. AND SHALL RE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS (SI00.000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN 1 SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY i I HERESY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3097, CIV. C.). I LENDERS NAME LENDERS ADDRESS I I CERTIFY THAT 1 HAVE READ THIS APPLICATION AND STATE THAT DIE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BVJD!NO 3 CONSTRUCTION. AND HEREBY AUTHORIZE REPRESENTATNES OF THIS COUNTY TO ENTER UPON THE AROVE.MENTIONEO PROPERTY FOR INSPECTION PURPOSES. _DA V 1 rfb 3 PERMITTEE U5# -RM SIGNATURE Lr PERMTREE DATE (j�;S7ESS FIRMLY APPLICATION 0 PERMIT P/C t DATE t NUMBER 0 ISSUE TYPE OCC DATE CONST, GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE'SIDESTREET RW ❑ SIDE ❑ PROPOSED USE •T O IJODI�K� (iu57�}LL ( llJ00 J� Te4L(.' 1I.St f1 -.t - NO. DWEL. NO. N6. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. ARE=ALUATION SFR/ADD/REM cf) Garaga/Carport - W Patio/Deck LL PooVSpa ZRe -Roof Commercial - Oa VAluation ZOO 0 ADJ.AREA QUANTITY DESCRIPTION FEE Q U ir W J w Z m J Q U_ Z Q S U W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING`. ��,4 MECHANICAL INSPECTION FEE ISSUANCE J SMTP ENERGYP/C :.�TI-+I-'IIII ro` 'yTV ENFRGY PFRMII� RETENTION FEE: PRE -ALT FEE: TOTAL FEES COMMENTS I RECPT. NO. PAID BY VALIDATION WHITE—Dennr"Ant Copy. YELLOW—FtR*"Cory, PINK—Atl"kff Lary, LivwtNHV II9 UWY. ui rirrI r7pncama L,opy 475 .e,�N CITY OF DIAMOND BAR INSPECTION RECORD 1x,_1.0\- B+ m' SET BACKFLOOR JOIST FIGS/FORMS/STEEL FHA REQMTS ELECTRIC GROUND UNDER FLOOR DUCT, ,... GROUND PLUMBING UNDER FLOOR CONDUIT -- - SLAB GRADE FIREPLACE FOUNDATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICE MID HT BOND BEAM Rcbr SHEATHING"' ". ,'U 8 Fr13OND BEAM :. FRAMINGNENTIL IATION 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 I DEDICATIONS SEWER 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 HEALTH DEPT, FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY COMMENTS SEPTIC TANK SIZE SEEP PIT/Ll SIZE 1. J I -4 iJ