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Home My WebLink About10294 (5)CITY OF DIAMOND BAR COMMUNITY DEVELOPMENT DEPARTMENT 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 861.3117 Ri 1 113ING PERMIT APPLICATION TE ADDRESS I.Z�tj CoCc"NAIP L/U APN LOT — TRACT OWNER ADDRESS CITY I�xc'r+r>G 1 / ZIP 0; 1 TEL. APPLICANT— TEL. CONTRACTOR C2U_,WC /L ADDRESS CITY 21P TEL. ARCWENG/ DESIGNER ADDRESS CITY ZIP TEL OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I ASA EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOW NG REASON ISEC. 70.71.5 BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUHTYVMICH RE WIRES A PERMIT TOCONSTRUCT.ALTER, IMPROVE. DEMOLISH, OR RERAIRANYSTRUC. TURE. PRKOR TO ITS 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 LI- CENSE LAW (CHAPTER 5 (COMMENCING WITH SECTION TWO) OF DIVISION 3 OF THE BUSINESS AND PRO- FESSONS CODE) OR THAT HE OR SHE IS EXEMPTTHEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLAT`oN OF SECTION 7071.5 BY ANYAPPLICA NT FORA PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS ($5(0).): O LASOWNER OF THE PROPERTY.MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION. WILL DO THE WORK. AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEG 7044, BUSI- NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES Nor APPLY TO AN OWNER OF PROPERTY WHOBUILDSOR IMPROVES THEREON. AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES. PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE, IF. HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE- TON. THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE} O I. AS OWNER OF THE PROPERTY. AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE LAW DOES NOTAPPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON. AND SYHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAO Tons LICENSE LAW.). O IAM EXEMPT UNDER SEC. B. i P.C. FOR THIS REASON DATE, OWNER LICENSED CONTRACTORS DECLAWATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IMI LICENSED LANDER PROVISIONS OF CHAPTER B (COMMENCING WITH SECTION 70001 OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE SIN N FULL FORCE AND EFFECT. LICENSE CLASS LIC. NO. DATE CONTRACTOR WORKERS' COMPENSATION DECLARATION 1 HEREBYAFFIAM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATION$: _I RAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELFJNSURE FOR WORKERS! COMPENSATION. AS PROVIDED BY SECTION 37000F THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. —I HAVE ANO WILL MAINTAINWORKERS' COMPENSATION INSURANCE. AS REOUIRED BY SECTION 5700 OF THE LABOR WHICHCODE. FOR THE PERFORMANCE OF THE WORK FOR WHICHTHIS PERMIT IS ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER POLICY NUMBER (THIS SECIICNNEED NOTBE COMPLETEDOFTHE PERUIT IS FORCI.E HUNDRED DOLLARS (5100)ORLESS1 I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I SHALL NOT EMPLOY ANY PERSON N ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS COMPENSATION LAWS OF CALIFORNIA. AND AGREE THAT IF 1 SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 7700 OF THE LABOR CODE.I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE: APPLICANT. WARNING: FAILURE TO SECURE WORKERS'COMPENSATKON COVERAGE IS UNLAWFUL. ANO SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CAVIL FINES UP TOONE HUNDRED THOUSAND DOLLARS ($100,000). N ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 3705 OF THE LABOR CODE. INTEREST. AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY I HEREBYAFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 5057. CIV. C.). LENDER'S NAME LENDERS ADDRESS 1 CERTIFY THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION 1S CORRECT. I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION. AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE AIiOVE�MENTKNED PROPERTY FOR INSPECTION PURPOSES. PERMITTEE NAME (PRINT) _ 3� SIGNATURE O TTE GATE in PRESS FIRMLY DATEAPPLICATION l ISSUE DATE PERMIT NUMBE TYPE CONST. N1C OCC GROUP ZONING SETBACKS FRONT REAR SIDEISIDE STREET SIDE RW RW ❑ ❑ ❑ ❑ PROPOSED USE NO. DWEL� NO. UNITS STORIES NO. BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION SFR/ADD/REM N Gerape/ICarport W PatkVDeck LL. PooV'Spa ZRe -Roof Commercial m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J CD r m 7 J CL J CONSTRUCTION PLAN REVIEW ELECTRI LUMBI MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: - �'� •i4 �' E V. f TOTAL FEES COMMENTS t� RECPT PAID BY VALIDATION 5 WHITE --Department Copy, YELLOW --Fiance Copy, PINK—Assessor Copy. GOLDENROD—FIM Copy. GREEN—Applicant's Copy CITY OF DIWAOND DAIS'. INSPECTION'REC09113 SET BACKI I-FLOORJOIST I FIV, REONI.TS FIGS/FORMS/STEEL ELECTRIC GROUND GROUND PLUMBING _-..• FUNDER FLOOR DUCT 7— I UNDFI`4?I'C�AntONDLATIO - VT, - SLAB GRADE FIREPLACE FOUNDATION TEMP POWER WATER SERVICE jE IREPLACE BOND BEAM MID HT. BOND BEAM ROOF SHEATHING 8 F.T. BOND BEAM Lfi!t,!LL BONDB FA— PRE -GRADING BENCHING R OUGH GRADING FINISI I GRADING POOL ELECTRIC POOLFENCING- ...... FRAMINGNENTILIATION?%,l ROOFCOVER - ROUGH HEATING ROUGH ELECTRIC ROUGH PLUMBING SHOWER,TUB TEST EXT. LATH.!SIDING--- INSULATION -POOL FINIA1. OFF SITE P.IPS. DEDICATIONS CEILING INSULATION DRYWALL NAILING SEWER-...-. ENG. .SEPTIC TANK.:. _FINAL LANIDSCAFE/IRRIG. SEEP PITIL.L. ON SITE IMPS. GAS AIR TEST.' FINAL ZONING FINAL CONST FINAL HEATING (5 §7 HEAL111 DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ' !Z F _jfRSY CONAMENTS 1 7 - SEPTIC TANK SIZE SEEP PIT/1-I'SIZE ------