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Home My WebLink About15158CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES c 21660 E. Copley hive Suite 190 (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION JOBSITE ADDRESS r of APN LOT —/-- TRACT OWNER o!V ADDRESS /1 'LTr- A( CITY ZIP TEL. APPLICANT TEL. o CONTAACTO o b ADDRESS CITY I TEL 3 ATE G/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT i AM EXEMPT FROM THE CONTRACTORS LI- CENSE MW PDRTHE FOLLOWING. REASON (SEC. 70312 SUSMESSAND PROFESSIONS OODE:ANY CITYOR COUNTY WI UCH MCIMESA PM49TTO ODNSTRUCT. ALTER IMPROVE. DEMOLISH. Oft REPAIRANY STRUC- TtNE, PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE S UGE145ED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW (CHAPTER S (COMMENCING WITH SECTION TWO) OF OMSION 3 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 7051.5 BY ANY APPLICANT FORA PERMIT SUBJECTS THE APPLICANT TO ACIVL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (3500)-1- O LAS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DD THE WORK, MID THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, &At- NESSMIO PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTYWHO BUDS OR 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 F, HOWEVER THE BURANOORMPROVEMENTIS SOLD WITI INONEYEAROFCOMPLE- TON, THE OWNER -BUILDER WALL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT auto OR IMPROVE FOR THE PURPOSE OF SALE} O LAS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WRH UCENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC • 7044. BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS U. CENSE LAW DOES NOT APPLY TOAN OWNER OF APROPERTY WHO BUILDS OR IMPROVES THEREON. AND WHO CONTRACTS FOR SUCH PROJECTS W ITHAOONTRACTOR(S) LICENSED PURSUANTTO THE CONTRAC- TORS ONTRAOTORS LICENSE LAW.} O IAM EXEMPT ANDER SEC. S. a P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER N (COMMENCING WITH SECTION TOW) OF DIVISION S OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE S N FULL FORCE AND EFFECT. ? LK.`ENSE LIC. NO. DATE CONTRACTORSb WORKERS' COMPENSATION DECLARATION 1 HEREEY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: J_ I NAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF•WSURE FOR WORKER& COMPENSATION. AS PROVIDED BY SECTION 37W OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. _I HAVE AND WILL MAINTAIN WORKERS COMPENSATION INSURANCE. AS REQUIRED BY SECTION 37000E THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WOR/KEER(SW COMPENSATION INSURANCjE CAR IEA AN POLICY NUMBER ARE: CARRIER _`+'��' POLICY NUMBER J (DE SECTION NEEDNOT BECOMRFrEDO THEPERITS FOR ONE HANDREDDOLLAR4(SI00)ORLESS), I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT S ISSUED, I SHALLNOT EMPLOYANY PERSON IN ANY MANNER BOAS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT M I SHOULD BECOME SUBJECT TO THE WORKERS, COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE SHALL iORTHVATHCOMPLYWRHTHDSEPROYISIONS. DATE: PPLOANT: �� • ` WARNING: SURE TO SECURE WOHKERS'COMPENSATKN COVERAGE ESUNIAWFUL,ANO SHALL BE SUBJECT EMPLOYER TO CRIMINAL PENALTIES AND CML FW ES UP TO ONE HUNDRED THOUSAND DOLLARS (3100.WD), N ADDITION TOTHE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR N 1 SECTION 3705 OF THE LABOR CODE. INTEREST, AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY i 1 HEREBYAFFIRM UNDER PENALTY OF PERJURY THAT THERE S ACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR "" THIS PERMIT IS ISSUED (SEC. 5037, CIV. C.) I LENOER'8 NAME LENDER'SADDRESS I CERTIFY THAT 1 WINE READ THIS APPLICATION AND STATE TWRTHEABOVE INFORMATION 15 CORRECT. (AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS REU(TNG TO BUILDING CONSTRUCTOR AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE 1 ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. 1 S PERMITTEE SIGNATURE OF PERMIT TE PRESS FIRMLY APPLICATION ERMIT (�,P/C DATE UMBER -/ R ISSUE TYPE OCC DATE CONST GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDEISIDE STREET RW ❑ SIDE ❑ PROPOSED USE • 11 ?-- W frt%E fly u NO. DWEL NO. UNITS STORIES fir- . BEDROOMS DESCRIPTION SO. FT I FACTOR PSF ADJ. AREAIVALUATION SFRIADO/REM Garage/Carport WPa11G0e0k L= POOVSPS Re -Roof 0 Commercial - Valuatlw ADJ.AREA QUANTITY DESCRIPTION FEE Q U 2 U W J W 7- 7 - CONSTRUCTION CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL '. INSPECTION FEE ISSUANCE SMfP CITy(-)y.!_)?t;_MMJ) UAR ENERGY P/C ENERGY PERMIT i<'.l I L[ DT -Nr RETENTION FEE: PRE -ALT FEE: TOTAL FEES COMMENTS vL _ E .., RECPL NO. PAID BY VALIDATION WHITE-0eparonent Copy/YELLOW--Finance COW PINK—Assessor COW. GOLDENROD FlIe Cly, GREEN --Applicant's Copy CITE' OF DIAMOND BAR 114SPECTIC.?N RECORD FLOOR JOIST _`__ -------------- —�-- — -- — — Ea.Et � I ! FHA REQMTS E, a Iv GR, 0UNIDi UNDER FLOOR DUCT -- -- -- — -- U.l F'E �' e� -- ._ — UPJD` R FLOOF. COI DIiIT -- FIREPLACE FOUNDATION. � FIREPLACE BOND BEAN'l � I Slv r za !� i MIG H T. SOND BEAN! t !- IPG-7� 8 Ft. 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