The URL can be used to link to this page

Home My WebLink About15030 (19)CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY do DEVELOPMENT SERVICES cf):w 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 PRESS BUILDING PERMIT APPLICATION FIRMLY JOBSITE ADDRESS eaio oo o v ADDRESS C,I N' V' APN LOT TRACT OWNER Pi zIr -e ADDRESS CITY IP TE - .l� APPLICANT TEL. CONTRACTO uk7611 r DDDR S CITY ZIP � f ARC NG/ y 6 DESIGNER ADDRESS CITY ZIP EL, OWNER -BUILDER DECLARATION I HEREBY AFFIRM LNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE ANY CITYCR COUNTYNHICH REOU RESAPERMRTO CONSTRUMAI,TER NPROVE DEMOUSKOR REPAIRANYSTRUC- TIME 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 LI- CENSE LAW (CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PRO- FESSION5 CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7051.8 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (11500}): DI. AS 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, BUSI- NESS AND PROFESSIONS CODE: AHE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREOMANDWHO DOES SUCH WORKFOMSELF OR HERSELF OR TMROUGHHIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FCR SALE IF, HOWEVER THE BUILDING OR IMPROVEMENT 15 SOLD WITHIN ONE YEAR OF COMPLE- TION, THE OVNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FORTHE PURPOSE OF SALE). O L AS OWNEROF THE PROPERTY, AM EXCLUSIVELYCONTRACTNG WRH UCENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7041, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE LAW DOES NOTAPPLY TO AN OWNER OF APROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITHACONTRACTOR(S) LICENSED PURSUANTTO THE CONTRAC- TORS LICENSE LAW.} ❑ IAM EXEMPT UFIOER SEC. B. A P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREay AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 0 (OOLIMENCNG WITH SECTION 7000) OF DIVISION 3 O THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS N FULL FORCE AND EFF CL yj C LIC. NO. y DATE CONTRACTORS / WORKERS' COMPENSATION DECLARATION 1 FIEREBYAFFlgM INOER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: —aiF/J—I HAVE AID WILL MAINTAIN A CERTIFICATE OF CONSENTTO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROWDEO BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED- -1 SSUED._1 HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY SECTION 97000E THE LJIBOR CODE THE PERFORMMCE Of THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS COMP NSA NSURAN� RIER OIICY Ny\MBER ME: CARRIER `� - POLI:Y NUMBER (THISSECTIONN® NOTBE amuiEDOFTFE PERMIT 15 FOR ONE FAWiEDDDIURS (11100)OR LESS). I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. 1 SHALLMOT EMPLOY ANY PERSON N ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CA IFORNIA - - AGRE THAT IF I S 1) BECOME SUBJECT TO THE WORKERS' COMPENSATXNI P IONS OFCTION F THE E�IFO TH COM�MTH.PRO'DA ICARNING: FAURE ION COVERAGE 15 NUWFUI. AND SHALL BE SUBJECT AN EMPLOYERTO CRIMINAL PENALTIES MD CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS (5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3701 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS ACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3017, CIV. C.). LENDERS NAME LENDER'S ADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. 1 AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDIW LACES AND STATE LAWS RELATING TO BLALDING CONSTRUCTION. AND HEREBY AUTHORIZE REPRESENTATIVES OF IS COUNTY TO ENTER UPON THE VE-MENTKX�IED ROY FOR INSPECTION PURPOSES. E AME(PRINT) SE OF PERMUTUDATE J �J APPLICATIO 1 PERMIT P/C DATE t NUMBER_ N ISSUE =5 YPE OCC DATE OVIST. GROUP ZONING SETBACKS FRONT RW p 1 REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM In Garage/Carport W Patio/Dock LL POOVSpa (51 Z Re -Roof C1Commercial - 5 m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE U H U W J W Z Do J( a a U { Q 2 U W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE PA irn ISSUANCE SMIP ENERGY P/C MAY ENERGY PERMIT CLI_y er� Db7L A Tye_ OND BAR RETENTION FEE: 12LI—ID4N T' S ; : PRE -ALT FEE: leis TOTAL FEES 130 0 COMMENTS e RECPT. NO. V U PAID BY VALIDATION VVMI 1 t--LJepanment [Copy, YeLLuw-fmanoq Copy. PINK—Assessor Copy, GOLDENROD --File Copy, GREEN—Applicant's Copy ti CITY OF DIAMOND BAR i INSPECTION RECORD SET BACs ! - i i FLOOR aOIST,,--, -- _ FTGS'FORMSiSTEEL FNA RE:QMTS — ELECTRIC GROUND -. _ ( UNDER FLOOR DUCT GROUND PLUMBING — UNDER FLOOR CG, ,-JUIT ' SLAB GRADE i: I FlRER1 EICE_ FOUL�ATION -TEMP POWER it -FIREPLACE BOND BEAM _ E WATER SERVICE i I MID HT. BOND -BEAM- ROO= SHEATHING 8 FT. BOND BEAM FRAM!NGrVENTiLIATION I - ` _ FINAL BOND BEAM ROOF COVFR ( PRE -GRADING - E (C!lGH HEATINGIto BENCHING t ROUGH GIS Ems-CTRIC _ f ROUGH GRADING _ F�.I UMBING i ! FINISH GRADING i I �v� :� UB TES T I POOL ELECTRIC I i h:`S?DING ! POOL FENCING _ VrA L. INS 1LATION - POOL FINAL CEI: INN It _=UL ATION ' OFF SITE IMPS. i s DRlL NAILING lDEDICATIONS S -WE ; — FINAL ENG, _ •vANK -- ! LAPJDSCAPElIRR!G. ----- —___ i ON SITE IMPS. —ST— I FINAL ZONING p NST. -- FIRE DEPT. FINAL iEAT'NG j _ HEALTH DEP i. FINAL ELF" Ri DEV. FEES PAID PLUMSINt ENERGY — — — - I i SEPTIC TANK SIZ- SF_EP PIT/U SIZE_------ EEiill �