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Home My WebLink About10072may.. 0 O M w zd CC O 0 0 wCIO 53 53 Ln czO w U W I C7 O Z O Z W L" F LL O CLd W 10— In In Q d 0 D W Z S2 0 J Q LU O Zcc W 0 m Q N N iE CITY OF DIAMOND BAR f COMMUNITY DEVELOPMENT DEPARTMENT 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 13MLDING PERMIT APPLICATION 164211 /1/, �,re 010 P ADDRESS ADDRESS APN L T TRACT OWNER ADDRESS CITY ZIP TEL. APPLICANT TE CONTRACT ADDRESS CITY ZIP TEL ARCFVENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM LNDER PENALTY OF PERJURY THAT IAM EXEMPT FROM THE CONTRACTORS U4 CENSE LAW FOR THE FOLLOWING REASON (SEC. 70.11.5 BUSNESSAND PROFESSIONS CODE ANYCIT/ OR COUNTY WHICH REQUIRES A PERMITTO CONSTRUCTALTER, IMPROVE, DEMOUSH.OR REPAIRANY 3TRU' TURF 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 LL CENSE LAW (CHAPTER I (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS ANO PRO. FESSIONS COOE) OR THAT HE OR SHE IS EXEMPTTHEREFROM AND THE BASIS FOR THE ALLEGED EXEMP. TION. ANY VIOLATION OF SECTION 7031.5 BY ANYAPPL)CANT FORA PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT LKXNE THAN FIVE HUNDRED DOLLARS (11500)): " D 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. 70/1. BUSI- NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OW NER OF PROPERTY WHO BUILDS OR IMPROVES THEREOK AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES. PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FORSALE. IF, HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WITH NONE YEAR OF COMPLE- TION. THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DW NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALEL O 1. AS OWNER OF THE PROPERTY. AM EXCLUSIVELY OONTRACTNO WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044• BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TORN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON. AND WHO CONTRACTS FOR SUCH PROJECTS WTHAOONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS ONTRAOTORS LICENSE LAW). O I AM EXEMPT UNDER SEC. B. A P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBYAFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISCNS OF CHAPTER s (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS N FULL FORCE AND EFFECT. s LICENSE CUS LIC. NO. DATE CONTRACTOR Aff WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: _I HAVE AND W1LL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSUnE FOR WORKERS' COMPENSATKON,AS PROVIDED BY SECTION 5700 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 5700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORK fi3'cc PE 3AYp INSUIC AIR{ POLICY NUMBER ARE CARRIER POLICY NUMBER rmsECTCN NELDNOTBECOMPLETmOFTIE PERMIT 15 FCR ONE M1NCRtDDOU.At9 CSIM) OR LESS) 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 ULD LAWS OF CALIFORNIA AND AGREE THAT IF 1 SHOBECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CppE, F TH COMPLY T �SI DATE: APPLICANT:/j�'lF WARNNG: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THIXI3.LND DOLLARS IF 100.000). N ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 37050E THE LABOR CODE. INTEREST AND ATTORNEYS 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 (SEG 3097, 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 WRHALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATNES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR NSPECTION PURPOSES. PERMITTEE EJp]yT1�E& ' � .t? SIGNATUREOF EQ%QE - WHITE—Department Copy. YELLOW—FMnce Copy, PINK—Assessor Copy, GOLDENROD—File Copy. GREEN—/W ICIM"ICs COPY PRESS FIRMLY APPLICATION PERMIT O DATE NUMBER 8 ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW -O REAR ❑ SIDE/SIDE STREET RW D SIDE ❑ PROPOSED USE NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION SFR/ADD/REM Garage/Carport W Patlo/Deck LL Poovspa ZRe -Roo! Commercial In Valuation ADJ.AREA QUANTITY DESCRIPTION FEE ¢ W LU LU L7 Z 2. a U 2 lull CONSTRUCTION PLAN REVIEW ELECTRIC MECHANICAL INSPECTION FEE ISSUANCE SMTP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE•ALTFEE::1997 TOTAL FEES COMMENTS RECPT. NO. PAID BY VAIJDA -L 7 CITY OF DIAMOND .,,BAR INSPECTION RECORD -1 pl 7 --J Lz V Q SETBACK- I-FLOORJOIST- FrGSIFORMSISTEEL ------- -jFHAREQMTS--- 7, ELECTRIC GROUND UNDEFLpbR DUCT GROUND PLUMBING UNDER FLOOR CONDUIT SLAB GRADE FIREPLACE F2UNDATION TEMP -POWER z7 FIREPLACE -BOND BEAM WATER SERVICE—-, -BEAM MID HT, BbND( ROOF SHEATHING 8 Fr. BOND BEAM FRAMINGNENTILIATION FINAL BOND BEAM - ROOF COVER -PRE-GRADING -ROUGH HEATING--! BENCHING -ROUGH ELECTRIC -J-- ROUGH GRADING , ROUGH PLUMBING 'FINISH GRADING SHOWERrrus-rEsT-'--- POOL ELECTRIC -EXT. LATH/SIDING POOL FENCING WALL INSULATION POOL] FINAL ir CEILING INSULATION OFF SITE IMPS., DRYWALL NAILING DEDICATIONS SEWER I -FINAL ENG., LAND.SCAPEIIRRIG, SEEP_PITlL.L__t___ -ON SITE IMPS. -GAS, AIR TEST FINAL ZONING FINAL -CONST.- - FIRE DEPT FINAL FINAL-HEATfNG HEALTH DEPT. FINAL FINAL ELECTRIC- 7— -DEV.FEES PAID - FINAL:PLUMBING_____ ENERGY Y. COMMENTS— ____. • • 'SEPTIC TANK -SIZE 'SEEP PIT/L) SIZE