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Home My WebLink About15088 (30)CITY 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 Gly Di ADDRESS 1 72 'u./D I IA -k ISSUE v TYPE OCC DATE- � f Ti - CONST, GROUP APN LOT TRACT OWNER nJA b ADDRESS CITY '' ZIP TEL L^ APPLICANT TEL CONTRACTOR ADDRESS CITY ZIP TEL - ARCH/ENGt DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERAIRY THAT 1 AM EXEMPT FROM THE CONTRACTORS LF CENSE LAW FOR THE FOLLOWING REASON (SEG 7171.6 BUSINESS AND PROFESSK)NS CODE: ANY CRYOR COUNTYTVHICH REOUMRESA PERMRTO CONSTRUCTALTER IMPROVE, DEMOLISH. OR REPAIR ANY STRUC. LURE 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 L (COMMENCING WITH SECTION 7000) OF DIVISION S OF THE BUSINESS AND PRO. FE33IONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EKEMP- TIOR ANY VIOLATION OF SECTION 7001.6 BYANYAPPLICAFIT FOR A PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (SSW).): O L AS OWNER OFTHE PROPERTY, OR MY EMPLOYEES WITH WAGES A3 THEIR SOLE COMPENSATION, WILLDO THE WOM AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEG 7044, BUSK FESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUL0 OR IMPROVES THEREON, AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HIER OWN EMPLOYEES. PROVIDED THAT SUCH IMPROVEMENTS ARE NOT MENDED OR OFFERED FOR SALE IF, HOWEVER THE BUILDING OR IMPROVEMENTIS SOLD W7THINONEYEAR OF COMPLE• TION, THE OWNEFHOUIILDER WILL KAYE THE BURDEN OF PROVING THAT FIE OR SHE DO NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). E3L AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS ,ATO CONSTRUCT 1HE PROJECT (SEG 7044, BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LI• ,CENSE UW GOES NOTAPPLY TO AN OWNER OF A PROPERTY WAD BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITHACOfNTRACNOR(5) LICENSED PURSUANT TO THE CONTRAD TORS LICENSE LAW.), O 1 AM EXEMPT UNDER SEG S. L P.C. FOR THIS REASON L DATE OWNER LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 6 (COMMENCING WITH SECTION 7000) OF DIVISION 3 O THE BUSINESS AND PROFESSIONS CODE AND MY LICENSE IS N FULL FORCE AND EFFECT. LICENSE CL/ SS � y,,-t7r LIC. NO. 1 DATE 1, —? — L Y CONTRACTOR J L -`O• 0-31 WORKERS' COMPENSATION DECLARATION l I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: —I HAVEAND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SCLFNN SURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION 2700 OF THE LABOR CODE, FOR THE PERFORMANCE OF TME WORK FOR WHICH THIS PERMIT IS ISSUED. �1 HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REWIRED BY SECTION 5700 OF THE LABOR COOS FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARPIER POLICY NLIIABER t rNIS SECTICNNEMNOYBEOCAFlETTDOFTHE PERMIT 6 FOR ORE ILII>lXREDOOLLAR, ($100) OR LESS) 1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I $HALL NOT EMPLOYANY PERSON N ANY MANNER SO AS TO BEOOM_ SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT i I SHOULD BECAME SUBJECT 70 THE WORKERS' COMPENSATION PROVISIONS OF SECTION 2700 OF THE LABOR E, I SHALL FORTHYATH COMPLY WITH THOSE PROVISIONS DATE: _2—y:! APPLICANT: WARNING: FAILURE TO SECURE WORKERS'COMPENSATI C;VE GE IS UNLAWFUL, AND SHALL BE SVSACTAN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONG HUNDRED THOUSAND DOLLARS (7100,000), INADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 2708 OF THE LABOR CODE. INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UDDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEG 3067, CIV. G). LENDERS NAME LENDERS ADDRESS I CERTIFY THAT HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT I AGREE TO COMPLY WITH ALL CrrY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTOR AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE MENTIONED PROPERTY FOR INSPECTION PURPOSES. 'x_6 ek PERMITE (PRi1NT TE SIGNATURE OF PERMI ATE 1 01 PRESS FIRMLY APPLICATIO L PERMIT f s P/C61), DATE NUMBER / 1 ISSUE v TYPE OCC DATE- � f Ti - CONST, GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE p AOPOSED USE NO. DWEL NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION SFR/ADDMEM Garage/Carport WPatlo/Deck - LL Pool/Spa Z RrRoo1 0 Commercial - ED Valuation ADJ.AREA OUANTITY DESCRIPTION FEE Q U_ U w J , w 2 z m 2 Q U Z Q S U w S'l CONSTRUCTION l PLAN REVIEW � V - ELECTRIC PLUMBING MECHANICAL INSPECTION FEE 1 ISSUANCE SMIP 01 A ENERGYP/C IV 0, r ENERGY PERMIT RETENTION FEE: PRIhALTFEE TOTAL FEES COMMENTq RECPT. N PAID BY VALIDATION WHITE --Department COPY. YELLOW --Finance Copy. PINK—Assessor Copy, GOLDENROD -file Copy, GREEN—Applicant's Copy `I CITY OF DIAMOND BAR INSPECTION RECORD 7GS/FORMISISTEEL [� .`, FLOORJpIST„ .fjilt ` . r ... _ .._. FHA REOMTS " ^' ROUND ... `. l c,� UNDER FLOOR DUCT 'GROUND PLUMBING UNDER FLOOR CONDUIT SLAB GRADE FIREPLACE FOUNDATION TEMP POWER - FIREPLACE BOND BEAM WATER SERVICE MID HT. BOND BEAM ROOF SHEATHING.: 8 FT: BOND BEAM • FRAMING/VENTILIATION FINAL BOND BEAM ROOF COVER PRE -GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWER/TUBTEST POOL ELECTRIC. EXT. LATH/SIDING POOL FENCING'; WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS. i DRYWALL NAILING DEDICATIONS SEWER FINAL ENG. SEPTIC TANK LANDSCAPE/IRRIG. SEEP.PIT/L.L. ONSITE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST 1 I l po . - FIRE DEPT. FINAL 'FINAL HEATING -... HEALTH DEPT. FINAL FINAL ELECTRIC �� DEV. FEES PAID FINAL PLUMBING ENERGY77F l COMMENTS i .- Yd , r-' �,.I: , ,., _•. - . _ SEPTIC TANK SIZE SEEP PIT/U SIZE I "1 ,