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Home My WebLink AboutPR 11-1162DIA114IND HAIIi CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21825 Copley Drive, Diamond, Bar, CA 91765 909) 839-7020 Fax (909) 861-3117 Building Inspection Hotline (909) 839-7027 PRESS BUILDING PERMIT APPLICATION FIRMLY JOBSITE ADDRESS APN LOT TRACT OWNER ADDRESS 22, McLI t. CITY C rY?'iYYIA ZIP TEL. Q ^ q APPLICANT y T L. CONTRACTOR L f t ADDRESS W • I CITY ZIP C4 Joao%TEL. 1 - O' o v ARCH/ENG/ / DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS U. CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE: ANY CITY OR CW NTY WHICH REQUIRES A PERMIT TO CONSTRUCT, ALTER, IMPROVE, DEMOLISH, OR REPAIR ANY STRUC. TURE. PRIOR TO ITS ISSUANCE. ALSO REWIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENTTHAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS L4 CENSE LAW IOCHAPTER8 (COMMENCING WITH SECTION 7000) OF DIVISION 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 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS ($500).): 1, 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: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS 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 IF, HOWEVER. THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE- TION, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). 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 NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON. AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). 1 AM EXEMPT UNDER SEC. B. 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 e (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE. AND MY LICENSE IS IN FULL FORCE AND EFFECT. n Q LICENSE CLASS ` LIC. NO. O Jy DATE 0 2-1/I /L CONTRACTOR X1.1 V WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: 1 HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCEeIOFTHEWORKFORWHICHTHISPERMITISISSUED. HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE. AS REWIRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' C MPETIN INS CE CARRIER AND POLICY NUMBER ARE: CARRIER Y POLICY NUMBER IMG SECTION NEED NOT BE COIMIPLETED OFTI-E PERMIT IS FOR ONE HU DRED DOLLARS ($100) OR LESS} I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHI HIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO B ME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA, AND AG I SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISION F SECT W OF THE LABOR 3C0DE. SH-1..-T,H COMPLY WITH THOSE PROVPNS. DATE:APLICANT: WARNINLURE TO SECURE WORKERS' COMPENS ION COVERAGE IS UNLAWFUL, AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY 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. 3087, CIV C.). LENDER'S NAME LENDERSADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS 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 ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSk wh ma--, t vim. PERMITTEE NAME (PR SIGUbjW0233EJaGQM7E DATE APPLICATION PERMIT t DATE _ /.gk ' (, NUMBER 1 lI- \ 110-3, #/F19- %a, ISSUE TYPE OCC DATE o S A\ CONST. GROUP ZONING SETBACKS FRONT RW REAR SIDE/SIDE STREET RW E] SIDESIDE PROPOSED USE LLU INA 4A1N&L Lz-rrr_P_5 NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREAIVALUATION SFR/ADD/REM C/) Garage/Carport WPatio/Dock LL 0 Pool/Spa Z Re -Roof Commercial m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J F- 0UW W Z_ GO a U ZQ2 W CONS UCTION C LAN REVIE ELECTRIC S Q PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ) j ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: TOTAL FEES COMMENTS S ffRECPT. NO. ' a is PAID BY WT VALIDATION n1 I c—vupunmenl wpy, TeL.L.vw---tnance L;opy, VINK—Assessor Copy, GOLDENROD—File Copy, GREEN— Applicant's Copy CITY OF DIAMOND RAR INSPECTION RECORD Oa pCC 400[,YJ DQ4C 4 =h mpCC40G;` Oa3Ga@0400}' :' QIa4C-' OGl 3PGG°; SET BACK FLOOR JOIST FTGS/FORMS/STEEL FHA REOMTS ELECTRIC GROUND 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/VENTILATION " FINAL BOND BEAM ROOF COVER PRE -GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWER/TUB TEST POOL ELECTRIC EXT. LATH/SIDING POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER FINAL ENG. SEPTIC TANK LANDSCAPE/IRRIG. SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST. FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC/ j' I DEV. FEES PAID FINAL PLUMBING ENERGY _ COMMENTS SEPTIC TANK SIZE SEEP PIT/U SIZE a a