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Home My WebLink About12583CITY OF DIAMOND BAR' -� DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 961-3117 / PRESS BUILDING PERMIT APPLICATION FIRMLY JOBSITE ADDRESSES%J� 5, i�IRmencl �l�f 1� APN LOT TRACT OWNER c -CG ADDRESS •O (toe *2 5 a CITY &w. ZIPS'TA TEL.719 'lay—[AJ APPLICANT'!' -t$ 1 TELf41� �Ll-)461 CONTRACTOR LAkMCA c ADDRESS ;!V J7 CITY ReSec o- ZIP R� TELIEnirC ' ARCFVENGI DESIGNER ADDRESS CITY ZIP TEL OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LF CENSE LAW FOR THE FOLLOWING REASON (SEG 7 W I.S SUSINESSAND PROFESSIONS CODE:ANYCITY OR COUNTYWHICH REOMES APERMITTOCONSTFNCT.ALTER FMPFIOVE. DEMOUSH, On REPAIR ANY STRUC- TURE. PRIOR TO ITS ISSUANCE, ALSO REGUINES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS U• CENSE LAW (CHAPTER P (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESSAND PRO. FESSI NS CODE) ORTIIAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED E%EMP- TION.ANYVIOLATION OF SECTION 7031.5 BYANYAPPLIOANT FOR A PERMITSUBJECTS THEAPPLIC NT TO A CML PENALTY OF NOT MGRE THAN FIVE HUNDRED DOLLARS (35001.7.0 0 LAS OWNER OF THE PROPERTY. OR MY EMPLOYEES VATH WAGES AS THEIR SOLE COMPENSATION, VALL DO THE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FCR SALE (SEG 7044, BUSI. NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUIDS 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 SAIF IF, HOWEVER THE BUILDING OR IMPROVEMENT IS SOLDWITHIN ONE YEAROF COMPLE- . TION•THE OWNER431-1I1-DER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF BALE). . 0 L 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 F CENSE LAW DOES HOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON. AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR($) LICENSED PURSUANT TO THE CONTRAC- TOU E LAW.} - IAM E RS XEMPTUNDER SEG B.3 P.0 FOR THIS REASON DATE / Gj Cl St OWNER �� LICENSED CONTRACTORS DECLARATION I HEREBYAFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 5 (COMMENCING WITH 3ECTIDN 7000) OF DIVISION 30FTHE BUSINESS AND PROFESSIONS COOE.ANO W LICENSE IS N FULL FORCE AND EFFECT. LICENSE CLASS C t I / HO DATE H -3C - aa�CCii CONTRACTORL��i_i - r3r�✓ WORKERS' COMPENSATION DECLARATION • [�i7U " I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: - _I HAVE AND PALL MAINTAIN A CERTIFICATE OF CONSENT TO SELF.INSVRE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION 3700 OF THE LABOR CODE. FOR THE PERFOnMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE, AS REWIRED BY SECTION 3700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER POLICY NUMBER (THIS$ECnWNEEDNOT BE CDM IETE)OF -C PEPMT IS FORONE MINLREDDCl1ARS(310))CRLESSL 1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I V SHALLNOT EMPLOY ANY PERSON N ANY MANNER $0 AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA AND AGREE THAT IF 1 SHOULD BECOME SUBJECT TO THE WORKERS COMPENSATION PROVISIONS OF5.SE. 4437000E THE LABOR CODE, I SHALL FORTHWITH COMPLY WITH THOSE FIRSX)r1 i DATE:IO'�7- Q2'l APPLICANT _j1- WARNING: FAILURE TO SECURE WORKERS COMPENSATION C RAGE IS UNLAWFUL. AND SHALL BE SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ON F. HUNDRED THOUSAND DOLLARS (SI 00,0W). N ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN 1 SECTION 370A OF THE LABOR CODE, NTE RE ST. AND ATTORNEYS FEES. L CONSTRUCTION LENDING AGENCY i 1 OR THE ERFO UNDER PENALTYOFFORWYTHATTHERE ISACONSUED ISSN LENDING AGENCY FOR THE PERFOFSAANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED ISEG 7097. CIV GI. 5 LENDERS NAME LENDER'SADDRESS 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 ORDINANCES AND STATE LAWS RELATING TO BUILDING 'CONS7RUCTKON. AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COLNTY TO ENTER UPON THE ABOVE.YENTIONE PERTY FOR INSPECTION PURPOSES. PEPM NAM (PW D D SIGNATURE OF PkWTIEE DATE APPLICATION PERMIT O 2� 0 2583 PIC DATE NUMBER ISSUEq TYPE OCC DATE 10'I 2- CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ ' SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE <ic75 '4 11QIriCjPC ��rVliP NO. DWEL NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION SFR/ADD/REM Garage/Carport - W Patio/Dock L- PooVSpa ZRe-Rool Commercial m Valuation O G ADJ.AREA QUANTITY DESCRIPTION FEE Q U U -A W Z m J 1a Q U 2 Q 2 U W pp 53 O CONSTRUCTIO r T PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE PAID ISSUANC 2 S Ly o MIP 1 ENERGY P/C �I2. 19 98_ ENERGY PERMIT RETENTION FEE: CITY OF DIAMUN D BAR. BUILDING PRE -ALT FEE: TOTAL FEES q0 COMMENTS RECPT. NO. PAIDBY VALIDATION Y WHITE-0epeRmant GOpy, YELLUw-+Inence l:Opy. rlrvn—nssessorLapy. uvwcnnln.--rlw a,oyy, un��I.—.�Inw�il, wy7. - - CITY OF DIAMOND_ BAR!. - 'INSPECTION RECORD'... . jNS#ttrnON'DATE SETBACK �L C� -, I •. '. c, c . Cr S • �� •• FLOOR„JOIST-,: 0 `.. •. ; FTGS/FORMS/STEEL FHA REQMTS - -- ELECTRIC GROUND ':_ ..- `' UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR CONDUIT SLAB GRADE " " - _ " FIREPLACE FOUNDATION -TEMP POWER - - - FIREPLAbEBdND BEAM WATER SERVICE .MID HT. BOND BEAM . • , ROOF SHEATHING ' - S FT. BOND BEAM ' FRAMING/VENTILIATION �- 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. - - 3 - - FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT.. FINAL..: FINAL ELECTRIC - - DEV. FEES PAID FINAL PLUMBING ENERGY COMMENTS - - SEPTIC TANK SIZE Lf Ci.i^i.Si,lfr -TO Y'1'J--" SEEP PIT/U