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Home My WebLink About11392 (9)f ---. CITY OF DIAMOND BAR �7 COMMUNITY DEVELOPMENT DEPARTMENT f 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 B1 LDING PERMIT APPLICATION JOBSIT 3DZ ADDR APN LOTTR CT OWNER AQ_r ADDRESS14- c K co CITY Z 90(07 3 TEL. 71q 470 -'aiOA APPLICANT. -ice- TEL. CONTRACTOR ADDRESS CITY ZIP TEL. ARCWENG/ �1 DESIGNER . T S o i 4 ADDRESS It < CITY ZIP TEL. I=�Q OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC. 7071.5 BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH RE WIRES A PERMITTO CONSTRUCT. ALTER IMPROVE. DEMOLISH , OR REPAIRANY 3TRUC- TURE. PRIOR TO m5 ISSUANCE, ALSO REWIRES 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 0 (COMMENCING WITH SECTION 7000) OF DMSION 3 O THE BUSINESS AND PRO- FESSKONSCODE) ORTHAT HE OR SHE IS EXEMPTTHEREFROM AND THE BASIS FOR THEALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7071.6 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO ACIV:L PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (5500).1 O L AS OWNER OF THE PROPERTY, OR MYEMPLOYEES 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 IR HOWEVER THE BUILDINGOR IMPROVEMENT IS SOLA WITMNCNE YEAR OF COMPLE- TION, THE CYINER BUILDER WILL HAVE THE BURDEN OF PROMO THAT HE OR SHE DID NOT BUILD OR IMP FOR THE PURPOSE OF SALEI- . AS FOR OF THE PROPERTY,AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO TR THE PROJECT (SEC 7044. BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI. CENSE LAW DOES NOTAPPLY TOAN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTORS) LICENSED PURSUANTTO THE CONTRAC- TORS NTRAGTORS LICENSE LAW.). O I AM EXEMPT UNDER SEC. S. S PC. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER f (COMMENCING WITH SECTION 7000) OF DIVISION 7 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FULL FORCE AND EFFECT. LICENSE C�6�'� � \ LIG. NO. DATE __' G CONTRACTOR WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENTTO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION 37000F THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. jfffl 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 13 ISSUED. MY RKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER �E~� �— POLICY A"I" (THIS SECroN NEED NOTSE OOMPLETEDGFTrE PERMITIS FORONE HUNDRED DOLLARS (sIm)OR IFSS) 1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK 'R WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON INANY MANNER SO O BECOME SUBJECT TO %f WORKERS' COMPENSATION LAWS OF CALIFORNIA.AN AG .E THAT IF I SHOULD BECOOIE SUBJECT TOTHE WORNERS'COMPE A.. PROVIS NSO SECTION 37000F THE LABOR +� �CODE, I SHALL FORt}�TH�WITH COMPLY TH TH !PR 'ON BATE; APPLICANT: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UL. OSHALLBE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ON DRIED THOUSAND DOLLARS(St00.0D0). IN ADOMCN TO THE COSTOF COMPENSATION. DAMAGES ROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 7007, CIV. C.I. LENDERS 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 OMTV ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION AND HEREBY AUTHORIZE H PRESENTATIVES OF THIS COUNTY TO ENTER UPON THE •ME OPERTV FOR INSPECTION PURPOSES. N P RMI - (PR ) SIGNUR ATEOFPERMITTEE DATE PRESS FIRMLY APPLI PIC CATION / Z/L Z� DATE NU BE / ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDEISIDE STREET RW ❑ SIDE ❑ PROPOSED USE sf.__ n , '. lew- NO. DWEL. NO 1 NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT, FACTOR PSF ADJ.AREANALUATION SFRIADDIREM � Garaga/Carport WPatio/Deck U" Poovspa Z Re -Roof D Commercial m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE Q U CL U W J Lu Z m J a J 42 Z S U W ON LAN RE ��• QD — ELECTRIC PLUMBING MECHANICAL As. M� INSPECTION FEE _ -7 ISSUANCE r SMIP ENERGY PIC _1M1612 ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: TOTAL FEES COMMENTS 5 RECPT. NO. 1PAID BY VALIDATIO WHITE—Depart Copy, YELLOW inflflCe Copy, PINK—Assessor Copy,,, GOLDENROD—File GopY, GREEN—Applicant's G,Opy i ✓I Is�Iq�1_ ten,, ('l AJ -AI ('rPf_ -jTnA *7 in 2�%1�%_ 0x7 rA L CITY .OF DIAMOND BAR ; INSPECTION RECORD INSPECTION DATE INSPECTOR ikspeotm DATE INSPECTOR SETBACK FLOOR JOIST FTGS/FORMS/STEEL - FHA REQMTS I ELECTRIC GROUND UNDER FLOOA,DUCT_,:i. 'GROUND PLUMBING UNDER`•ELbbll''COlfDUIT -"t' _! • I .;__? SLAB GRADE - Fl REP CEOUNDATION -TEMP POWER = - : FIREPLACE BOND BEAM WATER SERVICE :' - ` "' MID HT BOND BEAM ROOF SHEATHING 8 FT. BOND BEAM FRAMINGNENTILIATION FINAL'BOND,BEAM ROOF COVER PRE -GRADIN; ° : ;' �; . "_ , , �::. , •' 7 ROUGH HEATING BENCHING ROUGH ELECTRIC - ROUGH GRADING ROUGH PLUMBING - FINISH GRADING SHOWERITUB TEST ' - POOL ELECTRIC EXT LATH/SIDING POOL FENCING' WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER _. .._ FINAL'ENG. SEPTICTANK. 'LANDSCAPE/IRRIG. + ; SEEP PIT/L.L. - ON SITE IMPS, GAS AIR TEST - FINALZONING FINAL CONST. - FIRE DEPT.-F,1146II_ FINAL HEATING - - HEALTH DEPT. FINAL FINAL -ELECTRIC - DEV. FEES PAID FINAL PLUMBING ENERGY COMMENTS SEPTIC TANK SIZE SEEP PIT/U SIZE f