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Home My WebLink About13213CITY OF DIAMOND BAR - DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION . JOBSITE ADDRESS ADDRESS APN LOT Z TRACT AM- 7-7- OWNER ZOWNER ADDRESS 1 ?3*Z-{A_-TIIA $4 1-- CITY ZIP TEL APPLICANT TEL. CONTRACTOR ST QCK kaNS-T r ADDRESS CITY k ZIP '7 STEL. 8 ARCFMNGI DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC. 70.71.6 BUSINESS AND PROFESSIONS CODE:ANYCITYOR COUNTY WHICH REDWRESA PERMITTDOONSTRUCL ALTER. IMPROVE DEMOUSH.OR REPAIRANY STRUC- TORE, PRIOR TO ITS ISSUANCE. ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE 15 LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS UI - CENSE LAW (CHAPYER a (COMMENCING WITH SECTION 7000) OF DIVISION S OF THE BUSINESS AND PRO- FESSONSCODE) OR THAT HE OR SHE IS EXEMPT THERE FROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 70.77.6 BYANYAPPLIGANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (7500}): O L AS OWNEROFTHE PROPERTY OR MY EMPLOYEES WITH WAGESAS THEIR SOLE COMPENSATION, MOLL DO THE WORK AND THE STRUCTURE 15 NOT INTENDED OR OFFERED FOR SALE (SEC. 704. BUS4 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 W'ORKNIMSELF OR HERSELFOR THROUGH HIS OR HER OMI EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ME NOT INTENDED OR OFFERED FOR SALE IF.MOW'EVE(LTHE BULLIINO OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COUPLE. - TION. THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SAIF.). 0 LAS OWNER OF THE PROPERTY. AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 704, BUSINESS AND PROFESSIONS CODE. THE CONTRACTORS LI. CENSE LAW DOES NOTAPPLY TO AN OWNER OFA PROPERTY WHO BURRS OR IMPROVES THERLON. AND WHO CONTRACTS FOR SUCH PROTECTS PATH A CONTRACTOR(S)LICENSED PURSUANT TO THE CO TRAC. TORS LICENSE LAW). O IAM EXEMPT UNDER SEC. S. t PC. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNS UNDER PROVISIONS OF CHAPTER a (CDMMENCNGYATH RECTION TOW) OF DIVISION 3 O THE BUSNESSAND PROFESSIONS CODE. AND MY LICENSE IS N FULL FORRC7E AND EFFECT. Q LICENSE CLA/$�S 6 1 LK:. NO. SOJZ�p�� DATE �•'t ^ — q C%CONTRACTOR W td T t WORKERT COMPENSATION DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MANTA:N A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION 57000E THE LABOR COOS FOR THE PEnFORMANCE /p/FME WORK FOR WHKCI THIS PERMIT IS ISSUED. AGI HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REOUIRED BY SECTION 5700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' COMPENSATIONINSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER i',NI may_ Vt1MP POLICY NUMBER_oZ (' D( (1145 SW NFEED NOT BECOMTLETEDOFTTE PERASTIS FOR ONE HfL(IEDOOLARS (slm) OR LEs% I CERTIFYTHAT INTHE PERFORMANCE OF THE WORK FOR VO4ICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN ANY MANN EH STO BECOMES ECTTOTHE WOPo(ERS'COMPENSATION µWS OF CALIFORNIA, :REE THAT IF 151 7lAD BECOME SUBJECr TO THE WORKERS'COMPENSATONP '75 OF SECTION 'OF THE LABOR CODE, I SHALL FORpTIWIT ICOMPLY WITH THOS �.0 TONS. DATE:_(Q 1Q 1 APPLICANT. _ WARNIO: FAILURE TO SECURE WORKERS'COMPENSATION 'E GEI UNLA .AND SHALLBE SUBJECT AN EMPLOYER TO CFI PENALTIES AND CML F E UPT EH RED THOUSAND DOLLARS LFIOO.000), N ADDITION TO THE COST OF COMPENS r GES PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE. INTEREST, AND ArTORNET FES. CONSTRUCTION LENDING AGENCY 1 HEREBYAFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEG ]00'7. CN. G.I. LENDERS NAME OW IQ LENDEWSADORESS 1 CERTIFY THAT 1 HAVE READ HTS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. 1 AGREE TO COMPLY WTTH 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 PURPOSES. S PERMITTEE T) SIGNATURE OFPERMrTTEE DATE YI N1 f PRESS 1 FIRMLY APPLICATION �(- PERMIT 0p /x DATE 1 NUMBER ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDEISIDE STREET RW O SIDE ❑ PROPOSED USE NO. DWEL NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION SFR/ADD/REM Cjj Garage/Carport Patio/Ded LLU LL Pool/Spa fj Z Re -Roof aCommercial - 5 M Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J Q d W L U W - LU W ' C7 Z m (L (L U Z Q 2 U W ZIP CONSTRUCTION PLA�VIEW ELE I PLUMBING I w ID MECHANICAL INSPECTION FEE ISSUANCE SMIP—`��.�.�7 ENERGY P/C =1 1 OF 1 'U, ) ENERGYPERMIT ILDING RETENTION FEE: PRE -ALT FEE: TOTAL FEES r COMMENTS % 0 RECPT, NO. PAID BY VALIDATION KITE—Department Copy, YELLOW—Finance Copy. PINK—Assessor Copy, GOLDENROD—File Copy, GREEN --Applicant's Copy CITY OF DIAMOND BAR.. INSPECTION RECORD r lil. =l .•)�ff`l �zl� D.:'.VR � ��l��.��a.� ��i��.�ple�►'� ale A.J�:. `SET BACY. FLOOR JOIST ;FTGS!FORMS/STEEL j FNA REQMTS ;ELECTRIC GROUND _ UNDER FLOOR'DUCT"�' - • � 1 'GROUND PLUMBING UNDER FLOOR COf•IDUI "` ,.r —. '" 'SLAB GRADE FIREPLACE FOUNDATION ,TEMP POWER FIREPLACE BOND BEAM WATER SERVICE MID HT. BOND t36. -IJ' f ilROOFSHEATHING.8 FT.B-N ,BF,E1 ..� _,`, _ C''� t. 7 _3f IFRAMING,NENTILIATION FINAL BOND B AM \, :ROOF COVER .' PRE -GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING !ROUGH PLUMBING FINISH GRADING S IOVJER.rfUB TEST POOL -ELECTRIC EXT. LATH/SIDING POOL FENCING \VALL INSULATION POOL FINAL CEILI �G INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER FINAL ENG. SEPTIC TANK LANDSCAPE/IRRIG. SEEP.PIT/L.L. ON SITE IMPS. GA.S AIR TEST j FINAL ZONING FINAL CONST, FIRE DEPT. FINAL I , ;F1'JAL HEATING.. i3 - i ' HEALTH DEPT. FINAL ! r.;•.rr ;� ,��-.�_ ELECTRIC _ �—�Y�� DEV. FEES PAID FINIAL PLUMBING � ENERGY j "CF:AMENTS . .17 'SEPTIC TANK SIZE `SEEP PIT /U SIZE — a ,: