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Home My WebLink About12281 (11)N i D J� CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 (909) 860.3195 Fax (909) 861-3117 PRESS BUILDING PERMIT APPLICATION _ _ ( FIRMLY JOBSiTE ADDRESS /,,501 [ _/1 1 IoW! 1. 1-0 APN LOT TRA i� 7 OWNER ADDR CITY ✓ i ZIP ' j TEL. APPLICANT TEL. CONTRACT !7 ADDUPS C Veln _ CITY I T h --ZIP EL. ` Z ARCKING/ 1(i. ly 7(iJ DESIGNER •! ADDRESS CITY ZIP TEL OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM (ANDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS U4 CENSE LAW FOR THE FOLLOWING REASON (SEC. 7011.5 BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTY WMCH REOLARESA PERMrTTO CONSTRUCT.ALTER MPRCVE DEMOUSH.OR REPAIRANY STRLAO- TURE. PRIOR TO ITS ISSUANCE. ALSO REWIRES THE APPLICANT FORS" PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS W CENSE LAW ((>APTER a (COMMENCING WITH SECTION 7000)OF DIVISION S OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- 7ON.ANY VIOlA7ION OFSECTION 7W 1.5 BV ANY APRICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT YORE THAN FIVE HUNDRED DOLLARS (5500).): O L AS OWNER OFTHE 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. 7GN. BUS) NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE UW DOES NOT APPLY TO AN OWNER OF PROPERTYWHO BUILDS OR IMPROVES THEREON. AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUd1 MS OR HER OWN EMPLOYEES• PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE IF, HOWEVER THE BUILDING OR IMPROVEMENT R SOLD WITHINCNE YEMROF WIMPLE- TON, THE OWNER_URDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE 010 NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE) O L YMER OF THE PROPERTY. AM EXCLUSAS ONELYCDNTRACTNG WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEG I..,, BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LI• CENSE LAW DOES NOT APPLY TORN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON. AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S) LICENSED PURSUANT TO THE COHTRAC- TORS LKXNSE LAW} O 1 AM EXEMPT UNDER SEC. B. L P.C. FOR THS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFBiA UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER (COMMENCING WITH SECTION 7000) OF DIVISION SOF THE BUSINESS AND PROFESSIONS CODE. AND MY LICENSEIS S7 CEAND FFECT. �t CN L1AS5 • - LIC. NO. carrnucTm ? WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY CNE OF THE FOLLOWING DECLARATIONS: _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR YORKERS' COMPENSATION, AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR II.CM TMS PERMIT O ISSUED. 1 HAVE AND WILL MANTAJN YORKERS COMPENSATION INSURANCE. AS REOUIRED BY SECTION 97M OF THE LABOR CODE, FOR THE PERFORMANCE OF THE YORK FOR WHICH THIS PERMIT IS ISSUED. MY RIMER$' COYPENS N NSU E CARR RAND PMC'/ NUMBER ARE: _ - CARRIER .% POLICYNUMBER ]LOL2—fit— (RIS SECTION NEED NOT BE COMFUTDOFTEE PEFMT IS FCRON'E HNDREDDOUARS IsL I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 61551 "D.I� SHALL NOT EMPLOY ANY PERSON N ANYNER SO AS TO BECOME SUBJECT TO THE WORKERS' CTHE W RKE T (FOR NIA ANO AC E THAT SUa1E TO THE WORH(ErRS' PENSATION RONSI QCT 97 F HE N f pOQE. SHALL FOR7MNITH DATE: (�1f APPLICA WARNING: FALURC TO SECURE WORKERS' EN COVERAGE IS UNLAWFUL, AND SNALLBE SUBJECT AN EMPLOYER TO CRIMINAL PEN IES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS (f 100,000), N ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDEO FOR IN I SECTION 97050E THE LABOR CODE, INTEREST. AND ATTORNEYS FEES. 1 CONSTRUCTION LENDING AGENCY i 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY ICH T THERE M A CONSTRUCTION LENONO AGENCY FOR 711E PERFORMANCE OF THE WORK FOR WHICH T aS PERMIT IS ISSUED (SEC. 9097, CN CJ. I LENDERS NAME LENDERSADORESS 1 I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. 1 AGREE TO COMPLY WITH ALL CITY MIO COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION. AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE . AB§-1MENTON EDP CM FOR INSPECTTjwPU, > Ali'J PERMITTE E (PRI T) C , 54MATURE OF PE DATE APPLICATION q _ PERMR P/C DATE [/ NUMBER A ISSUE TYPE OCC . DATE CONST. GROUP ZONING SETBACKS FRONT- RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE NO. DWEL NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. -`FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Ln Garapa/Carport WPatiofDack LL Pool/Spa Z Re -Root 0 Commercial - 5 m Valuation AD (.AREA QUANTITY DESCRIPTION . FEE U it W J W Z DID zi J a J Q Z ; Q U W CONSTRUCTION PLAN REVIEW ELECTRIC PL MA CHANICAL� R INSPECTION FEE ISSUANCE a 177 SMIP ENERGY PIC ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: TOTAL FEES j��A COMMENTS / RECPT. NO. PAID BY VALIDATION WHITE—Dopanment Copy. YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD—Filu Copy, GREEN—Applicant's Copy CITY OF DIAMOND. BAR , • r.� ', .:.: ;�:-1NSPECTION'RECORD' . „ ', -- • o DATE 1NSPECTOR INSPECTION DATE INSPECTOR SET BACK I •, j "' ''' J FLOOR JOIST FIGS/FORMS/STEEL : ' j FHA REQMTS:r- —. ELECTRIC GROUND- _'` "' UNDER FLOOR DUCT --_t 1 GROUND PLUMBING UNDER FLOOR CONDUIT.' SLAB -GRADE - - - - FIREPLACElFOUNDATION '- ` - - — -=-�=• `' I ` TEMP POWER - - FIREPLACE BOND BEAM WATER SERVICE.. - __ _:... _ .. _ . - -- _ .._ MID HT.BOND BEAM ROOF SHEATHING - - 8 FT. BOND BEAM : N 7 FRAMING/VENTILIATION FINAL BOND BEAM ROOF COVER: __ PRE -GRADING ROUGHHEATING ..,---- o ZI - BENCHING i ROUGH ELECTRIC - ROUGH GRADING t 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 __- _... _ _ ..._. LANDS CAP E/IRRIG. SEEPPITlL.L.--- =- -� � _. _ _... _ _ ON SITE IMPS. - GAS AIR TEST-! - - - - FINAL ZONING -FINAL CONST-'---.. _.__-. -. FIRE DEPT. FINAL - FINAL HEATING - -- G - HEALTH DEPT. FINAL -FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY ,y,., __ �4 • ..: �j4 _ ,.... .. •.•• -. . _ - �� . ,/ COAiiMENTS'', ` -_ .�i��_ r SEPTIC TANK SIZE SEEP PIT/U SIZE M