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Home My WebLink About15140 (30)I11,lAlIJU Itlli CITY OF DIAMONJ R DEPARTMENT OF OMMUN Y & DEVELOPMENT SERVICE 21660E. Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 PRESS BUILDING PERMIT APPLICATION �� FIRMLY JOBSITE DATE NUMBE ADDRESS ISSUE (_ n D TYPE APN LO 1_ITCT OWNER 5ILL ADDIS SS CITY ZIP TEL. APPLICANT TEL. CONTRACTOR ADDRESS CITY ZIP TEL ARCRIENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM! UNDER PENALTY OF PEPLURY THAT 1 AM EXEMPT FROM THE CONTRACTORS U. CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.8 OLIS04ESS AND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REWMESA PERMrr TO CONSTRUCT ALTER IMPROVE. DEMOUSt OR REPAIRANY STRUC- TURE, PRIOR TD RS ISSUANCE. ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO RLE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONT RACTORIS L4 CENSE LAW (CHAPTER a (COAMENCNG WITH SECTION 7000) OF DIVISION S OF THE BUSINESSAND PRO- FESSK)NS OOOE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 705I.S SY ANY APPLICANT FORA PE W.OT SUGUECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (3500) ): CLAS CWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGESAS THEIR SME COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7014. BUSI. NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY YAIO BUILDS OR IMPROVESTHEREON. AND W40 DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE G, HOWEVER THE BULDING OR IMPROVEMENT IS SOLD WmnN ONCYEAR OF COMPLE- TION, THE OWNER-SUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE] D I AS OWNER OF THE PROPERTY. AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PNOTROJECT (SEC. 70M, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE LAW DOES APPLY 70AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON. AND LTHO CONTRACTS FOR SUCH PROTECTS WITH A CONTRACTOR(S) LICENSED PURSUANTTO THE ODNTRAG TORS LICENSE LAW.). D IAM EXEMPT UNDER SEC. B. E P.C. FOR THIS REASON DATE �-OWNER LICENSED CONTRACTORS DECLARATION I WJ HEREBYAFFIUNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER tl (COMMENCING WITH SECTION TOM) OF DIVISION 7 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS N FULL FORCE AND EFFECT. LICENSE CLASS LIC. NO. DATE CONTRACTOR WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PENURY ONE OF THE FOLLOWING DECLARATIONS. -I HAVE AND WILL MANTAIN A CERTIFICATE OF CONSENT TO SELFHNSURE FOR WORKERS' - COMPENSATION, AS PROVIDED BY SECTION 77000E THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. -IHAVE AND WILL MN AINTAWON(EPIT COMPENSATION INSURANCE, AS RU ECRED BY SECTION .,700 OF THE LABOR CODE, FOR ME PERFORMANCE OF THE WORK FOR WHICH THIS PERMITIS ISSUED. MY YORKERS COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER " POLICY NUMBER - - (THIS SECTION NE®KIOI BE COMPLETED OF THE PEF INV IS PORCINE HUNDRED DOLLARS (SIOC)ORLES4 I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHK34 THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON N ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFOFNIA, AND AGREE THAT IF 1 SHOULD BECOME SUSJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 57000E THE LABOR CODE. I SHULL FOFRHNATH COMPLY WITH THOSE PROVISIONS. DATE: APPLICANT. WARNING: FAILURE TO SECURE WORKERT COMPENSATION COVERAGE IS UNLAWFUL, ANO SHALL BE SLAIECTAN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS (f 100,0001, N ADDITION TO THE COST OF COMPEN SATIN, DAMAGES AS PROVIDED FOR N SECTION 5708 OF THE LABOR CODE, INTEREST, AND ATTORNEYS 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 3097. CIV. C.I. LENDERS NAME LENDERS ADDRESS I CERTIFY THAT 1 RAVE 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 BURRING CONSTRUCTION. AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE MENTIONED PROPERTY FOR INSPECTION PURPOSES. RA �&t�-��1 0 PERMITT E (PRI \ w � - JrJ-BATE SIGNATUI I OF PERM TREE PPLICATION CU PERMIT q D P/C 004 DATE NUMBE M ISSUE (_ n D TYPE OCC DATE l� �! CONST- GROUP ZONING SETBACKS rFRONT RW p REAR L p SIDE/SIDE STREET RW p SIDE 13 PROPOSED USE NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION S0. FT. FACTOR PSF ADJ.AREA/VALUATION SFRFADD/REM Garage/Carport WPatio/Dock LL PoOVSpa 0 Z Re -Root 0 Commercial ED Valuation ADJ.AREA GUANTITY D SCR(PTION FEE .J d U , H U LL w C9 r O] � J a 4 U Z C 2 U W CONSTRUCTION - PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE E ]MIP ENERGY PIC -a`L ENERGY PERMIT RETENTION FEE: 9 PRE•ALTFEE: n-•---• . uJJ a:,itJ:ALJ 1_, TOTAL FEES i?TgAeC COMMENTS 1 t� RECPT. NO. L -f 41PAID BY VtZ VALIDATION WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy. GOLDENROD—File Copy, GREEN—Applicant's Copy CITY OF DIAMIOND BAR INISPECTION RECORD r`i: �i�-.r=e�iw;ilt�.'••• :el:\iir'-• I,��i�i=it*rr1=J�' � 'I;�1�1=�-ee.-If1^I;�r.':�� f. �l�e�' e�1�� SET encs�.... FTGS.'FOR"."S/STEEL l�� I FLOOR JOIST I FHA REQMTS .ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUNIBINGI l UNDER FLOOR CO^•IDUIT FIREPLACE FOUNDATION'± SLAB GRADE TEMP POWER i i FIR -PLACE BOND BEAM (WATER SERVICE I MID HT. BOND BEAM _ ROOF SHEATHING I 8 FT. BOND BEAM FRAMINGNENTILIATION I FINAL BOND BEANi ROOF COVER I PRE -GRADING ROUGH HEATING BENCHING ROUGH ELECT RICI g I _ 'ROUGH PLUMBING0, SHOWERTrUB TEST —� I ROUGH GRADING FINISH GRADING I I POOL ELECTRIC ^� EXT. LATKISIDING POOL FENCING I WALL INSULATION POOL FINAL CEILING INSULATION I OFF SITE IMPS. DRYWALL NAILING I DEDICATIONS _ SEWER FINAL ENG. 'SEPTIC TANK _ LANDSCAPE/IRRIG. I SEEP PIT/LL. I I ON SITE IMPS. _ GAS AIR TEST�� 19-�aif— I FINAL ZONING _ _ FIIJAL COttiST. a FIRE DEPT. FINAL FINAL HEATING i�_ — j I HEALTH DEPT. FINAL FINAL ELECTRIC I �� DEV. FEES PAID -i _ FINAL PLUMBINGG-� X1 1 ; 1 ENFRGY------ COiI'llf- LENTS ---- .0 f�z,11 ��a - oo Lc g -D f �f l: _CI a �— SEPTIC TANK SIZE SEEP PIT/U SIZE - - ti