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Home My WebLink About15146 (19)0 2 �UI.1(!`IIIJU II.11: i CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 216W I- Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 i PRESS BUILDING PERMIT APPLICATION J FIRMLY JOBSITE ADDRESS APNLOT TRACT OWNER r/�� ADDRES� CITY ZIP TeCi4-2 APPLICANT TEL. CONTRACTOR fuiV NoeT�Q� �a ADDRESS CITY ZIP 9-��TEL.� ARC NG/ DESIGNER �. ADDRESS CITY ZIP TEL OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE UW FOR THE FOLLOWING REASON (SEC. 7031.6 BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REQUIRES A PERMITTO CONSTRUCLALTER IMPROVE. DEMOUSK CR REPAIR ANYSTRUG TURF PRIOR M ITS 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 CONTRACTORS LI- CENSE UW (CHAPTER I (COMMENCING WITH SECTION 7000) OF DIVISION 3 O THE BUSINESS AND PRO. FESSIONS CODE) OR THAT HE OR SHE 15 EXEMPTTHEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7031.5 BYANY APPLICANT FORA PERMIT SUBJECTS THE APPLICANT TO ACRAL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (3500).): O L AS OMMER 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 (SEG 70N, BUSI- NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BURRS OR MPROVESTHEREpL 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 i, HOWEVEItTHE BUILDING OR IMPROVEMENT B SOLD WTTMH ONE YEAR OF COMPLE- TION. THE OW7NERAlXLDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DD NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE), O L AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING YM14 LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 70". BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE UW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON. AND WHO CONTRACTS FOR SUCH PROJECTS WITH A COINTRACTONS) LICENSED PURSUANT TO ME CONTRAC- TORS LICENSE LAW.). D I AM EXEMPT UNDER SEC. B. 6 P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER 6 (COMMENCING WITH SECTION 7000) OF DIVISION S OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS N FULL FORCE AND EFFECT. LICENSE CUSS 42 LIC. NO. DATE �[ tnF /? —Z G O CONTRACTOR A/ii% KgEe2T WORKERS' COMPENSATION DECLARATION - 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY BECTON 3700 OF THE LABOR CODE, FORTHE PERFORMANCE OF THE WORT( FOR WHICH THIS PERMIT IS ISSUED. N _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE, AS REOUIRED By SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS COMPENSATION INSURANCECARR i ANDPOLOY NUMBER ARE: -_ CARRIER POLICY NUMBER (THIS SECTION NEED NUT BE COMPLETEDOFTHE PERMIT IS PORCINE I UNDRCD DOLL AR5 CSIM DRLES% I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON N ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA AND AGREE TULD .IAT IF I SHOBECOME SUBJECT TO THE WORKERS'COMPEINSATION PA0VIS*4WoF SECTONS7DOOFTHELASOR COE.I SHALL FORTHIVIH CONn T1W IONS. DATE: DEL�AL�P' . WARNING: FAILURE TO SECURE WORKERS' COMP NSATION COVERAGE 15 UNUWRUL AND S,HALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FNES UP TO ONE HUNDRED THOUSAND DOLLARS (6100,000), N ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN BO SECTION 3706 OF THE LAR CODE. INTEREST. AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THATTHERE 6 A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3067, CIV. C). LENDER'S 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 CIT' AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BURRING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTONEDP ERN FOR INSPECTION PURPOSES. PER EE NAME T) SIGNATURE OF PERMITTEE DATE O APPLICATION Zl( �! PERMIT z5/w DATE NUMBER /T N ' C ( l TYPE OCC ISSUE /' 19 7 _ OD DATE [� J CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDESTREET RW ❑ SIDE ❑ KOPOSED USE NO. DWEL NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREANALUATION SFR/ADD/REM CO Garage/Carport WLL Patia/Deck Poo Spa Z Re -Root 0 Commercial m Valuatian ADJ.A QUANTITY DESCRIPTION FEE cc H U W J w 2 z m J a J d _U 2 Q U UU2 CONSTRUCTION 0� L PLAN REVIEW ELECTRIC PLUMBING MECHANICAL ' ,.INSPECTION FEE ISSUANCE SNIP ENERGY P/C ENERGY PERMIT `r + ►� RETENTION FEE: ALT FEE: TOTAL FE�.v/ES1, �%I COMMENTS—�/ v � + V v REC� PAID BY VALIDATION WHITE—Department Copy, YELLOW—Finance Copy, PINK—AssassDT Copy, GOLDENROD—File Copy, GREEN—Applicant's Copy CITY OF DIAMOND BAR. ANSPECTION RECORD Mr M 7�j P �SET BACK' FLOOR JOIST FTGS1FORl'V`IS/STEEL- FNA R I'S' !ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLummN G UNDER FLOOR CONDOIT iSLAB GRADE - Li . I FIREPLY6ft'f'b NQAtibN -" TEMP POWER FIREPLAGE-SC11',11D BEAM WATER SERVICE MID HT -BOND BEAM ROOF SHEATHING 8 Fr. BOND SEAM FRAMING rVENTILIATION FINALBOiN,D.. ,V_ ROOF COVER PRE -GRADING !ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING !ROUGH PLUMBING FINISH GRADING �SHOWER.ITUB TEST- POOL•ELECTRIC !EXT.-LATH!SIDING- POOL,FENCING fflALL. 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 A I R TEST FINAL ZONING 'FINAL CONST. pawl FIRE DEPT. FINAL ;FINAL HEATING HEALTH DEPT. FINAL :FINAL ELECTRIC DEV. FEES PAID - FINAL -PLUMBING - ENERGY ;COINAIMIEN TS c Log�w p4a civix (2- CC�X Q—Ao7- ;:SEPTIC TANK SIZE rl ;1SEEP'PIDU SIZE Mr