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Home My WebLink About10282CITY OF DIAMOND BAR COMMUNITY DEVELOPMENT DEPARTMENT�� 21660E- Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 PRESS BUILDING PERMIT APPLICATION FIRMLY JOBSITE y� ADDRESS �q9V epl�rcQI •L APN LOT TRACT Si OWNER Cmr !/L1 U H.&.rq- ADDRESS Q QC77% 00 /)4I4CAJG V CITY ZIP W'41 TEL. I�i g ` L7I Va APPLICANT TEL. CONTRACTOR ADDRESS CITY ZIP TEL ARCFVENG/ DESIGNER ADDRESS CITY ZIP TEL OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM EXEMPT FROM THE CONTRACTORS LL CENSE LAW FOR THE FOLLOWING REASON (SEC.70.71.6 BUSINESS AND PROFESSIONS CODE: ANY CITY OR CWNTY WHICH REQUIRES A PERMIT TO CONSTRUCT.ALTER. IMPROVE. DEMOUSH.OR REPAFIANY STAN_ TURF. PRIOR TO ITS ISSUANCE, ALSO REQUIRES 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 4CENSE LAW (CHAPTER a (COMMENCING WITH SECTION 7000) OF DIVISION 5 OF THE BUSINESS AND PRO. SESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7041.5 BY ANYAPPLICANT FORA PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (SSW).): O L AS OWNER OF THE 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. 7014. BUSL NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PRDPERTY WHIO BUILDS CR IMPROVES THEREON. AND WHO DOES SLK H WORK HIMSELF OR HERSELFOR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE IF. HKOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OFCOMPLE- TION. THE OW NER�BUILOER 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 WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044. BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI. CENSE LAW DOES NOT APPLY TORN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND VMO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTONS) LICENSED PURSUANT 70 THE CONTRAC• . TORS LICENSE LAW.). ET I AM EXEMPT UNDER SEC. B. S P.C. FOR THIS REASON DATE �• OWNER LICENSED CONTRACTORS OECLAFIXTION 1 HEREBYAFFIRM UNDER PENALTY OF PERJURY THAT I AAI LICENSED UNDER PROVISIONS OF CHAPTER 0 (COMMENCING WITH SECTION 7000) OF DIVISION 4 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT. LICENSE CUSS LIC. NO. DATE CONTRACTOR 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 SECTION 3700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND VALL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REWIRED BY SECTION 7700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. SAY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY HUMBER ARE: CARRIER POLICY NUMBER (THIS SECTION NEEDNOTBE C@.PLETW OFTHE PERMITIS FORONE H NCREDDOLIAfti(t10MOR LESS). 1 CERTIFY THAT N ME PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOYANY PERSON N ANY MANNER $O AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WOR(ERT COMPENSATION PROVISIONS OF SECTION 47000E THE LABOR CODE, I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE: APPLICANT: WARNING FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL_ AND SHALL BE SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (5100.0001. IN ADDITION TO THE COSTOF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 5708 OF THE LABOR CODE. INTEREST, AND ATTORNEY'S FEES, CONSTRUCTION LENDING AGENCY 1 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. 5007. CIV C.I. LENDERS NAME LENOERSADORESS - 1 CERTIFY THAT I HAVE 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 BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATNES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES PERMITTEE NAME (PRINT) 'VV 1GRATURE OF PE7E , DATE APPLICATIO DATE ISSUE DATE PERMIT '%/C NUMBER v TYPE CONST. T/ OCC i GROUP ZONING SETBACKS FRONT RW REAR SIDE/SIDE STREET RW SIDE ❑ ❑ O ❑ PROPOSED USE NO. DWEL UNITS Ur+74ilty G NO. STORIES NO. BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREANALUATION SFRIADDIREM cf) Garage/Carport WPatio/Deck LL PooPSpa .- z Z Re -Pool Commercial m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE W J w (7 2 ' m Z�L' [iv v ✓ f eL CONSTRUCTION PLAN REVIEW CTRIC lUMBIN MECHANICAL INSPECTION FEE ISSUANCE SMTP ENERGY PNC�� ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: rN TOTAL FEES COMMENTS 7�7 4:7 if RECPT. N PAID BY Al IdA VALIDATION 1 WHITE—Department Copy. YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD—File Copy, GREEN --Applicant's Copy (! CITY .OF_DIAfAOND BAR',.,:! INSPECTION RECORD' ..:` 15*01 _40 !Nf J Ira SET BACK FLOOR JOIST FrGS/FORMSISTEEL-- - - - FHA REQNITS ELECTRIC GROUND UNDER FLOqR:DUp_T-...-A_\ 01j\1 GROUND PLUMBING UNDERIF-Lbb'ntbUIT 1V 'A SLAB GRADE- _-.- - : I _.. FIREPLACE FOUNDATION -TEMP POWER FIREPLACE BOND BEAM - WATER SERVICE IAID HT. BOND BEAM ROOF SHEATHING- 8 Fr. BOND BEAM FRAMING/VENTILIATION 'FINAL BOND BEAM -ROOF COVER PRE- GRADING ROUGH HEATING BENCHING....._.._.- ----- ----- -- ROUGH ELECTRIC-- - ROUGH GRADING, ROUGH PLUMBING--.----' -FINISH GRADING SHOWERrrUB TEST POOL ELECTRIC EXT. LATHISIDING POOL FENCING WALL INSULATION i POOL FINAL CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING I DEDICATIONS SEWER. -TERTICT-ANKz. FINAL ENG. LANDSCAPEIIRRIG. SEEP_PIT/LL._-;-_, ON SITE IMPS. -GAS AIR TEST.....__.....FINAL ZONING FINAL CONST.-- FIRE DE4a-T.-qQAq FINAL -HEATING-.__.....__ HEALTH DEPT. FIN -FINAL ELECTRIC FNAL:PLUMBJNG7:. ' DEV. FEES PAID ENERGY =77i COMMENTS. SEPTIC TANK SIZE SEEP PIT/U SIZE ipj