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Home My WebLink About14670J� CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 (909) 860.3195 Fax (909) 861-3117 ' ^M' BUILDING PERMIT APPLICATION JOBSITE .2Z 9y2 -5 C r, UNC ADDRESS L APN LOT TRACT Iwii OWNER ADDRE S !V? - CITY -111A ZIP7a =7r2 APPLICANT TEL. fir CONTRACT Nelb ADDRESS CITY L ZI T ARC NG/ DESIGNER ADDRESS CITY ZIP TEL OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS U• CENSE LAW FOR THE FOLLOWING REASON ISEC.7031.6 SUSNESSAND PROFESSIONS CODE: ANY CITYOR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT,ALTER. MPROMMMOUSH. ORREPNRANYSTRUG TURF, PRIOR TO ITS ISSUANCE, ALSO RECUBRES THE APPLICANT FOR SUCHI PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LIP CENSE UW (CHAPTER P (COMMENCING WTM SECTION TODD) OF DIVISION S OF THE BUSINESS MPJ PRO0. FESSIDNS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEJAP• . TON. ANY VIOLATION OF SECTION 7031.6 BY ANY APPLICANT FOR A PERMIT SUBJECTS THEAPPLICANT TO ACN0. PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (3SMP: D LAS OWNER OFTHE PROPERTY, OR MYEMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR BALE (SEC 7044, BUSI. NESS LVID PROFESSIONS COOS THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON. AND WHO DOES SUCH WORK HIMSELFOR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FORSALE IF, HOWEVER THEBULDNGOR IMPROVEMENT IS SOLD WITHNONE YEAR OF COMPILE. TICK. THE OWNER41 0 ILDER WILL RAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE} O L AS O'NNER OF THE PRDPERTY, AM EXCLUSIVELY CONTRACTI G WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044. BUSINESS AND PROFESSIONS CODE. -THE CONTRACTORS U. CENSE LAW DOES NOTAPPLY TO AN OWNER OFA PROPERTY WHO BURRS OR IMPROVES THEREON, AND VMO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S) LICENSED PVPSUANT TO THE CONTRAC- TORS LICENSE LAW). O 1 AM EXEMPT UNOER SEC. B. S P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PEHIURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER (OOLeMENCHG WITHSECTION 7000) OF DIVISION 7 Of THE BUSINESS AND PROFESSIONS CODE. AND MY LICENSE R N FULL FORCE AND EFFECT. ^� LICENSE CLASS LIC. NO..L— � DATE_.,.. CONTRAC70R .�. 1 WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM TINDER PENALTY OF PERJURY ONE OF THE FOLLOWMID DECLARAT . _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELFINSURE FOR RKEP OOMPENSATION,ASPROVOEDBYSECTONSFOGOFTHELABOROOOF, FORTHL RMMICE OF THE WORK FOR WHICH THIS PERMIT IB ISSUED. I HAVE AND WILL MAINTAIN WORKERS' DOM PENSATON INSURANCE, AS RE WIRED BY SECTION STOIC OF THE LAROR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER POLICY NUMBER (TMSSEC11014NEEDNOTBECOld'lETEDCFTHE PEPMT IS FOR ONEHLAEREDDOL ALS (6100) OR LESS) I CERTIFY THAI N THE PERFORMANCE OF THE WCRK FOR WHICH TH RM ITIS ISSUED.I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER $O AS TO BE E JECT TO THE WORKERS COMPENSATION LAWS OF CAUFORN DAG AT IF OBECOME SUBJECT TO THE WORKERS'COMPENSATION A)NS 3700 OF THE LABOR COO ISNALL FORTHWITH COMPLY WITH S DAT��APPLICANT: WAiiNING: FAIURE TO SECURE WORKERS'COMPENSA7ON c AGE J WFUL,ANOS ALLBE SUBJECT AN EMPLOYERTO CRIMINAL PENALTIES AND CMLFINES UP7 ONE UFIOR[D iNOUSAND DOLLARS 111100. Pt NAOOmON TO THE 005TOFCOMPENSATON, D GES PROVIDED FCA IN SECTION 3701 OF THE LABOR CODE, INTEREST, ANO ATTORNEY'S FEES CONSTRUCTION LENDING AGEN 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, CW. C.). I LENDERS NAME LENDERSADDRESS I CERTIFY THAT I RAVE READ THIS APPLICATION AND STATE THAT THE AaoVE NFORMATON IS CORRECT 1 AGREE TO COMPLY WITH ALL CrTY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE -HENT PROPERTY FOR INSPECTION PURFIQSES. i i L PERMITTEE NAME (PRI ) 3 SIGNATURE OF PBRMIXjE DATE PRESS FIRMLY APPLICATION! PERMIT q P/C DATE_bj l NUMBER N ISSUE Ir TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW Cl SIDE ❑ PROPOSED USE NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ_ AREA/VALUATION SFR/ADD/REM N GarapelCarport Patio(Deck LLIJ LL POOVSpa Z Fie -Roof Commercial m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J Q U cc EU W J LU ( r, r U 'L v m C J a U 4 2 U W CONSTRUCTION PLAN REVIEW ELECTRIC 17V Q L"'•"" —c MECHANICAL INSPECTION FEE ISSUANCE pa J7 7 SMTP ENERGY P/C --MA,�� 20 ENERGY PERMIT �� ,�JJ RETENTION FEE:Cl7y--()r�IAMOND-BM - PRE•ALTFEE: BL7TT:;ii7I TOTAL FEES L7 L COMMENTS RECPT. NO. PAID BY VALIDATION WALE—partment Copy, YELLOW—France Copy, PINK—A35a3SOT COPY. GOLDENROD—r=ile COPY. GHLLN—ApplCanrs L:opY .. . .. . ♦ , { , -. u'.!!. � it i � 't .. , . i �'. i•T .. '•♦ .... � I. .,. r.. ,,. , ,. — CITY OF DIAMOND.BAR . i "INSPECTIONS RECORDcl— ` �.. 'SET BACK�;�� ;FTGS!FORMS,'STEEL ..... iELECTRIC GROUND...... (GROUND PLUMBINGUNDER ;,,, ..`...,.'....`, - - ..:, ....... _... .. _ ___._.._. _ .. FLOOR'JOl~ _FHA REQMTS_ UNDER FLOgt'UCT kOOR CU •DU1T. ,- - ^ - "' c-.. _ I .. iSLAB GRADE .._ .. -...._ ..._... FIREPL1AbETOO` NATION ITEMP POWER ,- - FIREPLACE BOND BEAM I !WATER SERVICE - MID HT. BOND BEAM I ROOF SHEATHING 8FT.'BONQ.8EAh,A 'FRAMING.NENTILIATION _ - FINANONb bEAM :ROOF COVER PRE -GRADING :ROUGH. HEATING" : -- _. .. _ __ BENCHING ;ROU aH ELECTRIC ._...__ ".' .ROUGH GRADING _....-•.._� .. IROUG�; PLUMBING--. --- - - _ FINISH GRADING .. --- j �SHG�Vt.R?+ UB TEST- - - - POOL ELECTRIC QCT. LnTF!ISIDING ._ i_.... _ ..__ .:.. '- -._.. POOL,FENCING `. 11t1,`ALL-INSULATION _... .- _- ._. _ _ ... _ -- -........ ... ... POOL'FINAL . I ICEiLifJG INSLILATION• _. OFF SITE IMPS. RDDEDICATIONSF;Yb"JAL:L-NAILING --: . __i_.&A,ER .._........ _..... - FINAL ENG. i ! ,c5E•P-10 TANK LANDSCAPE/IRRIG. IS�_�PiT/LL. ON SITE IMPS. EST FINAL'ZONING I =; FIRE DEPT. FINAL . T -(EATING ...__..___ . _.... _..... HEALTH DEPT. FINAL ! ,; ELECTRIC - - _ DEV. FEES PAID PLUMBING -� - : _ 7 . """"1 ENERGY _ IC t MENTS !SEPTIC TANKS! z .SEEP PIT/U SIZE `• ... .:Air __......-• i iL!)l)T` I -- - - - -. . --