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Home My WebLink About10288} a 0 w O c 0 en Cr O LU W U O Z W D Z W C3 O lL Z O C1_ W H— w e/7 O W Q D J5 UJ CDZ S O LL J Cr W O Or- a - i5 Q.W C d Ci Z m Q Cn N CITY OF DIAMOND BAR�� COMMUNITY DEVELOPMENT DEPARTMENT Ai ,.0 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) B61.31 tT PRESS '`"' BUILDING PERMIT APPLICATION FIRMLY JOBSITE ADDRESS 22-862 ��TeJ21 L APN LOT TRACT r OWNER ADDRESS &C CITY , 7: iocV zip"302441 TEL' APPLICANT TEL CONTRACTOR 4Oko C n ADDRESS CITY ZIP TEL. ARCN/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEG 7011.5 BUSINESSAND PROFESSIONS COCE: ANY CITY OR COtJ NN WHICH REOL)IRESAPERMITTO CONSTRUCT,ALTER. IMPROVE. DEMOUSH, OR REPAIR ANY STRUC- TURE. 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 LN CENSE LAW (CHAPTER 5 (COMMENCING WITH SECTION 7000) OF DIVISION 1 OF THE BUSINESS AND PRO, FESSKXNS COOE1 OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP. TION. ANY VIOLATION OF SECTION 7011.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (5500).): 0 L AS OWNER OF THE PROPERTY. OR MY EMPLOYEES WITH WAGESAS THEIR SOLE COMPENSATION, WILL DO THE WORK, AND THE 57RUCTURE IS HOT INTENDED OR OFFERED FOR SALE (SEC. 7044, BUSI. NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES. PROVIDED THAT SUCH IMPROVEMENTS ARE NOT MENDED OA OFFERED FOR SALE IF, HOWEVER THE BUILDINGOR IMPROVEMENT IS SOLA WITHIN ONE YEAR OFCOMPLE- TLON. THE OWNER BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SAE), O L AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT ISEC. 7041, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TOAN &^ER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON. AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAG TORS LICENSE LAW.). 01 AM EXEMPT UNDER SEC. B. S P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTOR ECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROV15IONS OF CHAPTER s (COMMENCING WITH SECTION 7000) OF DIVISION 1 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 HEREBYAFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: _I HAVE AND WILL MAINTAIN ACERTIFICATE OF CONSENTTO SELF -INSURE FOR WDRKEIW COMPENSATION, AS PROVIDED BY SECTION 1700 OF THE LABOR OQOE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT R ISSUED. _I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY SECTION 57000E THE LABOR 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- (OIssEcTIONNEEDNOT BEDoL rLELEDofTHE PERMIT 6FOR ONE HUNDRED DOLLARS a100)ORLESS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. 1 SHALL NOT EMPLOY ANY PERSCN N ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATON LAWS OF CALIFORNIA. AND AGREE THAT IF 1 SHOULD BECOME SUBJECTTO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 1700 OF THE LABOR CODE.1 SHALL FORTHWITH COMPLY WITH THOSE PROVISCHS. DATE: APPLICANT: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNAAW'UL, AND SHALL BE SUBJECT AN EMPLOYER TO CRIMNO NAL PENALTIES ACML FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), N TO TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR N SECTION 5705 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 MIS PERMIT IS ISSUED (SEC. 3007. CIV. C). LENDERS NAME LENDERS ADDRESS I CERTIFY THAT 1 HAVE READ THIS APPUCAION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY NTH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION. AND HEREBYAUTHORZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABBOVE4AENTIONEDD PROPERTY FOR INSPECTION PURPOSES, P RMITTEE NAME (PRNnn `+ SIGNATURE OF P E DATE Y APPLICATION DATE ISSUE DATE PERMITl v NUMBER TYPE CONST. P/C k OCC GROUP ZONING SETBACKS FRONT RW REAR SIDEISIDE STREET RW SIDE ❑ ❑ ❑ ❑ PROPOSED USE NO. DWEL UNITS NO. STORIES NO. BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREANALUATION SFRIADDUREM Cn Garage/Carport WPatjo(Deck ' LL. Poovspa -- ZRe -Roof Commercial .I til Valuation ADJ-AREA OUANTITY DESCRIPTION FEE , J t7 Z to CL CL 4 CONSTRUCTION PLAN REVIEW ELE LUM MECHANICAL INSPECTION FEE ISSUANCE SMIPENERGY PIC ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: t7- r. �_. 1 TOTAL FEES COMMENTS 623 Lg0 RECPTA NOJ PAID BY VALIDATION WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy. GOLDENROD—File Copy, GREEN—AppllcaRYs Copy CITY ORDIAMOND BA13.',':* INSPECTION RECORD ................ NJ SETBACK FLOOR JOIST FTGSIFORMSISTEEL- IFHA REQM.TS ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING UNDER �L-da�ijPDUIT SLAB GRADE FIREPLACE FOUNDATION TEMP POWER FIREPLACE BOND BEAM. WATER SERVICE TA MID HT. BOND BEAM ROOF SHEATHING 8 17,17. BOND BEAM FRAMING/VENTILIATION FINAL BOND BEAM -ROOF COVER PRE -GRADING =ROUGH HEATING--: ..DENCHING ROUGH ELECTRIC- ROUGH GRADING . ROUGH PLUMBING FINISH GRADING SHOWER/TUB TEST "EX7. LATH/SIDING'1 POOL ELECTRIC POOL FENCING, WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING I DEDICATIONS ..SEWER. FINAL ENG. SERTICTANK... LANDSCAPEIIRRIG. SEEPPIT/LL.- ONSITE IMPS. GAS AIR TEST, ---- ---- FINAL ZONING FINAL -CONST.: - -FINAL- HEATING -'FINAL-ELECTRIC FIRE DEPT.. I L'. HEALTH DEPT. FINAL, DEV. FEES PAID FINAL PLUMBING ENERGY TAFF, oF--,7n COMMENTS •-- - - -----..... ---' - ' -� - - - -• � .. ... ... - . , . ,, f . j SEPTICTANK-SIZE SEEP PIT/U SIZE 71 J -",(,T .1w