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Home My WebLink About11752V� 4 D O 0 Cr0 8 • �oo Z C77 3 X� W C0 O C O dn �Z Q c LU Z Nn S O O CLL J Q w d O Q CL 7 IL a 2 IziJ m Q co S9 J,ra� CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 /� T SS BUILDING PERMIT APPLICATION 6A / 19.7Y jjj / tPR PRESS v JOBSITE ADDRESS-ZO %/t -RL-1 KI C AIE: (�47.7 R] APN LOT TRACT OWNER ADDRESS CITY ZIP TEL APPLICANT III TEL O CONTRACTOR O ADDRESS CITY ZIP_ TEL17 !M4 ARCREN DESIGNER ADDRESS CITY ZIP TEL OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LF CENSE LAW FOR THE FOLLOWING REASON [SEC. 7031.5 BUSINESS AND PROFESSIONS CODE ANY CITY OR COUHTYYMICH REGMESA PETJAITTO CONSTRUCT, ALTER IMPROVE. DEMOLISH. OR REPAIRANY STRUC• TUBE. 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 T.I. CENSE UW (CHAPTER 6 (COMMENCING WITH SECTION 7000) OF DIVISION S OF THE BUSINESS AND PRO. FESSONS CODE) OR THAT HE OR SHE IS EXEMPTTHEREFROM ANDTHE BASIS FORTHE ALLEGED EXEMP. TION.ANY VIOLATION OF SECTION 7031.6 W 1.6 BY ANYAPPUCANT FORA PERMIT SUBJECTS THE APPLICANT TO ACRAL PENALTY OF NOT MORE 7HAN FIVE HUNDRED DOLLARS IFSWI.): . O L AS OWNER OFTHE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION. YVILL DO THE WORK AND THE STRICTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC 7044, BUST. NESSAND PROFESSIONS CODE. THE CONTRACTORS LICENSE UW DOES NOT APPLY TO AN OWNER OF PROPERTY YWO BUILDS OR IMPROVESTHEREON. AND LWO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HOS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT MENDED OR OFFERED FOR SALE F, HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF OOMPLE- TON, THE OWNERSUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DO 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 U. CENSE LAW DOES NOTAPPLY TORN OWNER OF A PROPERTY WHO BUILDS OR IMPROV99 THFRECK AND W40 CONTRACTS FOR SUCH PROJECTS WITHAODWRACTOR(S) LICENSED PURSUANT TOTHE CONTRAC- TORS LICENSE LAW.)_ O 1 AM EXEMPT UNDER SEC. B. L P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBYAFFIRM UNDER PENALTY OF PER MTHAT 1 AM 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 CLASS % LIG NO. O C DATE carrRAcroR�(g d WORKERS' COMPENSATION DECLARATION 1 1 HEREBYAFFSIM UNDER PENALTY OF PERAM CNE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION. AS PROVIDED BY SECTION SM OF THE LABOR CODE. FOR THE PERFORMANCE OF THE VNORC FOR WHICH THIS PERMIT IS ISSUED. _I HAVE AND WILL MAINTAIN WORKERS COMPENSATION INSURANCE. AS REOUIRED BY SECTION 5700 OF THE LABOR CODE FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS tSSUED.MYWORKERSCOM NSATION INSURANCE BIER AND POLICY NUMBER ARE: CARRIER +' POLICY NUMBER (THIS SEC110NN®NOTRECCMP EIED� OFTE PERMIT 6 RORCN.E HLNDREDDOU ARS(SH00) OR LES% I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,1 SHALL NOT EMPLOY ANY PERSON N ANY MANNER SO AS TO BECOME SUBJEC7 TO THE WORKERS' COMPENSATDN LAWS OF CALIFORNIA AND AGREE THAT IF I SHOULD BECOME SUBJECTTO THE WOMERT COMPENSATION PROVISIONS OF SECTION 7700 OF THE LABOR CODE. I SHALL FORTHWITH COMPLY WITH PRDVLSIONS. DATE: APPLICANT: (_ WARNING, FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND - DOLLARS (I100.000)• IN ADDITION TO THE COST OF COMPENSATKN, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST. AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY I HEREBYAFFIRA UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY R THE PERFORMANCE OF THE WORK FOR FOWHICH THIS PERMIT IS ISSUED (SEC. 5067, CIV C.). LENDERS NAME LEIOERSADDRESS I CERTIFY THAT I HAVE READ THIS APPUCATONAND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMRY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THS COUNTY TO ENTER UPON THE ABOVE.MENTONED PROPERTY FOR INSPECTION PURPOSES. !� P PERMITTEE E (PR OF PEHIMI EE DATE IT DATEICA ON !t NUMBER PERM �` � ISSUE /� /l TYPE OCC DATE_ 4 O CONST. GROUP ZONING SETBACKS FRONT RW O REAR p SIDE(SIDE STREET RW p SIDE p PROPOSED USE 7p r ~ NO. DWEL. NO. NO. UNITS / STORIESf_ BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ.AREA(VALUATION SFRIADDIREM U) GaragaNCarport WPatioMack - - u- POOVSPa Z Re -Roof , 0 Commercial _ Ib I n Valuation • ADJ.AREA QUANTITY DESCRIPTION FEE a - U ir - Ui J W C7 Z ' DO J a a U 2 a S W M CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE ! A O O SMIP A ENERGY PIC ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: TOTAL FEES / COMMENTS l RECPT. NO-_ PAID BY Cr- VALIDATION '7'r (1. WFR I t—•Oepamnent ,opy. YELLOW—Flnanea copy, PINK—Assessor Copy, GOLDENROD—File Copy, GREEN—Applicant's Copy CITY OF DIAMOND BAR,;-_ ; INSPECTION RECORD.. MMOTION SETBACK DATE 'INSPECTOR, -.INSPECTION DATE INSPECTOR' FLOOR JOIST71 FTGS/FORMS/STEEL ; �, • .FHA REOMTS - - - ELECTRIC'GROUND- _: ` - UNDER FLOOR DUCT ` GROUND PLUMBING 'UNDER FLOOR CONDUIT..'. - ; . ,: : L• SLAB GRADE - FIREPLACE FOUNDATION TEMP POWER - -- ' - FIREPLACE BOND BEAM --- - - ---. . -WATER SERVICE - - -- -: - MID HT. BOND BEAM ROOF-SHI''ATHING " 'J' 3 y� '' " . �- ': 8 FT. BOND BEAM - - FRAMING/VENTILIATION "' , r ', ' FINAL BOND BEAM ROOF COVER .. >' P PRE -GRADING - -ROUGH HEATING - - BENCHING -ROUGH ELECTRIC -:- - - - ROUGH GRADING ROUGH PLUMBING-;- - - FINISH GRADING • •. SHOWER/TUB TEST - -- - POOL ELECTRIC , EXT. LATH/SIDING --..._. ... POOL FENCING ' :... . WALL INSULATION POOL FINAL i CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER _. _ ._ FINAL ENG. SEPTIC -TANK .. -_ _ _- _. _.. LAND SCAPE/I RRI G. SEEP PIT/L.L. ; - :_:..�_: __.: -- _ -.. _. , ON SITE IMPS . GAS AIR TEST - - - FINAL ZONING -FINAL-CONST.- - - 'FINAL HEATING - - - - - FIRE DEPT. FINAL HEALTH DEPT. FINAL -FINAL'ELECTRIC '- DEV. FEES PMD i FINAL PLUMBING ENERGY_ COMMENTS - SEPTIC TANK SIZE SEEP PIT/U-SIZE ,