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Home My WebLink About15073 (20)r 0 CITY OF DIAMOND BAR w DEPART14ENT OF COMMUNITY & DEVELOPMENT SERVICES a 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION JOBSiTE ADDRESS APN OT TRA T OWNER ADDRESS CITY ZIP_-- TEL. APPLICANT TEL. CONTRACTOR ADDRESS CITYZIP frEE ARCH/ G/� DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESSAND PROFESSIONS OODE: ANY CITY OR COUNTY WHICH REOUIRESA PERM IT TO CONSTRUCT. ALTER, IMPROVE, DEMOLISH, OR REPAIR ANYSTRUC- TURE, PRIOR TO RS 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 LAW (CHAPTER B (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PRO. FESSIONS CODE) OR THAT HE OR SHE IS FXEMPTTHEREFROM AND THE BASIS FOR THEALLEGED EXEMP- TION. ANY VKXAT1GN OF SECTION 7031.5 BY ANY APPLICANT FORA PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS ($600).): ❑ 1, AS OWNER 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 (SEC. 7044, BUSI- NESSAND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOTAPPLY 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 INTENDED OR OFFERED FOR SALE IF, HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OFCOMPLE- TION. THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). ❑ I, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7046, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI. CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S) LICENSED PURSUANTTO THE CONTRAC- TORS LICENSE LAW.). D I AM EXEMPT UNDER SEC. 8, 5 P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBYAFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER B (COMMENCMQ WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS M FULL FO F ECT. LICENSE CLASS LIC. NO. 75 DATE CONTRACTOR WORKERS' COMPENSATION DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OFTHE FOLLOWING DECLARATIONS: �HAVF LLMAINTAIN ACERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' N,ASPROVIDEDBVSECTION TEOF 0O SENT O SOF-INSU EFOR THEFORW PERFORMANCE FOR WHICH THIS PERMIT IS ISSUED. LL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY SECTION 3700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MV WIG! COM INSURANCE ARC=�91`NUMBER ARE: CARRIER POLICY NUMBER (IHISSECTIONNE®NOT BE(x7ARLETEDOFTHE R1ITISFgiONEHJHd7RED (SI00)ORLESS) I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I SWILL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS' COMPEN TION LAWS OF CALIFORNIA, AND AGREE THAT IF I SHOULD BECOME SUBJEC OTHE PIKEflS'COMPENS ROVISIONS OF SECTION 97000F THE LABOR HALL 7A HWITH COMPLY WI TH VISIONS. DATE-. PPLICANT I j WARNING: ILURE O ECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($700,000), IN ADDITION TO THE GOSTOF COMPENSATION, DAMAGES AS PROVIDED FOR IN 1 SECTION 3703 OF THE LABOR CODE, INTEREST, AND ATT'ORNEY'S FEES. CONSTRUCTION LENDING AGENCY i THEREBY AFFIRM UNDER PENALTY OFPERJURY THIS PE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICHICHTHIS PERMIT IS ISSUED (SEC. 3087, CIV C), I LENDER'S NAME LENDER'S ADDRESS CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT AGREETO COMPLY WITH ALL CITY AND COUNTY ORDINANCES ND STATE LAWS RELATINGTO BUILDING s CONSTRUCTION, AND HEREBY AUTHORRE REPRESENTATIVES FTHIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECT PURPOSES. l PERMITTEE NAME PRI SIGNATURE OF PERNUE DATE lll'3c% PRESS FIRMLY APPLICATION PERMIT J /') P/C `E' DATE `C� NUMBER 1 # ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREA/VALUATION SFR(ADD/REM Garage/Carport W Patio/Deck LL Pool/Spa ZRe -Roof 0 Commercial - m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J Q U F- U w w 0 VC Z_ mOUT d U_ Z Q S LU CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL ,{'t g^�q� INSPECTION FEE [ 3 r, 200,lil ISSUANCEgulp 1 Y OF !A;.r`�e.7s I� 1tN11 CITY . 13 LJ ELDINW3, JA, IN Ji':.i-':..A' w,:'� S x ENERGY PIC ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: TOTAL F////E��11'/ES ` COMMENTS`f�� 'Z7%,0 reit t RECP2T. NO. U_ PAID BY _ , VALIDATION s WHITE- Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD—Flee copy, GREEN—Applicant's Copy CITY OF DIANPIOND BAR MR% W. MEN MR, �Xofo all Tf M.: moll F M L ®a M, �. --a .., �N I EMU-! �lk 0 w FL.00H jQL'� S BACK S' Fl-TG1Sll�-l0RMS1,rlT ES.- -�H�FREOMI"S ........... — - E- ! N DE: M 0Oq D--------- �j,-JNP FL'CT- - L E Q RC 'G R, U U ... ... . . .. - ------ -- — ------- *'UMD PLUNM,�NY,33 1. D�R F1,06P.,C'ONDW SLAB GRPlrJr-' 77- FIRYIOLAC TEMP PUVVER FIREF ... . .. . ............. . . . W: Fri .... ..... .. . . ;;00F SHE,4J," ftl'�'� r-T. 8 o tiqbb �Evl FRMMHH-G9i`VMN-1,H amatl rFINVIL BOND UAMI ADINIG PR& GP . ...... ... R(A)GH HEATING BE N H N'r--' ...... . ... - RlU OGH GRADING , .... .... .. - ------ - - ---- . .. .... ..... .. .. . . . ... . .............. RADINIC FIN118H, GF ---------- ,SHl'l-'A,v-7!7lRSUP TEST POOL ELEC � RIC ... ...... . . . ........ k_XT ,ATHI'll L L .,�'01NG POO' FENCING ANAL L ill"'A7K-N Pn,,-)L psi NAL -2 DED i('-,%Tl0NS 0M,'vVALL NAQ..lN N-.; L AT 10 OFF SiTE NP.S. J G SEWEjq F 1 N A 1, EN G. SETIFIC TANK, ANDSCA: MiG, S IT E I ld: P S, -1 NAL Z t �'f (3A,-',', As P. Tr�z, ............. . . .... ........ . - HNAL GONST, FURE . ........... .. . RNA'- HEATNG� I HEALTH DEPT F�MAI- ELE�'-7' MIC 1 DEEM- F=-ES PilliD I - ------------- — -- ----------- FINAL PLONUBNNG, 4% El 17RGY -4 4 10 1- ME looluffiffi=