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Home My WebLink About15041 (17)J� CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 (909)860.3195 Fax(909)861-3117 PRESS BUILDING PERMIT APPLICATION FIRMLY JOBSITE ADDRESS7Z-I(000 E.4njU1`ft 4GWRi w s[ APN LOT TR CT OWNER '` ADDRESS ui CITY I F ZIP `�ZIo� TEL APPLICANT TEL CONTRACTOR ')-"e 1 ' Its ADDRESS L /L+ . CITY .11rn- ZIP94870 TEL.ZIV_5 039/9 ARCHJENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS T.- CENSELAW FORTHE FOLLOWING REASON (SEC 7071.5 BUSINESSAND PROFESSIONS CODE:ANYCrT'CR COUNTIWHICH RECIMESA PERMIT TO CONSTRUCT.ALTER IMPROVE, DEMOLISH. OR REPAIRANY STRUC- TURF_ PRIOR TO ITS ISSUANCE. ALSO REWIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS U• CENSE LAW (CHAPTER 6 (COMMENCING WITH SECTION 70001 OF DIVISION 5 OF THE BUSINESS AND PRO. FESSIONS CCOE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION, ANY VIOLATION OF SECTION 7071.6 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CMLPENALTY OF NOT WRE THAN FIVE HUNDRED DOLLARS (7500).): ❑ LASOWNEROFTHE PROPERTY,ORMY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK, IND THE STRUCTURE IS NOT INTENDED OR OFFERED FOA SALE (SEC. 70". BUSI• NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR "PROVES THEREON. AND WHO DOES SUCH WORK HIMSELF OR HERSELFOR THROUGH HIS OR HER OWN EMPLOYEES. PROVIDED THAT SUCH IMPROVEMENTS ARE NOT NTENOED OR OFFERED FOR SKF_ IF, HOWEVER THE BUILDING OR"PROVEMENTIS SOLD WITHIN ONE YEAR OF COMPLE- TION. TXE OWNER40JILDER WALL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). D L AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC 70". BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI. CENSE LAW DOES NOTAPPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON. AND WHOGONTRACTS FOR SUCH PROJECTS WITH A OCJTRACTORIS) LICENSED PURSUANT TO THE CONTRA, TORS LICENSE LAW). O INA EXEMPT UNDER SEC B. I PC FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER / (COMMENCING WITH SECTION 7000) OF DIVISION 7 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE 15 N FULL FORCE AND EFFECT. ,jam Q LICENSE LAS `' LIC. NO. S "'( v DATE�� CONTRACTOR WORKERS' COMPENSATION DECLARATION 1 HEREBYAFFIRM UNDER PENALTY OF PERJURY ONE OFTHE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PTOVIDEDBV SECTION 7700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WM:CH THIS PERMIT IS ISSUED. �I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REOUIRED BY SECTION 77000E THE LABOR CODE FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS'COMPENSATION INSURAYCE CA(IRIER:y POLICY 11 MIER ARE: CARRIER Ch�-r/ �� l LNr \� 5 (� POLICYNUMOER cra%SECTTJN"CLDNOTSENAF'LETIDOFT/EPEFW LSFORONEKMCDWIMr (s100)CHLESS) 1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL HOT EMPLOY ANY PERSON N MANNER SOAS TO BECOME SUBJECT TITHE WORKEAS'COMPF.NSATION LAWS OF ORYI^-.AGR EE7 AT IF ISHOV OBECOME SUBJECT TO THE WORHKCRS CLAP NS KON PROVISIONS OF SE 77000E THE LABOR COO .1 AIL FORT/HW/ITH COMPLY HOSE PROVISIONS. DATE:�� APPL 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 OCLLNLS (5100,000), N ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN I SECnON77060F THE LABOR CODE. INTEREST. AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY i 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 7097,CV. C). i IFNDERS NAME LENDERSADDRESS I 1 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. 1 AGREE TO COMPLY WITH ALL CRY AND COUNTY ORDINANCES AND STATE LAW RELATING TO BUILDING s CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OFTHIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. L E EE NAME (PRINT) SIGRXTVREVT PERMITTEE ATE 111 —1 ICATION I -�,\ PERMIT P/C V" � DATENUMBER 11 ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDEISIDE STREET RW ❑ SIDE ❑ PROPOSED USE NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION SFRIADD/REM fn Garage/Carport WPatic/Deck LL Pool/Spa ZRe -Roof Commercial - M Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J Q U cc 0 W J w t7 Z GO J a Z Q 2 U W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL ^ nn INSPECTION FEE illy L V ISSUANCE CjTY nr IIT A 7 4n'\Tji:i AR - - SMIP BUIL-1— i3UA_ _: T c' ENERGY PAC ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: TOTAL FEES COMMENTS RECPT. NO. PAID BY VALIDATION WHITE—Department Copy, YELLOW—Finance Copy. PINK—Assessor Copy, GOLDENROD --Elle Copy, GHEeN—Applicant's copy CITY OF DIAMOND BAR 114SPECTION RECORD NMI- �&-Awlmlai .SET BACK FLOOR JOIST: .._.. -� .� FTGSIFORMS/STEEL FHA REOMTS r— ELECTRIC GROUND UNDER FLOOR DUCT . GROUND PLUMBING UNDERFLOOR 60-NDUIT .SLAB GRADE FIREPLACE FOUNDATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICE MID HT. BOND•BEAM•! ` •: ROOF SHEATHING ' i } 8 FT. BOND. BEAM. FRAMING/VENTILIATION FINAL BOND'BEAki ROOF COVER PRE -GRADING 'ROUGH HEATING BENCHING ,ROUGH ELECTRIC (��p� ROUGH GRADING _ ROUGH PLUMBING FINISH GRADING -SHOWER/TUB TEST POOL ELECTRIC EXT. LATH/SIDING POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS. _ DRYWALL NAILING DEDICATIONS SEWER FINAL ENG. SEPTIC TANK LANDSCAPE/IRRIG. _ SEEP PIT/L.L. i ON SITE IMPS. GAS AIR TEST FINAL ZONING :FINAL CONST. FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC FINAL PLUMBING DEV. FEES PAID --T ENERGY COMMENTS - r,Lr.:.r.:jc r,�= SEPTIC TANK SIZE SEEP PIT/U SIZE �I dew — —