The URL can be used to link to this page

Home My WebLink About15051 (17)J� CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION. JOBSITE ADDRESS 1688 61f W C APN LOT TRACT OWNER T A✓7 A'A r_[/ <. r.0 4L/ ell ADDRESS CITY ZIP TEL APPLICANT TEL. CONTRACTOR ADDRESS - CIL -Cvlo 1TAMC , CRY ' ZIP `117/( TEL42L 4/y Z�� ARCRTNG/ DESIGNER ADDRESS CITY ZIP TEL OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM CINDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.6 BUSINESS AND PROFESSIONS CODE: A4Y CITY OR COUNTY WHICH REOUIRESAPERMR TO CCNSTRUCT,ALTEK IMPROVE. DEMOLISH, OR REPAIRANY 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 U CENSE LAW (CHAPTER 0 (COMMENCING WITH SECTION 70DO) OF DIVISION ] OF THE BUSINESS AND PRO FESSIONS CODE) OR TKATHE OR SHE IS EXEMPT THEREFROM ANDTHE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7031.5 BY AIYAPPLICAfT FOR A PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS 155001.} O L AS OWNER OF THE PROPERTY, OR MY EMPLOYE ES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC 7044, BUSI- NESS AND PROFESSIONS COOS THE CONTRACTORS LICENSE LAW DOES NOTAPPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON. MND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES. PROVIDED THATSUCH IMPROVEMENTS ARE NOT MENDED OR OFFERED FOR SKE IF, HOWEVER. THE BULDINGOR IMPROVEMENT IS SOLD WITHIN ONE YEAROF COMPLE- TION. THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD ORE). IMPROVE FOR THE PURPOSE OF SAL O L AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING N".TH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC law, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS U• CENSE LAW DOES NOTAPPLYTOAN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON. AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTON,S) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). D 1 AM EXEMPT UNDER SEC. B. A P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IMM LICENSED UNDER PROVISIONS OF CHAPTER 0 (OOMMENCNO WITH SECTION YOM) OF DIVISION ] OF THE EUS:NESS AND PROFESSIONS COOE.AND MY LICENSE IS N FULL FORCE AND EFFECT.'00 t , LICENSE CLASS 3 G LIC. NO. '1'CLASS DATE �LO! CONTRACTOR WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWNG DECLARATIONS: I HAVE AND WALLMAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS COMPENSATION. AS PROVOED BYSECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. _I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE. AS REQUIRED BY SECTION 37DO OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MYRS' COMDENSATI ON INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER / N+��rs I, �V�p POLICY NUMBER ,QCi9//DlX1�_ A C05 %�/O �L i (OHS SECTION NEDDNOT BE O71.11LETEDOFTIE PERMIT IS FOR ONE HU YIEDWILAM(SIM)ORLES% I CERTIFY THAT IN THE PERFORMANCE OF THE W WLK FOR WHICH THIS PERMIT IS ISSUED. I J SHALL NOT EMPLOY ANY PERSON IN ANY MANNER 50 AS TO BECOME SUBJECT TO THE j WORKERS' COMPENSATION LAWS OF MPTHAT IF I SHOULD BECOME SUBJECT TO THE WORKERS' COMPENECTION 3700 OF THE LABOR COOE.IS ALL OR7}TMTH COMPLY W� 1 DATE: O� APPLICANT: j WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL BE SUBJECT AN EMPLOYER TO CRM'NAL PENALTIES AND CML FINES UP 70 ONE HUNDRED THOUSAND DOLLARS (5100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN L SECTION 3708 OF THE LABOR CODE. INTEREST, ANDATTORNEY'S FEES. N CONSTRUCTION LENDING AGENCY )_ 1HEREBY AFFIRMUNDERorPENALTY OFPERJURY ICHTHAT IS PE MACONSTRUCT UED(SEC, LENDING AGENCY FOR ORAE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC 3097.0V C.). - LENDER'S HALE LENDER'S ADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING yCONSTRUCTION. AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. PERMRTEE NAME (PRINT) r](GNAT EOF PERMITTEE C PRESS FIRMLY. APPLICATION/___V PERM"�I PIC DATE NUMBER' Sa # ISSUE// -•� b TYPE OCC DATE__ (D�--O'-" CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE rillAl+ NO. DWEL. N UNITS ST S ROOMS DESCRIPTION SO, FT. FAT SF ADJ.AREA/VALUATION SFR/ADD,'REM Garage/Carport WPatio/Dack L- PooVSpa Q Z Re -Roof 0 Commercial co Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J Q U U 0 W J W U 5 , 2 m 1 J a a U_ 2 Q S U W zi CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBINGLL— MECHANICAL A INSPECTION FEE ISSUANCE�A SMTP ENERGY P/C z4' ENERGY PERMIT L RETENTION FEE: L PRE -ALT FEE: S TOTAL FEES COMMENTS RECPT. NO. PAID BY VALIDATION WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy. GULULNHULI--/-la L:opy, UILLN—Appllcam s L,opy CITY OF DIAMOND.BAR INSPECTION RECORD • '�� )�I' SET BACK ------ ----- �� (►`��;�� ®]� 1��.�'� °`.1+1�)nve _4 FLOOR JOIST FTGS/FORMSISTEEL j FHA REOMTS ELECTRIC GROUND GROUND PLUMBING SLAB GRADE 1 �5 UNDER FLOOR DUCT UNDER FLOOR CONDUIT FIREPLACE FOUNDATION _ _ 'TEMP POWER FIREPLACE BOND BEAM WATER SERVICE MID HT. BOND BEAM ROOF SHEATHING • 8 FT. BOND BEAh1 FRAMINGNENT)LIATION FINAL BOND BEAM ROOF COV R• ' f PRE -GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING _ ! 6a FINISH GRADING _ SHOWERITUB 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/LL. ON SITE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST. FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC :FI^JAL PLUMBING _ ?. 00 DEV. FEES PAID � ENERGY COMMENTS y�rt.IJ, 7 SEPTIC TANK SIZE SEEP PITH SIZE t - - -