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J� CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 (909)660-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION ADDRESS ! 1(P $ 6 4 Ni r_ �, �'^io qo ADDRESS !� I l Q 0 '/Ll7(�i1. "_ I tt �/i� ►F d/Y .7j�_N/ APN LOT TRACT OWNER '1 CITY ADDRESN M / ZIP %- ' EL. - 11-11 APPLICANT TEL- CONTRACTOR ELCONTRACTOR ADDRESS CITY ZIP TEL ARCHIENG1 DESIGNER ADDRE 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. 7031.6 BUSINESS AND PROFESSICNS CDOE: ANY CITY OR CMAMYIABLIN REGUMSA PERMrT TO CONSTRUCT,ALTER IMPROVE, DEMOLISH. OR REPAIRANY STRUG TURF. PRIOR TO ITS ISSUANCE ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED 97ATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LL CENSE UW t"PTER a (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PRO. FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE MIS FOR THEALLEGED EXEMP• TON. ANY VIOLATION OF SECTION 7071.6 BY ANYAPPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (ISM).): O L AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WOR, ANO THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, BUST. NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE UW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO RU LDS OR IMPROVE.. THEREON. AND VMO DOES SUCH WORK HIMSELF OR HERSELF OR UGH THROHIS OR HER= EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE IFHOWEVER THE BUILDING OR IMPROVEMENT IS SOLOWITHIN ONE YEAROFCOMPLE. TON. THE OWNERBUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DO NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). O I, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEG 7044. BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI. CENSE UW DOES NOT APPLY TORN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON. AND WINO CONTRACTS FOR S_PROJECTS WrrHA CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW). O IAM EXEMPT UNDER SEC. R.1 P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRMUNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER I (COM IENCNNG WITH SECTION 70001 OF DIVISION S OF THE BUSINESS ANO PROFESSIONS CODE, AND LI LICENSE A SiULL]D FORCE v AND EFFECT. 6� LICENSE CUSS � t�CkG LIC. NO. DATE — — a O CONTRACTOR C' w Cia S t . WORKERS' COMPENSATION DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' I�JLNRENSATON, /5 PROVIDED BY SECTION 77M OF THE LABOR CODE FOR THE PERFORMANCE THE WORK FOR WHIM THIS PERMIT IS ISSUED. ��// I HAVE AID WILL MAINTAIN WORIERS'COMPENSATON INSURANCE, AS REQUIRED BY SECTION 77000E THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY V/1O'n�KER��S'�O�OMPPE.N.�SAATION INSURANCE CARRIER AND POLI�NUM,,B1ER ARE: CARVER C+ wY ,`�'T�'-wh o%- 0 f`• GO POLICY NUMBER 0 l�3I aM SECTION NEEDNOT BECOA7iETEDOF THE KX"T IS FORONE HIJOREDDOLLARS (610D) ORLESS� I CERTIrY THAT N THE PERFORMANCE OF THE WOR( FOR MICH THIS PERMIT 6ISSUED. I SHALL NOT EMPLOY ANY PERSON N ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS'COMPENSATION LAWS OF CALIFORNIA AND AGREE THAT IF 1 SHOULD BECOME SUBJECT TO THE MAKERS' (OMPEI 'KIN PROVISIONS OF SECTION 77000E THE LABOR CODE.: S/H�AIL FORTHWITH COMP LY 1H PROP DATE: 00 APPLICANT _�--NWARNING: FAILURE TO SECURE WORKERSCOMPENSATIOESUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIAN DOLLARS (6100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3 706 OF THE LABOR CODE. INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY 1 HEREBYAFFIRM UNDER PENALTY OF PERUURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3007, CIV C.). LENDERS NAME LENDERS ADDRESS :CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. (AGREE TO COMPLY WITH ALLCITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTOR AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. %^Y�s\-CALL L� 1I PE EE NAME (PRINT) (0-6-oo SIG F PE ITTEE f DATE PRESS FIRMLY DATE APPLICATION MITR J NUMBEPER • I U� ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE NO. DWELL NO. ` NO. UNITS STORIES BEDROO DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION SFRIADDIREM to GarapB/Carport WPatio(Deck LL POoVSpa ZRe -Roof OJ Commercial 3_ m Valuat' ADJ.AREA QUANTITY D -SCRIPTION FEE J 4 U L) �- W A (� "' Z z p ,T _J Q ✓ U 2 Q 2 U W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMTP ENERGY PIC • ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: I TOT L FEE r7 17,1 /b COMMENTS 141-1 RECPT. NO. PAID BY _ VALIDATION WHITE—Department Copy, YELLOW—Finance Copy. PINK—Assessor Copy, GOLDENRO(?LFile Copy. GREEN—Applicant's COW CITY OF DIAMOND BAR INSPECTION RECORD'- �1�+:�.=la�c��'P'(".!►`f -.. r.....�rar... ...-..r..-... _ 'o�'��t`= '�►�-��=�� �©j� _-.rn...r rw.ee. taa.. .un.i.•.. _i _�I�`!~y�=;�'sal<ea►'I�� ���r= _ l►! bra=l�� a a.. .tea _- n •.wrrw•—r�.rn... -rr.ti�.,ri.sn.• .a.r a+a •...�LA'... ._' .4�. ' SET BACK' _ l_ FLOOR JOIST . 'FTGS/FOR%1,S'STEEL' - I FHA REG ITS ELECTRIC GROUND_ GROUND PLUt: BING _ rZ�Gal_: UNDER FLOOR DUCT - UNDER FLOOR CONDUIT SLAB GRADE - I - FIREPLACE FOUNDATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICE MID HT. BOND BEAM 'ROOF SHEATHING _ _ :FRAMINGIVENTILIATION 8 FT. BOND BEAM FINAL BOND BEAM ROOF COVER PRE-GRADIIJG ;ROUGH HEATING_+�_ ROUGH ELECTRIC Z76 IOJ . ( BENCHING i •' i ROUGH GRADING ROUGH'PLUI IBING- ! - FINISH GRADING SHOWERJUB TEST POOL ELECTRIC EXT. LATH!SIDING POOL FENCING WALL INSULATION POOL. FINAL j CEILING INSULATION DRYWALL NAILING_� OFF SITE IMPS. D_DICATIONS SEWER I = FINAL ENG. SEPTIC TANK _ �- LANDS CAP Ell RRIG. SEEP PIT/LL. - ON SITE IMPS. - GAS AIR TEST FINAL CONST, . i lib / FINAL ZONING FIFE DEPT. FINAL I FINAL.HEATING C I HEALTH DEPT. FINAL - FINAL ELECTRIC --- I DEV. FEES PAID FINAL. PLUMBING ( ( ENERGY COMMENTS SEPTIC•TATIIK SIZE SEEP PIT/U SIZE - --- 1