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Home My WebLink About15078 (17)CITY OF DIAMOND BAR (;D DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES I Ij III LIM 11 Lit 11:91 & ,-C 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 ^� BUILDING PERMIT APPLICATION f 1 JOBSITEADDRES / G R ADDRESS ' GS S APN LOT TRACT OWNER —'�rt� r..�� L�01,_ J ADDRESS CITY ZIP TEL APPLICANT TEL. CONTRACTOR ADDRESS ` - CITY TEL L 9/ Si C-1 ARCR ENG/ DESIGNER ADDRESS CITY ZIP TEL OWNER -BUILDER DECLARATION I HEREBY AFFWLI UNDER PENALTY OF PERJURY THAT I W EXEMPT FROM THE CONTRACTORS U' CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE: ANY CITYOR CGL*MV MREOURESAPERMITTOCONSTRUCT•ALTERIMPRCVFDEMOJSFLORREPAJRANYSTRLr- TURF_ PRIOR TO FrS 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 UAW (CHAPTER 9 (COMMENCWQ WITH SECTION 7000) OF DIVISION $ OF THE BUSINESS AND PRO. FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7031.6 BY ANYAPPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (A60O).): D LASOWNER OF THE 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. 70". BUSL IO NESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WINO SULDS OR IMPROVES THEREON. AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR T/NOUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTSARE NOT INTENDED OR FTERED FOR SALE. IF. HOWEVERBUILDING THE OWNER.BUILDER WALL HAVE THE BURDEN OF PROVING THAT HE OR SHE OD NOT BURR OR IMPROVE FOR THE PURPOSE OF SALE). E3 LAS OWNER OF THE PROPERTY.AM EXCLUSIVELY OONTRACTNG WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 70W, BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LI CENSE OF A PROPERTY WHO BU CENSE LAW DOES NOT APPLY TORN BUILDS OR IMPROVES THEREON. AND 14 10 CONTRACTS FOR SUCH PROJECTS WITHA CONTRACTORS) LICENSED PURSUANTTOTHE CONTRAG TORS LICENSE LAW.). O INA EXEMPT UNDER SEC. B. A P.C. FOR THIS PERSON DATE OWNER LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM TINDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS O CHAPTER a (COMMENCING WITH SECTION 7000) OF DIVISION 0 O THE BUSINESS AND PROFESSIONS CODE,AND W LICENSE IS N FULL FORCE AND EFFECT. C LICENSE CLASS _ ✓ V UC. NO.-.-J'�-1U 7 G DATE �V CONTRACTOR WORKERS' COMPENSATION DECLARATION 1 HERESYAFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: —,HAVE AND W.U. MAINTAIN A CERTIFICATE OF CONSENT TO SELF•INSURE FOR WORKERS' COMPENSATION. AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FCR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT B ISSUED. _I HAVE AND WILL MANtAIN WORKERS' COMPENSATION INSURANCE. AS AEQUIREO BY SECTION 7700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY MID CERS'COMPENSATION INSURANCE CARRIER AND POLICY NNUW8F R ARE: POLK:YNiMars -eg/ c,22,?-7c,22,?-7ARG (DISSECTION NEED NOT BECOMPLETED OF7FE PERMIT IS FOR ONE HUNDRED DOLLARS ($100)ORLESS1 I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO 8ECOME SUBJECT TO THE WORKS RT COMPENSATION LAWS OF CALIFORNIA AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROW SIGNS OF SECTION 3700 OF THE LABOR CODF_ ISHALL FORTHWITH COMPLY WITH THOSE PFIOW DATE: APPLICANT: � S� � WARNING:: ALU O SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINE$ UP TOONE HUNDRED THOUSAND DOLLARS IS1 M.OW). N ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN I SECTION 370S OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES, CONSTRUCTION LENDING AGENCY 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED (SEG 7097, CIV C.). LENDER'S NAME LENDERS ADDRESS I CERTIFY THAT 1 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 COUSTRUCTION. ANO HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE A80�ED PR FD� RPOSES* i i PERMITT(PRINT) i /4✓ -r71>IrCJ SIGNXTUREOFPERMITTEE DATE PRESS FIRMLY APPLICATION PERMfr, 0 P/C DATE NUMBER R 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. AREA/VALUATION SFR/ADD1'REM co Garage/Carperi WPatio/Dock LL POOVSPa ZRe -Roo! 0 Commercial 1 M Valuation ADJ.AREA QUANTITY DESCRIPTI04 FEE J a U H W J W 0 I ` �`- Z CO J a _U Z Q S U W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING M _CH ANIC*iL INSPECTION FEE L x = I ISSUANCE SMIP ENERGY P/C 1 ENERGY PERMIT CNTY OF DtAk'iUl"D L.114 � RETENTION FEE: PRE -ALT FEE; III TTI ,T) NG ANO TOTAL FEES COMMENTS RECPT NO. PAID BY VALIDATION WHITE—Department Copy. YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD --File Copy, GREEN—Applicant's Copy CITY OF DIAMOND .BAR :.. INSPECTION.RECORD 'r.' :•a:a--�Inl,\L yrs ww.`+.rte ^1.11�1a�rr.'►'cl�'1: ��I.\l�l•J �•rR-��IrY.\! ^�-�^• .�L'.N e'�� .. 1.\l�.i:i�irr N�:l :] . 15 ET BACK. L. FLOOR JOIST "--- ....__..r_._._ `_ ._-._____...,..i ......_..._..._.-..._ _.,,-- -•- EL FNA REQ"ATS _ ELECTRIC GROUND j _ j ROU 'J F'LUF:'BIidG �j UNDER FLOOR DUCT �' I UNDER FLOOR CO;•!DUII' GRADE FIREPLACE FOUNDATION rhCt FOt"� ER j j FIREPLACE BO, --!D BEAM "•1 •TPR SERVICE I M1D HT. BOND BEAM �' s ;F1'MF SHEATHING FT?^.Mlr-!G,%lE 1TILIATIOf`. :ir)F COVER 1 _ _ ---__ 9S r, !� La FT. BOND BEP,"" _( FINAL BOND BEAM PRE -GRADING �'— -� Z.�UGH IiEl,TIN3�` BENCHING I?0!Jr3H ELECTRIC ROUGH GRADING ::.;JGH PLU.M.SI G --. -. � 6ad! .�'. FINISH GRADING j ^• O�".'cIi'111G TEST t POOL ELECTRIC i'EX.T. 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