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Home My WebLink About15079 (19)-4!-, J CITY OF DIAMOND BAR p� DEPARTMENT OF COMMUNITY NAL DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION ( 1 JOBSITE ADDRESS 65a e" APN LOT TRACT OWNER �� rv-L�_ C R1175 - ADDRESS CITY ZIP TEL APPLICANT TEL CONTRACTOR 66SNL DMZ ADDRESS ASS SY - L ALL-/ L'Gt JCD DA7 I_e-- a . Cfryg! lF)= ZIP '71'7-1( TEL. v / ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PETWRY THAT 1 AM EXEMPT FROM THE CONTRACTORS LF CENSE LAW FOR THE FOLLOWING REASON (SEC. 7071.6 BUSNESSAND PROFESSIONS ODOE:ANY CRY OR COMfTY WHICH REOLMESA PERMRTO CONSTRUCT.ALTER IMPROVE, DEMOLISH. OR REPAIR ANYSTRUO TUBE PRIOR TO ITS ISSUANCE ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FIE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS L.I. CENSE LAW (CHAPTER a (COMMENCING WITH SECTIO! TOM) OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE) OR THATHE 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 CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (35003. 0 L AS OWNER 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. 7044, BUSI- NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY 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 CNE YEAR OF COUPLE. TION. THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). ❑ L AS OWNER OF THE PROPERTY, AM EXCLUSNELYCOMRACTNC WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEG 7044. BUSINESS AND PROFESSIONS CODC THE CONTRACTORS U - CENSE LAW DOES NOTAPPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IM PROVES THEREON. AND N40 CONTRACTS FOR SUCH PROJECTS WITHACONTRACTOR(S) LICENSED PURSUANT TO THE CDNTRAC? TORS LICENSE LAW). O I AM EXEMPT UNDER SEC. B. A P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBYAFFAM UNDER PENALTY OF PERJURY THAT 1 AM LICENSED UNDER PROVISIONS OF CHAPTER S (COMMENCING WITH SECTION 7000) OF DIVISION S OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS N FULL FORCE AND EFFECT. LICENSE CLASS _ LIC. NO. DATES %�OO CONTRACTOR�t/��/L - WORKERS' COMPENSATION DECLARATION I HEREBYAFFIRM UNDER PENALTY OF PERJURY ONE OFTHE FOLLOWING DECLARATIONS: _I HAVE AND PALL MMNTAN A CERTinCATE OF CONSENT TO SELFNNSURE FOR WORKERS COMPENSATION, AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FORWHICH THIS PERMIT IS ISSU W. I HOVE AND WILL MABOR NMAN WORKERS' COMPENSATION INSURANCE. AS REQUIRED SY SECTION .700 OF THE LACODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PE RMR IS ISSUED. MY WDRI "' dOMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER dL0 POLICY NUMBER . ^ 1'109- a' 1L`� `j—I NCJLi7 %O cries =nDN NEED NOT BE CONFLEIEDOFTHE PERK S FOR ONE HUNDRED DOLLARS (F10010RLFSS) i 1 CERTIFY THAT N THE PERFORMANCE OF THE YWDf71N FOR WHICH THIS PERMIT 6ISSUED, 1 I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE j WORKERS COMPENSATION LAWS OF CALIFORNIA AND AGREE THAT F I SHOULD BECOME SUBJECT TO THE WORKERS CCMPENSATICN PROVISIONS OF SECTION 3700 OF THE LABOR CODE, L SHALL FO THY47H COMPLY WITH THOSE PROVO I ;60 DATE: j��=v APFiICAM: A �/`�/ � WA7W ING: FALURE TO SECURE WORKERS' COMPENSATION OMERAGE IS UNLAWRL. AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FNES UP TO ONE HUNDRED THOUSAND DOLLARS ($1 '0 IN 000). ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN ION7706 1 SECTE LABOR CODE. INTEREST, AND ATTORNEYS FEES. L CONSTRUCTION LENDING AGENCY i FOR THE ERFO UNDER PENALTY OF PERJURYTHAT THERE SACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WNIILII THIS PERMIT IS ISSUED (SEC. 3007, CIV C.). i LENDERS NAME LENOERSADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREETO COMPLYWI ALL CT' AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, 1L YAUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE -MENTION PROPS FOR INSPECTIONPVRPOSES. i A 5 CPERMITTEEN E(PRINT) v_=> O SIGNATURE OF PERMITTEE DAIS PRESS FIRMLY APPLICATION(P VPERMIT 50- �G P/C DATE NNUMBS UMBS M ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW O 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 WPabo/Deck LL PooVSpa Z Re -Root Commerclal - 5 m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U cc H U W J W - JA 03 �. U'I'v�� J a J U Z S W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL n )I' rY"t: INSPECTION FEE ISSUANCE SMIP / 1110 ~{ A111 ENERGY P/C • -� A C11 Y ENERGY PERMIT 1S1 �+ 1Vl.s !i1'.11 �7N'A i� RETENTION FEE: PRE -ALT FEE: TOTAL FEES L2, �1 V COMMENTS FIECPT. NO. PAID BY V VAUDATION WHITE --Department Copy, YELLOW—Finance Copy, PINK—M"S6or Copy, GULL1LNHUUF—r'10 L:opY. GHttN—APPIICanca L:opy CITY OF DIAMOND BAR INSPECTION RECORD -:..1-c,;� Ci.ac'-.rl^I�'i-___.__c�T�_��_- -, .a=,c*�'r."l�� .I1�}� c:s r.-:�CI�a►�C .._e_.-._.__�Y: ... -`_Ii �i�.��r:�r�c�1,� :_BACK , E EL ;ELECTRIC GROUND ,GI;OUND PLUMBINGI�(— SI tJ GRADE I � -- - ji —- I I .FLOOR JOI:`�i, FHA REQ.MTS UNDER FLOOR DUCT _ UNDER FLOOR Cdr•1DUl i - - I FIREPLACE_ FOUNDATION _ — — - _ POWER I I I FIREPLACE BOND BEAR", �— _'.:••,Ti rJIID HT. BOND.BEArA'`.. SH�.ATHING. I I E FT. BOND BEAM .' _; _i?! P'I"JG l'ENTiLIATIOtJ I I FINAL BOND BEAM I COVER I I I PRE 7GRADING I -H HE=ATING BENCHING ?.0 ELEC'TR1C _ _ ROUGH GRADING FINISH GRADING _ UB TEST I i POOL ELECTRIC -=XT. L ATH!SIDING I POOL FENCING '.:'!•,LL INSULATION I POOL FINAL I ''7iLING INSUUMON I OFF SITE IMPS. I ; l?1",BALL NAILINGj DEDICATIONS _ ER i FINAL ENG. ---- _ c EPTICTANK I _ ^T LANDSCAPE/IRRIG. I — EEP PITiL.L.__�—ON SITE IMPS. ^, R TEST ASAI I I I I FINAL ZONING I I FIRE DEPT. FINAL. j _CO?:ST-�-�— HEATINGH"ALTH DEPT. FINAL T I DEV. FEES PAID ) - - GJ E'J E R G I' —_ ----� --I ---- —