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Home My WebLink About15079 (20)-4!-, J CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 BUQ.DING PERMIT APPLICATION ( 1 JOBSITE ADDRESS APN LOT TRACT OWNER �� rv-L�_ C R1175 - ADDRESS CITY ZIP TEL APPLICANT TEL CONTRACTOR 66SNL DMZ ADDRESS AS_ -AS_ — L LL'/I.tdxJ,7>A7I a . Cfryg! lF)= ZIP '71'7-1( TEL. /y ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PE7WRY THAT 1 AM EXEMPT FROM THE CONTRACTORS LF CENSE LAW FOR THE FOLLOWING REASON (SEC. 7071.6 BUSNESSAND PROFESSIONS CODE:ANY CRY OR COUNTY WHICH REOUIHESA 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 135003. CO L AS OWNER OF THE PROPERTY. OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION. WILL DD 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 MTMNCNE 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 EXCLUSNELYCONTRACTNC NTH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEG 7044. BUSINESS AND PROFESSIONS CODC THE CONTRACTORS LI- CENSE LAW DOES NOTAPPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IM PROVES THEREON. AND YNO 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 MOMMENCNG WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS N FULL FORCE AND EFFECT. �f LICENSE CLASS _ LIC. NO. / 4tq f p��-p DATES %�OO CONTRACTOR R&t/��/` - WORKERS' COMPENSATION DECLARATION I NEREBYAFFIRM UNDER PENALTY OF PERJURY ONE OFTHE FOL.LOWNG DECLARATIONS: _I HAVE AND PALL MANTAN 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 HOVEAD WILLMA TABOR N WORKERS'COMPENSATION INSURANCE.AS REQUIRED BYSECTION .700 OF THE LACODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PE RMR IS ISSUED. MY WOAK ,' UPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER _td POLICY NUMBER ��'�"(/}- �'r1L`7 `a 4� 7%O (THIS SECTION NEED NOT BE COMPLETED OF THE PERK 6 FOR ONE HUNDRED DOLLARS 6100) ORLESSI i 1 CERTIFY THAT N THE PERFORMANCE OF THE YWDIOIN 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 THM7H COMPLY WITH THOSE PROVO I /j�j DATE: j�=v APFiICAM: A �/`�/ � WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FNES UP TO ONE HUNDRED THOUSAND DOLLARS (S I0o.000). N ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN 1 SECTION 3706 OF THE LABOR CODE. INTEREST, AND ATTORNEYS FEES. L CONSTRUCTION LENDING AGENCY i FOR THE ERFO MINDER OF THE WORK FOR WHICH T THISHERE PERMIT 15 LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WFIIL71 THIS PERMIT IS ISSUED (SEC. 30I7, 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 CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, 1L YAUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE -MENTON PROPS FOR INSPECTONPVRPOSES. i A 5 CPERMITTEEN E(PRINT) v_=> O SIGNATURE OF PERMITTEE DAIS PRESS FIRMLY APPLICATION(P V PERMIT P/C it P# DATE NUMBE UMBE� 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 WPatio/DBck LL PooVSpa Z Re -Root Commerclal - 5 m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U cc H U LU J W - �. U'I'v�� J o_ J U Z S W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL n )I' rit< INSPECTION FEE ISSUANCE LoP SMIP / 1110 ~{ A111 ENERGY P/C • -� A C11 Y ENERGY PERMIT ISL iL 1Vl.s �i1'.11 RETENTION FEE: PRE -ALT FEE: TOTAL FEES L2, �1 V COMMENTS FIECPT. N0. PAID BY V VALIDATION WHITE --Department Copy, YELLOW—Finance Copy, PINK—M"S6or Copy, GOLnLNHULF—r'10 L:opY. GHttN—APPIICanTa L:opy CITY OF DIAMOND BAR INSPECTION RECORD -:..;;,r�;.:lr'.,�rl^Ii'a-__.____r�r't��— >o .a�,c'°�'r."l�� .___��}: c:� r.•:�CI�a►�C .._e_.-._.__�Y ... -`..Ii `ice{�r��c�1,� S -T BACK !FTCS'i-OR_�'S:STEEL ':ELECTRIC GROUND G! OUND PLMMING G...A� GRADE _ - I� I I FLOOR J01 FHA REQ',ATS UNDER FLOOR DUCT UtJDER FLOOR COi•>DUI i I FIREPLACE_ FOUNDATION �— _ E_L'i= PO4'JcR FIREPLACE BOND BEAK,, �— ,;"i rJIID HT. BOND.BEAM' !R �0 SHPAT HING. EFT. BOND BEAM :`._i.?! P';^:G l'ENTiL1ATIOIJ I I FINAL BOND BEAM— I rs':�C;� COVER I I I PRE -GRADING GH HEATING BENCHING ?OU,'!1 EL 'RI PLU"RING _ _ ROUGH GRADING FINISH GRADING _ TUB TEST I i POOL ELECTRIC .^);T. L ATH!SIDING I POOL FENCING --� ."!•,LL INSULATION I POOL FINAL ',71LING INSULATION I OFF SITE IMPS. 1R1"�ALL NAILINGj DEDICATIONS LN'EA i FINAL ENG. ---- f EPTICTANK I _ ^T LANDSCAPE/IRRIG. I — EE:P PIT/L.L. _� �— _�—ON SITE IMPS.-- _ ^, ASAI R TEST I I I I FINAL ZONING I I FIRE DEPT. FINAL. j _CONIST-�-�— :'! •.'_ Ei�:Tl"JG H"ALTH DEPT. FINAL 1 . LECTR13 . j I j DEV. FEES PAID —� I l'-`,'.: PWIMFING ' I ENERGY --- I -- ,E'1TS - EP T IC TANK SIZE i- _!' PIT/'U SIZE — — --- —