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Home My WebLink About15100 (19)CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES I- 21660 E. Copley Drive Suitt 190 (909) 860-3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION JOBSITE ADDRESS z`U � E • �` � C --r fL.VP-"0 APN LOT TRACT OWNER7P .6 1 �IM�w1lA 61.�Y N.G ADDRESS IA /&ov CITY may' ZIP !q,7kq TEL. APPLICANT TEL. CONTRACTORL�j� t' :A ►J•� ADDRE S 'LI G� CITY ZIP i9 2401a TEL71V3W, 6QI4/ ARCWENG/ DESIGNER ADDRESS CITY ZIP TEL OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PENURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE UW FOR THE FOLLOWING REASON (SEG 7031.5 BUSINESS AND PROFESSIONS CODE: ANI OR COUNT(VMICHRECLRESAPERMrTTOCOMTRUCLILLTERMPRM- DEMOUSH,ORREPNRANYSTRUC- TURE, PRIOR TO ITS ISSUANCE, ALSO REWIRES 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 70001 OF DIVISION s OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATK7N OF SECTION 7031.5 BY ANY APPLICANT FORA PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FIVE HUNORED DOLLARS (FSOO) ): O L AS OWNER OF THE PROPERTY, OR MYEMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WI AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044. SUSF NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE UW 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 tF HOWEYER THE BUTANG OR IMPROVEMENT IS SOLD WITHN ONEYEAROF COMPLE- TION. THE OWNERAUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DO NOT BUILD On IMPROVE FOR THE PURPOSE OF SALE) O LAS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING W TH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 70". BUSINESS AND PROFESSIONS COLE THE CONTRACTORS LF CENSE LAW DOES NOTAPPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH A COWRACTOR(S)LICENSED PVRSUANTTO THE CONTRAC- TORS LICENSE LAW.). D 1 AM EXEMPT UNDER SEG B. E P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED LNOER PROVISIONS OF CHAPTER (oo w mem 1MTH SECTION 7000) OF DIVISION 7 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS NIA FT FORCE AND EFFECT. _ Q LICENSE S C- ZD UC. NO. /�Q ZIP �8 lo it ATE CONTRACTORNZ+JEnL"Vw I T WORKERS' COMPENSATION DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PENURY ONE OF THE FOLLOWING DECLARATIONS: —I HAVE AND WILL MANTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COWEN SATON, AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED. _,HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS RECUIRED BY SECTION .700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MYWDRKEP ' COMPENSATION INSURANCE CARRIER AND POLICYE. TY NUMBER ARE CARRIER "L*t-00 /^1C.v 1 POLICY NUMBER r� (OILS SECTION NE®NOT BE 0341MaF TIE PER�RT 6 FOR"ORM CAm IXXR; IAR •0010(1 LESS) CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, 1 HA LL NOT EMPLOY ANY PERSON N ANY MANNER SOAST-COLAESLIBJECTTOTHE RKERS'COMPENSA.1 v CALIFORNIA ANOAGR E TIF I SHOULD BECOME V&IECT TO EWORKERS' P 'ATOM PROVISONSO SL TON ]7000F THE LABOR E. 5 FGRTH'MTN CA 'Y THOSE PROVISION D TE: AP JT. W IN(1FA0.URE 0SECURE WCRKERS'COMPENSATION COVERAGE IS UNLAWFUL -AND SHALL eE SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE MINDRED THOUSAND DOLLARS (11100,000I. IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN i SECTION 3700 OF THE LABOR CODE. INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY 1 HEREBY AFFIRM UNDER PENALTY OF PERJURYTHAT THERE IS AGONSC LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH iH15 PERMIT IS ISSUEDUED (SEC. ]OY7, CIV. G). LENDER'S NAME LENDERSADDRESS I 1 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. 1 AGREE TO COMPLY WRH ALL CITY AND COL N" ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION. AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE.MENTIONED PROPERTY FOn INSPECTioN PURPOSES. tw DAs,-r�� NIUEE NAME (PRINT) sO RMITTEE DATE PRESS FIRMLY APPLICATIONPERMIT/�� P/C /5 DATE 1 !T� � NUMBER - N ISSUE TYPE OCC O CONST- GROUP SATE ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE 09'1 L 6.9' NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREANALUATION SFR/ADDIREM C/) Garage/Carport W Patio/Deck LL- POOI/SPa ZRe -Raaf Commercial - m Valuation ADJ.AREA OUANTITY DESCRIPTION FEE J a U 2 LU 0 W J w U Z Go J CL 3 S Z Q L) U W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE v ` ISSUANCE SMIP ENERGYP/C ENERGYPERMIT G RETENTION FEE: .L • ' T� PRE -ALT FEE: H-0 \1 TOTAL FEES COMMENTS RECPT. NO. PAID BY VALIDATION WHITE—Department COPY. YELLOW—Finance Copy. PINK—Assessor Copy. GOLDENHOO--F De Copy, GHtEN—AppBCanTS L:Opy CITY OF DIAMOND.BAR . INSPECTION RECORD _�•Ir�_i:t�_c:t,,��+i SET BACK... TTGS/FORMS/STEEL 'ELECTRIC GROUND X, F, 1►'.Ela.�..f.e"��,�i►'�-�;�=��.�c�1`I I 1 I FLOOR 401S�T_ I I _FHA REOeft' UNDER FLOOR DUCTT_ GROUND PLUMBING I UIJDER'FLOOR CO; =JIT - SLAB GRADE FIREPLACE FOUNDATION _ _ TEMP POWER FIREPLACE BOND BEAM _ WATER SERVICE I MID HT. BOND BEAK" • , j ..:, ROOF SHEATHING 8 FT. BOND BEAM, ' _ FRAMR•:GNENTILIATION FINAL BOND BEAM :ROOF COVER ROUGH HEATING ROUGH ELECTRIC _: _ I (� PRE -GRADING BENCHING ROUGH GRADING ROUGH PLUMBING . - FINISH GRADING SHG': %;_ R! i UB TEST- POOL ELECTRIC ;EXT. LAT H,.SIDING - POOL FENCING WALL INSULATION - POOL FINAL CEILtNa INSULATION OFF SITE IMPS. f DRYVYALL NAILING DEDICATIONS t S EViER FINAL ENG. TANK i LANDSCAPE/]RRIG. i �E-E=' D''.T/L.L. I ONSITE IMPS. i"EST FINAL ZONING O'JST. — IEATING ELECTRIC - I f �. FIRE DEPT. FINAL HEALTH DEPT. FINAL DEV. FEES PAID _ PLUMBING ENERGY .. SEPTIC TANK SITE .SEEP PIT/U SIZE - ---