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Home My WebLink About15107 (19)CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 PRESS (909) 860-3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION FIRMLY JOBSITE _ ADDRESSZIL'f'!EG/:)"FE„cj 67;1 PS, t7 P f % APN LOT TRACT OWNER ADD SS 7L. _F�f CITY, U' ' rt TL ZIP TEL. APPLICANT - T TEL, WT=�=��I CONTRACTOR ADDRESS CITY F��:�rvlC: ZIP -,3ir'--Z TEL IVj-_.�/ ftd ARCWENG1 G DESIGNER 4ec- :u ADDRESS CITY ZIP TEL OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM LNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE UW FOR THE FOLLOWING REASON (SEC. 7031,6 BUSNESSAND PROFESSIONS CODE:ANY CITYOR COUNTY WHICH REQUIRES APERMRTO CONSTRUCT, ALTER IMPROVE ,DEMOLISH. ORREPAIR ANYSTRUC- TUR _ PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PRONSONS OF THE CONTRACTORS LI• CENSE UW ICRAPTER I (COMMENCING WITH SECTION 7000) OF ONISION S OF THE BUSINESS AND PRO. FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THENIEFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 70]1.6 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF HOT MORE THAN FIVE HUNDRED DOLLARS (SSW) 1: OLASOWNER 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 ISEC. 70AA BUSI- NESS AND PROFESSKNS COOS THE CONTRACTORS LIOENSE UW DOES NOT APPLY 70 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 ORIMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE TION. THE OWNER -BUILDER WALL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE), a LAS OWNER OF THE PROPERLY, AM EXCLUSIVELY CONTRACTNQ WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS U. CENSE UW DOES NOTAPPLY TO AN OWNER OFA PROPERTY WRO BUILDS OR IMPROVES THEREON. AND WHOOONTRACTS FOR SUCH PROJECTS WITHA CONTRACTORS) LICENSED PURSUANT TO ME CONTRAG TORS LICENSE LAW.). + O IMI EXEMPT UNDER SEG B.1 P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER P (OOMMENCIIG WITH SECTION YOM) OF DIVISION S OF THE BUSINESS AND PROFESSIONS CODE. AND MY LICENSE IS N FULL FORCE AND EFFECT. �• LICENSE_CLASS LIC. NO-• i C T DATE• �Z7 �Cr3 CONTRACTOR% 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 MARKERS' COMPENSATION. AS PROVIDED BY SECTION 5700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. i I HAVE IMO NIU. MAINTAIN WORKERS' COMPENSATKIN INSURANCE, AS REQUIRED BY SECTION 0700 OF THE LABOR CODE FOR 714E PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CAFnF.R�[f/lc5iNIrj_fL ! POLICY NUMBER .f,2�s R 2 I -: I _ (T16 SECTION NEED NOT BE COMPLETED OF THE PERMIT BFOR OS RLIOiiED DOLLARS R10o)CRLESS} ! I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED.I 1 SHAH NOT EM PLOY ANY PERSON N ANY MANN ER SO AS TO BECOME SUBJECT TO THE j WORKERS'COMPE NSAT ION LAWS OF CALIFORNIA AND -AGREE IHATI SHOULDBECOME SUBJECT TO THE WORKERS'COMPENSATION PR$WISKXI OF SE N 0700 OF THE LABOR CODE. 161UlLL FORTHWITH COMPLY WITHT KIP j L DATE: APPLICANT. ✓' L 1 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND A.S p t0 DOLR0,000),IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN i SECTION 370B OF THE LABOR CODE. INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY 1 OR THE AFFIRM UNDER PENALTY OF PERJURY THAT THERE 6 A TRUCTIONLENDINOAQCNCY DING C.). FOR 714E PERFORMANCE OF 114E WORK FOR WHICH THIS PERMIT is ISSUED (SEC. DOW, CIV C.). J " LENpCR'S NAME LENDERS ADDRESS I CERTIFY THAT I RAVE 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 CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE•MENTONEDPRDPERTY FOR INSPECTION P RPOSES. r 5 PERMITTE N PRIM zs.-> 2 i PE E DATE C APPLICATIO!tj /1- N PERMIT P/C 00-17, DATE (/ NUMBER M ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE NO. DWEL. NOe NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADDIREM Cn Garage/Carpon WPatio/Dock LL PooVSpa Z Ra -Root OJ Commercial til - 5 m / Valuation ADLLAREA OUANTI DESCRIPTION FEE a U E: H w 1 t2.L� L7 ��r� • �uu •�wTT�TI Ail • Q'• v 1 1 Vl •• •• Q U Z Q U W CONSTRUCTION PLAN REVIEW — ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE d1 s--�— SMIP ENERGY PIC ENERGY PERMIT RETENTION FEE: PRE- T E:/f// 1 TOTAL FEES 0 COMMENTS RECPT NO. PAID BY VALIDATION WHITE --Department Copy. YELLOW—Finance Copy. PINK—AssessorOopy. FjULutNHULJ—rRe wq. UNctN—APPIICanrs 1,0py CITY OF DIAMOND BAR "INSPECTION RECORD,t . .. �IR��•`j•l�C�°^riI^)!'hY��= SET BACK _I_ �-' N ».IFLOOR JOIST. . FTGS/FOR%lS!STEEL- FHA REMITS' - 'ELECTRIC GROUND- - UNDER FLOOR DUCT GROUND PLUMBING I UNDER FLOOR CONDUIT I SLAB GRADE I � FIREPLACE FOUNDATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICE I MID HT. BOND BEAM I ' 'ROOF SHEATHING ` . 8 FT. BOND BEAM FRAMINGNENTILIATION I FINAL BOND BEAM ROOF COVER I PRE -GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC -�--� ROUGH GRADING 'ROUGH PLUMBING FINISH GRADING SHOWER/TUB TEST POOL ELECTRIC .EXT. LATH,/SIDING - - POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE. IMPS. 'DRYWALL NAILING _ I DEDICATIONS SEVER FINAL ENG. SEPTIC TANK I LANDSCAPE!IRRIG. SEEP PIT/L.L. ON SITE IMPS. ;GAS AIR TEST FINAL CONST. FINAL HEATING. I FINAL ELECTRIC FINAL PLUIMSING I I I FINAL ZONING FIRE DEPT. FINALS HEALTH DEPT. FINAL DEV. FEES PAID ENERGY COMMENTS _. (SEPTIC TANK SIZE .SEEP PIT/U SIZE _ Z1