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Home My WebLink About15108 (17)CITY OF DIAMOND BAR i DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 BUELDING PERMIT APPLICATION JOBSITE ADDRESS7-r ,O GILL v -. 7l- S? °.joy APN LOT TRACT OWNER ADDRESS CITY ZIP TEL. APPLICANT TEL. T CONTRACTOR ir::, - `' IL 1: ADDRESS c k' 2S • �'r=�1 % �_ : L A,� i= CITY/3-N1it+►'tH: ZIP ZQG� TEL71Lf✓S'l'r� l; ARCKENG/ DESIGNER [�✓� ft►fFiZ�Vi`U.°J ADDRESS CITY ZIP TEL OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LL CENSE LAW FOR THE FOLLOWING REASON (SEC. 7071.5 BUSINESS AND PROFESSIONS COO E: ANY CITY OR COUNTY WFfCH REOtARES A PEMrT TO CONSTRUCT,ALTER IMPROVE, DEMOUSK OR REPARANY STRUO TUBE. PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT 70 FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS U. CENSE UW (CHAPTER I (COMMENCING WITH SECTION 7000) OF DIVISION S OF THE BUSINESS AND PRO- FESSMS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED E%EMP• TON. ANY VIOLATION OF SECTION 70]1.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO M A CL PENALTY OF NOT MORE 71" FIVE HUNDRED DOLLARS 15500).): O LAS OWNER OF THE PROPERTY.OR MY EMPLOYEES WITH WAGESAS THEIR SOLE COMPENSATION. WILL DO THE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, BUSL NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUIDS OR IMPROVES THEREON, AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES PROVIDED THAT SUCH aAPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE IF,HOWEVER.THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAROF COMPLE- IRON, THE OLNERSULDER WILL RAVE THE SURDEN OF PROVING THAT HE OR SHE DD NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALEL D L AS OWNER OF THE PROPERTY, AM EXCLUSNELYCONTRAC nNO WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7041, BUSINESS AND PROFESSIONS CODE. THE CONTRACTOR$ L4 CERISE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON. AND WRO CONTRACTS FOR SUCH PROJECTS MATHACONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW). D IAM EXEMPT UNDER SEG 0. A P.C. FOR THIS REASON I DATE OWNER LICENSED CONTRACTORS DECLARATION 1 HEREBYAFFIRM UNDER PENALTY OF PERIURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER B (COMMENCING WITH SECTION 70001 OF DIVISION S OF THE BUSINESS AND PROFESSIONS CODE. A40 MY LICENSE 1$ N FULL FORCEAND EFFECT. LICENSE CUSS LIC. NO. % l L•� C-L� DATE J , A!' CONTRACTOR ✓�C_� LL -G. i'it• •+' WORKERS'COMPENSATION DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DCCLARATONS: I HAVE AND WILL MAINTAIN A CERTIF1CArE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION 31OU OF THE LA00A CCCE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. L_I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REWIRED BY SECTION 0700 OF THE LABOR COOS FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUES MY WORKEAS' OOMPENSATON INSURANCE CARFL'ER AND POLICY NUMBERL.ARE: CARRIER �1-l» ri'✓ P eZ � ? ?= -% ._I' _r %.� POLICY NUMBER .6�2• t' 1y =11,, (nir ;EC'TDN WMNDTaE OCM;E7E DOFT[ PEFVXT IS FOR CNE FLNDKD DOLLARS (SIOC)CRLESSL 1 CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT O ISSUED. I SHALL NOT EMPLOY ANY PERSON N ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS Of CALIFORNIA. AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS COMPENSATION PROVISONS OF SECTION 3700 OF THE LABOR E, I SHALL FORTHYATH COMPLY WITH SE PROVISIONS.DATE:`CG, ' E APPLICANT: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS (f [00.0007. N ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 0705 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEG 3MI. CIV. G). I LENDERS NAME LENDERSADDRESS I 1 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. 1 AGREE TO COMPLY WITH ALL CRY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION. AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVEM'''NT KNE0; E FITY FOR INSPECTION PU OSES. PE/R/jy�� E/ENI -,0MfATUREOFeE4WWEC GATE PRESS FIRMLY APPLICATION 00 ~I DATE vv NPERMIT UMBER/ SIC ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDEISIDE STREET RW Lj ❑ SIDE ❑ PROPOSED USE NO. DWEL. O. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM U) Garage/Carpert WPatiolDeck LL PooVSpa ZRe -Roof 0 Commercial - m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE _J U U w LU LU C7 Z m p_J L d U Z 2 U W T CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE f I , r , ISSUANCE v�1Y I P - ��1�11� ,7 -O_d SMIP�•- ENERGY P/C L (j 111 7', ENERGY PERMIT V RETENTION FEE: PRE- LT - 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 �I1�1+'1:a 6 F!}_!�'.��.I �r�1i,�� .SET BACK .~I�^-'I ~ :FTGS/FORT.,SISTEEL �^ '�►v��r+,�[�.�O�r� '►' 'I��I+`��Ci9(=�►�� :.f=��'� �� / `�; �i6'9 0 ' ~ �, I hFLOOR JOIST _ FHA REQ,"" -S ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING L UNDER FLOOR CONDUIT SLAB GRADE FIREPLACE FOUNDATION 'TEMP POWER FIREPLACE BOND BEAM Xt ER SERVICE MID HT. BOND BEAM ROOF SHEATHING 8 FT. BOND BEAM iFP.Ah11NGr%/ENT.ILIATION I FINAL BOND BEAM !ROOF COVER PRE -GRADING ROUGH HEATING BENCHING 'ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING -' - i FINISH GRADING 'SHOWER:.TFU6 TEST ` POOL ELECTRIC EXT: LATH/SIDING POOL FENCING WALL INSULATION- { POOL FINAL CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER FINAL ENG. SEPTIC TANK i I LANDSCAPE/IRRIG. SEEP PIT/L.L. I ON SITE IMPS. GAS AIR TEST FINAL CONST. FINAL ZONING FIRE DEPT. FINAL I�j s6 DO ! HFALTH DEPT. FINAL —i .FINAL HEATING ._. _�_ -FINAL ELECTRIC DEV. FEES PAID .Flt' AL PLUIMBING j ENERGY COMMENTS fi-D 'SEPTIC TANK SIZE 'SEEP PIT/U SIZE I iJrf _ --