The URL can be used to link to this page

Home My WebLink About15130 (17)J CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION JOBSITE 60 ADDRESS• 7APN LOT TRACT OWNER ADDRESS CITY ZIP TEL. APPLICANT TEL. CONTRACTOR kO 1 lC' ADDRESS CITY ZIP EL. ARCHIENG/ DESIGNER O ADDRESS CITY^�Qt /°AJ j., ZIP T.I STEL. 11, 5(701631 OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LI- CENSE 4CENSE LAW FOR THE FOLLOWING REASON (SEC. 7071.5 BUSINESS AND PROFESSIONS CODE. ANY CITY OR COUNIN WHICH RECIIJI PERMITTO CONSTRUCT.ALTER IMPROVE. DEMOLISH, OR REPAIRANY STRUC- TURF. 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 LF CENSE LAW (04APTER 1(C.OMMENCING WITH SECTION TWO) OF DIVISION 7 OF THE BUSINESS AND PRO. FESSIONS WOE) OR THAT HE OR SHE IS EXEMPT THEREFROM ANDTHE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7071.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS [ISM).): O L AS OWNER OFTHE PROPERTY. OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEE 7041 BUSI. NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BULDS OR IMPROVES THEREON. AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES. PROVIDED THAT SUCH IMPROVEMENTS ARE NOT MENDED OR AL OFFERED FOR SE IF, HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONEYEAR OF COMPLE- TION. THE OWNER BUILDER PALL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE} 0 L AS OWNER OF THE PROPERTY. AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044. BUSINESS AND PROFESSIONS CODE. THE CONTRACTORS U - CENSE LAW DOES NOTAPPLY TO AN OWNER OF A PROPERTY WHO BUNDS OR IMPROVES THEREOK AND WHO CONTRACTS FOR SUCH PROTECTS WITH ACONTRACTCR(S) LICENSED PURSUANT TO THE CONTRA4 TORS LICENSE LAW.). O IAM EXEMPT UNDER SEC. B. L P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER • (COMMENCING WITH SECTION 7000) OF DMSION S OF THE BUSINESS AND PROFESSIONS CODE. AND MY LICENSE IS N FULL FORCE AND EFFECT. C� L1CIMSE CLASS `t 0 LIC. ND. "� 3 DATE CONTRACTOR WORKERS' COMPENSATION DECLARATION ?iJ 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: _I HAVE AND WILL MAINTAIN ACERTIFICATE OF CONSENT TO SELFaNSURE FOR WORKERS' COMPENSATION. AS PROVIDED BY SECTION 1700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WALL MAINTAIN WORKERS COMPENSATION INSURANCE, AS RE W:RED BY SECTION 1700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: uwmew POLICYNUMBER �, 'Ulf. I !%0.q :F-7 1 7 (D1SSEC I0N NCEDNOT SEccM PUr=CFT E POW G FCR ONE HLNO7MCOLLARS (SIOD) OR LESS) I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHIALLNOT 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 PROVISIONS OF SECTION 77M OF THE LABOR COOS, I SMALL FORTHWITH OOMPLYWI PROVISIONS. i DATE: L_s_1—/: APPLLCANT. WARNING: FAILURE TO SECURE WORKERS COXPENSATION COVERAGE IS UNLAWFUL40 SMALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($700.000). N ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN I SECTION 7701 OF THE LABOR CODE, INTEREST. AND ATTORNEYS FEES. I CONSTRUCTION LENDING AGENCY i 1 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 (SEE 1007. CIV e). I LENDER'S NAME LENDERS ADDRESS 1 1 CERTIFY THAT I HAVE READ THIS APPLICATION MID STATE THAT THE ABOVE INFORMATION IS CORRECT. 1 AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTKXN. AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE AHOVE•MENTIONED PROPERTY FOR INSPECTION PURPOSES. S PERNrTrEEt!. f (PRINT) ` FLL_-^, f L'a O 1 SIGNATURE O ERMITTEE DATE PRESS FIRMLY PERMIT DATE APPLICATI �C* NUMBER �1 D P/C ISSUE TYPE OCC DATE G ! U CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ Ll SIDE ❑ PROPOSED USE 71 NO. DWEL. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION SFRlADD/PEM U) Garage/Carport WPatio/Deck LL POOVSpa Z R. -Roof Commercial - m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE a w 4o7 9241nl H 2 0 C7 W C7 Z m U 2 Q 2 U W 1 CONSTRUCTION PLAN REVIEW 7• R IR, i'T`Y ELECTRIC PLUMBING MECHANICAL -- I J 1 (1 21,1011 INSPECTIONFEE- •^ CT 1 1-TVTI' lllt.l )V+�J✓ +�N■� �( -� ISSUANCE }1 FDI SMTP `L' INU f-ll`:1) 0;.VL.1 ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: TOTAL FEES 26 • C, COMMENTS i 141 RECPT. NO. PAID BY VALIDATION WHITE—Department Copy, YELLOW—Fnenoe Copy, PINK —ASSGSsor Copy, Gvu7tNHUu—rae L:opY. UHetN—PpPPICWI S L:OPy CITY OF DIAMOND BAR RJSPECTIOP� RECORD �•�li��.l.•?=�.fl(^1�`I o,�;;��= 'l.�.f��.�,`.ir.��-1 +� Ii�F=i �.�c;..��]�`�•�•�. �'.�I�� : �' SET BACK l FLOOR -JOIST-,, FTGS/FORMS/STEEL I FHA REWATS. iELECTRIC GROUND UNDER FLOOR DUCT (GROUND PLUMBING I FLOOR CONDUIT .SLAB GRADE _UNDER FIREPLACE FOUNDATION 'TEMP POWER FIREPLACE BOND BEAM WATER SERVICE_ MID HT. BO?&BEAM ; :ROOF SHEATHIfJ68 FT. BpND,eEAM . I - ;FRAMII•IGNENTILIATION FINAL BOND BEMA ROOF C00 --R I PRE -GRADING ROUGH HEATING 'ROUGH ELECTRIC ROUGH PLUMBING - 1 _ �7�� _ - G: BENCHIN': (. ;. •. ROUGH GRADING FINISH GRADING SHOWER,TUB TEST POOL ELECTRIC EXT. LATHISIDING POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEW.:R I FINAL ENG. SEPTIC TANK LANDSCAPE/IRRIG. :SEEP PITiL.L. �— ON SITE IMPS. GAS AIR TEST I FINAL ZONING 'FINAL CONST. f .. FIRE DEPT. FINAL FINAL HEATING 1-1EALTH DEPT, FINAL -Fi;dAl_ ELECTRIC ;FINAL PLU'.1BING COMMENTS _ I DEV. FEES PAID 7'_% Ov ( / w ENERGY _ - -- 'SEPTIC TANK SIZE SEEP PIT/U SIZE ..x ;