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Home My WebLink About15130 (19)J 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 �� I ADDRESS• 7APN LOT TRACT OWNER ADDRESS CITY ZIP TEL. APPLICANT TEL. CONTRACTOR kO 1 lC' ADDRESS CITY ZIP EL. ARCWENG/ DESIGNER O ADDRESS CITY^�Qt/°AJ I.. ZIP T.I STEL. 11, 5QOIL(31 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 COUNTY WHICH REOURESA 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 UW (CHAPTER P (COMMENCING WITHSECTION 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 TWT.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 (SEC. 7041 BUSI. NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE UW 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 UW DOES NOTAPPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON. AND WHO CONTRACTS FOR SUCH PROTECTS WITH ACONTRACTOR(S) LICENSED PURSUANT TO THE CONTRA4 TORS UCENSE LAW.). O IAM EXEMPT UNDER SEC. B. L P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER • (COMMENCING WITH SECTION 7000) OF DMSON S OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS N FULL FORCE AND EFFECT. C� LICME CLASS `t LIC. NO. "' 3 DATE CONTRACTOR .3j1 `-C_;-V -N.[/1 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 WORKERT COMPENSATON 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' COMPENSATON INSURANCE CARRIER AND POLICY NUMBER ARE: uwmew POLOYNUMBER -..All. I !%2q :F-7 i 7 Z (T1SSECICNNCEDNOTDEccMPUr=CFTE POW GFORCNE HLNO7E CCLIARS(SIOD)ORLESS) I CERTIFYTHAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS 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 PROVISIONS OF SECTION 77M OF THE LABOR COOS, I SMALL FORTHWITH COM PLY LVI PROVISIONS. i �I DATE; APPLICANT: WARNING: FAILURE TO SECURE WORKERS COXPENSATION COVERAGE IS UNLAWFUL. OSMALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($700.000). N ADDITION TO THE COST OF COMPENSATX7N, DAMAGES AS PROVIDED FOR IN I SECTION 7701 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. I CONSTRUCTION LENDING AGENCY i 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEG 1007. CIV G). I LENDER'S NAME LENDERS ADDRESS 1 1 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. 1 AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTKXH. AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE AHOVE•MENTIONED PROPERTY FOR INSPECTION PURPOSES. S PERNrTrEEt!. f (PRINT) ` D 1 SIGNATURE O ERMITTEE DATE PRESS FIRMLY PERMIT DATE APPLICATI �C* NUMBER �1 D P/C ISSUE TYPE OCC DATE G ! U CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ Ll SIDE ❑ PROPOSED USE 71 NO. DWEL. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION SFRlADD/PEM U) GaragetCarport WPatio/Deck LL POOVSpa Z R. -Roof Commercial - m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE a w 407 9241 l H 2 0 C7 W C7 Z m U 2 Q 2 U W r: IONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL -- I J 1 (1 21,1011 INSPECTIONFEE- •^ C1111 Lllt.l )V+�U +�N ■� �( -� TVTI' ISSUANCE 1 }1 SMTP `i' DIIN'U f-ll`:1J 0;.1'G ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: TOTAL FEES 26 • C, COMMENTS RECPT. NO. PAID BY VALIDATION WHITE- Department Copy, YELLOW—Fnenoe Copy, PINK —ASSOS$Df Copy, GULULNHUu—raa L:opY. UHLLN—P4)PICWI S L:OPy CITY OF DIAMOND BAR II4SPECTION RECORD _ SET BACK o�;r • l FLOOR -JOIST-,,, FTGS/FOR.IS;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. 130?&BEAM :ROOF SHEATHING 8 FT. BpND,eEAM . I - ;FRAMINGNENTILIATION FINAL BOND BEAM ROOF C00 --R I PRE -GRADING ROUGH HEATING 'ROUGH ELECTRIC ROUGH PLUMBING - 1 _ � _ - BENCHING!,, G: (. ;. •. 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 SEWER I FINAL ENG. SEPTIC TANK LANDSCAPE/IRRIG. :SEEP PITiL.L. ON SITE IMPS. GAS AIR TEST I FINAL 7.ONING 'FINAL CONST. f .. FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT, FINAL 'Fi;JAI_ ELECTRIC ;1=1NAL PLU'.181NG COMMENTS _ I DEV. FEES PAID 7'_% Ov ( / w ENERGY _ - -- 'SEPTIC TANK SIZE SEEP PIT/U SIZE ..x ;