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Home My WebLink About13-1317 (7)0 M CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 (909) 839-7020 Fax (909) 861-3117 Building Inspection Hotline (909) 839-7027@ BUILDING PERMIT APPLICATION JOBSITE ADDRESS APN LOT TRACT OWNER7)rorQ ADDR S G r CITY IL44w oil W ZIP APPLICANT L. CONTRACT08 ffCPI P! ADORE S I CITY r� ZIP T d ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL, OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REIN IAES A PERMITTO CONSTRUCT. ALTER• IMPROVE. DEMOU SH, OR REPAIR ANY STRUC TORE, 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 LI- CENSE UW (CHAPTER Y (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PRO FESSIONS CODE) OR THAT HE OR SHE IS EXEMPTTHEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- 7KXN. ANY VIOLATION OF SECTION 7031.6 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (3500).}. ❑ 1, AS OWNER OF THE PROPERTY. OR MY EMPLOYEES WTD/ WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK. AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 70". BUST. NESS AND PROFESSIONS COOE: THE CONTRACTORS LICENSE LAW 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 IF, HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAROFOOMPLE- TION, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR `IMPROVE FOR THE PURPOSE OF SALE). ❑ 1, AS OWNER OF THE PROPERTY. AM EXCLUSIVELY CONTRACTING WTTH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LI. CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CDNTRAO TORS LICENSE LAW.). ❑ 1 AM EXEMPT UNDER SEC. B. 8 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 f/ (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EF7T / LICENSE CLASS 3 6 LIC. NO. DATE CONTRACTOR WORKERS' COMPENSATION DECLARATION 1 HERFBYAFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOW WG DECLARATIONS: I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED. YYO ERS' COMPENSATION INSU-C�„•CARRI RAND POLICY NUMBER ARE: CARRIER I., l POLICY NUMBER l f_/ v ( % / (TINS SECTION NEED NOT BE OOMPLETFDOFTHE PERMIT IS FOR ONE IA/NDRED DOLLARS (3100)OR LESS? I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN 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 37M OF THE LIBOR CODE, I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE LA _ 3 APPLICANT WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL BE SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (III W.000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE INTEREST AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY 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 (SEC. 3097, CIV C.F LENDERS NAME LENDER'S ADDRESS I CERTIFY THAT I HAVE 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.MENTIONEDPROPER OR INSPECTION PURPOSES. /r L PERMITTEE NAME (PRINT) -/� SIGNATURE OF PERMITTEE DATE PRESS FIRMLY APPLICATION f 3 PERM IT NUMB R l l3 f 1#/C ISSUE TYPE OCC DATE j CONST-_ GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ..AREAIVALUATION SFR/ADD/REM U) Garage/Carport WPatio/Dock LL Pool/Spa Z Re -Roof Commercial - 5 M Valuation ADJ.AREA QUANTITY DESCRIPTION FEE Q U U LL) w ED Z Q J d Q U_ Z Q 2 U w CONSTRUCTION PIAN REVIEW ELECTRIC _ PLUMBING MECHANICAL INSPECTION FEE ISSUANCE M . SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: TOTAL FEES COMMENTS RECPT. NO. PAID BY VALIDATION WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy, GOLDFNROD--File Copy, GREEN—Applicant's Copy CITY OF DIAPvl0N D BAR lN;SPE TfQ'A RECORD W SETBACK FTGSiFORN15/STEELFHA GROUND LL �FLOORJOIST REQtNTSELECTRIC UNDER FLOOR DUCT --- _- -- -- - - -- --- ---- UNDER FLOOR CONDUIT FIREPLACE FOUNDATION GROUND PLUMBING _-_-! SLAB GRADE _ ---- r - 1-_-- - TEMP POWER --� - _ FIREPLACE BOND BEAM WATER SERVICE _ MID HT BOND BEAM ROOF SHEATHING 8 FC BOND BEAM FRAMING/VENTILATION _ FINAL BOND BEAM__ ROOF COVER_-_- - -_ - -- -- _ -- - _- CPRE -GRADING _- ROUGH HEATING _ r - - - I BENCHING ROUGH ELECTRIC I - ---- -__`-_ - IrROUGH GRADING ROUGH PLUMBING t' 3 FINISH GRADING SHOWER/TUBTEST I POOL ELECTRIC EXT. LATH/SIDING POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS FINAL E_NG�-T"-- -- SEWER - _ _ _ - SEPTICTANK_ - _ _ _ -^ - -^ _ LANDSCAPEARRIG. J SEEP PIT/L.L. --- ON SITE IMPS. - - -- GAS AIR TEST FINAL ZONING FINAL CONST. --�-^ _ FIRE DEPT. FINAL FINAL HEATING _ HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAIQ FINAL PLUMBING FINAL PLANING FINAL ENGINEERING COMMENTS J ENERGY - - --- SEPTIC TANK SIZE SEEP PIT/U SIZE ------"----- - GLENORPE------------__ -