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Home My WebLink About15018 (19)\ 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 0 c� O c w u� Or O _N W S LL O N to ZoZ 8< JOBSITE ADDRESS APN - L T TRACT OWNER ADDRESS &n I CITY t�/QYNnIXf lSel' ZIP APPLICANT TEL. CONTRACTOR (741-- ADDRESS- CITY DDRESSCITY ZIP TEL. ARCHIENG/ DESIGNER;'+>«� ADDRESS CITY ZIP TEL OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LI- CENSE UW FOR THE FOLLOWING REASON (SEG 7051.6 BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTY 0.0014 REOUIRESAPER MrTTO CONSTRUCTALTERL IMPROVE DEMOUSW OR REPAIRANY STRUG 7URE, 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 PROVISIONS OF THE CONTRACTORS L4 CENSE UW (CHAPTER F (COMMENCING WITH SECTION 7000) OF DIVISION 3 O THE BUSINESSAND PRO- FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP. TON. ANY VIOLATION OF SECTION 7031.6 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS tIS00).): El L AS OWNER 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 (SEC, 7044. BUSL NESS AND PFOFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO SULDS OR IMPROVES THEREON, AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES. PROVIDED THAT SUCH IMPROVEMENTS ARE NDT INTENDED OR OFFERED FOR SALCIF, HOWEVER THE BUILDING OR IMPROVEMENTIS SOLD WITHIN ONE YEAR OF COMPLE- TION. THE OWNER -BURLIER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DO NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). D LAS OWWEROF THE PROPERTY. AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044. BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE LAW DOES NOTAPPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPRDVES THEREON. WHO CONTRACTS FOR SUCH PROJECTS WTTHACONTFACTOR(S) LICENSED PURSUANTTOTHECONT C• TORS LICENSE LAW.). O I AM EXEMPT UNDER SEG B. C. FOR TH A DATE —M =--- --AD O LICENSED CONTRACTORS DECLARATION IHEREBYAFTIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER (COMIAENCNO CORM SECTION 7000) OF OIVISKIN 3OF THE BUSINESS AND PROFESSIONS COOE,AND WY LICENSE IS N FULLFORCE AND EFFECT. LICENSE CUSS LIC. NO. DATE CONTRACTOR WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS. I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION. AS PROVIDED BY BECTON 7700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. _1 HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY SECTION 57000E THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHIR THIS PERMIT IS ISSUED. MY WORKERS' CDMPENSATNON INSURANCE CARRIER AND POLICY NUMEERARc: CARRIER POLICY NUMBER McSSECTON NEED NOT BE COMPLETED OFTHE PERMFT SFOR ONE HUN)nED DOLLARS (SIODI OR LESS1 I CERTIFY THAT N THE PERFORMANCE Of THE WORK FDA WHICHTHIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON N ANY MANNER SO AS TO BECOME SUBJECT 70 THE WORKEFITCOMPENSATI N LAWS OF CALIFORNIA AND AGREE THAT IF 1 SHOIAD BECOME SUBJECT TO THE WORiKERT COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE.1 SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE: APPLICANP, WARNING: FAILURE TO SECURE WORKERTCOMPENSATION COVERAGE IS UNLAWFUL. AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS 111100.000), N ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVOED FOR IN 1 SECTION 3708 OF THE LABOR CODE.INTEREST. AND ATTORNEYS FEES- CONSTRUCTION LENDING AGENCY i 1HEREBY AFFIRMUNDER PENALTY OFPERJURY THAT THERETHIS IS L4ACONSUEDISKN LENDING AGENCY FOR 114E PERFORMANCE OF THE COOP/( FOR WHICH THIS PERMIT IB ISSUED ISEC.3w7, CIV. C.I. I LENDER'S NAME LENDER'S ADDRESS 1 1 CERTIFY THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. 1 AGREE TO COMPLY VAIN ALL CITY AND COUNTY ORDINANCES AN STATE LAWS RELATINGTO BUILDING CONSTRUCTINUN .AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTYTO ENTER UPON THE ABOVE MENTIONED PROPERTY FOR INSPECTION PURPOSES. i r , i 3PERM ITT AM PRINT) �SKLNAIUREOFPERMITTEE DATE PRESS FIRMLY G/ APPLICATIONSO DATE PERMIT f NUMBER I k�- ISSUE TYPE - OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE 13 - PROPOSED USE PROPOSED NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREANALUATION SFR/ADDIREM co GaragaTCarport W Patio/Dock LL POoUSpa ZRe -Roof JO Commercial m Valuetlon ADJ.AREA OU DESCRIPTION FEE 4 Rx U W W 0 Z m CL D_ 0 U Z a x U W r! �70 CONSTRUCTION _ PLAN REVIEW ELECTRIC PLUMBING I MECHANICAL INSPECTION FEE � �� 14Y 3 x+ –20 ISSUANCE 1!'Y OF wA ► NU BAN SMIP BUILDING AND SAFETY ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE -A T F TOTAL FEES COMMENTS RECPL NO. PAID BY VALIDATION WHITE—Department Copy. YELLOW—Fnance Copy. PINK—ASSOSSOr L:Op/, UULutNHuL—rue copy, t;nceN—Pppncanrs wpy = CITY OF DIAMOND,BAR , INSPECTION,RECORD SETBACK. SET BACY. ,FTGS/FORMS'STEEL ELECTRIC GROUND_ _ r ' ' _ __. �., tti _ .�.� , 'r w FLOOR JOIST I UNDER FLOOR DUCT ;GROUND PLUMBING UNDER' FLbbA'COP,IDUIT SLAB GRADE _ FIREPLACE FOUNDATION ; , ; :TEMP POWER _ _.. FIREPLACE BOND BEAM ' _ ;WATER SERVICE -- :_ MID HT. BOND BEAM,\ . _ ••.•. � � . \•. (ROOF SHEATHING' :' ; .. ,8 FT. BOND BEAM _..;.. I . 'FRAMiNG,NENTILIATiON FINRL BOND BEAM IROOFCOVER .::' PRE -GRADING > ` _'- IROUGH HEATING - BENCHING IROUGH ELECTRIC ROUGH GRADING [ROUGH PLUMBING - l FINISH GRADING 'SHOWER/TUB TEST POOL'ELECTRIC TEXT: LATH/SIDING--- ! _.. _ POOL FENCING WALL' INSULATION --; - - -- POOL FINAL ;CEILING INSULATION' OFF SITE IMPS. DRYWALL NAILING DEDICATIONS !SEWER _ . .. FINAL ENG. 'SEPTIC TANK LANDSCAPE/IRRIG. ;SEEP PIT/LL.. ! ON SITE IMPS. GAS AIR TEST - iFINAL.CONST�' r - -- _ 23 � _ _ � FINAL ZONING FIRE DEPT FINAL, ,HEALTH DEPT:%FLNAL: ' _ ,.. •,, .. , FINAL ELECTRIC-..- __... - DEV. FEES PAID ;FINAL PLUMBING ENERGY ' I COMMENTS , ..I wlr..i... C'. �'.m_aC f11`•..rx-__..,., .. i. i ! SEPTIC TANK SIZE !SEEP PIT/U SIZE i