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Home My WebLink About15048 (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 JO SITE' ADDRESS Q C7UI N APN LOT TRACT OWNER ADDRESS C.?C CITY e,-_7 / ZIP EL9G 4/- P S APPLICANTf L. CONTRACTOR ADDRESS C ZIPWqV TEL 5-1176 CA-R-CEWNG/ IGNER ADDRESS CITY ZIP TEL OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM EXEMPT FROM THE CONTRACTORS L4 CENSE UW FOR THE FOLLOW NG REASON (SEG 7051.5 BUSINESSAND PROFESSIONS CODE: ANY CITYOR COIAVTY W 41CH REQUIRES A PERMITTO CONSTRUCT,ALTER IMPROVE. OEMOLISROR REPAIRANY STRUC, TORE, 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 U. CENSE UW (CHAPTER 60 (COMMENCING WITH SECTION 7000)OF DIVISION S OF THE BUSINESS AND PRO- FESSKNIS000E) OR THATHEOR SHE IS EXEMPT THEREFROM ANDTHE BASIS FOR THEALLEGED EXEMP- TTON. ANY VIOLATION OF SECTION?MI.S BY ANYAPPLICAHT FOR A PERMIT SUBJECTS THE APPLICANT TO A CrViL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (SSW).): O L AS OWNER OF THE PROPERTY. OR MY EMPLOYEES WITH WAGES ASTHEIR SOLE COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEG 7041, BUSI- NESS AND PF40FESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO DOES SUCH WORK HIMSELF OR HERSELFOR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT MENDED OR OFFERED FOR SALE IF, H OWEVEILTHE BALDING ORIMPROVEMENT IS SCID WITHIN ONE YEAR OF COMPLE- TION. THE OWNER -BUILDER VALLHAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE} . ❑ L AS OWNER OF THE PROPERTY• AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7011, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE LAW DOES NOTAPPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND V040 CONTRACTS FOR SUCH PROJECTS VATHACONTRACTOR($) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW,). O 1 AM EXEMPT UNDER SEC. B. A P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER e (COLOAFNCM WITH SECTION 7000) OF DIVISION 0 OF THE BUSINESS AND PROFESSIONS CODE AND MY LICENSE MIN FULL FORCE AND EFFECT. LICENSE CLASS LIC. NO. . .DATE - 00 COtFTRACTOR WORKERS' COMPENSATION DEC RATIO % 1 I HERESYAFFIRM UNDER PENALTY OF PERJURY ONE OF THE F OWING DEC TIONS: ij HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT SELFaNSUFIE FOR WORKE 5 COMPENSATION.AS PROVIDED BY SECTION 37000FTHE R CODE, FOR THE PERF R CE OF THE WORK FORW H04 THIS PERMR IS ISSUED. _1 HAVE AND W ULUANTAN WOWERS'COMPENSATION INSURANCE. E0N4GD.B 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PE RIS _r ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER .. POLICY NUMBER (THM SEICIMNEEDNOT BE CONPLETEDOFTHE PERMIT IS FORCNE KLMIEDOOLARS 4100) CRUM I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, l SHALL NOT EMPLOY ANY PERSON N ANY MANNER SO AS TO BECOME SUBJECT TO THE. , WORKERS' COMPENSATION LAWS OF CAUFORNIA.ANO AGREE THAT IF 1 SHOULD BECOME SUBJECTTO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 37000F THE LABOR' CODE I SHALL FORTHWITH COMPLY WITH�THDIIIPROVISIONS. DATE:. APPLICANT. 7 //tCI'f SG�e'1-1!�C/� WARNING: FAILURE TO SECURE WORKERS COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL SE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS (5100.000), N ADDITION TO THE COST OF COMPENSATION. DAMAGLS AS PROVIDED FOR N SECTION 5705 OF THE LABOR CODE. INTEREST. AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY _. I HEREBY AFFIRM HINDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 30607, CW. C.I. LENDER'S NAME LENDERSADORESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THATTHE ABOVE INFORMATION IS CORRECT. 1 AGREE TO COMPLY WITH ALL CRY AND COUNTY ORDINANCES AND STATE LAWS RELATING 70 BUILDING CONSTRUCTKON•AND HEREBYAUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE . ABOVE-MENTK)NEO PROPERTY FOR INSPECTKM PURPOSES. 77- i G-- rC Ilt I PERMITTEE E (PRI ' H SIONATU REOF PERMITTEE DATE PRESS FIRMLY APPLICATIO a UV PERMIT P/Cj� DATE NUMBER M (/�l 4 ISSUETYPE OCC. DATE CONST. GROUP ZONING SETBACKS 1 FRONT - RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE p PROPOSED USE�� - . NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT FACTOR PSF ADJ. AREAIVALUATION SFRIADDIREM 1 . Garage/Carport W PalbDeck L" Poot/Spa ZBe -Roof i Commercial /S` 5 A m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J¢ I 1,. r U w LU V r� Q CONSTRUCTION. r. PLAN REVIEW ELECTRIC PLUMBING MECHANICAL T.Tyi, L INSPECTION FEE , ISSUANCE SMIP ENERGY P/C --42FFk" OF ENERGYPERMIT L Yl 1 / RETENTION FEE: J AND & . Y PRE- � TOTAL FEES -33' -0 COMMENTS JAL RECPT. NO. PAID BY VALIDATION WHITE—Department Copy, YELLOW—Finance Copy, PINK --Assessor Copy, GOLDENROD—FIW Copy, GREEN—Applicant's Copy 7 CITY OF DIAMONa BAR INSPECTION RECORD, ; " -I 14S ot-ft lbdN DATE 'INSPECTOR INSPECTION DATE INSPECTOR SETBACK". FLOOR JOIST,: t •... ! _ •.. FTGS/FORMS/STEEL ! FHA REQMTS ELECTRIC GROUND - UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR CONDUIT- SLAB GRADE FIREPLACE FOUNDATION - TEMP POWER FIREPL'A•CE'BOND BEAM WATER SERVICE - MID HT. -BO BEAM ROOF SHEATHING`� -ND, ' , _ - t '_. , 8 FT. B9 D:BEAM ..e - ...;3 _ 1, FRAMINGNENTILIATION FINAL BONDEEAM ROOF COVER PRE -GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC - - - -ROUGH GRADING ROUGH PLUMBING "" FINISH GRADING , SHOWERITUB TEST - ..POOL ELECTRIC EXT. LATH/SIDING POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION ` ` : •, ! OFF SITE IMPS. DRYWALL NAILING 3 Ddz57-+ DEDICATIONS ;. I SEWER_ FINAL ENG. SEPTIC TANK': ! ; _ '`, 11 LANDSCAPE/IRRIG. SEEP PITIL,L. -- _ `'_._ ON SITE IMPS. GAS AIR TEST', - FINAL ZONING FINAL CONST. ` `' - ' ' ' =� ` ` FIRE DEPT. FINAL FINAL HEATING (�(} HEALTH DEPT. FINAL FINAL ELECTRIC �— DEV. FEES PAID FINAL PLUMBING " ', ENERGY COMMENTS 012/6-:S,` aiS 'IgD Q p- �C b °33�_1_nJ S Z = c - ogtfig wr Esc v , SEPTIC TANK SIZE SEEP PIT/U SIZE ! 1: