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Home My WebLink About11052 (5)Iu►�tt ttu: �tt�V CITY OF DIAMOND BAR' • ' . ' COMMUNITY DEVELOPMENT DEPARTMENT (909) E. Copley Drive 9) Suite6190 31 (909) 860-3195 Fax (909) 861-311? BUILDING PERMIT APPLICATION / — 4111' JOBSITE ADDRESS ADDRESS C�✓�/�CW vf/�/�J�n,7 APN LOT TRACT OWNER ADDRESS CITY _ L • ZIPTEL Z APPLICANT 4 _- TEL. �1 CONTRAS CT ADDRES< x!r- CITY ZIP q l_ ARCWENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM EXEMPT FROM THE CONTRACTORS U. CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE: ANYCITYOR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT, ALTER IMPROVE, DEMOUSH, OR REPAIR ANY STRUC- TURE PRIOR TO ITS ISSUANCE. ALSO REQUIRES THE APPLr" FOR SUCH PERMIT TO FRE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS L4 CENSE LAW (CHAPTER s (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS WOE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (5500).): 13k AS ONER OFTHE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE 15 NOT INTENDED OR OFFERED FOR SALE (SEC. 70/4, BUSI• NESS AND PROFESSIONS MOE: 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 THR LICH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT MENDED OR OFFERED FOR SALE IF, HOWEVER. THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONEYEAR OF COMPLE- TION. THE OWNER -BUILDER WALL HAVE THE BURDEN OF PROVING THAT HE OR SHE DO 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 (SEG 7011 BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE LAW DOES NOTAPPLY TO AN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON. AND WHOCONTRACTSFOR SUCH PROJECTS WrTHACONTRACTOR(S) LICENSED PURSUANTTO THE CONTRAC. TORS LICENSE LAW.). O IAM EXEMPT UNDER SEC. B. I RC. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER P (COMMENCING WITH SECTION 7000) OF DIVISION 3 O THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS N FULL FORCE AND EFFECT LICENSE CLASS f C A LIC. NO. DATE G CONTRACTOR r' WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING OECLARAT.d I UUU I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COUP ENSATIDN.AS PROVIDED BY SECTION 3700 OF THE LABOR COO E. FOR THE PERFORMANCE M OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. 1 HAVE AND WILL MANTAN WORKERS' COMPENSATION INSURANCE, AS REOUIRED BY SECTION 1700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH BTHISS PERMIT IS ISSUED. MYWIORKERS'COMPENSATDN INSURANCE CARRIERANOC�.J ARE: CARRIER gooCQ POLICY NUMBER (TILS SECrICN NEED NOTBE COLLETED OFTE PEFMRIS FORONE HIRLYEDDOLLAiS acro DR LESS). 1 CERTIFY THAT NTHE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER BOAS TO BECOME SUBJECT TO THE MAKERS' COMPENSATION LAWS OF CALIFORNIA, ANO AGREE THAT F 1 SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR COOE,I HALL THCOAPLYYRTH ROVISIONS. F� DATE: APPLICANT: `_\\A WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. AND SHALLBE SUBJECT AN EMPLOYER TO CRMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS (f100.000), N ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR N SECTION 3706 OF THE LABOR CODE, INTEREST. AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THATTHEIRE IS ACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT I$ ISSUED (SEG 3097, CM C.). LENDERS NAME LENDERSADDRESS 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 CONSiRUCiION.ANO HEREBYAUTHOFI2E REPRE ENTLTIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-IIENTIONEDPROPERTY FORT SPECTION RPOSES. PERMITTEE . G �t SiGNATURECFPEFrAiTFEE DATE I ■ I PRESS FIRMLY -7j APPLICATION I PERMIT P/C DATE NUMBER N ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDEISIDE STREET RW ❑ SIDE ❑ PROPOSED USE NO. DWEL NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM co Garapa/Carport W PatiolDeck LL. PQOVSpa (5 Z Re -Roof 0 Commercial Ib Valuation ADj.AREA QUANTITY DESCRIPTION - - FEE J 4 U U W J w 0 m M V : Z Q x U W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP P ENERGY P/C s ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: TOTAL FEES ' T COMMENTS — RECPT. N0. PAID BY VALIOATI U. WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD—File COPY, GREEN—Appik-Amrs CON CITY OF. DIAMOND -BAR 1 z . NSPECTION RECORD F SET BACK � _DII�A_R: fi�� l p t 0) f FLOOR JOIST. FIGS/FORMS/STEEL F HA 13EQMTS--"- ELECTRIC GROUND )UNDEPFLOOR DUCTt. GROUND PLUMBING UNDER kbbF1'0bNDLIIT SLAB GRADE FiREOabt FOUNDATION TEMP POWER -: -: -FIREPLACE BOND BEAM WATER SERVICE MID Hfj30NDBEAM ROOF SHEATHING 8 F.T. BOND BEAM FRAMINGIVENTILIATION 'FINAL. BOND BEAM .nOOFCOVER. PRE -GRADING- - 'ROUGH HEATING -BENCHI -ROUGH ELECTRIC - (-ROUGH GRADING, ROUGH PLUMBING FINISH GRADING -SHOWERITUE3 TEST'-- ----- - - ..._. I - -' -- - .::POOL ELECTRIC EXT. LATH/SIDING_'._ POOL FENCING' WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER FINAL ENG.. .SEPTIC TANK . LANbsCAPE/IRRIG.L. SEEP-PIT/L,L. ON S,TE Imps. GAS AIR TEST il FINAL ZONING FINAL- CONST. FIRE DEPT. FINAL FINAL HEATING - HEALTH DEPT. FINAL FINAL ELECTRIC 'DEV. FEES PAID Irl FINAL PLUMBING- ENERGY---,, COMMENTS VI . jlk SEPTIC TANK SIZE --- SEEP PIT/U-SIZE ..-.