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Home My WebLink About15165 (27)t CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES ?mac 21660 E. Copley Drive Suite 190 PRESS (909) 860-3195 Fax (909) B DING PERMIITg61-3117 APPLICATION FIRMLY DDREE ASS q 5�.Iy N, A& E SV O(. ADDRE APN LT TRACT OWNER CITY 121 ZIP + TEL (O I f APPLICANT fJ TEL. CONTRACTOR ADDRFSS S. CITY tjarAe.QL2 ZIP C4bZ(TEL._ ID M ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL OWNER -BUILDER DECLARATION [HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEG 7031.5 SUSINESSAND PROFESSIONS CODE: ANY GTYOR COUNTY WHICH RECUIRESA PERMITTO CONSTRUCT. ALTER IMPROVE, DEMOLISH. OR REPAIR ANY STRUC- TURE PRIOR TO ITS ISSUANCE, ALSO REWIRES THE APPIICANT 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 P (COMMENCING WITH SECTION 7000) OF DIVISION 7 OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7031.5 BY ANYAPPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS US= 1: . O LAS 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. 70". BUSI- NESS AND PROFESSIONS WOE: 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 T/RO(JGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT MENDED OR OFFERED FOR SALE IF, HOWEVER THE BUILDING OR IMPROVEMENT 15 SOLD WITHIN ONE YEAR OF COMPLE- TION. THE OWNER -BUILDER WALL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FORTHE PURPOSE OF SALEL O L AS OWNEROFTHE PROPERTYAM EXCLUSNELYCONTRACTNO WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 70x1. BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS U. CENSE LAW DOES NOT APPLY TO AN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S) LICENSED PURSUANT TOTHE CONTRAC- TORS LICENSE LAW} 0I AM EXEMPT TINDER SEG B L P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION 1 HEREBYAFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 0 (COMMENCING WITH SECTION 70001 OF DMSION 7 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS N FULL LFAFORCE AND EEFFF�ECT. LICENSE CUSS P. LIC. NO. DATE CON" RACTOR a_L0_LL:& Imo_ . I I WORKERS' COMPENSATION DECLARATION I I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATION S. I _I HAVE ANO WM.LLMAINTANACERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION. AS PROVIDED BY SECTION 3700 OF THE LABOR CODE Fon THE PERFORMANCE OFTHE WORK FOR WHICHTHIS PERMIT IS ISSUED. 1 _I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE- AS REOUIREO BY SECTION - 37000F THE LABOR COLE FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS I LSSUED. MYRKF S' PFNSATION I URAICE,1RIER AND POLICY NUMBER ME: CARRIER OT 1 POLICY NUMBER _ (TMSECDON NEED NOT BE CoMU7EDOF THE PERMIT IS FOR ONE HJFOFIED DIXJADM CSIM OR LEM I 1 CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 5 ISSUCD,1 1 SHALL NOT EMPLOY ANY PERSON N ANY MANNER SO AS TO BECOME SUBJECT TO THE j WORKERS'COMPENSATKN LAWS OF CALIFORNIA. AND AGREE THAT IF I SHOIAD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 37DO CF THE LABOR CODE, I SHALL FORTHWITH COMPLYWLTH THOSE PROVISIONS c.�ia�Cona c � DATE: APPLICANT: iWARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. AND SHALLBE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS IV 00.000). N ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN J SECTION 3708OF THE LABOR CODE, NTERESLANDATTORNEYS FEES. CONSTRUCTION LENDING AGENCY THEREBY UNDER PENALTY OFPERJURYTHATTHERE IS ACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEG SOW, CIV. C.). 7 LENDERS NAME LENDERSADDRESS VI CERTIFYTIWT I HAVE READ THIS APPLICATION AND STATE THATTHE ABOVE INFORMATION IS CORRECT. L I AGREE TO COMPLY WITH ALL CRNO Y AND COUNTY ORDINANCES ASTATE LAWS RELATING TO BUILDING CONSTRUCTION. AND HEREBY AUTHORIZE REPRESENTATIVE S OF THIS COUNTY TO ENTER UPON THE F.NTIONF.D PROPERTY FOR INSPECTION PURPOSES. PERMITTEEN E 0NT) n F3 SK: TUREOFPERMITTEE DATE / i APPLICATION �� / P/C DATENUMBEPERMITR ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT" RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE NO. DWEL NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION SFR/ADDIREM Cin Garaga/Carport WPatioMeck LL PooUSpa Z Re -Root 0 Commercial _ DO Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J Q - U cc H LU W LU LU C7 lu- Z cc L J a Z 2 U W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE UO �— SMIP ENERGY P/C ENERGY PERMIT A� RETENTION FEE: PRE -ALT FEE: TOTAL FEES �� G COMMENTS RECPT NO. _ PAID BY VALIDATION WHITE—DeDartment Cop'/. YELLOW—Finance L;Opy, FINK—ASSesSGT L;Opy, uUw NMULu 110 -Py, a %_v7 ---. . - CITY OF DIAMOND BAR INSPECTION RECORD IN SETBACK + _ D�. "-! INSPECTION �,'INSPECTOR FLOOR FTGS/FORMS/STEEL ; - �: ; ,-, FHA REQMTS'- ELECTRIC GROUND UNDER FLOOR DUCT , i - GROUND PLUMBING UNDER FLOOR CONDUIT:.`.' •,': + SLAB GRADE - FIREPaCE FOUNDATION TEMP POWER FIREPLACEBONb'BEAM WATER SERVICE MID HT. BOND BEAM ROOF SHEATHING 8 FT BOND BEAM •, ' ; . • ; FRAMING/VENTILIATION FINAL BOND BEAM ROOF COVER.: PRE -GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING FINISH GRADING 'SHOWER/TUB TEST, POOL ELECTRIC EXT. LATH/SIDING POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS . SEWER FINAL ENG. -SEPTIC TANK LANDS CAPE/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 -Z. ='ZZ-. i ! ENERGY COMMENTS SEPTIC TANK SIZE SEEP PIT/U SIZE • ,