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Home My WebLink About12157 (6)W L:3 -i. . t J� CITY OF DIAMOND BAR ' DEPARTMENT OF COMMUNITY & DEVELOPM NT SERVICES 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 *' BUILDING PERMIT APPLICATION JOBSITE Z �) 5 ADDRESS V ✓ APN LOT TR CT OWNER ADDRESS Se CITY Ia rZIP TEL APPLICANT TEL. CONTRACTOR ADDRESS 1 CITY ZIP TEL. W f-S'fF "4 FV ARCENG/ DESIGNER ADDRESS CITY ZIP TEL OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AAI EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FORTHE FOLLOWING REASON (SEC.7051.5 BUSNESSAND PROFESSIONS CODE: ANY CITY OR COUNTY WMCH REOLURES APERMITTO CONSTiWCLALTER SAPROVE. DEMOLISH. CR REPAIRANYSTRUC- TUURE. 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 LAW (CHAPTER s (COMMENCING WITH SECTION 7000) OF DIVISIONS OF THE BUSINESS AND PRO- FESSIONSOODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THEALLEGEDEXEMP- TOOM. ANY VIOLATION OF SECTION 70]1.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FrVE HUNDRED DOLLARS ISSM).): O L ASOWNER OF THE PROPERTKOR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044. BUSI- NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS On IMPROVES THEREON. AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH MS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFEREDFOR SALE IF,HOWEVER THE BUILDING OR IMPROVEMENT G SOLD WITHIN ONE YEAROF COMPLE- TION, THE OWNERIBUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE) O L AS OWNER OFTHE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 70M. BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS L4HD CENSE LAW DOES NOTAPPLYTOAN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON, A WHO CONTRACTS FOR SUCH PROJECTS WITHACOHTRACTOIIS) LICENSED PURSUANT TO THE OONTRAC- TORS LICENSE LAW} O 1 AM EXEMPT UNDER SEC S. A P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERAJRY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER s (COMMENCNO WITH SECTION 7000) OF DIVISION S OF THE BUSINESS AND PROFESSIONS CODE, AND W LICENSE IS N FULL FORCE AND EFFECT. LICENSE CLASS LIC. NO. ldo 9�A10/ DATE O �D CONTRACTOR�/s SSS WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: _I HAVE AND WILLMASJTNN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS• OM CPENSATION, AS PROVIDED BY SECTION 57M OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHI HTHIS PERMIT 15ISSUED. MI D I HAVE AND WILL MAINTAIN WORKERS COMPENSATION INSURANCE, AS REO IRED BY SECTION 5700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER ... .. . POLICY NUMBER (DIS SECT)]N HERD NOT BE am-LETEDOFhF PEPIWT IS FO1 CNE la_MIED COLLARS 8100) OR LESS) Z (CERTIFY THAT LATHE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 6ISSUED. 1 SHALL NOT EMPLOY ANY PERSON N ANY MANNER SO AS TO BECOME SUBJECT TO THE N WORKERS'COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS COMPENSATION PROVISIONS OF SECTION 5700 OF THE LABOR CODE,(SHALL ORTHWRH COLIPLYWITH THOSE PR SIONS. I DATE: APPLICANT: - WARNING: FAA E TO SECURE WORKERS' COMPENSATION CEI U WFUL. AND SHALLBE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS ()100,000), N ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN 1 SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. I CONSTRUCTION LENDING AGENCY i FOR THE ERFO UNDER PENALTY OFPERNRYTHAT THERE IS A CONSTRUCTION LENDING AGENCY C,). FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. SOFT, CIV C.). I LENDERS NAME LENDERSADORESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. 1 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-MENTIONED PROPERTY FOR INSPECTION PURPOSES. ' R f�111 PERMITTEE NAME SIGNATURE EE DATE PRESS FIRMLY APPLICATION PERMIT Z P/C O _.30D DATE NUMBE N O ISSUE TYPE OCC ' ZS DATE CONST. GROUP ZONING SETBACKS EXPREDRw FRONT ❑ REAR ❑ SIDE/SIDE STREET RW O SIDE V U ❑ PROPOSED USE NO. DWEL NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREANALUATION SFRIADDIREM (n Garaga/Calport LU Patio/Dock-- (L^ PoOvspa ZPwRGo( Commercial - 5 m Valuation ' ADJ.AREA QUANTITY DESCRIPTION FEE cc G / {. Uj W J W 0 m J a Z Q 2 W CONSTRUCTION `" F PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY PIC ENERGY PERMIT RETENTION FEE: 4 PRE -ALT FEE: TOTAL FEES F COMMENTS Lam% RECPT. NO. PAID BY CA- VALIDATION WHITE—DepaRment Copy, YELLOW—+ -mance L:Opy. FINK—ASS6350f WPF, U Uwtlrnvv—rRe wpy, Unetlr—nppllCan7 s L-opy .�F DIAMOND, BAR_ ; INSPECTION RECORD . INSPIr S.FT'BACK',' 'INSPECTOR INSPECTION FLOOfl JOIST , . DATE INSPECTOR , FTGS/FORMS/STEEL :. -, 5 1 -, , FHA REOMTS ELECTRIC GROUND - _. "' GROUND PLUMBING _- ti UNDER FLOOR DUGT,; UNDER FLOOR COIy _ . ;• UIT% .: •; •t =, .. - ':�: S.4 I SLAB GRADE--- FIREPLACE FOUNDATION `+;;` ; . ^.;. r. ,� ` '• ."; TEMP POWER I , - FIREPLACE BOND BEAM - WATER'S ERVICE -- - •- --- -�-r-- � --- �-- - - -MID HL BOND BEAM ROOF SHEATHING' I' . `r i FRAMINGNENTILIATION ' ' 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 - _._ _. LANDSCAPE/IRRIG. SEEP PIT/L.L. = - ,': ' , . _ ON SITE IMPS. GAS AIR TEST - - - - - FINAL ZONING FINAL CONST.: - - FIRE DEPT. FINAL t FINAL HEATING .. - HEALTH DEPT. FINAL FINAL ELECTRIC DEV, FEES PAID -- ----- FINAL PLUMBING ENERGY COMMENTS- i. _..\; •I yew \` ... .... ...... SEPTIC TANK SIZE SEEP PIT/U SIZE Vit,