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Home My WebLink About14160— CITY OF DIAMOND BAR COMMUNITY DEVELOPMENT DEPARTMENT 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION JOBSITE f �_ -- PERMIT PIC ADDRESS NUMBERS APN LOT TRACT OWNER 7- ADDRE S e CITY ? ZIP s'FEL n _c APPLICANTItf TEL. CONTRACTOR x ADDRES ti• CITY ZIP TEL i ARCFVENG/ DESIGNER ADDRESS CITY ZIP TEL. - OWNER-BCILDER DECLARATION - 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM 74 COMPACTORS LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESSAND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REOUIRES A PERMIT TO CONSTRUCT, ALTER IMPROVE. DEMOLISH. OR REPAIR ANY STRUC- TURE. 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 LI- CENSE LAW (CHAPTER i (COMMENCING WITH SECTION 7000) OF DIVISION 30F THE BUSINESSAND 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 ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO ACRAL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (3500).): C3 I, ASOWNER OFTHE 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, BUSI- NESS AND PROFESSIONS CODE. THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO'AN OWNER OF PROPERTY WIIO BUILDS OR IMPROVES THEREON, AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE. MPLE- IF, HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WITHINONE YEAR OF CO TION, THE OWNER BUILDER WILL HAVE 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. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON. AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW). O 1 AM EXEMPT UNDER SEC. B 8 P.C. FOR THIS REASON DATE OWNER . . LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISKNIS OF CHAPTER 0 (COMMENCING WITH SECTION M) OF DIVISION 3 O THE BUSINESS AND PROFESSIONS CODE. AND MY LICENSE IS N FULL FORCE AND EFFECT. ko LICENSE CLASS LIC. NO. DATE ��` ►'1/l -CONTRACTOR WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' -I COMPENSATION, AS PROVIDED BY SECTION 3700 OF THE LABOR CODE. FOR THE PERFORMANCE OFTHEWORK FOOW111CHTHIS PERMITISISSUED. , 1 HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REWIRED BY SECTION 3700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' COMPENSATION INSS(BANCE CARS AND POLIpgNUMBER ARE: CARRIER Z It r (rte L�/.✓w,.fCi1/JI ! - POUCYNUMBER__`j5 (MSSEC ION NEED NOT BE COMPLE7EDOF THE PERMIT IS RORONE 141140REDDOLLARS(1i10C)ORLESS} I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I SHALT. NOT EMPLOYANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODEE".�I SMALL EP TH COMPLY WITH THOSE PROM S. • ze DATE: L/ C APPLICANT WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (T 100.DOO). N ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3705 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMI7 IS ISSUED ISEC 3007, CIV. C.P. LENDER'S NAME LENDERSADORESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. 1 ACRE E 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-MENTIONEOPROPERTYFORINSPECTIONP PERMITTEE ME (/ SIGNATURE OF PERMITTEE DATE PRESS FIRMLY APPLICATION G PERMIT PIC DATE NUMBERS k ISSUE TYPE OCC DATE CONST.t GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET L-1 RW ❑ SIDE ❑ PROPOSED USE r E " fJ6�DWEL. O. r NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAAIALUATION SFR/ADD,'REM ' CO Garage/Carport W PatiofDeck ' LL. Pool/Spa ZRe -Raaf OJ Commercial D ca Valuatio K� ADJ.AREA QUANTITY DESCRIPTIO14 FEE _J d U � 1 W J w (.7 2 J 0. U i Z Q S U LU CONSTRUCTION�A3��1 Park PLAN REVIEW ELECTRIC PLUMBING MECHANICAL DIAMOND B INSPECTION FEE _—BUILUINCT _ ISSUANCE AND SAFETY -3Z -[ZT SMIP ENERGY PIC ENERGY PERMIT RETENTION FEE: - PRE -ALT FEE: TOTAL FEES COMMENTS + f � RECPT. NO. I PAID BY VALIDATION WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD—File Copy, GREEN --Applicant's Copy Ed CITY. OF. DIAMOND BAR INSPECTION RECORD . -_QTION SET BACK . DATE INSPECTOR ' ' INSPECTION DATE INSPECTOR FLOOR JOIST FIGS/FORMSISTEEL', FHA REQMTS t, + ELECTRIC GROUND UNDERFLOOR ;DUCT GROUND PLUMBING UNDER'FLOOR'CONDUIT SLAB GRADE FIREPLACE FOUNDATION y TEMP POWER FIREPLACE BOND BEAM : ? `''' '= '•' ' WATER SERVICE MID HT. BOND BEAM: t ROOF SHEATHING . ' /(y-)�7-� ` , '8 FT. BOND BEAM 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.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 SEPTIC TANK SIZE SEEP PIT/U SIZE ; + i