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Home My WebLink About10071CITY OF DIAMOND BAR 1 COMMUNITY DEVELOPMENT DEPARTMENT 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 861.3117 BUILDING PERMIT APPLICATION I ADDRESS A ADDRESS APN OT TRACT OWWe NER ADDU CITY ZIP TEL. APPLICANT EL CONTRACTOR ADDRESS CITY 29W371 TE . ARCH/ENG/ DESIGNER ADDRESS CITY OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LH CENSE LAW FOR THE FOLLOWING REASON (SEG 7031.6 BUSINESS AND PROFESSIONS CODE: ANYCRY OR CONTYWHKN REQUIRES A PEF MIT M CONSTRUCT.ALTEP, BMPROVE, DEMOUSKOR REPNRANTSTRUC TURF- PRIOR TO ITS ISSUANCE. ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS UCENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW (CHAPTER 0 (COMMENCING WITH SECTION 7000) OF DIVISION S OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE IMSIS FOR THEALLEGEA EXEMP- TION. ANY VIOLATION OF SECTION 7051.6 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS IBM).): O L AS 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 FON &ALE (SEG 7044, BUSI- NESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON, AND M40 DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES. PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FORSALE F, HOWEVER.THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAROF ODMPLE- TI N, THE OWNER.BUILDER WALL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUND OR IMPROVE FOR THE PURPOSE OF SALE} O t AS OWNER OF THE PROPERTV,AM EXCLUSNELYCONTRACTNG WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044. BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS U. CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BURDS OR IMPROVES THEREON. NO WHO CONTRACTS FOR SUCH PROJECTS WTTHA CONTRACTOR(S) LICENSED PURSUANT TO THE OO1VTRA1 TORS LICENSE LAW.). O 1 AIA EXEMPT UNDER SEC. B. B P.G FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER - I (COMMENCING WITH SECTION TOM)OF DIVISION S OF THE BUSINESS AND PROFESSIONS COOE.AND MY LICENSE IS N FALL FORCE AND EFFECT. LICENSE CLASS > LIC. NO. 3 C' DATE I1• n - I fl--, I CONTRACTOW__7= < WORKERS' COMPENSATION DECLARATION HEREBY AFFIRM TINDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATION& 1 HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORI(ER5 COMPENSATION, AS PROVIDED BY SECTION 37000F THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WALL MAINTAIN WORKERS COMPENSATION INSURANCE, AS REQUIRED BY SECTION 3700 OF THE LABOR CODE. FORTHE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED -SKY WORKERS COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE CARRIER POLICY NUMBER (DRS SECTEN IE® NOT BE COMPLETED OF THE PERMIT 6 RJRow REDDLTJARSPIRORLEM 1 CERTIFY THAT LATHE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I SHALL NOT EMPLOY ANY PERSON N ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT F 1 SHOULD BECOME SUBJECT TO THE WORKERS COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR COComI SHALL FORT COMPLY WITH THOSE PROVISIONS. DATE: �"42;f APPLICANT. WARNING: FAILURE TO SECURE WORKERS COMPENSATIOI(X>wERAGEIS UNLA AN06NALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (11100.000). N ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR N SECTION 3700 OF THE LABOR CODE. INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SECM 30R. CN. C.). LENDERS NAME LENDERS ADDRESS 1 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION M CORRECT. I AGREE TO COMPLY WITH ALL CRY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING ' CONSTRUCTION. AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER RIPON THE _ ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. PERMITTEE NAME PRVIT) OF pEE • DAT �ITURE \!� \-'•'fit.^. T: °\ri ^. �.=Ml _ �. 1 PRESS FIRMLY APPLICATION I PERMIT P/C q� g— \O DATE NUMBER 9 ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDEISIDE STREET RW ' ❑ SIDE ❑ ROPOSED USECA 1571, 4f Apo. NO. DWEL \' NO.' NO. 2___ UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION GBrBOBICarDOlt �`- 1 ) A • L �• i W PBtWD*& LL POOYSps ZRFRoof Commerdel m VolQBtlo- ADJ.AREA QUANTITY DESCRIPTION FEE pvrc6TS U � Gy.Fars _ W W U_ QZ U CONSTRUCTION PLAN REVIEW L ELECTRIC PLUMBING MECHANICAL INSPECT)ON FEE ISSUANCE 7 SMIP 7i • ��% ENERGY P/C B ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: TOTAL FEES au l f COMMENTS .RECPT. NO. ° AID By VALIDATION WHITE—OIpBRmnnt Copy. YELLOW—Fimnos Copy. PINK—Anon& Copy. GOLDENROD—FIM Copy. GREEN--"ImnCB Copy a P? CITY OF DIAMOND I3AR'-'-`1 INSPECTION RECO_ :Icy 01, SETBACK OIST-------- _FLQOR JOIST------- — – -- - -- - ----- -- -a FTGS/FORtAS/STEEL FTGS/FORtASISTEEL GROUND UNDER FLOOR-DUCTELECTRIC GROUND PLUN113ING UNDEFJ.FLOOR CONDUIT SLAB GRADE------ i FIREP CE'FO'NDATION. -TEMP POWER:---- FIIIJEPLAd BbIND131FAM', E� WATER SERVICE"" ROOF -SHEATHING--- NT: BON 8 FjT. bdNb BEAM FRAMINGNIENTILIATION �FNAt BOND BEAM ROOF COVER -PRE-GRADING' ROUGH HEATING ROUGH ELECTRIC 7 -7-ROUGH GRADING... ROUGH PLUMBING FINISH GRADING_ SHOWER/TUS TEST; _EXT. LATH/SIDING WALL INSULATION I IL 7� j -POOL ELECTRIC -POOL F ejobllFl NALt-,- ' CEILING INsuLATibNOFF SITE IM PS DRYWALL NAILING i $5X/ z /7,2 DEDICATIONS -•.:. SEWER FINAL ENG.. SEPTIC TA IN K LANDSCAPE/IRRIG. - SEEP PIT/L.L._'___ ONSITE Imps. GAS AIR TEST -.,-FINAL ZONING FINAL CONST; FINAL -HEATING TIRE DEPT. FINAL HEALTH-DEPT'FINAL1_:-------7 FINAL ELECTRI.0 FINAL PLUMBING- 'ENE:RGY 1 14 COMMENTS -1,; y 1, ; T.. ,SEPTIC -TANK-SIZE--- SEEP PIT/U SIZE r 1 A .7 - --------- r Tk