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Home My WebLink About8979CITY OF DIAMOND BAR COMMUNITY DEVELOPMENT 68PUTNitk 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 RI TILDING PERMIT APPLICATION JOBSITE ADDRES"' APNO IRA OWNER S !�P ADDRESS CITY ZI1�,�� TE APPLICANT TEL. A, CONTRACTOR ADDRESS CITY ZIPS TEL. !a ARCH/ENG/ DESIGNER ADORESS CITY ZIP TEL. OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS U. CENSE LAW FORTHE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE: ANY CrtYOR COUNTY WHICH REOUIRESA PERMITTO CONSTRUCT, ALTER. -IMPROVE, DEMOLISH, OR REPAIRANYSTRUC- TURE, PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO RLE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW (CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISiON'3 OF'T14E,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 BYANYAPPLICANT FOR A� PERMIT SUBJECTS TOE APPLICA ITTO A CIVIL PENALTY OFNOT MORE THAN FIVE HUNDRED DOLLARS (ESDD).): ❑ I, AS OWNER OF THE PROPERTY, OR MV EMPLOYEES WITH WAGESAS 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'OP PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO DOES SUCH WORK HIMSELF OR 11 RSELF'OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTSARE NOT IK ENDED OR OFFEREDFORSALE IF, HOWEVER. THE BUILDING OR IMPROVEMENTIS SOLD WITHIN ONE YEAR FCOMPLE TION, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR BHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SAE). " U LAS 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 TOAN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES TFIEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTORS) LICENSED PURSUANTTOTHE CONITRAC- TORS LICENSE LAW). ❑ 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 PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT- LICENSE�CL-A6SS LIC. NO, ` DATE J !�' CONTRACTOJ TTTT WORKERS'COMPENSATIONDECLARATION/�Or I HEREBYAFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: VIC ,I HAVEAND WILL MAINTAIN A CERTIFICATE OF CONSENT TO'SELF-INSUnE FOR WORKERS' -, COMPENSATION, AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY SECTION 3700 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 (fH1S SECTION NEED NOT BE 07MPLErED OFTHE PERMIT IS FORONE HlN. DRED OOL ARS (SIOD)OR LESS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, 1 SHALL NOT EMPLOYANY PERSON IN ANY MANNER SOAS TO BECOME SUBJECTTOTHE WORKERS' COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT!F I SHOULD BECOME SUE.IECT TO THE WORKERS' COMPENSATION PROVIS SOF SEC TION 3700 OF THE LABOR ;WITH COMPLYWIDATE:APPLICANT. WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SI4ALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (SI 00.000), IN ADDITION TO THE COST OF COMPENSATION; DAMAGES AS PROVIDED FOR IN SECTION 37D3 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FORTHE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3087, CIV. C.). LENDER'S NAME _-_ LENDER'SADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THATTHE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWSRELATINGTO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. PE E IF SKIN70FIE ITTEE DATE � WHITE—Department Copy, YELLOW—Finance Copy. PINK -Assessor Copy, GOLDENROD—File Copy, GREEN—Applicant's Copy 1 PRESS FIRMLY APPLICATION S 1 PERMIT P/C DATE / UMBER # 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 SQ. FT. FACTOR PSF ADJ. AREA(VALUATION SFWADD/REM U) Garage/Carport WPatio/Deck LL Pool/Spa ZRe -Roof CJ Commercial Z) Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J d TJ C9 W W Ca d Z Z -10 J 0- z Z d Z w CONSTRUCTION PLAN REVIEW ELECTRIC MECHANICAL INSPECTION FEE A ISSUANCE t. SMTP 9 Q ) ENERGY PIC ENERGY PERMIT RETENTION FEE' Cl I'°1_0 F ilI WI/'.ANI. C?:42 PRE -ALT FEE. Pl j tl'..1 &AtD SAFETY TOTAL FEES COMMENTS AIT RECPT. NO. PAID BY r VAL.IATINr f CITY OF DIAMOND BAR INSPECTION REC,ORP, SET BACK FLOOR JOIST FT-GS/FORMS'/STEEL FHA REOMTS -77 — . ELECTRIC GROUND UNDER FLOOR 66CT GROUND PLUMBING _ _ - UNDER, FLOOR CCit 601T a SLAB GRADE _-_ _., FIREPLACE FOUNDATION .: TEMP POWER FIREPLACE BOND BEAM +JATR'SERVIOE..- `_ _ ;MID HT. ® SEAM ; ROOF SHEATHING - 8 FT. POND BEAM FRAMINGNENTILIATION FINAL BOND BEAM ROOF COVER : RRE-GRADING ROUGH HEATING = BENCHING ROUGH ELECTRIC .<.. . _.. __._ _ _ - ROUGH GRADING ., ROUGH PLUMBING- _ :. __, .: FINISH L,RADING SHOWER/TUB TEST _:, POOL ELECTRIC — EXT LATH/SIDING POOL FENCING. WALL INSULATION POOL FINAL;- CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEINER _ . -_. i._.... _..' _ FINAL ENG. , SEPTIC TANK s LANDSCAPEIIRRIG. ON SITE IMPS. GAS AIR TEST _ .. __.. _.. _ FINAL ZONING - FINAL CONST.r FIRE DEPT. FINAL - FINAL HEATING HEALTH DEPT. FINAL FINA Ei`_ECTRIC FINAL LUMSING _ .�--„- k � DEV. FEES PAID ENERGY V W F a COMMENTS Z. � � z 4 SEPTIC TANK SIZE -- _.... .__ _... _ s�EFy €SIT/U SozE .: ..A- N:: y (