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Home My WebLink About16867An 0 O 0 w O 0 0 Yn Cr O Q� Z N O W O LL_ d Ll: FC-- d V; Cr C Z d SCEJJ,, Q C Z a C Z C U t L LL LL C n a O s a O F CITY OF DIAMOND BAR EXPIRED DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 JUN 119.77,.' PRESS BUHMING PERMIT APPLICATION _ _ FIRMLY JOBSITE ADDRESS S APN LOT TRACT OWNERb h C�QC�TCf ADDRESS CIN L ZIP M& TEL. APPLICANT 10TEL.% 1 CONTRACTOR ADDRESS CITY IP 01 14b b TEL 1--b FWtO ARCKENG/ 4 100 DESIGNF.Li ADDRESS CITY ZIP TEL OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS U. CENSE UW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESSANO PROFESSIONS CODE: ANY OTYOR COIMTY WHICH REWIRESA PERMrT TO CONSTRUCT,ALTER IMPROVE. DEMOUSH.OR REPAIR ANY STRUC• TORE. PRIOR TO ITS ISSUANCE. ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE 15 LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS U• CENSE UW (CHAPTER 0 (COMMENO WNG WITH SECTION 70DO) OF DIVISION S OF THE BUSINESS AND PRO- FESSIONS OE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7031.5 BYANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CMLPENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (SSwH: D L AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WOW, AND THE STRUCTURE 15 NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, BUSI• NESS AND PROFESSIONS COOS 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 THROUGH HIS OR HER OWN EMPLOYEES. PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FORSALE.6, HOWEVERTHE BUILDING OR IMPROVEMENT IS SOD WITHIN ONE YEAR OFCOMPLE. TION. THE OWNER4" DER WALL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FORTHE PURPOSE OF SALE). O L AS OWNER OF THE PROPERTY, AM EXCLUSIVELYCONTRACTNG WITH UCENSEO CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044. BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE LAW DOES NOTAPPLY TO AN OWNER OF A PROPERTY WHO BULDS OR IMPROVES THEREON. AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S) LICENSED PURSUANT70THE CONTRAO TONS LICENSE LAW.), 01 AM EXEMPT UNDER SEG B. a 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 S (COMMENCING WITH SECTION 700))OF DIVISION S OF THE BUSINESS AND PROFESSIONS CODE. AND W LICENSE IS IN FULL FORCE AND EFFECT. LICENSE CUSS It+ LIQ. NO. 16$0112 - DATE 'I - �' CONTRACTOR WORKERS' COMPENSATION DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: �I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PRDVIDED 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 COMP ENSATI�Q�N�INS CE RIER AND POLICY NUMBER ARE: CARRIER I rArt5 F�lt hQ POLICYNUMBER W C� 7-01 t• (TINS SECTION NEED NOT 13E COMPLETED, OF THE POW S FOR ONE HUNDRED DOLANRS (S100)OR LESSI I CERTIFY THAT N THE PERFORMMCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON N ANYMANNER AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNI AGR EE THAT IFI SHOULD BECOME SUBJECT TO THE WORKERT COMPENSATION P Y INS OF SECTION 3700 of THE LABOR COOE,ISHALL FORTHWITH COMPLY WITH TH RONSI DATE: 7 -24-a 1 APPLICANT: WARNING: FAILURETO SECURE WORKERS' CDMPENSA ON COVERAGE IS UNLAWFUL ANO SHALLBE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FNES UP 70ONE HUNDRED THOUSAND DOLLARS (510.0001. INADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY 1 HEREBY AFFIRM UNDER PENALTYOF PERJURY THAT THERE IS A CONSTRUCTKN LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED ISEC. 3W7. OV. C). LENDER'S NAME LENDERS ADDRESS 1CERTIFY THAT 1 HAVE READ THISN APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. 1 AGREE TO COMPLY WITH ALL CIN 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. � l( PERMITTEE (PR I SIONATU _OF E TILE DAT APPLICATION PERMIT P/C DATE NUMBER 9 ISSUE YPE OCC DATE U CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE l 'eil I NO. DWEL. 1. t� NO. NO. UNITS .5 r ✓ STORIES ' BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION SFR/ADDIREM Garape/Carpon WPatio/Dock LL PDOI/Spa 0 Z Re -Roof Commercial - m ValUelkm ADJ.AREA QUANTITY DESCRIPTION FEE Q U tY H- W J W (7 Z EE J CL a Z Q 2 U W o�fN CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL --� �^ 1 INSTYPERMIT 1SSn / SHIF L EN ENf RETENj�}J�EE—� _— PRE -ALT FEE: TOTAL FEES COMMENTS RECPT. NO. !CPAID BY VALIDATION WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD --File Copy, GREEN—Applicant's Cc" I - CITY OF DIAMOND BAR -INSPECTION•RECORD SET BACK -, i �•- ,i ' INSPECTION DATE INSPECT -OR FLOOR JOIST FTGS/FORMS/STEEL F FHA REQMTS ! ELECTRIC GROUND i UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR CONDUIT SLAB GRADE FIR EPLACE:FOUNDATION TEMP POWER - FIREPLACE BOND BEAM _ WATER SERVICE - MID HT. BOND BEAM ROOr-SHEATHING 7,31-u1 ' S 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 PIT/L.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 COtJiMENTS7-21-off 2"� nkkc S1t-f- uol R� t SEPTIC TANK SIZE SEEP PIT/U SIZE .J