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Home My WebLink About10085 (5)CITY OF DIAMOND BAR — COMMUNITY DEVELOPMENT DEPARTMENT 21660 E. Copley Drive Suite 190 (909) 860.3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION t ADDRIESS APN LOT TRACT OWNER _-- - ADDRESS CITY 32ffA.jqjaec,4 ZIP TEL. APPLICANT TEL. CONTRACTOR ADDRESS CITY ZIP jg�!t TEL DESIGNER �-_ 04l ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LF CENSE LAW FOR THE FOLLOWING REASON (SEC. MI.$ BUSINESSAND PROFESSIONS CODE: ANY CITY OR COUNTYWHICH REOUIRESAPERMITTO CONSTRUCT,ALTER, IMPROVE, DEMOLISH, ORREPAIRANY$Me- TORE, PRIOR TO ITS ISSUANCE. ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE M LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LM CENSE LAW (CHAPTER 0 (COMMENCING WITH SECTION 70001 OF DIVISION S OF 7HE BUSINESS AND PRG FISSIONS OWE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7031.6 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (360)1.): O L AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK. AND THE STRUCTURE 16 NOT INTENDED OR OFFERED FOR SALE (SEG:. TCM, wsF NESS AND PROFESSIONS OXIDE: THE CONTRACTORS LICENSE LAA' DOES NOT APPLY TO. AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH MS OR HER OWN EMPLOYEES. PROVIDED THAT SUCH IMPROVEMENTS ARE MDT INTENDED OR OFFERED FOR SALE IF, HOWEVER THE BUILDING OR WPOVIMENT M SOLD WITHIN ONE YEAR OFOOMPL6 TONN, THE OWNER -GUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF ME), i OI. AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. TOM, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LM CENSE LAW GOES NO1TAPPLY TO AN OWNER OFA PROPERTY WHO SUNDS OR IMPROVES THEREON. AND WHOOONTRACTS FOR SUCH PROJECTS WITHACONTRACTOR(S) LICENSED PURSUANT TO THECONTRAC. TOR$ LICENSE LAW.). i. O 1 AM EXEMPT UNDER SEC. B. 3 P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION L HEREBY AFFIiM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER S (COMMENCING WITH SECTION TOW) OF DIVISION S OF THE SUSINESSAND PROFESSION$ CODE. AND MY LICENSE IS IN FULL FORCE AND EFFECT. LICENSE CLASS��N,., LIC. NO.� ?.. DATECONJTRACTOR' .0:!_:A- gy!21 ✓- WORKERS' COMPENSATION DECLARATION �Z'' �1�1 I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATION$: IIlilft _ I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO aELFdNSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION 3700 OF THE LABOR OXIDE, FOR THE PERFOFAW40E OF THE WORK FOR WHIT( THIS PERMIT IS ISSUED. _—I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE, AS REQUIRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER •Z POLICY NUMBER ! � � "SEC" NEED NOTI'BECDMWLETEDOOFTHE PERMIT FORONEFMSDRED (1100)ORLE$bT. 1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I SHALL HOT EMPLOY ANY PERSON IN ANY MANNER BOAS 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 CODE,1 FORTHWITH COMPLY WITH THOSE PROVISIONS. A DATE: --:Fl. APPLICANT: /l�'14 WARNING: SEOJURE WDRKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS (1100.000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OFTHE LABOR CODE, INTEREST AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE Ne ACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH( THIS PERMIT M ISSUED ($a. SOW, CIV. C.). LENDER'S NAME LENDER'S ADDRESS I CERTIFY THAT 1 HAVE READ THIS APPLICATI NAND STATETHAT THEABOVE INFORMATION N CORRECT. I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING 10 SUEDIND CONSTRUCTION, AND HEREBY AUTIOR12E REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE#IENTIONED PROPERTY FOR INSPECTION PURPOSES, Q PERMITTEE NAME (PRINT) M SONATURE OF PERMITTER ' DATE �, { PRESS FIRMLY APPLK:ATION' BER.e _21PERMIT P/C ,� DATE NUM ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW _ _ ❑ REAR SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE A&M10-4L, NO, DWEL. —T'NO. n NO. UNITS �! STORIES f^ r BEDROOMS _ DESCRIPTION S0. FT. FACTOR PSF AD1'AREAVALUATK)N SFR/ADD/REM to Gampe/Carport W Pat1o1Dock POIOVSPa no -Roof _Z 9 (Commercial Ysluaticn A ADJ.AREA QUANTITY DESCRIPTION FEE W P117L-a �E.VIEF ELECTRIC PLUMBING MECHANICAL INSPECTION FEE F Z C) -or-P71),r O ERGY P/C ENERGY PERMIT RETENTION FEE: PRE -ALT FEE:_ TOTAL FEES �C7C� p 5 COMMENTS RECPT. NO C/ PAID BY VALIDA WHITE—Department Copy. YELLOW—Finance Copy, PINK—Asss$sor Copy. GOLDENROD—File COPY, GREEN—Applicant's COW "r OIF 'r DIAMOND BAR,l CITY r ' INSPECTION . RECORD,` SET BACK .: _.. FLOOR JOIST - FTGS/FOAMS/STEEL FHA REQMTS ELECTRIC GROUND UNDER FLOOR DUCT, GROUND PLUMBING . UNDERFLOOR CONDUIT ' `,'.. SLAB GRADE T , _ FI E .. , CE F0UN'bAT16N -TEMP POWER -._. _ __ FIdEPLACE BOND BEAM' WATER ..SERVICE- MII) HT. OND BEAM ROOF SHEATHING g NRPEAM FRAMINGNENTiI IATION Y�"P ... ` _ , FINAL BOND BEAM ROOF COVER . _ _ _. ..... .. :. PRE -GRADING._ ROUGH HEATING .. _ _EEVCHING 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 /y DEDICATIONS SEWER _ - _. .. FINAL ENG. ;. SEPTIC TANK:-,:. _–�---___ I _.:: ;` �" '"_: LANDSCAPEARRIG. " SEEP PIT/L.L. f . ON SITE IMPS. – GAS AIR TEST _.. .... r FINAL ZONING FINAL CONST. ! ys z FIRE DEPT FINAL _ FINAL HEATING HEALTH DEPT: FINAL:,:, FINAL ELECTRIC FINAL PLUMBING f _ DEV.•FEES PAID ENERGY - COMMENTS .- —Yi\F:Ote 'k