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Home My WebLink About13390 (17)CITY OF DIAMOND BAR DEPARTMENT OF COMMUN WOPM NTS RVICES 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 PRESS ^^ BUILDING PERMIT APPLICATION FIRMLY JOBSiTE ADDRESSN37/t` TA )CNA Wlfz:i'•. APN LOT TRACT OWNER Z_ 05f -- ADDRESS fADDRESS SGi,»t_Q CO CITY ZIP TEL APPLICANT Y TEL CONTRACT o Durr' TD -o:, e (n/Ci. ADDRESS (3 � L'o k D/L CfiYl ZIP TEL ARC NG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FORTHE FOLLOWING REASON (SEC. 7011.5 BUSINESSAND PROFESSIONS CODE:ANY CRY OR COUNTYYIHW REOURESA PERMRTOCONSTRUCT.ALTER. IMPROVE. DEMOLISH. OR REPA:RANYSTRUC• TURF, PRIOR TO ITS ISSUANCE. ALSO REWIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISK)NS OF THE CONTRACTORS Ll - CENSE LAW (CHAPTER 0 (COMMENCING WITH SECTION 7000) OF DIVISION S OF THE BUSINESS AND PRO- FESSIONSCODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7031.5 By APPLICANTANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICA NTTO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (55004 OL ASOYMER OF THE PROPERTY -OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE YORK, 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 WHO BUILDS OR IMPROVES THEREON. AND VA40 DOES SUCH WORK HIMSELF ORHERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFEIRED FOR SALE IF. HOWEVER THE BUILDING OR IMPROVEMENT IS SOLO WTTNNONEYFJJLOF COMPLE. TION, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE On SHE DO NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). O 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 NOTAPPLY TOAN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHOCONTRACTSFOR SUCH PROJECTS WTTHACONTRACTORISILICENSED PURSUANTTOTHE CONTRAO- TORS LICENSE LAW). O IAM EXEMPT UNDER SEC. B. S P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER S (COMMENCING WITH SECTION 7000) OF DIVISION 1 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS N FILL FORCE AND EFFECT. Q Q LICENSECLASS LIC -NM / / 2— DATE 44 . . WORKERS' COMPENSATION DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOYANG DECLARATIONS: VI HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS, ComPENSATKON. AS PROVIDED BY SECTION J7000F THE LABOR CODE. FOR THE PERFORMANCE OFTHE WORK FORWHICH THIS PERMIT IS ISSUED. _I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REWIRED BY SECTION 1700OFTHE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER POLICYNUMBER / %! miswCIICHNEEDND'TBE `CLN.SiETMOFTFE AWEFOAM!E 11L%OMIAi5a100)ORLM% 1 CERTFY THAT INTHE PERFORMANCE OF THE WORK FORYMICH 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 IF I SHOULD BECOME SUBJECT TO THE WORKERS COMPENSATION PROISKONS OF SECTION 17700E THE LABOR CODE.1 FORTFMOTH COMPLY VM THOSE PROVISIONS. PATE: APPLICANT: ��Y .YL//-L'y�•• WARNINQF HIRE TD SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL -AND SHALL BE SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (5100.000). N ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 1700 OF THE LIBOR 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 15 ISSUED (SEC. 3097. CIV. C.). LENDER'S NAME LENDERS ADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL CIT' AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION. AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS CCUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. i ^ i PERM E N (PPINT) E I -V7 ZZ SIGNAT E I GATE APPLICATION PERMIT 2 P/C I33- DATE NUMBER k ISSUE TYPE OCC DATE CONST. GROUP ZONING EXPIRED ROCKS RW ❑ REAR ❑ SIDE/SIDE STRE RW ❑ SIDE ❑ PROPOSED USE WAVfr )-p OW6 W A LyIA COH a 1 NO. DWEL NO. NO. Z UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREANALUATION SFRNADD/REM co Garapa/Carport Patlo/Dack LLLI LL POOVSpa 0 Z Re -Roof Commercial t0 Valuation ADJ.AREA QUANTITY bESCRIPTION FEE J Q U cc 1— U W J W CD Z W J a U 2 Q S W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE �• ISSUANCE y Inn SMIP-t ENERGY P/C •�%l` �'� ENERGY PERMIT,�� ~ RETENTION FEE:�'� PRE -ALT FEE: ^� . TOTAL FEES COMMENTS RECPT. NO. PAID BY VALIDATIO WHITE—Oepsrtment Copy, YELLOW --Finance Copy. PINK—Assessor Copy, GOLDENROD --File Copy, GREEN ---Applicant's Copy C-'� OIT�N OND,BRR =� _ tNSPEE IOV' RECORD . `11►��1+']:a�'I=1►�I.._['= 1►`ti'i_'E1:) I►'�'ia, 9l�Ji�I' ;ry:�j f►`�-y�c�� I � SET BACK FLOOR JOIST ..,� ,,,......_; .... ......»_ f.,......,..r....,......., -i __._ F TGS'FORMS.'STEEL ' FH.A REQMTS ... . . _ ELECTRIC GROUND : - UNDER FLOOR DUCT - _ GROUND PLUMBING UNDER FLOOR CONDUIT: .SLAB GRADE FIREPLACE FOUNDATION T_EI:'P POWER i•"t it i; ;', 1f FIREPLACE BOND BEAM ,JAT ER SERVICEMID `MOOF SHEATHING rj - � ��( —. Ffi,11IdG,�IENTIL•IATiON I. - �1C — HT. BOND BEAM t '' _ � I a FT. BOND BEAM FINAL BOND'BEAM' _ . V • ;PROOF COVER , PRE -GRADING - ROUG4 HEATING BENCHING ROUGH ELECTRIC_ ROUGH GRADING - - - -- ROUGH PLUMBING - -- - - . FINISH GRADING S!�;OWERITUBTEST. - ----- POOL ELECTRIC - EXT. U%TH/SIDING - - POOL FENCING ALL INSULATION POOL FINAL -IN CEILING INSULATION OFF SITE IMPS. DRYVVAL.L-NAILING DEDICATIONS (:SEWER FINAL ENG. I SEPTIC TANK �� LANDSCAPE/IRRIG. EEP.P;T/L.L. ON SITE IMPS. � GF.S AIR TEST FINAL ZONING %i,•:AL CONST. FIRE DEPT. FINAL r • �, i r i HEATING I 1 HEALTH DEPT. FINAL ---f i ELECTRIC ;1„`JI— i.fLPLU',181NG - �_ - I- DEV. FEES PAID — ENERGY - _ .767 i- -SEPTIC TANK SIZE :EP PIT/U SIZE I i' --