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Home My WebLink About14282 (20)G a C CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 1= 21660 & Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 PRESS �^ BUILDING PERMIT APPLICATION FIRMLY JOBSITE ZIUZjb ADDRESS ISSUE TYPE OCC APN LOT T T .Z OWNE fL ADDRESS C ZI TEL. APPLICANT TEL. CONTRACTOR ADDRESS CITY ZIP TEL ARCH/ENG1 DESIGNER �t_J ADDRESS CITY ZIP TE . ' OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LH CENSE LAW FOR THE FOLLOWING REASON (SEG 70.71.3 BUSINESSAND PROFESSIONS CODE: ANYCrTYOR COUNTY V"CH REOUIRESAPERMIT TOCONSTRUCT-ALTER MPROVE DEWXJSH OR REPAIRANY STRUG TURF PRIOR TO ITS ISSUANCE. ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS U - CENSE UW (CHAPTER F (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THEALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7001.5 BYANYAPPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (3500)-): 04AS OWNEROFTHE PROPERTY, OR MY EMPLOYEES WITH WAGESAS THEIR SOLE COMPENSATION, MALL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR BALE (SEG 704A, BUS;. NESS AND PROFESSIONS OODE: THE CONTRACTOAS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON. ANO WHO DOES SUCH WDRK HIMSELFOR NERSELFOR THROUGH WS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT MENDED OR OFFERED FOR SALE Jr. HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OFCOMPLE- TION. THE OWNER-DUILDER WALL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSC OF SALE1 0 L AS OWNER OF THE PROPERTY. AM EXCLUSIVELY CDNTRlCTL40 WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7D44. BUSINESS AND PROFESSIONS CODE: THE CONTACTORS LI- CENSE LAW DOES NOTAPPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMF ROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITHACONTMCTOR(S) LICENSED PURSUAMTO THE CONTAC- TORS LICENSE LAW.). O IMI EXEMPT UNDER SEG S. L P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION HEREBY AFFLW UNDER PENALTY OF PERJURY THAT I AM LICENSED DER PROVISIONS OF CHAPTER 1 UN a (OCMMENCNG WITH BECTON 7000) OF DIVISION 0 OF THE BUSINESS AND PROFESSIONS CODE. AND MY LICENSE IS N FULL FORCE AND EFFECT. LICENSE S UC. NO. DATE !,�t�1 c� CONTRACTOR _ WORKERS' COMPENSATION DECLARATION I HEREBYAFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWNG DECLARATIONS: HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF- INSURE FOR WORMERS _I COMPENSATION. AS PROVIDED BY SECTION 37000E THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED. I HAVE AND WALL MAINTAIN WORKERS'COMPENSATKN INSURANCE. AS REQUIRED BY SECTION 3700 OF THE LABOR COO E. FOR THE PERFOAMANCE OF THE WORK FOR WHICH THIS PERMIT IS _ISSUE0. YY ER��j(y�f.NSATON INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIERPV L - _ -- ! POLOYNUMBER (THSWCONNEWD MBECCAFi-rEDCFTf PEMCISMAMCHPCHEDDULA1LSR100JOnu= I CERTIFY THAT LATHE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.1 j SHALL NOT EMPLOY ANY PERSON N ANY MANNER SO AS TO BECOME SUBJECT TO THE j WORKEATCOMPENSATON LAWS OF CALIFORNIA. AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORY.ERS'COMPENSATION PROVISKNS OF SECT N GOOF THE LABOR coo IS/IAL ORTHWITHCOMPLY WITH THo s. L DATE: APPLICANT. _ 1 i FAILURE OBE RE WORKERS' COMPENSATION COVERAGE IS USKALLSE SWARNiUSECQ: THOUSAND SUa7ECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND TO ONE HUNDRED - DOLLARS R100.000L N TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN i SECTION 3705 OF THE LABOR CODE. INTEREST AND ATTORNEYS FEE S. CONSTRUCTION LENDING AGENCY i 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR ICH THIS PERMIT IS ISSUED (BEG 3007, GY G). 7 _ LENDERS NAME LENDER'SADDRESS 1 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT 1 AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS REUTY40 TO SUXDINQ CONSTRUCTION. AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY to ENTER UPON THE PURPOSES. ABOVE-MENTIONED PROPE TY FOgIl jNSPECTION J$ iu- PERM RI I, 7 r0 SIQNAT LEOFPERMITT AfE C APPLICATION) I� �,PERM fT DATE / NUMBE ISSUE TYPE OCC DATE CONST, GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW 13 - SIDE ❑ SIDE PROPOSED USE NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREANALUATION SFR/ADDIREM U) Garage/Carport WPalk)/De& ... . L- POOVSP3 ZRe -Roof 0 Commercial m Valuation t '� ADJ.AREA OUANTITY DESCRIPTION FEE J U N U W J W z 03 0. a Al v z S NOV I r, Rqq4 W .A Aa�a !` i BUILDING 3 CONSTRUCTION �Tr? .1: L - -- - - - - PLAN REVIEW ELECTRIC PLUMBING _ MECHANICAL INSPECTION FEE ISSUANCE 3 SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: TOTAL FEES COMMENTS RECPT, NO. PAID BY 17 1 VALIDATION WHITE— DePartment Copy. YELLOW --Finance Copy. PINK—ASSeSSOr 1L M. UUwr=N"UIr III wPY. u--410-1 s a WY CITY OF DIMAOND.BAR INE ECOr -PEC -iD;, i;--: N' AL i iL!%] I;'- -!-'a _'_HFAITHDEPT. FINAL DEV, F -:F -S pmt) ENFRGY S E PT 1,C �Jl W S 1 Z E S ,i -ars Pffu S 17 E j FLOOR JOIST FI IA REMITS.... N, � FLOORI,f%k, D E J, FIR IPl-PLACE BOND BEAMI ,VAT FR SF R V i C, F MID HT. BOND BEAM ji.-S-F-T.13OND.-B.EAM rlc1-1 'll G IVE N T I L 1 AT I —tNAL BOND BEAN, PRE -GRADING n-t4cti OUGH GRAr)i.,,-(3 NISH GRADING-- E L E " T,9!,7, EYT 1-,^.THjSz;,D!NG P0OL.'FENCI'NG POOL FINAL cq-t-Ir:7, )' DRV.71.1 L OFF Sl E I?A�S. DED NS 'lGATIO' FINAUENG. SEPTIC I M VV U%NDS.CAPE)IRRIG. PITI! L. ot., SITE ItIlf's. aA s P, I rl. TE S-11 1 FIRE DEPT, FINAL i;--: N' AL i iL!%] I;'- -!-'a _'_HFAITHDEPT. FINAL DEV, F -:F -S pmt) ENFRGY S E PT 1,C �Jl W S 1 Z E S ,i -ars Pffu S 17 E j