The URL can be used to link to this page

Home My WebLink About14283J� CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION JOBSITE -_ ADDRESS LWIOG APN LOT TRACT Z O OWNER SFA" t46-1- ADDRESS_mI=-C CITY ZIP TEL APPLICANT TEL. CONTRACTOR ADDRESS CITY ZIP TEL ARCHIENGI DESIGNER 1J�S�� r1lT ADDRESS CITY ZIP TEL OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM LNDER PENALTY OF PERJURY WATT AM EXEMPT FROM THE CONTRACTORS LL CENSE UW FOR THE FOLLOWING REASON (SEC 7M7.6 SUSNESSAND PROFESSIONS CODE: ANY CITY OR COUNTY WF6CH REOUIRES APOWtTTO CONSTRUCT,ALTER.MPROVE. DEMOUSK OR REPAIRANY STRUG TUBE, PRIOR TO ITS ISSUANCE. ALSO REQUIRES THE APPLIC iT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE -SHEIS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LF CENSE UW (GNPTER F (COMMENCING WITH SECTION 7660) OF DIVISION S OF THE BUSINESS AND PRO. FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP• TION. ANY VIOLATION OF SECTIO! 7031.6 BY ANYAPPLK:ANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (3500).}. ❑ LAS OYMNER OF THE PROPERTY. OR MY EMPLOYEES WITH WAGE SAS THEIR SOLE COMPENSATION, WALL DO THE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC 7041, BUS I. NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE UW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR MPRDVES THEREON. AND WHIG DOES SUCH WORK HIMSELF OR HERSELF OR On THROUGH HIS OR HER EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED On OFFERED FOR SALE IF, HOWEVER THE BUILDING OR IMPROVEMENT M SOLD WITHIN ONE YEAROFCOMPLE• TION, THE OWNER -SUI DER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE) ❑ L AS OWNEROF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7o". BUSINESS AND PROFESSIONS COOL THE CONTRACTORS LL ODES NOT APPLY TO AN OWNER OF A PROPERTY WHO BU CENSE LAW ILDS OR IMPROVES THEREON. AND WIOCONTRACTS FOR SUCH PROJECTS WITH A CONTRACTORS) LICENSED PURSUANT TO THE CONTRAC. TORS LICENSE JAW.). O IAM EXEMPT UNDER SEC B. 9 P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER s (COMMENCING WITH SECTION 7000) OF DIVISION 7 OF THE BUSINESS AND PROFESSINS CODE, AND MY LICENSE IS N FULL FORCE AND EFFECT. LICENSE SS UC. NO. Q l DATE -19 CONTMC7DR LA WORKERS COMPENSATION DECLARATION 1 HEREBYAFFIRM LNDER PENALTY OF PERJURY ONE CF THE FOLLOWING DECLARATIONS: __I HAVE AND WILL MAINTAIN CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' CXMNPENSATIOR AS PROVIDED BY SECTION 3700 OF THE LABOR CODE FOR THE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED. ��1�[[//�� ,�I RAVE AND VRLL MAINTAIN WOPXERS' COMPENSATION INSURANCE, AS REQUIRED BY SECTION 7K TT/Jo00F THELABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY RS, MQOF P{P .y1TION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER •ISl//r,Fi1 ! POLICY NULBER (JIMS SECTION NEEDNOT BE aMIETEDCFTJE PERMIT 6 MR ONE MADAM DOLLARS (3100) OR LFSSL 1 CERTIFY THAT LATHE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT T.5 ISSUED.I V SWLLL NOT EMPLOY ANY PERSON N ANY MANNER SO AS TO BECOME SUBJECT TO THE i WORKERS' COMPENSATION LAWS OF CALIFORNIA. AND AGREE THAT IF I SHOULD BECOME - SUBJECT TO WE WORKERS'COMPENSATION PROVISIONS OF SECTION 37000 H R 1 FORTTIVYITH COMPLY WITH THOSE PROVISI�w . I (� ( DATE: _ -APPLICANT: 7 WARNING: FAILURE TO SECURE WORKERS COMPENSATION COVERAGE IS UNLAWFUL AND SHAT. E SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS (3100,D00), N ADOTION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN 1 SECTION 37030E THE LABOR CODE, INTEREST, AND ATTORNEYS FEES 1 CONSTRUCTION LENDING AGENCY i T HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS URUCTIONLENDINGAGENCY IS FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMITT LS ISSUED (SEG 700r, CN. G). 7 TENDER'S NAME f • LENDERS ADDRESS - I 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 RELATING TO BUILDING 7 CONSTRUCTION. AND HEREBYAUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTERUPONTHE ABOVE-MENTIONED P GFOR INSPECT PURPOSES. i O P RMITTEEN (PRINT) PLAN REVIEW C ` O �Y r PLUMBING SIG EOFPER DAT PRESS FIRMLY APPLICATION -I' 'PERMrr% P/C DATE N ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE NO. DWEL — 90. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION SFRIADDIREM CD Garape/Carpert WPatio/Deck - - - - - LL Pool/Spa 0 z Re -Roof Commercial - m Valuation — ADJ.AREA QUANTITY DESCRIPTION FEE U Cr f -- U U.1 LU LU E7 Z lI] J C6 4 U Z a 2 U W LY.� CONSTRUCTION i A PLAN REVIEW ELECTRIC �Y r PLUMBING MECHANICAL f' n v INSPECTION FEE I1` rn Yr ,1 ISSUANCE -1 s .. -Cz SMTP ENERGY PIC ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: TOTAL FEES 3 COMMENTS RECPT NO. PAID BY i LU t ALIDATION WHITE—Department Copy. YELLOW --Finance Copy. PINK—Assessor COPY, GULDENHUD--f Re L;opy, GHhhN—ApplCWt-S L;opy CITY OF DIAMON13,13AR .'ANSPECT1011 RECORD ;,SET R JOIST FLO07 Ef-LFH.A R!-70,'.',TS I ELECTRIC RRt-)! -','.,'D - UNDEr, FLOOR T C- P. D 11 N 1) P 1, L I INIG P R FIREPLACE 8, ND RFA"11' P. SF; P. V 1 CE j f ID HT. BOND BEAM I F1 F si i r.tL,.i I: V? FT. BOND BEAN1 i..l c, v T I I ",.T f c 0 FINAL BOND BEAM lw.)OF colll:� R PRE -GRADING RIC FIOLIT! GRAD G 115! 11')!- 1,-! pl! 11.1 FINISH GRADING POOL., ELECTRP Cl E\l'T. -LATH)SIDI POOLTEINCINO P OL'FINI At - CFF SITE IMPS. TiRWITILL INAl'UNG DEDICATIONS G R FINAL' ENIG., ISL=DTIC 1'A LANDSCAPURRIG. PIT/LL. f call, APTE-S-1 FINAL 70NING Tli v 2-,6 FIRE DEPT FINAL Hr ---ALF DEPT. FINAL DEV. F --FS PAID ENERG',' L IT, 43 PL,'TI C Tl� N' K S17 i C, -'Ellp Pl'f/'! J SIZI- 7 J,j Ji