The URL can be used to link to this page

Home My WebLink About13583 (11)CITY OF DIAMOND BAR Com. DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES t 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 '.. BUILDING PERMIT APPLICATION JOBSITE ADDRESS APN T 7MJMTR CT CWNER DDRESS S CITY ZIP TEL APPLICANT AL. CONTRACT ADDRE LL- Ari-ZaNau CITY TEL ARCFUENG/ DESIGNER ADDRESS CITY ZIP TEL OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS L4 CENSE LAWFOA THE FOLLOWING REASON (SEC. 703I.S BUSINESS AND PROFESSINNS CODE: ANYCITY OR COUNTY WHICH IIEOLIIRES A PER rrTO CONSTRUCT ALTER, IMPROVE. DEMOLISH OR REPARANY STRUC- TURE, PRIOR TO ITS ISSUANCE. ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE 15 INCENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE FCENSE UW (CHAPTER 4 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AM THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7031.6 BY ANY APPLICANT FOR A PERMITSUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FINE HUNDRED DOLLARS (11500).): O LAS OWNER OFTHE PROPERTY, OR MY EMPLOYEES WITH WAGESAS THEIR SOLE COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7014, BUSI- NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY BUILDS OR IMPROVESTIEREON, AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE IF, HOWEVER THE SULDNO OR IMPROVEMENT IS SOLD WRHN ONEYEAROF COUPLE - TION. THE OWNER.SULDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALEI O L AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE OT PRECT (SEG1x 70. BUSINESS AND PROFESSIONS CODE THE CONTRACTORS U - CENSE LAW DOES NOTAPPLYTOAN OWNER OFAPROPERTY WHO BUILD$ ORIMPROVES THEREOHANO W HOCONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S) LICENSED PURSUA TTO THE OONTRAC- TORS LICENSE LAW.). O IAM EXEMPT UNDER BEC. B. L P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFBIM UNDER NALTYOFPE%M THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER .(COM/AENCNO C 7000)OFDMSION30F THE SIN SAN PROFESSIONS COD ,AVD MY LICENSE IS IN FUL F CEAND EFFECT LICENSE CUSS LIC. N0. U DATE CONTRACTOR WORKERS' COMPENSATION DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: _I HAVE AND WALLMANTAN A CERTFICATE OF CONSENTTO SELF4NSURE FOR WORKERS' COMPENSATION. AS PROVIDED SY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT S ISSUED. _I HAVE AND WILL MAINTAIN WORKERS' COMPENSAIIN INSURANCE, AS REWIRED BY SECTION 57000E THE LABOR COOS, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. W WORKERS' CCUPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER POLICY NUMBER (C6 SECTION NEED NOT BEC OMPLETEDOFTHE PERMIT IS FOR ONE HUNDRED DOLLARS(11100)OR LESSI I CERTIFY THAT LATHE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORMA, AND ACRE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE.1 SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE: APPLICANT: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL BE SUBJECT AN EMPLOYER TO CRMIWLL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS (5100,000), N ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3705 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE N A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3041, CN. C.). i LENDERS NAME LENDERS ADDRESS' I CERTIFYTHATI RE THIS IO S APPLICATN AND STATE THAT TH E 0RMATKON IS CORRECT. (AGREE TO Y WI LCT' AND COUNTY ORDINANCES T , E LAWS RELATING TO BUILDING CONSTRUCT .AND EBYAUTHORIZE TION PENTAT 5 7H COUNTY TO ENTEg yRHE i. ABOVE -U ERTY FOR INSPECTION PUR 1 1 I PERMITTEE NAM SIGNATURE CIPPERMITTEE DATE PRESS FIRMLY APPLICATION PERMIT P/C DATE NUMBER M TYPE OCC DATE ` lILJ `�� + CONST, GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDEISIDE STREET L-1 RW ❑ SIDE ❑ PROPOSED USE NO. DWEL NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ.AREAIVALUATION SFRIADDIREM to Garage/Carport WPatio/Dock LL PooVSpa 0 Z Re -Roof Commercial - CD Valuation ADJ.AREA OUANT(TY DESCRIPTION FEE QJ U it U W J w C3 Z EO J o_ U_ Z Q 2 U W O CONSTRUCTION PLAN REVIEW ELECTRIC T J PLUMBING r MECHANICAL INSPECTION FEE /•�" r" It') 0 L, ISSUANCE SMIP * IT'i;. LULL 171"',: ... •. ' ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: `• TOTAL FEES ' A �1A3 COMMENTS RECFT. NO. PAID BY VALIDATION WHITE—Department Copy, YELLOW Finance Copy. PINK—ASSeSSOr GM, U0LOLNHUL?-11119 UM, UHLLN—AppIIGLnTS L;M CITY OF DIAMOND BAR NSPECTION RECORD �v�;,•a G r1 a►�1 � r�r SET BACK S �l k , ff-p 1jN 41- �a � lo�►�E I FLOOR d-OIST'� r— 1��-�� cel � FTGS/FORMS/STEEL FHA REONITS ELECTRIC GROUND UNDER FLOOR DVICT .GROUND PLUMBING UNDER FLOOWCONDUIT .--•'.,' ;`- 'SLAB GRADE -- FIREPLACE FOUNDATION TEMP POWER FIREPLAEE'BONDBEAM MATER SERVICE MID-HT!BOND-BEAM':-V' i ROOF SHEATHING. , , �-;�f�'- .1i., _ FRAMINGNENTILIAtb, , i` `' 8 FT. BOND BEAM' FINAL BOND BEAM r 1 'ROOF COVER PRE -GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWERRUB TEST POOL'ELECTRIC EXT. LATH/SIDING POOL FENCING VVALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER FINAL ENG. SEPTICTANK _ ,� LANDSCAPE/IRRIG. SEEP PIT/LL. ON SITE IMPS. GAS AIR TEST_ FINAL ZONING FIPIF,L CONST, - __ ��D� FINAL HEATING FIRE DEPT. FINAL HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID =INAL PLUMBING ENERGY COWAIENTS SEPTIC TANK SIZE SEEP PITlU SIZE _