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Home My WebLink About13583 (13)CITY OF DIAMOND BAR lam. DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES t 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 '.. BUILDING PERMIT APPLICATION JOBSITE ADDRESSW 66� APN T TRACT CWNER DDRESS S jj CITY �' y ZIP TEL APPLICANT L. CONTRACT ADDRE CITY TEL ARCH/ENG/ DESIGNER �/ ADDRESS CITY ZIP TEL OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS L4 CENSE LAWFOA THE FOLLOWING REASON (SEC. 7001.6 IO BUSINESS AND PROFESSNS CODE: ANYOTY OR COUNTY WHICH IFMtES A PER rrTO CONSTRUCT ALTER, IMPROVE. DEMOLISH, OR REPARANY STRUC- TURE, PRIOR TO ITS ISSUANCE. ALSO REWIRES THE APPLICANT FOR SUCH PERMIT TO RLE A SIGNED STATEMENT THAT HE OR SHE 15 LICENSED PURSUANT TO THE PROVISONS 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 ANO THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 701.6 BY ANY APPLICANT FOR A PERMITSUBJECTS ME 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 UW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR MPROVESTHEREON, 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 BUILDING ORIMPROVEMENT LSSOLD WITHIN ONEYEAROFCOUPLE- TICK THE OWNER -BOLDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALLI 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 THEREON,ANO VMOCONTMCTS FOR SUCH PROJECTS WITH ACONTRACTOR(S) LICENSED PURSUA TTO THE CONTRAC- TORS LICENSE LAW.). O IAM EXEMPT UNDER BEC. B. L P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIFWI UNDER NALTYOFPE%MTHAT I AM LICENSED UNDER PROVISIONS OF CHAPTER .(COM/AENCNO C 700)OFOMSION30F THE SIN SAN PROFESSIONS COD ,AVD W LICENSE IS IN FIX F CEANO EFFECT LICENSE CLASS LIC. N0. DATE CONTRACTOR WORKERS' COMPENSATION DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: _I HAVE AND WALL MAINTAIN A CERTFICATE OF CONSENT SELF4NSURE FOR WORKERS' COMPENSATION. AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT S ISSUED. _I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REWIRED BY SECTION 0700 OF THE LABOR COOS, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. W WORXERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER POLICY NUMBER (D6 SECTION NEm NOT BEC OMPLETEDOFTNE PERMIT IS FOR ONE HUNDRED DOLLARS (S100)OR LESS} 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 CALIF OAMA, AND ACRE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 370 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 CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS (510,000), 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 ME PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3041, CM C.). f LENDERS NAME LENDERS ADDRESS' I CERTIFYTHATI RE THIS APPLICATION AND STATE THAT TH E 0RUMATION IS CORRECT. (AGREE M Y W7 LCITY AND COUNTY ORDINANCES T , E LAWS RELATING TO BUILDING CONSTRUCT .AND EBYAUTH E PENTAT S 7H COUNTY TO INS EMEgj ME i. ABOVE -M ERTY FOR INSPECTION TION UR 1 1 ) PERMITTEE NAM SIGNATURE CIPPERMITTEE DATE PRESS FIRMLY APPLICATION PERMIT P/C DATE NUMBER M ISSUE ! �, TYPE OCC �,.� _nq DATE ` ll[ J "� 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 SFFVADDIREM Garage/Carport WPatio/Dock LL PooVSpa 0 Z Re -Roof 0 Commercial - m Valuation ADJ.AREA OUANTITY 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 1•�" r" It') 0 L, ISSUANCE SMIP kjC L•:l;-,. _ . -.-:-. 1;Ul 17it.l: ... •. ' ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: `• TOTAL FEES ' A �13 COMMENTS RECFT. NO. PAID BY VALIDATION WHITE—Department Copy, YELLOW Finance Copy. PINK—Assessor Copy, GOLDENROD --File GM, GREEN—Applicant's Copy CITY OF DIAMOND BAR NSPECTION RECORD �v�;,•aGr1a►�1 �r�r SET BACK S poEr— I FLOOR dPIST'� FTGS/FORP,dS,'STEEL- FHA REONITS ELECTRIC GROUND UNDER FLOOR D(1CT ,GROUND PLUMBING UNDER FLOOWCONDUIT .--•'.,' , 'SLAB GRADE -- FIREPLACE FOUNDATION TEMP POWER FIREPLACE`BONDBEAM MATER SERVICE MID -HT!, OND -BEAM' ,',-V'j -; - . i : ).•; ROOF SHEATHING, , ,-;�f�_'' .�, FRAMINGNENTILIAtION _- , /` `' 8 FT. BOND BEAM FINAL BOND BEAM ., - 'ROOF COVER PRE -GRADING . ' c ='; �•' . ,..' .. �.'; ROUGH HEATING' BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWERiTUB 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, - __��0� FINAL HEATING FIRE DEPT. FINAL HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID =INAL PLUMBING ENERGY COWAIENTS _ SEPTIC TANK SIZE SEEP PITlU SIZE _