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Home My WebLink About13585 (11)'J CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES c 21660 E Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 BUILDRIG PERMIT APPLICATION JOBSITd ADDRES (A W • ADORE APN � L EC OWNER ADDR CITY S• ZIP TEL APPLICANT L CONTRAC ADD SS C PAIP TEL —� DESIGNER l�� -" yl T-'S�•7cn+ ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS It. CENSE UW FORTHE FOLLOWING REASON (SEG 7031.6 BUSINESS AND PROFESSIONS CODE: ANY CT' OR COUNTY WHICH REOUIRESA PERMIT TOCONSTRUCLALTER IMPROVE.DEMOUSH. CRREPAJR ANYSTRUC. TORE, 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 LAW (CHAPTER 0 (COMMENCING WITH SECTION TDOO) OF DIVISION ) OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THEALLEGED EXEMP- TON.ANY VIOLATION OF SECTION 7031.6 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLIC WT TO A CML PENALTY OFNOT MORE THAN FIVE HUNDRED DOLLARS O I, AS OWNEROF THE RK, PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WALL DO THE WOAND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEG 7O". BUSI- NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVESTHEREON. AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH 'US OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT MENDED OR OFFEREDFORSALE IF. HOWEVER THE WADING OR IMPROVEMENT IS SOLD WITHIN ONEYEAR OFCOMPLE- TON. THE OWNER -BUILDER WALL HAVE THE BURDEN OF PROVING THAT HE OR SHE DO NOT BUIL] 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, 70". BUSINESS AND PROFESSIONS CODE THE CONTRACTORS L4 CENSE LAW ODES NOT APPLY TOAN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WFO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTORIS) LICENSED PURSUANT TO THE CONT RAC- TOM LICENSE LAW.). O I AM EXEMPT UNDER SEC. B. A P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER O(COMMENCNGWIT)H SECTION? OF VISION SOFTHE BUST SS D PROFESSIONS COCE, AND W LICENSE S N FULL FORCE EFF T. LICENSE CLASS LIC. NO. / DATE CONTRACTOR WORKERS' COMPENSATION DECLARATICN 1 HEREBY AFFIRM TINDER PENALTY OF PERJURY ONE OFTHE FOLLOWING DECLARATIONS: _I NAVE ANO WILLMANTAN A CERTIFICATE OF CONSENT TO SELFINSURE FOR WORKERS' COMPENSATON.AS PROVIDED SY SECTION 5700 OF THE LABOR CODE, FOR THE PERFORMANCE OFTHE WOAK FOR W RICH THS PERMIT IS ISSUED. 1 HAVE AND WtU. MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REWIRED BY SECTION 5700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WIDRKEAS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER PoucVNUUBEn (THIS SECTION NEED NOT BE CANIPLETEDOFTIC PERMIT 15 FOR ONE HUNDRED DOLLARS (SHOD) OR LESS) 1 CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I SHALL NOT EMPLOY ANY PERSON N ANY MANNER BOAS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA AND AGREE THAT IF 1 SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 07DO OF THE LABOR CODE, I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE: APPLICANT: j WANING: 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 1$100,000), N ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN I SECTION 370O OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY i I HEREBY AFFIRM UNDER PENALTY OF PERJURY THATTHERE S A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT S ISSUED (SEG 30Y7, CIV. C.). LENDERS NAME LENDER'SADORESS i (CERTIFY THATIH R S APPUCATIONAND STATE THAT TME NF ATION IS CORRECT. I AGREETO Y CITY AND COUNTY ORDINANCES AT YNSIkELATm TO BUILDING s CONSTRUCT RESP AUTHORIZE REPRESENTAT HIS NTY 7D ENrtER LLLJ��OOONNN THE ABOVEMM j $RETION PU N C s PERMITTEE NAME I SIGNATURE OF PERMITTEE DATE C PRESS FIRMLY APPLICATION PERMIT L , P/C DATE NUMBER J� J M ISSUE n ] TYPE OCC _ DATE `'`�� CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE NO. DWEL NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM CO Garage/Carport WPatio/Deck LL PooVSpa Z Re -Roof 0 Commercial 5 Iii Valuati / ADJ.AREA QUANTITY DESCRIPTION FEE ,.( K 1' U Cr L) U W J W (7 2 cc J a U 2 4 2 U W CONSTRUCTION_ PLAN REVIEW T ELECTRIC PLUMBING MECHANICAL ^ ' INSPECTION FEE ISSUANCE T SMIP Ci ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: TOTAL FEES COMMENTS 1 RECPT. NO. PAID BY VAUDA WHITE—Department COPY, YELLOW—Finance Copy. PINK—ASSISSSOr L:opy, UULUtNHLJLr III L;Opy, unttrv— PiPi N111 ropy CITY OF DIAMOND BAR _ INSPECTION.RECORD ......,�C`'ir��11.(�,�V�', ISET BACK .' 1��4!�.-_ �1�1�1eT��F',�1!.1 I ��ii��-��'��:A.I.��'�� s•� FLOOR JR1ST -1 ��or'��'=� __.��.E-��?�� ... ;FTGSlFORPAS/STEEL I FHA REOMTS\ ELECTRIC GROUND ._ UNDER FLOOR DUCT ,-.-_ t 1 'GROUND PLUMBING UNDER FLOOB'C,ONDUIT ` 'SLAB GRADE - I FIREPLACEfOUNDATION TEMP POWER FIREPLACE BONbSEAM "'' :'::t ` WATER SERVICE MID HT. BOND BEAM.; -i ',► ' ! )? _ a '' ROOF SHEATHING, �_ 4 8 FT. BOND BEAM FRAMING!VEilTlL'IATION FINAL BOND BEAM' ROOFCOVER ' PRE -GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC _ ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWER/TUB TEST POOL ELECTRIC EXT. LATH/SIDING POOL FENCING WALL INSULATION POOL'FINAL CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER FINAL ENG. SEPTIC TANK �, LANDSCAPEARRIG. SEEP PIT/L.L. ."`- c:t ON SITE IMPS. .GAS AIR TEST FINAL ZONING _FINAL CONST. FINAL HEATING FIRE DEPT. FINAL HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID - FINAL PLUMBING ENERGY COMMENTS SEPTIC TANK SIZE SEEP PIT/U SIZE