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Home My WebLink About13585 (13)'J CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES y 21660 E. Copley Dive Suite 190 (909) 860-3195 Fax (909) 861-3117 BUILDRIG PERMIT APPLICATION JOBSITd ADDRES (A W • DDRE APN � L EC OWNER ADDR CITY S • ZIP TEL O APPLICANT L CONTRAC ADD SS C IP TELARCHIE —� 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 L4 CENSE UW FORTHE FOLLOWING REASON (SEG 7031.6 BUSINESS AND PROFESSIONS CODE: ANY CT' OR COUNTY WHICH REOUIRESA PERMIT TOCONSTRUCLALTER IMPROVE. DEMOLISH. CR REPAIR ANYSrRLC. 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 D OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THEALLEGED EXEMP- TIDN.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 L AS OWNEROF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WALL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEG 70". BUSI- NESSANDPROFESSIONS 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 SUFI IMPROVEMENTS ARE NOT MENDED OR OFFEREDFORSALE. IF. NOWEWR THE WADING OR IMPROVEMENT IS SOLD WITHIN ONEYEAR OFCCMPLE- TON. THE OWHER-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 LJ_ CENSE LAW ODES NOT APPLY TOAN OWNER OF A PROPERTY WHO SUILDS 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 LIFDER 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 0(CDMMENCNGWIT)H SECTION? OF VISION SOFTHE BUST SS D PROFESSIONS COCE, AND W LICENSES 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: _t NAVE AND WILLMANTAN A CERTIFICATE OF CONSENT TO SELFdNSURE FOR WORKERS' COAPENSATXON.AS PROVIDED SY SECTION 5700 OF THE LABOR CODE, FOR THE PERFORMANCE OFTHE WORK FOR W RICH THS PERMIT IS ISSUED. _I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REWIRED BY SECTION 3700 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 POLIcY NULH9sn (THIS SECTION NEED NOT BE C OMPLE'fEDOFTHE PERMIT 15 FOR ONE HUNDRED DOWNS (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 COOS, I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE: APPLICANT: WANING: FALURE 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 SECTION 3700 OF THE LABOR CODE, INTEREST, AND ATTORNEYS F EES. CONSTRUCTION LENDING AGENCY 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 { (CERTIFY THATIH R S APPLICATIONAND STATE THAT TME NF ATION IS CORRECT. I AGREETO Y CffY AND COUNTY ORDINANCES AT YNS ELATING TO BUILDING s CONSTRUCT RESP AUTHORIZE REPRESENTAT HIS NTY 7D ENrtER LLLJ��OOONNN THE ABOVE4A ERTY R $PECTION PU �/ } PERMITTEE NAME I SIGNATURE OF PERMITTEE DATE C PRESS FIRMLY APPLICATION PERMIT PIC DATE NUMBER -1:Y365 M ISSUE ClTYPE OCC l _ 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. AREAIVALUATION SFRIADDIREM CO Garage/Carport WPatioMeck LI- PooVSpa Z Re -Roof 0 Commercial 5 Iii Valuati / ADJ.AREA QUANTITY DESCRIPTION FEE U 2 H U W J W (7 2 cc J a U 2 4 2 U W M CONSTRUCTION_ PLAN REVIEW T ELECTRIC PLUMBING MECHANICAL ^ ' INSPECTION FEE ISSUANCE Ci SMIP J ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: TOTAL FEES � r �v%o3 ov.1 COMMENTS RECPT. NO. PAID BY VAUDA WHITE—Department COPY, YELLOW—Finance Copy. PINK—ASSOSSOr L:opy, UULUtNMVL�11e I;Opy, %a"LLN PiPi anc a ropy CITY OF DIAMOND BAR INSPECTION.RECORD ISET BACK I FLOOR FTGSlFORMS/STEEL I FHA REOMTS\:ELECTRIC GROUND ._ UNDER FLOOR DUCT,—.-_� t 1 'GROUND PLUMBING UNDER FLOOB'C,ONDUIT ` 2't �'• � --.' .. �—�' 'SLAB GRADE — I FIREPLACEfOUNDATION TEMP POWER FIREPLACE BOND WATER SERVICE MID HT. B ND BEAM -•: J ',► ' ! i 1 _: a ;'.? ROOF SHEATHING, �_ 4 8 FT. BOND BEAM - FRAMING!VEf4TtL'IATION FINAL BOND -BEAM' 1 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 GOMMENTS SEPTIC TANK SIZE SEEP PIT/U SIZE