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Home My WebLink About13369 (7)uC F C 2 'r r CITY OF DIAMOND BAR r DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 (909)860.3195 Fax (%9) 861-3117 PRESS BURMING PERMIT APPLICATION FIRMLY JOBSITE ADDRESS �Os, O v1_ APN LOT TRACT /L OWNER EA4D R7f . ADDRESS LA CITY ZIPCI TEL APPLICANT Jim NoL&PJ TEt CONTRACTOR ADDRESS CITY ZIP TEL. DESIGNER J DESIGNER ADDRESS CITY zips_ Q"jr TE OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC. 7051.5 BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTYWHICH REIWRESA PERMrTTO WNSTRUCr,ALTER IMPP.OVE. DEMOLISH, OR REPAIRANYSTRUC- TURE PRIOR TO ITS MWANCE. ALSO RECUIRES 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 I (COMMENCING WITH SECTION 7000) OF DIVISION S Of THE BUSINESS AND PRO- FESSgN4 CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION TWI S BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO ACIVIL PENALTY OF NOT MORE TI -IAN FIVE HUNDRED DOLLARS ($5001.). O LAS OWNER OFTHE PROPERTY, ORMY EMPLOYEES WITHWAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 70". BUST• NESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON. 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 G HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONEYEAROF COMPLE- TION. THE OMPLE- TION,THE OWNERJGUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR TIC 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 COWRACTCFS LI- CENSE LAW DOES NOTAPPLY TOAN OYMER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON. AND WILD CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). O IAM EXEMPT LINDER SEG B. L P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER I (COMMENCING WITH SECTION 7000) OF DIVISION S OF THE BUSINESS AND PROFESSIONS CODE, AND W LICENSE IS N FULL FORCE AND EFFECT. LICENSE CUSS I.C. NO. DATE - CONTRACTOR WORKERS' COMPENSATION DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OFTHE FOLLOWING DECLARATIONS- _ I NAVE AND WILL MAINTAIN ACERTIFlCATE OF CONSENTTO SELFaNSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION WOO OF THE LABOR CODE. FOR THE PERFORMANCE Of THE WORK FOR WHICH THIS PERMIT IS ISSUED. _I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE. AS REOVIRED BY SECTION 57000E THE LABOR CODE FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE CARRIER ... POLICY NUMBER (R6SECTION NEEDNOT BECCASSETEDOFTIE KIM S FOR ONE HUM)RED DOLLARS(T100)OR LESS) 1 CERTIFY THAT 14 THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT S ISSUED.I SHALL NOT EMPLOYANY PERSON IN ANY MANNER BOAS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 5700 OF THE LABOR CODE.I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. I DATE: APPLICANT: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE S UNLAWFUL. AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), N ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN 1 SECTION 3700 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I CONSTRUCTION LENDING AGENCY 1 FOR THE ERFO MUNDERANCE PENALTY OFPERAIRVICH THIS PE SACONSUED(SE. LENDING AGENCY FOR THE PERFORMANCE OF THE YNORK FOR NMK]N THIS PERMIT IS ISSUED (SEG 5047, CIV. G). I LENDER'S NAME LENDEFSADDRESS I CERTIFY THAT I IIAVE 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 CONSTRUCTION. AND HEREBY AUTHOR= REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR NSPF PURPOSES. 3 � U PERMITTEE NAME R I TE SIGNATURE OF DATE APPLICATION ¢ PERMIT 13 �� /�[_ A� DATE ` NUMBER ISSUE �/ TYPE OCC / DATE / CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDEISIDE STREET RW ❑ SIDE ❑ PROPOSED USE W FLA64ra9L -Aix 1!1 22--1 4a6!Kw NO. DWEL ,i NO.�� NO. UNITS T STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION SFR/ADD/REM – CD Garage/Carport WPat!wDeck IL PoOVSpa ZRe -Root 0 Commercial -- 5 m Valuation ADJ.AREA QUANTITY 6ESCRIPTION FEE �W.I W a ti A 1 0 1 j C"'y OF DI A 1,11 VNI BAR >, aLllING AND SA -TTY a J Q U Z Q 2 U W CONSTRUCTION PLAN REVIEW ELECTRIC 120 DIN11b PLUMBING MECHANICAL INSPECTION FEE ISSUANCE 5 SMIP J ENERGY P/C ENERGY PERMIT RETENTION FEE: P{FJ��ALT FE�E:Lv n Nf I�l/lam TOTAL FEES COMMENTS RECPT. NO. PAID BY Q X VALIDATION WH(TE--Wartment Copy, YELLOW—fIRarICe GDW, riNr—^sse54or L opy, uvWcmnVL im L upy, unciar —npg— a vuW CITY OF DIAMOND. BAR_, , . `INSPECTION RECORD W _0 SP DATE SET BACK 'INSPECTOR INSPECTION DATE FLOOR JOIST- FTGS/FORMS/STEEL " i.,, �,.` _ �' :1 FHA REQMTS ELECTRIC GROUND - - - ` UNDER FLOOR DUCT - GROUND PLUMBING =' UNDER FLOOR CONDUIT- • '>'_� 1 SLAB GRADE FIREP FOUNDTION TEMP POWER .. - ; - ;- r .. FIREPUffbbib BEAM ; WATER SERVICE - -- - -. - MID HT. BOND BEAM ROO�Si�ERl'HINCi. ' '! 8 FT. BOND BEAM FRAMINGNENYIL.IATI-ON)'-'- _ FINAL BOND, BEAM, +•. . ; i t' t , ROOF COVER 4 -PRE GRAQIN,G Ci ROUGH HEATING ROUGH ELECTRIC - - - ROUGH GRADING - ROUGH PLUMBING - FINISH GRADING SHOWER/TUB TEST i - - - - POOL ELECTRIC EXT LATH/SIDING POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS. I DRYWALL NAILING I DEDICATIONS SEWER_ -.- -- _ FINAL ENG. SEPTIC TANK _. _ �__,__ _ . LANDSCAPE/IRRIG. . SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST - - - FINAL ZONING ? . FINAL CONST',FIRE FINAL -HEATING O DEPT. FINAL HEALTH DEPT. FINAL FINAL ELECTRIC - DEV. FEES PAID FINAL PLUMBING ENERGY COMMENTS SEPTIC TANK SIZE SEEP PIT/U SIZE - ;s r., _