The URL can be used to link to this page

Home My WebLink About20177r 0 OU- mm z g zd O Inw0ZLuIOL_ CnCn D CrO mWUZW t— g LLLzZ w W dY O dXW O Uw Cn Z Q W Z 0 WZCD Cn O lL J W cC ZW H CCliW CDZ 001 0 m a H UIGI III U.II,1R i WK CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21825 E. Copley Drive 909) 860-3195 Fax (909) 861-3117 BUILDING PERWF APPLICATION . JOBSITE - ADDRESS— ADDRESS JO / OU k• APN LOT TRACT OWNER r [_C G z ADDRES/S 50 `, Ic; N.•4 1; 1,f,5 CITY // / 01 U4 fin ZIP TEL. APPLICANT TEL. CONTRACTOR ADDRESS CITY ZIP TE CSARCH/E G/ , DESIGNER /" r 'Z ADDRESS d. CITY :a. a:a,tis ZIP !U-777 TEL. OWNER -BUILDER DECLARATION IHEREBYAFFIRM UNDER PENALTY OF PERJURYTHAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSELAWFORTHEFOLLOWINGREASON (SEC. 7031.6BUSINESSAND PROFESSIONSCODE: ANYCITYOR COUNTYWHICH REQUIRESPERMITTOCONSTRUCT, ALTER, IMPROVE. DEMOLISH, ORREPAIRANYSTRUC- TURE. PRIOR TO ITS ISSUANCE. ALSO REWIRES THE APPLICANT FOR SUCH PERMIT TO FILEA SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSELAW (CHAPTERY (COMMENCING WITH SECTION7000) OF DIVISION 3 OF THEBUSINESS AND PRO- FESSIONSCODE) OR THATHE ORSHE IS EXEMPTTHEREFROM AND THE BASIS FORTHEALLEGED EXEMP- TION. ANY VIOLATION OFSECTION7031.6BYANYAPPLICANT FOR A PERMIT SUBJECTS THE APPUCANTTOACML'PENALTYOF NOT MORETHAN FIVE HUNDRED DOLLARS (6600).): LASOWNEROFTHE PROPERTY, ORMY EMPLOYEESWITH.WAGESAS THEIR SOLECOMPENSATION, WILL DOTHE WORK, AND THESTRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, BUSI. FESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OFUERTYWHOBUILDSORIMPROVESTHEREON, AND WHO DOES SUCHWORKHIMSELFORHERSELF OR THROUGH HISOR HEROWN EMPLOYEES, PROVIDED THATSUCH IMPROVEMENTSARE NOT INTENDEDOR OFFEREDFOR SAL& IF, HOWEVERTHEBUILDINGOR IMPROVEMENTISSOLDWRMNONE YEAROFCOMPLE. TIONSTHE OWNER -BUILDERWILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD ORIAPROVEFORTHEPURPOSEOFSALE). I, ASOWNEROF THE PROPERTY, AMEXCLUSIVELYCONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI. CENSE LAW DOES NOTAPPLY TO AN OWNEROFAPROPERTY WHOBUILDSOR IMPROVES THEREON, AND WHO CONTRACTSFORSUCHPROJECTSWITH ACONTRACTOR(S)LICENSED PURSUANTTOTHE CONTRAC- TORS LICENSE LAW.). 1AMEXEMPT UNDERSEC. B. 8P.C. FORTHIS REASON DATE OWNER 1 LICENSED CONTRACTORS DECLARATION I HEREBYAFFIRM UNDER PENALTY OFPERJURY THAT 1AM LICENSED UNDER PROVISIONS OFCHAPTER I (COMMENCING WITH SECTION 7000) OF DIVISION 3OFTHE BUSINESSAND PROFESSIONSCODE, AND MYLICENSE IS IN FULL FORCE AND EFFECT. LICENSE CLASSLIC. NO. O / DATE r7f;S--- CONTRACTOR -Lei e4 WORKERS' COMPENSATION DECLARATION I HEREBYAFFIRM UNDER PENALTY OF PERJURY ONE OFTHE FOLLOWING DECLARATIONS: HAVE AND WILLMAINTAINACERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION370D OFTHE LABOR CODE, FOR THE PERFORMANCE OF THEWORK FOR WHICHTHIS PERMITIS ISSUED. I HAVEAND WILL MAINTAINWORKERS' COMPENSATION INSURANCE, AS REWIREDBY SECTION 3700 OFTHE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FORWHICH THISPERMITIS ISSUED. MYWORKERS' COMPENSATION I IJRANCE CARRIERAND POLICYNUMBER ARE: CARRIER T e. POLICYNUMBER A THISSECTIONN® NOTBECOMPLETEDOFTHEPERMIT IS FORONEH JNDREDDOILARS ($100) ORLESS} I CERTIFY THAT IN THE PERFORMANCE OF THEWORK FORWHICHTHIS PERMIT IS ISSUED, I SHALLNOT EMPLOY ANY PERSON INANY MANNERSOAS TO BECOME SUBJECTTOTHE WORKERS' COMPENSATION LAWS OFCALIFORNIA. AND AGREE THATIF I SHOULD BECOME SUBJECT TO THEWORKERS' COMPENSATION PROVISIONS OF SECTION 3700 O THE LABOR CODE, 1 SHALL FORTHWITH COMPLY WITHT E ROVISIONS. 2 7 DATE: F -7--f" APPLICANT: /® C - WARNING: FAILURE TO SECUREWORKERS' COMPEN ATION COVERAGE ISUNLAWFUL, AND SHALL BE SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UPTO ONE HUNDREDTHOUSAND DOLLARS ($I00,000), INADDITION TO THE COSTOFCOMPENSATION, DAMAGESAS PROVIDED FOR IN SECTION 3700 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. yf; CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTYOF PERJURY THAT THERE ISACONSTRUCTION LENDINGAGENCYMFORTHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMITISISSUED (SEC. 3007, CIV. C.). LENDERS NAME LENDERSADDRESS I CERTIFYTHATI HAVE READTHIS APPLICATIONAND STATE THATTHEABOVE INFORMATION ISCORRECT. IAGREE TO COMPLYWITH ALLCRYAND COUNTYORDINANCES AND STATELAWS RELATING TOBUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTYTO ENTER UPON THEABOVE-MENTIONEDPROPERTY FOR INSPECTION PURPOSES. Ada e C .• PERMITTEE N E (PRINT) / SIGNATURE RMITTEE DATE PRESS FIRMLY APPLICATION/ PERMIT , P/C Q 3 _ 2DATEIDZSNUMBq ISSUE TYPE OCCj DATE DD ONST GROUP ZONING SETBACKS FRONT Rely REAR SIDE/SIDE STREET RW SIDE PROPOSED USE P . ased ' 9 NO. DWEL.- NO. NO. UNITS STORIES BEDROOMS DESCRIPTION .- SQ. FT.:,,, FACTOR PSF ADJ. AREANALUATION SF EM L/ Garage/Carport WPall)/Dock LL. PGouspa 0 Z Re -Root Cl Commercial m 3 5Valuation ADJ.AREA QUANTITY DESCRIPTION FEE U U J W CDZ m a JQU Z Q2 W x CONSTRUCTION PLAN REVIEW ELECTRIC _ t, 1) -0 PLUMBING MECHANICAL INSPECTION FEE 0^1` `` ISSUANCE VV V SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: . V PRE -ALT FEE: TOTAL FEES 7 COMMENTS 1 CD3/ -7 L RECPT. NO. D By, VALIDATION WHITE—Department Copy, YELLOW --Finance Copy, PINK—Assessor Copy, GOLDENROD --Rio Copy, GREEN—Applicants Copy CITY OF DIAMOND BAR o 0 D JS 0 Qa 0 mug UU J 11r15V U LNt1 SET BACK FLOOR JOIST FIGS/FORMS/STEEL FHA REQMTS ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR CONDUIT SLAB GRADE FIREPLACE FOUNDATION TEMP POWER FIREPLACE BOND BEAM WArER;SERVICE ROOF SHEATHING MID HT. BOND BEAM ' 8 FT. BOND BEAM FRAMINGNENTILIATION ROOF COVER FINAL BOND BEAM PRE -GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC 1 i_ 0 ROUGH GRADING ROUZ3H PLUMBING 1 FINISH GRADING SHOWER/TUB TEST POOL ELECTRIC EXT LATH/SIDING WALL INSULATIONPOOL POOL FENCING FINAL CEILING INSULATION OFF SITE IMPS. DRYWALL NAILIN DEDICATIONS SEWER 1 FINAL ENG. SEPTIC TANK LANDSCAPE/IRRIG, SEEP PIT/L.L. ON SITE IMPS. GAS AIR. TEST FINAL ZONING FINAL CONST. f.-tlj FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING 03L_ 66c, ENERGY CXR a 7 JSEPTIC TANK SIZE SEEP PIT/U SIZE