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Home My WebLink About266211 CITY OF DIAMOND BAR DEPARTMENT OF COMMUNHY & DEVELOPMENT SERVICES 218251~ Copley Drive 909)460461ifax (909) 861-3117- i O BUILDING PERMIT APPLICATION JOBSITE JAS'/ LvOAO'; ADDRESS A LOT Z TRACT S OWNER /N/ ADDRESS CITY ZIP TEL. APPLICANT TEL CONTRACTOR ADDRESS % CITY G ZIP TEL. RCNG/ ` -— DESIGNER n A AA ADDRESS /O CITY4 `—O IR` } CdA ZIP TEL OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS L4 CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.6 BUSPNESSAND PROFESSIONS CODE ANY CITYOR COUNTY WHICH REOURESA PERMITTO CONSTRUCT, ALTER. IMPROVE, MADUSH, OR REPAIRANY STRUC- TURE PRIOR TO ITS ISSUANCE. ALSO REQUIRES THE APPLI_ANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTACTORS LN CENSE SECTION (CHAPTER 9 (COMMENCING WITH SECTN 7000) OF DIVISION! 3 O THE BUSINESS MND PRO. FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASS FOR THE ALLEGED EXEMP. TON. ANY VIOLATION OF SECTION 7031.6 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO ACML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (fb00}J: O LAS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORM. AND THE STRUCTURE S NOT INTENDED OR OFFERED FOR SALE (SEC. 70u, BUSL 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 OFFEREDFOR SALE IF, HOWEVER THE BUILDING OR IMPROVEMENT S SOLD WITHIN ONE YEAR OF CONIPLE- TION, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). . 0 L AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING VM14 LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7o . BUSINESS AND PROFESSIONS COOS THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEAEOR, AND WHO CONTRACTS FOR SUCH PROJECTS WITH CONTRACTORS) LICENSED PURSUANT TO THE CONTRA_ TORS LICENSE LAW.). 1 AM EXEMPT UNDER SEC. B. a P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, ANDMYLICENSESINFULLFORCEANDEFFECT. LICENSE CLASS / r .. N.- DATE !/ CONTRACTOR WORKERS' COMPENSATION DECLARATION 1 HEREBY AFFIFYA UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION 370D OF THE LABORCOOE. FOR THE PERFORMANCE XOF THE WORK FOR WHICH THIS PERMIT S ISSUED. I HAVE AND WALL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY SECTION 3700 OF THE LABOR CODE- FOR THE PEERFORRRMAANNCCEEEOOFF THE WORK FOR WHICH THIS PERMIT S ISSUED. PAY ER T7!//F/dJq IN L A. rCARRIER AND POLICY ER ARE: CARRIER. POLICY N..BER W X III- _VLOF PE GD &fS RMSECRgN NEED NOT BE COM P ETEDOFTHE PETMT IS FOR ONE HUNDRED DOLLARS (f1000OR LESS) I CERTIFY THAT IN THE PERFORMANCE OF THE WOR( FOR WHICH THIS PERMIT S ISSUED, I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER 50 AS TO BECOME SUBJECT TO THE WORKERT COMPENSATION LAWS OF CALIFORMA AND ADREE THAT IF 1 SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR coDu FartHLWTH COMPLY DATE: APPLICANT: WARN : FARU 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 (SIM.000), IN ADDITION TO THE COSTOF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37M OF THE LABOR COOS. INTEREST, AND ATTORNEYS FEES CONSTRUCTION LENDING AGENCY I HEREBY AFFBbA UNDER PENALTY OF PERJURY THAT THERE S A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT S ISSUED (SEC. 3097. CIV. C.). LENDER'S NAME LENDERSADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION. AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. vt L fir. SIGNATURE OF PERMITTEE DATE- TD I - --I PRESS FIRMLY APPLICAPERMIT P/CNoeDATE_ NUMBER # TYPE OUPDATE {F3`Z!/C/ p CONST. GROISSUE ZONING SETBACKS FRONT RW p REAR p SIDEISIDE STREET RW p SIDE p PROPOSED USE NO. DWEL. O. O. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREANALUATION SFR/ADD/REM Garage/Carporl WPatWoo& LL 0 PoOVSPa Z Re -Roof Commercial m Pk Vatua . ADJAREA U d QUANTITY DESCRIPTION FEE 0 X cc I— UW w Zz m jL Zd2 W g 13 H °- CONSTRUCTION • PLAN REVIEW ELECTRIC PLUMBING MECHANICAL 1 INSPECTION FEE ISSUANCE /• SMTP 7' ENERGY P/C ENERGY PERMIT 4 N RETENTION FEE: S . PRE -ALT FEE TOTAL FEES -A =tr-" 7 7 Lf COMMENTS ;^,Icy 7st RECPT. NO. PAID Y VALIDATION WHI 1 UOPy, YLLLOW—F61aRCe Copy, PINK—Assessor Copy, GOLDENROD --File Copy, GREEN—ApplicarWs Copy CITY OF -DIAMOND BAR INSPECTION RECORD SETBACK j !FLOOR JOIST FIGS/FORMS/STEEL I FHA R QMTS ELECTRIC GROUND UNIB FLOOR DUCTUNDER 1-7 GROUND PLUMBING I I UNDER FLOOR CONDUIT SLAB GRADE FIREPLACE FOUNDATION TEMP POWER FIREPLACE BOND.BE - AM WATER SERVICE MID HT, BOND BEAM ROOF SHEATHING I 18 FT. BOND BEAM FRAMINGNENTILATION FINAL BOND BEAM ROOFCOVER 1PRE.GRADIN ROUGH HEATING 1BENCHING ROUGH ELECTRIC 2 1 ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWER/TUB TEST i POOL ELECTRIC EXT. LATH/SIDING G I POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION I OFF SITE IMPS. DRYWALL NAILING I I DEDICATIONS SEWER ', FINAL ENG. SEPTIC TANK I LANDSCAPE/IRRIG. SEEP PIT/L.L, ON SITE IMPS, GAS IR TEST FINAL ZONING FINAL CONST.. FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGYJ COMMENTS SEPTI TAK SIZE SEEP PIT/U SIZE