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Home My WebLink About13387 (7)CITY OF DIAMOND BAR J "-- DEPARTMENT OF COMMUNITY &. DEVELOPMENT SERVICES y 21660 E. Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 PRESS .rte BUILDING PERMIT APPLICATION FIRMLY JOBSITE ADDRESS 1 M��'►'l�4>� ul APN LOT TRACT OWNER G - ADDRESS CITY b LZIP0AjjfCTEL a APPLICANT TE -1 CONTRACTOR ADDRESS CITY ZIP TEL ARCWENG/ DESIGNER ADDRESS CITY iaM�ZIP TEL OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LN CENSE UW FORTHE FOLLOWING REASON (SEC.7031.5 BUSINESSAND PROFESSIONS COOS ANY CIN DR COUNITYWNIUl/ REOUNES A PERMRTO CONSTRUCT ALTER. IMPROVE, DEMOLISH, OR REPAIRAlY STRUC- TORE PRIOR 70 ITS ISSUANCE. ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE 15 LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LH CENSE UW (CHAPTERS (COMMENCING WITH 5ECTION TWO) OF DIVISION 3 O THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7W 1.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANTTo A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (1500).): ❑ LASOWN E4 OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION. WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, BUSI- NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON. AND WINO DOES SUCH WORKHIMSELF OR HERSELF OR TIWOLUH MS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE F, HOWEVER. THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OFOOMPLE- TION, THE OWNEROJILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DD NOT BUILD OR MPFINE FOR THE PURPOSE OF SALE). CO L AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS L4 CENSE LAW DOES NOTAPPLY TO AN OWNER OF A PROPERTYWHO BUILDS OR IMPROVES THEREON, AND TWIOCONTRACTS FOR SUCH PROJECTS WITH A CONTRACTORS) LICENSED PURSUANT TO THE CCNTRAC- TORS LICENSE LAW.). O 1 AM EXEMPT UNDER SEG 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 S (COAWENCNG WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE 15 N PULL FORCE AND EFFECT. LICENSE CLASS UC. NO. DATE - CONTRACTOR WORKERS' COMPENSATION DECLARATION 1 HEREBYAFFIRM TINDER 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 ADO OF THE LABOR CODE FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. _I HAVE AND WILL MAINTAIN WORKERT COMPENSATION INSURANCE, AS RECUR ED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS• COMPCNSATDN INSURANCE CARR ER AND POLICY NUMB ER ARE: CARRIER POLICY NUMBER (MSSECL1oN NEED NOT BE COMPLETEDOFTIE POW IS FORONE H NORFDDOLIARS(L1Mi OR LESS), 1 CERTIFY THAT N THE PERFORMMICE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WCSKERT COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WOR(ERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE, I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE: - APPLICANT. WARNING: 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 (SIDO.D00). N ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37050F THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS ACONSTRUCTXON LENDING AGENCY FOR THE PERFORMANCE OF THE WOR( FOR WHICH THIS PERMIT IS ISSUED (SEC, 3007, CIV C} LENDERS NAME LENDERS ADDRESS 1 CERTIFY THAT 1 HAVE 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 AUTHORIZE REPRESENTATIVES OFTHI COUNTYTO ENTER UPON THE ABOVE-MENTIONEOPROPERTYFORINSPE RPOSES. F PERMITTEE NAME tpnift SIGNATURE OF RMI OA CATIONq /�_ C� PERMIT / gT #'C DATE O ! NUMBER ✓ 3 ISSUE TYPE OCC DATE '" CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDESTREET RW ❑ SIDE ❑ PROPOSED USE M NO. DWEL NO. 2 NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Cl) Garage/Carport W Patio/Deck LI- PGOI/Spa Z Re -Root Commercial m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE Q H- J LIj - � 1_n 03 J Z r H1V1111N U is T7 = r� Jt1CL' 1 U W CONSTRUCTION PLAN REVIEW ELECTRIC tq_ PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SNIP (� ENERGY PIC ENERGY PERMIT RETENTION FE PI—E!: / yr TOTAL FEES COMMENTS RECPT. NO. 1 PAID BY j, VALIDATION WHITE—Department Copy, YELLOW—Finance Copy. PINK—Assessor Copy, GOLDENROD—File Copy. GREEN --Applicant's Copy / .. I � 1, .'-1 ,r. .I.N •..., ... . .. ..J. r., .1 x.. 1'. :.n '1^ ry � �.n .. I. JI. �.r. >. l's . - , ,� r CITY OF DIAMOND BAR INSPECTION'RECORD �e a t+ BACK t •- _ V, • �i OR FLOOR JOISTt,l FTGS/FORMS/STEEL , ; c. _ FHA REOMTS --- - - ELECTRIC GROUND UNDER FLOOR DUCT t ', GROUND PLUMBING UNDER FLOOR CONDUIT.:;'.. r1, , . !y, .; �; ►-•'. SLAB GRADE FIREQ F UND TION •-� •' TEMP POWER ___ _ _ FIREPLA E d6ndiltAm WATER SERVICE - - - - - -- MID HT. BOND BEAM RbOF SH ATH N6':''1 ' • `'' 8 FT. BOND BEAM FRAMING/VENTILIATION ROOF COVER J .4- FINAL BOND BEAM..- PRE -GRADING' , ` �. ' ' "•.',` ` ,:: ; i :.';; ;" ROUGH HEATING.. - -BENCH 161 •1': : % :''i %� ,\�:� sit, . ROUGH ELECTRIC -- ROUGH GRADING ROUGH PLUMBING - FINISH GRADING SHOWER/TUBTEST - POOL ELECTRIC EXT. LATH/SIDING POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS . SEWER_._ _ - FINAL ENG. SEPTICTANK_ _ _ LANDSCAPE/IRRIG. SEEP PIT/L.L. t`' ON SITE IMPS. GAS AIR TEST'- FINAL ZONING FINAL CONST. - p pp I FIRE DEPT. FINAL FINAL -HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID - FINAL PLUMBING ENERGY COMMENTS mWWANEt SEPTIC TANK SIZE SEEP PIT/L) SIZE I I r