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Home My WebLink About11394 (5)- - CITY OF DIAMOND BAR , COMMUNITY DEVELOPMENT DEPARTMENT 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 861.3117 ^^ BUILDING PERMIT APPLICATION JOBSITE ADDRESS APN- ��Qj TRACT OWNER n1`�•"'019t�vr"r`I AD S O CIT ' ZU 404, TEL. 64-2oD-b APPLICANT TEL. CONTRACTOR ADDRESS CITY ZIP TEL ARCHIENG/ DESIGNER ADDRESS CITY ZIP TEL. 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. 7031.5 BUSINESS AND PRCFESS:ONS COOS: ANY CITYOR COUNTY WHICH REWIRES A PERMIT TO CONSTRUCT,ALTER. IMPROVE. DEMOLISH, OR REPAIRANY STRUC- TURE, PRIOR TO ITS ISSUANCE, ALSO REWIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE 15 LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW (CHAPTER P (COMMENCING WITH SECTION 7000) OF DIVISION 3 O THE BUSINESSAND PRO- FESSIONS COCE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VKXATION OF SECTION 703t.8 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (TS001 y O LAS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL 00 THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, BUSI. NESS A.ND PROFESSIONS 000E THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO DOES SUCH WOnK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE. IF, HOWEVER. THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE. TION, THE OWNER.BUILOER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). ❑ LAS OWNER OF THE PROPERTY. AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI. CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS On IMPROVES THEREON. AND WHO CONTRACTS FOR SUCH PROJECTS WITHA CONTRACTORS) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW). O IAM EXEMPT UNDER SEC. B. & P.L. FOR THIS REASON DAT OWNER LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROW IONS OF CHAPTER i (COMMENCING W17H scc7KNN 7000) OF DNISION 3 OF THc BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT. LICENSE CLASS LIC. NO. DATE CONTRACTOR WORKERS' COMPENSATION DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS. I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COM.PENSATION.AS PROVIDED BY SECTION 37000F THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. ' I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE. AS REQUIRED BY SECTION 3717 OF 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 (THIS SECTION NETDNOTBE COMPLETEDOF THE PERMIT IS FOHCnEHUPDRED DOLLARS (SI D)ORLESS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER 50 AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAI IF I SHOULD BECOME SUBJECT TO THE WOnKERT COMPENSATION PROVISIONS OF SECTION 3700 OFTHE LABOR CODE,1 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 TOONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 7708 OF THE LABOR COD E. INTEREST, AND ATTORNEY -S FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS 15 SUED IS EC. 3087, CIV C.). LENDER'S NAME LENDERS ADDRESS I CERTIFY THAT 1 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-MENTCNED PROPERTY FOR INSPECTION PURPOSES. JWgAGT}e �P-vv,.I =PEER—MI—TTEEv�'E PRI S,GNATUH .'P' M. TEE _ DATE PRESS FIRMLY DATE APPLICATION PERMIT_ NUMBER �#!C ISS?�� TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDEISIDE STREET RW ❑ SIDE ❑ PROPOSED USE NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION SFRIADOMEM Garage/Carport WPatio/Deck LL Pootspa Z Re -Roof O Commercial m Valuation ADJ.AREA OUANTITY DESCRIPTION FEE C. G J CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP d ENERGY P,C ENERGY PERMIT RETENTION FEE:MAR- - PRE -ALT FEE: 1 1n V TOTAL FEES COMMENTS RECPT. NO. — PAID BY Z VALIDATIONW WHITE—Department Copy. YELLOW—Finance Copy. PINK—Assessor Copy. GOLDENROD—File Copy, GREEN—Applicant's COpy CITY. OF DIAMOND BAR INSPECTION RECORD V-010#5vo SETBACK FLOOR JOIST �' t• FTGS/FORMS/STEEL FHA REQMTS ELECTRIC GROUND UNDER FLOOR DUCT-*: I , : • �; GROUND PLUMBING UNDER FLO0I3•CONDUIT SLAB GRADE FIREPLACE FOUNDATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICE MID HT. BOND BEAM ROOF SHEATHING 8 FT. BOND BEAM FRAMINGNENTILIATION FINAL BOND BEAM ROOF COVER PRE -GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWERTFUB 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 LANDSCAPE/IRRIG. SEEP PIT/L.L ON SITE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST. FIRE DEPT. FINAL • ,•,`} ;, ; j% - FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC .•.�-, ,.,� DEV. FEES PAID., FINAL PLUMBING 'ENERGY \ j \ COMMENTS SEPTIC TANK SIZE "` -RA SEEP PIT/U SIZE