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Home My WebLink About10074 (5)i itffli MLU, i{ CITY OF DIAMOND BAR COMMUNITY DEVELOPMENT DEPARTMENT 21660 E. Copley Drive Suite 190 (909) 660.3195 Fax (909) 861.3117 BUILDI;IGPWMITAPPLIC V---' PRESS FIRMLY JOBSITE ADDRESS ADDRESS i APPLICATION PERMIT H77f✓ 7y P/C �� DATE - ` NUMBER / N 1 TYPE OCC DA EE �(? �%� CONST GROUP ' APN LOr T ACT` "�' OWNER �Z 'ZONING SETBACKS FRONT RW ❑ REAR ❑ 1:1SIDEISIDE STREET RW ` 0 - SIDE ❑ ADDRESS U-2.: if CITY ZIP TEL d APPLI ANT TEL. CONTRACTOR PROPOSED USE %/I! Q,Q� I CIT YRESS ZIP TEL ARCFVENG/ DESIGNER ADDRESS CITY ZIP TEL -NO. DWEL NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAMALUATION OWNER -BUILDER DECLARATION SFFVADD/REM (n Garage/Carpolt - 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSELAWFORTHEFg10WINGREASON(SEC-70.11.5 BUSNESSAND PROFESSIONS CODE:ANYCITYOR COUNTY WHICH REOUIRESA PERMIT TO CONSTRUCT,ALTER. IMPROVE DEMOUSRORREPAIRANYSTRUC- TUBE, PRIOR TO ITS ISSUANCE ALSO REWIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW (CHAPTER 0 (COMMENCING WITH SECTION 7000) OF DIVISION ] OF THE BUSINESS AND PRO- LU LL Pat10/DeCk LL POOVSPEL - - FESSIONSCODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THEALLEOED EXEMP. (9T1014. Z Re -Roof ANY VIOLATION OF SECTION 7071.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (ISOO).): O J Commercial O L AS OWN ER 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. 704, BUSI. - NESS ANO 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 THR000HHIS ORHER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m OFFERED FOR SALE F. HOWEVER. THE BUILDING OR IMPROVEM ENT IS SOLD WITHIN ONE YEAR OFCOMPLE- - TON. THE OWNERbULDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). O L AS OWNER OF THE PROPERTY, AM EXCLUSNELY CONTRACTING WITH LICENSED CONTRACTORS Valuatl ADJ.AREA TO CONSTRUCT THE PROJECT (SEC. 704, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS U. DENSE LAW DOES NOTAPPLYTOAN OWNER OFA PROPERTYWOHO BUILDS OR IMPROVES THEREON, AND QUANTITY DESCRIPTION FEE WHOCONTRACTS FOR SUCH PROJECTS WITHA CONTRACTOR(S) LICENSED PURSUANT TOTHE CONTRAC- TORS LICENSE LAW). U AM EXEMPT UNDER SEC. B. S P.C. FOR THIS REASON DATE OWNER W LICENSED CONTRACTORS D LARATION _ I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER 0 (COMMENCING WITHSECTION 70001 OF DIVISION ] OF THE BUSINESS AND PROFESSIONS CODE- MY LICENSE IS IN FULL FORCE AN EFFECT. T.J• Z m �J LICENSE CUSS MIC. NO. DATE CONTRACTOR a NDECLARATIO / WORKERS'COMP/OFTHE V Z - I HEREBY AFFIRM UNDER PENALTY OF PERJURYHE FOLLOWING CIARATONS: _ I HAVE AND WILL MAINTAIN A CERTIFICAENT TO INSURE FOR WORKERS' COMPENSATION. AS PROYOED BY SECTF THE CLUE, FOO THE PERFORMANCE OF THE WORK FORWHICHTHIS PERMIT W LU CONSTRUCTION I HAVE AND WALL MAINTAIN WORKERS'CINSURANCE, AS REOUIRED BY SECTION ]700 OF THE LABOR COD E. FOR THE PE EOFTHE WORK FOR WHICH THIS P ERMIT ISISSUED. MY WNRXERTOOMPENSATIONE CARRIER AND POLICY NUMBER ARE: CARRIER PLAN REVIEW 1 L POLICY NUMBER ELECTRIC - (T/ISSECRNNEEDNOTBE CFTHE PERMIT S R]RONE HUNDAEDOCUARS($100)OR LESS} PLUMBING I CERTIFY THAT N THE P ORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I MECHANICAL SHALL HOT EMPLOY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS'COMPEN KDNLAWSOFCALIFORNIA•ANDAOREETHATFISIOULDBECOME INSPECTION FEE SUBJECT TO THE RKERS'COMPENSATON PROVISIONSOF SECTION ]7000F THE LABOR CODE, I SHALL F TiWITH COMPLY WITH THOSE PROVISIONS. ISSUANCE DATE: APPLICANT: SMIP WARNINMF RE TOSECURE WORKERSCOMPENSATIONCOVE RAGE ISUNLAWFUL AND SHALL 0E ENERGY P/C SUBJECT EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOL IsI00,000), N ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR N ENERGY PERMIT S ION ]Toe OF THELABOFt CODE. INTEREST, AND ATTORNEY'S FEES. RETENTION FEE: . . ppE•ALT FEE: CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS ACONSIIIU LENDiNO AGENCY {111(IL'`Fr,..�� FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PER LIED (SED ]III7,CN. G). LENDERSNAME LENDERS ADDR I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTAL FEES 1 AGREE TO COMPLY WITH TILL CITY AND COUNTY ORDINANCES AAD STATE LAWS RELAYING TO BUILDING CONSTRUCTICK AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE7 - 7ENTIONEDEC PROPERTY FOR INSPECTION PURPOSES. �9�+ �� * COMMENTS PEA" NAAE (PRINT) SIGNATURE OF PERMITTEE - DATE - I - RECPT. NO. 3 S_ Z- _7", PAID BY .3 VAUDATK)N WHITE—Department Copy. YELLOW—Finance Copy. PINK—Asseasar Copy, GOLDENROD—File Copy. GREEN--AcOlcant's Copy CITY OF DIAMOND BAR'l. 114SPECTION RECORD .Al SETBACK FLOOR JOIST FIGS/FORMS/STEEL - FHA REQMTS, ELECTRIC GROUND UNDER FLOOR 'DUCT - GROUND PLUMBING UNDERFLOOR CONDUIT SLAB GRADE---.---- FIREPLAkCE FbLNDATION -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 SHOWER/TUB 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 LANDSCAPEARRIG. -SEEPPIT/L.L- ON SITE IMPS. GAS AIR TEST-'- FINAL ZONING FINALCONST.-i- FIRE DEPT FINAL, FINAL HEATING HEALTH DEPT. FINAL FINAL -ELECTRIC DEV. FEES PAID FINAL -PLUMBING ---- -- - ENERGY 0 1 Mc COMMENTS .SEPTIC TANK SIZE .SEEP PIT/U SIZE 7 7