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Home My WebLink About12327 (6)�i t: V C C J� CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 PRESS M BUILDING PERMIT APPLICATION FIRMLY JOBSITE ADDRESS 3%�Ig APN LOT TRACT OWNER 6PC"(<0 nr' y j41'j ADDRESS enAH E CITY ZIP TEL. --rte_ APPLICANT TEL CONTRACTOR r isi - ADDRESS Q''7Lge r C�Acr-IFJty.J IST r��:��1� CITY ZIP TEL -_Z37 j0,'S•`L� - ARCWENG! DESIGNER ADDRESS CITY ZIP TEL OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS U - CENSE LAW FOR THE FOLLOWING REASON (SEC. 7001.6 BUSINESS AND PROFESSIONS CODC: ANY CITYOR COUNTY WHICH REQUIRESA PERMIT TO CONSTRUCLALTER IMPROVE. DEMOLISH, OR REPAIR ANY STRUC- TURE. PRIOR TO ITS ISSUANCE. ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LF CENSE UW (CRAFTER I (COMMENCING WITH SECTION 70001 OF DIVISION 5 OF THE BUSINESS AND PRO- FESSIONS CODE) OR THATHE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. XEMP. TIO N. ANY VIOLATION OF SECTION 7071.6 BY ANYAPPLICANT FORA PERMIT SUBJECTS THEAPPLICAYT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (SM4 17 LAS OWNER 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 WIND BUXDS OR IMPROVES THEREON. AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH W PROVEMENTSARE NOT INTENDED OR OFFERED FOR SALE IF.HOWEVER.THE BUILDING OR IMPROVEMENT IS SOLD WRHINONEYEAR OFOOMPLE- TION, THE OWNERNBUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR MPROVEFOR THE PURPOSE OF SALE} O IL AS OWNER OF THE PROPERTY. AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC, 7044. BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS U - CENSE UW DOES NOTAPPLY TO AN OWNER OF APROPERIY WHO BUADS OR IMPROVES THEREON. AND W/q CONTRACTS FOR SUCH PROJECTS WRHA CONTRACTORS) LICENSED PURSUANT TOTHE CDNTRAr, TORS LICENSE LAW.), O IAM EXEMPT UNDER SEC. B. L P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER •(COMMENCING WITH SECTION 7000) OF DIVISION S OF THE BUSINESS AND PROFESSIONS Coot -AND - MY LICENSE IS IN FULL FORCEAND EFFECT. q LICENSE CLASS IS —/ UC, No. 4'""'' Z I DATE 3,0 lap CONTRACTO `t'u'Jenot WORKERS' COMPENSATION DECLARATION I HEREBYAFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: - -1 HAVE AND WILL MAINTAINA CERTIFICATE OF CONSENT TO SELFdNSURE FOR WORKERS' COMPENSATION. AS PROVIDED BY SECTION 5700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. r _I "IWILL MAINTAINWORKERS' COMPENSATION INSURANCE, AS FECUIRED BY SECTION 5700 OF THE LABOR WOE FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE-- CARRIER RECARRIER POLICY NUMBER (RCS SCC TONNE W NOTU COLFILETEDOFTrE PERMIT S FORONE HI.OFEDDOLLARS (L100)ORLM I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER $O AS TO BECOME SUBJECT TO THE WORKERT COMPENSATION LAWS OF CAUFORNA, AND AGREE THAT IF I SHOIL BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 5700 OF THE LIBOR WO I SHALL FORTHWITH COMPLNWPT E P VISIONS. DATE: r APPLICAN_ WARNING: A0.URE TO SECURE WOR(ERSCOVERAGE IS UNLAWFUL•AND SHALLBE SUBJECTAN EMPLOYER TOCRMINAL PENLFWESUPTOONEHNDREDTHOUSAND DOLLARS (51WAM). IN AODITICN TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN I SECTION 5701 OF THE LABOR CODE. INTEREST. AND ATTORNEYS 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 ISSUED (SEC. 5007, CRC O). I LENDERS NAME LENDERS ADDRESS 1 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. 1 AGREE TO DOM PLY WITH ALL CRY 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 NSPECTICN PURPOSES. I PERMITTEENAME (P - ' 7 BW E RTEE _;.r.t - DATE APPL PERMIT /Z P/C DATENUMBERICATIO >J 1i TYPE OCC DATE CONST, GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDESTREET RW O SIDE ❑ PROPOSED USEr (Jcr n . s41A NO. DWEL. NO. - UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport WPatlo/Deck ' PDOVSPa Re -Roof J COmmerclal - m Valuation - ADJ.AREA QUANTITY DESCRIPTION FEE J a U lL F U U.1 LU LU 0 2 m ; o. �Q U a 2 U W CONSTRUCTION I W L.IQ PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE co . SNIP_ _ J� ENERGY P/C I •�}J�% 'ENERGY PERMIT RETENTION FEE: PRE-ALTFEE: TOTAL FEES COMMENTS RECPT. NO. PAID BY VALIDATION L 1 � WHITt—Uepertment t:Opy, TtLLUYV—+Hence L:opy, rmn—wSseeev a.0py, uuwcnnvv--Elro wpy, unccrr—np1UTAarn s I,vpy CITY OF DIAMOND BAR.,.i,, j s INSPECTION RECORD SET BACK \ __ .= , ' . t • FLOOR JOIST,,.,, ' t;t FTGS/FORMS/STEEL FHA REQMTS ELECTRIC GROUND _- -:_ ':_ '- - ' ' ' .:: UNDER FLOOR DUCT r GROUND PLUMBING UNDER FLOOR CONDUIT SLAB GRADE _ .__ . -_-._ _ FIREPLACE FOUNDATION TEMP POWER- -- '.! - FIREPLAbI= BOND BEAM r -- WATER SERVICE MID HT.,BOND BEAM -- ROOF SHEAtHING 8 FT. BOND BEAM t FRAMING/VENTILIATION :._ , .: - 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 . _ _..._ .. __ _ _ ... ___ .. _. , _ . LANDSCAPE/IRRIG. SEEP PITIL.L. = =-- =-' -== J' ON SITE IMPS. ' GAS AIR TEST -- - FINAL ZONING i FINAL -CONST.- ' - - FIRE DEPT. FINAL FINAL HEATING = ' - - HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY COMMENTS --- — SEPTIC TANK SIZE SEEP PIT/U SIZE ,