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Home My WebLink About13396CITY OF DIAMOND BAR EXPI -�� — DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES i 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 PRESS BUILDING PERMIT APPLICATION FIRMLY JOBSITE 2 y y3 ,4 nj C ADDRESS APN LOT TRACT OWNER ADDRESS y A y LIC_ A CITY _Ix e) 5iM)� �EL.Qel5 Wr-IS6? APPLICANT TEL. CONTRACTOR x- ADDRESSlfft CITY -A2 ZIP TEL ARCWENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS L$ CENSE UW FOR THE FOLLOWING REASON (SEC. 70.71.6 BUSINESS AND PROFESSIONS CODE: ANY CITY OR COIWTY V"M REQL 4P.FSAPEWrrMCONSTRUCT.ALTERIMPROVEDEMOIJSK OR REPAIRANY STRUC TURF 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 I.I. DENSE UW (CHAPTER 6 (COMMENCING WITH SECTION 7004) OF DIVISION $ OF THE BUSINESS AND PRO• FESSIONS CODE) OR THATHE OR SHE IS EXEMPTWEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OFSECTION 7071.6 BYANY APPLK.NJT FOR A PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS ($500).): O LASOWNEROF7HE PT10PfRTY,ORMY rMPLOYEES WAGES AS THEIR SOLE COMPENSAT, WILL DO THE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC 7044, BUS4 NESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY VMO BUILDS OR MPROVESTHEREON. AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER CNN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SAIF IF, HOWEVER THE BUILDING OR IMPROVEMFUNT13 SOLD WITHIN ONE YEAR OF COM PLC - TION. THE OWNER -BUILDER WALL HAYE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE} ❑ L AS OWNER OF THE OF AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044. BUSINESS AND PPCFESSIONS NDE: THE CONTRACTORS LI- DENSE FDENSE UW DOES NOTAPPLY TO AN OWNER OFA PROPERTY WHO BUNDS OR IMPROVES THCREON. AND WHO CONTRACTS FOR SUCH PROJECTS WTWA CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). 0 IAM EXEMPT UNDER SEC B. A P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER 6 (COMMENCING WITH SECTION 7000) OF DIVISION $ OF THE BUSINESS AND PROFESSIONS CODE, AND MYLICENSE IS N FALL FORCE AND EFFECT. vJ� LICENSE CLASS TC (J LIC. NO. DATE lMlg _ �� CONTRACTOR -i � 1 WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: _I HAVE AAO WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVO ED BY SECTION $7DO OF THE LABOR CODE, FOR ME PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. Y-1 HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE. AS REWIRED BY SECTION 37000F 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 S () P �IFL(�At7 _ POLICY NUMBER I,( Y S 61 (DIS SECTION NE®FOTBE OCIAPLETED OFTFE PER,(T IS FOR ONE HUNDRED DOLLARS LTM00)ORLESSI 1 CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN MANNER SO WEMMEO 744E WOMERS'COMPENSATIONlAYN3 OF CALIF RM{d, ANECOME Sl18JERT0THE WORKERVOOMPENSA NPRd\'SHE LIBOR COOE I iQ��T�jT1/ COMPLY Wl THOSE P DATE: , ! - 1 APPLICANT i I WARNING: FAILURE TO SECURE WORKERS -COMPENSATION COVERAGE ISUNLAWFUL. AND SNALLBE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS (6100,000). N ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR N I SECTIONS70L OF THE LABOR CODE, INTEREST. AND ATTORNEYS FEES. 1 CONSTRUCTION LENDING AGENCY i I HEREBY AFFWM UNDER PENALTY OF PERJURY THAT THERE IS ACONSTRUCTKN LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3W7, CIV. CL 1 LENDER'S NAME LENDERS ADDRESS I 1 CERTIFY THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL CT' AND COUNTY ORDINANCES AND STATE LAWS RELATING TO GULDINO s CONSTRUCTION HE IEBYA E REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVEME EDP ERTY FO N PECTION PMNJDFj]"5. i OU i L PERMITTEE (PR O i 7 SONATUREOFPERMITTEE DATE APPLICATION PERMfTk PIC DATE NUMBE # ISSUED t n (� (] TYPE OCC DATE -=9-9--CONST. GROUP ZONING .SETBACKS FRONT RW ❑ REAR 0- SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE NO. DWEL. NO. NO. UNITS STORIES - BEDROOMS DESCRIPTION 80. FT. FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM C13 Garage/Carport WPatio/Deck U- Pool/Spa ZRe -Roof Commercial - M Valuation ADJ.AREA QUANTITY DESCRIPTION FEE a _U W J W 0 Z DO �A 0L ' DO J a U d� S U W CONSTRUCTION PLAN REVIEW ELECTRIC ,MBIN _ MECHANICAL INSPECTION FEE mn ISSUANCE SMTP ENERGY P/C 01 lr� G11V A �^• ENERGY PERMIT,�ir T�ily t. RETENTION FEE: PRE -ALT FEE: TOTAL FEES 3 C7 U COMMENTS RECPT 440. PAID BY VALIDATION WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD -File Copy, GREEN—Applicants Copy TiON•RECORD .' TWN SET BACK -'� = FLOOR JOIST��` FFTGS/FORMS/STEEL -- -- - „ FHAREQMTS- -- - - - (ELECTRIC GROUND _. _.- -" -" - r J\_. 'UNDER FLOOR DUCT - '' - - - 'GROUND PLUMBING UNDER FLOOR CUfaDU1T` ,SLAB GRADE- --- -- FIREPLACE'FOUNDATION - 'TEMP POWER -----------'-V, - I FIREPLACE BOND BEAM (WATER SERVICE -- - - - - MID HT BOND BEAM !ROOF SHEATHING 8 FT. BOND,BEAM- , !FRAMINGNENTILIATION — - - - FINALIBOND BEAM (ROOF COVER .c : PRE -GRADING - -- - -- = !ROUGH_ HEATING' -- - -- - - BENCHING- ;. - -- ; , ! iROUGH'ELECTRIC_ I - - ."::: , : ROUGH GRADING. - - - - - --- ,: ;ROUGH PLUMBING -- - --- - -- - ---------- ' - 'FINISH GRADING !SHOWEWTUBTEST-' --- - - _POOL`ELECTRIC :EXT.-LATH/SIDING-';- - --- ---- --- POOL'FENCING '.b`lALL-INSULATION -' - - - - POWFINAL ; CEILING -INSULATION - -- - OFF SITE IMPS., I :, DRYWALL -NAILING - - - - - -DEDICATIONS r , �ISEWER - -- - - -- FINAL ENG:' . ,. ,. ±:SEPTICTANK I LANDS CAP E/IFIR IG. i ,SEEP_P;T/L.L. _ _ ON SITE IMPS.. iGz S Al TEST I FINALZONING FIRE DEPT. -FINAL - .1 1:_ .HEATING_._____- -- - -- - - - HEALTH DEPT. FINAL - -- ELECTRIC - - - - - DEV. FEES PAID - - - - ----- ENERGY' (.. ;OMMENTS , yip. �r j , ' t !SEPTIC TANK SIZE !SEEP PIT/U SIZE I _• ; , r- , I _ ; , , \1