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Home My WebLink About13396 (7)ff*XP1 CITY OF DIAMOND BAR -�� — 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 _1A e> 5iM)� �EL.Qel5 Wr-IS6? APPLICANT TEL. CONTRACTOR x - ADDRESS CITY -A 2 ZIP TELJ2, 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 REOUMESAPEWrrMCONSTRUCT,ALTERIMPROVEDEMGJSK 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 L4 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 ALLEOED EXEMP. TON. ANY VIOLATION OFSECTKN 7071.6 BYANY APPLICMJT FOR A PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS ($500).): O LASOWTNEROF7HE PROPfRTY,ORMY EMPLCOMPENSATION.H WAGES AS THEIR SOLE COMPENSAT, WILL DO THE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, BU54 NESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY VMO BUILDS OR IMPROVES THEREON. AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SAIF IF, HOWEVER THE BUILDING OR IMPROVEMENT13 SOLD WITHIN ONE YEAR OF DOM 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 WTW LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044. BUSINESS AND PROFESSIONS NDE: THE CONTRACTORS LF DENSE UW DOES NOTAPPLY TO AN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THCREON. AND WHO CONTRACTS FOR SUCH PROJECTS W"HA CONTRACTOR(S) LICENSED PURSUANT TO THE CDNTRAG TORS LICENSE LAW.)L O IAM EXEMPT UNDER SEC. B. A P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERRDRY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER P (COMMENCING WITH SECTION 7000) OF DIVISION $ OF THE BUSINESS AND PROFESSIONS CODE, AND MYLICENSE IS N FULL FORCE AND EFFECT. (J vJ� LICENSE CLASS TC LIC. NO. __��^AA....,, DATE lMlg _ �� CONTRACTCR-i 1 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' COMPENSATKIN 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 O P S -A- 1 0 4_ POLICY NUMBER --1./ i •D (DRS SECTION WE)NDTBE OOMELE IM)OFTHE PERMIT IS MR ONE HUNDRED DOLLARS t$100)CALESSI 1 CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON N ANY MANNER SO WEMMEO THE WOMERS'COMPENSATIONlAYV3 OF CALIF RM{A, ANECOME Sl18JERT0WEWORKERS'COMPENSA IPRd\'SHE LIBOR COOE I iQ��T`j�T1/ COMPLY Wl THOSE P DATE: , ! - 1 APPLICANT i I WARNING: FAILURE TO SECURE WORKER S -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 AFFIRM 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. GL 1 IEMOER5 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 BULDNO s CONSTRUCTION HE IEBYA E REPRESENTATIVES OF THIS COUNTYTO ENTER UPON THE ABOYEME EDP ERTY FO N PECTION PMHJDFj]"5. i LL,.J C' i L PERMITTEE (PR Q i 7 SONATUREOFPERMITTEE DATE APPLICATION PERMfTk PIC DATE NUMBE # ISSUED t n (� (] TYPE OCC DATE -=9-9--CONST. GROUP ZONING .SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE NO. DWEL. NO. NO. UNITS STORIES - BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ.AREA/VALUATION SFR/ADD/REM Cn Garage/Carport WPatio/Deck U- Pool/Spa ZRe -Root QCommercial - M Valuation ADJ.AREA QUANTITY DESCRIPTION FEE a _U W J W CG Z J n_ U d2 2 U W CONSTRUCTION PLAN REVIEW ELECTRIC ,MBIN _ MECHANICAL INSPECTION FEE ISSUANCE SMTP ENERGY P/C V OV lr� A �^• ENERGY PERMIT ,�ir'01N 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 r;�_��1'>>,'��' � ••'iNSPE TiONRECORD :s _ ,��:; �...� - � " SET BACK FLOOR JOIST�� IFTGS/FORMS/STEELTWN — —— — „ — —__111,FHAREQMTS — — — — IELECTRIC GROUND - -- - - - UNDER FLOOR DUCT- GROUND PLUMBINd UNDER FLOOR CONDUIT ' ` --- ,SLAB GRADE- FIREPLACE -FOUNDATION, - TEMP POWER-----------,-',-, - I FIREPLACE BOND BEAM IWATER SERVICE -- - - - - MID HT BOND BEAM !ROOF SHEATHING 8 FT. BOND,BEAM- , !FRAMINGNENTILIATION — - - - FINALIBOND BEAM IROOF COVER -c : PRE -GRADING iROUGH_HEATING' -- - -- - - BENCHING--- - iROUGv+ELECTRIC_. I-_-_ _.'._' ._'_ _. ROUGHGRADING ;ROUGH PLUMBING -- -- --- - -- :- ----------' - - 'FINISH GRADING i !SHOWERITUBTEST-' --- - - _POOL'ELECTRIC :EXT.-LATH/SIDING-';- - --- ---- --- POOL'FENCING VALL-INSULATION -' - - - POOL!FINAL ; CEILING -INSULATION - -- - OFF SITE IMPS., I :, DRYWALL -NAILING - - - - -DEDICATIONS r �ISEWER - -- - - -- - FINAL ENG:' ?:SEPTICTANK I LANDSCAPE/IRRIG. ' i ;�SEEf?_P;T/L.L. _ _ ON SITE IMPS.. ivi-S AIR TEST I FINALZONING kf:'t '':,':ONST,-1- _FIRE DEPT FINAL - Tf:, -HEALTH DEPT. FINAL - -- :.;_ ELECTRIC - - - - - DEV. FEES PAID - - - - - - ------ ENERGY (; . ;OMMENTS r. • - _ 1 , t !SEPTIC TANK SIZE !SEEP PIT/Ll SIZE a I