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Home My WebLink About14955 (19)A CITY OF DIAMOND BAR ' DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190(909) 860-3195 Fax (909) 861-3117 PRESS BUILDING PERMTI' APPLICATION FIRMLY JOBSITE _(�2N ADDRESS / �L! APN LOT TRACT OWNER_ ADDRESSL CITY ZIP T�PEII APPLICANT TE CONTRACTOR C _ ADDRESS CITY ZIP TE J ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION. I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE UW FOR THE FOLLOWING REASON ISEC. 7071.6 BUSINESS AND PROFESSIONS CODE ANY CITYOR COUNTY WHICH REQUIRES A PERMIT TOOONSTRUCF.ALTER RAPROVE, DEMOLISH OR REPAIR ANYSTA— TVRE. 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 LI. CENSE LAW 00 (CHAPTER 0 (COMMENCING WITH SECTION 70) OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM ANT) THE BASIS FOR THE ALLEGED EXEMP- TION.ANY VIOLATION OF SECTION 7071.6 BY ANY APPLICANT F07 A PERMIT SUBJECTS THE APPLICANT 70 A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (SSW).): 0 L AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK ANO THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, BUSI- NESSAND PROFESSIONS CODE: THE CONTRACTORS LICENSE UW DOES NOTAPPLY TO AN OWNER OF PROPERTY W WHO BUNDS OR IMPROVESTHEREON. AND WHO DOES SUCH WORKHIMSELFOR HERSELFOR 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 -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE), 0 L AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTNO WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEG 7044. BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS U - CENSE LAW DOES NOT APPLY 70AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WWHO CONTRACTS FOR SUCH PROJECTS WITHACONTRACTOR(S) LICENSED PURSUANT TO THE CONTRACT TORS LICENSE LAW.). O IAM EXEMPT UNDER SEG B. L PC. FORTHIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJUFTY THAT IAM LICENSED UNDER PROVISIONS OF CHAPT a(COMMENCNG WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONSCOOE, O W LICENSE NFIAJ. FORCE AND ECT. F�.�nl LICENSE LIC. NO. ` p1 (/ U —/ DATE CONTRACTOR i WORKERS'COMPENSATION DECLARATION //OnnO ~ 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS _IHAVEANDWILLMANTAINACERRFICATE OF CONSENT TO SELF -INSURE FOR WORKS S' COMPENSATON, AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE 0FTHE WORK FOR WHICH THIS PERMIT IS ISSUED. _I HAVE AND WALL MAINTAN WORKERS' COMPENSATION INSURANCE. AS REWIRED BY SECTIO 77000E THE LABOR CODE, FOR THE PERT-0RMANCF�FTHE WOi1K iCytWMICHTHIS PEP ISSUED. MY WORK PE . TIONINSU C1 r VD ..IO'NUMBER CARRIER i. _ . 17 CVY POLOYNUUTIER (IFESSECTICN FEED NOT BE COMPLETEDOP THE PERMIT IS FOR ONE HUNDRED j. (Simi 10ERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I SHALL NOT EMPLOY ANY REASON N ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF 1 SHOULD BECOME SUBJECT TO THE WORCERT COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE.I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE: APPLICANT. - WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALLBE SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES ANO CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS IS100,000), N ADDITION TOTHE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37080F THE LABOR CODE. INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE ISA CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICHTHIS PERMIT IS ISSUED (SEC.3097, CIV. C.). LENDER'S NAME LENDERSADDRESS 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 ABO'VE.MENTIONED PROPERTY FOR INSPECTION PURPOSES. 1 - PERMITTEENAME(PR 3 BIGNATLOEOF P IMI EE DATE APPLICATION PERMIT /C DATE 1 0�1p. w NUMBERISSUE �� TYPEOCC ✓ " DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE NO. DWEL. NO. NO. UNITS - STORIES BEDROOMS DESCRIPTIONSO. FT. FACTOR PSF J. AREAIVALUATION SFRIADD/REM ch Garage/Carport f WPatio/Deck LL- POOVSPD ZRe -Roof OJ Commercial m Valumia. ADJ.AREA QUANTITY DESCRIPTION FEE J Q _ _ U U W . _J : t7 � Z Q W CONST CTION R P`��p!/� RE - J �LECTRI TO— I .. UNG MECHANICALM INSPECTION FEE Id � ISSUANCE SMIP ENERGY P/C ENERGY PERMIT �T //'w 13 —iT ,10 f RETENTION FEE: I�t72tTt+iL�L�'7 AND SA A PRE -ALT FEE: TOTAL FEES .SO COMMENTS PECK. NO. PAID BY r VALIDATION W-RITE—Depe rtment Copy, YELLOW—Finance Copy, PINK—Assessor Copy, GULULNHVU—rile UOpy, UHELN—APPIWOnTS UOM CITY OF DIAMOND BAR., INSPECTION 'RECORD . ms-p-otfou i -Ow SETBACK DATE 'INSPECTOR INSPECTION DATE INSPECTOR� FLOOR JOIST, FTGS/FORMS/STEEL r FHA REOMTS ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR CONDUIT SLAB GRADE FOEPLACE -FOUNDATION TEMP POWER FIREP'12ACE BOND BEAM WATER SERVICE. MID HT. BOND-13EAM. - ROOF SHEATHING f- 8 F.r.,BOND BEAM .................. :-.1 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, i OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER FINAL ENG. SEPTICTANK_ LANDSCAPE/IRRIG. SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST.: FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC FINAL PLUMBING tbDEV. FEES PAID ENERGY COMMENTS... 1J. SEPTIC TANK SIZE -SEEP PlT/U. SIZE