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Home My WebLink About13044 (17)CITY OF DIAMOND BAR / DEPARTMENT OF COMMUNITY_ & DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 PRESS BUILDING PERMIT APPLICATION FIRMLY JOSSrTE ADDRESS�Z��l�OQKFf"VLL P� APN LOT 4- TRACT OWNER ADDRESS 6' L4 A. CITY _PIAMOAvh &4 -IL ZIP TEL. APPLICANT TEL CONTRACTOR I T- GNo wic•C+ ADDRESS 4r, L1.1 Afk CITY P94dalk ZIP TELxn1s w ARCH/ENG/ / '' DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS U. CENSE UW FOR THE FOLLOWING REASON (SEC. 7031 6 BUSINESS AND PROFESSIONS CODE ANYCrTY OR CCNINTYYHIICH REO WES A PERMIT TO CONSTRUCT.ALTER.IMPROVE. DEMOLISH, OR REPAIRANY STRUC. TURE PRIOR TO ITS ISSUANCE. ALSO RECUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS U. CENSE U1M W (CHAPTER I (OOMENCNO WITH SECTION TODD) OF DIVISION 7 OF THE BUSINESS AND PRD FESSIONS CODE) ORTHAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FORTHE ALLEGED EXEMP- TION. ANY VIOIADON OF SECTION 7011.6 BY ANYAPPLICANT FORA PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS O L AS OWNER OF THE PROPERTY. OR MY EMPLOYEES WITH WAGESAS THEIR SOLE COMPENSATION, WILL DO THE WORK. AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044. BUSI- NESS AND PROFESSIONS CCOE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY VINO BUILDS OR IMPROVES THEREON, ANDYNNO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES. PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE IF. HOWEVER THE RUILDNG OR IMPROVEMEMIS SOD WTTHN ONEYEAROF CCMPLE- TON, THE CWNERBWDER WILLHAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUID OR IMPROVE FOR THE PURPOSE OF SALE). O LAS OVMER OF THE PROPERTY. AM EXCLUSMELY CONTRACTINO WTM LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS L4 CENSE LAW DOES NOTAPPLY TO AN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON. AND YIHOCONTRACTS FOR SUCH PROJECTS WITH A OONTRACTOR(S)LICENSED PURSUANTTO THE CONTRAC- TORS LICENSE LAW). O I AM EXEMPT UNDER SEC. B. L P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION . I HEREBY AFFIRM MINDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER I (COMMENCING WITHSECTION 7000) OF OW SALON 30F THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS N FULL FORCEANDD7EF/FIE�CT. LICENSE CLASS 6. `ij 3 LID. No. DATE I �`��T_ CONTMCTOFl 7 U WORKERS' COMPENSATION DECLARATION V IHCREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WLL MAINTAIN A CERTIFICATE OF CONSENTTO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION 3700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH H THIS PERMIT IS ISSUED. I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY SECTION 5700 OF THE LABOR CODE FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMITIS ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE CARRIER POLICY NUMOER r,/•.,�f _ (RLS SECTION NEEDNOT BEC/OMPEIrMCFTIE PEMV IS FOR ONE HIN•DREDD LIARS ISIODIORLESSI I CERTIFY THAT LATHE PERFORMANCE OF THE WORK Fon WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER BOAS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF 1 SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 1700 OF THE LABOR CODE.I SHALL FORTHWITH COMPLY WI7H THOSE PROVISIONS. DATE:. �'2_Zl_ APPLICANT: =6 1r m dL— WARNING: FAILURE TO SECURE MARKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL BE - SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (3100.0m). N ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 370a 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. 3W7• CIV. C.). LENDER'S NAME LENDER'SADDRESS I CERTIFY THAT I 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 AUTHORZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. wXV .PERMITTEE NAME (P� , r _ 7 - 2 T L, , I SKUNA7 F ERgTTEE • DATE APPLICATION 1 ��5_/� 1 "1 DATE NUMBE N!C ISSUE �, TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDEISIDE STREET RW ❑ SIDE ❑ PROPOSED USE to 11,14 M I " (` S NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. -FACTOR PSF ADJ. AREAIVALUATION SFR/ADDIREM N Garage/Carport Patio/Deck LLLI LI- Pcol/Spa ZRe -Roof OJ Commercial - 5 CO Valuation ADJ.AREA QUANTITY : DESC ON FEE 4 G l',L ', -•. L - WV�' •/ S 1 • U w ' J W { Z CO L L a U _ t S U W CONSTRUCTION PLAN REVIEW ELECTRIC A PLUMBING L MECHANICAL { INSPECTION FEE ��-�� =VJ �h� D1,UCI 1In r GhI01,wIa :10 Ajj ISSUANCE SMIP L _ ENERGY PIC st ENERGY PERMIT RETENTION FEE:-� PRE -ALT FEE: TOTAL FEES �� Z� • 7D COMMENTS RECPT.NO. PAID BY �� VALIDATION v WHITE—Depanment Copy, YELLOW—Finance Copy. PINK—Assessor Copy, GOLDE' D RO-Fpe Copy, GREEN,44ican' Copy \ �l CITY OF DIAMOND BAR ' INSPECTION RECORD" INSPECT[ON DATE �ANSPECTOR SETBACK. ! "' ! j .'INSPECTION FLOOR JOIST DATE FTGS/FORMS/STEEL FHA REQMTS - ELECTRIC GROUND - UNDER FLOOR DUCT i GROUND PLUMBING UNDER FLOOR CONDUIT SLAB GRADE- FIREPLACE FOUNDATION TEMP POWER - FIREPLACE -BOND BEAM _ : _ .. _ _ . - WATER SERVICE. - MID HT. BOND BEAM. " ROOF SHEATHING' S 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 _._.. _:._..__ LANDSCAPE/IRRIG. SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST- FINAL ZONING FINAL• CONST:' 0, �' �( r FINAL HEATING T FIRE DEPT. FINAL HEALTH DEPT. FINAL . FINAL ELECTRIC DEV. FEES PAID FINALPLUMBING ENERGY COMMENTS- SEPTIC TANK SIZE SEEP PIT/U SIZE