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Home My WebLink About10168 (5)CITY OF DIAMOND BAR COMMUNITY DEVELOPMENT DEPARTMENT 21660 E. Copley Drive Suite 190 . (909) 860.3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION PRESS FIRMLY APPLICATION 6 DDRIESS 2 $1 $ Oo K K Vi o l d cTE P/C DATE APN LOT TRACT 'y7 9 SI OWNER ALL No ms-" c ADDRESS RRAUCAE a Y Z CITY Auc-t ZIP9pc?7� TELSjO SgD:Yj5l g APPLICANT TEL. CONTRACTOR i C- ZONING SETBACKS ADDRESS-t3n T CITY_"AAA2)j h4fj7 ZIPSi[3-13 TEL o ARCWENG/ RW DESIGNER a ADDRESS CITY ZIP TEL SIDE/SIDESTREET cn ❑ Q OWNER-BCtLDER DECLARATION ' O p in I HEREBY AFFIRM UNDER PENALTY OF PERAIRY THAT 1 AM EXEMPT FROM THE CONTRACTORS U• W CENSE LAWFORTHE FOLLOWING REASON(SEC.7031.6 BUSNESSAND PROFESSIONS CODE:ANYCITYOR Q COINTYWHICH REOUIRESA PERMITTOCONSTRUCT.ALTER IMPROVE. DEMOLISH, OR REPAR ANY STWJC. TORE, PRIOR TO RSISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED UNITS STORIES STATEMENT THAT NE OR SHE - LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS U CENSE LAW PWTER 0 (COMMENCING WITH SECTION 700010E DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM MIO THE BASIS FOR THE ALLEGED EXEMP" FACTOR PSF TION. ANY VIOLATION OF SECTION 7071.6 BY ANY APPLICANT FOR A PERMI7 SUS.IECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS 16500).} O1.ASOWN EA OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, " MOLL W THE YORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044. BUSI- GaragwrA n - HESSAND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUI.DS OR IMPROVES THEREON, AND WINO DOES SUCH WORK HIMSELF OR HERSELF OR =THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR 0 OFFERED FOR SALE IF, NOWEWP'THEBULDNG OR IMPROVEMENT IS SOLD WITNNONEYEAROFCOMPLE• z TION. THE OWNER"BUIUDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SAL EI. W 0LA30YMER OF THE PROPERTY - AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS 1= LLJ TO CONSTRUCT THE PROUECT (SEC. TOaF, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS U. CENSE LAW DOES NOTAPPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND RATIO CONTRAC73 FOR SUCH PRWECTS WITHACONTRACTOR(S) LICENSED PURSUANT 70 THE CONTRAC- TORS LICENSE LAWL O O I AIL EXEMPT UNDER SEG B. A P.C. FOR THIS REASON 3 LL DATE OWNER Z LICENSED CONTRACTORS DECLARATION I HEREBYAFFlAM LANDER PENALTY OF PERJURY THAT IATA LICENSED LANDER PROVISIONS OF CHAPTER (i 0(COMMENCNG WITH SECTION 700010E DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE AND `Ilxl MY LICENSE IS N FULL FORCE AND EFFECT. — �// a y `f 11 Z2 Z UCENSECUSS UC.NO. U DAIS CONTRACTOR LU WORKERS' COMPENSATION DECLARATION N EA I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND MILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WOWIERS• 6 COMPENSATION. AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FORI THE PERFORMANCE OF THE WOR( FOR WHICH TWS PERMIT IS ISSUED. —Le4VEAND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE. AS REOUIREO BY SECTION Q 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS! SATION EJIRIVER AND POLICY NUMBER ARE Ht ONURANC CARRIER •`i VL O r,r POLICY MAAan d) 0 I�� V W . 0 (1T6 SECTION NEED NOT BECOMPLETED OFTHE PERMIT 15 FOR CNEHIIOFED DOLLARS 161 ODI OR LESSI LU Z I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH TRS PERMIT IS ISSUED. 1 C:} SHALL NOT EMPLOY ANY PERSCN N ANY MANNER SO AS TO BECOME SUBJECT TO THE U3 WORK ERWCOMPENSATKON LAWS OF CALIFORNIA, AND AGREE THAT IF I SHOULD BECOME S SUBJECT TO THE WORKERS•COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR MOE.1 SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. O p DATE: APPLICANT: LU WARMING: FAILURE 70 SECURE WORKERS• COMPENSATION COVERAGE IS UNLAWFUL AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND Y DOLLARS(6100,000LNAOOmON TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LIBOR CODE. INTERESL ANDATTORNM FEES, CL CONSTRUCTION LENDING AGENCY O I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE RACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WOW( FOR WHICH THIS PERMIT IS ISSUED (SEC. 3007, CN. O). zz CD LENDER'S NAME LENDERSADORESS THAT 1S CORRECT. LLj I CERTIFY THAT I WINE READ THIS APPLICATION AND STATE THE ABOVE INFORMATION RATING TO CI_ I AGREE TO COMPLY WITH ALL CRY AND COUNTY ORDINANCES AND STATE LAWS BULONG CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF INS COUNTY TO ENTER UPON THE Z ABOVE•MENTIONED PROPERTY FOR INSPECTION PURPOSES. o m R PERMITTE (PRN'T) . rn 2 OF PEIIMIT7EE OAT PRESS FIRMLY APPLICATION 6 PERMIT d P/C DATE NUMBER f ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR F-1 ❑ SIDE/SIDESTREET RW ❑ SIDE p PROPOSED USE NO. DWEL NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREA/VALUATION SFRIADO/REM " W GaragwrA n - . Wl Patme& LL p0OySpa yRe -Roof 0 Commerclal m Valuallon ADJ.AREA QUANTITY DESCRIPTION FEE Ht teeth O r,r V W LU 2 m �.1 C U 2 2 ul CONSTRUCTION P7LrCTRIC PL MECHANICAL INSPECTION FEE ISSUANCE F SMTP ENERGY P/C ENERGY PERMIT U 74 RETENTION FEE: PRE -ALT FEE: TOTAL FEES 3 COMMENTS RECPL NO. PAID BY ' VAUDATION V WHITE—Department Copy. YELLOW --Finance Copy. PINK--As"ssw COPY, GOLDENROD—File Copy, GREEN—WImnra Copy i CITY OF DIAMOND -BAR INSPECTION RECORD-:" SETBACK, -FLOOR JOIST FTGSIFORMS/STEEL J.FHA HEQ.kATS ELECTRIC GROUND J,UNDER FLOOR DUCT - GROUND PLUMBING UNDEF,_FLb0lR'CONDUIT YT!', SLAB GRADE FIREPLACE FOUNDATION-— TEMP POWER= FiliEPLACE BOND'BEAwi...... WATER SERVICE'- Kin HT; BOND ROOF SHEATHING 8 FT. T30ND BEAM FRAMINGNENTILIATION '-FINAL BOND BEAM-- I q . e . ROOF COVER .PRE -GRADING -------- ROUGH HEATING- .ROUGH ELECTRIC -` - BENCHING 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 - LANDSCAPEARRIG. .SEEP..PITlL.L'.._ ON SITE RAPS. .GAS AIR -TEST---- FINAL ZONING 7FINALCONST.-l- -FIRE DEPT FINAL 'FINAL -HEATING -HEALTH DEPT.'FINAL-.---,-- FINAL ELECTRIC ----- FINAL PLUMBING--- -DEV. FEES PAID, -ENERGY 7-7 77. 421-1 COMMENTS 7 ni SEPTIC TANK SIZE ---- -- SEEP PIT/IJ SIZE 7. A. V,