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Home My WebLink About14962 (17)CITY OF DIAMOND BAR l� DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES J 1 c 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 PRESS BUILDING PERMIT APPLICATION FIRMLY r =D Z> d JOBSITEZ( _� I O ADDRESS 3( APIN LOT TRACT OWNER _j�edj VW IJA f ADDRES7n r c.�<1l'o CITY 7 R (n — Nr, r ZIP (TEL. APPLICANT TEL. CONTRAC OR��o WA 'YsnY;n. C'L AD RES 'Sra� SI-WAu� CITY ZIP C111`i-3 _ TEL tip 1:10 ' ARCWENG/ DESIGNER ADDRESS CITY ZIP TEL OWNER -BUILDER DECLARATION I HEREBY AFFBW UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS l4 CENSE LAW FOR THE FOLLOWING REASON (SEC. 76711 BUSINESSAND PROFESSIONS CODE: ANY CITYOR COUNTY WMOC REOLI3RES A PERMRTO CONSTRUCT.ALTER IMPROVE. DEMOUSH,OL REPAIR ANY STRUC- TURE. 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 LF CENSE LAW (CHAPTER 0 (COMMENCING WITH SECTION 7000) OF DIVISION 7 OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7D71.8 BY ANYAPPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (3500).): O L ASOWNEROF THE PROPERTY.OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION. WILL DO THE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 70". BUSI- NESS AND PROFESSI ONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON. AND WHO DOES SUCH WORN HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES. PROVIDED THAT SUCH MPROVEMENTSARE HOT INTENDED OR OFFERED FOR SALE IF, HOWEVERTHE BUILDING OR IMPROVEMENT IS SOLD WITHIN CNE YEAROFCOMPLE- T10N. THE OWNER -IMA DER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). O L AS OWNER OF THE PROPERTY, MC EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044. BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS U. CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR MP ROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS ONTRAOTORS LICENSE LAW.). . O I AM EXEMPT UNDER SEG B. 3 P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBYAFFIRM UNDER PENALTY OF PERJURY THAT 1 AM LICENSED UNDER PROVISIONS OF CHAPTER e (COMMENCING WITH SECTION 70001 OF DIVISION 7 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT. LICENSE CLASS % V1 LIC. NO. DATE 3��1 OI CONTRACTOR WORKERS' COMPENSATION DECLARATION I HEREBYAFRRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINTAIN ACERTIFICATE OF CONSENT TO SELFdNSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTKX137000F THE LABOR CODE FOR THE PERFORMANCE OF THE WORK FORWHICH THIS PERMIT O ISSUED. 1 HAVE AND WILL MAINTAIN WOCOMPENSATION INSURANCE. AS REOUIRED BY SECTION 37000E THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY YR7jjK��ER..�S�.--COAPLTISATION URMICE CARRIER AND POLICY NUMBER ARE: CARRIER �T�'I'+ II^ POLICY NUMBER - 1 rMSECMN NEMNOT SEGO XU7ED OF hE PEF#ATISFORCNE RRCFCDDdLARS RIOLTOnLFSSI 1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA. AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE.I $HALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE: APPLICANT: i j WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE ISUNLAWFUL,AND SHALLBE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (3100,600). IN ADDITION TO THE COST OF COMPENSATION, DAMAGE3 AS PROVIDED FOR IN i SECTION 3708 OF THE LABOR CODE. INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY i 1 HEREBYAFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OFTHE WORK FOR WHICHTHIS PERMIT IS ISSUED (SEC. 3007• CIV. G). LENDER'S NAME LENDERSADORESS 1 1 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 SULDINO CONSTRUCTION, AND HERE8Y AUYMORIZ6 REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVEJZED PROPERTY FORINSPECTI)N PU ES. 3 ` I PERM AN -,& 7 ;;T EOF ITTEE DATE APPLICATION I VL) P/C DATE NUMBER ISSUE ten, TYPE OCC DATE V " CONST. GROUP ZONING SETBACKS FRONT 'RW ❑ REAR ❑ - SIDEISIDE STREET RW ❑ SIDE ❑ - PROPOSED USE ZL 3,0 .I . -- {J,I r• . O r NO. DWEL NO. NO. 1 UNITS STORIES _i BEDROOMS 3 .... DESCRIPTION SO. FT. FACTOR PSF ADJ. AREANALUATION SFRIADDIREM U) Garaga/Carport WPatio/Deck LI•' Pool/Spa ZRe -Roof O Commercial CD Valuation ADJ.AREA QUANTITY DESCRIPTION FEE F -- U w w w t7 2 m J a U Z 4 2 U W 1 L7 -A CONSTRUCTION PLAN REVIEW ELECTRIC ,�► PLUMBING _- T 11 MECHANICAL INSPECTION FEE ISSUANCE AY SHIP Cr 7� 0ND 11 AR _ ENERGY PIC BUILDING ENERGY PERMIT .AL _ RETENTION FEE: PRE -ALT FEE TOTAL FEES J a / I COMMENTS RECPT. NO. PAID BY V VALIDATION WHITE—Deparbronl Copy. YELLOW—FlnaRco Copy. PINK—Assessor Copy. GOLDENROD --File Copy. GREEN—ApplicaRCs (;" CITY OF DIAMOND -BAR INSPECTION`RECQRD ; SET BACK INSPECTION DATE INSPECTOR FLOOR JOIST FTGS/FORMS/STEEL ' FHA REQMTS ELECTRIC GROUND "'. " - '.-' `'. UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR CONDUIT SLAB GRADE _ FIREPLACE FOUNDATION TEMP POWER- " - FIREPLACE BOND BEAM... ... WATER SERVICE == MID HT. BOND BEAM ROOF SHEATHING''. - �%% -- �P/!YL -. S`FT. BOND -BEAM FRANUNGNENTILIATION FINAL BOND BEAM ROOF COVER i 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., FIRE DEPT. FINAL -FINAL-HEATING - HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID - - FINAL PLUMBING ENERGY COMMENTS - SEPTIC TANK SIZE SEEP. PIT/U SIZE 1