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Home My WebLink About10115CITY OF DIAMOND BAR COMMUNITY DEVELOPMENT DEPARTMENT 21660 E. Copley Drive Suite 190 (909) 86D•3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION JOBSITE ADDRESS Li'i Gt LArx R I $ u m rn :-k d APN LOT TRACT OWNER L4./f, 1 ADDRESS�'� ��]� � yr �:rYr.rrt%IT br CITY'ZIP cL TEL. 1(� S APPLICANT TEL. CONTRACTOR q- g! etc'F"'I ADDRESS CITYC�•� /rnar iJ�1 ZIP TEL. ARCRTNG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AIA EXEMPT FROM THE CONTRACTORS LE CENSE LAW FOR THE FOLLOWING REASON (SEC. 7831.6 BUSINE'SSAND PROFESSIONS CODE: ANY CITYOA COUNTY WHICH REO IRESA PERMIT TO CONSTAUCT, ALTER IAG IMPROVE, DEMOLISH, OR REPAANY STRU TUBE. PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE SIGNED STATEMENT TRAY HE OR SHE IN LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LF DENSE LAW (CHAPTER 9 (COMMENCING WITH SECTION 7888) OF DIVISION S OF THE BUSINESS AND PR6 FESSIxNS CODE) OR THATHE OR SHE 18 EXEMPT THEREFROM AND THE BASIS FOR THE ALLE0E0 EXEMP• TION. ANY VIOLATION OF SECTION MIA BYANYAPPLICANT FOR A PERMIT SUBJECTS THEAPPLK:ANT TO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS 196801); 0L AS OWNER OF THE PROPERTY. OR MY EMPLOYEES WITH WAGESAS THEIR SOLE COMPENSATION, WILL DO THE WORK AND THE STRUCTURE 18 NOT INTENDED OR OFFERED FOR SALE (BEC. 70M, SUSI. NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH NIS OR HER OWN EMPLOYEES. PROVIDED THAT SUCH IMPROVEMENTS ARE NOT NTENDEDOR OFFERED FOR BALE IF, HOWEVER THE BUILDING OR IMPROVEMENT 18 SOLD WITHIN ONE YEAR OF COMPLE. TON. THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DD NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). ❑ L AS OWNER OF THE PROPERTX AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PRO.IECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI. CENSE LAW DOES NOT APPLY TOMO OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITHACONTWICTOR(S)LICENSED PURSUANTTO THE CONTRAC- TORS LICENSE LAW.). ❑ 1 AM EXEMPT UNDER SEC. B. A P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM LICENSED UNDER PROVISIONS OF CHAPTER III(COMMENCING WITH SECTION 7000) OF DIVISION S OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS N FULL FORCE AND EFFECT. LICENSE CLASS C- 7-! LIC. NO. �3 �� r=• F DATE' �0+4i'�7 CONTRACTORy r r,•t,.�', rv�_ WORKERS' COMPENSATION DECLARATION 1 HEREBYAFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: __I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF4NSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION VW OF THE LABOR CODE, FDA THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. _I HAVE AND WALL MNNTAN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY SECTION 8708 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT N OWED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMSERARE: CARRIER POLICY NUMBER (MSECfON NEEDNDrBE CONPLETEDOFTHE PERMIT 0 FOR ONE HA•DREDDOLLAM (910MORLESS). 1 CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT M 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 SUSJECTTO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR OODE. I SHALL FORTHWITH COMPLY WITH THOSE PR A6KONS. DATE: 1 -' APPLICANT. WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, U. SHALL BE SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TOONE HUNDRED THOUSAND DOLLARS ($700,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 8708 OF THE LABOR CODE. INTEREST. ANDATTOHNEY'S FEES. CONSTRUCTION LENDING AGENCY 1 HEREBYAFFNM UNDER PENALTY OF PERJURY THAT THERE I8 A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEG 30I7, CIV. C.). LENDERS NAME LENDERSADDRESS 1 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT, AGREE TO COMPLY WITH ALL CRY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ASOVEIAENTIONED PROPERTY FOR INSPECTION PURPOSES. PERGIRTEE NAVE (PRINT) ra IGNATURE7OF ►E V G / E ZA -'- N .. PRESS FIRMLY APPLICATION7 2 zi PERMIT ,Q�� P/C DATE NUMBER N ISSUE / TYPE OCC DATE G!/ Z f CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE 5 NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREM/ALUATION SFRIADDIREM N GaRape/Carpon W Patlo/Deck LL 2 POOVSPA Re -Roof Commercial m Valuatlon ADJ.AREA OUANTiTY DESCRIPTION FEE J d z 2 TRUCTI <Zjs PLAN RENEW ELECTRIC PLUMBING MECHANICAL in 03 !USZEQTION FEE SSUAN SMIP ENERGY PIC nn aI ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: TOTAL FEES Q. 0� COMMENTS RECPT. NO. Q &GSL' PAID BY f e 4 /VI VALIDATION WHITE—Oepartmsnt Copy, YELLOW—FInsncs Copy, PINK—Assessor Copy. GOLDENROD—FOILS Copy, GREEN—Appilgnre Copy CITY OF DIAMOND BAR 114SPECTION RECORD Ulu "I"_611-jigm 7FTGS/F0F!lMS/STEEL FL_O_OR JOIST _ _ _ FHAREQMTS GROUND _ UND_F:R FLOOR DUCT UNDER FLOOR'CONDUIT •. GROUND PLUMBING SLAB GRADE- FIMEPLACE FOUNDATION_ TEMP POWER - - I- `- ; FIREPLACE BOND BEAM --- ------ --- _ WATER SERVICE - - - - MID HT. BOND BEAM - = 8 FT. BOND BEAM_ ROOF SHEATHING - FRAMINGNENTILIATION _ BOND BEAM - " I ROOF COVER _ _ _FINAL PRE -GRADING ROUGH HEATING _ BENCHING _ ROUGH ELECTRIC - _ ; _ROUGH GRADING rJ ROUGH PLUMBING I FINISH GRADING SHOWERrrUB TEST POOL ELECTRIC EXT: LATH/SIDING - - -- ------ -- POOL FENCING - -- WALL INSULATION - POOL FINAL CEILING INSULATION _--_------- OFFSITE IMPS. DRYWALL NAILING DEpICATIONS J -- SEWER. --._-----.--.- FINAL ENG. SEPTIC TANK ! LANDSCAPEARRIG. SEEP PIT/L.L. - --- - �I.-ON SITE IMPS. -- --_-- --- GAS AIR TEST FINAL CONST. FINAL Z6NING - T: FIRE DEPT. FINAL - -------"-- - FINAL HEATING - HEALTH DEPT. FINAL i FINAL ELECTRIC i DEV. FEES PAID FINAL PLUMBING • ENERGY I k COMMENTS I SEPTIC TANK SIZE - --� --":------------ - --_-_. _.__ SEEP PIT/U SIZE -- ---- --- --- -