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Home My WebLink About15074 (17)CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 (909)860-3193 Fax(909)861-3117 BUILDING PERMIT APPLICATION JOBSITE ^' j` ``II 4 N y ADDRESS 2& 1 APN LOT TRA T OWNER ADDRE G IN CITY ZIP TEL, APPLICANT TEL CONTRACTOR ADDRE CITY ZIP /TEL ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE OOM7IACTORS LI- CENSELAW FORTHEFO XW JG REASON (SEC.7091.6 BUSINESSAND PROFESSIONS CODE: ANY CITYOR COUNTY WHICH REQUIRESA PERMITTOOONSTRUCT,ALTEFI, IMPROVE, DD]AOUBH, OR REPAIR ANY STRLJC• TURF, PRIOR 70 ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO RLE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS U. CENSE LAW (CHAPTER 0 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PRO. FESSIONS CODE) OR THAT HE OR SHE N EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMR TION. ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO ACRAL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (SSW).): O LAS OWNER OF THE PROPERTY. OR MV EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WSL DO THE WORK. AND THE STRUCTURE IS NOT MRENDEO OR OFFERED FOR SALE (SEC. 7044. BUSI- NESS US4NESS 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 HERSELFOR THROIJOH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FORT M -E W HOWEVER, THE BLIWINGOR aWROVEMENT IS SOLD WITHINONE YEAR OFOOMR.E- TKK THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR fl1E PURPOSE OF SALE). O L AS OMNEROF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TD CONSTRUCT THE PROJECT (SEG 704. BUSINESS AND PROFESSIONS OODE: THE CONTRACTORS L4 CENSE LAW DOES NOTAPPLY TO AN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON. AND WHOCONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S) LICENSED PURSUANTTOTHE CONTRAC- TORS LICENSE LAW.). O 1 AM EXEMPT UNDER SEC. B. S PC. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER S (COMMENCING WITH SECTION 7000) OF DIVISION S OF THE BUSINESS AND PROFESSIONSCODE. ND MY LICENSE IS N FULL FORCE AND EFFECT. �r 7 LICENSE GLASS LIC. NO. DATE CONTRACTOR CAW WORKERS' COMPENSATION DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINTAIN A CER IRGATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION 5700 OF THE LABOR CODE. FOR THE PERFORMANCE OfiT11E WORK FOR WHICH THIS PERMIT IB ISSUED. I HAVE AND WILL MAINTAIN WORKERS' COAPENSATKXI INSURANCE, AS REQUIRED BY SECTION 5700 OF THE LABOR OWE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' COMPE'NSAT 1117 E1rCARRIER D POL MBER ARE: CARRIER � / POLICY NUMBER , !q� (TARSSECDONNE®NOTBECOAfi.SMOFr EM9FA TISRORONEHUNAMDCtJAFIS(f1W)ORIESSL I 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 IRNA, AND AIIREF THAT IF 1 SHOULD BECOME SUBJE TO WORKERS' OOMPENSA VISIONS OF THAT 3700 0E E LABOR CODE, ALL TH COMPLYM TH E OVISIONS. DATE: PPIJCANT: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL BE SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (S100,6N), IN ADDITION TO THE COSTOF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3700 OF THE LABOR CODE. INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THATTHERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3047, CIV. G). LENDERS NAME LENDERSADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STA THAT THE ABOVE INFORMATION IS CORRECT. (AGREE TO COMPLY WITH ALL CITU' AND COUNTY ORD CES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, AND HEREBYAUTFORIZE REPRESS TIVES OFTHIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR )PECTION PU OSE . r� PERM E (PRINT) SIGNATUP O PERMITTEE 0111' WHITE—Department Copy, YELLOW—Finance Copy, PINK --,Assessor Copy, GOLDENROD -file Copy, GREEN—Applicant's Copy PRESS FIRMLY APPLICATION/� p► PERMIT �o PIC DATE �L.� NUMBS p ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDEMIDE STREET RW ❑ SIDE p PROPOSED USE 1 NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREANALUATION SFRIADDIREM 0 GaragalCarport W PatiolDeck U, POOIlSpa ZRe-ROof J Commerclal m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE U LU LU w 0 Z 10 JE� DO Q U Z Q U w CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING f MECHANICAL INSPECTION FEE ISSUANCE ll: , SMIP ENERGY PIC ENERGY PERMIT RETENTION FEE: )1IL11n1 L J PRE•ALTFEE: TOTAL FEES c�7 CO TS RECPT. NO. PAID BY VALIDATION C,X.X W El-=! T I i i f 4 §' a IC iAlx4a SI IF 4c:ER P11/0 SIZE -- ------ — PRE -GRAD ING l SET BACK ! FLOOR JOIST - BENCHING FTti:::-, -:lE:%)R;,rlSi ;rte: E_l E0,GH E i EG,Tp:,t I FHA RF.t1MTS ' ROUGH GRADINGROUGH ' -i 'E_:OJ RK, GROW," } l UNDER FLO 13 E3UvT ' � FINISH GRADING T UNDER FLOOR0NDUIT :POOL ELECTRIC &: R G RADE - _ - FIREPLACE. FOONbATION-_-� I ; POOL FENCING — - 'FIREPLACE BON'd BEAM POOL FINALj j ILII G INSULATION MID HT, BOND13EAM �.. OFF SITE: IMPS. 17 F I DRYV •LR I f ILI,If� �F:tir,E E _.. B FT. BOND SEAM DcDICATIOy� F!NALENG. - ; -EPTIC Ti"IN ti FINAL BOND BE AM LANDSCAPURRIG. C,X.X W El-=! T I i i f 4 §' a IC iAlx4a SI IF 4c:ER P11/0 SIZE -- ------ — PRE -GRAD ING l - HOUG" H? 'A_EiNG I BENCHING E0,GH E i EG,Tp:,t I ' ROUGH GRADINGROUGH FL.UM13ING ' � FINISH GRADING T :POOL ELECTRIC I Lt1' F I IIIdS I ; POOL FENCING POOL FINALj j ILII G INSULATION OFF SITE: IMPS. I DRYV •LR I f ILI,If� �F:tir,E E DcDICATIOy� F!NALENG. ; -EPTIC Ti"IN ti LANDSCAPURRIG. SEEP PIT/L.L. UN S;TE IMPS. � 1 GAS AIS, T. FINAL FINAL") FIRE DEPT FlilAL. FINAL HEX' HEALTH DEF17. FINAL � FINAL EWLEI-TRIC 7IIti1`,:L f'LUME'NJ, DEV. FEE=S PAID E.. RIMY C,X.X W El-=! T I i i f 4 §' a IC iAlx4a SI IF 4c:ER P11/0 SIZE -- ------ —