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Home My WebLink About12727CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 ' BUULJ)ING PERMIT APPLICATION JOSSITE ADDRESS --= 3 s 4/111" k -V oA F - y APN LOT TRACT OWNER - ZZ ADDR S CITY _ %_J An ZIPQ� TEL.923 TV-T7,f0 APPLICANT TEL. CONTRACTOR An- F - — C- CO ADDRESS A t-rl r' _k_jL_- CITY 4 V4,--<< ZIP &t'tl TEL. 71V- 735 ARCWENG/ DESIGNER 4!!�/ �'- ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION 1 HEREBY AFRRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS U - CENSE UAW FOR THE FOLLOWING REASON (SEC. 7031.6 BUSINESS AND PROFESSIONS CODE: ANY GTYOR COUNTY WHICH REOUIRESA PERMIT TO OONSTRUCT,ALTER IMPROVE, DEMOUSH, OR REPAIR ANY STRUG TURF, PRIOR TO ITS ISSUANCE. ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS UCENSED PURSUANT 70 THE PROVISIONS OF THE CONTRACTORS U - CENSE LAW (CHAPTER a (COMMENCING WITH SECTION 7WO) OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS ODDE) OR THATHE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- 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 (SSO01J: O L AS OWNER OFTHE PROPERTY. OR MY EMPLOYEES WITH WAG ES AS THEIR SOLE COMPENSATION. WILL DO THE WORT. AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, BUSI- NESS AND PRDFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PHIOPERTY WHO BULDS OR IMPROVES THEREON, AND WHO 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. HOWEYERTHE BUILDING OR IMPROVEMENT ISSOLD WITHIN ONE YEAROFOOMPLE- TION, THE OWNER'61JROER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALEI. O I, ASOWNER OFTHEPROPERTY AME.CLUB CONT RACTINOWITHLK:ENSEDCONTRACTORS TO CONSTRUCT THE PROTECT (SEG 7044, B INESS D P ESSIdd3 CODE: THE CONTRACTORS U. DENSE LAW DOES NOTAPPLY TO AN OWN A O 'RTY S OR IMPROVES THEREON, AND WNDOONTRACTS FOR SUCH PROJECTS � )LK:EN6EDPURSUANTTDTHEODNTRAC- TORS LICENSE LAW.). ❑ 1 AM EXEMPT UNDER SEC. B. a P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION 1 HERESYAFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER e (COMMEND NG WITHSECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS W FALL FORS£ AND EFFECT. LICENSE CUSS LIC. NO. 2-( oILTE coNTRacTDR WORKERS' COMPENSATION DECLARATION / I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATION : I 9 I HAVE AND WILL MAINTAIN ACERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION 37M OF THE LABOR CODE. FOR THE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVEAND WILL MAINTAIN WORKERS' ODMPENSATKJN HSUMNCE. AS REQUIRED BV SECTION 700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS SSUED.MY WO KERS'OOMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE. CARRIER POLICY NUMBER 1T I OM KCUDN NE®NDTBE ODNPLEMOFTIE PEMC S FORONE MPOREDDOUARS (SIMOR LESS4 I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. 1 SHALL NOT EMPLOYANY PERSON IN ANY MANNER BOAS TO BE ME SUBJECT TO THE WORKERS'COMPENSATION LAWS OF CALIFORNIA, AND AGREET AT IF I SHOULD BECOME SUBJECTTOTHEWORKERS'COMOVI PE P SIO OF :.T ION 37000E THE LABOR CODE,1 SH ITH COMPLY WITH < H DATE: Z APPLICANT: WARNING: FAILURE TO SECURE WORKERS' PENSATION COVERAGE IS UNLAWFUL, AND SMALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENAL S AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (5100,000), IN ADDITION TO THE CO T OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 3708 OFTHE LABOR CODE. INTEREST. AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY THEREBY AFFIRM UNDER PENALT"alU OFAT ERE SA STRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE H TyqtXRMfrM ISSUED (SEC. 3097, CIV. 0.1. ` LENDERS NAME J LENDERS ADDRESS I CER71FY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. 1 AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIYES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR PECTION PURPOSES. 1 1 PERMITTEENAM (PRI 7 SIGNATURE OF LRL41TTEE DATE EXPIRED NOV 2 2 1000 PRESS FIRMLY APPLICATION DATE J� -1�� "�% PERMIT �1 P/C NUMBER O ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDESTREET RW ❑ SIDE ❑ PROPOSED USE NO. DWEL. NO.�] NO. UNITS STORIES — BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREA/VALUATION SFRIADDIREM Co Garage/Calyort UPaliwDeck LL- PoDUSpa ZRe -Roof Commercial - m Valuation Jog hTl ADJ.AREA QUANTITY DESCRIPTION FEE U W J W 0 Z m a Q U W CONSTRUCTION U r PLAN REVIEW ELECTRIC PLUMBING p�Tn MECHANICAL INSPECTION FEE t1 ISSUANCE mpSMTP-TIF�TiTA' 5:_ �� _�� `ONDy ENERGVP/C s 1A1131Y1 IRAR l AND SAF'FTy ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: li-4 7M TOTAL FEES F COMMENTS - 1 RECPT, WW PAID BY ALIDATION WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy, GOLMNBIOD--File Copy, GREEN—fWicanr$ COW /V CITY OF DIAMOND BAR INSPECTION 'RECORD SET BACK FLOOR JOIST ... . FIGS/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 0—/4- 8 FT. BOND BEAM FRAMINGNENTILIATION FINAL BOND BEAM ROOF COVER PRE -GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWERITUB TEST POOL ELECTRIC EXT. LATH/SIDING POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION ! j OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWERi FINAL ENG. SEPTIC TANK LANDSCAPEIIRRIG. SEEP PIT/L.L. ON SITE IMPS. r GAS AIR TEST I FINAL ZONING FINAL CONST. _ FIRE DEPT. FINAL FINAL HEATING I ! HEALTH DEPT. FINAL FINAL ELECTRIC j -��+ DEV. FEES PAID FINAL PLUMBING ENERGY i COMMENTS s j I %' • • .�.�,�. f fir; � s SEPTIC TANK SIZE SEEP PIT/LI SIZE