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Home My WebLink About12410J CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 / '+ ax (909) 861-3117 PRESS (909) 860-3195 PERMIT APPLICATION FIRMLY JOSSITE ADDRESS 8 ILA APN LOT L_ TRACT ---577-7-15 OWNER ADDRESS CITY - ZIP 9z4�&eTEL. If APPLICANT _ TEL. _� CONTRAC4� j�R��ZjPT�f-7S�Lt ARCWENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FORTHE FOLLOWING REASON (SEC. N XMA BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTYYMICH RESARESAPERMITTO CONSTRUCT,ALTER. IMPROVE, DEMOLISH, OR PV%IRANY STRUF TUBE. PRIOR TO ITS ISSUANCE, ALSO REOUItES THE APPLICANT FOR BUCK PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE N LICENSED PURSUANT 70 THE PROVISIONS OF THE CONTRACTORS U• CENSE LAW ICNAPTER 6 (COMMENCING WITH SECTION 7000) OF DIVISION S OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OR SHE S EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7031.6 BY ANY APPLICANT FORA PERMIT SUBJECTS THE APPLICANT TO ACJVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (5600).1: O L A60WNEROF THE PROPERTY, OR MY EMPLOYEES WITH WAGESAS THEIR SOLE COMPENSATIOR WILL DO THE WORK, AND THE STRUCTURE 15 NOT INTENDED OR OFFERED FOR SALE (SEC. 70". SUSI• NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS On MPROVESTHEREON, AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH 115 OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTSARE NOT INTENDED OR OFFERED FOR SALE, IF HOWEVER THE81"ING OR IMPROVEMENT IS SOLD WITHIN ONE MROFCOMPUF- TON, THE OWNERSULDER 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, AM EXCLUSWELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEG 7041, BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LF CENSE LAW DOES NOT APPLY TO AN OWNER OF APROPERTY WHO BUILDS OR IMPROVES THEREON. AND WHO CONTRACTS FORBUDH PROJECTS MTNA CONTRACTOR(S) LICENSED PURSUANT TOTHE CONTRAC- TORS LICENSE UAW.). 171 AM EXEMPT UNDER BEG B. 5 P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER P (OOMMENCVIO WITH SECTION 1FDOM OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE. AND MY ]LICENSE 15 N FULL FORCE AND EFFECT. �,y 'QAR� E �� • M CCONTRACTOR t17-4^" -r WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I NAVE AND WILL MAINTAIN ACERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION. A3 PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WILL MAINTAIN WORKERS COMPENSATION INSURANCE, AS REWIRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' OOMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER L i il� 1407V Y POLICY NUMBERf�.� • �� ' o Z (M6SECEpN NNS NOTSE OokRtTEnOFTHE PERMITS FOR ONE HLPDREDDOUARS (SIMORLES% ICERTNFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, 1 I SMALL NOT EMPLOY ANY PERSON N ANYMMINER SOAR TC IE E USJECTTOTHE WORKERS' COMPENSATION LAWS OF CALIFORNIA, I SHOULD BECDME SUBJECTTOTHE WORKERS:f ON ,ION�g7ap THE I(BcjR CODE, I SHALL FORTLM9 L ITH EPROM ',��'Tj�' Q1r•1"L.�j I PPL)CA ' 0 low 59wk WARNING: FAIWR[ TO SECURE INZAN T CINES UP T IS UNLAWFUL. AND SHALL BE D SUBJECT AN EMPLOYER TOCRIMINAL PEN IES IL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (51 OD.ODD) IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN 1 SECTION 37050E THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDINGAGENCY i THEREBY ERFO UNDER PENALTY OFPERJURY THAT THERE MACONSTRUCTION 097. CIG AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3047, CIV. C.) LENDERS NAME LENDERSADDRESS I CERTIFYTHAT I HAVE READ THIS APPL CATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITHALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BULDNG CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. 3L_ PERLrrrnz NAME (PR SIGNATURE OF D APPLICATION O . lii IUMB r U NPERMIT R f/C ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREANALUATION SFR/ADD/REM C0 Garaga/Carport W Petkl/Deck LL POOVSPR ZRe -Root J Commercial m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE U a r U W J W U 2 m 3 a J a ✓ a } 17— CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE – ISSUANCE SMTP ENERGY PIC ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: TOTAL FEES 147. 0 COMMENTS RECPT. NO. PAID BY VALIDATION WHITE-0apornnent Copy, YELLOW --Finance Copy. PINK—ASSBBSOr ILWY, UVLUENHLXJ'– I9 (:OPY, UMLLN—Ap101"ITFS 1iOpy CITY OF DIAMOND BAR INSPECTION RECORD III!, I ol III SETBACK sit FLOOR JOIST. FTGS/FORMS/STEEL _ FHA REOMTS ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR r✓ONVUIT SLAB GRADE FIREPLACE FOUNDATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICE MID HT. BOND BEAM - ROOF SHEATHING 8 FT. BOND BEAM- FRAMINGNENTUATION FINAL BOND BEAM ROOF COVER `PRE -GRADING ROUGH HEATING t BENCHING ROUGH ELECTRIC ROUGH GRADING i 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 EL I HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY I COMMENTS SEPTIC TANK SIZE SEEP PET/U SIZE i