The URL can be used to link to this page

Home My WebLink About19097rDIVIOND IIAIU r CITY OF DIAMOND BAR �xP-k czl__l DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21825 E. Copley Drive (909) 860-3195 Fax (909) 961-3117 BUILDING PERMT APPLICATION 1 JOBSITE z� ADDRESS I1 S �' 1 141 O-C C ¢w"( III t APN LOT TRACT OWNER N- 1 LAI arVG'ISet— ADDRESS 2-3 i1I I S"e^' V 1�iIlLe L %1®k- 1' CITY01#-p�1V0-0 In/TYIP g1215_TFL.116t'7ri� APPLICANT TEL. CONTRACTOR i tat ADDRESS CITY ZIP TEL. ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FORTHE FOLLOWING REASON (SEC. 7MI.5 BUSINESS AND PROFESSIONS CODE; ANY CITYOR COUNTY WHICH REQUIRESA PERMTTO CONSTRUCT, ALTER, IMPROVE, DEMOLISH, OR REPAIRANY 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 LI- CENSE LAW (CHAPTER 9 (COMMENCING WITH SECTION 7WO) OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OR SHE 13 EXEMPTTHEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS ($500).): ❑ 1.AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGESAS THEIR SOLE COMPENSATION, WILL 00 THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, BUSF NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE IF, HOWEVERTHE BUILDING OR IMPROVEMENT IS SOLD WITHINONEYEAROFOOMPLE- TION, 71-IE OWNER-BU)LDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). ❑ I, AS OWNER OF THE PROPERTY,, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS U. CENSELAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR($) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.), I AM EXEMPT UNDER SEC. 8.3 P.C. FOR THIS REASON DATE ;'- / '�' Cr'T _� OWNER LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER 0 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT, LICENSE CLASS LIC. NO. DATE CONTRACTOR WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF411SURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION 37M 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 REQUIRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER POLICY NUMBER (THIS SECTION NEED NOT BE OCM'LETED OF TIE PERMIT IS FOR ONE HUNDRED OC U ARB (S1 CO) OR LESS) 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 CALIFORNIA, AND AGREE THAT IF 1 SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE, I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE: APPLICANT. WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,00 )), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3007, CIV C)_ LENDER'S NAME LENDER5ADDRESS CERTIFY 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 REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ASOVE.MENTIONED PROPERTY FOR INSPECTION PURPOSES. *E AM P P, L, 0G/i Yv- PERMI RINTI SIGNATURE DATE PRESS FIRMLY APPLICATION PERMIT N p/C DATE UMBER # ISSUE If) TYPE OCC DATE 1 t CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDEISIDE STREET RW ❑ SIDE ❑ S7 PROPOSED USE NO. DWEL. NO. NO. UNITS �% ` i STORIES Z BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREANALUATION SFR/ADD/REM U) Garage/Carport WPatio/Deck U- PooySpa Z Re -Roof 0 Commercial 5 Ib Valuation ADJ.AREA QUANTITY DESCRIPTION FEE U ✓r H U W W Z S 11 0 Ill A m J a U Z Q 2 U W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES COMMENTS RECPT. NO. PAID BY VALIDATION WHITE —Department Copy. YELLOW —Finance Copy. PINK Assessor Copy, GOLDENROD --File Copy, GREEN —Applicant's Copy CITY OF DIAMOND BAR INSPECTION RECORD 1 SFi BACK% i rLC7C�Fl JC�1ST {{ FTxSfFtC�I�1St-TIW':� ( � LLIA�-t172�1�� LINDER FLOOR DUG" GROUND PLUMBING,_ � j UNDER 'FLOOR CONDUIT _ ---�— SLAB C RADL_ _ FIREPLACE FOUNDATION TEMP POWER ..__-.._- _ �� - FIREPLACE BOND BEAM _ WN TE d RV" IC E MID Ill BOND BEAM ROOF SHEATHING� Fi, BOND BEAM__- '__. FINAL BOND BEAlFFAvlNCJ ENTILIATION ROOF COVER PRE -GRADING R71N FB TINC3 j BENCHING ROUGH ELECT , RIB (�� t ROUGH BRA il� ROUGH PLUMBING FINISH GRADING Si (aWERf 1"UB TEs 1 POOL ELECTRIC; _. ": LATF3ISIDING i POOL FENCING MALL_ INSULATION � POOLFINAL 0I*F S ITS IPS. DR ALIw NAILING DEDICATIONS SEWER FINAL ENC. SEEP PIT/,L. ; ON SITE IMPS FINAL ZO—NING FINAL. CONST: FIRE DEPT FINAL FINAL P ATINC � _. HEALTH DEPT, FINAL. I DEV, FEES rAIDAffLECTRiC -- — FINAL PLUMBING !ENERGY COMMENTS EPTI6 TANK SIZE SEEP PIT/U SIZE PRESS FIRMLY IS APPLICATION DATE la i 1 1 (D2NER.,T 19 UMBER 04 # DATE OCC SUE li ( i')C- TYCOPNEST GROUP k FRONT SETBACKS ZONING REAR SIDE RW p CI SIDE/SIDE STREET RW I=1 CI PROPOSED NO. UNITS USE DWEL II 49 ,-- 5 f ° 0 WA* NO. NO. "1 i LI to STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREANALUATION SFR/ADD/REM Garage/Carport Patio/Deck PooVSpa Re -Roof 5 —1 Commercial 5 03 Valuation ADJ.AREA QUANTITY DESCRIPTION FEE --I 0 Fc I- 0 ui _1 Lu 'I a m D —I 0- 1 3'14 et..ves_P st-,-- CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PEFIMIT RETENTION FEE: PRE-ALT FEE: TOTAL FEES (1271 SO COMMENTS RECPT. NO. PAID BY VALIDATION 'EX CITY OF DIAMOND BAR p DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21825 E. Copley Drive (909) 860-3195 Fax (909) 861-3117 BUILDING PERMIT APPU( JOBSITE ,-% ADDRESS .e.-Seil -SIii - - P P 14-10-e c *4-'4o) APN LOT TRACT OWNER t4 - a L. i L41 i IV fr" e4— ADDRESS 2-3 ;4.? i $ ,S ik-1, r of Ad- (-4-0.- •to &I- 11-v cI1YO i 0-m. en*, is zip 0/17 is-TEL? q7 Qs' APPLICANT TEL. CONTRACTOR 5 ji3-i P- ADDRESS CITY ZIP TEL. ARCFVENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC 7031.6 BUSINESS AND PROFESSIONS CODE:ANY CITY OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT, ALTER, IMPROVE, OEMOUSH, OR 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 LI- CENSE LAW (CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY V/OLATION OF SECT/ON 7031.6 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS 195001.): 0 I, AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL 00 THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, BUSI- 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 HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE IF, HOWEVER THE BUILDING OR IMPROVEMENT IS SOW WITHIN ONE YEAR OF COMPLE- TION, THE OWNER-BU/LDER W/LL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE) 0 I, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC 7044, BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW ) 7JAM EXEMPT UNDER SEC. 8 & P.0 FOR THIS REASON DATE i 7.- - i 7 - C? 1-- OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT f AM LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT. LICENSE CLASS LIC NO DATE CONTRACTOR WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS - I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH TH/S PERMIT IS ISSUED I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE. CARRIER POLICY NUMBER (THIS SECTION NEEDNOT BE COMPLETEDOF THE PERMIT IS FOR ONEHUNDREDDC(LARS (61110) OR LESS). 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 LANS OF CALIFORNIA, AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE, I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS DATE. APPLICANT'. WARNING. FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3097, CIV C ) LENDER'S NAME LENDER'S ADDRESS I CERTIFY THAT I 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 BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE -MENTIONED PROPERTY FOR /NSPECTION PURPOSES. H. p. L lie LL'i ", 1/. feje... PERM!)" E AM PRINT) SIG URE DATE WHITE —Department Copy, YELLOW --Finance Copy, PINK —Assessor Copy, GOLDENROD —File Copy, GREEN —Applicant's Copy ^t• A M.OND 3A h E^10r;• ' 104f f-LOOF., 2sr ELF( LPTh_42:7R FLCOP FOUNOAHON LTEr,f,P Hr.-in!: SI-it-Ai-HNC- FRAMINt,_.:,(N! ' ROr... )F flOtiGt HizAT!,\!(-, 14,41 _,E BONI) i_mn HT, ac.)Nr,-) BOND FINAL I.30N1) DEAly) PRE:Ght,DINC, IT BENCHING ROliGH POOL EI.,ECIFV,i,-; I P-O-OL FENCING ^ POOL HNAL OFF SITE IMPS. I DEDICAI IONS FINAL ENG LANDSCAPEIIHRIG, I ON SITE, IMPS, FINN 71,3i,Nri I -IRE- DEP 1, FnAL HEALTH DEPT. FINAL DEV, FEET: PA,D f;,NERGY