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Home My WebLink About15121 (8)DIAMIXU IIAH!j CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 PRESS BUILDING PERMIT APPLICATION FIRMLY RI SS 1-SL—r;",#t� APN LOTRACT OWNER .S kJ ADDRESS /-S td �_S :� e4;�Ie. I C__ L iJ CITY —QiC1 ,LT•: f+r ZIP q4)4 STEL. APPLICANT TEL. CONTRACTOR �`� r t%L Z ADDRESS CITY > i ' ZIP f7EL ARCWENG/ DESIGNER C .C U, J `L 3 S ADDRESS L, 'L/. CITY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS U. CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.6 BUSINESS AND PROFESSIONS CODE: ANY CITY OR COl1NTY WHICH REOUIRESA PERMIT TO CONSTRUCT, ALTER IMPROVE, DEMOUSK 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 NSU- CEE LAW (CHAPTER Y (COMMENCING WITH SECTION 7000) OF DIVISION AN ION 3 OF THE BUSINESS D PRO- FESSICNS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7031.6 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CMLPENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (Il6o0).): T7 I. AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK AND THE STRUCTURE IS NOT INTENDED OR 7G44,`PRoOFFERED FOR SALE (SEC. 7o, BUSI- NE. AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF •.ATTYwHo BUILDS OR THEREON, AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFER® FOR SALE IF, HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONEYEAROF COMPLE- ' TION, THE OWNEROJIDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE} ❑ L AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 70". 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 ACONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). ❑ 1 AM EXEMPT UNDER SEC. B. 6 P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBYAFFI M UNDER PENALTY OF PERJURYTHAT I AM LICENSED UNDER PROVISIONS OF CHAPTER Y (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS N FULL FORCE AND EFFECT. / LICENSE CLASSL_ •% ! y 1, LIC. NO. 6C DATEC'_L-�� 3 -� (,l Q CONTRACTOR �Y - : `•��'!• ':IJV S WORKERS' COMPENSATION DECLARATION I HEREBY APjkM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: AND WILLMAINTAIN ACERTIFICATE OF CONSENT TO SEL1INSURE FOR WORKERS' FJVSAT. AS PROVIDED BY SECTION 3700 OF THE LABOR CODE FOR THE PERFORMANCE E 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 CAR�P,IJ§R AND POLICY NUMBER ARE: CARRIER �) Gr- r�. •f-- 0 :r POLICY NUMBER i (TFISSECTION NE®NDT BE OOMPET®OF THE POW B FOR ONE HUNDRED DXLARS ($100) ORL& I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I dZ NOT EMPLOY ANY PERSON N ANY MANNER SO AS TO BECOME SUBJECT TO THE ERS'COMPENSTION LAWS OF CALIFORNIA, AND AGREE THAT IF I SHOULD BECOME CT TO THE WORKERS COMPENSATION PROVISIONS OF SECTION 37000F THE LABOR I SHALL FORTHWITH COMPLY WITH(\HO,�E PROVISIONS. DA �/3 ,ng APPLICANT: ✓'��l�Y / 1 Cllr'�LL,�CL WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL BE SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), N ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 370E OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY 1 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 LENDERS 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 INSPECTION PURPOSES. P I1TEE E A"FUMM EOF PERWTTEE I DATE APPLICATION _ PERMIT C / P/C 0 r- 16 DATE a a) O ' NUMBER J # V (/ ISSUE_ TYPE'-_ 1 OCC —(J - DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USEIRS ox NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION SFR/ADD/REM U) Garage/Carport _ L.0 Patio/DeoX d-' - Uj LL PooUSpa 0 Z Re -Roof Commercial M_ Valuation ADJ.AREA OUANTITY DESCRIPTION FEE � ZJ U U W _J w Z m a _U 2 Q 2 W CONSTRUCTION OVILAN REVIEW ELECTRIC PLUMBING MECHANICAL r.�I INSPECTION FEEiUl i7 ISSUANCE -7>- 0 SMIP qjuAl ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE- T FEE' '7 22b n .�'-RA T V TOTAL FEES COMMENTS If A RECPT. NO. PAID BY VALIDATIO WHITE—Department Copy, YELLOW—Finance copy, PINK—Assessor copy, GOLDENROD—Rle Copy, GREEN—Applicant's Copy al_�� 4/!, «, '7a lJ/�,.l)-,- n, -I-nL C- Flo. Me R--• r� /~ �� ~� '/iI �.� � K-Li`r'L� `Tim �.% h��-�.,� /!/ c..�+�yD y /�_S �_�/) vaG.��-SLI=U CM Y OF MAMOND BAR NSPECTMN RECORD OuVCi7J- l=,L:l U UL:JUV D��J i,s o � � O�J(r�lJ U iJIJUV '. DW� OUVL�.YIS � o SET BACK FTGS/FORMS/STEEL �� /�n� FLOOR JOIST _ FHA REQMTS ELECTRIC GROUND / j Y l ttt(((fff 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 - F RAMING/VENTILIATION /( P 8 FT. BOND BEAM FINAL BOND BEAM ROOF COVER PRE -GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING 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 y l SEWER FINAL ENG. SEPTIC TANK LANDSCAPE/1RRIG. SEEP PIT/L.L. ON SITE IMPS.. GAS AIR TEST FINAL ZONING FINAL CONST. FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY GOMMENTS al_�� 4/!, «, '7a lJ/�,.l)-,- n, -I-nL C- Flo. Me R--• r� /~ �� ~� '/iI �.� � K-Li`r'L� `Tim �.% h��-�.,� /!/ c..�+�yD y /�_S �_�/) vaG.��-SLI=U SEPTIC TANK SIZE SEEP PiT[U SIZE