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Home My WebLink About14950 (24)I'* UL1!IIIJU I1A ii CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION , JOBSITE ADDRESS ISSq Sap�l,�r� L.�n� APN LOT 14L TRACT OWNER iL ' • -I 4c, w ADDRESS 155"1 SA?PLAl lnu LM. CITY 32723Mml &2K ZIP X765' TEL.Qf92 S9S' L43I APPLICANT r cc cTEL. C(,uOil 9 -f -2.a CONTRACTOR C't." ADDRESS CITY ZIP q174,0 TEL( is - 1070 ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS L4 CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.6 BUSINESS AND PROFESSIONS COOS ANY CITY OR COUNTY WHICH REQUIRESAPERMrTTO CONSTRUCT, ALTER IMPROVE, DEMOLISH, 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 7 (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 VIOLATION OF SECTION 7031.6 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (5600).): ❑ L AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WOFK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, BUSI- NESS USHNESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BURS 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 SOLD WITHIN ONE YEAR OF COMPLE- TION, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DO NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). 17 L AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE THE CONTRACTORS U. CENSE LAW DOES NOTAPPLY TORN OWNER OF A PROPERTY WHO BURRS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC. TORS LICENSE LAW). ❑ I AM EXEMPT UNDER SEC. B. 5 P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 7 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT. r LICENSE CLA `— 7,-7 LIC. NO. 7�SS.D t% / DATE & 7- CONTRACTOR WORKERS' COMPENSATION DECLAR TION �- I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECL RATIONS: _ I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR COMPENSATION, AS PROVIDED BY SECTION 3700 OF THE LABOR CODE. FOR THE PERFO OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. 1 HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REQUI BY SECTION 37M OFTHE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR THIS PERMIT IS I ISSUED. MY WORKERS' COMPENSATXXN INSURANCE CAR TER AND Y N £ E: r CARRIER POLICY NUMBER (IHBBEcTION NEID NOT BE COMPLETED OFTHE PERMIT IS ONE HUNDRED 00) OR } 1 CERTIFY THAT N THE PERFORMANCE OF THE WORK FO WHICH THIS PER IT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS BECOME SU CT TO TH WORKERS' COMPENSATION LAWS OF CALIFORNIA AND AGR T IFI ME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE 1 SHALL FORTHWITH COMPLY WITH THOSE,P 1 S. DATE �1 ��' APPLICANT: WARNING: FAILURE TO SECURE WORKERS' COM NSATKNI COjH AOE IS UN L, AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTI AND CML F SUP TO ONE HUNDRED THOUSAND DOLLARS (5100.D00), N ADDITION TO THE CO F COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37M 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. 3077. CIV. C.). LENDERS 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 CRY 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. o ti •rte PERMITTEE giG= 15FPERMITTE DTE —Department Copy, YELLOW—FManoe Copy, PINI EXPIRE®. O C T 2 5 2002 PRESS FIRMLY APPLICATIO I a PERMIT(� P/C %� DATE NUMBER V # V ISSUE /1. TYPE OCC DATE O� CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE 43 iA to f NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREANALUATION SFR/ADD/REM Garage/Carport W Patio/Deck 3D LL Pool/Spa 0 Z Re -Roof 0 Commercial M Valuation ADJ.AREA QUANTITY DESCRIPTION FEE U oC U w Z z m J J U NSTRU TION / LAN R EW !EL RIC LUMBING MECHANICAL INSPECTION FEE ISSUANCE 1YK! x 4R4FA SMIP i ENERGY P/C ENERGY PERMIT RETENTION FEE:A Tx PRE -ALT FEE: IM I DIAMOND TET TTT r � wTT'rr AN V 1 TOTAL FEES COMMENTS nn RECPT. NO. PAID BY VALIDATION 000� wpy, GOLDENNVu—FNIe copy, GREEN—ApplicanrS Copy CITY OF DIAMOND BAR INSPECTION RECORD D _ SET'$ACK-; a i ; r .C- I '— FLOOR JOIST FTGS/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 8 FT. BOND -REAM,. ; • ;; ` FRAMINGNENTILIATION 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 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 HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY COMMENTS S - / S -"-0 l ,'�, .�G 4 x%11 4 SEPTIC TANK SIZE SEEP PIT/U SIZE h R 1F{'� •}P'1' `•t o