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Home My WebLink About14950 (25)IY- J� 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 L JOBSITE ADDRESS I55_� �Wry LAne APN LOT 14= TRACT OWNER ADDRESS_ 5'1 getapkirm CITY T77AM kIIP81765' TEL.nfySTS-L D APPLICANT + tTEL.(L3L%�(��1� CONTRACTOR ADDRESS CTTYLai ZIP 1111744 TELiLE}Z� ARCWENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC -7031.5 BUSINESS AND PROFESSIONS CODE ANY CrTY OR COUNTY WHICH REQUIRES A PERMIT TOCONSTRUCT.ALTER IMPROVE. DEMOLISH, OR REPAIR ANY STRUO TORE. 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 LF CENSE UAW (CHAPTER i (_MENCNG WITH SECTION 7D00) OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE ORSHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- T10N.ANY VIOLATION OF SECTION 7071.5 BY ANY APPLICANT FORA PERMIT SURIECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (1500).): OL AS OWNER OFTHE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 70". BUSI- NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WIO BUILDS OR IMPROVES THEREON, AND WHO DOES SUCH WORKHIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES. PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE tF. HOWEVERTHE BUILDING OR IMPROVEMENTIS SOLD WITHIN ONE YEAR OF COMPLE- TION.THE OWNER -BUILDER 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. 7D4, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE LAW DOES NOTAPPLY TO AN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON. AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S) LICENSED PURSUANTTO THE CONTRAO TORS LICENSE LAW). - ❑ 1 AM EXEMPT UNDER SEC. B. It P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERAIRY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER WI 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE. AND MY LICENSE IS N FULL FORCE AND EFFECT. �+ LICENSE CLA C 2 I LIC. NO. %.��7---''J�� DATE 7, - CONTRACTOR C WORKERS' COMPENSATION DECLA TION �- THEREBY 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 PERFORM OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REOVI _ BY SECTION 3700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WOnK FOR THIS PERMIT 1 ISSUED. MY WORKERS• COMPENSATION INSURANCE CAR RAN O' ..Y NU E E: i CARRIER C' tZ I POLICY NUMBER �+ ,^ (StyA (DMSECTI)NWMNOTBECOL6U=OFTVEPEMVtSRO ONE HUNUFSD (SIMIOR _ .) I CERTIFY THAT LATHE PERFORMANCE OF THE WORK FDI WHICHTHIS PER JT M ISSUED,1 I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SOAS BECOME SUBACT TO TH WORKERTCOMPENSATION LAWS OF CALIFORNIA AND AGR ATIFIS " ..LME SURIECT TO THE WORKERS' COMPENSATION PROVISIONS OF SE CTZN-37DO OF THE LABOR CODE SHALL FORTHWITH COMPLY WITH THOSE P L DATE: � r✓ � APPLICANT: 3 FAILURE TO SECURE WORKERS• COM _NSATKN _ AGE IS U .YELL. AND SHALL BE SUBJECT SUBJECT ANEMPLOYER To CRIMINAL PE ; ANDCMLF XSUPTO ONEHUNDRED THOUSAND DOLLARS (f100.000),NADDITION TO THE CO FCOMPENSATKN,OAMAGES ASPROVIDED FORIN - l SECTION 3705 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY )_ I OR THE AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSUED (SEC LENDING 97.CIV AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 70V7, CIV C.). J - LENDERS NAME LENDERSADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL CrTY AND CHANTY 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 H/ PERMrrrcEN I ) 7 SIGN A FPERMITTE D m TE—Department Copy, YELLOW—flnance Copy, PINK—Assessor Copy, GOLDENROD—File Copy, GREEN—Applicant's Copy - -- EXPIRED . OCT 25 zooZ PRESS FIRMLY APPLICATIO la PERMIT P/C �i DATE NUMBER p V ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE 4 3 x o ��- . e GpJa✓' , NO. DWEL NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION SFRIADD(REM Garage/Carport W Patio/Deck 3Q LL Pool/Spa ZRe -Roof 0 Commercial 5 m ValUation ADJ.AREA QUANTITY DESCRIPTION FEE J Q U cc LU 0 W w w 0 2 CO J J I Z U 1 TION _ / /CipN)REW PVVLAEL LUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY PIC ENERGY PERMIT -' - RETENTION FEE: PRE -ALT FEE: C i A WN bpEr- n7 TTT 1lIN�i AND TOTAL FEES COMMENTS / n n RECPT. NO. PAID BY VALIDATION CITY OF DIAMOND BAR INSPECTION RECORD (NISMOTIOU DATE SETBACK INSPECTION DATE INSPECTOR FLOOR JOIST FTGS/FORMS/STEEL FHA REQMTS ELECTRIC GROUND 1 UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR CONDUIT, -SLAB GRADE FIREPLACEFOUNDATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICE MID HT BOND BEAM ROOF SHEATHING `' 8 FT. BOND -BEAM 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 _ i '.. `, 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 11 -mealPENN IN m.. COMMENTS I \/'l i A `SEPTrC TANK SIZE- SEEP PIT/U SIZE '