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Home My WebLink About15082 (27)CITY OF DIAMOND BAR EXPIRED DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 0 C T Z PRESS (909)860-3195 Fax(909)861-3117 5 1002 BURMING PERMIT APPLICATION FIRMLY JOBSITE '" ADDRESS S h h le APN LO TRACT OWNER ADDRESS 1 z CITY D_jw&j IPAl7g.r TEL -&70Z APPLICANT TEL.G1 !j(PS'Be zo CONTRACTOR Ey �n tc�iiS..J ADDRESS 14 ZgDn '�w.n K , % CfTY Pem.Tlinj ZIP TEL.f, `fks_$e%Z ARCFVENG1 DESIGNER ADDRESS CITY ZIP TEL OWNER -BUILDER DECLARATION I NEREBY AFFIRIA UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LI- CENSE UW FORTHE FOLLOWING REASON (SEC. 7031.5 BUSNESSARD PROFESSIONS COOE.ANY CITY OR COUNTY WHICH REGUNES APERMrTTO CONSTRUCT,ALTER. IMPROVE.DEMOUSH, OR REPAIRANY STRUC- TURF- PROR TO ITS ISSUANCE. ALSO REWIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS L4 CENSE LAW (CHAPTER a (COMMENCNG WITH SECTION 7000) OF DIVISION 3 O THE BUSINESS AND PRO- FESSIONS WOE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED MMP- TXON. ANY VIOLATION OF SECTION 7031.6 BYANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (6600).): 13, LAS OWNER OF THE 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. 7044.BUSI- NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON. AND VMO 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. HOWEVERLTHE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE- TON, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROYNO THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE} O t 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 WITHA CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAO TORS LICENSE LAWI. O 1 AM EXEMPT UNDER BEC. B. a PC. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER B (COMMENCING WITH SECTION 7000) OF DIVISION 3 O THE BUSINESS AND PROFESSIONS COOS -AND MY LICENSE IS N FULL FORCE AND EFFECT. LICENSE CUSS �Z7 LO. NO. 71 rtV a DATE G /'�/ Z"" CONTRACTOR' WORKERS' COMPENSATION DECLARATIO 1 HCREBY AFF1RM TINDER 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 SECTICN VW OF THE LABOR CODE, FOR THE PERFORMANCE V OF THE WORK FOR WH ICH THIS PERMIT IS ISSUED, I HAVE AND WILL AMMAN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY SECTION 37OD OF THE LABOR COOS, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERSCOMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER---4.se ( ✓r7O �N-t �^ ri+�fi<, POLICY NUMBER G 12 A 2T , 10 5 7 AP (MS SECMNFEMNOTBE COMPLETEDOFTIE PEFAHT IS FORMC WtCREDODl1ARS (SIO3)CRLESS) 1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER 50 AS TO BECOME SUBJECT TO THE WORIKERS' COMPENSATION LAWS OF CALIFORNIA AND AGREE THAT IF 1 SHOULD BECOME SUBJECTTO THE WORKERS' COMPENSATION PROMS S OF SECTION 3700 OF THE LABOR I STALL FOT 1IP4 C(XdPLY WITH TH P VISIONS. WTE� Z' gAPF'LICANi. WARM FA.URE TO SEWRE WORKERS' PENSATON RAGE IS UNLAWTkAND SHALL BE SUBJECTAN EMPLOYERTO CRIAAVAL PEN TIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS (5100.000), N ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR N SECTION 370F OF THE LABOR CODE, MEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY i IHERESY AFFIRMLNOER PENALTY OF PERJURY THAT THE RE IS A CONSTRUCTION LEWG AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 70Y7,097. CN. C.). LENDER'S NAME LENDERSADDRESS I 1 CERTIFY THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. 1 AGREE TO COMPLY WITH ALL CRY AND COUNTY ORDNMCES AND STATE LAWS RELATING TO BUILDING yCONSiRUCTION.A D HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTERUPON THE ADOVE.MENTONEO PROPERTY FOR INSPECTION PURPOSES. L N MN vj i � PERMITTEE w SIGNATLIR OF PERMITTEE DAM APPLICATION UU PERMITP/C /V, ` %r- J DATE NUMBER N ISSUE 10_/Yj ` ' TYPE - ' . OCC DATE V CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ 7_8 6 PROPOSED USE NO. DWEL NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREANALUATION SFRtADDIREM Garage/Carport W Palb/Deck LI" PODUSpa 0 Z Re -Roof 0 CO I - Tuu- m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J Q U U W LU W 0 Z m J o. J U 2 a x U W CONSTRUCTION PLAN REVIEWS F ELECTRIC PLUMBING MECHANICAL!8 INSPECTION FEE �Jo ISSUANCE SMIP v ENERGY PIC �•� - j yr MOND P AD ENERGY PERMIT .Ulil RETENTION FEE: u � 111 `J AND IZ,=m4 TOTAL FEES /5777 F DG Ni$ h till RECPT. NO. PAID BY - VALIDATION / I WHITE—Dep6Kment Copy, YELLOW—Finance copy, PINK—ASSBSSO LiM, uuwt;Nm n ue A opy, um=n nppi0 n%s wiry . ..,'kr �� ^r.'v �.. ..'rt�Y ..��n ••1.!'.'. ^r� .�' x�•♦ ., Y�J•.�a;-y .. ..as: •. .. .. - .. CITY OF DIAMOND BAR :INSPECTION RECORD SET BACK:' .__ FTGS/FORMSiSTEEL I. _� 1 r FLOOR JOIST FHA REOMTS ELECTRIC GROUND_ - _ _ I ! 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 BEAM FRAMINGNENTILIATION - FINAL BOND BEAM ;ROOF COVER PRE -GRADING •ROUGH HEATING BENCHING 'ROUGH ELECTRIC ROUGH GRADING ;ROUGH PLUMBING - FINISH GRADING 'SHOWERITUB TEST POOL ELECTRIC ;EY.T. LATHISIDING - POOL FENCING WALL -INSULATION - POOL FINAL 'CEILING INSULATION _ OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER FINAL ENG. SEPTIC TANI' LANDSCAPE/IRRIG. SEEP PIT/LL ON SITE Ih1PS. GAS AIR TEST FINAL'ZON!NG FINAL CONST. FIRE DEPT. FINAL FINAL HEATING ____ HEALTH DEPT. FINAL ,FINAL ELECTRIC- - DEV. FEES PAID FINAL PLUMBINGj ENERGY 'COMMENTS - - .SEPTIC TANK SIZE ;SEEP PIT/U SIZE