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Home My WebLink About12-727E W�ED II,111 i CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 DPIRESS (909) 839-7020 Fax (909) 861-3117 Building Inspection Hotline (909) 839-7027 BUILDING PERMIT APPLICATION JOBSITE ADDRESS 2 ( S T.3 Pf C �Oc� ADDRESS APN LOT TRACT OWNER ADDRESS CITY t:2 A • E5&ZIP ^ TELG APPLICANT'T�!2KtJ TEL��fCl-lei/ j CONTRACTOR 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 LF CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.6 BUSINESS AND PROFESSIONS WOE: ANY CITY OR COUNTY WHICH REOUIRESA PERMIT TO CONSTRUCT, ALTER, IMPROVE. DEMOLISH, OR REPAIR ANY STRUG TURE, PRIOR TO ITS ISSUANCE, ALSO REWIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS UCENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW (CHAPTER 8 (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 CIVIL PENALTY OF NOT MORE THAN. FIVE HUNDRED DOLLARS ($6W).):❑ 1, AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAG THEIR SOLE COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044. BUSI- NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BU LDS OR IMPROVES THEREON, AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE IF, HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OFOOMPLE- TION, TH ER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPASO THE OFTHEEOFSOLEI L AS OWNER OF THE PROPERTY, AM E%CLUSNELV CONTRACTING WITH LICENSED CONTRACTORS TO TRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS U - CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CTOR(S)LICENSEDPURSUANTTOTHECONTRAC- TORS LICENSE LAW.). ❑ 1 AM EXEMPT UNDER SEC. B. a ,C. FOR THIS REASON DATE OWNER LICENSED CONTRAS DECLARATION I HEREBYAFFIRM UNDER PENALTY OF PERDU THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER 8 (COMMENCING WITH SECTION 7000) OF DIVISION 30F THE BUSINESS AND PROFESSIONS ODDS, AND MY LICENSE 19 IN FULL FORCE AND EFFECT. LICENSE CLASS LIC. NO. DATE CONTRACTOR WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: 1 HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF4NSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION 37000F THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. 1 HAVE AND WILL MAINTAINWORKERS' COMPENSATION INSURANCE; AS REWIRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND .POLICY NUMBER ARE: CARRIER POLICY NUMBER (RES SECTION NEED NOT BE COMPLETED OF THE PERMIT is FOR ONE FAMIEDOOL ARS ($+00)OR LES% 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 P I SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE. 1 SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE: APPLICANT. 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 (S1Oo,000), W ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 370E OF THE LABOR CODE, INTEREST AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS ACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3087, GV C.). LENDER'S NAME LENDER'S ADDRESS 1 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 ABOVE-MENTIONED PROPERTY FOR {NSPECTION PUUPOSES. PERMITTEE NAME (PPo/JT) j NANRE OF P DATE FIRMLY CATION �jj i Z_ PERMIT I Z J 7li7 DATEAPPLI (l NUMBER �P/C ISSUE Z_ TYPE OCC DATE 1C/ I l 1 CONST.&_ GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE PROPOSED USE �L�) S>✓ NO. DWEL. NO. O - UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION SFR/ADD/REM Garage/Carport WPatio/Dock - IL 0 PWuspa Z Re -Roof Commercials c 5 m Valuation • ADJ-AREA -- QUANTITY DESCRIPTION FEE U U 0 Z_ m IL _ _U aZ 2 U W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP r ENERGY P/C ENERGY PERMIT RETENTION FEE: ®D URE- Ef r_> I O TOTAL FEES Zo COMMENTS ' RECPT..NO. PAID BYLoi VALIDATION wn1 I L—uepanment L:Opy, YLLLOW--Flnanco Copy, PINK—Assessor Copy, GOLDENROD--FIIe Copy. GREEN—Applicant's Copy (2— CITY OF DIAMOND BAR INSPECTION RECORD SETBACK FLOOR JOIST v.. FTGS/FORMS/STEEL I FHA REQMTS ELECTRIC GROUND I UNDER FLOOR DUCT GROUND PLUMBING SLAB GRADE TEMP POWER WATER SERVICE I UNDER FLOOR CONDUIT FIREPLACE FOUNDATION FIREPLACE BOND BEAM MID HT BOND BEAM ROOF SHEATHING FRAMING/VENTILATION _ _ 18 FT. BOND BEAM FINAL BOND BEAM ROOF COVER I PRE -GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH PLUMBING ROUGH GRADING FINISH GRADING SHOWER/TUBTEST POOL ELECTRIC EXT. LATH/SIDING I POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER FINAL ENG. SEPIICTAN_K_ 1 LANDSCAPEARRIG. SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST FINAL CONST. FINAL ZONING FIRE DEPT. FINAL FINAL HEATING FINAL ELECTRIC HEALTH DEPT. FINAL i DEV. FEES PAID FINAL PLUMBING ENERGY FINAL PLANING FINAL ENGINEERING , l COMMENTS _ JXJI.IA.t t �S 4.i �„M� Q LOLL �2 SEPTIC TANK SIZE SEEP PIT/U SIZE N