The URL can be used to link to this page

Home My WebLink About13268} O LL 0 Z O w.. Ca z a, cc C_ O w:. ZI. W. 0 W LU O C] W O LLAT' C0 C/A LUD d. Q. O I d. 4 W,. 9 C7. D LL Lll O W cc C3 m a 52 Cly 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 JOBSITE pp cc �� "J Ive,� ADDRESS U, I L ;�✓F.i ISSUE-�1 ®�a Q TYPE OCG APN LOT TRACT OWNER 'r,. 0,:'C ADDRESS 5-A&IM , CITYZIP TEL: , L 1 APPLICANT "TEL CONTRACTOR b ADDRES CITY ARCH/ENG/ DESIGNER" ADDRESS CITY ZIP TEL. SFR/ADD/REM WNER-BUILDER DECLARATION I HEREBY AFFIRM UNDER gENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FORTHE FOLLOWIN COUNTYWHICH REQUIRESAPER 1 REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE: ANY CITYOR ITTOCONSTRUCT,ALTER�, IMPROVE, DEMOUSH,ORREPAIRANYSTRUC- TURE, PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE 11 LICENSED PURSUANT TO'THE PROVISIONS OF THE CONTRACTORS LI, CENSE LAW (CHAPTER B (COMM :NCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE) ORTHATHE0SHEISEXEMPTTHEREFROMANDTHE BASIS FOR THE ALLEGED EXEMP- TION.ANY VIOLATION OFSECTIC 4?031.5 BY ANY APPLICANT FORA PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF HOT MORE TIIHAN FIVE HUNDRED DOLLARS ($500).): D I,AS OWNER OF THE PROPERTY, ORMY EMPLOYEESWITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK, AND THE S RUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, BUSI- NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY VMO BUILDS OR IMP GVESTHEREON, ANDWHO DOES SUCH WORKHIMSELFORHERSELFOR' THROUGHWIS OR HEROWN EM OYEES, PROVIDEDTHAT SUCH IMPROVEMENTSARE NOT INTENDEDOR OFFEREDFORSALE IFHOWEVEF.THEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFOOMPLE- TION, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). '. ❑ I, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS To CONSTRUCTTHE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS U - CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS DR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S) LICENSED PURSUANTTO THE CONTRAO TORS LICENSE LAW). ❑ IAM EXEMPT UNDER BE B. & P.C. FOR THIS REASON DATE OWNER LICE SED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENAL OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER 9(COMMENCING WITH SECTION'S 000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE A 4D EFFECT. LJSE CLASS LIC. NO_'i IJU! �O vA _apCONTRAC TOsR C\�-� (4 + WORINERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINTg1N ACERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PRC VIDED BY SECTION 37M OF THE LABOR CODE, FOR THE PERFORMANCE ' OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED. I HAVE AND WILL MAINTd 114 WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY SECTION 3700 OFTHE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS YWORI$E'y�OMNINSECARRIER AN, POLICY ARE: CARRIER CI(I✓7�Tl POLICY NUMBER VIC 1 (THIS SECTION NEED NOT EODMPLETEDOFTHE PERMITS FOR ONE HUNDREDDOUARS(S10D)OR LESS). I CERTIFYTHAT INTHE ERPORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOYAN WORKERS' COMPENSAT BECOME SUBJECT TO THE PERSON IN ANY MANNERS��NDA ON LAWS OF CALIFOE TH ISHOULDBECOMESUBJECT TO THE WORK RS' COMPENSA P VIN 3 0 OF THE LA6OR pE, ISHALL FORTHW HCOMPLY HTHOS DATE: PPLICAN : WARNING: FAILURE TO SECURE'WORKERS' COMPENS ION COVERAG IS UNLAWFUL, AND SHALL BE SUBJECTAN EMPLOYERTO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND DOLLARS ($10D,000), INADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'5 FEES. CONSTRUCTION LENDING AGENCY 1 HEREBY AFFIRM. UNDER PENAL�F,Y FOR THE PERFORMANCE OF THE OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3097, CIV. C.). LENDER'S NAME LENDER'SADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THATTHE ABOVE INFORMATION IS CORRECT. I ACRE' TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION. AND HEREBY REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY �THORIZE OR INSPECTION PURPOSES- S PERM7TTNAME -4 SIGNATURE OF ttffqWME DAT APPLICATION PERMIT i��J DATE NUMBERI ✓ `(?)#P/C ISSUE-�1 ®�a Q TYPE OCG DATE 4 1 1 CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDElSIDE STREET RW SIDE ❑ PROPOSED USE NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT- FACTOR PSF ADM. AREA/VALUATION SFR/ADD/REM Garage/Carport WPatio/Deck _ LL Pool/Spa C7 Z Re -Roof Commercial - CIO Valuation I ADJ.AREA QUANTITY DESCRIPTION FE Q U OC LU Z O_ Q 115 -7 O Cc, 0 ®--� (ajZi .9 - CONSTRUCTION PLAN REVIEW ELECTRIC. PLUMBING MECHANICAL INSPECTION FE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT C,`� RETENTION FEE: PRE -ALT FEE: 4°L TOTAL FEES /iq . (DD COMMENTS - RECPT. NO. PAID BY -VALIDATION WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD—Fila Copy, GREEN—Applicant's Copy g 1 11' "Him,"Himum IBM SE7 BAG: - - - - - - - - - - - - - - - - - FHA REWTS FT('�48/F0'RA/,,,S/STEEL, UNDER ---L GOlU -,00e�GCNDIJ, Ri !AD pL1-1UM1,:3�lNG, UNDER F LjT t 3 GRAM PIRELLAC-E BOND BEANI TEMP POI.IVEi2 EAM ILI, 112-1-17 R C -, C F l 3, H E, 40, - H i 1 G 1�- cMi- BOND EEAMi C'Cl' E�n� PREIRADING ROUGH 11EA"PhIG ------- t'(X JGH ELECTMC FiE,' 67 i i P! B G 1-FINI H GRADING SHO'l-AfERIT US TEST C,'OL.. ELECTRIC , I EXE P OL FENUNG 'YVALL INSUM'10N POOL FWAL b,,FF St T E i � A PjSUL/-M0t\! DR`4111,bll NkLM SEA $" FINAL ENG. W�CAPiij:RRIG. SUM TANK D SEE' (YlSiTEUMIPS� GASKR "Ill-ES17 MAL COWIE FIRE DEPT 9NFAL F I f v; A 1, Hi E-AT;,N G -,5�f�FHAL I rNV EFFETIF'r, I DEV, FEES PAID SEP710' TANK, 8 �ZE