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Home My WebLink About13252 (29)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 JOBSITE ADDRESS] DDRES ADDRESS APNLOT TRACT OWNER 17 to ADD SS CI ZIPt`�(�EL. APPLICANT TEL. CONTRACTOR ADDR S CITY KC U - F ZIP TEL. ARCFVENG/ IY�`•-cl• DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LL CENSE LAW FOR TME FOLLOW NG R[ASON (SEC. 7071.6 BUSINESS AND PROFESSIONS COOS ANY CrTY OR COUNTY WHICH REOLARESA PERMrTTO CONSTRUCT,ALTER IMPROVE, DEMOUSH-OR REPAIRANY STRUC- TURE. PRIOR TO ITS ISSUANCE• ALSO REOUIRES THE APPLICANT FOR SUCH PER IT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI. CENSE LAW (CHAPTER I (COMMENCING WITH SECTION 70DC) OF DIVISION 7 OF THE BUSINESS AND PRO- FESSIONSCODE) OR THAT HE ORSHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7071.6 BY ANY APPLICANT FORA PERMIT SUBJECTS THE APPLICANT TO A CML PENALTYOF NOTMORE THAN FIVE HUNDRED DOLLARS (!500).1: O L AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORAND THE STRUCTURE IS NOT INTE D NDED OR OFFERED FOR SALE (SEC 7044, BUSK NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PFgPERTY WHO BURRS On IMPROVES THEREON. AND VAHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH MS On SUCH HER OWN EMPLOYEES, PROVIDED THAT SUIMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE F, HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE- TION. THE OWNEREUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE), 0 L AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 70", BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUMS OR IMPROVES THEREON{ AND VMO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR($) LICENSED PURSUANT TO THE CONTRAC- TORS ONTRAGTORS LICENSE LAW). 01 AM EXEMPT UNDER SEC. B. l P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER I (OOMMENCNO WITH SECTION 700010E DIVISION 70F THE BUSINESS AND PROFESSIONS CODE. AND LEY LICENSE IS N!IALFORCE ANDE FECT. /.� rp�,4 LICENSE CLASS LIC. N0. ✓�`�' '` DATE _,,.Z_ CONTRACTOR J-� WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS. I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONS ENT TO SELF -INSURE FOR WORKERS COMPENSATION, AS PROVIDED BY SECTION 7700 OF THE LABOR COCE- FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY SECTION 77000E THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY E ^ COMPENSAT N URANCE CARRIER AMI POLI Y NUMBER": CARRIER AN6 POLICY NUMBER _�• (D6SECrTO IN®NOT B COMPLETEDOFTHE PERMIT IS FOR ONE HI.FORMDMLARS(SIM DR LESS) 1 CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I SHALL NOT EMPLOYANY PERSON N ANY MANNER SO AS TO BECOME SUBJECT TO THE WORK ERS'OOMPENSATK)NLWPFW7FUiF ISIIOIAD BC ME WORKERS EQ'pl%tliiO L'F ZN LAVECTTOTHE J�.F_y1 {/�/'T T I WARNING: FAILURE TO SECURE WORKERS' COMPENS COVERAGE IS UNLAWFUL AND SIULLLBE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS (7100.000), N ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN IO SECTN 3707 OF THE LABOR CODE. INTEREST. AND ATTORNEYS 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 IS PERMIT IS ISSUED (SEC.I0II. CIV C.I. LENDERS NAME LENDER'S ADDRESS 1 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IB CORRECT. I AGRETZ TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS ACLATNG TO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECT VRP0.5E5. /�- La-Frics �Y) - vE rtTEE SIGNATUN EE M% PRESS FIRMLY APPLICATION PERMIT -DATE NUMBER127rL # # ISSUE 1 1 , �1 f1_ TYPE . OCC DATE LLJ CONST. GROUP ZONING SETBACKS FRONT RW p REAR p SIDE/SIDE STREET RW O SIDE p PROPOSED USE NO. DWEL NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT FACTOR PSF ADJ. AREA/VALUATION SFRIADD/REM C5 Garaga(Carport WPatio/Deck . LL- Pool/Spa 0 Z Re -Roof 0 Commercial m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J a U EC V W I LU LU L7 Z a Y� 0-1z '�'_ C O� D �- CO- O U LLI CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL -`• +''f INSPECTION FEE ISSUANCE SHIP �{ •'ti=� LI �sV ENERGY P/C n1•r"J CL��'L'' ENERGY PERMIT l'TY A , ;:•�� RETENTION FEE:��111' u' PRE -ALT FEE: TOTAL FEES J�• COMMENTS RECPT. NO. PAID BY 11 nE V 41 VALIDATION WHITE—Oepartmml Copy. YELLOW—Finance Copy, PINK—Assessor Copy. GOLDENROD—File Copy, GREEN-440icant'a Copy CITY OF DIAMOND BAR INSPECTION RECORD.' SET BACK �' ' INSPECTION D AT I- -R;- FLOOR JOIST FTGSlFORMS/STEEL FHA REQMTS - ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING UNDERFLOOR CONDUIT SLAB GRADE FIREPLACE' FOUNDATION = - - • - TEMP POWER FIREPLACE BOND BEAM - -' - - WATER SERVICE -MID HT: BOND BEAM' ' ROOF SHEATHING 8 FT. ZIOND BEAM FRAMINGNENTILIATION FINAL BOND BEAM ROOF COVER .' PRE -GRADING ROUGH HEATING +--6• 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 LANDSCAPEIIRRIG. SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST. FIRE DEPT. FINAL FINAL HEATING l0 0 HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY COMMENTS I SEPTIC TANK SIZE SEEP PIT/U SIZE i r-