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Home My WebLink About15159CITY 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 2- 3 $ 3 L` SUNS APN LOT TRACT OWNER "7 �A� ADDRESS fj&_<C)_ ,J CITY P TEL.116,6 O _ S' APPLICANT O AlK L'EX TEL. CONTRACTOR � NesNle ADDRES S r/ ! L L If CITY O f7el--n ZIP TEL ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS Lt CEME LAW FOR THE FOLLOWING REASON (SEG 7031.S BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REOURESA PERMIT TO CONSTRUCT ALTER. IMPROVE. DEMOLISH, OR REPAIR ANY STRUG LURE PRM TO ITS ISSUANCE. ALSO REWIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE 15 LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS L4 CENSE LAW (CHAPTER I (CDIAMENCTNG WITH SECTION 7000) CFDMSION 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 VIClATION OF SECTION 7031.6 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (SSW) ): O L AS 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. 70N, BUSI. NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOTAPPLY TO AN OWNER OF PROPERTY Woo BUILDS 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 0) SOLD WITHIN ONE YEAR OF COUPLE. TION. THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SAL R O L AS OWNER OF THE PROPERTY; AM EXCLUSIVELY CONTRACTING WITM LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 70". BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LH CENSE LAW DOES NOT APPLY TORN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND V440 CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAG TORS LICENSE LAW). O IMI EXEMPT UNDER SEC. B S P C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HERESYAFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISK)NS OF CHAPTER I (COMMENCING WITH SECTION 700)) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS COCE AND MY LICENSE IS IN FULL FOR'CJE AND EFFECT. LICENSE C((ASS `— �y LK:. NO. DATE Y �� 1 CONTRACTOR. WORKERS' COMPENSATION DECLARATION�v 1 HEREBYAFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATONS. I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF4NSURE FOR WORKERS' COMPENSATION,AS PROVIDED BY SECTION 37000F THE LABOR COCE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED. ' I HAVE AND YPLLMM7ITAIN WORKERS' COMPENSATION INSURANCE. AS SCOURED BY SECTION 3700 OF THE LABOR CODE. FOR THE PERFORMANCE OF ME WORK FOR WHICH THIS PERMIT IS ISSUED, MY WORKERS' COMPENSATION INSURANCE CARRIER ANO POLICY NUMBER ARE. CARRIER POLICYNUMBER (THIS SECII7NNE® NOTBE COMPLETED OFDC PERMfT IS FO(ICNE HUNOREDDOUARS 111100) CALM 1 CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SOAS TO BECOME SUBJECT TO THE WORKERS COMPENSATION LAWS OF CALIFORNIA AND AGREE THAT IF 1 SHOULD BECOME SME CTTOTHEWORKEFtTODMPENSATIONPRD_WSK7N5 SECT OO OF TH ABOR E^T SCt� �A FORT!pWgt1 COMPLY WITH T'1CS`.-ROVIS — GATE: �/J (/J �,.CL-k APPLICANT: .. WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL BE SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TOONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COSTOF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3703 OFTHE LABOR CODE, INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY 1 HEREBY AFFIRM UNDER PENALTY OF PERIURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3W7, CIV C.). LENDERS NAME LENDERS ADDRESS 1 CERTIFY THAT 1 HAVE READ THIS APPLICATION AND STATE THATTHE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCT101y AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOYEM�E/N/T71�pNED PROPERTY FOR INSPECTION R7R SCS IV ESMMF,3rAM�yNINTL / .' Lit /! :../ .. 1 — �ATURTTUURREOFPE/RMIT7/IE ♦ w DATE PRESS FIRMLY �,. C O PERMIT I P/C D 7 ATE 'IIATE NUMBER M ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDEISIDE STREET RW ❑ SIDE ❑ PROPOSED USE NO. DWEL NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREANALUATION SFR!ADD/REM TO GarageXarport W Patio/Dock LL POOl7Spa 0 Z Re -Roof OJ Commercial M Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J 4 U cc t3 w w 0 Z m 2 J Q U 2 Q 2 ' U W CONSTRUCTION PLAN REVIEW 1� ELECTRIC PLUMBING MECHANICAL Tn F INSPECTION FEE -•j I ISSUANCE SMIP II IF; !1 /? ENERGY PIC ENERGY PERMIT CFFY 07' EjIAL. ju,\ U iii SL♦ RETENTION FEE: 'ZI ITT.DINO A,i`:D S,",11 1 l 11 PRE -ALT FEE: o J TOTAL FEES - ! COMMENTS RECPT. NO. PAID BY VALIDATION WHITE—Department Copy, YELLOW—Finanoe Copy, PINK --Assessor Copy, GOLDENROD—File Copy, GREEN—Applicant's Copy CITY OF DIAMOND BAR INSPECTION RECORD �€ ��1!h _ e)'_ irir l�k� : �"t?� _� 1►�I`y t@)► �� r SETBACK FTGS/FORMS/STEEL LOOR JOIST u FHA REOMTS ELECTRIC GROUND j UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR CONDUIT SLAB GRADE FIREPLACE FOUNDATION TEMP POWER WATER SERVICE FIREPLACE BOND BEAM iT. BOND BEAM ! ROOF SHEATHING 8 FT. BON -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 j .CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS I SEWER J'FINAL ENG, j SEPTIC TANK LANDSCAPE/IRRIG. SEEP PIT/L.L. I ON SITE IMPS. j GAS AIR I -EST FINAL ZONING FINAL CONST. FINAL HEATING j7— DEFT. FINAL HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ; ENERGY COMMENTS 10 -0— t \_41 _n _D SEPTIC TANK SIZE SEEP PIT /U SIZE �a t - --- —