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Home My WebLink About15561 (23)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 ADDRESS APN LOT TRACT OWNER A5 Sii LY L ADDRESS Z3 . 3 ,5_Urt/Lfc�7 CITYf%�A�i✓� ZIPy17b5__ TEL 6o -'S2 (-'I APPLICANT rtEi6Lr6- TEL. CONTRACTOR ADDRESS CRY ZIP TEL. ARCRTNGL l DESIGNER ADDRESS CITY ZIP TEL OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS U - CENSE LAW FOR THE FOLLOWING REASON (SEC. 7637.5 BUSINESS AND PROFESSIONS CODEANY CITYOR COUNTY W4CH REOL)IRESA PERMITTOCCUSTRIICCALTER. IMPROVE, DEMOLISH .OR REPARANY STRUC• TORE. PRIOR TORS LSSUANCE. ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI• CENSE UW (CHAPTER a (COMMENCING WITH SECTION TOGO) OF DIVISION S OF THE BUSINESS AND PRO• FFSSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP. TION, ANY VIOLATION OF SECTION 7641.5 BYANYAPPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL. PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (]500).); O 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. 70". S USI - NESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR AAPROVES THEREON, AND WH0 DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES. PROVIDED THAT SUCH IMPROVEMENTS ARE NOT NTENOED OR OFFERED FOR SALE F, HOWEVER THE BULDNG OR NPROVEMENTLs SOLA WITHIN ONE YEAR OF COMPLE- TION. THE OWNER-0UILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPFIOVE FOR THE PURPOSE OF SALE} O L AS OWNER OF THE PROPERTY, AIA EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEG 70M BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE LAW DOES NOTAPPLYTOAN OWNER OFAPROPERTY WHO BUILDS OR IMPROVES THEREON. AND WHO CONTRACT3 FOR SUCH PACUECTS WITH A OONTRACTOFI(S) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW). O 1 AM EXEMPT UNDER SEC. B. a P.C. FOR THIS REASON DATE ^ U d GONER LICENSED CONTRACTORS DECLARAT�CINI 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMOENCNO WITH SECTION TOM) OF DIVISION ] OF THE BUSINESS ANC PROFESSIONS CODE, AND MYLICENSE IS N FULL FORCE AND EFFECT. LICENSE CUSS LIC. NO. DATE CONTRACTOR WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS. _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELFaNSURE FOR WORKERS' COMPENSATION. AS PROVIDED BY SECTION 4700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. _I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE. AS REWIRED BY SECTION 4700 OFTHE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS SWED. MY WORKEFLS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE CARRIER POLICY NUMBER L (Dies SECTION NEED NOT BEO:MPLF7TDOFTE PERMIT IS FORCNE HUNDRED D0l1MS(L1O0) ORLC&% I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT TO TH ED. I WORKS OT EMPLOY ANY PERSON WS NARY MANNER AND S TOAGR BECOME SI OJECTSHOULD B THE j WORKERS' THE AT*NWORKERS* COMPENSATION NIA.PRO VISIONS OF EE THAT N3100 F BECOME - SUBJECT TO THE WORKERS'COMPENSATXON DROVISIONS OF SECTION ]7000F THE LABOR OWE.1 SHALL FORTNVVITH COMPLY WITH THOSE PROVISIONS. I I DATE: APPLICANT: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS NE HUNDRED AND SMALL BE D SUeIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TOONE HUNDRED THOUSAND DOLLARS IS 100.000). N ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN F SECTION 77050E THE LABOR CODE. INTEREST AND ATTORNEYS FEES. 1 CONSTRUCTION LENDING AGENCY i I HEREBYAFFIRMULCER PENALTY OF PERJURY TENTTHERE WSACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORKK FOR WOR WHICH THIS PERMIT IS ISSUED (SEG ]OW, CIV. G). 3 LENDERS NAME LENDER'S ADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING 3 CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTA7IYES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. 7 0 5oz"-G///6.7 PERMITTEE NAME PRINT) 7 _/L+� D� 7 f O SIGNATURI:OFFERAWny DATE APPLICATION _ Q PERMIT /55& P/C DATE NUMBER 1 k ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR 13- SIDE/SIDE SIDE/SIDE STREET RW ❑ SIDE PROPOSED USE NO. DWEL NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREANALUATION SFR/ADD/REM ' (n Garage/Carport WPatiG/Deck LL POCUSpa ZRe -Roof 0 Commercial - m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE _U W J W 0 2 J a J a U Z a x U W CONSTRUCTION PLAN REVIEW -11 ELECTRIC[ -- PLUMBING_ MECHANICAL INSPECTION FEE ISSUANCE �� r r ►�F SMIP�T-tNM Ci'TtiU-Sr;rL ENERGY P/C 1 ENERGY PERMIT II RETENTION FEE: PRE -ALT FEE: TOTAL FEES 7u COMMENTS AL RECPT. NO. PAID BY VALIDATION WHITE—Department Copy, YELLOW—Finance Copy. PINK—A33e830r L 4PY, UULUn NhVL r %,Wy, U...r -- PP -11 s —Py CITY OF DIAMOND BAR . INSPECTION -RECORD %t p SET BACK FLOOR JOIST. FTGS/FORMS,'STEEL FHA REQMTS ELECTRIC GROUND 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 Fr. BOND BEAM FRAMING/VENTILIATION FINAL BOND BEAM ROOF COVER PRE -GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC 61 ROUGH GRADING ROUGH PLUMBING FINISH GRADING �SHOWER,TUB TEST POOL ELECTRIC 'EXT. LATH/SIDING -WALL INSULATION INSULATION POOL FENCING POOL FINAL OFF SITE IMPS. .'CEILING .DRYWALL NAILING DEDICATIONS SEWER FINAL ENG. SEPTIC TANK LANDSCAPE/IRRIG. SEEP PIT/L.L. _b N SITE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST. FIRE DEPT, FINAL FINAL HEATING FINAL"ELECTRIO FI -NAL PLU%IB!N ¢ HEALTH DEPT. FINAL DEV. FEES PAID ENERGY COMMENTS SEPTIC TANK SIZE SEEP PIT/U SIZE L