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Home My WebLink About17786 (444)CnT OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES X� 21825 E. Copley Drive (909) 860-3195 Fax (909) 861-3117 <: BUILDING PERMIT APPLICATION JOBSITE ADDRESS Z/0 APN LOT TRACT OWNER ADDRESS CITY ZIP TEL. APPLICANT TEL. CONTRACTOR ADDRESS CITY ZIP ;TEL. 2`S ARCFVENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC. 7071.5 BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTYVMICH REOUIRES A PERMITTO CONSTRUCT,ALTER. IMPROVE, DEMOLISH. OR REPAIRANY STRUG TORE. PRIOR TO ITS ISSUANCE. 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 LAW (CHAPTER 5 (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 ANYAPPLK.ANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FINE HUNDRED DOLLARS (11500).1: 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. 7044, BUSI- NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON. AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER —EMPLOYEES. PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE IF HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WITHINONEYEAROF COMPLE- TION. THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). O L AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044. BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI. CENSE LAW DOES NOTAPPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON. AND VMO CONTRACTS FOR SLX H PROJECTS VATHACONTRACTOR(S) UCENSEO PURSUANT TO THE CDNTRAG TORS LICENSE LAW.). O 1 AM EXEMPT UNDER SEC. B. a P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER S (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT. LICENSE CLASS LIC. NO. DATE CONTRACTOR WORKEFITCOMPENSATION DECLARATION I HEREBYAFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: _I HAVE AND WILLMAINTAIN A CERTIFICATE OF CONSENT TO SELFaNSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION 7700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. 1 HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE. AS REQUIRED BY SECTION 37000E THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER &NNo POLICY NUMBER ARE: CARRIER/-...�- � L. POLICY NUMBER (DISSECTICNNEEDNDT BE OOMPLETEDOFTHE POW S POR ONE HUNDREDDOU.AR5 ($100)OR LESS) 1 CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT S ISSUED, I SHALL NOT EMPLOY ANY PERSON N ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERVOOMPENSATION LAWSOF CALIFORNIA AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE, HALL ORTHWITH COMPLY WITH THOSE PROVISIONS. DATE: /yC%L% APPLICANT. _[ WARNING: FAILURE TO SECURE WORKERS'COMPE AT KJN RAGE IS UNLAWFUL, AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS (11100.000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3705 OF THE LABOR CODE. INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3097, CIV C.). LENDERS NAME LENDERSADDRE55 I 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 RELATW G TO BUILDING CONSTRUCTION. AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. i PERMITTEE NAM/E�(PRI 7 SIGNATUREO PERMI - V" ��- PRESS FIRMLY APPLICATIONS p DSL PERMIT /� �l PIC 7_L.LSZ DATE o NUMBER �.[ # ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ L-1 SIDE ❑ PROPOSED USE C NO. DWEL NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREANALUATION SFR/ADD/REM U) Garage/Carport WPatio(Deck LL PcoVSpa 0 Z Re -Roof ,2 OJ Commercial 5 m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE U iz F- U W J w (.O 2 F0 J - a J U 2 Q S U W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: TOTAL FEES 5 g COMMENTS ✓ / RECI T. NO. PAID BY __(�VALIDATION WHITE—Department Copy. YELLOW—Finance Copy. PINK—ASSOSSor COpy, GOLDENROD—FlIe Copy, 5HEEN—AppIIcanr3 OOpy CITY OF DIAMOND BAR INSPECTION RECORD SET BACK FLOOR JOIST FTGS/FORMSISTEEL FHA REGIVITS ELECTRIC GROUND j 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 FT. BOND BEAM FRAMINGIVENTILIATION ROOF COVER ROUGH HEATING FINAL BOND BEAM PRE GRADING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWER/TUB TEST POOL ELECTRIC EXT. LATH/SIDING j POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION I OFF SITE IMPS. DRYWALL NAILING j DEDICATIONS SEWERFlNAL ENG. SEPTIC TANK LANDSCAPE/IRRIG. SEEP PIT/L.L. j ON SITE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST. j FIRE DEPT FINAL FINAL HEATINGHEALTH DEPT. FINAL FINAL ELECTRIC j DEV. FEES PAID FINAL PLUMBING i ENERGY COMMENTS SEPTIC TANK SIZE SEEP PIT/LI SIZE 51