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Home My WebLink About14391 (878)r 0 i� aL 0 UJ O CC_ O (ZB W TW F LL O Cn Cn CO O WFz F-- �oZ Q 0 W z E7 to s O W �L J Ei O Cr LL 0 GOco coN J CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive Suitt 190 (909) 860-3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION JOSSITE A DRESS ! 31/5 Sc� _V --e It'& APN LOT TRACT OWNER V ADDRESS CITY ZIP TEL APPLICANT TEL CONTRACTOR 4-1, A ADDRESS CITY f�pn'I(� ZIPV.PZ TEI �i�( �1•( F9X�Y ARCWENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFUIM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS U• CENSE UW FOR THE FOLLOWING REASON (SEG 7031.5 BUSINESS ANO PROFESSIONS CODE ANY CITY OR COUNTY WHICH REOUIRESAPERMITTO CONSTPUCT,ALTERIMPROVE, OEMOUSH, OR REPMFIANY STRUG TURF. PRIOR TO RS ISSUANCE. ALSO REWIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LF CENSE UW (CHAPTER P (COMMENCING WITH SECTION 7000) OF DIVISION 7 OF THE BUSINESS AND PRO- FESSIONS CODE) ORTHAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION.ANY VXXATION OF SECTION 700I.S BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLIGWT TO A CML FENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS USOO).X CI L AS OWNER OFTHE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WALL GO THE WON(, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE ISEC. 7044, BUSI- NESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE UW DOES NOTAPPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON. AND WINO DOES SUCH WORK HIMSELFOR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES. PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR ER OFFED FOR SALE. IF, HOWEVERTHE BUILDING ORIMPROVEMENTIS SOLOWITHIN ONEYFAR OF COMPLE• TION, THE OWNER 8U6DER WALL HAVE THE BURDEN OF PROVING THAT HE OR SHE DO NOT BUILD OR IMPROVE FORTHE PURPOSE OF SALE). EI L AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WTM LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEG 7044. BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS U. CENSE LAW GOES NGTAPPLY TO AN OWNER GFA PROPERTY WHO DUADS OR IMPROVES THEREON, AND W4 0 CONTRACTS FOR SUCH PROIECTS WITH A CON7RACTOR(S) UCENSED PURSUANTTO THE CONTRAO TORS LICENSE LAW.). O IMI EXEMPT UNDER SEG S. S P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION 1 HEPEBYAFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER P (OCMMENCNO WITH SECTION ?ODD) OF DIOSKN S OF THE BUSINESS AND PROFESSIONS CODE, AND W LICENSE IS N FLU FFOTICE?AND EFFECT. LICENSE CUSS ` _ l UC. NO. !Y�? / .GATS eP _ d _coNTRAc7o WORKERS' COMPENSATION DECLARAMON 17 1 NEREBYAFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOUJ7N'ING DECD -I HAVE AND W^LLMAINTAN ACERTIFICATE OF CONSENTTO SELF -INSURE OR WORKERS' COMPENSATION. AS PROVIDED BY SECTION Y700 OF THE LABOR WOE F THE PERFORM OF THE WORK FOR TWIG/ THIS PERMIT IS ISSUED I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE. AS REQUIRED§Y' CtION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH�TOS PERMIT IS ISSUED. MY WOR(EFIV COMPENSATION INSURANCE CARRIER AND POLICY UMBER ARE. CARRIER POLICY NLIMBER �� Il MtssEcrK)NN,EMNOIBEOM"XrEDCFT[t PV*VrFORONF RDJ DOLLARS(SI ))ORLE.SS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR W CH THIS PERMIT IS ISSUED.I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO TO COME SUBJECT TO THE WORK'cRS COMPENSATION LAWS OF CALIFORNIA.A ACRE THAT IF DBECOME SUBJECTTO THE WORKERS'COMPENSATION ' IONS OF CTION 7 FTHE NAB CODE, I SHALL FOR'MNTH COMPLY WITH Ro IONS. DATE: 12__a!22_ APPLICANT. WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL BE S'JBJECTAN EMPLOYER TO CRIMINAL PENALTIES ANO CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS IS 100,000), N ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 37" OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THATTHERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEG 0007, CN. C.). LENDERS NAME LENDER'S ADDRESS 1 CERTIFY THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ADOYE INFORMATION IS CORRECT. 1 AGREE TO COMPLY WITH ALL CRY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCT IN. AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. PERMITTEEN NT) SKINATUR&OF PERMITTEE ATE EXP1F;1.-U SEP 14 PRESS FIRMLY APPLICATION PERMIT P/C U I DATE NUMBER / M ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ Lj SIDE ❑ PROPOSED USE NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION SFRIADDIREM CAI Garage/Carport UJ Patio/Dedl LL PooUSpa 0 Z Re -Root Commercial - 5 M Valuation ADJ.AREA OUANTITV DESCRIPTION FEE U lL . 50 Wu,, /rkTr l LU z a' i UCT N 'C P REV' LECT BING ECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE•ALT FEE: TOTAL FEES COMMENTS RECPT NO. PAID BY VALIDATION WHITE—Department Copy, YELLOW ---Finance Copy. PINK—Assessor Copy, GOLDENROD—File Copy, GREEN—Applicant's Copy CITY OF DIANIIOND.BAR INSPECTION'RECORD 1►��;�=c1ri•i lo'"" :SET BACK i Ila-c�+ni►�k-��-��.�1�a��; � FLOOR JOIST �'��".�i�� . . !►��-'1�=�';�m �I '� ;FIGS/FORMS/STEEL- - ,ELECTRIC GROUND GROUND PLUMBING FHA REQMTS UNDER FLOOR DUCT UWER FLOOR CO;,+,)JIT SLAB GRADE - - - FIREPLACE FOUNDATION TEMP POWER FIREPLACE BOND BEAM 'WATER SERVICE -- MID HT. BOND BEAM i !ROOFSHEATHING 8 FT. BOND.BEAly1 ` FRAMINGNENTILIATION - FINAL BOND BEAM' ;ROOF COVER PRE -GRADING 'ROUGH HEATING BENCHING :ROUGH ELECTRIC_ ROUGH GRADING ,ROUGH PLUMBING FINISH GRADING SHC'.-' =R! -i UB TEST POOL ELECTRIC =r: l hi fi SIDIPJG POOL FENCING WALL INSULATION -, POOL,FINAL E �CsEILiNS INSULATIONi OFF SITE IMPS. dE YtJt�I,L_NAiLING - DEDICATIONS• S L1eER - FINAL ENG. Y . iC TANK LANDSCAPE/IRRIG. _ ';T/L.L. ON SITE IMPS. _ .:; <,[F' TEST FINAL -ZONING FIRE DEPT. FINAL •.: ,AEATING _ HEALTH DEPT. FINAL __UE .!E ; DEV. FEES PAID - PLUh1BING ENERGY 7.J!l ,SEPTIC TANK SIZE :SEEP PIT/U SIZE - —