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Home My WebLink About15131!. CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 BUILDING PERMIT APTLICATION JOBSITE /tj ADDRESS lJ APN LOT TRACT ft OWNER eq ADDRESS 33N2p P e_ CITY ZIP TEL. ? APPLICA S+ISS TEL.09— � CONTRACTOR FAd ADORE S CITY ZI TEL7 fid. 2 ARCFVENG1 DESIGNERCRR�tu®�I ADDRE S 404T, CITY Mf wl - M/� ZIP ?_fid TEL O ER -BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS U. CENSE LAW FORTHE FOLLOWING REASON (SEC. 7031.3 BUSINESS AND PROFESSIONS CCOE: ANY CITY OR COUNTY WTRCH REOURtESAPERMRTO CONSTRUCLALTER RMPRUVE, DEMOLISH, OR REPAIR ANYSTRUC- TURE. PRIOR TO ITSISSUANCE, ALSO REOURES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS U. COME LAW (CHAPTER I (COMMENCING VATH SECTION 7330) OF DIVISION 0 OF THE BUSINESS AND PRO. FESSIONS CODE) OR THAT HE OR SHE Is EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TON. ANY VIOLATION OF SECTION 7371.3 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (5000).): 0 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. 7044, BUSI- NESS AND PROFESSIONS CME: THE CONTRACTORS LICENSE NAW ODES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO DOES SUCH WORK HIMSELFOR 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 IS SOLD WITHIN ONE YEAR OFCOMPLE- TION. THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE 00 NOT BUILD OR IMPROVE FOR THE PURPOSE OF BALE). 12 L AS OWNER OF THE PROPERTY, AI EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OFA PROPERTY WHO BUNDS OR IPA PROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTORS) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). O 1 AM EXEMPT UNDER SEC. S. B P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM LICENSED UNDER PROVISIONS OF CHAPTER / (OOMMENCING WITH SECTION TOW)OF DIVISION 3 O THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS C D FF LICENSE CLASS - UC. NO, i DATE CONTRACTOR CgImm" ORKERS' COMPENSATION DECLARATION 1 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 7700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT Is ISSUED. _ I HAVE AND WALL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY SECTION 8700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR LII ICH THIS PERMIT IS ISSUED. MY WORNE S' COMPEAN NSATION INSURANCE CARRIER AND POLICY NUMBER ARE. •� //// N CARRIER ` 447' POLICY NUMBER A It ITIM SECION NEEDNCT BE COMPLFTEDOFTHE PERMIT IS FOR CNEM7-DREDDOLARR($100) IFS% 1 CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IB ISSUED, I SHALL NOT EMPLOY ANY PERSON N ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 5700 OF THE LABOR LL CODE, 1 SHAFORTHWITH COMPLY WITH THOSE PROVISIONS. DATE: APPLICANT: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL BE SUBIECTAN EMPLOYER TO CRIMINAL PENALTIES ANO CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (81 00.60(l), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR N SECTION 7703 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERIURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORT( FOR WHICH THIS PERMIT IS ISSUED (SEC. 70W, OV G). LENDER'S NAME LENDERS ADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL CRY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. y44 --a PERM w SIGNATURE OF PERMITTEE DATE PRESS FIRMLY APPLICATIONPERM �0 TPIC �N O �� DATE_(01 NUMBE ` N ISSUE TYPE OCC DATE CONST, GROUP ZONING SETBACKS FRONT Rw ❑ REAR ❑ SIDE(SIDE STREET RW ❑ SIDE p PROPOSED USE + NO. DWEL NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ.AREANALUATION SFR(ADO/REM U) Garage/Carport WPatio/Dock , LL POOVSpe 0 Z Re -Roof 0 Commercial M Valuation ADJ.AREA QUANTITY DESCRIPTION FEE .J Q U LU U Z K 2 U W I Z CONSTRUCTION PLAN REVIEW ELECTRIC _ PLUMBING _ MECHANICAL INSPECTION FEE ISSUANCE 1 SMIP M ENERGY P/C R ENERGY PERMIT S RETENTION FEE: t15 dw PRfRE:� t v 1 TOTAL FEES 17 �] COMME r S Ins RECPT. NO. PAID BY VALIDATION WHITE—Department Gopy, YELLOW—Financo Copy, PINK—Aseessor Copy, GOLDENROD --File Copy, GREEN—Applicant's Copy ^� CITY OF DIAMOND BAR :9 MOAN [411119,111-11ZE0101 vf] SEPT IC G[ZE '--'FEr,' rlT/L] S|ZE _____ _ ----------'------'-- UNDER FLOOR DUCT G rl CU ND j IA F-,' N G UNDER FLOOR CONDUIT DONE) nL-AM TEWIP POWER WATER SERVlcf= MID H_:. BOND BEAM R_'101' SHEATHING 8 FT. 13OND BEAM - FINAL BOND BEAM P00-1 COWR PRE -GRADING "I GnADI�G POOL ELECTRIC P POOL FENCING 1.1'. -ALL INSITLATIOIN' PO LFINIAL. C,EILING INSULATION ------------- DRYVj OFF SITE-. SEW-I'� FINAL ENG. SELF PIT"'L.L. ON SITE INIPS FINAL ZOWNK' FINAL SEPT IC G[ZE '--'FEr,' rlT/L] S|ZE _____ _ ----------'------'--