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Home My WebLink About15045 (447)I CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES c 21660 E. Copley Drive Slur 190 (909) 860-3195 Fax (909) 861-3117 ++ BUILDING PERMIT APPLICATION JOBSITE ADDRESS �$ 918 �% I S I FQ CJ4.I:-� APN - LOT kid TRACT OWNER a oA-W 1- 6A ADDRES -2- ✓ (SLA Cow4-r CITY V /AIS W1) 6M ZIP / 76 TEL. 66 D -OS00 APPLICANT TEL CONTRACTOR Gyle -'Rs Gµ170A 000 If S ADDRESS 2 2 UA CITY C&4ilkd0 ZIP 17W.TEL ARCH/$/ DESIGNER «J �L ADDRESS 12-01 T11fr-1 CITY A 4 A4110" ZIP _ '* I TEL. 0 OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LI- DENSE F CENSE UW FOR THE FOLLOWING REASON(SEC.7W1.5 BUSINESS AND PROFESSIONS CODE: ANYCITYOR COUNTY WHICH REOUIESA PERMITTO CONSTRUCT.ALTER, IMPROVE, DEMOUSH, OR REPAIR ANY STRUC• TUBE. PRIOR TO ITS ISSUANCE. ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO RLE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS Ll- DENSE MCENSE UW (CHAPTER 0 (COMMENCING WITH SECTION T000) OF DIVISIONS OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OR SHE M EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP. TIX•1. ANY YKXATION OF SECTION TW 1.6 BY ANYAPPLICANT FOR A PERMIT SUBJECTS THE APPLICANT M A CMHAN L PENALTY OF NOT MORE TFIVE HLINORED DOLLARS ($500).): O LAS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK. AND THE STFA MFLE IS NOT INTENDED OR OFFERED FOR SALE(SEG 7044, SUSI, W NESS AND PROFESSIONS OE: THE CONTRACTORS LICENSE UW DOES NOT APPLY TO AN OWNER OF PROPERTY V440 BUMS OR IMPROVES THEREON, AND VA40 DOES SUCH WORK HIMSELF OR HERSELF OR TNROLKLH HIS OR HER OWN EMPLOYEES, PROVIDEO THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE F. HOWEVER, THE BLAJXNG OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE- TION. THE OWNWI HAVE THE BURDEN OF PACVNO THAT HE OR SHE DO NOT BUILD OR IMPROVE FOR THE PURPOSE OF $ALF). O LAS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEG 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS U DENSE UW DOES NOT APPLY TO AN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTIONS) LICENSED PURSUANT TO THE CONTRAC- TORS ONTRAGTORS LICENSE LAW.). - O IAM EXEMPT UNDER SEG B. S 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 9 (COMMENCING WITH SECTION 7000)OF DIVISION S OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS N FULL FORCE AND EFFECT. LICENSE CLASS C- S 3 LIC. NO. G G DATE 1 -7—U0 CCNTRACTOn CN.AT1I 1 WORKERS' COMPENSATION DECLARATION i 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION 5700 OF THE LABOR CODE. FOR THE PERFOnMANCE OF THE YORK FOR WHICH THIS PERMIT IS ISSUED. I 1 _T HAVE AND WILL MAINTAN S' W WORKERMPENSATOON INSURANCE, AS REOUIRED BY SECTION 3700 OF THE LABOR CDC) I- FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WOf!ERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE- .13.0 RE: CARRIER /"1 +•` - POLICYNUMBER LDAs sEcn N rem NOT BE COMPLETED OF TIC PfFW S Fort CW IHU aREDDOLLARs ($100) OR LES% 1 CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I i SHALL NOT EMPLOY ANY PERSON N ANY MANNER SO AS TO BECOME SUBJECT TO THE j WORKERS'COMPENSATION LAWS OF CALIFORNIA AND AGREE THAT IF I SHOULD BECOME SUBJECTTO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 5700 OF THE LIBOR CODE, I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. � DATE: -APPLICANT: - J j WARNING: FALURE TO SECURE YORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND BL/ALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TOONE HUNDRED THOUSAND DOLLARS ($100,000), N ADDITION TO THE COST OF COMPENSATION, OAMAGE3 AS PROVIDED FOR IN JSECTIONS7060F THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. J 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 ISSUEDUED[SEC. 7097, CIV G). 3 LENDERS NAME LENDERS ADDRESS CV I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. L I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUNTING CONSTRUCTI R AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTONED PROPERTY FOR INSPECTION PURPOSES. lge'ralg- 602 _f PERMffTEE NAY n7 Nv SIGNATURE OF PERMITTEE DATE EXPIRED AIIG 012002 PRESS FIRMLY ` V v qs P!C DATECATION4 ✓ NUMBER ISSUE OCC j_C1,0!TYPE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDEISIDE STREET RW ❑ SIDE Iq ❑ PROPOSED USE NO. DWEL. NO., NO. UNITS STORIES BEDROOMS DESCRIPTION " SO. FT.' FACTOR PSF ADJ. AREAIVALUATION SFR/ADD/REM ri) Garage/Carport W Patio/Dock V- PooVSpa ZRe -Roof Commercial - m Valuation ADJ.AREA QUANTITY DESC ON j FEE 6 U it U W J U.1 0 1 -9- Z -n i 0 - U 2 Q 2 U w CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP - Cl ENERGY P/C BU ATifilc�T�TY ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: I TOTAL FEES l COMMENTS ti RECPT. NO. PAID BY VALIDATIOh:iL,N WHITE—Department Copy, YELLOW—Finance COPY. PmW—wsxssor wpy. �uw�r...,1.—r�ro...+vF. ��=G•--wv��,� wvT CITY OF DIAMOND BAR,. _ INSPECTION RECORD MPEG M- SET BACK.; VATE INSPECTION FLOOR JOIST i.�� : c. _� �_ DATE INSPECTOR , :.. ,\, FTGS/FORMS/STEEL J -FHA REQMTS - - - - - ELECTRIC GROUND _1 1 UNDER FLOOR DUCT ,. GROUND PLUMBING UNDER FLOOR COAlDUiT :' ► ; < �'' '� `• '•- SLAB GRADE - FIREPLACE PbbhbATION •" %'�' �,\' , >� TEMP POWER - FIREPLACE BOND BEAM WATER SERVICE r MID HL BOND BEAU • _, . , : ,,.. ,. ROOF SHEATHING 8 FT. BOW) VCAV FRAMING/VENTILIATION FINAL BOND BEAM ROOF COVER PRE -GRADING -ROUGH HEATING - -- BENCHING''' ►' :., . :...,, Sn,, f; ROUGH ELECTRIC - rp - ROUGH GRADING ROUGH PLUMBING ! FINISH GRADING , SHOWERJTUB TEST EXT. LATH/SIDING _ POOL ELECTRIC POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER _ . FINAL ENG. SEPTIC TANK LANDSCAPE/IRRIG. SEEP PIT/L.L. - . -- GAS AIR TEST _' 1 _ ON SITE IMPS. FINAL ZONING FINAL CONST. - - FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC - DEV. FEES PAID FINAL PLUMBING ENERGY COMMENTS 6 d� moo_ - �� o C pz�z,a�� . ,� . v o� welre,,� l4W SEPTIC TANK SIZE SEEP PIT/U SIZE N