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Home My WebLink About108248'7I?r -ail"- c`5 CITY OF DIAMOND BAR COMMUNITY DEVELOPMENT DEPARTMENT �, w 21660 E. Copley Drive Suite 190 (909) 860.3195 Fax (909) 861-3117 '""' BUILDING PERMIT APPLICATION JOBSITE ADDRES 302-0 V'A401 9F -,08c1'4 LAt-1G APN LOT 2 TRACT� - a 9 OWNER -GF(C « IN `i Wr -S PIW6eHU Yi%I` & ADDRESS 2 2-2- E IBC- CITY 7 iIAWN.!> j3f ZIPjIT TEL. -- & 027-0 APPLICANT TEL CONTRACTOR ALAI 1 S VI EC.rI ®LCOi av ADDRESS 1 6 1-] t AL Alya. sUi E ZOO CITY iLy'DU.5-Tg.`( ZIP i P - TEL. B/ 9 0- 0123 ARCH/ENG/ _ DESIGNER ��" kms'= - -e6rL RA ADDRESS frit , 0F;e1Z.T ' r�b . 5 tI lM CITY t51': "Ot ZIP %1-2- TEL -7--E' v 2 OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXE PT FROM TeHE LI CENSE LAW FORTHEFOLLOWING REASON(SEC. 70315 BUSINESS AND PROFESSION DOE: ANYCITY OR COUNTY WHICH REQUIRES A PERMITTO CONSTRUCT,ALTER, IMPROVE, DEMOUSH REPAIRANYSTRUC- TURE. PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCFJ PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI. CENSE LAW (CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVIS 093 OF THE BUSINESS AND PRO. FESSIONS CODE) OR THAT HE OR SHE IS E%EMPT THEREFROM AND,,jj BASISFORTHEALLEGEDEXEMP. TION. ANY VIOLATION OF SECTION 7031.5 BY) APPLICANT FOBACPERMIT SUBJECTS THE APPLICANT TO ACIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLAR ($5w)); CI, AS OWNER OFTHE PROPERTY, OR MY EMPLOYE ITHWAGESASTHEIR SOLE COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE IS NOT INTTEE DED OR OFFERED FOR SALE (SEC. 7066, BUSI- NESS AND PROFESSIONS CODE: THE CONTRACT LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO GUILDS OR IMPROVES THERED DWHODOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES. PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE_ IF. HOWEVER,71-E ING OR IMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE- TION, THE OWNER -BUILDER WILL HA THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVEFOR THE PURPOSE OF EL G I, AS OWNER OFTHE P ERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PRO) (SEC. 7009, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI. CENSE LAW DOESNOT LY TO AN OWNER OF A PRO PERTY WHO BUILDS OR IMPROVES THEREON, AND WHOCONTRACTS UCH PROJECTS WITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC. TORS LICENSEELLA .1. I A £%EMPT UNDER SEC. B b PC. FOR THIS REASON IMTE 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 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT. LICENSE CLASS LIC. NO. -75 DATE 5- — ZC •� 9 CONTRACTOR _y.P__ WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS. _ 1 HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION 37M OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MYWORKERS COMPENSATION INS,AURANCE CARRIER AND POLICY NUMBER ARE. CARRIER c A L,C, '1 -1 POLICY NUMBER L.. �l Pc •y�� 1 (THIS SECTION NEED NOT BE COMPLETEDOFTHE PERMIT IS FOR ONE HUNDRED DOLLARS (5100) OR LESS), I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I SHALL NOT EMPLOY ANY PERSON IN 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 3700 OF THE LABOR CODE ISHAL FORTHWITH COMPLY ITH THO$BPR VIS ON9 DATE: APPLICANT: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL BE SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (S1 00 .000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 F THE LABOR CODE, INTEREST AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCEOFTHE WORK FOR WHICH � )THIS PERMIT IS ISSUED (SEC. 337, CIV. C.). LENDERS NAME N I YGI 0gL111`i 1 LENDER'S ADDRESS 1 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 CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. PERMITTEE NAME (PRI E � .�� SIGNATURE OF PERM( EE DATE 4 PRESS FIRMLY APPLICATION ' PERMIT DATE NUMBER # ! l 1GJ ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR r, SIDEISIDE STREET RW C SIDE 0 - PROPOSED USE ArAzE-� NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREANALUATION SFR/ADD/REM Garage/Carport LLLJ J Pat,o/Deck LL Pool/Spa Z Re -Root Commercial tt II Valuation — ADJ.AREA _ QUANTITY DESCRIPTION FEE C U U w U. 0 2 m ii Q _U Z Q 2 U W F ) • �(� CONSTRUCTION _ � PLAN REVIEW __�• G" ELECTRIC _ PLUMBING / MECHANICAL _— �V INSPECTION FEE _ h F ISSUANCE @ '',. _—! SMTP r ENERGY P/C ENERGY PERMIT OCT a V97 RETENTION FEE: PRE -ALT FEE: TOTAL FEES COMMENTS RECPTNf> ° Pv PAID BY VALIDATI N WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD—File Copy, GREEN—Applicant's Copy SETBACK FLOOR JO 1ST V-[FTGS/FORMS/STEEL FHA REQ.S ELECTRIC GROUND GROUND PLUMBING�IbUIT -UN D' FL 0RDUQT UNDER 'b SLAB GRADE FIREPLACE FOUNDATION TEMP POWER •FIREPLA�.E'BCNb BEAM ROOF SHEATHING MID HT. BQND PEAM 8 FT. 13OND BEAM' FRAMINGNENTILIATION FINAL BOND _REAM ROOF COVER PRE-GOANIN3"' BENCHING ROUGH GRADJNG HNISH'dRADINC� ROUGH HEATING ROUGH ELECTRIC-- ROUGH PLUMBING SHOWERITUB TEST POOL ELECTRIC EXT. LATH/SIDING t POOL FENCING WALL -INSULATION POOLFINAL -CEILING INSULATION DRYWALL NAILING SEWER SEPTIC TANK amuOFF SITE IMPS. DEDICATIONS FINAL LANDSCAPE/IRRIG. SEEP PITIL.L. ON SITE IMPS. GAS AIR TEST FINAL CONST.,FIRE 0_ DEPT FINAL FINAL HEATING I --- i HEALTH DEPT FINAL C IN ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY COMMENTS SEPTIC TANK SIZE SEEP PIT/U SIZE --- - -------