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Home My WebLink About17385 (446)0 0 0 Lu S Q 0 0 w 0Z SLA a Cr O G w 8 F— Z N 2 w 0 Z CC w w F Y 1i LL Z O Xa W O U�M.J �..D6 M co d.. D ZO O Lu Z C7 J Q w O Cr 91- CL lCL LU CL. C7 Z D ca m Cn Cn 2 IM1101IRK CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY 21825 E. Copley Drive (909) 860-3195 Fax (909) 861-3117 & DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION ADDRESS ` g77 APN LOT ? TRACT 41?A<0 OWNER v ADDRESS" 56 O-t'Z.�IL�Mt ✓ CITYYTEL7At2 ?jW APPLICANT TEL. CONTRACTOR. v 17•' ADDRESS Hv w ow CITY e l,•ve ZIP ! TEL ARCFVENG/ DESIGNER ADDRESS CITY ZIP TEL OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS UF CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.6 BUSINESS AND PROFESSIONS CODE ANY CITY OR COUNTY WHICH REOUIRESAPERMIT TO CONSTRUCT,ALTER. IMPROVE, DEMOLISH, OR REPAIRANY STRUG TURF. 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 a (COMMENCING WITH SECTION 7000) OF DIVISION s 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 7071.6 BY ANY APPLICANT FORA PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS ($500).): ❑ 1,AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION. W LL Do THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7011, BUSK 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 OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE IF, HOWEVER THE BUILDING DRIMPROVEMENTIS SOLD WITHIN ONE YEAR OF COMPLE- MON. THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALEL O LAS OWNEROFTHE PROPERTY.AM E%CLUSNELYCONTRACTWG WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEG 70". BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTCR(S) LICENSED PURSUANT TOTHE CONTRAC- TORS LICENSE LAW ). O 1 AM EXEMPT UNDER SEC. S. l P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER f (COMMENCING WITH SECTION 7000) OF DIVISION S OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EEFFECT. LICENSE CLASS 4 UC. NO. _1160R % 7 DATE CONTRACTOR S60 !4 OA- p/0gd:. WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINTAIN ACERTIFICATE OF CONSENT TO SELF -INSURE FOR WCRKEFW COMPENSATIO.AS PROVIDED BY SECTION 0700 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 0700 OF THE LABOR CODE, FORTHE PERFORMANCE OF THE WORK FOR WHICHTHIS PERMIT IS ISSUED. MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY Nl1MSER ARE: CARRIER S ra - h w -e POLICY NUMBER 17- 'V 4 1 e! 1- '1 MCS SECTION WED NOT BE COMPLETmOF THE PERMIT 6 FOR ONE Hl•DREDDDIUJlS ($10)) ORLESS) 1 CERTIFYTHAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 6ISSUED. I SHALLNOT EMPLOYANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF I SHOULD BECOME SUBJECTTO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3100 CF THE LABOR CODE. I SHALL FORTHWITH COMPLY WITH THO PROVISKNIS. DATE: APPLICANT. WARNING: FAILURE TO SECURE WORKERS'COMPENSATKON COVERAGE IS UNLAWFUL. AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO CNE HUNDRED THOUSAND DOLLARS (5100.000). IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 7708 OF THE LABOR CODE. INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY 1 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. 8087, CIV. C.). LENDERS NAME LENDERS ADDRESS 1 CERTIFY THAT 1 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. HAS I/ M � PERMITTEEN (PRINT) SIGNA HEOFPERMII EEDATE P) V�J,�, b PRESS FIRMLY DATE APPLICATION Plc PERMIT -'/5-NDi NUMBER 1739S # ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE p PROPOSED USE �(j / -, 13, % FC %-rje'fir, NO. DWEL NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM U) Garage/Carport LLLJ Patio/Deck LL PooVSpa ZRe -Roof Commercial m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE > 7(- YO a 9AWAt.. .IO w .2 -7---67 z1.e w LM6i� f,y , z .Wd rxi A& To 3 _ 2 t ,70 Wsex• Q -,2 C ,�/� 4�/. k, CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL..__ INSPECTION FEE (41 ISSUANCE �`�- �,� • Oi~1 SMTP ENERGYP/C "' f ENERGY PERMIT"'' �`--'.-:'"'.--------- RETENTION FEET. - • g� PRE -ALT FEE: TOTAL FEES PQ COMMENTS RECPT. NO. PAID BY VALIDATION WHITE -Department Copy, YELLOW -finance Copy, PINK -Assessor Copy, GOLDENROD -File Copy, GREEN -Applicant's Copy CIT'( OF DIAMOND BAR INSPEC T ION RECORD FLOOR JOIST FTGSIFORMSISTEEI- ELECTRIC GROUND f I FHA REQMTS. UNDER FLOOR DUCT 'GROUND PLUMBING UNDER FLOOR CONDUIT SLAB GRADEFIREPLACE FOUNDATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICE -t ROOF SHEATHINE1 FRAMING,rVENTILIATI N MID HT. BOND BEAM 8 FT, BOND BEAM FINAL BOND BEAM PRE -GRADING ROOF COVER ROUGH HEATING III0 It VROUGH t BENCHING ROUGH ELECTRIC GRADING ROUGH PLUMBING FINISH GRADING SHOWER/TUB TEST j j POOL ELECTRIC EXT. LATH/SIDING POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING j DEDICATIONS SEWER FINAL LNG. SEPTIC TANK LANDSCAPE/IRRIG, SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST. FIRE DEPT. FINAL FINAL HEATING FINAL ELECTRICDEV. HEALTH DEPT. FINAL FEES PAID FINAL PLUNtBING ENERGY c; SEPTIC TANK SIZE SEEP PIT/U SIZE