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Home My WebLink About14927 (1093)CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 (909)860-3195 Fox(909)861-3117 PRESS BUILDING PERMIT APPLICATION __ I I I I FIRMLY JOBSrrEADDRESS �-- $.� ) D v� APPLICATIO PERMIT P/C ADDRESS Z� � f-�s-�'v'u.v�'•+ DATE NUMBER M ISSUE TYPE OCC APN LOT T CTDATE-�� CONST. GROUP OWNER ADDRESS ZONING SETBACKS CITY •� ZI TEL. ,� 5%D Hy/F �% FRONT RW ❑ APPLICANT TEL. REAR El SIOE/SIDE STREET RW ❑ CONTRACTOR SIDE El ADDRESS Y 44ZIP EL. PROPOSED USE ARCFUENG1 DESIGNER NO. DWEL. NO. NO. ADDRESS UNITS STORIES BEDROOMS CITY ZIP TEL. DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION OWNER -BUILDER DECLARATION SFR/ADD/REM I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- Garage/Calpon CENSE LAWFORTHE FOLLOWING REASON (SEC. 7031A SUSINESSAND PROFESSIONS CODE:ANY CITY OR (n COUNTYWHICH REOUIRESA PERMITTO CONSTRUCT, ALTER IMPROVE. DEMOLISH, OR REPAIRANY 9TRUC- ANtW PBt'IDlDeCk TURF- PRIOR TO ITS ISSUCE, 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- LL POOI/Spa FESSIONS CODE) OR THAT HE OR SHE 18 EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7091.8 BY ANY APPIJCJNT FOR A PERMIT SUBJECTS THE APPLICANT TO Re -ROOF 7A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (CSWI J: i O L AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, a Commercial WILL 00 THE WORK AND THE STRUCTURE IS NOT NTENDED OR OFFERED FOR SALE (SEC. 70". BUST- J_ NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF ! PROPERTY VIVO BUILDS OR IMPROVES THEREON. AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR = `THROUGH HIS OR HER OWN EMPLOY EES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m OFFERED PORSALE IF, HOWEVER THE BUILD" OR IMPROVEMENT IB SOLD WITHIN ONEYFAROF OCMR-E- ! TION, THE OWVNER41ULDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DD NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). O LAS OWNER OF THE PROPERTY, AM EXCLUSIVELYCONTRACTNG WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 70" BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- VBIUetirn ADJAREA 1 CENSE LAW DOES NOTAPPLY 70AN OWNER OF A PROPERTY WHO SUADSOR IMPROVES THEREON, AND WHOCOHTRACT8 FOR SUCH PROJECTS WITH AOONTRACTOR(S) LICENSED PURSUANTTD THE OONTRA4 QUANTITY DESCRIPTION FEE TOPS LICENSE LAW.). .J ' O 1 AM EXEMPT UNDER SEC. B. 8 P.C. FOR THIS REASON Q I I V Or DATE OWNER t.- LICENSED LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PENURIV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER I (COMMENCING MTN SECTION TOW) OF DIVISION 3 O THE BUSINESS AND PROFESSIONS CODE. AND 0 O MY IS N FULL FORCEAND EFFECT Z I m LICENSE CLASS LIC. NO, .L DATE Oa CONTRACTOR d J WORKERS'COMPENSATION DECLARATION 2 1 HEREBY AFFIRM UNPERJURY DER PENALTY OF PERRY ONE OF THE FOLLOWING DECLARATIONS: QZ __IHAVEAROWILLMAINTAINACER?IFICATEOFCONSENTTOSELF-INSUREFOFIVIORKEFW , . y ' I , OOMPENSATION. IIS PROWDED BY SECTION 9700 OF THE LABOR CODE, FOR THE PERFORMANCE U OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. i I HAVE AND WILL MANTAN WORKERS' COMPENSATION INSURANCE. AS REOUIREO BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORD OR WHICH THIS PERMIT IS (J(L•i// ISSUED. MY WORKERS'O P AT NINSU CY NUMBER ARE: CONSTRUCTION CARRIER PLAN REVIEW 1A POLICYNUMBER 4S ELECTRIC 2 (1}058ECfDN NEW NOT BE OO1.pLETEDOFTE PERMIT 18 FOR ONE HUNDRED DOLLARS (StOD)ORL65} PLUMBING IL ICEFFTIFYT14ATINTHEPERFORMANCEOFTHEWORKFORWNICHTHISPERMITIsISSUED,I MECHANICAL SHALLNOT EMPLOYANYPERSONINANY MANNERSOASTOBEOOME SUBJECTTOTHE WORKERTOOMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF I SHOULOSECOME INSPECTION FEE ALJ--L�1L_L11.-_ SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 97M OF THE LABOR lT - OWE.I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS, ISSUANCE M 'n R DATE: APPLICANT. SMTP +� V17T J WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL BE ENERGY P/C Cl : 4 r- SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND ENERGY PERMIT'll DOLLARS (3100,000). N ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR N CSECTION 3709 OF THE LABORCODE, INTEREST, AND ATTORNEYS FEES. RETENTION FEE: � CONSTRUCTION LENDING AGENCY PRE -ALT FEE: - - C- HEREBYAFFIRMUNDERPENALTVOPERJURY TTHEREISACONSSICLENDING AGENCY FOR THE PERFORMANCE OFTHEWORK PDRWHICHTHISPERMIT IS ISSUED(BEC. 3017, CIV. C). s G C LENDERS NAME r LENDERSADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION 19 CORRECT. TOTAL FEES A710 L 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. COMMENTS , PERMITTEE NAME (PRINT) A 80NATURE OF PERMITTEE ADE = D RECPT NO. PAID BY VALIDATION WHITE --Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD --File Copy, GREEN- WicenCs COW CITY OF DIAMOND BAR INSPECTION RECORD SET BACK FLOOR JOIST, FTGS/FORMS/STEEL _ FHA REQMTS ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR CONDUIT SLAB GRADE FIREPLACE FOUNDATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICE MID HT. BOND BEAM ROOF SHEATHING 8 FT. BOND BEAM FRAMINGNENTILIATION FINAL BOND BEAM ROOF COVER PRE -GRADING ROUGH HEATING t BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWER/TUB TEST POOL ELECTRIC EXT. LATH/SIDING POOL FENCING WALL INSULATION_ -T POOL FINAL _ CEILING INSULATION I OFF SITE IMPS. DRYWALL NAILING i DEDICATIONS SEWER FINAL ENG. SEPTIC TANK LANDSCAPE/IRRIG. SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST I FINAL ZONING FINAL CONST. Q ( FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL _ FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY f COMMENTS ) SEPTIC TANK SIZE SEEP PITlU SIZE