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HomeMy WebLinkAboutPR09-0130 C3 DL1tHll�p �1%�'I CITY OF DIAMOND PAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21825 Copley Drive, Diamond Par, CA 91765 (909) 839-7020 Fax (909) 861-3117 Building Inspection Hotline (909) 839-7027 BUILDING PERMIT APPLICATION JOBSITE ADDRESS APN LOT TRACT OWNER , o-j;�7/,,_' ADDRESS CITY r ,;" ,a ZIP r ? Tlk� APPLICANT TEL, CONTRACTOR ADDRESS CITY ZIP TEL. ARC}FENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LF CENSE LAW FOR THE FOLLOWING REASON (SEC.7031.5 BUSINESS AND PROFESSIONS CODE: ANY CIN or]COUNTY WHICH REQUIRESA PERM ITTO CONSTRUCT, ALTER IMPROVE. DEMOLISH, OR REPAIR ANY STRUC- TURE, 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 9 (COMMENCING WITH SECTION 700o) OF DIVISION 3 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 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS ' WrAS 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. 7644, BUSI- 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 OFFEREDFORSALE. IF,HOWEVER, THE BUILDING OR IMPROVEMENT IS SOLD WITHIN CNEYEAROF COMPLE- TION, THE OWNER -BUILDER WILL HAVE THE BURDEN CF PROVING THAT HE CR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE)_ 0 1, AS OWNER OFTHE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC 7044, HUSINESS AND PHOFESSIONS CODE: 7HE CONTRACTORS Lk CENSE LAW DOES NOTAPPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND w3iocoN7RA0T5 FORSUCH PROJECTS WITHACCNTRAOTOR(SI LICENSED PURSUANT TOTHEcoNTRAD- TORS LICENSE LAW.). © I AM EXEMPT UNDER SEC. S. & P.C. FOR THIS ASON DATE_e4 2 — OWNER fi.ti 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 O THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE Is IN FULL FORCE AND EFFECT. LICENSE CLASS LIG. NO. DATE CONTRACTOR WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OFTHE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINTAIN ACERTIFICATE OF CONSENT TO SELFANSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION 3700 OF 7HE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REOUIRFD BY SECTION a70u OFTHE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER POLICY NUMBER (IHSS SECTION NEED NOT BE WMR-ETED OF THE PERMIT IS FOR ONE HUNDRED DOLLARS (5100) OR LESS), I CERTIFY THAT IN THE PERFORMANCE CFTHE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SCAS To BECOME SUBJECT70THE WORKERS' COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF I SHOULD BECOME SUBJECTTO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 37x0 OF THE LABOR CODE. I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE: APPLICANT: WARNING FAILURE TO SECURE WORKERT COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL BE SULIJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (8790,006), IN ADDITION TO THE COST OF COMPFNSATION, DAMAGES AS PROVIDED FOR IN SECTION 3768 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY 1 HEREBYAFRRM UNDER PENALTY OF PERJURY THAT THERE IS ACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED {SEC. 3087. CIV C.). LENDERS NAME LENDERSAODRESS - CERTIFY THAT I HAVE READ THIS APPLICATION AND DTATETHAT THE ABOVE INFORMATION IS CORRECT. 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 ME ffINT) - - -' SIG R F PERMITTEDS " DATE r PRESS FIRMLY APPLICATI N PERMITS PIC DATE � ''k -S IC2 NUMBER # ! ISSUE TYPE OCC DATE : CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR SIDEISIDE STREET RW 0 SIDE ❑ PROPOSED USE F_ NO. DWEL. ' Y NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSI± ADJ. AREA/VALUATION SFRIADDIREM Cl) Garage/Carport W Pafio/Deck W LL PoDuspa Z Re -Roof 0 Commercial Do Valuation 7C its._. ADJ.AREA QUANTITY DESCRIPTION FEE U U W ,a W m .–I d Q U_ Z W CONSTRUCTION PLAN REVIEW ELECTRIC Tom' PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY PIC - ENERGY PERMIT , RETENTION FEE: PR&ALT FEE: TOTAL FEES �A 7 COMMENTS 4 RECPT. NO. PAID BY r r VALIDATION WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD—File Copy, GREEN—Applicant's Copy "� � , ,y �� INSPECTION RECORD SEF"f Ear Il1pp K SI E //a Irl,_�GR MLuT - - F=HA P.EU E S _ SET BACK FTG SIFOR EVJS/ 3 e -,E.'- E Iw.— �---� [ UN, 0r—R 'L0019G0NDJIB f-PEPLAGE FOUNDATION SLAB (33RADE MID HT:: BOND DEAN! .mm h a £BONS)BEAM, �.� lilt I ROOF 1M., of zo RC-) 0, CC) V Eek ROUGH "._.... t R 0 U,07. h EI C . ` c H ,e 3 PL!, I YOOL 1 �ALALL MLA 101N _- OFF SITE E IMPS. GEII INCI MUL ETt 110N � RYVV ALL NAILING - T SEVVE SEEP PIT/LL GAS AIR, TESD $ FWAI_ CONST ....__..—_.—_..__.—..—.—.—.�--..—.,_.—._...._.-. ___.—___._.__�..._� FINAL HE rMlNG FINAL Ei E G t i" j%G FINIAL Pi. U Iasi r I i SEF"f Ear Il1pp K SI E //a Irl,_�GR MLuT - - F=HA P.EU E S _ UNDER M`- r5 -R 1 ^-1 �---� [ UN, 0r—R 'L0019G0NDJIB f-PEPLAGE FOUNDATION MMEPLACE B OL MID HT:: BOND DEAN! .mm h a £BONS)BEAM, �.� lilt I of zo R. GF3ADl'€ t I. 1 90iJG" H OR AD;NG YOOL 1 POOLFINAL OFF SITE E IMPS. EENG. -FINAL ON SITE IMPS>�--.--- I" I NA L �P RE ` -E.DT F Nei%_.__ DEV, .FEES PAID ...._ . _. _._ ENERG`f