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HomeMy WebLinkAboutPR14-4586D� OArD'IiAI CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bat.-, CA 91765 (909) 839-7020 Fax: (909) 861-3117 Building Inspection Hotline (909) 839-7027 BUILDING PERMIT APPLICATION JOB SITE ADDRESS l� V T be l APN LOT TRACT OWNER hiivA6_1 yV ADDRESS # O •� i� 1917 CITY.)1ht%i�1i - ZIPI try TEL. 213-5YOT- APPLICANT TEL. CONTRACTOR ADDRESS CITY ZtP -` TEL.., � /n� ARCH/ENG/DESIGNER S 44 A S� AL sk ADDR S WyNe CITY L-0- ZIF TEL, 1 q— 0 OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License taw for the reason(s) Indicated below, by the chuckmark(e), I have placed next to the applicable item(s) tSeclion 7031.5, Business and Professions Code: Any oily or county that requires a permit to construct, alter, improve, demolish, or repair, any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License taw (Chapter 9) Commencing with Section 70M of Division 3 of the Business and Professions Code] or that he or she is exempt from licensur; and the basis for the alleged exemption, 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 ($5001. 111, as owner of the propertyar my employeeswilh wages as their sole compensation, will do (-) all of or (-) portions of the work, and the structure is not intended or offered for safe (Ssction 7044, Business and Professions Code: The Contractors' State license Law does not applyto an owner of property who, through employees' or personal effort, builds or improves the properly, provided that the improvements are not intended or offered for sale. If however, the building or Improvement is said within one year of completion, the Owner-Boilder will have the burden of proving that it was not built or Improved for the purpose of sale.). U 1, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of properly who builds or improves thereon, and Who contracts for the projects with a licensed Contractor pursuantto the Contractors' State License Law.). U I am exempt from lieensure under the Contractor's State License taw for the following reason(s); By my signature below I acknowledge that, exceptfar my personal residence in which I must have resided for at least one year priorto completion of the improvements covered by this permit,i cannot legally At a structure that I have built as an ovrner-buitderifithas listb onsWctedinits entirety bylicensed contractors. Iunderstand that acopy ofthe applicable u . nd Professions Code is available upon request when this application is submitted or at law, Sec0onally the followingvww.!qWo.ca.gov/Gidaw.htmI. OAT -SIGN: — LICENSED CONTRACTOR'S DECLARATION ereby of perjury that f 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 farce and effect. LICENSE CLASS: LIC, NO.: ATE: CONTRACTOR: WORKER'S COMPENSATION DECLARATION I HEREBYAFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I have and will maintain a Certificate of Consent to Self -Insure for Workers Compensatlon, as provided by Section 3700 of the Labor -Code, for the performance of the work forwhlch this permit is issued. I have and will maintain Worker's Compensation Insurance, as required by Section 3700 of the Labor Code, for the performance of the work forwhich this permit is issued. MyWorker's Compensation insurance Carrier and Policy Number are: x CARRIER POLICYNUMBER (IRIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($1 GO) 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 Worker's Compensation Laws of California. And agree that If I should become subject to the Worker's Compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. DATE: APPLICANT; WARNING: Failure to secure Worker's Compensation coverage is unlawful, and shall subject an employer to criminal penalties and civil fines up to one hundred thousand dollars ($100,000), In addition to the cast of the compensation, damages as provided for In section 376E of the labor code, Interest, and attorney's fees. 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 penmft Is Issued (Sec. 3097, Civ, C.). LENDER'S NAME; LENDER'S ADDRESS: I certify that I have read this application and stale that that 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 upabove-mentioned p in InspecBon purposes. on na Z DATE PRESS FIRMLY APPLICATION DATE:j y &,U I ! P/C# 1 Iv ISSUE DATE i i # PERMIT# TYPE CONST. OCC GROUP: ZONING SETBACKS FRONT REAR SIDE/SIDE STREET SIDE RW CI RW Q EI PROPOSED USE © 0 1 C�(&9 # DWEL. UNITS # STORIES r4,r� If BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport vy w Patio/Deck LL Pool/Spa 0 Z Re -Roof d -J 5 Commercial m Valuation. Adj. Area: QUANTITY DESCRIPTION FEE U sib ewr�� vv '� ai d 6 a •4rr< SC'Ctaodl U a � � L3 w CONSTRUCTION: FLAN REVIEW: ELECTRIC: a1�Cea • �J"T PLUMBING: MECHANICAL: I5`8 • �' INSPECTION FEE: ISSUANCE: SMIP: ENERGY P/C: ENERGY PERMIT: RFTFNTION FEE: PRE-ALT FEE: 5A - 0z, I FISAF: 3 • �� I I TOTAL FEES COMMENTS: $� I • I •t` 6 RECEIPT # Al_got'-117 PAID BY: `t�Q� �S VALIDATION: WHITE— Department Copy, YELLOW Finance Copy, PINK T-- Assessor Copy, GOLDENRO€] — File Copy, GREEN —Applicant's Copy 'OITY OF DIAMOND BAR INSPECTION RECORD TRACT AND D LEDGER SWITCH GEAR COMMERCIAL HOOD LlWINC ' T-BAR UG:'ELECTRICAL..:."" INTERCEPTER IlFER GROUNIi HOT MOPlSHOWERPAN SEWER LATERAL SEPTIC/CESSPOOL MAIN WATER LINE � r Tlz_ _._ ._. HERS REPORT RECEIVED SEWER CLEANOUT DEMOLITION ROOF SHEATHING _ � ROOF DRAINS FLOOR SHEATHING ROUGH CONDUIT HI=AR iALts EXTER[ R .. .. PGOU PAW SHEAR WAU fNTEMOR PLUMBING ... ' AM[NCAIEI IItC , .:: R0oGELECt#GAIx- . RUGH.]ECA4IAL - OL30 AN11�4i: ko" GH ELECTRICAL W( ).0 `. iE s - ROUGH PLUMBING.':.PRE G'UNITE ._. INSULATION MALL INSULATION CEILING DRYWALL LATH (PRE)—_._-___ LATH EXTERIOR LATH INTERIOR boll GAS TEST I SCRATCH COAT ELECTRIC METER RELEASE ------ CAS METER RELEASE SPECIAL INSPECTION �IIU� BlJILi21'NC _ �BI�AL i�iECH,4i+t(GA$� f4k ELEC' T ICAL T,C.4f octuPANCY GEI 6 ,OCCUP Refs. .,. Al FINAL POOL':':I', MALLS: WALL FOOTING/STEEL WALL STEEL 1 -( ) 2tf°( } LIFT WALL BOND BEAM WALL DRAIN! SEAL WALL FINAL CITY OF DIAMOND BAR s Community and Development Services Department �~ 1 1 E 21810 E. Copley Drive • Diamond Ear, CA 91765 _ '-. - Building Inspection Request Hotline (909)839-7027 Building Planning o Engineering (909)839-7020 (909)939-7030 (909)839-7040 CORRECTION NOTIE a.m. PERMIT NO. DATE: lf' ` TIME: P.M. CONTRACTOR/ OWNER BUILDER r ADDRESS (Project. Site) �`` ❑ PLEASE CONTACT THE UNDERSIGNED ❑ PLEASE MAKE CORRECTIONS AND CALL FOR REINSPECTION ❑ REINSPECTION FEE REQUIRED ❑ PLEASE MAKE CORRECTIONS AND PROCEED WITH WORK INSPECTOR: (print name) SIGNATURE OF INSPECTOR: