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HomeMy WebLinkAbout18125 (25)I MW J LL J LULUCl - C) OQd Z STW S F- W2 C7Z 03 m Q CO 2I.— U1I1IIINU HAK CITY OF DIAMOND BAR DEPARTMENT OF CONff4UNITY & DEVELOPMENT SERVICES 21825 E. Copley Drive 909) 860-3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION JOBSITE j ADDRESS I ©I APNL T TRACT OWNER L ADDRESS CITY TEL APPLICANT TE CONTRACT PENANCE INSTALIFRS INC. ( ADDRESS CITY Lakawnnrf rA 902 TEL. ARCFVENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REWIRES A PERMIT TO CONSTRUCT, ALTER. IMPROVE. DEMOLISH, OR REPAIR ANY STRUC. TURE, PRIOR TO ITS ISSUANCE. ALSO REWIRES 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 7000) 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 ($500).): I, AS OWN ER 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. 7044, 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 OFFERED FOR SALE IF, HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE- TION, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). I, AS OWNER OF THE PROPERTY. AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC, 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI. CENSE LAW DOES NOTAPPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITHACONTRACTOR(S) LICENSED PURSUANTTOTHE CONTRAC- TORS LICENSE LAW.). AM EXEMPT UNDER SEC. B. $ P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBYAFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FUL R AND EFFECT. LICENSE CLASS LIC. NO, DATE CONTRALTO 64WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATK)NS: I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION 37W OF THE LABOR CODE, FOR THE PERFORMANCE 1,,___ O?FIEWORK FOR WHICH THIS PERMIT IS ISSUED. E AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE, AS REQUIRED BY SECTION OF THE OR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHI HRMlTISISSUED. MV RS' M SATI I SURANCE CARRIER AND POLICY N CARRIER POLICY NUMB ER_ THIS SECTION NEED NOT BE COMPLETED OF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($100) 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 PROVISIOOF SECTION 37000F THE LABOR qLZAOR TH COMPLY WITH PR VI DAT PPLICANT: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 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 PERMIT IS ISSUED (SEC. 3097, CIV. C.). LENDER'S NAME LENDER'SADDRESS I 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 -MENTI NED P OPERTV FOR INSPECTION PURPOSES. l PE ITT E NAM (PRI ^ O SI NAT IE OF PrAMITTEE WATE PRESS FIRMLY CATIONDATE / NUMBER 1 #/ C ISSUE TYPE OCC DATE 34/pzCONST. GROUP ZONING SETBACKS FRONT RW REAR SIDE/SIDE STREET RW SIDE PROPOSED USE NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREAIVALUATION SFR/ADD/REM U) Garage/Carport w Patio/Deck LL.I LL Pool/Spa . 0 Z Re -Roof Commercial m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE JQU lTHULUJW C7Z_ E5 J CLQ U_ ZQ W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: TOTAL FEES . COMMENTS RECPT. NO. D P=D1VALIDATION i c1-1-1 —upy.. a---nance copy, rinn—Assessor Copy, GOLDENROD—File Copy, GREEN—Applicant's Copy COTY OF GOAMOND BAR NSPEC OOIM RECORD SET BACK r FLOOR Ji IST', FTGS/FORMS/STEEL FHA RECIMT& ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING -- U1 ODER FLOOR CONDUIT I __ SLAB GRADE _ FIREPLACE FOUNDATION _ TEMP POWER FIREPLACE BOND BEAM J WATER SERVICE T MID HT. BOND BEAM ROOF SHEATHING - 8 FT. BOND BEAM FRAMINGNENTILIATION - _ FINAL BOND BEAM ROOF COVER PPE -GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING FINISH GRADING _ SHOWERI#-UB TEST POOL ELECTRIC_- EXT. LATH/SIDING -• _ FOOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION -- OFF ;IT --IMPS. DRYWALL NAILING DEDICATIONS SEWER FINAL ENG. SEPTIC TANK LANC SCAPE/IRRIG. SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST. FINAL HEATING - __ _ F!R`-DEPT. FINAL HEALTH DEPT. FINAL Y J FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING j,l C ENERGY COMMENTS SEPTIC TANK SIZE SEEP PIT/U SIZE