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HomeMy WebLinkAbout11052.pdfCITY OF DIAMOND BAR COMMUNITY DEVELOPMENT DEPARTMENT 4P 21660 E.Copley Drive Suite 190 PRESS909)B60-3195 Fax(909)861-3117 ' ' 1 BUILDING PERMIT APPLICATION FIRMLY JOBSITEvi o ADDRESS APPLICATION I Z PERMIT P/C ADDRESS tJ C N CIJV'/VNC 117 DATE NUMBER N c ISSUE TYPE OCC APN LOT TFIACT DATE CONST.GROUP L02 OWNER L` ADDRESS ZONING SETBACKS LU CITY_ L • ZIP TEL 2 FRONT RW APPLICANT 4 TEREAR SIDEISIDE STREET RW CONTRACT f 1 SIDE ADDRESS x!r•1 O CITY C=-,• ZIP 4 EL PROPOSED USE o ARCWENG/DESIGNER NO.DWEL NO. NO. a ADDRESScoUNITSSTORIESBEDROOMS CITY ZIP TEL. se DESCRIPTION SO.FT. FACTOR PSF ADJ.AREA/VALUATION Q OWNER-BUILDER DECLARATION SFR/ADD/REM O El I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LF CGarapaarport 111111 CENSE LAW FOR THE FOLLOWING REASON(SEC.7031.5 BUSINESS AND PROFESSIONS CODE:ANYCITYOR U) U COUNTYWHICHREQUIRESAPERMITTOCONSTRUCT ALTER.MMPROVE,DEMOUSH,ORREPAIR ANY STRU6 W PatiNZeckTURF.PRIOR TO ITS ISSUANCE.ALSO REQUIRES THE APPLO/WT FOR SUCH PERMIT TO FRE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS L4 CENSE LAW(CHAPTER S(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO-POOVSpa FESSONS WOE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP• TION.ANVIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO Z Re-Roof A CIVIL PEY NALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(5500).1: O DLASOWNER OFTHEPROPERTY.ORMYEMPLOYEES WITHWAGES AST14EIRSOLE COMPENSATXN, O COmmerCial Z WILL DO THE WORK,AND THE STRUCTURE 15 NOT INTENDED OR OFFERED FOR SALE(SEC.7011.BUSI• J NESS AND PROFESSIONS MOE: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 CC THROUCH HIS OR HER OLIN EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT MENDED OR m W OFFERED FOR SALE IF.HOWEVER.THE BUILDING ORIMPROVEMENT ISSOLD WITHIN ONEYEAROFCOMPLE- TION.THE OWNER-BUILDER WALL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR Z IMPROVE FOR THE PURPOSE OF SALEI.W LASOWNER OF THE PROPERTY,AMEXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROTECT(SEG 7011 BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS U.VBIUellat ADJ.AREA CENSE LAW DOES NOTAPPLY TORN OWNER OFA PROPERTY WHOBUILDS OR IMPROVES THEREON.AND WHOCONTRACTSFORSUCH PROJECTS WrTHACDNTRACTOR(S)LICENSED PURSUANTTOTHE CONTRAG QUANTITY DESCRIPTION FEE TORS LICENSE LAW.). JJ O O IAM EXEMPT UNDER SEC. B.S RC.FOR THIS REASON qU li. DATE OWNER F WC> LICENSED CONTRACTORS DECLARATION W 2 I HEREBY AFFIRM UNDER PENALTY OF PER JURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER z, P(COMMENCNG WITH SECTION 7000)OF DIVISION OF THE BUSINESS AND PROFESSIONS COOE.AO Z X MYLICENSE ISIN FULLFORCEAND EFFECT O LICENSE CLASS LIC.NO. U DATE G CONTRACTOR W WORKERS*COMPENSATION DECLARATION G I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATION', I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' Z COUP ENSATXON.AS PROVIDED BY SECTION 3700 OF THE LABOR COO E.FOR THE PERFORMANCE WOFTHEWORKFORWHICHITHISPERMITISISSUED.UJ 1Q HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE AS REWIRED BY SECTION 3700 OF THE LABOR CODE FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.MYWORKERS'COMPENSATION INS ECARRIER MIO FVL RARE: CONSTRUCTION CARRIER PLAN REVIEW ZZQ POLICY NUMBER ELECTRIC 12 (DG SECTION NEED NOTBE COMPLETED OFTIE PEFMRB PORCNE HUNCIFIEDDOIUAS pim OR LESS). PLUMBING A 1 Z 1 CERTIFY THAT LATHE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I MECHANICAL C7 SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE I N INSPECTION FEEMAKERS'COMPENSATKONLAWSOFCALIFORNIA•ANDAGREETHATFISHOULDBECOME L SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR 5 COOE.1 IMLL THCOAPLYWRTH ROV1s10NS.F ISSUANCE p DATE: APPLICANT., LAC J` SMIPDEC p WARNING:FAILURE TO SECURE WORKERS*COMPENSATION COVERAGE IS UISAWFUI,AND SHALLBE ENERGY P/C s SUBJECT AN EMPLOYER TO CRMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND ENERGYPERMITDOLLARS(f10G000),N ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR N iSECTION 77050E THE LABOR CODE,INTEREST.AND ATTORNEYS FEES. RETENTION FEE: LLA13- CONSTRUCTION LENDING AGENCY PRE-ALT FEE: OdI HEREBY AFFIRM UNDER PENALTY OF PERJURY THATTHEIRE IS ACONSTRUCTION LENDING AGENCY ZZ FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT I$ISSUED ISEC.3097,CN.C.). W LENDERS NAME LENDERSADORESS wI CERT FrTHAT IHAVE READ THISAPPLICATIONAND STATE THAT THE ARM INFORMATIONISCORRECT. TOTAL FEES p_ I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAP'S RELATING TO BUILDING CONSTRUCTION.AND HEREBYAUTH0P02E REPRE ENTLTWES OF THIS COUNTY TO ENTER UPON THE T ABOVE-MENTIONED PROPERTY TORI SPECTKXN RPOSEs. COMMENTS Lb PERMITTEE cn VA SIGNATUAEQFPERMirTEE DATE RECPT.LA0. PAID BY VALwATl WHITE—Department Copy.YELLOW—Finance COPY,PINK—Assessor Copy,GOLDENROD—File Copy.GREEN—Applk mrs Copy N, -„ r:.,...:`e'::n•:'a?t,.Zv.S,r',,. .,e,i•,:;i"• ;"""'v(>Y;/o^Ow4'nC:arT';`.t::-n.x:' f,i,rk`:;W,'F I• v",,; rr,•,f.3" 'r•`:, c'•r 'rrh:c.r.ti,•r;,.y. k:. .<•n4ri,,ti .Y' fE -.{: 1`•.t'.•;. .:9`'!'gtl'•;1,.' .,t.. r"yi'4"•1 ,';.: ;5+;y"t•j!,fir. ; 1?,tqh 3ITY OF DIAMOND_BAW,A" )Y NSPECTION RECORD 11'I-p FsI J Z 'u ;r I'' . _ f 10 1 ,E t I !'f.1 f I y I SET BACK FLOOR JOIST._.. FIGS/FORMS/STEEL FHA REQMTS--"---- ELECTRIC GROUND r UNDER FLOOR DUCTt. GROUND PLUMBING '" ' UNDER+.FLbbR'GUNDUIT - SLAB GRADE. .-- ” ------ ..__. .. _ FIREPLACE FOUNDATION FIREPLACE BOND BEAMTEMPPOWER_.:.-: _.. .___ .::_.__.:_..-.:- ' ---. .._._ _ . WATER SERVICE MID HT,S©NDBEAM ROOF SHEATHING- - 8 F.T.BOND BEAM FRAMINGNENTILIATION FINAL.BOND BEAM PRE-GRADING- -ROOF COVER ... ... :...---- . :-:._... _ .. ROUGH HEATING BENCHING...-.... ROUGH ELECTRIC ROUGH GRADING, I ROUGH PLUMBING FINISH GRADING SHOWERITUB TEST i '_ _.._. - ' ' - - ..._.. _ __.. ...-' --- .: :POOL ELECTRIC EXT.LATH/SIDING-' ...- -'-- _.. i_.... POOL FENCING' WALL INSULATION POOL FINAL- CEILINGCEILING INSULATION OFF SITE IMPS, DRYWALL NAILING DEDICATIONS SEWER... .. ._ _. . FINAL ENG.. SEPTIC TANK___..i__ LANDSCAPE/IRRIG.I SEEP-PIT/L.L. -'-. . . . . ... _.....I.-., -... . ON SITE IMPS. GAS AIR TEST j --- -- FINAL ZONING FINAL-CONST:,_...._ __ FIRE pEPT. FINAL iFINALHEATINGHEALTHDEPT. FINAL ::.-. -;.- FINAL ELECTRIC---- - DEV. FEES PAID . FINAL PLUMBING ENERGY--; _ 777 IV COMMENTS .. . f! jlk I r y n•I It • 1 .i'; 7: .-._ J _._,Iv .. — ... :l:';1 • V I I SEPTIC TANK SIZE--- SEEPPIT/U SIZE - . ...... I I I