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Home My WebLink AboutPR 12-982.pdfCITY OF DIAMOND BAR ERS RATER'/ DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVIC VI 21810 Copley Drive, Diamond Bar, CA 91765 909) 839-7020 Fax (909) 861-3117 Building Inspection Hotline (9 83 EQUIRGas BUILDING PERMIT APPLICATION FIRMI V JOBSITE ADDRESS` 7,3413-5- 6C APN LOT TRACT OWNER uvina ADDRESS CITY TEL. APPLICANT 06h;-, TEL. CONTRACTOR ADDRESS 'l%` CITY ZIP 7o TEL 3Z r Z / ARCH/ENG/ 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. 7031.6 BUSINESS AND PROFESSIONS CODE ANY CITY OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT, ALTER IMPROVE, DEMOUSH, OR REPArRANY STRUC- TURE, PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIONED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS 1J - CENSE LAW (CHAPTER D (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 7031.6 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS ($600).1: LAS OWNER OFTHE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WALL DO THE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 70". BUS4 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 ONEYEAROF COMPLE TION,. THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DD 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 NOT APPLY TO AN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S) LICENSED PURSUANTTOTHE CONTRAC- TORS LICENSE LAW.). 1 AM EXEMPT UNDER SEC. B. 8 P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER D (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS W FULL FORCE AND EFFECT. / • LICENSE CLASS DATE k::?,d Z CONTRACTOR WORKERS' COMPENSATION DEC . N I HEREBY AFFIRM UNDER PENALTY.OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKER.. COMPENSATION, AS PROVIDED BY SECTION 37M OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. 1 HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE. AS REQUIRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS'COMPENSATION I• NSU CARRIER AND. POLICY NUMBER ARE CARRIER S POLICY NUMBER 1Z C.wL \Z 0HtS SECTION NE® NOT BE oDMFuTEDOFTIE PERMIT tS FON ONE HUNDREDDOL ARS (i10D) ORLESSt 1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SOAS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 37DD OF THE LABOR CODE, 1 SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE APPLICANT:- WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 15 UNLAWFUL. AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS (6100,000), 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. 3087, CIV C.I. LENDER'S NAME LENDER'S ADDRESS I CERTIFY THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION 1S CORRECT. 1 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. ZZI^k ZAV k Pr PERMITTEE NAME (PRINT) SIGNATURE OF PERMrTTEE DATE APPLICAi J PERMITV_Q P/C DATE---( NUMBER \a--'iPS;L ISSUE '=-1 TYPE OCC DATE \ ' CONST. GROUP ZONING SETBACKS FRONT RW REAR p SIDEISIDE STREET RW p SIDE 0 z PROPOSED USE NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT FACTOR PSF ADJ. AREANALUATION SFR/ADD/REM U) Garage/Carport W Patio/Dea V- 0 PoOUSpa Z Re -Root CI Commercial M Valuation ADJ.AREA QUANTITY DESCRIPTION FEE L4 IS ccI_ UW W DZ DO D CL 0 r UW g CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING S 1 MECHANICAL INSPECTION FEE ISSUANCE _ L,Gf SLS SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE -ALT FEE TOTAL FEES COMMENTS RECPT. NO.PAID BY V 1 VALIDATION, WHITE—Department Copy, YELLOW -Finance COW PINK—Assessor Copy, GOLDENROD—Flla Copy, GREEN—Applicant's Copy P.Lt• •p :c++9 .nib :' i 1. i p CITY OF DIAMOND BAR u ;•,? y_ ,; ; INSPECTION RECORD SET BACK FT SGF/ ORMS/STEEL ELECTRIC GROUND GROUND PLUMBING SLAB GRADE TEMP POWER WATER SERVICE ROOF SHEATHING FRAMING/VENTILATION ROOF COVER ROUGH HEATING ROUGH ELECTRIC ROUGH PLUMBING SHOWER/TUB TEST EXT. LATH/SIDING WALL INSULATION CEILING INSULATION DRYWALL NAILING SEWER SEPTICTANK SEEP PIT/L.L. GAS AIR TEST FINAL CONST. FINAL HEATING FINAL ELECTRIC FINAL PLUMBING FINAL PLANING FINAL ENGINEERING COMMENTS SEPTIC TANK SIZE SEEP PIT/U SIZE 16 1! I Z_ FLOOR JOIST FHA REQMTS UNDER FLOOR DUCT UNDER FLOOR CONDUIT FIREPLACE FOUNDATION FIREPLACE BOND BEAM MID HT. BOND BEAM 8 FT. BOND BEAM FINAL BOND BEAM PRE -GRADING BENCHING ROUGH GRADING FINISH GRADING POOL ELECTRIC POOL FENCING POOL FINAL OFF SITE IMPS. DEDICATIONS FINAL ENG. LANDSCAPE/IRRIG. ON SITE IMPS. FINAL ZONING FIRE DEPT. FINAL HEALTH DEPT. FINAL DEV. FEES PAID ENERGY