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Home My WebLink About2_22_01 - 2139 EVERGREEN SPRINGS DRLLC F C C 2 C LA2 5 U CITY OF DEPARTMENT : ; EXPIRED J — COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive suite 190 MAR 2 U 2002 PRESS909) 860-3195 Fax (909) 861-3117 BUILDING PERMIT'APPLICATION 7,FIRMLY JOBSITE ADDRESS,9/3Z-t/E1ZEs/'Fc£' SPEPIA)G- Pk, APN LOT— TRACT OWNER Acl_•N -1) . ADDRESS -> CITY "OJRUuoQp IC/iJIAZIP TEL.Lo P3pL APPLICANT orf /AJ-W,J J ) TEL., CONTRACTOR ADDRESS CITY ZIP TEL ARCFVENG1 DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS U - CENSE UW FORTHE FOLLOWING REASON (SEC. 70313 BUSNESSAND PROFESSIONS CODE: ANY CITY OR COUNTYV44K NREOUMESAPERMRTOCONSTM=,ALTEAIMPROVE, DEMOUSH,OR REPAURANYSTRUC- TUBE. PRIOR TO ITS ISSUANCE ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO RLE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS L4 CENSE UW (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 THEALLEGED EXEMP- TOOK ANY VIOLATION OF SECTION 7031.5 BYANY APPLICANT FOR A PERMIT SUBJECTS THE MAPPLICANT TO A CL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (3500).1c O L AS OWNEROF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION. WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR BALE (SEC. 7044• BUSI- NESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE UW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON. AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUG 1 NIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FORSALEF.HOWEVER.THE BOLDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE- TION. THE CWHER-BUILDER WALL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). O L AS OWNER OF THE PROPERTY. AM EXO_USNELYCONTRACTNG WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044. BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LJ - CENSE LAW DOES NOTAPPLY TO AN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON. AND. YMOOONTRACTS FOR SUCH PROJECTS YNTHACONTRACTOR(S) LICENSED PURSUANT TO THE CONTMO' TORS LICENSE LAW.), O 1 AM EXEMPT UNDER BEB. 5 P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER I (COMMENCING WITH SECTION TOW)OF OMSION S OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS N FULL FORCE AND EFFECT. LICENSE CLASS LIC. NO. DATE CONTRACTOR WORKERS' COMPENSATION DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINTAIN ACERTIFICATE OF CONSENT TO SELF4NSURE FOR WORKERS' - - COMPENSATION. AS PROVIDED BY SECTION 3700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I HAVE AND WILL MADMAN 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 INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER POLICY NUMBER IHIS SECIONNEEDNDT BE ccwrL =OFTE PLAMITIS FORONE HUNDRED CCLARS R100)ORLESS) 1 CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I 1 SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE j WORKERS CDMPENSATON LAYS OF CALIFORNIA.AND AGREE THAT MISHOULDBECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE I SHALL FORIHW17H COMPLY WITH THOSE PROVISIONS. I DATE: APPLICANT: I WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALLBE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS (S 100.000). IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN 1 SECTION 3708 OF THE LABOR CODE. INTEREST. AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY i 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WOR( FOR WHICH THIS PERMIT IS ISSUED (SEC. 3097, CM C.), I LENDER'S NAME LENDERSADDRESS j I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT1AGREETOCOMPLYWITHALLCITYANDCOUNTYORDINANCESANDSTATELAWSRELATINGTOBUILDING CONS7RUCTION, AND HEREBY AUTHORIZE REPRESENTATNES OF THIS COUNTY TO ENTER UPON THE ABOVE -MENTION ED PROPERTY FOR INSPECTION PURPOSES. At% — c..1 rte .f PERMrTTEE NAME ` as 7 SIGNATURE OF PERMITDATE C APPLICATION PERMIT P!C DATE NUMBER ISSUE TYPE_ OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW REAR SIDE/SIDE STREETL-1 RW SIDE PROPOSED USE AIWV? NO. DWEL NO.. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUAT10N SFR/ADD/REM uj Garage/Carport WPatio/Dock LL- POOVSpa 0 Z Re -Roof OJ Commercial 5 m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE G G v I H Uw LuW z CO J 0. JaU 2a UW CONSTRUCTION PLAN REV ELECTRIC 411 in PLUMBIN MECHANIC AL INSPECTION FEE ISSUANCE By - SMTP ENERGY PIC ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: TOTAL FEES j COMMENTS F RECPT. NO. PAID BY VALIDATION' WHITE—Department GOPy. YLLLUw—fuunce L:Opy, 1-INr—nssessOr wpy, uvwcnnuv—rue wy. unCcn— WPII am 5 k wy 03ARXE CITY OF DIAMOND BAR I,,,Ilv,sT-.,p,-,,`:INSPECTION'RECORD S003 OR RAM Vy. Te SET BACK P1 -FLOOR JOIST- E71H FTGS/FORMS/STEELf FHA REQMtS ELECTRIC GROUND.. UNDER FLOOR DUCT-- iG40-UND'PLUMBING UNDER FLOOR CONDUIT, SLAB GRADE - FIRLP LACtfoUNDATim TEMP _POWER ___ FIREPLACE BOND BEAM WATER SERVICE--- MID HT. BOND BEAM ROOF SHEATHING 8 Fr. BOND BEAM FRAMING/VENTILIATION FINL! BOND -BEAM IR65FCOVER (Iia_ PRE-GRADING IROUGH HEATING`_ BENCHING ROUGH ELECTRIC-- — :- 3 ,' c'-- "'i ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWER/TUB TEST POOLELECTRIC, lEXT.--LATH1SIDING------ - POOL FENCING IWALL INSULATION - POOL FINAL, 1- 14 ICEILING INSULATION OFF SITE IMPS. jDRYWALL-NAILING--,---- DEDICATIONS ISEWER------' FINAL ENG ISEPTIC TANK LANDSCAPE/IRRIG. ISEEP_PIT/L.L.__.__.. ON SITE IMPS. IGASAIRTEST FINALZONING I F1 NAL CONST_ - J FIRE DEPDEPT:FINAL , 7 jFINAL.HEATING_____ HEALTH DEPT. FINAL FINAL -ELECTRIC------- --------___ DEV.FEESPAID- FfNAL-PLUMBING-------- ENERGY.. Q COMMENTS TPJ1 SEPTIC TANK -SIZE T ' iF' SEEP PIT/Ll SIZE A 70 IY