HomeMy WebLinkAbout18554 CITY OF DIAMOND BAR
� - �'` ---' DEPARTME?�1T OF COIvA�IUM71'&�DEVELOPMENT SERVICES �i�Q
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� 21825 E.Copley Drive 0
(909)860-3195 Fax(909)861-3117 PRESS
��'-��� BUILDING PERMIT APPLiCATION FIRMLY
o� JOBSITE ��1� j�ER�� �r� APPLICATION �,�J�I� PERMIT ��lS� P/C
ADDRESS� DATE � � NUMBER � #
m ISSUE TYPE OCC
•- APN LOT TRACT _ DATE CONST. GROUP
p OWNER ��'�C'.5.��N�-�
p ADDRESS ' � � 2 GW1�1 ZONING SETBACKS �
Z CITY D ZlPyrtl�5 TEL. �oI' FRONT Ryy ❑
o APPLICANT/.ARiW • VCS TEL�00�7a'�•04�17 REAR ❑
Z —r—� SIDE/SIDE STREET RW ❑
Q CONTRACTOR P� T R rtA SIDE ❑
� ADDRESS � £SHO • _
o cirYk�Lt srNcl�� ZIP92530 TEL.BUD�`� ��,'7 PROPOSED USE
w ARCH/ENG/
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cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
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I HEREBV AFFIRM UNDER PENAL7V OF PERIURY 7HAT I AA1 E%EMPT FROM THE CONTRAC70R5 LI- Gdt892/C2fPOh
W CENSEUWFORTHEFOLLOWINGREASON(SEC.7o77.58U51NE5SANDFROfES510N5r,ODE:ANVCI7YOR (n
U COUN7YWHICHREOUIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISM,ORREPAIRANY:TRUC� W PdliO/DBCk
w TURE,PRIOH TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w
� STATEMENT THAT HE OF SNE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI� �
� CENSE UW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3(1F THE BUSINESS AND PRO- POOUSPB
FESSIONSCADE)ORTHATHEORSHEISEXEMPTTNEREFROMANOTMEBASISFORTHEALLEGEDE%EMP- (}
� TION.ANY VIOLATION OF SECTION 7031.5 BY ANV APPLICAN i FOR A PERMIT SUBJEC'i5 TME APPUCANT TO Z Re-Roof �
A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLURS(f5o0).): '
Z ❑I,ASONRJEHOFTHEPROPERTY,ORMVEMPLOYEESWiTHWAGE5A51HEIRSOLECOMPENSATiON, � Commercial
WILL DO 7HE WORK,AND THE STRUCTURE IS NO7 INTENDED OR OFFERED fOH SALE(SEC.70��,BU51� J
� NESS AND PROFESSIONS COOE:THE CONTRACTOFiS LICENSE UW DOES NO'APP�V TO AN OWNER OF �-
PROPERTV WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCN WORK HIMSELF OR HERSELF OR
� THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
QOFFEREDFORSPLE.IFHOWEVER,TIEBUILDINGORIMPROVEMENTISSOLDwITMINONEVEAROFCOMPLE-
Z TION,THE OWNER�BUILDEP WILL HAVE THE BURDEN OF PROVING'.HAT HE OH SME DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF SALE).
w ❑I,ASOWNEROFTHE PROPERTV,AM E%CLUSIVELY CONTRACTING WITH LICENSEO CONTRACTORS
� TO CANS7RUCT THE PRWEC7(SEC.70�a,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI� V81U0�i0� � ADJ.AREA �
W CENSELAWDOESNOTAPPLYTOANOWNEROFAPROPERTVWHOZUII.DSORIMPROVES7HEREON,AND —
� WHOCANTRACTSFORSUCHPROJECTSWITHACONTRACTOR(S)LICENSEDPUflSUANTTOTHECONTRAC- OUANTITY DESCRIPTION FEE
Y TORS LICENSE LAW.).
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O O I AM E%EMPT UNDER SFC. B.6 P.C.FOR THIS REASON Q
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DATE OWNER _ � '
Z w
� LICENSED CONTRACTORS DECIARATION w
� I HEREBYAFFIRM UNDER PENALTY OF PERIURV THAT IAM LICENSED UNDER PROViSIONS OF CHAP7ER �
d e(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF 7HE BUSINESS AND PP.OFESSiONS CODE,AND Z
`X MV LICENSE IS IN FULL FORCE AND EFFECT. �1 m J� �
� LICENSE CLASS C =�G�L� IIC.NO. IGJ �7 j "
U DATE �S� J
CONTRACTOR ' d
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� WOFKERS'COMPENSATION DECL RATION Q
� I HEREBV AFFIRM UNDER PENAL7Y OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: Z
� IHAVEANDWILLMAINTAINACERTIFICATEOFCqNSENTTOSEIF�INSUfiEFORWORKERS' _
Q CAMPENSATION,AS PROVIDED BV SECTION 3700 OF THE LABOR COOE,FOR TME PERFORMANCE w
OF THE WORK FOR WHICH TMIS PERMIT IS ISSUED. �
�
w I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOIIIRED BY SECTION
Q 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED.MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBERARE: CONSTRUCTION
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� CARRIER S�'�. NO pLAN REVIEW �
Z POLICY NUMBEfi / S��� ELECTRIC
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0 (IMISSECI%7NNE�NOTBECLMPIEfEDOFTI-IEPERMfTISFORONEVNI�DREDOp1PAS(St00)ORLE55). PLUMBING V ��/A I•( t
Z I CEFTIFV THAT IN TME PERFORMANCE OF THE WORK FOR WHICH THIS PEHMIT IS ISSUED,I MECHANICAL
(,�} SHALL NOT EMPLOY ANV PERSON IN ANY MANNER 50 AS TO BECOME SUBJE�T TO THE
� WORKERS'COMPENSATION LAWS OF CAUFOFNIA,ANO AGREE 7HAT IF 1 SHOULD BECOME INS?ECTION FEE
'= SUBJECT TO THE WORKERS'CAMPENSATION PROVISIONS SECTION 3700 OF THE UBOR
fADE.I SH FORT WITH COMPLV WITH THOSE PRO 5. ISSUANCE
� SMIP
p DATE: � PLICANT:
J WARNING:FAILUR SECURE WORKERS' PENSATI CAVERAGE IS UNUWFUL,AND SHALL BE ENERGY P/C
� SUBJECTANEMPLOVEHTOCRIMINALPENALTIESANDCIVILFWESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
DOLLARS(f100.00D).IN ADDITION TO THE COST OF COMPENSA710N,DAMAGES AS PROVIDED FOR IN (`�(
� SECTION 3708 OF THE LABOH CODE.INTEREST,AND ATTOFINEV'S FEES. RETENTION FEE: V U
� CONSTRUCTION LENDING AGENCY PRE-ALT FEE: �
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� 1 HEREBV AFFIRM UNDER PENALTV OF PEiL1URV THAT THEHE IS A CONS7RUC710N LENDING AGENCY
� FOR THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUEO(SEC.]OB7,CIV.C.).
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� LENDER'S NAME
H LENDER'SADDRESS
w I CERTIFY TFIAT I HAVE READ THIS APPLICATION ANO STATE THAT THE ABOVE WFORMATION IS CORRECT. TOTAL FE ES x I � � ` �
� I AGREE TO CAMFLY WITH ALL GTY ANO COUNTV ORDINANCES AND STATE LAWS REUTIN�TO 9UILDING V �`j �
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE
Z ABOVE-MENTIONED PROPERTV FOR INSPECTION PURPOSES. COMMENTS
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m PERMITTEE NAME( T) �
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� , � �� ;
� � FPERMI DATE
= RECPT.N0. PAI�BY VALIDATION
~ WHITE—De artment Co YELI.OW—Finance Co PtNK—Assessor Co GOLDENROD—File Co GREEN—A licant's Co
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GRCJUND PLUMBING � --- --- ---•-U^lD�R (-LOOR CUhiDUIT ; ---- -- -
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TEMP POWER � �; ; I F�RE�'LAGE BQNI� BEAM ' ......_.___
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ROOF BHEATHING__ � -----��_____ ;. � � �. E�C�ND BEAM � !
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ROUGH PLUMBING ; ; FINISH GRADING
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CEILING IN�ULATION ! � OFF SITE IMPS. '
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DRYWALL NAILING � j a� EDICI�TIQNS
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FINAL HEATING ; HEALTH QEP7. FINAL
-- --- ---- � ----------�_, ________ ------ ..._.__ .. -- - ------
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CUfViNiENTS ___�. __.__..�__._._. _____ _ _ __
SEPTIC TANK SIZE
SEEP PIT/U SIZE ---- ------- —_..__.-- ---.___---- -__.____._._._.__
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