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HomeMy WebLinkAbout15999 (9)a LU C, CM Q Ik �,! CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES x_ c 21660 E. Colley Drive Suite 190 (909)860-3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION JOBSITE ADDRESS % -iL9 AIDN LOT TRACT ' OWNER FIlaLaw �j ADDRESS !WSJ !� �LC CITY f�IR►YIV�LII�nrL ZIPr�= TEL. APPLICANT 01 TEL. IT CONTRACTOR ADDRESS CITY ZIP TEL ARCRMNG/ DESIGNER V I LAr,S_.__1`Zlh- ADDRESS�•�,�__ CITY ZIPQ19Q TEL.G&J4- t�aT --- OYJNER-BUILDER DECLARATION lr I FHEREBY AFFIRM LNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LI- OERSE LAW TOTHE FOLLOWING REASON (SEC 77D I.6 B'JS:NC55 RA PROF C SSIOhS CODE AVY CITY OR COUNTYYAIII]I REOUIFIES A PERVIT TO C0715:FYJCT.ALTE7; M'RCVE, CELIOLIEHL CR nC PAHR ANY STRJC. TURC. PRIOR TO ITS ISSUANCE. ALSO REQUIRES THE MPLICAtiT FOR SUCH PERMIT TO ME A SIGNED STATEMCNT THAT NC OR SIIE LS LICCh5r0 PUR.P.UAN- TO THE PROV S CNS OF THE CONTRAC10F15 L6 CCNSE LAW (CHAPTER K (CAMMENC"WITH SECTION 7X0) OF CPAS,ION S OF THE B'JSINCSS ANO PRO FESSIONS CW CI OR THAT HE OR Sill IS EXEMPT THEREFR0X.1 AND TI-E BASS FOR THE ALLEGED EXCM.'- TION. ANY VIOUrKY7 OF SECTION 7571.E BYANY APPLICANT FORA PERMIT SUELAC: S THE ARPLIUNT TO A CIV'L PENALTY OF NOT MORE THAN FIVE HONDRED DOLLARS O L AS O W VF.ROF THE PROPERTY.OR MY EMPLOYEES W-TH WA:.ES AS THE R SOLF COMPENSATION. PILL DO THE WORK( AND THE STFUCTUTE 1. NOT 1NTENCCD OR OFFLRED FOn SALE (SEC. 7344. BUSI. NESS AND PROFESS Id+S COCr THE CONTRACTCRS LICENSE LAN DOES NOT APPLY TO AN OWNER OF FRUPERTY VA ID BULDS OR MPROVC S THEREON. AND WHO DOES S:JCH H wong H:MSrLF OR HERSELF OR THROUGH1e5 OR HER OWN EMPLOYE ES. PROWMED THAT SUCH IMPROVEMENTS API NOT INTENDED ON OFFERED FOR SALE. KL HOwCVER THE BUILDING OR IMPROVEMENT IS SOLD YATHN ONE YEAR Oc COMPLE TEN. THE OWNER BUI DER W'LL HAVE THE BLIFI N OF PROWNG THAT HE OR SHC CID NOT BUILD OR IMPROVE FOR THE. PURPOSE OF SALE) C L AM1 OWNER OF THC PROPERTY. AM EXOL'r VELY CONTRATYARA NOTH LICENSED CON'CTO43 TO CONSTRUCT THE ONSTRU TTHE PROJECT (SEC 70". BJSINI 55 AM PROFESS CNS CODE TIEOCNTRACTORSLI- CENSE LAW DOES NOTAPPLY TO AN O'WNCR OF A PROPERTY WTO Timm OR wonc%TS THE PEON. AND MO CONTRACTS FOR SUCH PRC UECTS WITH A CONTRACTONS; LICENSED PLJR'.UANTTO THE CONTRAC- TORS LICEhrZ LAW). G I AAA EXEMPT DICER SEC. y� B APO FOR Th:S REASON DATE �t �P_ ._K' _ OWNER_�97.!%%L�_�1E.111:��� LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM WOE R PENALTY OF PEFLAJRY THAT I AM LICENSED CINDER PnOMSC , S OF CHAPTER P (COMMENCING WITH SECTION 7DDC10F CNISKYI S OF THE B.S:NE9S AND P-01 ESSIONS CODE. AID MY LICENSE IS INFULL FORCE ANO E F I CET. LICENSE CUSS LIC. NO DATE CONTRACTOR WORKERS' COMPENSATICN DECLAFIATION 1 HEREBY AFF:RM UNDER PENALTY CF PERJURY ONE OF THC FOLLOWNS DECLARATIONS _ 1 HAVE AND WILL MANTAN A CE47IFIUTE OF CONSENT TO £ELF-INSJ:iE FOR waP,lE FiS- COMP ENSATION. AS PROVOED BY SECTION TDDOF THE lA.^.OR CODE. FCFI TNC PERFORMANCE OF THC Nam FOR Will CH TI4:5 PE RM•T IS ISSUED I IMVC AND WILL MANTAN wOFIKERS' CCMPE`. SATXIh INSI:MNCC. A5 PEOU'RC] BY SECTION 9'00 OF THE LAS04 CODE, FOR THC PC RFCRMANCE OF T14• WORK FOR riH:CH THIS PERM-7 15 ISSUED. MY VK IHXERS' COMPE`SA'KOh INSUF:ANCE CARR:CR AND POLICY NIVIDER ARE GLRRIrn POLICY N17MBER (nc:SECTION 11EM NOTCCCCF.fT.ETL.,OrTEPEFWISFCRONCR MIr M L16 IsMic) ORLMEL 1 CERTITY' THAT N THC PE RFORMANCE OF THC. WOPK FOR WIIIC.H TIPS PE RM'T 1S ISS':ED. I STALL NOT EMPLCY ANY PETSON NA`rY MAJ4%E II SO AS TOB COME S'JEUCCT TO THE W"JRK ERS'COMPE NSATON LNNS OF CALIFOnN:A JINN AGRLF. THA: IF 15HOULD C ECOMC SUBJECT TO THC WIOrJ!E RS' COMPENSATION PRCVISONS CF SECTION 373C OF THE LATER CUUE.I $HALL FCR:INYITH COMPLY WITH THOSE PPCVISONS DATE: APPLICANT I WMNING FALCRC TO SCCURE YIOnKEn i CW'CNSATON OOVERACE 1S L'NLANrLl.. AND SHALL BE SUBJECT AN EM'LOYE170 CR;M.NAL PENA' T.ES AND C:WL FNC.S UP TO ONE H;JNDFIR D Iw)U SAND DOLLARS (SIMAX;. IN ADDITION TO THE COLT OF COMPCNSATOK DAMASES AS PROV'C ED FOR N i SECTION 37DF OF THE LABOR COOL• INTFRCST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY i IHEREHY AFFIRMUNDER Pr THI OFPEFLVRYTHAT TIHCRF. ISACONS'jED(S C. LENDING C.).AGENCY • iOR THE PCPFOWAAF7(:E Of THI WOCK I OR NTI'CII TN5 PERMIT IS ISS'DCD (SEC. ]D':T, CIV C.). I LENDERS NAME LENDERS ACOPESS 1 CCRT:FY THAT 1 HAIE AI'AD THIS APPLICATION AND STATE THAT THCC P ABOVrOSMATON IS CCRiIFCT 1 AGFEL TO COMELY WITH ALL CITY AND COUNTY OFO NANCES AND STATE LAW, RELATING TO BUM DING sCCIIRUCTON. AND IICRCCY AUTHOF•IZC REPRCSENTATrrCs OF THIS COUNTY TO ENTER UPON THE A110L•E MENTIONED PROPERTY FOR INSPECTION RURPOSES PERMITr CE NAMC (PRHNT) SIGNA'L'Wr; FPLR ILL DATL �,°�,• PRESS FIRMLY APPLICATION PERMIT < P/CO I O DATE-'�1J/10 W NUMBER a ISSUE TYPE . OCC DATE,!_ y1A_ CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDEISIDE STREET RW ❑ SIDE ❑ PROPOSED USE — elf - NO. DWEL. NO. /y NO. UNITS 1 STORIES _{ 13EDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION SrFvADanEM to Gars^„R'Ca'porT LJJ U.1 Pa!ID7TJPCk LL- POCVspa 0 Z no -Roof 0 Commmcial m tnf dD � Vaw!on A_ _ n ADJ.AREA QUANTITY DESCRIPTION FEE J Q U CC I.- 0 J L:J L7 -L C1 J a J C U I 2 U W ` C ©• c) Q CONSTRUCTION 3 `O PLAN REVIEW ELECTRIC PLUMM.NG MECHANICAL ��11 INSPECTION FEE �l ISSUANCE sm!P ANC ENERGY PHC L�I/l�tll.y ENCRGYPER!Ali tjjL_DjljNLC_ALvID_SAr RETENTION FEE: PRE•ALT FEE: L{ TOTAL FEES R U COMMENTS RECPT. NO. rm— _ PAID BY VALIDATION _ WHITE —Department Copy. YELLOW--I-manse Copy. PINK —Assessor GOO/. GOLDLNHUL —•/ 110 COPY. GNcnN pl„nr.FS copy CITY OF DIAMIOND BAR INSPECTION RECORD 1 56- r r i oi, mo %M j,'v r r ST-TBACK FLOOR JOIST M'GSA-0 IIEEL It HA REMITS` ELECT -I-C- G—R% U t � D I f UNDER FLCOR DUCT GROUND PLUt!r-lNG UNDER. FLOOR CC,'.'-L)-'IIT S L A D, G A D'-: i i FIREPLACE FOUNDATICNN FIREPLACE BOND.R. EAM. I vVATER SERVICE M0 [-!-I- COND MEAM F300 . F: Sl iPATHING i,, Fr. r--ok.10 BEAM, Fl.' BEMM n,,),)F GOVER P I RE-GRADINC, ---------- ROUE ! I I N, �-2 BENCHING ROJGH ELE-CTRIC ROUGH GMADING r 1) 0 1. 15! 11-1 L U *,.,. Il NG R."JISH GRADING 'qUB TEST I POOL ELECTRIC X T. LAT 14 IS 1 D I N G ,' PO0,L'FE.--ING 'A'ALL iNS-ULAT ION -71 1 1 POOL FIINAL ------- OFF SITE PNIPS. D E I D 1 1-1 AT, i ON' S F I NA L E WG. s P T I G TAINK FIT; L. ONN SITE IMPS. "i EST FINIALZON'ING FIEF DEFT. Fi,'.',-kL IR HEM AT i r-: I HEALIH DEFT. Fl%'Al. PL U.M. 5 E-NERGY -COMINIEENTS C-4 -L!2� _j 1SEPT IC TANK S I Z'-:. 'SEEP PIT!U SIZE' Wit!