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HomeMy WebLinkAbout15999n 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 APN LOT TRACT ' OWNER FIlaLaw �j ADDRESS !WSJ !� �LC CITY f� IR►YIV�LI I�nrL ZIP ,C=-ft-- TEL. APPLICANT 01 TEL. IT CONTRACTOR ADDRESS CITY ZIP TEL ARCRMNG/ DESIGNER V I LAr,S_.__1`Zlhl�'�a��? - ADDRESS�•�,�__ CITY ZIPQ19Q TEL.G&J4- t�aT -- OWNER -BUILDER DECLARATION lr 1 FHEREBY AFFIRM LINGER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LI- OERSE LAW TOTHE FOLLOWING REASON (SEC 77a I.6 B'JS:NC55 RA PRCi C SSIOhS CODE AVY CITY OR COUNTYYAIII]I REOUIFIES A PERVIT TO C0NG7rrJCT.ALTE7; M'RCVE, CELIOLIEHL CR nC PAHn ANY SrRDG TUBE. 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 P (CAMMENC"WITH SECTION 77D0) OF CPAS,ION S OF THE B'JSINCSS ANO PRO FESSIONS CCOEI OR THAT HE OR Sill IS EXEMPT THEREFR0X.1 AND TI-E BASS FOR THE ALLEGED EXCM.'- TION. ANY VK7LAr o,, OF SECTION 7571.E BYANY APPLICANT FORA PERMIT SUELAC: S THL ARPLIUNT TO A CIV'L PENALTY OF NOT MORE THAN FNE NONDRCD DOLLARS O L AS O W VF.ROF THE PROPERTY.OR MY EMPLOYEES W-TH WA:.ES AS THE R SOLF COMPENSATION. WILL CIO THE WOW( AND THE STTL ICTUTE 1. NOT 1NTENOED OR OFFLRED FOn SALE (SEC. 7344. BUSI. NESS AND PROFESS IdNS COCr THE CONTRACTORS LICENSE LAN DOES NOT APPLY TO AN OWNER OF FRUPERTY WI ID BUILDS OR MPROVC S THEREON. AND WHO DOES 5:7CH H WOFIK H:MSrLF OR HERSELF OR THROUGH I15 OR HER OWN EMPLOYE ES. PROWMED THAT SUCH IMPROVEMENTS API NOT INTENDED dI OFFERED FOR SALE. KL NOwEVER THE BUILDING On IMPFLOVEMENT IS SOLD YATNN ONE YEAR Oc COMPLE TEN. THE OWNER BUL DER W'LL HAVE THE BLIFIMN 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 CCNTRATYARA NOTH LICENSED CON'CTO43 TO CONSTRUCT THE PROJECT (SEC . 70N. BJSINI 55 AM PROFESS CNS COCr TI[OCNTRACTORSLI- CENSE LAW DOES NOTAPPLY TO AN O'WNCR OF A PnOPERrY WTO DULDS OR MiRCVES THE PCON. AND MO COH•MCTS FOR SUCH PRC UECTS WITH A CONTRACTONS; LICENSED PLIR',UA•NTTO THE CONTRA,^. TORS LICEhrZ LAW). G I AAA EXEMPT UFCCR SEC. y� B APO FOR Th:S REASON DATE �t �P_ ._K' _ OWNEn_�97.!%%1�_�1L.L11:��� LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM WOE R PENALTY OF PEFLAJRY THAT I AM LICENSED UNDER PROMSC , S OF CHAPTER P(COMMENCING WITH SECTION 7D 1Or CNISCYN SOF THE B.S:NE9S AND P-01 ESSIONS COOL. AID MY LICENSE IS IN FULL roncr ANO E F I ECT. LICENSE CUSS LIC. NO DATE CONTRACTOR WORKERS' COMPENSATICN DECLAFIATION 1 HEREBY AFF:RM UNDER PENALTY CF PERJURY ONE OF TPC FOLLOWNS DCCLAMT IONS _ 1 HAVE AND WILL MANTAN A CE47IFIUTE OF CONSENT TO £ELF-INSJ:iE FOR waP,lE FRS' COMPENSATION. AS PROVIDED BY SECTION TDDOF THE lAFKXI CODE. FCFI TNC PERFORMANCE OF Till Nam FOR Will CH TI4:5 PERM•T IS ISSUED I PAVE AND WILL MAMAN wOFIKERS' CCMPE`. SATX*, IN517RANCC, A5 PCOU'RE3 BY SECTION 9'00 OF THE LASO4 CODE, FOR TPC PC RFCRMANCE OF WE WORK FOR riH:CH THIS PERM-7 15 ICSUEO. MY VK IHXCRS' CCMPE`SA'K3N INSUF:ANCE CARR:CR AND POLICY N UPER ARE GLRRIrn POLICY NUMBER (TIc:SCCRUN11EMNOT CCCCMT.ETL.,OrTEPEFWISFOCIOI.CRMIr ML16IsMic)GRLMEL 1 CERTIrY' THAT N THC PE RFORMANCE OF THE WOPK FOR WIIIC.H TIPS PE RM'T 1S ISS':rD. I S'IAL L NOT E MPLCY ANY PETSON NA`rY MAIN[ II SO AS TOB COME S'JLUCCT TO THE W"JRK ERS'COMPE NSATON LNNS OF CALIFOnN:A ANJ AGRLF. THA: IF 15HOULD C ECOMC SUDJECT TO THC WIOrJ!E RS' COMPENSATION PRCVISONS CF SECTION 373C OF THE LATCn CUUE.I $HALL FCR:INYITH COMPLY WITH THOSE PPCVISONS DATE: APPLICANT I WINNING FALCRC TO SCCURE wOnKER'i CW'ENSATON OOVERACE 1S L'NLANrLl.. AND SHALL BE SUBJECT AN EM'LOYE170 CR;M.NAL PENAL' T.ES AND C:WL FNCS UP TO ONE HLI%DFIr D Iw)U SAX:) DOLLARS (SIMAX;. IN ADDITION TO THE COLT Or COMPENSATION. DAMA3ES AS PROV'C EO FOR N i SECTION 37DF OF THE LABOR COOL• IN7CRCST, AND ATTCRNr-rS FEES. CONSTRUCTION LENDING AGENCY i IHERCHY AFFIRM uNorn • Pr T70r P LVRYTHATTHERE ISACONSCLEMMING AGENCY Fort THE PCPFOW,ANcZ Of THI WOrK IUR NTI'CITN'SP[RMITISISS'jD(SEC. ]D:T.CIV C.). I LENDERS NAME LENDERS ACOPESS 1 CCRT:rY THAT I HALE RI'AD THIS APPLICATION AND STATE THAT THC ABOVC P:rOSMATON IS CCRiIFCT 1 AGFEL TO COMPLY WITH ALL CITY AND COUNTY OFO NANCES AND STATE LAW, RELATING TO BUM DING sCCIIRUCTON. AND FIERECY AUTHOPIZC REPnESCN ATr✓LS OF THIS COUNTY TO ENTER UPON THE AOOL•E MENTIONED PROPERTY FOR INSPECTION PURPOSES PERMITr EE NAMC (PRINT) 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 ❑ SIDFISIDE STREET RW ❑ SIDE ❑ PROPOSED USE — elf NO. DWEL. NO. /y NO. UNITS 1 STORIES _{ 13EDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION SrFvADDTtEM to Gars^„a'Ca'porT LL•I U.1 Pa!ID7TJPCk LL- POCL'Spa 0 Z Ro•Ro l 0 Commmcial m tnf dD Vaw!on L_ _ n ADJ.AREA QUANTITY DESCRIPTION FEE J Q U CC I.- 0 J L:J [7 -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 ,,Q_ sm!P ANC ENERGY PHC 1�111�tll.y ENCRGYPER!Ali tjjL_DjljNLC_ALv1D_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 —•F 110 COPY. GNcnN pl„nr.LS copy CITY OF DIAMIOND BAR INSPECTION RECORD 56- r r i 1m %W r v, "J 1-ze.- r • ST-TBACK FLOOR JOIST M'GS.'FORIMS,'MEEL l'-j -AFHA -,') R-E-MITS"" ELECT -I-C- G—R% U t ; D I f UNDER FLCOR DUCT GROUND PLUt!r-lNG UNDER. FLOOR CIC,'.'-L)-'IIT SLAD, G MAD: i i FIREPLACE FOUNDATICNN FIREPLAGEBOND.R.EAM, I VVATER SERVICE I IMID HT. COND BE: F300 . F: Sl i-,ATHING i,, Fr. r--01•.10 BEAM, .FIRMAINISNIENT ILIATION Fl.' -0-ND BEA-M n,,),)F COVER I PRE ------- --- ROUGIM BENCHING R O'J G: i E LE- C T R I C I I^ I I ROUGH GMADING fl) 0 1. 15! 1 F L U *,.,. D! I` l"G FiNISH GRADING 'qUB TEST I POOL ELECTRIC X T. LAT 14 IS 1 D I N G 'A'ALL iNS-ULAT ION -71 1 1 POOL FIINAL ------- C-MUNG i!:CTJL�jl 101"1 I I I OFF SITE PNIPS. j uRl_ :%_L!_ C: ,ILI:JG -- -I D E I D 1 1-1 AT, i ON' S =I� - --�-I F I NA L E WG. S--TIC TAINK tr,r c� 11 R P. 1 E ONN' SITE IMPS. "i EST FINIALZON'ING FIRE DEFT. Fi,'.',-kL HE AT I HEALIH DEFT. 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