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HomeMy WebLinkAbout217041 CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21825 E. Copley Drive 909)468a3d95 Fax (909) 861-3117 -7 o ao BUILDING PERMIT APPLICATION . JOBSITE tea3' ADDRESS aO I3 A -GpIok br. APN LOT TRACT OWNER ki>aC 10 Lu'Z rYlorc ADDRESS a<a 31 3 N C,+co Ick 40r-. CITY 1Z>12> ZIP TEL APPLICANT VA +Ylo,-C3- TEL. CONTRACTOR k c: f V - ADDRESS CITY ZIP TEL ARCH/ENG/ DESIGNER ADDRESS CITY ZIP • TEL OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AY EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FORTHE FOLLOWING REASON (SEC. 7031.5 OM04ESS AND PROFESSIONS CODE ANYCRYOR COLW" WH3CH REOUIRESAPERMRTOOONSTRUCT, ALTER, IMPROVE, DEMOLISH, OR REPAIRANY STRUC- TURE PRIOR TO ITS ISSUANCE, ALSO REWIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SONED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTOR4 LI- CENSE LAW (CHAPTER 0 (COMMENCING WfTm 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 E%EMR 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 0 L AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC 704/, BUSH NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TD AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO DOES SUCH WORN HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES. PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE IF, HOWEVER THE BULLING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF WMPLE- TON, THE OWNER-BUI DER WALL HAVE THE BURDEN OF PROVING THAT HE OR SHE DD NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). O L AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEG 70N, BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LF CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WINO BURRS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAG TORS LICENSE LAW.). 1 AM EXEMPT UNDER SEC. B. A P.C. FOR THIS REASON DATE ii OWNER LICENSED CONTRACTORS DECLARATION I HERESY AFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER COMMENCING WITH IONSECT7000) OF DIVISION 3 O THE BUSINESS AND PROFESSIONS CODE, AND FULLLICENSEISINFL FORCE AND EFFECT. LICENSE CLASS LIC. NO. DATE CONTRACTOR WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILLMAINTAINA CERTIFICATE OF CONSE T TO SELF-WSURE FOR WORKERS COMPENSATION, AS PROVIDED BY SECTION 37MOF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORT( FOR WHICH THIS PERMIT IS ISSUED. I HAVE MID WILL MAINTAIN WORKERS COMPENSATION INSURANCE AS REOWRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WOW( FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE CARRIER POLICY NUMBER UMSECTION NMEDNOT BEOCMFLEIEDOFTHE PEPI IT IS FOR ONE HIDRED DOLLARS WOD)OR LESS} 1 CERTIFY THAT IN THE PERFORMANCE OF THE WORX FOR WHICH THIS PERMIT IS ISSUED. I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORIC=RRS' COMPENSATION LAWS OF CALIFORNIA. AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE YORKERS' COMPENSATION PROVISIONS OF SECTION 37M OF THE LABOR CODE I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE APPLICANT: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SMALL BE SUBJECTAN EMPLOYER TO CWMNAL PENALTIES AN CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (SI OD,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3701 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WOW FOR WHICH THIS PERMIT IS ISSUED (SEG 3007, CNV. G). LENDERS NAME LENDERS ADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE 04FOFWATON IS CORRECT. I AGREE TO COMPLY WITH ALL CRY 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. PERMITTEE NAME (PRINT) x x SIGNATURE OF PERMITTEE DATE E PRED PRESS FIRMLY DATECATIO' a1 vl NUMBER PERMIT 2 //coo • 4C? ISSUE TYPE TOCC DATE CONST. GROUP ZONING SETBACKS FRONT RW REAR Lj SIDE/SIDE STREET RW SIDE PROPOSED USE Rt' }Q :1 - 7Q i NO. DWEL. NO. NO'-' UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM U) GBTBpBNCeTport W PBtb/Deck LL POOVSpe 0 Z Re -Roof Commercial .- m VBkNatm ADJ.AREA QUANTITY DESCRIPTION FEE U U U, w 0Z m Ja U ZQ Uw CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMTP ENERGY P/C ENERGY PERMIT RETENTION FEE PRE -ALT FEE: S_S • pcs 2c a c>c.L . 3 TOTAL FEES COMMENTS RECPT. NO. PAID BY VALIDATION mi I t—Lmpamnent txW, Ytuvw—hmence Copy. FINK—ABBBssoT Copy, GOLDENROD --RIO Copy. GREEN—Applkxnt'a Copy CITY OF DIAMOND BAR INSPECTION RECORD a o ®' SET BACK FLOOR JOIST GS/FORMS/STEEL I FHA REQMTS ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING UNDER_ FLOOR CONDUIT SLAB GRADE I _ f (REPLACE FOUNDATION TEMP POWER I ; 'FIREPLACE BOND BEAM WATER SERVICE 1 MID HT BOND BEAM ROOF SHEATHING 18 FT, BOND BEAM ! FRAMINGNENTILATION 1 I FINAL BOND BEAM ROOFCOVER iPRE-GRADING ROUGH HEATING i ' BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWER/TUB TEST i POOL ELECTRIC EXT. LATH/SIDING 1 POOL FENCING WALL INSULATION I POOL FINAL CEILING INSULATION i 1 OFF SITE IMPS. DRYWALL NAILING i DEDICATIONS SEWER FINAL ENG._ i L NALNADSCAPEARRIG. SEPTIC TANK SEEP PIT/L.L. ION SITE IMPS, GAS AIR TEST j FINAL ZONING FINAL CONST. FIRE DEPT. FINAL FINAL HEATING i ! HEALTH DEPT. FINAL FINAL ELECTRIC i r DEV. FEES PAID FINAL PLUMBING ENERGY i p- I A COMMENTS SEPTIC TANK SIZE SEEP PITJU SIZE y e, p