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HomeMy WebLinkAbout14907CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES « 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 •'"TM' BUILDING PERMU APPLICA70()N TE ADDRESS SS J 44 f4 N O NJ V1 C 1% d 17 fL APN LOT TRACT OWNER ` ADDRESS CITY T.-7 ZIP TEL.je O- 2b APPLICANT TAti1 ILtC] TEL. CONTRACTOR Ti 11""I t0A-M I? nur I J� ADDRESS �3 f 'TMJ[ �.,� Lt7✓ Ij/L CITY T> I //s ZIP ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM LANDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LF CENSELAW FOR THE FOLLOWING REASON (SEC.7031.5 BUSINESSAND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REWIRESAPERMrTTO CONSTRUCT. ALTER, IMPROVE, DEMOLISH, OR REPAIRANY STRUC. TURF. PRNOR TO ITS ISSUANCE, ALSO REWIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS T.4 CENSE LAW (CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 O THE BUSINESS AND PRO- FESSIONS CODE) OR THATHE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THEALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (9500).): L14ASOWNEROFTHE PROPERTY, OR MV EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 70". BUSI- NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE UW DOES NOT APPLY TO AN OWNER OF PROPERTY WHOOULDS OR IMPROVESTHEREON, AND WHO DOES SUCH WORK HIMSELF OR HERSELFOR THROUGH HIS OR HEROWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE IF, HOWEVER THE BUILDING OR KDNIMPROVEMENT IS SOLD WITHIN ONE YEAROF COMPLE- T, THE OWNER41LII WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). ❑ 4 AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTPACTORS TO CONSTRUCT THE PROJECT (SEC. 70", BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LI- CENSE LAW DOES NOTAPPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND VANO CONTRACTS FORSUCHPROJECTS WITHA CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- TORS NTRAC- TORS UCLAW.). O 1 AM EXEMPT UNDER SEC. B. & PC. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9(COWENONG WITH SECTION 7000)OF DIVISION 3 DIME BUSINESS AND PROFESSIONS CODE. AND LL W LICENSE IS IN FUFORCE AND EFFECT. LICENSE CUSS +A LIC. NO. (,y� , U�Z,c,.-. DATE I) CONTRACTOR I I WORKERS' COMPENSATION DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS, _ I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION 37W OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WILL MAINTAIN WORKERS- COMPENSATION INSURANCE, AS REQUIRED BY SECTION 7700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' COMPENSATKM INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER_. ^ F POLK:YNUMSER /.PZ -O NCO I DJ} -Q C-1 ©- (TNS SECTION NEEDNDTSE OOMFLETEDOFTHE PERMIT FORONE "MDREDDOUARS($IMIORLESSL 1 CERTIFY THAT INTHE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHAD, NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SURIECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA AND AGREE THAT IF 1 SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODS., SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS, DATE:Q� APPLICANT: WARNIN(k FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL Be SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (9100.000L IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIOEO FOR IN SECTION 37DA OF THE LABOR CODE. INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3Da7, CIV. C.). LENDERS NAME LENDERS ADDRESS 1 CERTIFY THAT 1 HAVE READ THISAPPLICATION AND STATE THAT THEASOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH AL CITY 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. JI t� PERM N E (PRION) Y SIGNOWIlE CF PEPPIRE DATE PRESS FIRMLY APPLICATION C A � DATE > W NUMBS NUMBER # It ISSUE) , _�b TYPE OCC DATE 5" rl"�' CONST- GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ - PROPOSED USE KC -7' Ifk%S ' NZ IIs S a NO. DWEL- NO, NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT I FACTOR PSF ADJ. AREAIVALUATION SFRIADD/REM Co Garagia/Carport WPatnMack U- POOVSPa z Ra-RNK)1 Commercial - 5 m ValDation ADJ.AREA QUANTITY DESCRIPTION FEE 6 U cc F- U W J w Z DO 7 J a a U_ Z S U w CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING170, IG_ MECHANICAL 4 INSPECTION FEE _ ISSUANCE SMTP 14h?1 S •Cl ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: TOTAL FEES COMMENTS RECPT. NO. PAID BY VAUDATIO WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD—File Copy, GREEN—Applicant's Copy II N T E BACK FLOOR JOIST FTS/FORMS/STEEL G 0 !G 7 FHA REGMTS ELECTRIC GROUND UNDER FLOOR DUCT PLUMBING UNDER FLOOR CONDUIT -GROUND GRAD; FIREPLACE FOUNDATION -SLAB TEMP POWER FIREPLACE BOND BEAM SERVICE MID HT. BOND BEAM' -WATER ROC SHEATHING 8 FT. BOND BEAM FWZiNGNENTILIATION FINAL BOND BEAM ROOF COVER PRE -GRADING HEATING BENCHING -ROUGH ELECTRIC ROUGH GRADING -ROUGH ROUGH PLUMBING FINISH GRADING SHOWERITUB TEST POOL ELECTRIC EXT. LATH/SIDING POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER FINAL ENG. SEPTIC TANK LANDSCAPE/IRRIG. SEEP PIT/L.L. t ON SITE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST. 746 a�lu k6jLt1oj_VL—) FIRE DEPT FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY COMMENTS 491--ob 1 7`1 SEPTIC TANK SIZE SEEP PITIIJ SIZE