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HomeMy WebLinkAbout14161 (16)JOBSITE ADDRESS Aa A APN LOT TRACT OWNER ADDRESS `i `l L CITY3-A ZIP q IU TEL.�v7�Zc a APPLICANT ir-- TEL. CONTRACTO °'� �a t ADDRESS -&A ri w CITY LA 12AAyOU2 ZIP _!�J L14 TEL.bj;1 ARCFVENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LF CENSE LAW FCRTHE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REOUIRESAPERMIT TO CONSTRUCT. ALTER. IMPROVE. DEMOUSK OR REPAIRANY STRUC- TURE, PRIOR TO ITS. ISSUANCE. ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW (CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 O THE BUSINESS AND PRO. FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FORTHE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO ACIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS ($500).): 0I,AS OWNER OFTHE PROPERTY, OR MY EMPLOYEES WITH WAGESASTHEIR SOLE COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7DA1, BUSI- NESS AND PROFESSIONS COUE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HEROWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE. IF, HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE- TION. THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). 111, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 70", BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS U. CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). U 1 AM EXEMPT UNDER SEC. B. L PG FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS 1N FULL FORCE AND EFFECT.`'j� LICENSE CLASS � LIC. NO. 'V -✓ DATE b t'�,t417D CONTRACTOR ,,{{ WORKERS' COMPENSATION DECLARATION /1 I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING OE0.ARATKNTS: �J __IHAVEAND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKS ' COMPENSATION,AS PROVIDED BY SECTION 37CO OF THE LABOR CODE. FOR THE PER ANC OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REOUIRED BY SECT 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMI IS ISSUED. MY WOnKKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER % -itle POLICY NUMBER (THIS SECTION NE®NOT BE OOMPLETEDOFTFE PEFW IS FOR ONE HUDREDDOUARSf$100)ORL )! I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA. AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE, I SHALL FORTHWITH COMPLY WITH SEP IS DATE: t U _ J APPLICANT:'- WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,ANDSHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND DOLLARS (f100,OOD), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3703 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I 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. 3097, CIV CLI - LENDERS NAME LENDERS ADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL 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. X� PE TTEENAME(PRINT)/ SI URE OF PIrATTEL DATE yY FXplR� ZOnnO PRESS FIRMLY APPLICATION) Q E�t" PERMIT / J_ P/C 4 1 IRAO CITY OF DIAMOND BAR COMMUNITY DEVELOPMENT DEPARTME ( ( 21660 E. Copley Drive Suite 190 .""" (909) 860-3195 Fax (909) 861-3117 TYPE OCC CONST GROUP BUILDING PERMIT APPLICATION JOBSITE ADDRESS Aa A APN LOT TRACT OWNER ADDRESS `i `l L CITY3-A ZIP q IU TEL.�v7�Zc a APPLICANT ir-- TEL. CONTRACTO °'� �a t ADDRESS -&A ri w CITY LA 12AAyOU2 ZIP _!�J L14 TEL.bj;1 ARCFVENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LF CENSE LAW FCRTHE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REOUIRESAPERMIT TO CONSTRUCT. ALTER. IMPROVE. DEMOUSK OR REPAIRANY STRUC- TURE, PRIOR TO ITS. ISSUANCE. ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW (CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 O THE BUSINESS AND PRO. FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FORTHE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO ACIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS ($500).): 0I,AS OWNER OFTHE PROPERTY, OR MY EMPLOYEES WITH WAGESASTHEIR SOLE COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7DA1, BUSI- NESS AND PROFESSIONS COUE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HEROWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE. IF, HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE- TION. THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). 111, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 70", BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS U. CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). U 1 AM EXEMPT UNDER SEC. B. L PG FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS 1N FULL FORCE AND EFFECT.`'j� LICENSE CLASS � LIC. NO. 'V -✓ DATE b t'�,t417D CONTRACTOR ,,{{ WORKERS' COMPENSATION DECLARATION /1 I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING OE0.ARATKNTS: �J __IHAVEAND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKS ' COMPENSATION,AS PROVIDED BY SECTION 37CO OF THE LABOR CODE. FOR THE PER ANC OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REOUIRED BY SECT 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMI IS ISSUED. MY WOnKKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER % -itle POLICY NUMBER (THIS SECTION NE®NOT BE OOMPLETEDOFTFE PEFW IS FOR ONE HUDREDDOUARSf$100)ORL )! I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA. AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE, I SHALL FORTHWITH COMPLY WITH SEP IS DATE: t U _ J APPLICANT:'- WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,ANDSHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND DOLLARS (f100,OOD), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3703 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I 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. 3097, CIV CLI - LENDERS NAME LENDERS ADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL 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. X� PE TTEENAME(PRINT)/ SI URE OF PIrATTEL DATE yY FXplR� ZOnnO PRESS FIRMLY APPLICATION) Q l 5 PERMIT / J_ P/C 4 1 DATE / ( ( NUMBER p ISSUE DATE TYPE OCC CONST GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE Glut - 4'4r'� I �r a-c��s�`6V�E�'te�D'Iy�`��-Gt. 'D Q « y 1V0 L� N0. NO. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREA/VALUATION SFPJADDIREM U) Garage/Carport WPatiomeck LL POOVSpa ZRe -Roof Commercial m Valuation ?rt ADJ-AREA QUANTITY DESCRIPTION FEE - J Q U Li N U W J W J x U NSTRUCTION L — AN REVIEW )�' ECTRIC UMBING MECHANICAL INSPECTION FEE ISSUANCE —f SMIP �p�e 5 3 1< Q ENERGY PIC Mrd DIAN OND RAR ENERGY PERMITANT)-3 AF2, T-( RETENTION FEE: PRE -ALT FEE: TOTAL FEES COMMENTS RECPT. NO.PAID BY If VALIDATION WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD—File Copy, GREEN—Applicani's COPY 651 .,.; :.; IT F DIi4�OfOND BAR INSPECTION RECORD INSPECTICIA ©SITE INSPEC7 OR w8PECTION CRATE INSPECTOR FLOOR JOIST • "FH REQMTS sUNDER FLOOR FINAL BOND BEAM COVER PRE -GRADING ROUGH HEATING BENCHING GRADINGROOF ROUGH J POOL ELECTRIC POOL FENCING am. well 01 FINALI -�,1.■ # • NAL ENG. .� SEEP . a GAS AIR TEST FINAL ZONING FINAL CONST. 11111 i II COMMENTS4 CERT OF OCC. SEPTIC TANK SIZE SEEP PIT/U SIZE 1tl YY �L _ i i r