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HomeMy WebLinkAbout10-929 (5) - — �� �v�-�, �� � . ` �,`_ CITY OF DIAMOND BAR '�.(�a� � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �, 21825 Copley Drive,Diamond Bar,CA 91765 � (909)839-7020 Fax(909)861-3117 Building Inspection Hotlioe(909)839-7027 � PRESS �"�"' BUILDING PERMIT APPLICATION FIIRMLY } JOBSITE , � � � n APPLICATION ` � j'� PERMIT j,�-� p/C o ADDRESS �3 S� C�A�Zm��Q�L f�/`� DA'TE � ` 1v NUMBER �# ��� � ISSUE TYPE OCC APN LOT TRACT DATE �� CONST. GROUP p OWNER p ADDRESS E ZONING SETBACKS 9�?,�9 �..--- RW ❑ Z CITY � IP TELQ� S3/� FRONT p APPLICANT TEL3��_`�f5-3sLZ REAR � Z SIDE/SIDE STREET RW ❑ � CONTRACTOR r /C� SIDE ❑ ADDRESS� G v � � CITY�v7Ti n 9TtYJ�13'�ZI P�� TE'L�'Z.�.�'SS.3S5Z PROPOSED USE � o ARCH/ENG/ _ z DESIGNER w NO.DWEL. / NO. NO. a ADDRESS � CITY ZIP TEL. UNITS / STORIES �_ BEDROOMS � cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION SFR/ADD/REM O � I HEREBV AFFIRM UNDEF PENAL7Y OF PERIURV THAT I AM EXEMPT FPOM THE CONTRACTORS ll- G8fd90/C8lPOh W CENSE LAW FORTHE FOLLOWING REASON(SEC.7031.5 BUSINESS AND PROFESSIONS CADE:ANY CITV Oii (n U COUNTYWHICHREQUIRESAPEfiMI7TOCANSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREFAIRANYSTqUC- � W TURE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOH SUCH PERMIT TO FILE A SIGNED W Patio/Deck � STATEMENT hiA7 HE OR SHE IS LICENSED PURSUAN7 TO 7HE PROVISIONS OF THE CONTRACTORS LI� � � CENSE LAW(CHAPTER B(CAMMENCMG WI7H SEC710N 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- POOUSPB O FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALIEGEDEXEMP� (� V TION.ANYVIOUTIONOFSECTION7a31.5BVANYAPPLICAN7FORAPERMITSUBJECTSTHEAPPLICANTTO Z Re-Roof � A CIVIL 7ENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(SSoo).): Z ❑I,ASONRJEROFTHEPROPERTY,ORMYEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, � COfTIfilOfdel WILL DO THE WORK,AND 7HE STRUC7URE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7o�t,BUSI- J � NESS AND PqOFE5510N5 COOE:THE CANTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF � PROPERTY WHO BUILDS OR IMPROVES THEFEON.AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR CC THROUGH HIS OR HER OMM EMPLOYEES,PROVIDED THAT SUCH IMPROVEMEN75 ARE NOT INTENDED OR m w OFFEREDFORSALEISHOWEVER,7HEBUILDINGOFIMPFOVEMENTISSOLDWITHINONEYEAROFCOMPLE- ' Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR �, � IMPROVE FOR THE PURPOSE OF SAIE). � w ❑I,ASONRJEROFTHEPROPER7Y,AME%CLUSIVELVCONTRACTINGWI7HLICENSEDCONTRACTORS [[ TO CANS7RUCT THE PRQIECT(SEC.7ola,BUSINESS AND PROFESSIONS CODE:THE CONTRACTOFS LI- V81U2t1Of1 ADJ.AREA W CENSELAWDOESNOTAPPLYTOANON?JEROFAPROPERTYWHOBUILDSORIMPROVESTHEREON,AND � WHOCONTRACTSFORSUCHPRQIECTSWITHACANTRACTOR(S)LICENSEDPURSUANT70THECANTRAC- QUANTITY DESCRIPTION FEE Y TORS LICENSE UW.). � ❑I AM EXEMPT UNDER SEC. B.6 P.C.FOR 7HIS REASON Q � � U � � DATE OWNER H W � LICENSED CONTRACTORS DECLARATION W I � I HEREBYAFFIRM UNDER PENALTV Of PERJURY 7HA7IAM LICENSED UNDER PROVISIONS Of CHAPTER � � Y(COMMENCING WI7H SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CO�E,AND Z - XL' MY LICENSE IS IN fULI FORCE AND EfFECT, m LLI � LICENSE lASS C� � LIC.NO. � ��� � V DATE ��=I �� I� CONTRACTOR d W � �WORKERS'COMPENSATION DECLARATION Q � I HEREBYAFFIFM UN�ER PENALTV OF PERJURV ONE OFTHE FOLLOWING DECURATIONS: Z Z _IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' a = U ¢ COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR COOE.FOR THE PERFORMANCE W Q OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. � � _IHAVEANDWILLMAINTAINWORKERS'COMPENSATIONINSURANCE,ASRE�UIREDBYSECTION Q 370o OF THE LABOR CODE,FOR THE PERFORMANCE OF TFiE WORK FOR WHICH THIS PERMIT IS ISSUED.MY WORKERS'COMPENSATION WSURANCE CARRIER AND POLICY NUMBERARE: CONSTRUCTION J j CARRIER PLAN REVIEW � POLICY NUMBER Z ELECTRIC ¢ 0 (IHISSECTIONNE�NOTBECOMR.EfEDOFTHEPEPMfTISFORONEFNI�DREDDOII?AS(E100)ORLESS). PLUMBING Z ERTIFV THAT M THE PERFORMANCE OF THE N'ORK FOR WHICH THIS PERMIT IS ISSUED,1 MECHANICAL � r�i� (} �AIL NOT EMPLOY ANV PERSON IN ANV MANNER 50 AS TO BECOME SUBJECT TO THE � WORKERS'COMPENSA710N LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE = SUBJECT70THEWORKERS'COMPENSA710NPROVISIONSOFSECTION ooOFTHELAeOR � CADE,I SHALL FORTHWITH COMPLV WITH TH E PROVISIONS. ISSUANCE � ///��� ��' ...��� ��, ��A��, SMIP �c ��7 p DATE:�APPLICANT: ' � �j"'� J WARNI G:FAIWFE TO SECURE WORNERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C � � SUBJECTANEMPLOVEflTOCRIMINALPENALTIESANDCNILFINESl1PTOONEHUNDREDTHOUSAND ENEFGYPERMIT DOLLARS(S70o.000�,IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN � SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. ' RETENTION FE ' �,1R7 � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � O � I HEREBV AFFIRM UNDER PENAL7Y OF PERJURY THATTHEFE IS ACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OFTHE WORK FOR WHICH 7HI5 PERMIT IS ISSUED(SEC.3a87,CIV.C.�. Z W � LENDER'S NAME � H LENDEF'SADDRESS � TOTAL FEES 'c}-� ^ w I CERTIFV 7HAT 1 HAVE READ THIS APPLICA710N AND STATE THAT THE ABOVE INFORMA710N IS CARREC7. � I AGREE TO COMPLV WITH AlL CI7V AND COUN7V ORDINANCES AND S7A7E LAWS REUTING TO BUILDING � CONSTRUCTION,AND HEREBV AUTHORIZE REPFESENTATIVES OF THIS COUNTY TO ENTEF UPON THE Z ABOVE-MENTIONED GROPERTV FOR INSPECTION PURPOSES. COMMENTS � 0 � �� � � m PERMI E NAME(PRINT) � � � -/7-lD = SIGNATU OF PERMITT E DATE RECPT.NO. S���I'$ PAID BY VALIDATION� ~ WHITE—Department Copy,YELLOW—Finence Copy,PINK—Assossor Copy,GOLDENROD--File Copy,GREEN—Applicant's Copy CB�V O� ���V1���9D �AR •- _ 9�S�I�C�'90� IRI���FiD , '� 'Oa�pCC�400a DGJ4G Oa�pCC�40GJ Oa�pGC��00�1. � �[��14G Qa�aGC�4Q`G��`�� SET BACK FLOOR JOIST FTGS/FORMS/STEEL FHA REQMTS ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR CONDUIT SLAB GRADE FIREPLACE FOUNDATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICE MID HT. BOND BEAM ROOF SHEATHING 8 FT. BOND BEAM FRAMINGNENTILATION FINAL BOND BEAM ROOF COVER PRE-GRAOING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWER/TUB 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. ON SITE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST. FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY ��o � COMMENTS �0-1n«A��l �� � __ SEPTIC TANK SIZE SEEP PIT/U SIZE a � � �