HomeMy WebLinkAbout16240 _ � CITY OF DIAMOND BAR �
I)EPAYtTMENT OF COMMUMTY&DEVELOPMENT SERVICES
W . 21660 E.Copley Drive Suite 190
(909)860.3195Fa�c(9p9)861-31t7 � �., � ���SS
'�`'�^ BUILDIlVG PERMIT APPLICAI'ION � FtRMLY
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YALL 007HE WORK,AND THE STRUCTURE�5 NOT INTENDED OR OFFERED FOR SALE�SEC.7o44,BLI51• J
� NESS MA�ROFESSIONS O�DE:TNE CONTRRCTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF ?
PqOPEqfY WHp gUI1DS OR IMPROVES THEREDN,MA WHO DOES SUqi WORK HIMSELi OR HERSELF OR
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CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21660 E.Copley Drive Suite 190
(909)860-3195 Fax(909)861-3117
BUILDING PERMIT APPLICATION
PRESS
JAODI3DSRIETsEs 93715-CANYOQ)ASIR CT
Xi
APN LOT -1111 tifeW
OWNER 1 aziltriolut igo
ADD'SS- -11141:111/e/PAIrdiM a
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CITY 10,t ifeiffl_Olgi .i IP aft 0 TEL Iductiisr. .j•
APPLICANT i P i' 111 i r 4. TEL
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CONTRACT't wrilitalliirett 0 .14.,v
ADD- trtilirfititi0" :T IIIMPA:rian7444-t7r-Ate
CITY %NU ZIP Pia TEL•02tirL4R21
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ARCH/NG/
DESIGNER 1 Ib ,.
ADDRESS v Urttlin.Wndl ia r4111111001RUTALV:in
CITY * .!'•to t.21 IP°kr. •9 L.00.lt :rflicerio
OWNER-BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 MI EXEMPT FROM THE CONTRACTORS LI.
CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE:ANY CITY OR
COUNTY WHICH FE . , . ..
TURF. PRIOR TO r • %
STATEMENT THAT ... .
CENSE LAW(CHAPTER B (COMMENCING WITH 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 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 15500)):
0 LAS OWNER OF THE PROPERTY,OR MY EMPLOYEES WITH WAGESAS THEIR SOLE COMPENSATION,
II'ALL. DO THE WORK. MID THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC. 7044,BUSI-
NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF
PROPERTY WHO BUILDS OR IMPROVES THEREON.AND INHO DOES SUCH WORK HIMSELF OR HERSELF OR
THROUGH HIS OR HER OWN 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).
0 I,AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS
'013 CONSTRUCT THE PROJECT(SEC. 7044,BUSINESS AND PROFESSIONS CODE-THE CONTRACTORS LI-
CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND
WHO CONTRACTS FOR SUCH PROJECTS wral A CONTRACTOR(S) LICENSED PURSUANT TOTHE CONTRAC-
ToRs LICENSE LAW).
CI 111.4 EXEMPT UNDER SEC. B.&PC. FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 111.4 LICENSED UNDER PROVISIONS OF CHAPTER
9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE.AND
MY UCENSE IS IN FULL FORCE AND EFFECT.
LICENSE CLASS Ft tic N0. .....
DATE ql---13-1)--01--- CONTRACTOR
EX P- WORKERS'COMPENSATION DECLARATION
I HEREBI AFFIRM UNDER PENAI:TY 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 3700 OF THE LABOR CODE, FOR THE PERFORMANCE
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.
I HAVE AND WILL IAAINTMN WORKERS COMPENSATION INSURANCE.As REQUIRED BY SECTION
3100 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED. MY • • '1X./MrSATION I • N GARR•AND POLICY NUMBER AR
• a ii 10 .
CARRIER
POLIC NUIr5R 4.11.4: de MU lif,41-1..
gilts NEZTIPCIPLEfEDOFTFE PERMIT FOR CNE I-UsPRED COLLARS(V CO)OR LESS)
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 SUdJECT 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 SHAU. FORTHWITH COMPLY WITH SE PRoVIS NS.
DATE-2-7-2-7415'( APPLICANT.
I
1 WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE
. SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS($150.000),IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
1 SECTION 3708 OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES
i
CONSTRUCTlON LENDING AGENCY
i
. I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY
IG ,
• FOR PERFORMANCE OF THE WORK FOR WH THIS PERMIT IS ISSUED(SEC 3097.CIV C).
THE \
! Ilt) —RAM HOIYIF,CORP)
LENDER'S NAME
LENDER'S ADDRESS
E
; 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
f ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES.
s
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1 PERMITTEE N E(PRINT)
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) SIGNATUR F PERMITTEE DATE
APPLICATION
DATE
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NUMBER 4iPIC O1 -Ort' I
ISSUE CONST.
DATE OCC
TYPE GROUP
FRONT SEfBACKS
ZONING REAR
SIDE RW 0
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UNITS
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SFR/ADD/REM
Garage/Carport
Patio/Deck ...
Pool/Spa
Re-Roof
Commercial ,
Valuation Li 3 ci,LY)a (-I ') AELLAREA
QUANTITY DESCRIPTION FEE
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CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
SMIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE:
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TOTAL FEES
COMMENTS .3 Lit'L 6(
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RECPT. N0. "-"/X Li PAID BY Call 1 VALIDATION
WHITE-Department Copy,YELLOW-Finance Copy, PINK-Assessor Copy, e Copy,G EN-Applicant's Copy
CITY OF DIAMOND BAR INSPECTION RECORD
i?.ACK
'GS/FORMS/STEEL..ECTRIC GROUND ROUND PLUMBING AS GRADE
-:MP POWER
ATER SERVICE DOF SHEATHING RAMING/VENTILIATION DOF COVER
DUGH HEATING OUGH ELECTRIC OUGH PLUMBING'HOWER-7UB TEST XT. LATH/SIDING
(ALL/NSULATION
SLING INSULATION
RYWALL NAILING EWER
EPTIC TANK
EEP PIT/L.L.03 AIR TEST INAL CONST. 1NAL HEATING
INAL ELECTRIC NAL PLUMBING
; H OCR
FHA REQMTS,_.
UNDER FLOOR Niel'
UNDER FLOOR QPNDtirt -,
FIREPLXCE,r'OONCAT E ON FIREPLACE BOND BEAM
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PRE-GRADING BENCHING
ROUGH GRADING FINISH GRADING
POOL ELECTRIC
POOL FENCING
POOL FINAL OFF SITE IMPS.
I DEDICATIONS
FINAL ENG.
LANDSCAPEJIRRI ON SITE IMPS. FINAL ZONING
FIRE DEPT. FINAL
HEALTH DEPT. FINAL
EV. FEES PAID
IENERGY
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SEETiO TA*SIZE SEEP P/T/LI SIZE
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