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HomeMy WebLinkAbout10001CITY OF DIAMOND BAR COMMUNITY DEVELOPMENT DEPARTMENT 21660 E. Coplcy Drive Suite 190 (909) 860-3195 Fax (909) 861.3117 BUILDING PERMIT APPLICATION TE ADDRESS --j" I 59 iW4?" �i 4 0 `(� . APN LOT TRACT OWNER M ADDRESS 7 CITY W 4rvlCW ZIP TELYW-6150 -65 APPLICANT TEL. 114-97/-/lJ/,S� CONTRACTOR ADDRESS s 1/n ie/lam CITY %r7nlE.¢Trn/ ZIP. 69 TEL. 19 , ARCKSNG/ /y DESIGNER ADDRESS 7G 57S /. Te'37 CITY ZIP 4Z4 TEL. OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS U• CENSE LAW FOR THE FOLLOW NG REASON ISEC. 7071.6 BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT, ALTER IMPROVE, DEMOLISH, OR REPAIR ANYSTRUC- TURE, PRIOR TO ITS ISSUANCE. ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO RLE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LH CENSE LAW (CHAPTER 6 (COMMENCING WITH SECTION 7000) OF DMSION 7 OF THE BUSINESS AND PR0. FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP. TION. ANY VIOLATION OF SECTION 7071.5 BY ANY APPLICANT FOR A PERMIT Sl1BJECT3 THE APPLICANT i0 A CML PENALTY OF NOT MORE THAN FriIE HUNDRED DOLLARS (1500).): O L AS OWNER OF THE PROPERTY. OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE M NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, BUST• NESS AND IO PROFESSNS CODE: 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 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 OWNERBUILDERWILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID 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 (SEC. 70x1. BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI. CENSE LAW DOES NOT APPLY TO AN*OFA PROPERTY WHO BUILDS OR IMPROVES THEREON. AND INFOOONTRACTSFOR SUCH PROJECTS WITH ACONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW). O 1 AM EXEMPT UNDER SEC. S. L P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PEFU IRY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION 7D00) OF DIVISION 7 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT. LICENSE CLASS LIC. NO. 5 w/7-3:5 DATE 7 CONTRACTOR//i��y��///�.� WORKERS' COMPENSATION DFCuIRAT100N`_a I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATXONB4:3 e I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR YORKERS' COMPENSATION. AS PROVIDED BY SECTION 5700OF THE LABOR CODE FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT S ISSUED. / 1 HAVE MID WALL MAINTAIN WORKERS' COMPENSATION INSURANCE. AS REQUIRED BY SECTION 5700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER TF e2w p• � y'C POLICY NUMBER Z Z -101y s - (1`41S SECTION NEEDNOTSECCMiLETEDOFTFEPERMTIS iOROWH NCIADDOLLARS(5100)ORLESS) 1 CERTIFYTHAT N 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 TME WORKERS' COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF I SHOLAD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 5700 OF THE LABOR CODE. I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE: APPLICANT. WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE M UNLAWFUL, AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TOONE HUNDRED THOUSAND DOLLARS (1100.000), IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 77D6 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE O A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 7067, CW. C.). LENDERSNAME LENDER'SADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE NFORmnoN 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. PERM; E E(PRINT) s 3 SIGNATURE OF PERMITTEE I& DATE I i I PRESS FIRMLY r APPLICATION PERMIT /avd/ P O� DATE 3 NUMBER # ISSUE TYPE OCC WZ�% l�r• DATE r 1. CONST, GROUP ZONING SETBACKS " FRONT RW ❑ REAR - D SIDEJSIQESTREET c - RW ❑ Ll SIDE 11PROPOSED USE �J/Yll.6� �itN-7 NO. DWEL NO. . • , 1 NO. % C> UNITS --• STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREANALUATION SFR/ADD/REM /1"(0 C0 Garaya^Carport WPatk1/Deck LL PooVSpa - Z Re -Roof 0 Commercial Ib Vatuelion • >7 AOJ.AREA QUANTITY DESCRIPTION FEE IL) 'Z T_S W L✓/ %FiJ J LU 2 CO �+ L a a U za Alayte- /J S CONSTRUCTION PLAN REVIEW 1 ELECTRIC G S� PLUMBING MECHANIC INSPECTIO fs�iAn`e �`�r ISSUANCE SMIP y ENERGY -ti i1 2 ENERGY PERMIT RETENTION FEE! PRE -ALT FEE: TOTAL FEES COMMENTS RECPT. NO. 23 PAID BY [CL/ G• F. d VALIDATION WHITE -Department Copy, YELLOW -Finance Copy, PINK -Assessor Copy, GOLDENROD -File Copy, GREEN -Applicant's Copy (f f _ CITY OF DIAMOND BAR INSPECTION RECORD ,1��-�'r�.3�"�[�►M !���1�= ���.�-���.��t�o��;,��■ : I ►r� l c�'�'{.e�1�1 � ;��'s'-�©I�': _.^_ . �c1`l�' SETBACK ; , - :. �.. FLOOR JOIST--- - - r' FIGS/FORMS/STEEL 3/ 7 ` ' 'FHA REOMTS ELECTRIC GROUND .' :' UNDER FLOOR DUCT - GROUND PLUMBING `' -- UNDER'FLUOR CONDUIT -- =' ' _ :'i.a j SLAB GRADE. FIREPL/10EFOUNDATION- -- -- - -- -- - - -i . TEMP POWER .-__::. -. _._ _:._ _ _.-... _ ..::' _ ._::: FIREPLACE. -BOND -BEAM _ ,•:,-, WATER SERVICE MID HT. Boo BEAM ROOF SHEATHING - -- - - - 8 FT. BOND BEAPh :''='r�-• ,. FRAMINGNENTILIATION � `FINALG-BROANtJDIN.GBE� A` ROOF COVER ... -A PRE --• ROUGH HEATING- •. "�_ -BENCHING ROUGH ELECTRIC `- - - ROUGH GRADING i ROUGH PLUMBING - - - FINISH GRADING . . SHOWERlfUBTEST -. — POOL ELECTRIC;' EXT. LATH/SIDING- - - — -POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS., DRYWALL NAILING DEDICATIONS SEWER -----_-. _._.. _... FINAL ENG. .. 1 -SEPTIC -TANK.:. :-.._:...-.___ _ :_ [ANDSCAPE/1RRIG. SEEP._.P1TlLL:_t _ON SITE IMPS. GAS AIR TEST L FINAL ZONING c FINAL -CONST.! FIRE DEPT: FINAL FINALHEATING- --- - — HEALTH DEPT. FINAL "FINAL ELECTRIC 11���f �..1.. _ ..-.. DEV. FEES PAID FINAL PLUMBING ENERGY COMMENTS; r ,•. „ ,.. ,: I . i, SEPTIC TANK SIZE -. I . ..... ..... ........ - SEEP PIT/U SIZE i