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HomeMy WebLinkAbout15090i 111.1►1Ko !l:1h ,T CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 (909) 860-3193 Fax (909) 861-3117 BUILDING PERMIT APPLICATION JOBSITE / ADDRESS APN LOT TRACj OWNER' (L ADDRESS CITY ZIP TEL. APPLICANT TEL. CONTRACT R ,ADDRESS CITY ZIP7-LTWa TEL ARCFI/ENGI DESIGNER ADDRESS CITY ZIP TEL OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS U- DENSE LAW FORTHE FOLLOWING REASON (SEC. 7031,E BUSINESS AND PROFESSIONS OOOE.ANYCITY OR COLNT WHICH REQUMESA PERMIT TOCONSTRUCTALTER, IMPROVE, DEMOLISH, DR REPAIRANY STRUC, TURF PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT TUT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS L4 CENSE LAW (CNAPTEA s (COMMENCING WITH BECTpN 7000) OF DrvL510N S OF 7HE BUSINE:S AND Pf W- fESSIONSOODE)DRTUTO M SHEIS EXEMPTTNEREFRCSIANDTHEBASISFORTHEALLECEDEXEMP- 710N.ANY VIOI.ATKJN OFSECTION7031-6 BY ANY APPLICANT FOR A PERMIT SIR.lEC15 THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (5600).): ❑ 1.ASOWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK, AND 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 PROPERT/YWNOBUaD9 on IMPROVES THEREON, AND W4OODES SUCH WORKHIMSELFOR HERSELF OR THROUGH HIS ORHER OWN EMPLOYEES PROVIDED THAT SUCH IMPROVEMENTSARE NOT INTENDED OR OFFERED FOR SALE IF, HOWEVER THE BUILDING OR IMPROVEMENTIS SOLO WITHINO NEYEAR OF COMPLE- TION, THE OWNER -BUILDER THAT DER WILL HAVE THE BURDEN OF PROVING HE OR SHE DD NOT VLXLD OR IMPROVE FOR THE PURPOSE OF SAE). O L AS OWNER OF THE PROPERTY, AM EXCLUSNELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (9EC. 7M1, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE LAW DOES NOTAPPLY TORN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON. AND WHO CONTRACTS FOR allCH PROJECTS WITHACONTMCTOR(S) UCENSED PURSUANTTO THE ODNTRAC- TORS LICENSE LAW.). _ O 1 AM EXEMPT UNDER SE(- B. 8 P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBYAFFMM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER e (COMMENCING WITH =ION 70D0) OF DIVISION 3 OF THE allSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN Ell L FORCE ANO EFFECT. LK�NSE�- /o D� C. NO. '"� ,2 "1- 11 IMTE CONTRACTOR WORKERS' COMPENSATION DECLA N I HEREBY AFFIRM UNDER PENALTY OF PER.AIRY ONEOFTHE INGD 1561 ML -:1 KWCAND WILL MAINTAIN A CERTIFICATE OF CON TTOSELF-INSURE RWORK.RS' P TION ID AS PROVIDED BY SECTION 37DO THE LABOR CODE. KORTHE PER ORM AE ENBA ' 1 FTIE WORK FOR WHICH THIS PERMIT IS ISSUE I I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION OUIREO BY - N 37000E THE LABOR CODE. FOR THE PERFORMANCE OF THE WORN FOR WHICH ITIS ISSUED. MY WORT ERS' COMPEN ION INSURAN E CARRIER AND POLICY N RAA CARRIER � � �� / � � POLICY NUMBER zj(( Lam+ i (rmsec CPNNEEDNOTSECONPLETIDOFTIE PERMMTIS FORONE DOLALS 7�IORUSs 1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR PERMI D.1 I $HAL.L NOT EMPLOY ANY PERSON IN ANY MANNER BOAS E TO THE j WORKERS' COMPENSATION LAWS OF CALIFORNIA, AN REE IF OULD BECOME SUBJECT TO TH WORK ERVOOMPENSATION PROVIS SOFS 00 OF THE LABOR � OLIO , 16HNJ. TH COMPLY M ION 1 l� DAT: ©O APPLICANT-. - - iWARNING: FAILURE TO SECURE WORKERS' COMPENSATION OOVE IS UNLAWFUL. AND SHALLBE DOLLARS is EMPLOYE RTOCRIMINALPENALTIES AND CMLFINES .UP DAMAGEHUNDREDTHOUSAND DOLLARS (8100.1100). IN ADDITION TO THE COST OF COMPENSATpN, DAMAGES A9 PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST. AND ATTORNM FEES. A CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OFPERNRYICH THAT HIS PE ISACONSUED(SE .LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 9007, CIV. C.). J LENDER'S NAME LENDERSAODRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THATTHE ABOVE INFORMATION IS CORRECT. (AGREE TO COMPLY NTH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING 7 CONSTRl1CTIONy AND HEREBY AIJr}�ORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ` ABOVE-MENTIONED PROPE (F Ri INSPECTION PURPOSES. i NAME (P Q SIGNATURE OF PERMITTEE DATE E PRESS FIRMLY APPLICATION ' /+ J� PERMIT 90 PIC DATE W NUMBER # ISSUETYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREANALUATION SFR/ADD(REM1-Woo co Gerage/Carport W Patw/DBCk LL POOVSpa ZRe -Roof Commercial - - m Valuation ADJ.AREA -QUANTITY DESCRIPTION FEE J U fE J W Z DO 4 2 ONS TION P REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEEMID ISSUANCE V (/ SMIP ENERGY P/C ENERGY PERMIT , L1VL RETENTION FEE: -- - - .lw Jr. 1 PRE -ALT FEE: .i TOTAL FEES` COMMENTS rl RECPT. NO. PAID BY VALIDATION WHITE --Department Copy. YELLOW—finance Copy, PINK—Assessor copy, uuLl]GNfiVll— ue l.Opy S I.OHy AM SET BACK FLOOR JOIST FTGS/FORf-.IS,ISTEEL HA REQMTS FNA ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUP41FING UNDER FLOOR CONDUIT SLAB GRADE FIREPLACE FOUNDATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICE MID HT. BOND BEAM ROOF SHEATHING 1 1 8 Fr. BOND BEAM FRAMINGIVENTILIATION FINAL BOND BEAM ROOF COWER PRE -GRADING ROUGH HEATING BENCHING --ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING oo> FINISH GRADING SHOWERITU13 TEST j POOL ELECTRIC EXT LATH/SIDING I POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS. . . ......... .... DRYWALL NAILING DEDICATIONS SEWER li FINALENG. -SEPTIC TANK LANDSCAPElIRRIG. SEEP PI L.L. O N SITE IMPS - GAS AIR TEST FINAL ZONING FINAL CON&T. FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FI"JAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY Arve AW COMMENTS SEPTIC TANK S17E SEEP PITlU SIZE