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HomeMy WebLinkAbout10564CITY OF DIAMOND BAR COMMUNITY DEVELOPMENT DEPARTMENT ..0 21660E Copley Drive Suite 190 . PRESS (909) 860-3195 Fax (909) 861.3117 BUILDING PERMIT APPLICATION FIRMLY ADDRESS V(3�0 Com\ �c C Com. APN LOT Z� TRACT 11Z 4- in OWNER k1 t ->t 17;,.L re& SLI 4+N ADDRESS C' CITY —b R ZIP STEL.— 1 S APPLICANT TEL. CONTRACTOR vC� ADDRESS CITY V'PC1a n ZIP TEL ARCHMNG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -Bl ALDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LF CENSE LAW FOR THE FOLLOWING REASON (SEC. 7071.6 BUSINESSAND PROFESSIONS CODE ANY CITY OR COUNTY WHICH REOUIRES A PERMITTO CONSTRUCT,AL7ER IMPROVE, DEMOLISH, OR REPAIRANY STRUC. TURF. PRIOR TO ITS ISSUANCE ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS L4 CENSE LAW (CHAPTER 6 (COMMENCING WITH SECTION 7000) OF DIVISION 7 OF THE BUSINESS AND PRO. FESSIONS CODE) ORTHAT HE OR SHE IS EXEMPTTHEREFROM AND THE BASIS FORTHEALLEGED EXEMP- TKON. ANY VIOLATION OF SECTION 7071.5 BY ANY APPLICANT FORA PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FINE HUNDRED DOLLARS (7600).): C3L AS OWNER OFTHE 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, BUST" NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVESTHEREON, 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 MPFiOVEMENTIS SCID WITHNONE YEAROF COMPLE- TION, THE OWNER-SURDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DD NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALEM 01. AS OWNER OF THE PROPERTY. AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS L7 CENSE UW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON. AND W7HOCONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S) LICENSED PURSUAITTO THE CONTRAG TORS LICENSE LAW.). O IAM EXEMPT UNDER SEC. V. L P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEFIEBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED TINDER PROVISONS OF CHAPTER s (COMMENCING WITH 5ECTON 7000) OF DIVISION 7 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS N FULL FORCE AND EFFECT. LICENSE CUSS LIC. NO. DATE CONTRACTOR WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: _I RAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED SY SECTION 7700 OF THE LABOR CODE, FOR THE PERFORMANCE `7( OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. -X-I HAVE AND WRL MMN.IN WORKERS' COMPEHSATIO N NSURANCE, AS REQUIRED BY SECTION 7700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY HUMBER ARE CARRIER &_!i:__T C K ! 'M a POLICY HUMBER 9--1 ` lk `A� pNSSECTIDN NEEDNOT cc cow IETEDOFTHE PERN6T 6 FORCNE H ICAED DOUAPS (610D)OR LESS) I CERTIFY THAT N THE PERFORMANCE OF THE WORK FgWHICH THIS PERMIT 6 ISSUED,1 SHALL NOT EMPLOY ANY PERSON W ANY MANNER 50A BECOME SUBJECT TO THE YVORKERS'COAIPENSATION LAWS OF CALIFORNIA AND EE THATI ISIOlxD 6ECOME SUBJECT TO MEWORNERS'COMPENSATION PROM SEC 77000E THE LABOR COOS I SHALL F THVATH COMPLY WITH 71105E DATE: �2� APPLICANT: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION R .IS WF7IL AND SHALL BE SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CMLFNE O HUNDRED THOUSAND DOLLARS (5100.000). N ADDITION TO THE COST OF COMPENSATION. J(GES AS PROVIDED FOR IN SECTION 77060F THE LABOR CODE, INTEREST. AND ATTORNEYS FEES. - CONSTRUCTION LENDING AGENCY IHEREBYAFFIOM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 7007. CIV C.). LENDERS NAME - � r LENDERS ADDRESS I CERTIFY THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY NTH 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. PERMITTEE NAME (PRI SIGNATUREOF PERMI DATE APPLICATION PERMIT %a /C ! DATE G� / NUMBER 6 K ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE A00 `I fn i N0. DWEL jf�, NO. NO. UNITS �+� STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAAIALUATION SFRIADD/REM G Cl) Garage/Carport WPatio/Deck I=- Pool/Spa ZRe -Root OJ Commercial m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE U � LU LU J w Z z C A J a U Z Q S U W L CONSTRUCTION VI PLAN REVIEW ELECTRIC M PLUMBING MECHANICAL INSPECTION FEE .� ISSUANCE n SMIP ENERGY PIC ENERGY PERMIT RETENTION FEE: PRE -ALT FEE:" TOTAL FEES COMMENTS RECPT. NO. PAID BY VALJDA-n T %.�E—Dspartment Copy. YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD --Fib Copy. GREEN—Applk ant's Copy 7 31L CITY. OF DIAMONDBAR""i INSPECTION RECORD k--1 P40e 190e yo SET_BACK:—,: oo FLOOR JOIST—,—, FTGS/FORMS/STEEL FHAREQMTS' .7— ELECTRIC GROUND -UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR CONDUIT SLAB GRADE FI REPLACE FOUNDATION -TEMP POWER 7 FIREPLACE BOND BEAM Z WATERSERVICE- ID HT BOND',BEAM ROOF SHEATHING: 8 FT. BOND BEAM FRAMINGIVENTILIATION `FINAL BOND BEAM ROOF COVER PRE -GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC 'ROUGH GRADING.. ROUGH PLUMBING— It F 41SH GRADING SHOWER/TUB TEST . POOL ELECTRIC . EXT. LATH/SIDING POOL FENCING WALL INSULATION I POOL FINAL CEILING INSULATION OFF SITE IMPS.. DRYWALL NAILING DEDICATIONS SEWER —FINAL ENG.. SEPTIC.TANK LANDSCAPE/IRRIG. SEEP PIT/L.L ONSITE IMPS. GAS AIR TEST— FINAL ZONING FINAL CONST. -FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC —DEV FEES PAID FINAL PLUMBING ENERGY COMMENTS _.— ifs: SEPTIC TANK SIZE — SEEP _P_IT/U.SIZE" 31L