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Home My WebLink About14162r 0 O w ti Q QOQ (zW W o� Z cc W v Z W 3 �xx W U N 7n O O =O 0 O W Y.7 CI] C Y Ix LL C [C d �T5 7 C ry LL C, C u C, F J� CITY OF DIAMOND BAR-�.: DEPARTMENT OFCOMMUNITY & DEVELOPJEAR SERzVICES 21660 E. Copley Drive Suite 190 (909) 860.3195 Fax (909) 861-3117 WELDING PERMIT APPLICATION ADDRIESS APN LOT TRACT OWNER GYotAXTP�( 1%I4PW 17V"Ar5 �rX ADDRESS CITY ZIP TEL APPLICANT _TEL.�$1461-7! 43 CONTRACTOR -ADIRRESS —- - CITY / f2,- ZIP TEL ARCWENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER.BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERAIRY THAT 1 AM EXEMPT FROM THE CONTRACTORS U. CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS DODE:ANYCITY OR COUNTY WHICH. REQUIRES A PERMITTO OONSTRUCT.ALTERIMPROVE DEMOUSIL On REPAIRANY STRUG TORE, PRIOR TO ITS ISSUANCE. ALSO REWIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LH CENSE UW (CHAPTER 9 (COMMENCING WITH SECTION TWO) OF DIVISION S OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALCEOED EXEMP. TION. ANY VIOLATION OF SECTION 7091.3 BY ANY APPLICANT FORA PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF HOT MORE THAN FIVE HUNDRED DOLLARS (SSW).): ' ' O L AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WOW, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEG 7011 BUSI- NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WINO BUILDS OR IM PROVES THEREON. AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER UNI EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE IF. HOWEVER NWI THE BUILDGOR IMPROVEMENT IS SOLD THIN ONE YEAR OF COMPLE- PON. THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALEL . . O L AS OWNER OF THE PROPERTY. AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 701M. BUSINESS AND PTIOFT_SSIONS CODE: THE CONTACTORS LF CENSE UW GOES NOTAPPLYTOAN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON. AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC. TORS LICENSE LAW. O I AM MMPI UNDER SEC. B. A P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM LINDER PENALTY OF PERJURY THAT IAM LICENSED LNDE R PROVISIONS OF CHAPTER I (COMMENCING WITH SECTION 7000) OF DIVISION S OF THE BUSINESS AND PROFESSONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT. LICENSE CLASS ✓ //� LIC. NO. 6 9 Z DATE rO I S —(� CONTRACTOR_ r� WORKERS'COMPENSATIONDECLARATIaN � I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF ME FOLLOWING DECLARATIONS: _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COLIPENSATION. AS PROVIDED BY SECTION 37000E THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED. -� I HAVEAND WILL MAINTAIN WORKERS' COLJPENSATION INSURANCE. AS REOUIRED BY SECTION 3700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WOW( FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS OOMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE,:/ CARRIER I —7 I /J CiL= POLICY NUMBER to J .�_[J'Q-Oy t 9 I I I (rMSEcnON NEM NDT EEOMrMMOFT/E KFW S FOR DME HRORMDOLIAL4 (3100)CR LESSL I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON N ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS COMPENSATION LAWS OF CALIFORNIA AND AGREE THAT IF I SHOULD BCCOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECT ON 3700 OF THE LABOR CODE,1 SWILL FOHTHW TH COMPLY WITH THOSE PROVVIISIIONS. DATED I S APPLICANT S �L• LyI WAANIN(i FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. ANO SHALL BE SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS (3100.000). N ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 3700 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PER.NRY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORT( FOR WHICH THIS PERMIT IS ISSUED (SEC. 3097. CV. GI. LENDERS NAME LENDER'SADDRCSS I CERTIFY THAT 1 NAVE READ THIS APPUCATKONANO 97ATE THAT THE ABOVE INFORMATION IS CORRECT. .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. I BIGNATUREO PERMITTEE ` GATE PRESS FIRMLY APPLICATIO1 6J % 5 6// Gj PERMIT C �/ PIC DATE `� (• i NUMBER � M ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED &bSPL ul0z)V NO. DWEL NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT FACTOR PSF ADJ. AREANALUATION SFR/ADDIREM U) Garace/Carport WPa!io/Dock LL PooVSpa ZRe -Roof 0 Commercial - m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE U JL L-301,.AW it LLI— _ J w o nND U ` 2 rn SAFE J , a .. QZ CONSTRUCTION PLAN REVIEW - ' ELECTRIC . PLUMBING MECHANICAL IN PF.CTION FEE ISSUANCE L /ENERGY P/C -ENERGY -PERM RETENTION FEE: PRE -ALT FEE: TOTAL FEES COMMENTS - RECPT. NO. "`'"' PAID BY VALIDATION l/ WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy. GOLDENROD --File Copy, GREEN—Applicant's Copy i CITY OF DIAMOND BAR "'INSPECTION RECORD ` E • ! • ' SET BACK • ! 0 FLOOR JOIST,-,, 4 `,I cl FTGS/FORMS/STEEL FHA REQMTS - ELECTRIC GROUND _ -. - UNDE FLOpR DUGT,a �,.-:. ,1 , ;•-,- ;: - _ , GROUND PLUMBING UND5R:FLOOR,CONDU.IT1 .- 5LA8 GRADE FIREPL'AbEfOUNbATION TEMP POWER - - FIREPLACh BOND BEAM WATER SERVICE MID HT. BOND 13EAIVI. ROOF SHEATHING',. .`:': '; 8 FT, BOND BEAM: FRAMING/ ENTILIATION .. `; • \ �' FINAL BOND BEAM ROOF COVER - .. PRE -GRADING ROUGH HEATING - - BENCHING - I ROUGH ELECTRIC ROUGH GRADING ROUGH PLUAABING - FINISH GRADING .. SHOWER/TUB TEST POOL ELECTRIC EXT. LATHISIDING POOL FENCING WALL INSULATION • �,' 1:._ 1 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.- - / FINAL HEATING ! - FIRE;DEPT. FINAL HEALTH DEPT, FINAL FINAL ELECTRIC -� :; r. T �, DEV. FEES PAID FINAL PLUMBING•!," C" ENERGY - COMMENTS r- .il5! q�j SEPTIC TANK SIZE _-----^K-� --- -�•^� -x-• ^� SEEP PIT/U SIZE ;r 1 1 :