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HomeMy WebLinkAbout14784CITY OF DIAMOND BAR ' DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 216601« Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 , ... BUILDING PERMIT APPLICATION y � JOBSiTE ADDDRESRES AS APN LOT TRACT OWNER W1 -Y(4 PrpI •t �rrA� ADDRESS CITY ZIP,._ TEL APPLICANT >...a br a nre._ TEL CONTRACTOR ADDRESS = �orwn/L�� (3!✓ CITY -P. n.gri ZIP 91761 TEL 4aRS4LoYT0 ARCR ENG/ DESIGNER ADDRESS CITY ZIP TEL OWNER -BUILDER DECLARATION I HEREBY AFFIRM AIDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC 7031.S BUSNESSAND PROFESSIONS CODE ANY CITYOR COUNTY WMCH REQUIRES A PEMIrTTO CONSTRUCT.ALTER IMPROVE. DEMOLISH• OR REPNRANY STP- -TORE, PRIOR TO ITS ISSUANCE. ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FRE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE UW (CHAPTER I (COMMENCING WITH SECTION 70001 OF DIVISION 7 OF THE BUSINESS AND PRO- FESSIONS COOL) OR TINT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION.ANY VKXATION OF SECTION 7071.6 BY ANYAPPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE OUN IFIVE HUNDRED DOLLARS (7SOO ): ❑ L ASOWNER OF THE PROPERTY.OR MY EMPLOYEES PATH WAGES AS THEIR SOLE COMPENSATION. WALL DO THE WORK AND THE STRUCTURE IS HOT INTENDED OR OFFERED FOR SALE (SEC. 704. BLISI- NESS OF AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERrY wHO BULDSOR IMPROVES THEREON. MO WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT a" MPROVEMENTSARE NOT INTENDED OR OFFERED FOR SNE IF.HCWEVERTHE BUILOM OR IMPROVEMENT IS SOLDNTTHIN ONE YEAROFCCMPLE- T10N, THE OWNEWBULDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALEI, CLAS OWNER OF THE PROPERTY. AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 70N. BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON. AND WHOICOF/TRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S) LICENSED PURSUANTTO THE OONTRA6 TORS LICENSE LAW.). O I AM EXEMPT UNDER SEC S. L P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION 1 HEREBYAFFI M UNDER PENALTY Of PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER I (COMMENCING WITH SECTCM 7000) CF OMKO SN 3 O THE BUSINESS AND PROFESSIONS COLE, AND MY LICENSE 6 N FULL FORCE AND EFFECT. LICENSECUSS -G�t S� LIC.NO. 3 DATE CONTRACTOR i WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERAATR ONE OF THE FOLLOWING DECLARATIONS: ' 1 I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION. AS PROVIDED BY SECTION 37DO OF THE LABOR CODE FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. 1 � �I HAVE AND WILL MAINTAIN WDRKCR5 COMPENSATION INSURANCE. AS REDUIREO BY SECTION 3700 OF THE LABOR CODE FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS 1 ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY MUMS CR ARE: ! CARRIER H 11•-� iA-Yl c er C 3- - I PoUcYNUMBrR. DHS SECTION NEID NOT BE CCMF%Z D OF THE FERMIT 6 FOR ONE HU•DpmDOUMS CSI W) OR LESS) I CERTTY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS, ISSUED, I 3 SHALLNOTEMPLOY ANY PERSON N ANY MANNER SO AS TO BERME SUBJECT TO THE j WORKERVCOMPENSATION LAWS OF CALIFORNIA. AND AGREE THAT IF I SHOULD BECOME SUEJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 37000F THE LABOR CODE, I SHALL FORTHWITH COMPLY WITH IH THOSE P :SIO 3 DATE: J APPLICANT. iWARNING: FAILURE TO SECURE WORKERS' CL/NSATION COVERAGE IS UNLAWFUL, AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FIVES UP TO ONE HUNDRED THOUSAND DOLLARS (3100,0M)C N ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN J SECTION 37GS OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. 3 CONSTRUCTION LENDING AGENCY I HEREBY AFFIN.1 UNDER PENALTY OF PEP -WRY THAT THERE 6 A CONSTRUCTION LENDING AGENCY FON THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT U^ ISSUED (SEC 3WT. CIV C). LENDERS NAYS LENDERS ADDRESS :CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. L I AGREE TO COMPLY VATH ALL CTC AND COUNTY ORDINANCES AND STATE LAWS REUTN0 TO BUIL DING CONSTRUCTION. AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVL-MENTIONED PROPERTY FOR INSPECTION PURPOSES - r?, In. URPOSES.Q,1 �+ L s ZPERMITTEE NAME (P NT) `•`-•-'� n 6MLN OF ERWTTEE GATE PRESS FIRMLY APPLICATION PERMIT PIC (� � DATE NUMBER M ISSUE TYPE OCC' DATEA[t CONST. GROUP ZONING SETBAC FRONT RW ❑ REAR ❑ SIDEISIDE STREET RW ❑ SIDE ❑ PROPOSED USE NO. DWEL NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD,IREM - - Garage/Carport W Patio0eck U- Pool/Spa ZRe -Roo( 0 Commercial m ValDatbn ADJ.AREA OU ESCRIUION - FE U F- U W LU m�t­aelq LL�iam�d tsar LL va U_ Z S U W CONSTRUCTION PLAN REVIEW ELECTRIC V PLUMBING MECHANICAL INSPECTION FEE A Th„ ISSUANCE �D r SMIP APR 0 2000 ENERGY P/C t) ENERGY PERMIT CITY ..n A R RETENTION FEE: AND SAFEW- . .--RU1LIXNG PRE • T If kA TOTAL S �� COMMENTSFE 45�- RECPT. NO. PAID BY 14 VALIDATION '— WHITE—DOpenment Copy. YELLOW—Finance Copy, PINrt—ASSesux A;Opy, UU­n 1V wVY. v Q'T— WOE '10 w y CITY OF DIAMOND, BAR , t,\ -��`� ...• ., ... _ ..�INSP•ECTION'RECOE�D .� ...,. r'�• _�� • _ • � . I PNS6 SET BACK..; , i + • ' • +INSPECTOR FLOOR JOIST, FTGS/FORMSlSTEEL i = • �' \. �:. ( � FHA REQMTS ELECTRIC. GROUND -: :__.. UNDER FLOOR DUCT \ GROUND PLUMBING _UNDER FLOOR CONDUIT SLAB GRADE FIREPLACE FOUNDATION - - - TEMP POWER-.. _.... - - ...- - - .. FIREPLACE BOND BEAM - WATER SERVICE --- - - - MID HT BOND BEAM ROOF SHEATHING' -' - -- S FT. BOND BEAM r FRAMINGNENTILIATION FINAL BOND BEAM ROOF COVER:`"' PRE -GRADING -ROUGH HEATING - -- BENCHING -ROUGH ELECTRIC ROUGH GRADING -ROUGH PLUMBING :" FINISH GRADING SHOWER/TUB TEST - - - POOL ELECTRIC i; EXT. LATH/SIDING j POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION - OFF SITE IMPS. DRYWALL NAILING DEDICATIONS . SEWER --._ FINAL ENG. SEPTIC -TANK LANDSCAPEIIARIG. -SEEP PIT/L.L. -- _ - _ :. - � - - - .. ON SITE IMPS. -GASAIRTEST - - -- - FINALZONING FINAL CONST. -' FIRE DEPT. FINAL FINAL HEATING - - - HEALTH DEPT. FINAL -FINAL ELECTRIC'------ FINAL PLUMBING -�j v DEV. FEES PAID ENERGY i COMMENTS-- OMMENTS--•-SEPTIC SEPTICTANK:SI7F";•....:� SEEP PIT/U SIZE"`-''! .