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Home My WebLink About14562 (20)CITY OF DIAMOND BARE ;red DEPARTMENT OF COMMUNITY & DEV OPMENT SERVICES 21660 E. Coplcy Drivc Slutc 190 PRESS (909) 860.3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION FIRMLY JOBSITE ADDRESS "n P67i 1C APN LOT�T— TRACT OWNER f♦1'Y1I�C=TVL7 �R�Q�IL ADDRESS CITY t et mil ZIP TEL. APPLICANT TEL CONTRACTOR TOR ADDRESS CITY ZIP TEL ARCWENG/ ,SZ1rf (rj DESIGNER ADDRESS CITY ZIP TEL OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE: ANY CRY OR COUNWWM(31 REGIONES A PERMR TO CONSTRLICT.ALTER. IMPROVE. DEMOUSH, OR REPAIRANY STRUG TURF. PRIOR TO ITS ISSUANCE- ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE 5 LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW (CRWMR 5 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE 13USINESSAND PRO- FESSIONSOODE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASIS FORTHEALLEGEDEXEMP- TION. ANY VIOLATION OF SECTION 7071.5 BY ANY APPLICANT FORA PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS 11500).k O L AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION. WILL DO THE VA)M AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044. BUST- NES3 AND PF40FISSIONS CODE THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BULDS OR IMPRO'VESTHEREON. AND WHO DOES SUCH WORT HIMSELF OR HERSELF OR THROUGH NIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE IF HOWEVER, 7HE BUILDING OR IMPROVEMENT R SOLD WRHN CNEYEAROF COMPLE- T10N. THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). 0 L AS OWNER OF THE PROPERTY. AM EXCLUSIVELY CONTRACTING MTN LICENSED CONTRACTORS 70 CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS I.J. CENSE LAW DOES NOT APPLY TORN OVMER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON. AND WHOCONTRAGTS FOR SUCH PROJECTS WITHAOONTRACTOR(S)LICENSEO PURSUANTTO THE CONTRAC- 701M LICENSE LAW.). . 0 I AM EXEMPT UNDER SEC B. L P.C. FOR THIS REASON DATE OWNER UCENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM LI DER PENALTY OF PERJURY THAT I ALA LICENSED UNDER PROVISIONS OF CHAPTER / (WFYJENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS N FULL FORCE AND EFFECT. LICENSE C !!'' LIC. NO. SS DATE ? � CONTRACTOR_ WORKERS' COMPENSATION DECLARATION !,,/J,vv I HEREBY AFFIRM UNDER PENALTY OF PERJURY CNE OF THE FOLLOWING DECLARATIONS: Y V HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED BYSECTION 3700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHIP/THIS PERMIT 15 ISSUED. I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY SECTION 77000E THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, MY YNRI S OOM SATIO /S�U�R/,.W, SCE /CLARRIER•FAND POLICY BER ARE: CARRIER .�32J.YL[/. / 1�� S • �1 i POLICY Nl1MBER �� f��L1— (R6 SECTION NEED NOISE OGMIPLETEDOF THE PERMIT 0 FOR ONE HLPOREDOCUARS (F10D) OR LEss) 1 CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I SHALLNOT EMPLOY ANY PERSON N ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA. AND AGREE THAT IF I SHOULD BECOME SUOUECT TO THE WORKERS'COMPENSATION PROVISIONS OF ON 3700 OF THE LAB OR COOE.1^S�HA1LL_FORTHVATH COMPLY q5E PROMS S. DATE: I•. PPLK:A� WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL BE SUBJECTAN EMPLOYER TO CRM NAL PENALTIE5 AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS (3 100,000). N ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 7708 OF THE LABOR CODE, INTEREST. AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERrORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC, 3097. CIV. C). LENDERSNAME LENDERSADORESS I 1 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCUON. AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-I.IENT ED PROPERTY FOR INSPECTION PURPOSES. r P I E NAME (P 1.3 I no NA OF TE CATION PERMIT Dv DATEAPPLI 1/--�,. NUMBER •/ ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDESTREET ' ' ❑ SIDE ❑ PROPOSED USE NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION SFR(ADD/REM Garage/Carport W Pallo/Deck LL PooVSpa ZRe -Roof Commercial m Valuation AOJ.AREA GUANTITY DESCRIPTION FEE J U ccQ F- U W J W CD2 m U Z Q 2 U W CONSTRUCTION PLAN REVIEW T 7-'t ELECTRIC I PI I ILJRINLO F MECHANICAL lA-1 rJ rr INSPECTION FEE ^' bpul ISSUANCE J i.:11JWm v N1., SHIP _ ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: TOTAL FEES , d COMMENTS RECPT. NO. PAID BY VALIDATION WHITE—DepaRment Copy, YELLOW—FiIaRea Cop/, PINK—Assessor Copy, GOLDENROD --File Copy, GREEN—Applicant's Copy r' t3I MOND BAR INS ECT16N RECORD;.' MEMO - SETBACK ? ., . i , ... FLOOR JOIST,`` 1-... J- -,r ,S FIGS/FORMS/STEEL r FHA REQMTS - - ELECTRIC GROUND - :-, .:, , : -: -"-- -- UNDER FLOOR DU T_;r . Q� ; r r - GROUND PLUMBING='r'�`' UNDER FLOOR CONDUIT SLAB GRADE _ .... _ .. _. FIREPL OE'FDON'tATIONL'2 0I. TEMP POWER ` =`'' ' - ' ` FIREPLACE BOND BEAM - -WATER SERVICE-'--=: - - :... _-.._. - MID HT.'B Nd BEAM'r/—.- ROOF SHEATHING - - - ' 8 FT. BOND.BEA R 1 r I ~ FRAMING/VENTILIATION FINAL BONDBEAM ROOF COVER '.: _'`; PRE -GRADING , . -ROUGH HEATING-.. _... _._-._... _... - .:.... BENCHING ROUGH ELECTRIC-'— - - ROUGH GRADING ; "ROUGH PLUMBING- - - FINISH GRADING SHOWER/TUB TEST - POOL ELECTRIC EXT: LATH/SIDING - - POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS. I , DRYWALL NAILING DEDICATIONS' SEWER FINAL ENG. , SEP.TIC.TANK_. __....: __ LANDSCAPE/IRRIG... ! SEEP .PIT/L.L..... = ._ .: = `- - - _ ON SITE IMPS. GAS AIR TEST;---- _. ._.._ ... FINAL ZONING 1 FINAL CONST. ; - - - - FIRE DEPT. FINAL FINAL HEATING - - HEALTH DEPT. FINAL -FINAL-ELECTRIC _ . _. _. _...... ..._ __.. DEV. FEES PAID ; FINAL PLUMBING. _ ENERGY -COMMENTS SEPTIC TANK SIZE SEEP PIT/U"SIZE. - •:. , i,