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HomeMy WebLinkAbout10178Ill,ll111111 It,11:' CITY OF DIAMOND BAR COMMUNITY DEVELOPMENT DEPARTMENT /1 21660 E. Coplcy Drive Suite 190 !T' �lr (909) 860-3195 Fax (909) 861.3117 BUILDING PERMIT APPLICATION JOBSITE r, ADDRESS �s. 0& 1 rF , i L_ '? tJM l APN LOT TRACT-I„2vLI OWNER L�»ti14 ADDRESS CITY ZIP!V I APPLICANT TEL CONTRACTOR ADDRESS CITY ZIP TEL. ARCW/ENG/ DESIGNER ADDRESS CITY ZIP TEL OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERAJRY THAT 1 AM EXEMPT FROM THE CONTRACTORS LN CENSE LAW FOR THE FOLLOWING REASON (SEC 7031.3 BUSINESSAND PROFESSIONS CODE: AWCrTYOR COUNTY WHICH REOUIRES A PERMIT TO CONSTRIICT,ALTER IMPROVE, DEMOLISH, OR REPA;RANY STRLIG TORE. PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SICKED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI. CENSE UW (CHAPTER P (C.OMMENCNO WITH SECTION 7000) OF DIVISION S OF THE BUSINESS AND PRO- FESSIDNS COOS) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FORA PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (7500) ): ❑ L AS OWNER OFTHE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO 714E WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7D14, BUST. NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOTAPPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON. AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HISOR HER OWN EMPLOYEES. PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE F,HOWEVER, THE BLALDNC OR MPROVEMENTIS SOLD WITHIN ONE YEAR OF COMPLE. TION, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DD NOT BUILD CR IMPROVE FOR THE PURPOSE OF SALE). 0 L AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING PATH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON. AND WHOCONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). ❑JJI AM EXEMPT UNDER SEC. BS P.C. FOR THIS REASON DATE Y .s 2 '( OWNER I LICENSED CONTRACTORS DE ON I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER P (COMMENCING WITH SECTION TODD) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS COOS. AND MY LICENSE IS N FULL FORCE AND EFFECT. LICENSE CUSS LIC. NO. DATE CONTRACTOR WORKERS' COMPENSATION DECLARATION 1 HEREBYAFFMIA UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WALL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH H THIS PERMIT IS ISSUED. I NAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE. AS REWIRED BY SECTION 7700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS COMPENSATION INSURANCE CARRIER AND POLICY NNADER ARE: CARRIER POLICYMJMSER IMLs SECTION NEED NOT BE GOMPLETEDOFTHE PERATT IS FOR ONE HUNDRED DOLARS t$100)OR LESS) I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SMALL NOT EMPLOY ANY PERSON N ANY MANNER 50 AS TO BECOME SUBJECT TO TME WORKERS' COMPENSATION LAWS OF CALIFORNIA. AND AGREE THAT IF H SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE.1 SHALL FORTHWITH COMPLY WITH THOSE PAWSKNS. DATE: APPLICANT, WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL BE SUBJECT AN EMPLOYER TO CRIMNAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ISI00,0001. N ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR N SECTION 37DB OF THE LABOR CODE. INTEREST. ANO ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM LNDER PENALTY OF PERMITY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 30W. CIV. Cl. LENDERS NAME LENDER'SADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE A80W INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL CRY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, AND HEREBYAUTHORIZE REPAESENTATNES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. Iri' Ofia-1 6:c l= {'r PERMITTEE NAME (PRINT) 3 EOFAIT7EE DATE P PRESS FIRMLY APPLICATION 1 PERMIT L O P/C DATE � NUMBER K ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR p SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE NO. DWEL NO. 92 UNITS STORIES ;ROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREANALUATION SFFUADD/REM ff) Garape/Carpoil Patio/Deck LWLI LL PooUSpa ZRe -Roof Commercial m Valuation ADJ.AREA OUANTITY DEbCRIPTlCN - FEE J 6 U cc V w J w l7 2 m 0- 0- _j 4 _U Z Q 2 U W K CONSTRUCTION ` N PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE if iL ISSUANCEf �`] SMIP F 1 Y In ENERGY P/C ENERGY PERMIT RETENTION FEE: zro— PRE -ALT FEE: TOTAL FEES J e COMMENTS ✓ W u � RECP7 N PAID B 1 VALIDATION WHITE—Department Copy, YELLOW—Finence, Copy, PINK—Assessor Copy. GOLDENROD—File Copy, GREEN-L"IcanCe Copy rCITY OF DIAMOND BAR ' . • �� INSPECTION! RECORD vl'1?e�gl•- SETBACK- - FLOOR JOIST ! FTGS/FORMS/STEEL FHA REQMTS ELECTRIC GROUND UNDER FLOOR DUCT:', GROUND PLUMBING - UNDERFLOOR CCII�(DUIT ' `•" "'' ' SLAB GRADE _ - " FIREPLACE FOUNDATION TEMP POWER - . -. FIREPLACE BOND BEAM WATER SERVICE'. ' ' - MID HT. BOND BEAM ROOF SHEATHING 8 FT. BOND BEAM FRAMINGNENTILIATION �1 FINAL BOND BEAM ! ROOF COVER--.. - -... PRE GRADWG ROUGH HEATING- - ---' BENCHING ROUGH ELECTRIC - - - - - ROUGH GRADING ROUGH PLUMBING - - _ FINISH GRADING SHOWERrrUB TEST - __.. ._ . ... POOL ELECTRIC -EXT. LATH/SIDING - POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER._ -- - .-- ......:..... . _. FINAL ENG.. SEPTIC TANK .::. LANDSCAPE/IRRIG. SEEP PIT/LL. - ____._._ ON SITE IMPS. GAS AIR TEST-; - ---- FINAL ZONING FINAL CONST. , - _ .... FIRE-DEPT>FINAL. ': i =.`.c i ;'... ; : • 1> _.... _ FINAL HEATING - - HEALTH DEPT. FINAL"- FINAL ELECTRIC - -- - DEV. FEES PAID FINAL PLUMBING ENERGY COMMENTS . _... +� I ; .I � . _ .. .. I.