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HomeMy WebLinkAbout151501HA110 1111A11 tj CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION JOBSITE p ADDRESS ` e APN LOT TRACT OWNER ADDRESS CITY ISG ZIP TEL. APPLICANT TEL. CONTRACTOR ADDRESS CITY ZIP TEL. AR:f DES! ERViQ ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LN CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.6 BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTYNMICH REQUIRESA PERMIT TO CONSTRUCT, ALTER, IMPROVE, DEMOLISH, OR REPAIR ANY STRUC- TURE. PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT 70 THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW (CHAPTER Y (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP. TION. ANY VIOLATION OF SECTION 7031.6 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (SSW).): ❑ I, AS OWNER OF THE 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, BUSI- NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON, 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 BURDWG OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF ODMPLE- TION, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). ❑ L AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 70H, BUSINESS AND PROFESSIONS COOS THE CONTRACTORS LI- CENSE LAW DOESNOT APPLY TO AN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S) LICENSED PURSUANT TO THE CONNTRAC- TORS LICENSE LAW.). ❑ 1 AM EXEMPT UNDER SEC. B. a P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION 1 HF-6)EBY AFFIRM UNDER PENALTY OF PERJURY THAT I AAI LICENSED UNDER PROVISIONS OF CHAPTER Y (� JMMENCWO WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND L/Y LICENSE IS IN 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 HAVE AND WILLMAINTAIN 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 THIS PERMIT IS ISSUED. 1 HAVE AND WILL MAINTAIN WORKER5 COMPENSATION INSURANCE, AS REQUIRED BY SECTION 37000E THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER POLICY NUMBER SECTION NIS NDT BE OON. PLETEDOF7FE PERMIT IS FORONE HUNDRED DOLLARS (110)) OR LESS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE RKERS' COMPENSATION LAWS OF CALIFORNIA AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 37M OF THE LABO CODE. I SH�AALL--''FORTHWITH COMPLY WIT PROVISION . DATE:W APPLICANT: I WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL BE SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN 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 PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 30Y7, CIV. C.). LENDERS NAME LENDER'S ADDRESS I CERTIFY THAT I HAVE READ THIS APP TION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. 1 AGREE TO WITH ALL CITY D COUNTY ORDINANCES AND STATE LAWS RELATWO TO BUILDING CONS 7 RRE REP ENTATNES OF THIS COUNTY TO ENTER UPON THE IONE PROPERTY O C N P SES. PE / F PE LTTE DATE EXPIRE® MAY 019 2003 PRESS FIRMLY APPLICATION PERMIT I 1 J DATE_ NUMBER V # 1 ISSUE TYPE OCC DATE CONST. GROUP ZONING SFMACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE NO. DWEL.NO. r 7 NO. UNITS �_ STORIES / BEDROOMS DESCRIPTION SO FACTOR PSF ADJ. AREA/VALUATION SF DD EM Cl) Garage/Carpon WPatio/Dock u Pool/Spa Z Re -Roof C1 Commercial - M Vetuati ADJ.AREA QUANTITY ESCRIPTI FEE U A l � N U W LU LU 0 Z m n_ 0 _U Z Q S U W � 9, 5D l CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL } INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT 4 -,T -r 7 n- -. JTF}'1�/5�1� RETENTION FEE: •„-r I9'r ',T1,Y5AT^ .A'1`i 77� .aleA}il-L- 1'S R�2ALT FEE � ; TOTAL FEES N r 6? - - Z` OMMEN / RECPT NO. PAID VALIDATION V / WHITE-0epartment Copy, YtLLUW—Finance L;opy, FINK—Assessor Copy, GOLDENROD—File Copy, GREEN—Applicant's Copy J CITY OF DIAMOND EAR INSPECTION RECORD s p r 0 ©}_� o p SET BACK FLOOR JOIST , FTGS/FORMS/STEEL 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 8 FT. BOND BEAM FRAMINGNENTILIATION FINAL BOND BEAM 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. DRYWALL NAILING DEDICATIONS SEWER FINAL ENG. SEPTIC TANK LANDSCAPE/IRRIG. SEEP PIT/L.L. ON SITE IMPS., GAS AIR TEST FINAL ZONING FINAL CONST, FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID V FINAL PLUMBING - ENERGY i f COMMENTS SEPTIC TANK SIZE SEEP PIT/U SIZE �. K� 11N '' ab�•�diti � i;'k,r i e�. z s� L 'lV