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HomeMy WebLinkAbout15034 (17)UL1!II►SU 11:11. CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 216601_ Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION ADDRESS li is APN LOT TRAC6 OWNER ADDRESS CITY ZIP TEL. APPLICANT TEL. CONTRACTOR ADDRESS O CITY ZIP {�� 7EL�Ji� ARCHlENG/ DESIGNER FAJWUSfAIw�ti'�sS-ntt�C ADDRESS_ CITY j=%d44 ZIP OWNER -BUILDER DECLARATION 1 HEREBY AFRMM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM TIE CONTRACTORS U CENSE LAW FON THE FOLLOWING REASON (SEC. 7031.5 BUSNESSAND PROFESSIONS CODE: ANCTORS TURE WHICH REQUIRES A PERMIT TO CONSTRUCT. ALTER WPROVE, DEMOUSH, OR REPAIR ANY STRUG TUBE. PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LL CENSE LAW (CHAPTER i (COMMENCING WITH SECTION 7D00) OF D'. VISION 3 O THE BUSINESS AVD PR6 FESSIONS CODE) On 7HAT FIE On SHE IS EXEMPT THEREFROM AND THE BASIS Pon THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION T03T6 BYANYAPPLICANT FOR APERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE T71A4 FIVE HLNORED DOLLARS O L AS OWNER OFTHE PROPERTY. OR MV EMPLOYEES WITH WADES AS THEIR SOLE COMPENSATION. WILL W THE WORK. AND THE STRUCTURE 15 NOT INTENDED OR OFFERED FOR SALE (SEC. 701+. BUSI. NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOCS NOT APPLY TO AN OWNER OF PROPERTY WHO, BUILDS OR IMPROVES THEREON. AND WHO DOES Si/CH WORK HIMSELF OR HERSELF OR THROUGH HIS S Oft HER OWN EMPLOYEES, PROVIDED TUT SUCH IMPROVEMENTS ARE NOT INTENDED On OFFEREDFORSAL 'IF-HOWEVERTHEBVILDN IOGORIMPROVEMENT ISSOLDWITHIN ONEYEAR OFCOMPLE- TN. THE OWNEREUILDER WILL HAVE THE BURDEN OF PnOVNO THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALET E1 L AS OWNEROFTHE PROPERTY. AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7011, BUSINESS AND PROFESSIONS COLE.' THE CONTRACTORS LI- CENSE LAW DOES NOTAPPLYTOANOWNER OFA PROPERTY WHO BU6DaOR APRovES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS MTM A CWWC`rOR(S) LICENSED PURSUANT TO THE COWRAG TORS LICENSE LAW). OI AM EXEMPT ANDER SEC. B IP.C.FORTH:SFEASON DATE OWNER LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIMI UNDER PENALTY OF PERJURY THAT I AJA LICENSED UNDER PROVISIONS OF CHAPTER I (COMMENCING W" M SECTION 7000) OF DMS ON 3 CF THE BVSINESS AND PROFESSIONSCOCC. AND MY LICENSE IS IN FULL FORCEANO EFFECT. /' iG LICENSE CUSS LIC. N0. 4(, a 1 3 DATE 1Ion CONTRACTOR r 4aTEc)-1__..rz_ WORKERS' COMPENSATION DECLARATION 1 HEREBY AFF1RU UNDER PENALTY OF PERJURY ONE OF THE FOLLOW.NG DECLARATIONS: —I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PRO`ADED SYSFCTDN 3700OF THE LABOR COLE. FCR THE PERFORMANCE OF THE WDRL FOR WHICH THIS PERM: T a ISSUED. HAVE AND YM -L MAINTAIN WORKERS' COMPENSA•ION INSURANCE. AS RF WIRED SY SECTION 3700 OF TIE LABOR CODE- FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORK 'CCO,MP,ENSATION INSURANCE CMnICR AND POLICY NUMBER ARE, TO CARE POLICY UMBER NNUMBER M-116 SECRON NEED NJT BL al.I LETEDOF THE PLTiMT 6 Fun a.'E M NDpEo E;CL AfiS 4100) OR LESSI I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS LSSUED. I SMALL NOT EMPLOY ANY PERSON N ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATON LAWS OF CALIFORNIA AND AGREE THAT IF I SHOULD BECOME SM,ECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR //CODE'. I SHALL FAOIRTHWRN COMPLY WTH EP '"SIGNS. DATE:1(44( y APPLICANT _ WAANIN��GL FAILURE TO SECURE WORKCRS' NSATON COVERAGE IS UNLAWFUL, AND SHALL BE SU&'ECTAN EMPLOYER TO CRIMINAL PENALTESAND CIVIL FNES UP TO ONE HUNDRED THOUSAND DOLLARS (3100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN IO SECTN 3706 OF THE LABOR COCE. INTER ESS AND ATTCRnM FEES. CONSTRUCTION LENDING AGENCY I HEACBYAFFIRM UNDEA PENALTY OF PENURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WOnK FOR WMCH THIS PERMIT IS ISSUED (SEC. 30P7, CIV C.), LENDERS NAME LENDERSADORESS 1 CERTIFY THAT I HA,'E READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. t AGREE TO COMPLY W'TH ALL CRY AND CW WTI' ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTON,AND HEREBYAUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE AW<- MENTONED PROPERTY FOR INSPECTION PURPOSES. J-7 R_AS&jja&tac �:�WOMAY E7NAME (PRINT)�.//J EOF PEIUMITTCE pM,SE' PRESS FIAILAI V APPLICATION I DATE PERMIT J]2 PIC NUMBER `✓�✓ p ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW REAR 0 SIDEISIDE STREET RW SIDE PROPOSED USE NO. DWEL. NO, NO. UNITS STORIES BEDROOMS IDESCRIPTION SO. FT. FACTOR PSF ADJ. AREANALUATION /ADD,'REM Garage/Carport WPalioMeck LL, 0 Poo'JSpa Z Re -Root Commercial _ co Valuation ADJ.AREA QUANTITY DESCRIPTION FEE (� U 0 W - J w 7 Do a U_ Z d z U W S CONSTRUCTION PLAN REVIEW ELECTRIC -yA PLUMBING ,..-..o, MECHANICAL INSPECTION FEE ISSUANCE__� 1\i SvIp ENERGYP/C '- ENERGYPERMIT RETENTION FEE: -- PRC -ALT FEE: TOTAL FEES < COMMENTS RECPT. NO. PAID BY VALIDATION ......wpy, r-K—Assessor Copy, GOLDENROD—Fila Copy, GREEN—ApplicaniS Copy CITY OF DIAMOND BAR :INSPECTION RECORD tt nn L� iA�F_ tt .�11 C .. © �}�[�Tp— 0) ., �f ::.��-- 0 � •arR z: t � '� �y 1 r y—1-.�•-rr--•--, _Si\.R SETBACK FLOOR JOIST'% , \:- FTGS/FORP.MSISTE L ELECTRIC GROUND 1 ,. \\ FHA REQMTS I UNDER FLOOR DUCT GROUND PLUMBING I UNDER FLOOR COP•; QUIT :SLAB GRADE - FIREPLACE FOUNDATION TEMP POWER FIREPLACE BOND BEAM 1 WATER, SERVICE _ i MID HT. BOND BEAM:.. -i ROOF SHEATHING 8 FT. BOND BEAM •' FRAMINaNENTILIATION FINAL BOND BE"APh I ' ' ROOF COVER PRE -GRADING - — ROUGH HEATING ROUGH ELECTRIC _ �� D7 __ BENCHI G;,-�; , ,."• .,` ROUGH GRADING ROUG H PLUPSBING - FINISH GRADING SHv:4' :R:TUB TEST _ POOL ELECTRIC i I- I XT. L�,TH:SIDING POOL FENCING WALL INSULATION POOL FINAL CEIL,"NS INSULATION I OFF SITE IMPS. � — 1-Dri'a7JALL NAILING I DEDICATIONS -c -;"'ER FINAL'ENG. i i-1 .17 1 , TANK LANDSCAPE/IRRIG. I SEE° iT;L.L. I ON SITE IMPS. _ 1 •- r•� ; i EST FINAL ZONING T. FIRE DEPT. FINAL -!EATING HEALTH DEPT. FINAL (?A� 1 DEV. FEES PAID - _ELECTRIC; ENERGY PLUMBING ' r-�:AMENTS • V SEPTIC TANK S!--,Z.-- I-ESEEP .SEEPPIT/U SIZE -