HomeMy WebLinkAbout13313 (14)I
J CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
�� 21660 E. Copley hive Suite 190
(909)860-3195 Fax(909)861-3117 PRESS
BUILDING PERMIT APPLICATION FIRMLY
JOBSITE
ADDRESS 4, V Q L g
APN LOT TRACT
OWNER 1-tt'I.Ij
ADDRESS 1^3
CITY �� TEL7 C
APPLICANT TEL.
CONTRACTOR
ADDRESS Q C+'j' N M-41 ►d 'Ti
CITY O?— -=.� ZIP L
ARCRENG/
DESIGNER
ADDRESS
CITY ZIP TEL.
OWNER -BUILDER DECLARATION
i
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS L4
DENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.6 BUSINESS AND PROFESSIONS CODE: ANY CITY OR
COUNTYW HIdf REOUIRESAPERMTTTOCONSTFOICT,ALTEN IMPROVE.OEMOUSH, OR REPAIRANY STRUC.
TU1E. PRIOR TO RSISSUANCE. 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 LF
CENSE UW (CHAPTER 6 (COMMENCING WITH SECTION 70DO) OF DIVISION 3 O THE BUSINESS AND PRO-
FESSIONS
RPFESSIONS CODE) OR THATHE OR SHE IS EXEMPT THEREFAOMAND THE BASIS FOR THE ALLEGED EXEMP-
TION. ANY VIOLATION OF SECTION 7031.9 BY ANYAPPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO
A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS DISW).):
O LAS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION,
WILL 00 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. ANO WHODOES SUCH WORK HIMSELF OR HERSELF OR
THROUGH HIS OR HER OWRN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR
OFFERED FOR SALE OF, HOWEVER THEBU0.DNOOR IMPROVEMENT IS SOLD WRHINONE YEAR OF COUPLE'
TION. THE OWNER-OULLDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DD NOT BOLD OR
IMPROVE FOR THE PURPOSE OF SALE). �
O L AS OWNEROF THE PROPERTY. AM EXCLUSIVELY CONTRACTING WTTH LICENSED CONTRACTORS
TO CONSTRUCT THE PROJECT (SEG 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LF
CENSE UW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON. AND
MAID CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CDNTRAP
TORS LICENSE LAW.}
O IMI EXEMPT UNDER SEG B. I P.C. FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER
I ICOMMENCNG WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND
MY LICENSE IS N FULL FORCEANDEFFECT. {y ,Y
LICENSE �CLA$/S,� � 6�y),_( LIC, NO.jy SC
DATE CONTRACTOR�'`�`�''"�'.
/WORKERS' COMPENSATION DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
I _I HAVE AND WILL MAINTAIN A CERTIFICATE OFCONSENTTOSELFiNSURE FORWORKERS'
COMPENSATION. AS PROVIDEDBY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.
1
I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY SECTION
3700 OF 744E LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
1 ISSUED, MY VARKEAS�COMPE�NSA'•TION INSURANCE CARRIER AND POLICY NUMBER ARE:
I CARRIER
POLICINUMBER QJr>(—I►3 F�iL
CTMBECTONNEMNOTSE03AI.EIEDOFD EPEFMTLSFORONErLro1IEDDCUARS(SIM)ORLESS),
I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUE D,1
f SHALL NOT EMPLOY ANY PERSON N ANY MANN ER SO AS TO BECOME SUBJECT TO THE
j WORLERS'COMPENSATXON LAWS OF CALIFORNIA, AND AGREE TWAT IF I SHOULD 8ECOME
SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR
DOD .I 1 FORTHWITH COMPLY WITH
THOSE
PROVISIONS. ifs jam.
DATE: �_!_ APPLICANT., VLA- 'Y
i
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL BE
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (3100.000). N AODITON TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN
J
SECTION 3700 OF THE LABOR OOOE, INTEREST, AND ATTORNEY'S FEES.
J CONSTRUCTION LENDING AGENCY
j
FOR TH YAFFIRMUNDER OF THE PERJURY H TTHERE MIT CONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE Of THE WORK FOR WINCH THIS PERMIT IS ISSUED (SEG 3007, CIV. GL
j
LENDERS NAME
LENDERS ADDRESS
C I CERTIFY THAT I L HAVE READ ALLCIry AND
COUNTY
AND STATE THAT THE ABOVEINFORMATIONWSRELATING
T CORRECT.
j IAGREE TO COIAPLY WITH ALLCITY MD CWNTY ORDINANCES AND 6UTE LAWS RELATING TO BUILDING
CONSTRUCTION, AND HEREBYAUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES.
Ag!eOjS .G.
ch PE E RNT)
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A —SIUMATUREOFPERWITEE DATL
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APPLICATION �� G� PERMiTI 13 P/C
DATE NUMBE
ISSUE TYPE OCC
DATE CONST. GROUP.
ZONING SETBACKS
FRONT RW ❑
REAR ❑
SIDE/SIDESTREET RW O
SIDE ❑
ROPOSED USE
NO. DWEL NO. NO.
UNITS STORIES BEDROOMS
DESCRIPTION SO. FT. FACTOR PSF ADJ.AREANALUATION
SFR/ADD/REM
Garage/Carport
W
Patio/Dock
LI-
PooVSpa
ZRe
-Roof
Commercial
m
Valuation _ ADJ.AREA
QUANTITY DESCRIPTION FEE
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Ui
w
Z
L
0-
o.
a
U
Z
Q
2
U
W
CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
APR 1999
ISSUANCE
CITY O.FDIAMOND BAR
SMIP
BUILDING ANT) SAFETY �
ENERGYP/C
ENERGY PERMIT
RETENTION FEE:
PRE -ALT FEE:
TOTAL FEES
COMMENTS
RECPT. NO. _ PAID BY VALIDATION
WHITE—OepaNnent Copy, YELLOW—Finance Copy. PINK—Assessor L:opy. UuwLNviv ue wp7, U—m—r.ppncenrs a wy
.. � - �-� .. 4 ��� ... ,fir•. .. � 1'• . . � r :.♦
CITY OF DIAMOND BAR . ,
"', INSPECTION RECORD •:
SE7 BACK ; : ` i = (
jFTGS/FORMS/STEEL '
I FLOOR JOIST
FHA REOMT
iELECTRIC GROUND .__ .
__. •
UNDER FLOOR DUCT.'
(GROUND PLUMBING
UNDER FLOOR COi'CiUIT;
SLAB GRADE
-- - -
r• FIREPLACE•FODPJflfrT ON
i..• ,t_�: ;:', !
TEMP POWER
-- -� FIREPLACE BOND BEAM
WATER SERVICE
I
MID HT. BOND;BEAM,� , ; �,_ : ,�•':;,
,ROOF SHEATHING
- ti:•.
8 FT. BOND -,BEAM .•, - .
> , ,., 1.. ,' ;
i
FRAMINGlVENTILIATION
` `
•'j FINAL BOND BEAM
_..
iROOF COVF_R
PRE -GRADING
ROUGH HEATING
'BENCHING
_
ROUGH ELECTRIC......
ROUGH GRADING
_...._ .... :,.
,ROUGH PLUMBING ---
._ ...._ .. _ ..
FINISH GRADING
,-
'SHO%tVtFR/TUB TEST
-- - --
POOL ELECTRIC
EXT: LATH/SIDING -
POOL FENCING
!
t^JALL INSULATION - -; -
POOL'FINAL
l 'CEILING IIISULATION,
-
OFF SITE IMPS.
'DRYWALL NAILING
__ . - DEDICATIONS
iSEV�iER
FINAL: ENG.
, .
3tP7I0 TANK
LANDSCAPE/IRRIG.
j :SE P P!T/L.L..
1c Orf SITE IMPS.
f,I T EST
.-.DNST.
':'; '._ aEAT1NG._
FINAL ZONING
FIRE DEPT. FINAL
... HEALTH DEPT. FINAL
.-ELECTRIC
-
DEV. FEES PAID
PLUMBING ... ....
_.. ._
ENERGY
!
r -
(SEPTIC TANK SIZE
SEEP PIT/U SIZE
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