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Home My WebLink About17392 � � l CITY OF DIAMOND BAR I ^---�F�— DEPARTMENT OF COIvIIvfUNTTY&DEVELOPIviENT SERVICES 21825 E.Copley Drive '�- (909)860-3195 Fax(909)861-3117 ��D�� PRESS ��'<�� BUILDING PERMIT APPLICATION FIRMLY � JOBSITE � ��/ �P�p�ICATION ��ERMIT o ADDRESS �� AT UMBER # � ISSUE TYPE OCC APN LOT . TRACT DATE CONST. GROUP p OWNER p ADDRESS � ZONING SETBACKS gCITY ZI �+?„ZT L. j RE�ART RW p� APPLICANT m ��• SIDE/SIDE STREET RW O � CONTRACTO SIDE p ADDRE , p ��, � '�OPOSED USE o ARC G/ � iz DESIGNER NO.DWEL. NO. NO. a ADDRESS � CITY ZIP TE�. UNITS STORIES BEDROOMS � cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER OECLARATION SFR/ADD/REM O p I HEREBV AFFIRM UNDER PENALTV OF PERIUi7V THAT I AM EXEMPT FitOM THE CONTRACTORS LI- Gefe(J0/CBfPOR W CENSE LAW FOR hIE FOLLOWINO fiEA50N(SEC.7031.6 BUSINESSANO PROFESSIONS CODE:ANV CITV OR (n C..� COUNTVWHICHREOUIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANVSTRUC- ' w 7URE,PRIOR TO ITS ISSUANCE,AL50 RE4UIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIONED w Patio/Deck � STATEMENT THAT HE OR SHE IS LICENSED W RSUANT TO THE PROVISIONS OF THE CONTRACTORS LI� � � CENSE LAW(q1APTER B(COMMENCINO WITH SECTION 7000)OF�IVISqN 3 OF THE BUSINESS AND PRO- POOUSPB � FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISf-0RTHEALLEGEDE%EMP- C7 V TION.ANV VIOLATION OF SECTION 7031.5 BY ANV APPLICANT FOR A PEFMIT SU&IECTS THE APPLICANT TO Z Re-Roof A CML PENALTV OF NOT MORE THAN FIVE HUN�RED DOLLARS(5600).): � ❑I,ASONMEROFTHEPROPERTY,OHMVEMPLOVEESWITHWAGESASTHEIRSOLECAMPENSATION, � COrt1rtIBfCi81 O - Z WILL DO THE WORi(,AND THE STRUCTURE IS NOT INTENDED OR OFFEFED fOR SALE(SEC.7w�,BU51- J � NESS M!D PROFESSIONS CODE:THE CANTRACTORS LICENSE UW DOES NOT APPLV TO AN OWNER OF � FROPERTY NMO BU0.D5 OR IMPHOVES THEREON,AND NTIO DOES SUCH WORK HIMSELF OR HERSELF OR Q THROUaHHI50RHEROWNEMPLOVEES,PqOVIDEDTHATSUCHIMPROVEMENTSAHENOTINTENDEDOR m w OFFEREDfOHSALEIF,HOWEVER,h1EBUILDINGORIMPROVEMENTISSOLDWI7HINONEVEAROFCOMPLE- � TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR Z IMPROVE FOF h1E PURPOSE OF SALE). _ ❑I.ASOWNEROFTHEPROPEHTV,AME%CLUSIVELVCqMqACTINGWfTHLICENSEDCONTRACTORS W Q TO CONSTRUCT THE PROJECT(SEC.7011,BUSINESS AND PROFESSIONS CADE:THE CONTRACTORS LI� VflIl1flIIM ADJ.AREA W CENSELAWOOESNOTAPPLVTOANON?JEROFAPROPERTVWFqBUILD50RIMPROVESTNEREON,AND � YMOCONTRACTSFORSUCHPR0.IECTSWIh1ACANTRACTOR(5)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE Y TORS UCENSE UW.�. � ❑I AM E%EMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q I ?� U � � DATE OWNER H Z U � LICENSED CONTRACTORS DECLARATION w � I HEREBY AFFIRM UNDER PENALTV OF PERIURV THAT I AM UCENSED UNDER PROVISIONS OF CHAPTER � � e(COMMENCINO WITH SECTION 7a0o)OF DIVISION 9 OF THE BUSINESS AND PROFESSKKJS CODE,AND Z �� MY LlCENSE IS W FU��/ n FC D EFFECT. m � LICENSE CLASS v - LIC.NO. � V DATE CONTRACTOR �- � y W � � WORKEAS'COMPENSATION DECLARATION Q � I HEREBV AFFlRM UNDER PENALTY OF PERIURV ONE OF THE FOLLOWING DECLARATIONS: � � _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE f-0R WOqKERS' a 2 Q COMPENSATqN,AS PROVIDED BV SECT70N 370o OF THE LABOR CODE,FOF THE PERf-0RMANCE U Q OF 7HE WORK FOR WHICH THIS PERMIT IS ISSUED. � w I HAVE AND WILL AWNTAIN WORKERS'CAMPENSATqN INSURANCE,A5 REOUIRED BY SECTqN Q , 3700 OF THE LABOR CADE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.MV WORKERS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION J j CARRIER PLAN REVIEW �Z POLICV NUMBER �� — ELECTRIC Q � (i}�5SECIKXJNE�NOTBEWMREfEDOFTHEPERAYTBR�RONEFiU�DHEDD0UJ3iSK100)ORLESS} PLUMBING ''�—_r----�-^—•� Z I CERTIFV THAT W THE PERFORMANCE OF THE WORI(FOR WHICH THIS PERMIT IS ISSUED,1 MECHANICAL�� //�'^�.\ I I I �-�=� CJ SHALL NOT EMPLOV ANV PERSON IN ANV MANNER 50AS TO 6ECOME SU&IECTTO THE I� � WORKERS'CAMPENSATION IAWS OF CALIFORNIA,AND AGREE THAT IF I SFIOULD BECAME INSPECTION FEE I � SU&IECTTOTHEWOF7KERS'COMPENSATIONPROVISION OFSECTKKJ37 OFTH BO{I } / I � E,I SHALL F THWITH COMPLV WI SE P OVIS�ONS. �SSUANCE N 1 � C. � ("� p DATE: � `v APPLICANT: SMIP � J WARNINO:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNUWFUL,AND SHALL BE ENERGY P/C � SU&IECTANEMPLOYERTOCRIMINALPENALTIESANDCNILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMI�'•. ---�----•- " ' DOLLARS(f 700,000),W ADDITION TO hIE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN [1 � SECTqN37080FTHELABORCODE,INTEflEST,ANDATTORNEV'SFEES. RETENTIONFEE: � vU OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: � Q I HEREBV AFFIRM UNDER PENALTY OF PEFJURV THATTHERE IS ACONSTRUCTION LENDING AGENCV d FOR THE PERFORMANCE OF THE WORK FOR WHICH TMIS PERMIT IS ISSUED(SEC.30G7,CIV.C.). Z W � LENDER'S NAME � LENDER'SAODRESS � w I CERTIFY THAT I HAVE READ THIS APPUCATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTAL FE ES � � I AGREE TO COMPLV WITH ALL CITV AND COUNTV ORDINANCES AND STATE LAWS RELATINO TO BUILDING � CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF 1}IIS CWNTV TO ENTER UPON TFIE � Z ABOVE�MENTIONED PROCERTV FOR INSPECTION PURPOSES. / �J COMMENTS 0 f / �I � L"i� m 1 E NAM (PRINT) '� Q I �n v Uj IONA U E M E E = RECPT.NO. � PAID BY VALIDATION ~ WHITE—Department Copy, ELLOW—Finence Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—Applicant' Copy �Q��'l �� [��%�1��6�9Q9 (�/�� `�- �I�l�ff�[�(�u flc�Df�l �f��ff�d� � � �a��oa� � f �ca� ; ��a . o�c�ooa �oQ� �c� SET BACK � �LOOR JOIST � � �I FTGS/FORMS/STEEL � � FHA REQMTS ELECTRIC GROUND iv � � � UNQER FLOOR QUCT GROUND PLUMBING UNDER FLOOR CUf�IDUIT SLAB GRADE FIREPLACE FOUNDATION ' TEMP POWER FIREPLACE BONQ BEAM WATER SERVICE MID HT. BONQ BEAM . ROOF SHE'ATHING' 1(Z7-c.��.��--�-• •..�. •� ...•.,,._ 8 FT. BONd BEAM � FRAIViINGNENTILIAT(ON ' FINAL BOND BEAM ROOF COVER ' PRE-GRADING ROUGH HEATING SENCNIPJG ROUGH EIECTRIC ROUGH GRADING ROUGH PLUfUIBING FINISH GRADING SHOWERJTUB TEST POOL ELECTRIC �i � EXT. LATH/SIDING POOL FENCING WAL�INSULATION ' POOL FINAL CEILING I(�lSULATI�R! OFF SITE IMPS. � DRYWALL IVAILING DEDICATIONS SEWER rINAL ENG. SEPTIC TAIVK LANDSCAPE/IRRIG. , SEEP PIT/L.L. OPJ SlTE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST. FIRE DEPT. FINAL FIPVAL HEATING HEALTH DEPT. FINAL ! FINAL ELECTRIC DEV. FEES PAID FItvAL PLUMBING ENERGY ��-ff'. o� o c , COi�ifViENI"S SEPTIC TANK SIZE SEEP PIT/U SIZE � � �� — — EXP�R�D ,. • ='7 ' � CITY OF DIAMOND BAbt S�� (�( A.M. DEPARTMENT OF COMMLJNITY&DEVELOPMENT SERVICES � 21660 E.Copley Drive Suite 190 • (909)860-3195 Fax(909)861-3117 PRESS ��'^�'� BUII:DING PERMTf APPLICATI + FIRMLY. o DDRESS Q�' EI� �i`� �'U V ' r DATECATION � �J o v NUMBEF� � #/C � APN�Q�T� RA T ISSUE TYPE OCC °C OWNER I� DATE CONST. GROUP pADD SS � �% • ' ZONING SETBACKS Z CITY ZIP TE�. R�RT RW p� g APPLICANT � TEL � SIDE/SIDE STREET RW O CONTRACTOR SIDE ❑ � ADDRESS ' PROPOSED USE NN CITY ZIP TEL. � wo AACH/ENG/ DESIGNER NO.DWEL. NO. N . ADDRESS UNITS STORI ES BE DROOMS � CITY ZIP TEL. y cn DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION- � OVYNER-BUILDEH DECLARATION � SFR/ADD/REM � � O 8 I HEREBY AFRRM UNDER PENALTY OF VEiWRV THAT I AA1 E%EMPT FROI.1 THE CONTRACTORS LF Gerage/Cflrport � � CENSEUWFORTHEFOLLOWPIOHEASON(SEC.7031.6BUSlNESSANDPROFESSIONSCODE:MIVCITYOR (n COUHTYWMCHREWIRESA7ERMRTOCON57AUCT,/�LTER�MPROVE.DEMOLISH,ORREP/URANYSTAUG W P0t10/DgCk NRE,VRIOR TO R9 69UANCE,AL90 REOUIRES THE A7PLICANT FOR SUCH PERMIT 70 FlLE A SIONED w S7ATEMEHT THAT HE OR SHE IS LICENSED WRSUAHT TO 7HE PROVISIONS OF hIE CONTMC70R5 LI- C CENSE UW(CNAPTER Y(COMMENCWO WITH SEC710N 7000)OF DIVISION 9 OF THE BUSINESS M1D PRO- � PooVSpe �E FE&4qNS COO�OR TFIAT HE OR SHE IS IXEMPTTHEREFROM AND THE BASIS f-0R THEALLEOED E%EMP• (� V TpN.AHYVIOLA710NOFSEC710N7031.6BVANVAPPUCAHTFOqAVERMI75UB1ECTSTHEMPIICAN7T0 Z Re-Root � A CML PENALTY OF NOT MORE THAN FNE HUNDRED DOLLARS(f600)J: � ❑I,ASOMMEROFTHEPROPERTI,ORMVEMPLOVEESWITHWAOESAS7HEIRSOLECOMPENSA710N, � (`qmmOfCiel . � YVILL DO THE WORK,ANO iHE STRUCNRE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70/�,BU51� J � NE99 MID PROFESSION3 CODE THE COHTRACTOiLS LICEHSE UW DOES NOT APPLV TO AN OWNER OF � PROPEHfY W/10 BU0.D9 OR W PROVES THEREON,AND WHO OOES SUq1 WORK HIMSELF OR HERS0.F OR ' Q iHROUGH HIS OR HER OMM EMPLOYEES,7ROVIDED THAT SUCH IMPROVEMENT9 ARE NOT INTENDED OR m � OFFEREUFORSALEIF,NOWEVER7MEBUIL.DWOORIAIPHOVEMENTI9SOLDWfTMNONEVEAROFCOMPLE- �'TION,THE OhVNER�UILDER MALL HAVE THE BURDEN OF PROVINO T1AT HE OR SNE DID NOT BUILD OR UAPROVE FOR THE PURPOSE OF BALE). � ❑4ti4UN�NEROFTHEPiqPEHfY,AAIIXQUSIVELYCOMMCTPI(iWITMLICENSFDCONTMCTOR3 TO CONSTRUCT THE PROJECT(SEC.7014,WSINESS AND PROFESSIONS CO�E THE CONTAACTORS LL V9IUfifIOf1 ADJ.AFiEA CEN9E LAW DOES NOT MPLV TO AN ONRIER OF A PiIOPERTV WFq BULDS OR IMPROVES THERC-0N,M!D � NR7000NTMCTSPoHSUCHPRQIECTSWITIACOHfRACTOR(S)LICENSEDPURSUANTTOTHECOHTMP pUANTITY DESCRIPTION ��E . � TWi4 LICENSE LAW.). 0 ❑I AM IXEMPT lR1DER SEC. B.8 P.C.FOR THIS REASON � � 3 c� � � DATE OWNER � � � � UCENSED CONTRACTORS DECIARATION W � I HEREBY AFFlRN UNDER PENPLTY OF PERIURV THAT I AM UCENSED UNDER VROVISIONS OF CNAPTER � � Y(COAWENCWO VYfTH SECr10N 700D)OF DMSION 70f THE BUSINE55 AND PROFESSIONS COOE,AND Z ' X, MY LICENSE IS IN FULL FORCE A!ID EFFEC7. m LlJ � UCENSE CLASS LIC.NO. � � . U DATE CONTRACTOR d LL � WORKERS'COMPENSATION DECLARATION Q . � I HEREBV AFFlRM UNDER PENALTY OF PERAIitY ONE OF 7HE FOLLOW WO DECLARA710N9: Z � _I HAVE AIA N7LL MAPITAW A CERTIFlCATE OF CONSENT TO SELF-INSURE FOR N�ORI(ERS' a COMPENSATION,AS PHOVI�ED BV SECTION 3700 OF TNE UBOR CODE,FOR THE PERFORMANCE U OF 7HE WORK FOR NR11CH THI9 PEFMIT IS ISSUED. w � _I NAVE AND MALL MAPlfAPI WORKERS'COMPENSATION INSURANCE.AS RC-0UIRED BY SEC710N � Q 37000F THE LABOR CODE,PoR THE PERFORMMICE OF THE WORI(FOq WHICH THIS PEFiMI7I5 ISSUED.MV HpRI(ER$'COMPENSATION IN9UfUNCE CAARIER AND POLICV NUMBER AiiE: � CARRIER .pE7e�}{�/�� POLICY NUAIBER � Z ELECTRIC Q � (nassEcnoNr�Mo7sEml.a.EfEDOFnfvERMrtsfaaoMEHUK7fi�oou�As(Stoo)oqtESS� PLUMBING Z 1 CERTIFY THAT M THE PERFORMANCE OF hiE WORK FOR WHIC}1 THIS PERMIT IS ISSUED,I MECHANICAL C3 SHALL NOT EMPLOV ANV PERSON w ANY MANNER SOAS 70 BECOME SU&lECT TO hiE (/j WORKERS'COMPENSATION LAWS OF CALIFORN11 M!D A(iHEE THAT IF I SMOULD BECOME INSPECTION FEE � � �Yl'^ S SUBJECT TO THE NCHKERS'COMPENSATION VROVISION9 OF SECTION 37ao OF THE LABOR J-t — coo�,i srw�war�n�cor�a�v win�rrasE aao�sar�s. ISSUANCE � r O p DATE: � APRICANP. ' SMIP � WAANINO:FAILURE 70 SECURE WORKERS'COMPENSATION COVERAOE IS UNUWFUL,AND SHALL BE ENERGY P/C S�P 1 � 7III�A __ _ _ SUBJECTAN EMPIOYER 70 CRIIA WAL PENALTIES Mlll CML FINES UP TOONE HUNDRED THOUSAND �y_� LV UU LL DOLLAHS(i100.000).W ADDITION TO THE C0.ST OF COMPENSATIDN,DAMAOES AS PROVIDED FOR IN ENERGY PERMfT'Y _ � J &ECTqN 970e OF THE UBOR CODE,INTEREST,AND ATTORNEI"5 FEES. � 1 �L� T�it� d CONSTRUCTIONLENDIN6AGENCY REfENTIOIJ�:FE�:T�j�v�A�D ivL�B,�T� � 0 PRE-ALT FEE: j� '`� '�'� � I HEREBV AFFIRM UNDER PENAL7Y OF PERIURV THAT 7NERE IS A CONSTRUCTION LENDINO A�ENCV ' . ' FOR THE PERFORMANCE OF TME WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.�OY7,qV.C.). ,�ZT . 's LENOER'S NAME /� � � � �� LENDERS E ��W I CER �T FUVE R M �CATION M1D STATE THAT TiE ��Nw��T�,�S�RRE�T. TOTAL FE ES � � � � � 1 A6N �T PLV WITH C , CWNTV ORUINMICES S TE UWS RELATIN�TO BUq.DIN(i T� HE IZE REPRESEN7ATIVES O COUNTY TO ENTER UPON 7HE ER �INSPECTION WRPOSES. /�� .,,��fl� LQ p f _ � COMMENTS v� V(MT� (lV L � J � , .. (�\.. J m � ¢ PE (P�il/!T) .� � / � N E E �iE RECPT.NO. PAID BY � IDATION /�+' � WHIT —Depertment Capy,VELLOW—Flner�ce Copy.PINK—Asseasor Copy,ap�p N �le ,GREEN—Applicant's Copy � 1 %j'�ri%j� � ' ` L CIT'Y OF DI�f�UiOftlD �e�E� �= • -:� � 1?VSPECTBO� R��4�D � .. �., � . � � .-� � :.� �L��'.«� �� '� o. '� .�� '��I��G� �C�CC�'�U�[�3 .... p .. p ��, �p . � . �,� � 0 SET BACK �� FLOOR JOIST FTGS/FORMS/STEEL � FHA REQMTS ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR CUMDUIT S�AB GRADE FIREPLACE FOUNDATION TEh,P POWER FIREPLACE BOND BEAM WATER SERVICE MIQ HT. BOND BEAM ROOF SHEATHING � � 8 FT. BOND BEAM FRAMfNGNENTILIATION FtNAL BOND BEAM ROOF COVER PRE-GRAQING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUNIBING FINISH GRADING SHUWER/7U6 TEST POOL ELECTRIC EXT. LATH/SIDING POOL FENCING WALL INSULATION POOL FINAL CEILING {NSULATION OFF SITE IMPS. DRYWALL tVAIL{NG DEDICATIONS ' SEWER FINAL ENG. SEPTIC TANK LANDSCAPE/IRRIG. SEEP PIT/L.L. ON SITE IMPS. � AS AIR TEST FINAL ZONlNG FINAL C�NST. ' FIRE DEPT. FINAL F1NAL HEATINC'.,� HEALTH DEPT. FINAL • FINAL ELECTRlC DEV. FEES PAID FINAL PLUMBING ENERGY b :O O y,� �� •� . S�" •y, COMMENTS � SEPTIC TANK SIZE SEEP PIT/U SIZE --- �a y� ''�'� �er v. w�',,, c�.r� :�.�a xr;� ;fN '�1 �s,.��'. . Y��`'^.�r tig sinau i „ a r �S�! ,a�•^:p . . '�''� y al.{ ':i' 'i a :i b �_t�,r • �;�.�a�#" ;`''� � . �s� �k�u'. '9s r ,�a -, � r x.'N.�,i v,'�� p�: r ,�; � "��£�c�at a �v�� f �i t� � y�. ..� y ��l �� A Y n w __�� __. a�+" � .g -� ��,�.., r�.'�,a.,�, . ':;�:'�"�r.��,�'a;� '� r � r.��,^ �,-.: . ;� n • f� .� �``+� �'• ,, ��'.�p.�t#k"'^L.S� � 2'��".1k V" 'b.' ,..� ' f��i�•`,d4a„�"-E��g'�,� ,o-.r...�p��.� . . • 4 F. , C . � . .• -- CITY OF DIAMOND BAR �� ' --��`— DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES ziazsE.copi�rn��e SE' X X A.M�pRESS '° (909)860.3195 Fax(909)861-3117 "%��"W BUILDING PERMIT APPLICATION FIRMLY � JOBSITE �//�{v � Q� ��./� � APPLICATIO � � � NUMBER 17gY1 �� 12 oADDRESS / DATE � ISSUE �' NPE OCC APN—�� LOT TRACT DATE CONST. GFOUP °G OWNER L�i i"Y'e+u-� O ADDRESS 3� � �CtQYI �r/H SS � ZONING SETBACKS Z C�Ty .l.�.r^ nu ZIP 9 78 TEL. P$- S3� FRONT RW ❑ REAR � o APPLICANT TEL. SIDEISIDE STREET RW O � CONTRACTOR r� Q i� SIDE � I O C��,RESS Z P��,�� TE��B�6R�'��,7� pROPOSED USE w ARCH/ENG/ �pm� Z DESIGNER � NO.DWEL. NO. NO. � d ADDRESS UNITS STORIES BEDROOMS , NC�7y ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION I � OWNER-BUILDER DECLARATION SFR(ADD/REM O � I HEREBY AFFlRM UNDER PENALTV OF PERJURV THAT I AM EXEMPT FROM THE CONTRACTORS LI- G8f8gB/C9fpO�I � W CENSEUWFORTHEFOLLOWIN6FiEASON(SEC.70.11.68USINESSAN�PROFESS40NSCODE�.N7YCITYOR (n U COUNTYNMICHRC-0UIRESAPERMRTOCONSTRUCT.ALTERIMPROVE.DEMOLISH,ORREPAIRANYSTRUG W PgllO/DBCI( � wTURE,PRIOR TO ITS ISSUMlCE.ALSO REQUIRES THE APPIICANT FOR SUCH PERMIT TO FILE A SIGNED w � STATEMENT h1AT HE OR SHE�UCENSED PUFSUAN7 TO TME PROVISIONS OF 7HE CONTRACTORS LI� � p�US B � CENSE LAW(CHAPTER Y(COMMENCWO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � P � FESSIONSCODE)OR1}UITHEORSHEISEXEMPTTHEREFROMANDTNEBASISFOHTHEALLEGEDEXEMP- TION.ANYVIOLATIONOFSECTION7031.SBVANVAPPUCANTFORAPERMITSU&lECTSTHEAPPLICANTTO Z Re-Roof � A CIVIL PENALTV OF NOT MOiiE THAN FIVE HUNDiiEO DOIURS(f5o0).): J p p1,A50VMEFOFTHEPROPERTV,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOAIPENSATION. � Commarcial Z WILL DD THE WORK,AND 7HE STRUC7URE IS NOT IMENDED OR OFFERED FOR SALE(SEC.7a�,BU51- J � NE55 AND PROFESSIONS CODE:THE CONTqACTORS UCENSE LAW DOES NOT A7PLY TO AN OWNER OF � PROPEHTY N?IO BURDS OR IMPROVES THEREON.AN�WHO DOES SUCH WORN HIMSELF Oq HERSELF OR m [[ THROU�H HIS OR MER OWN EMPLOVEES,7ROVIDED THAT SUCN IMPROVEMENTS ARE NOT INTENDED OR QOFFEREOWRShLEIF,MOWEVER,TNEBU1l01NQORIMPROVEMENTISSOIDWfTM�NONEVEAROFOOMPLE- Z TION,iHE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVINQ iTiAT HE OR SHE DID NOT BUIID OR � IMPROVE FOR 7HE PUflPOSE OF SALE). w ❑I,JS OWNEH OF THE PROPERTY,M/E%CLUSNEL�CONiRACT1N6 WfTH LICENSED CONTMCTORS [L TO CANSTRUCT THE PROJECT(SEC,7oN,BUSINE55 AND PROFESSIONS CODE:THE CONTMCTORS LI- V81U8t1Of1. � ADJ.AREA W CENSELAWDOESNOTAPPLVTOANOWNEROFAPqO�ERTVWHOBUILD50RIM7ROVESTHEREON,ANO Z NRIOCONTMCTSFORSUC}1PR0.1ECTSNATHACONTRACTOR(S)UCENSEDPURSUANTTOTHECONTRAF pUANTITY DESCRIPTION FEE F- TORSLICENSELAW.). ]C J O ❑I AA1 E%EMPT UNDER SEC. B.8 P.C.FOR THIS REASON � � � V' DATE �WNER U Z W � LICENSED CONTRACTORS DECLARATION —� � w I HEREBYAFFIqM UNDER PENALTV OF PERIURV THAT I AM LICENSED UNDER PqOVI510N50G CHAPTER � d o(COMMENCINO WITH SECTION 7000)OF DMSION 3 OF THE BUSINE55 AND PROFESSIONS CODE,AND Z MV LICENSE�S M FUIL FORCE AND EFFECT. / m � LICENSEC SS `/LIC.NO. � V DA7E G1O CONTRACTOR a W � WORKERS'COMPENSATION DECLARATION � Q � I HEREBV AFFIRM UNDER VENALTV OF PEFUURV ONE OF THE FOLLOWINO DECLARATqNS: � � Z Q � �I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' 2 Q COMPENSATION,AS PNOVIDED BV SECTION 37000F THE LABOR CODE.FOR THE PEHFORMANCE W OF TNE WORN FOR WHICH THIS VERMIT IS ISSUED. � � W �1 HAVE ANO WILLMAIMAIN WORKERS'COMPENSATION INSURANCE,AS FEOVIRED BV SECTION (� Q 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMfT IS �[ ISSUED.MV WORNERS'COA/PENSATqN INSURANCE CMFIEFl.WO POLICV NUMBER AAE: CONSTRUCTION � �� „ � � � CARRIER PLAN REVIEW � ZPOIICYNUMBER ELECTRIC Q � (tY4SSECiIONNE�NOTBE�mOFRfPERMRISPOR�NEf#JN)Fl£DODUAfLS(f10olORLES51 PLUMBING w MECHANICAL Z I CERTIFV THAT IN TNE PERFORMANCE OF THE N�ORK FOR WHICH THIS PERMIT IS ISSUED.I (,'} SHALLNOT EMPLOV ANV PERSON IN ANY MANNER SOAS TO BECAME SU&IECT TOTHE �NSPECTION FEE � WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AOREE THAT IF 1 SHOULD BECOME �� SU&IECT 70 THE WORKERS'CAMPENSATqN PROVIS�ONS OF SECTION 370o OF THE�BOP � CADE,I SHALL FORTHWITH COAIPLY WITH hiOSE PROVISIONS. ISSUANCE ,_._ I - � � SMIP � DATE: APPLICANT: _ cl !_ w ENERGY P/C /� U � I J WARNINO:FAILVRE TO SECURE MNRKERS'COMPENSATION COVERAOE IS UNUWFUL.AND SHALL BE I �-y SU&IECT AN EMPLOVER TO CRIM WAL PENALTIES AND CML FINES UP TO ONE MUNDRED THOUSNJD ENERGY PERMIT DOLLARS(f 100.000).IN�DDITION TO THE C0.5T OF COMPENSATION,DAMAGES AS PFOVI�EO FOR IN . � � SECTION3�OBOFTHELABORCADE.INTEREST,ANDATfORNEY'SFEES. RETENTIONFEE: �tT- - - � CONSTRUCTION LENDING AGENCY PRE-ALT FEE: —'�� O � I HEREBV AFFIRM UNDER PENALTV OF PENURV THAT THERE IS A CONSTRUCTION LEN�INQ AGENCY d FOR THE PERFORMANCE OFTHE WORK FOR WHICH 7HIS PERMIT IS ISSUED(SEC.30B7,CIV.C.). Z W � LENDEA'S NAME 4_ LEND£RSADDRESS p � 1 CEPTIFY THAT I HAVE PEI�D THIS A7PLICATION AND STATE THAT TME ABOVE INFORMATION IS CARFECT. TOTAL FE ES �l� � � I AQREE TO COMPLV WITH ALL CITY AND COUNTV ORDINANCES AND STATE LAWS RELATINa TO BUILDINO CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE , ZABOVE-ME E PROPER Y FOR INSPE a++vuaaosFs. COMMENTS � �/ � m PEHMI NT� . � � � SIGNATU OF PERMfT�EE �T � RECPT.NO. PAID BY VALIDATION H WHITE—Department Copy,YELLOW—Finance Copy,PiNK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy (C8�1� �fr f�U�4f�1��9� �� •.. . , �. ,, of�Sf��EcC'V'V¢�� f�� ° � tt o 0 1�.?@ �C� . D��C t o DGQS� . DG�[�� ; SET BACK FLOOR JOIST FTGS/FORMSISTEEL FHA REQMTS ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR CUNDUIT SLAB GRADE FIREPLACE FOUNDATION TEMP POWER FIREPLACE BONQ BEAM W,4TER SERVICE MID HT. 80ND BEAM ROOF SHEATHING 8 FT. BOND BEAM FRAMINGNENTILIATION FtNAL BOND BEAM ROOF COVER PRE-GRADING � ROUGH HEATING BENCHlNG ROUGH ELECTRlC ROUGH GRADING R�UGH PLUMBlNG FINISH GRADING SHOWEH/TUB TEST POOL ELECTRIC EXT. LATH/SIDING POOL FENCING • WALL INSUTATION POOL FINAL CEILING IMSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER FINAL ENG. SEPTIC TANK LANDSCAPE/tRRiG. SEEP PIT/L.L. ON SITE IMRS. GAS AIR TEST FINAL ZONING FIN,4L CO�lST. FIRE DEPT. FINAL FlNAL HEATING � HEALTH DEPT. FINAL FINAL ELECTRiC DEV. FEES PAID FIIVAL PLUMBING ENERGY C�Of� a Pa _ . . � COMNiENTS SEPTIC TANK SIZE SEEP PIT/U SIZE � � � > c�