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HomeMy WebLinkAbout15093 (19)III.EM,gXD IIA 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 (/ }. ADDRESS Z 7 ,3 Z 01-df-C"�- APN LOT TRACT OWNER �'LEPil-t3y-z' / Sh l ADDRESS /L ,^_ fL-e- CITY Ahoyj5vC ZIP TEL. O APPLICANT TEL. CONTRACTOR IQ C f C ADDRESS CITY ek �: O ZIPImo/ �/d TEL.909 9 2 ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS L4 CENSE LAW FOR THE FOLLOWING REASON (SEC.7031.6 BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REQUIRES A 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 TO STATEMENT THAT HE OR SHE IS LICENSED PURSUANT THE PROVISIONS OF THE CONTRACTORS U - CENSE LAW (CHAPTER 9 (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 RA ACL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (5600).): ❑ LAS 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 SAE (SEC. 701x, 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 BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAROF COMPLE. I TION, THE OWNER -BUDDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). ❑ I, AS OWNER OF THE PROPERTY AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7011, BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY VAIO BUILDS OR IMPROVES THEREON. AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC. TORS LICENSE LAW.). O 1 AM EXEMPT LINDER SEC. B. & P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL �FORCE AND EFFECT. LICENSE v LIC. NO. �g DATE_ 603 CONTRACTOR W o!G WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATION$! 1 HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION 37M OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE. AS REQUIRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORRKE,wRRT COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: nw CARRIER (lirr'p 1 AJ J POLICY NUMBER U-1 20 00 l -2 - (THIS SECTION N® NOT BE COMPLETED OF THE POW IS FOR ONE HIAORFD DOLLARS ($100)OR LESS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT LS ISSUED. I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE. IISSHALL FORTHWITH COMPLY WITH THOSE P 1SIONS. DATE:y �—20 d(J APPLICANT: / J T%d WARNING: FAILURE TO SECURE WORKERS' COMP NSATKON COVERAGE IS UNLAWFUL, AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS (5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 370E OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS ACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3097. CIV. C.). LENDERS NAME LENDERS ADDRESS I CERTIFY THAT I RAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MEHTIQNED PROPERTY FOR INSPECTION PURPOSES. 90� 121_ I Cf. (CCS C f o PERMITTEE ZOO 0 SIGNA OF PERMITTEE DATE WHITE—Department Copy, YELLOW—Finance Copy, IN EXPIRED JUN 19 2002 PRESS FIRMLY APPLICATION PERMIT P/C DATE NUMBE # ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE NO. DWEL. UNITS NO./!�(� O STORIES ICJ �0. -BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM U) Garage/Carport W Patio/Dock LL PooUSpa Re -Roof 7— Commercial Commercial m Valuation 0 Q ADJ.AREA QUANTITY DESCRIPTION FEE Q U NZ H- U w W 0 _Z Go J Q U Z Q 2 U w n I 'V CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: AN3 200U PRE -ALT FEE: Crry 01P 9)IAR40ND 13 AR 'RT TTT nTTTIf3 AiVTI C a1 'T5/ TOTAL FEES t , COMMENTS RECPT. NO. PAID BY vALIDATIt7Ny --WY-wwcrvnCJU --- rlNe LOPY, UIttN—Applicant's Copy CITY OFDIAMOND BAR, INSPECTION RECORD Jx­ SET BACK FLOOR JOIST FTGS/FORMS/STEEL - FMA RE©'MTS ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING 1 UNDER FLOOR CO.NOUIT SLAB GRADE FIREPLACE= 'FOUNOATION TEMP POWER FIREPLACE BOND BEAM -•- WATER SERVICE ; -MID HL BOND BEAW ROOF SHEATHING 8' FT. BOND,BEAM . ,;.. . • FRAMINGNENTILIATION _ �' �� FINAL BOND BEAM ROOF 'COVF_R "PR'E-GRADING ROUGH HEATING _ -BENCHING- - ROUGH ELECTRIC ROUGH GRADING ROUGH PLUMBING :FINISH GRADING, SHOWERITUB TEST POOL ELECTRIC EXT. LATH/SIDING POOL FENCING VIIALL INSULATION ti . POOL FINAL CEILING INSULATION OFF SITE IMPS, DRYWALL NAILING DEDICATIONS SEWER .FINAL ENG- SEPTIC TANK =- LANDSCAPE/IRRIG.. SEEP PiT/L.L. GAS: AIF; TEST "ON SITE IMPS. -• -FINAL ZONING hFil:':'� CONST. -,' •FIRE DEPT- FINAL _ 1 .-HEATING - - - HEALTH DEPT. FINAL . 3 ELECTRIC _. _._ .. _ DEV: FEES PAID --- PLUMBING - ENERGY VIMENTS .1 SEPTIC TANK SIZE SEEP PIT/U SIZE - ' -