HomeMy WebLinkAbout13209 (20) -
_1� CITY OF DIAMOND BAR
R �DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21660 E.Copley Drive Suite 190 ������� pRESS
(909)86Q3195 Faz(909)861-3117 O C T 2 FIRMLY
�-'9N', BUILDING PERMIT APPLICATION 5 2002
o DDRIESS �� {/�OW ��/!��"'� 1 APPLICATION PERMIT I q P/ ,�
DATE 2-� NUMBERI l p
c� ISSUE � TYPE OCC
APN LOT TRACT DATE CONST. GROUP
p OWNER �U L� G�
ADDRESS ZONING SETBACKS �
w CITY ' ,ZIP TE . FRONT RW ❑
� APPLIC NT ^- � TEI� � REAR ❑
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� CONTRACTOR SIDE ❑
Q AODRESS PROPOSED USE ���I'1/17 �� IZOf1/t'1
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� DESIGNER • NO.DWEL. NO. NO.
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� ,DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
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p I HEREBY AFFlRAI UNDER PENALTV OF PEiL1URV THA7 I AM EXEMPT FHOM THE CONTRACTORS LI- GflfBQB/C8fp0ll
W CENSEUWFORTHEFOILOWINGREA50N�SEC.7031.5BU51NE55ANDPROFESSIONSCADE:ANYCI7YOR (n
U COUNTYWHICFIREWIRESAPERMflTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC- W P8fi0/DBCk
� NRE,PRqH TO ITS ISSUANCE.ALSO RE�UIRES THE APPLICAN7 FOR SUCH PERMIT TO FI�E A SIGNED w
STATEMENT THAT ME OR SHE IS LICENSEO PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI�
� CENSE UW(CHAPTER Y(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF 7HE BUSINESS AND PRO- � PooVSpa
FESSIONSCODE)ORTHATHEOHSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP- (�
TpN.ANVV10l.ATIONOFSECTION7031.58VANVAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Root
� A CIVIL VENALTV OF NOT MORE THAN FNE HUNDRED DOLURS(5500).):
� ❑I,ASOWNEROFTHEPROPERTV,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, � COfTIffl0fCl21 � �
WILL DO THE WORK,AND THE STRUC7URE IS NOT INTENDED OR OFFERED FOR SALE(SEC.701I,BUSI� J
� HESS AND PROFESSIONS CODE:THE CANTMCTORS LICENSE UW DOES NO7 APPLY 70 AN OWNER OF � � , , �
PROPEHTY N'F10 BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
Q TIROUGH HIS OR HER OWN EMPLOYEES,PROVIDED 7HAT SUCH IMPROVEMENTS AHE NOT IHTENDED OR m
0 OFFEREDFORSALEIF,HOWEVERTMEBUIIDINGORIMPROVEMENTIS50LDWITHINONEYEAROFCOMPLE- �
Z ��TIOH,7HE OWNEHAUILDER NALL HAVE THE BURDEN OF PROVINO THAT HE Ofi SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF SALE).
W ❑I,iVOVMEROFTHEPROPER7V,AAlEXCLUSIVELYCOMMCTINGWIhILICENSEDCONTRACTORS
� TO CONSTRUCT THE PR0.IECT(SEC.7011.BUSINESS AND PROFESSIONS CODE:THE CONTRACTOpS LI� V31U3i1Of1 ADJ.AREA
W CENSE UW DOES NOTAPPLY TO AN ONMER OF A PROPERTV M?i0 BUILDS OR IMPROVES THEREON,AND
� NM1IOCONTMCTSFORSUCHPROJECTSWITHACONTRACTOR(5)LICENSEDPURSUAHTTOTHECONTRAC pUANTITY DESCRIPTION FEE �
TORS LICENSE LAW.�.
� ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON � � PI✓ G1�
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DATE G���I R� OWNER'�,p�7^+�'� � �
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�Q LICENSED CONTRACTORS DECLARATION W
2 1 HEREBV AFFIRM UNDER PENALTY OF PEfUURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �r �
� Y(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CADE.AND Z
�� MY LICENSE IS IN FULL FORCE AND EFFECT. m
� UCENSE CLASS LIC.NO. � j
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V DATE CONTRACTOR a
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� WORKERS'COMPENSATION DECLARATION Q
� 1 HEREBY AFFIRM UNDER PENALTV OF PERIURY ONE OF THE FOLLAWING DECLARATIONS: � �
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� _IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFOPWORKERS' _
� COMPENSATION,AS PROVIDED BV SECTION 370o OF TME LABOR CODE,FOR THE PERFORMANCE • `U
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. - � . .
� . .
w _I HAVE AND WILL MAIMNN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BY SECTION � /
Q 37000F THE UBOR CODE.FOR THE PERFOHMANCE OF THE WORK FOR WHICH THIS PERMIT IS _ �� 1/7 �.-�
ISSUED.MY WORNERS'COMPENSATION INSURANCE CARRIER AND POIICY NUMBER ARE: CONSTRUCTION `�� �
� CARRtER PLAN REVIEW
Z POLICV NUMBER ELECTRIC L
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0 (fFUBSECTIONNE�NDTBE00MPLEfIDOFhEPER1.�LSFORONEl0.NDRmDOL1PAS(Lt00)ORLESS� PLUMBING
Z I CERTIFV TMAT IN THE PERFORMANCE OF THE WORK FOR WHICH 7HI5 PEflMIT IS ISSUED.I MECHANICAL A 1 �
C7 SHALL NOT EMPLOY MIY PERSON IN ANY MANNER SO AS TO BECAME SUBJECT TO THE Tt'
� WORKERS'COMPENSATIONUWSOFCALIf-0RNIA,ANDAGREETHATIFISHOULDBECOME INSPECTIONFEE �1� r _�h�i"����71✓AD➢ "
S SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR ' e" �u�
CODE,I SHALL FORTMWITH COMPLV WITH THOSE P{30VISIONS. ISSUANCE �U T :ATT�` S:�h n�_'1�''F'�i d
p DATE: APPUCANT. -SMIP � . .�• ~ +�� a � .
J WARNINO:FAILUHE TO SECURE WORKERS'COMPENSATION CAVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C �
� SUBJECT AN EMPLOVER 70 CRIMINAL PENAL7IES AND CIVIL FINES UP 70 ONE HUNDRED THOUSAND ENERGY PERMIT
DOLURS(i100,000),IN ADDITION 70 THE COST OF COMPENSATION,DAMAGES AS PHOVIDED FOR IN
J SECTION 97oB OF 7HE UBOR CODE,MTEFEST,AND ATfORNEV'S FEES. RETENTION FEE:
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� CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� I HEREBV AFFIHM UNDER PENAL7Y OF PERIURV THA77HERE IS A CANSTRUCTION LENDING AGENCY
FOR THE PERFORMMICE OF 7HE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.�.
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� LENDER'S NAME .
F= LENDER'SADORE55 ^
� TOTAL FEES��Ir��j �P q a ' ''"' �
w I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. �`"��
� I AGHEE TO CAMPLY WITH ALL CITV AND COUNTV ORDINANCES AND STATE UWS RELATING TO BUILDING
� CONSTRUCTION,AND HEREBY AUTHOfiIZE REPFESENTATIVES OF THIS COUNTV TO ENTER UPON THE �
Z ABOVE-MENTIONED PROPERTV FOR INSPECTION PURPOSES. • COMMENTS �'`L�
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m PERMITTEE NAME IHT) �
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� SIG I E DATE -
= RECPT.NO. PAID BY VALIDATION
~ WHITE—Department Copy,YELLOW—Finence Copy,PINK—Assessor Copy,G LDENROD—File Copy,GREEN—ApplicanYs Copy
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SET BACK � � FLOOR JOIST �
FTGS/FORMS/STEE� •y-i� '4�(� . . � FHA RE�MTS � __
ELECTRIC GROUND UNDER FLOOR DUCT
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GROUND PLUMBING UNDER FLOOR CUf�;�3UIT , '
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SLAB GRADE FIREPLACE FOUNDATI4N i
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TEMP POWER j FIREPLAGE BONR BEAM � ___�
WATER SERVICE MID HT. BOND BEAM
ROOF SHEATHING � � � � � 8 F7. BOND BEAM � ____ �
FRAMINGNENTIUATION �-`�Sl'� __� _�INAL BONf� BEAM v_ _ __ _ __
ROC7F COVFR PRE-GRADING �� '
ROUC�H HcATING BENCHING " � -1-- � � � '
ROUGN E�ECTRIC ; ROUG�i GRADING � ' '
RC�UGFi P�UiV161NC ' ' • FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSlJLATIOtV � POOL FINA� __
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