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Home My WebLink About13010CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive SL7ite 190 ' (909)860-3195 Fax(909)861-3117 WELDING PERMIT APPLICATION JOBSITE ADDRESS�ZO2S Oqk knLL APN LOT TRACT OWNER _ b 19V P NA0 ADDRESSRdCIIJ CITY 13 AA ZIP -TEL. - APPLICANT CONTRACTOR u i cHla if) n ADDRESS grd'$P tge San 3 CITY-- .ZIP _!_jW#2 EL. fl - W- ARCFVdNdV DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM EXEMPT FROM THE CONTRACTORS LF CENSE UW FORTHE FOLLOWING REASON (SEG 7041.6 BUSNESSAND PROFESSIONS CODE ANY CrTYOR COUNTY WHICH REQUIRES A PERMRTO CONSTRUCT,ALTER. IMPROVE. DEMOUSH.OR REPAIR ANY STRUO _ TUBE PRIOR TO ITS ISSUANCE- ALSO REOUIRES TRE 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 P (COMMENCING WITH SECTION 7000) OF DIVISION S OF THE BUSINESS AND PRO- FESSIONS CODE) 09 THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION. ANY VIOLATION OF SECTION 7041.5 BY ANYAPPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS 13500).)• - - . O t AS OWNEROF THE PROPERTY. OR MY EMPLOYEES WITH WAGES ASTHEIR SOLE K COMPENSATION, WILL DO THE WORAND 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 PROPERTYWHO BUILDS OR IMPROVES THEREON.AND WHO DOES SUCH WORK HIMSELF OR HERSELFOR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE IF, HOWEVERTHE BUILDING OR IMPROVEMENT is SOLD WITHIN ONE YEAR OFOOMPLE- TION, THE CWNERbUI DER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DD NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). D 1. AS OWNER OF THE PROPERTY, AM EXCLUSNELYCONTRACTNO WITH LICENSED CONTRACTORS TO CONSTRICT THE PROJECT (SEC- 7041, BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LI- CENSE LAW DOES NOTAPPLY TORN OWNER OF A PROPERTYWHO BUILDS OR IMPROVES THEREON. AND WHOCONTRACTSFOR SUCH PROJECTS WATHACONTRACTORIS) LICENSED PURSUANTTITHE CONTRAG TORS LICENSE LAW.} O 1 AM EXEMPT UNDER SM B. L P.C. FOR THIS REASON DATE OWNER ' LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM LICENSED UNDER PROVISIONS OF CHAPTER I (COMMENCING WITH SECTION 7000) OF DMSION 4 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS N FULL FORCE AND EFFECT. -70 /f LICENSE CUSS. f-4�I• S3 LIC. NO. jr2%09,5-- DATE �'� CONTRACTOR I- If WORKERS' COMPENSATION DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS. _I HAVE AND WILL MAINTAIN A CERnrIGTE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATgN, AS PROVIDED BY SECTION 4700 OF THE LABOR CODE,FOR THE PERFORMANCE NCE SOF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �I HAVE AND WILL MAINTAIN WORKERS COMPENSATOR NSURANCE, AS RECURRED BY SECTION 3700 OFTHE LASOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MYWORKERSy' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER POLICY NUMBER VM SECTION NEEDNOT BE OOAi LETEDOFTHE PERMIT 6 FOR ONE HUNDRED MIARS (SIDO)OILESS), 1 CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I SHALL NOT EMPLOY ANY PERSON N ANY MANNER SO AS TO BECCME SUBJECT TO THE WORKERS COMPENSATION LAWS OF CALIFORNI 0 AGREE THAT IF 1 SHOULD BECOME SUBJECT TO THE WORKERS'COMPENSATIONP NS S �ECXICH 4700 OF THE LABOR CODEISH L FORTHWITH COMPLY WITH •EP YISK DATE: APPLICANT: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UN VL AND SHALLBE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO 'N)RED THOUSAND DOLLARS (III f f 00,D001 N ADDITION TO THE COST OF COMPENSATION, OAIAAG S AS PROVIDED FOR IN SECTION 7708 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES CONSTRUCTION LENDING AGENCY 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHK71 THIS PERMIT IS ISSUED (SEC. 3097, CIV C). LENDER'S NAME LENDERSADDRESS I CEFMFYTHAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE NFORMATKON IS CORRECT 1 AGREE TO COMPLY WITH ALL CITY ANO COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRL CTNOK AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. PERMITTEE NAME (PRINT) SIGNATURE OF PERMITTEE DATE EXPIRED OCT 2 6 2000 PRESS FIRMLY APPLICATION PERMIT P/C DATE NUMBER �Q I() p ISSUE �) TYPE OCC DATE � CONST. GROUP. ZONING SETBACKS FRONT RW ❑ REAR. ❑ SIDE/SIDE STREET RW ❑ SIDE p PROPOSED USE -lie_ n(rtiCZL' NO. DWEL, NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. ' FACTOR PSF ADJ. AREANALUATION SFRIADD/REM Garage/Carport . WPatiolDedc _ _ _ 77 LL Pool/Spa Z Re -Roof 0 Commercial - 5 m Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J 4 _ U F �1 o AJ U W J W z Z p 1./ /Yt V 1 C4 um J D_ U Q x U W CONSTRUCTION PLCO REVIEW ELECTRIC PLUMBING MECHANICAL - INSPECTION FEE ISSUANCE R SMTP ENERGY P/C ENERGY PERMIT RETENTION FEE: _(�` L PRE -ALT FEE: 4iy 1 TOTAL FEES COMMENTS RECPTNO. PAID BY VALJDATI N WHITE -Department Copy, YELLOW -Finance Copy, PINK -Assessor Copy, GOLDENROD -File Copy, GREEN -Applicant's Copy CITY OF DIAMOND BAR.,.i :. INSPECTION RECORD lltd,'706eAs- SET BACK (.; INSPECTION DATE INSPECTOR FLOOR JOIST t ' FTGS/FORMS/STEEL i _ FHA REQMTS ELECTRIC GROUND :_ ... - . UNDER FLOOR DUCT i GROUND PLUMBING UNDER abO CONDUIT % SLAB GRADE FIREPLACE FOUNDATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICE - - - - - MID HT. BOND BEAM - = • - ` ROOF SHEATHING - 8 FT: BOND BEAM FRAMING/VENTILIATION FINAL BOND BEAM ROOF COVER , PRE -GRADING - ROUGH HEATING -- - -- BENCHING ROUGH ELECTRIC_;__ ROUGH GRADING ROUGH PLUMBING- - FINISH GRADING SHOWER/TUB TEST " - - POOL ELECTRIC EXT. LATH/SIDING POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER- FINAL ENG. SEPTIC TANK _. _..._. LANDSCAPE/IRRIG. SEEP PIT/L.L.--- -- - ON SITE IMPS. ; • . GAS AIR TEST FINAL ZONING FINALCONST : FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL -ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY COMMENTS 1 , SEPTIC TANK SIZE SEEP_PIT/U SIZE i