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HomeMy WebLinkAbout15116 (20)`UTA�111.1U ItARi CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY 21660 E. Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 & DEVELOPMENT SERVICES BUILDING PERMIT APPLICATION JOBSITE /✓ % ADDRESS [ G APN LOT T T O NER AD SS CI ZIP TE . AP LICANT TEL CONTRACTOR L ADDRE CITY ZIP T, ARCWENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FORTHE FOLLOWING REASON (SEC. 7031.6 BUSINESSAND PROFESSIONS CODE: ANY CITYOR COUNTY WHKCI REQUIRESA PERMITTO CONSTRUCT,ALTER, IMPROVE, DEMOUSH, OR REPAIR ANYSTRUC- TURE, PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SNE IS UCENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS U_ CENSE LAW (CHAPTER a (COMMENCING WITH SECTION 7D00) OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THEALLEGED EXEMP- TION. ANY VIO ATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS ($5001.): 0 L AS OWNEROFTHE PROPERTY,OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 704x, BUSI- NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOTAPPLY 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 FORSALE IF, HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OFCOMPLE- TION, THE OWNER43UILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). 0 I, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS UI CENSE LAW DOES NOT APPLYTO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S) LICENSED PURSUANT TOTHE CONTRAC- TORS LICENSE LAW.). O 1 AM EXEMPT UNDER SEC. B. & P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER B (COMMENCING WITH SECTION 7DOO) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL LICENSE C LIC. NO. - r DATE CONTRACTOR WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: _ I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED BY SECTION 3700 OF HE 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 WORKERRV COMP T�DN INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER i f _ _ ,Y . POLICY NUMBER (THIS SECTION NEED NOT BE COMPLETED OF THE PEPMT IS FOR ONE HUNDREDDOLLARS ($100) OR LES). I CERTIFYTHAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJEC O THE WORKERS' COMPENSATION LAWS OF CALIFORNIA: D AGREET HAT IF 1 SHOUL ECOME SUBJECT TO THE WORKERS' COMPENSATION P OVI 5 OF SECTION 37000F E LABOR DE tS ALLF HWITH COMPLY WITH T EPROVI S. DATE:APPLICANT: WARNING: F LURE TO SECURE WORKERS' COTION COVERAGE IS UNLAWFUL, AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTI AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($1 OD,DOO), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY 1 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 3087, CIV. C.). LENDER'S NAME LENDER'SADDRESS IC IFY THAT I HAVE T!MON AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I R TO COMPLY WNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING ST CTION, AND HEPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE A VE- NITK)NEO PRTION PURPOSES. P MI NAME (PRI SIGNATURE0 PE EE DATE PRESS FIRMLY APPLICATION PERMIT i P/C DATE .% NUMBER ` # ISSUE TYPE OCC DATE]fj�.j CONST. GROUP ZONING SETBACKS FRONT RW REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREA/VALUATION SFR/ADD/REM Garage/Carport W Patio/Deck LL Pool/Spa Z Re -Root 0 Commercial M Valuation ADJ.AREA QUANTITY DESCRIPTION FEE Q U H U w W U Z G m J a Q _U Z Q W CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE,. -"- ISSUANCE SMTP ENERGY P/CC17 _ S i,3zf '1jlNi a_.�::: 3'Z ENERGY PERMIT ' RETENTION FEE: PRE -ALT FEE: TOTAL FEES COMMENTS RECPT NO. PAID BY _ _ VALIDATION WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD—File Copy, GREEN—Applicant's Copy W INSPECTION RECORD SF s 3A K FLOOR JOIST J:Tr-iS/;:0RMS,lST=-Ell I FHA REQMTS .. ..... .... . E UNDER 'FLOOR DUCT LE C -f I R C G 1,01,N r, UNDER FLOORCONDUIT SL, FIREPILACE FOUNDAMON n,F-,' GRADI--: ------ — ------ ....... TOVIP POWER F111REPLACE BOND BEAM — — — ------------------ — - WAT - R S7 R V � C E MI -D HT. E30ND REAM Irz 0 0, F S H E AT H i N GA 8 FT BOND RE -AM FPS: MN,IGPI ENT LIATION' RNAL BOND BEAM Rom�,- OVER PRE-GRAEDING BENCHING ROUGH HEAT ING ROUGH FEF-c",T01CROUGd � GRADING F j M4 3 i N j G Fi N 1SHGR I ADING SHO"WErR;7UP POOL ELECTR�C Fro LA.. 1 VS 1 D INN P001 FENUNG 1--.1 . WALL IN�I.JLAT!ON POOL F�NAL NG '�.NIJLATK)N OFF 97F IMPS. D �VA, DEDiCATIONS nY L-,,�"AIIJNG s ENE R F!M�L �NG ............ SEPT IC TANK LANDSCAPE/IRRIG. ..... ..... I SEEP Pffi; . L.LGN SITE IMIPS, — — ---------- ------- F I N A I - -70t, N, I'- i FINAL CONST. Fl. R E SEPT --'N AL iF� k�71f' f -1 -E-A-T—IN HEALTH FiNAL Fff��AL ELECTRIC DEV. FEES PAID R"NAL PLUMBING ENERGY COMMENTS -:F TANK S7E PITTUSIZE -------------- . .............. — ------ - - --------------- ...... . ...