HomeMy WebLinkAbout21025CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
21825 E. Copley Drive
909) 866-3195 Fax (909) 861-3117 PRESS
BUILDING PERMIT APPLICATION. FIRMLY
JOBSITE ' 754 PenarthADDRESS
APN LOT TRACT
OWNER Southcoast Cabinet
ADDRESS 755 Pinefalls Avenue
CITY Wainut ZIP TEL. — 9
APPLICANT A M Electric, T1 6/855-L21
CONTRACTOR A M Electric, Inc
ADDRESS . 1 51 3 Clark Ay -ri -
CITYHar-i ender ug}ZIP 917..4 TEL855-1 91 1
ARCWENG/
DESIGNER
ADDRESS
CITY ZIP TEL.
OWNER -BUILDER DECLARATION
I HEREBY AFRRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI-
CENSELAW FORTHEFOLLOWING REASON (SEC. 7031.5 BUSINESSAND PROFESSIONS CODE: ANYCIT' OR
COUNTYWHICH REQUIRESAPERMIT TO CONSTRUCT, µTER, IMPROVE, DEMOLISH, ORREPAIRANYSTRUC-
TURE. PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
STATEMENT THAT HE OR SHE IS LICENSED PURSUANTTOTHE. PROVISIONS OF THE CONTRACTORS LI- CENSE LAW (CHAPTER 9 (COMMENCING WITH SECTION 7000) OFDIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE) ORTHATHE ORSHEIS EXEMPTTHEREFROM ANDTHEBASIS FOR THEALLEGED EXEMP.
TION. ANYVIOLATION OFSECTION 7031.5 BYANYAPPLICANT FORAPERMITSUBJECTSTHEAPPLICANT TO
ACMLPENALTYOF NOTMORE THAN FIVE HUNDREDDOLLARS ($500).):
O I, AS OWNEROFTHE PROPERTY, ORMY EMPLOYEES WITHWAGESASTHEIR SOLE COMPENSATION,
WILLDO THE WORK, AND THE STRUCTURE IS NOTINTENDED OR OFFERED FOR SALE (SEC. 704, BUSI.
NESS AND PROFESSIONS CODE: THECONTRACTORS LICENSE. LAW DOES NOTAPPLYTO AN OWNER OF
PROPERTYWHOBUILDS OR IMPROVES THEREON, AND WHO DOES SUCHWORT( HIMSELF ORHERSELFOR
THROUGH HIS OR HEROWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARENOT INTENDED OR
OFFEREDFORSALE IF, HOWEVER THEBUILDING ORIMPROVEMENTISSOLD WITHIN ONEYEAR OFCOMPLE.
TION, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
IMPROVE FORTHE PURPOSE OF SALEJ_
LAS OWNER OFTHE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSEDCONTRACTORS
TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE THE CONTRACTORSL4
CENSE LAW DOES NOT APPLYTO AN OWNER OF APROPERTYWHO BUILDSORIMPROVES THEREON, AND
WHOCONTRACTS FOR SUCH PROJECTS WITHACONTRACTORS) LICENSED PURSUANTTOTHECONTRAC.
TORS LICENSE LAW).
O 1 AM EXEMPT UNDER SEC. B. 8 P.C. FORTHIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
IHEREBYAFFIRM UNDER PENALTY OF PERJURY THATI AM LICENSED UNDER PROVISIONS OF CHAPTER
9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OFTHE BUSINESSAND PROFESSIONS CODE, AND
MY LICENSE IS IN FULL FORCE AND EFFECT. '
LICENSE CLASS C-1 0 LIC. NO. 704176
DATE 2/12/4n CONTRACTOR T AA -L T
WORKERS' COMPENSATION DECLARATION
I HEREBY AFRRM UNDER PENALTY OFPERJURYONE OFTHE FOLLOWING DECLARATIONS:
I HAVEAND WILLMAINTAIN ACERTIFICATE OF CONSENTTO SELF -INSURE FORWORKERS'
COMPENSATION, AS PROVIDED BY SECTION 3700 OF THE LABORODDE, FORTHE PERFORMANCEOFTHEWORKFORWHICHTHISPERMITISISSUED.
1 HAVE ANDWILLMANTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BYSECTION
370D OFTHELABOR CODE, FORTHE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS
ISSUED. MYWORKERS' COMPENSATION INSURANCE CARRIER AND POLICYNUMBER ARE,-
CARRIER RECARRIERStateFundInsurance
POLICY NUMBER 002919-04 Tin i t 046
TMS SECTION NEEDNOTBE OLOMPLErEDOFTHE PERMIT ISFOR CNE HU DREDDOLLARS ($1DD) OR LESS}
1 CERTIFY THAT IN THE PERFORMANCE OF THE WORT( FOR WHICHTHIS PERMIT IS ISSUED, I
SHALL NOTEMPLOYANY PERSON IN ANYMANNER SOAS TO BECOME SUBJECT TO THE
WORKERS' COMPENSATION LAWS OF CALIFORNIA, AND AGREETHAT IFI SHOULD BECOME
SUBJECT TOTHE WORKERS' COMPENSATION PROVISIONS OF SECTION 37DO OFTHELABOR
CODE. ISAT FORTHWITHCOMPLY WITH THOSE PROVISIONS.
DATE: 2 fI12104 APPLICANT:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALLBE
SUBJECTAN EMPLOYERTO CRIMINAL PENALTIESAND CML FINES UPTOONE HUNDREDTHOUSANDDOLLARS ($100,000), INADDITIONTO THE COST OF COMPENSATION, DAMAGES ASPROVIDED FOR IN
SECTION3705OF THE LABOR CODE, INTEREST ANDATTORNEYSFEES.
CONSTRUCTION LENDING AGENCY
1HEREBYAFFIRM UNDERPENALTY OF PERJURY THATTHERE IS ACONSTRUCTION LENDINGAGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMITIS ISSUED (SEC. 3097, CIV. C.).
LENDER'S NAME
LENDER'SADDRESS
ICERTIFY THAT 1 HAVE READ THIS APPLICATION AND STATE THATTHEABOVE INFORMATION IS CORRECT.
I AGREE TOCOMPLY WITH ALLCITYAND COUNTY ORDINANCESAND STATE LAWS RELATINGTO BUILDING
CONSTRUCTION, ANDHEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THEABOVE-M;ED OR IN
PE %ITTE E (PRINT) '//
ZLJ
N RE OF PERMITTEE DATE
APPLICATIO / PERMIT P/C
DATE S / O NUMBER 10c p
ISSUE ./ TYPE OCCSO9- DATE / CONST. GROUP
ZONING SETBACKS
FRONT RW p
REAR p
SIDE/SIDE STREET RW
SIDE 0 -
PROPOSED USE
NO. DWEL. NO. NO.
UNITS STORIES BEDROOMS
DESCRIPTION SCI. FT FACTOR PSF ADJ. AREANALUATION
SFR/ADD/REM
U) Garage/Carport
WPatio/Dock
LL
0
Pool/spa
Z Re -Root
Commercial ,
M
Valuation ADJ.AREA
QUANTITY DESCRIPTION FEE
JQ 1 cSU
Service with
LU same 120Y208.
W
CDZ
C13
Ja.
U_
ZQ2UW
CONSTRUCTION
PLAN REVIEW
ELECTRIC .-7O
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
SMIP
ENERGY P/C
ENERGY PERMIT
OVRETENTIONFEE:
PRE -ALT FEE:
TOTAL FEES % Q3 . 1
COMMENTS
RECPT. NO. ' I 5 PAID BY o% I i(e VALIDATION w1
4,,o WHITE—DeP>ftttmenl Copy. YELLOW—Finance Copy, PINK—
CITY OF DIAMOND BA
INSPECTION RECORI
SETBAC FLOOR JO-
IST7 FHA ES- ...... ... . GS!
EL UNDER FLOOR
GROUND PLUMBING
I-- UDEFLOOR OND T .......... ..........
SLAB GRADE FIREPLACE FOUNDATION . . . ............. . . .
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID HT, BOND BEAM
ROOF SHEATHING 8 FT. BOND BEAM
FRAMING/VENTILATION FINAL. BOND BEAM
ROOF COVER PRE GRADING
ROUGH HEATING 1 BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING_ FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC . .. . ....... . ......... . . . ................. . .. .................. . . .
POOL FENCING . ............ EXT. LATH/SIDING
POOL FINALWALLINSULATION
SITE IMPS,
DEDICATIONS . .......... ......... . . .. . ... . ........ ...........
CEILING INSULATIONOFF
DRYWALL NAILING - - -------
SEWER. FINAL ENG. .................. ........... .
I LANDSCAPEARRIG.
11 ................ . ..... . . ... . ........ .. . ... . ............... ........ ......... . . .... . ........ .........
SEPTIC TANK
ON SITE IMPS. SEEPPITIL.L,
GAS AIR TEST FINAL ZONING
FINAL CONST. FIRE DEPT. FINAL
FINAL HEATING
EINAL
HEALTH DEPT.f-INAL
DEV, FEES PAIDELDC
FINAL PLUMBING iENERGY . . . ..................... . ........ . ....----------- r-..__....._.- --------------
COMMENTS-==--------...._
SEPTIC TANK SIZE
SEEP PITl'U SIZE
