Loading...
HomeMy WebLinkAboutPR 13 11380 9'. U1.1 I11 D:U.1R i CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21810 Copley Drive, Diamond Bar, CA 91765 J(909) 839-7020 Fax (909) 861-3117 Building Inspection Hotline (909) 839-7027 y BUILDING PERMIT APPLICATION JOBSITE 34-69ADDRESSC2PL'_RSA07 APN LOT t9 TRACT OWNER 6 R A( L -F `.Z (-Q P A 121 k ADDRESS •23/408 PL-E-A-5AWT rDO CITY 01 A."O W'D 134P, ZIP q'17" TEL. 0, 177 APPLICANT 5 ETA (c-9SN T295AA TEL. -7 1 226 CONTRACTOR 5 i-1 A l Leri sA 'D E 5AA 1 ADDRESS I 05- I Ct`1 e CITY 4 I`/"1 ZIP TEL Z ARCFI/ENG/ DESIGNER 4k70H $1-(I 9 ri X,556 - ADDRESS 55d• ADDRESS 20 CITY A"APF_Ihm ZIP 9Z9b'T TEL. 71 2 OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS U. CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.6 BUSW ESS AND PROFESSIONS CDDE: ANY CITY OR COUNTY WHICH REWIRES APERMITTO CONSTRUCT, ALTER IMPROVE, DEMOLISH, OR REPAIR AMI STRUC. TURE. PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS UCENSEO PURSUANT TO THE PROVISIONS OF THE CONTRACTORS Li. CENSE LAW (CHAPTER 9 (COMMENCING WITH SECTION 7DW) 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 A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (SSW).): 01, AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE lli) COMPENSATION, WILL DO THE WORK, ATHE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 70". BUSK NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON. AND MAO 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 YEAR OF COMPLE. TION, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). 0 4 AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044• BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS U. CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). 0 1 AM EXEMPT UNDER SEC. B. & P.C. FOR THIS REASON DATE -_ OWNER LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER D (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT. Q LICENSE CLASS LIC. NO. SO Ej DATE O CONTRACTOR HAILrr5H WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: 1 HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENTTO SELF -INSURE FOR WORKERS' C0 PENSATINI.AS PROVIDED BY SECTION 37000F THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I RAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY SECTION 37000E THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER POLICY NUMBER DES SECRCN NEEDNOT BE COMfiETEDOFTHE PERMTIS FOR CNE HUNDRED DOLLARS W MDRLESSl I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. 1 SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SOAS 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 37M OF THE LABOR CODE HALL RTHWITH COMPLY WITH THQ¢I EE P ROV IS,,IONS. DATE: d / APPLICANTx V"• WARNING: FAILURETO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL_ AND SHALL BE SUaJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 370E OF THE LABOR CODE, INTEREST. AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE M ACONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3097, CIV, C.). LENDER'S NAME LENDER'S ADDRESS I CERTIFY THAT 1 HAVE 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-MENTIONED PROPERTY FOR INSPECTION PURPOSES. 116"A(H `RASA-( PERMITTEE NAME RINn 0 2Z 13 SIGNATURE OF PrRMrrrEE DATE PRESS FIRMLY APPLICATI N l PERMIT F'Q N3 P/C VR \3 DATE a a 1 3 NUMBER 1 V31t> I ISSUE TYPE DATE OCC CONST. GROUP ZONING SETBACKS FRONT RW 0 - REAR 0 SIDE/SIDE STREET RW 0 - SIDE p PROPOSEDUSE IZI'MayAL. d'F E-1Si ly te, 50il4 aad F'!!1 C L'Q 51 1 I© / H O w F -X301 Z -V ( NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION SFR/ADD/REM U) Garage/Carport W Patio/Deck LL PooUSpa 0 Z Re -Roof 0 Commercial m 5L) Roa 2-'75 Valuation i dd 0 ADJ.AREA QUANTITY DESCRIPTION FEE Q 6 0 07 L U3 U W Lr' h F ISI 41" C W ZZ m a Q U ZZ 2UW CONSTRUCTION PLAN REVIEW ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE ENERGY P/C ENERGY PERMIT RETENTION FEE: g a . co PRE -ALT FEE: TOTAL FEES a, 3 • ' 1 . 8 \ COMMENTS le e 1S RECPT. NO, PAID BY. .S ' c VALIDATION ' 1 WHITE—Department Copy, YELLOW—Finance COW PINK—Assessor Copy, GOLDENROD—File Copy, GREEN—Applicant's Copy f i UrY OF MANIOND BAR NSPECTION RECORD WX. SET BACK; FTGS/FORMS/STEEL ELECTRIC GROUND pa FLOOR JOIST FHA REONITS UNDER FLOOR DUCT GROUND PLUMBING_ UNDERFLOOR COND_UIT -I _ SLAB GRADE r FIREPLACE FOUNDATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICE MID HT. BOND BEAM _ ROOF SHEATHING 18 FT. BOND BEAM FRAMING/VENTILATION FINAL BOND BEAM ROOF COVER ROUGH HEATING ROUGH ELECTRIC I_ PRE -GRADING i BENCHING ROUGH GRADING ROUGH PLUMBING FINISH GRADING SHOWER/7UBTEST POOL ELECTRIC EXT. LATH/SIDING WALL INSULATION POOL FENCING POOL FINAL CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING SEWER j } _ DEDICATIONS _ - FINAL ENG SEPTICTANK LANDSCAPEARRIG._ SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST. FIRE DEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY FINAL PLANING FINAL ENGINEERING -_---- COMMENTS-----------'1 SEPTICTANKSIZE SEEP PIT/U SIZE i'