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HomeMy WebLinkAbout10810CITY OF DIAMOND BAR COMMUNITY DEVELOPMENT DEPARTMENT C 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 ` BUILDING PERMIT APPLICATION JOBSITE ^� ADDRESS J l ,^X- APNLOT TRACT OWNER ADD RE S CITY ZI TEL APPLICANT - fujir CONTRACT R ADDR CITY Mtn'r— 1 rIP TE ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY. AFFIRM UNDER PENALTY OF P,ERIURY.THAT I AM EXEMPT FRCM THE CONTRACTORS U - CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT, ALTER, IMPROVE, DEMOLISH, OR REPAIR ANY STRUC- TUBE,PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO RLE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PYRSUMIT TO THE PROVISIONS OF THE CONTRACTORS U. CENSE LAW (SECTIONP7ERa (COMMENCING WITH SECTION 700.7) OF DIVISION 10F 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 ?D31.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVILPENALTY OF NOT MORE THAN FIVE MON13RED dOLLARS (5500).): O 1, AS OWN ER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE ISNOT INTENDED OR OFFERED FOR SALE (SEC. 7044, BUSI. NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OfUMPROVES THEREpN, AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH MPROVEMENTSARE NOT INTENDED OR . OFFERED FOR SALE IF, HOWEVER,THE BUILDING ORIMPROVEMENT IS SOLD WITHIN ONE YEAROF 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). Elk AS OWNEROF THE PROPERTY,AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044. BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS U. CENSE LAW DOES NOTAPPLYTO AN OWNER OF A PROPERTYN'HIO BUILDS OR IMPROVES THEREON. AND WHO CONTRACTS FOR SUCH PROJECTS WITHAOGNTRACTOR(S) LICENSED PURSUANT TO THE ODWRAC- TORS LICENSE LAW.). J IAM EXEMPT UNDER SEC. B. S P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER 0 (COMMENCING WITH SECTION 7000) OF DIVISION 3OFTHE BUSINESS AND PROFESSIONS CODE. AND MY LICENSE IS IN FULL FORCE AND EFFECT. UCENSE CLASB LIC. NO. _ 7 _ DATE _.�� CONTRACTpR g_ .. 3 WORKERS' COMPENSATION GLA TION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE r-0 WING CLARATIONS: _ I HAVEAND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' CO 11ON. AS PROVIDED BY SECTION 57000E THE LABOR CODIL FOR THE PERFORMANCE THF, WORK FOR WHICH THIS PERMIT 18 ISSUED. I HAVEAND WILL MAINTAIN WORKERS' DOMPENSATON INSURANCE, AS REQUIRED BY SECTION 3700 OF 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 „- C 1 Ifcl + t f POLICY NUMBER 1.?JIC 16 L "' 3 S �S E 2. I (rHISSECRCNNEEDNC T BEOOMPLEMDOFTHE PEWS FOR ONE H 1211DREDDOLIARS IS1o0)OR LESSL I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, 1 SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CAU FORM A6 AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS' DOMPENIATKON PROVISIONS OF SECTION 3700 OF THE LABOR CODE, I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE: APPLICANT: WARNING: FAILURE TO SECURE WORKERS' OOMPENBAYICN COVERAGE IS UNLAWFUL, AND SHALL BE SUBJECT AN 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 3705 OF THE LABOR CODE, INTEREST, AND IRTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE S A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3087, CIV. C.). LENDER'S NAME LENDER'S ADDRESS - I CERTIFY THAT I HAVE READ.TF0 APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT 1 AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND 87ATE LAWS RELATING TO BUILDING CONSTRUCTION, AND HERESYAUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. Cc 41?, f,-- PER TTEE NAME (PRINT) SIGN NFPERMITTEE DAT PRESS FIRMLY APPLICATION PERMIT /���d P/C DATE_ NUMBER M ISSUTYPE OCIC / /���( DATE 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. AREAIVALUATION SFR/ADD/REM • GarageFCalport - LU Patio/Dock . 'LL. POOVSpa Z Re -Roof 0 Commercial 5 In Valuation ADJ.AREA QUANTITY - DESCRIPTION FEE t too ?5 U Q H U W LU 0 Z J� a _U Z Q 2 W CONSTRUCTION ' PLAN REVIEW E EC as Ij -our �j .PLUMBING OCT MECHANICAL - 1007 INSPECTION FEE y ISSUAN 5"� SMIP ENERGY P/C ENERGY PERMIT RETENTION FEE: PRE-ALTFEE: TOTAL FEES , J COMMENTS RECPT. NOif.�1�7 PAID BY VALIDATION WHITE—Department Dopy, YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD—File Copy, GREEN—Applicant's Copy --- CITY OF DIAMOND BAR INSPECTION RECORD . e SET BACK , ®. a FLOOR JOIST FIGS/FORMS/STEEL FHA REOMTS ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR CONDUIT SLAB GRADE FIREPLACE FOUNDATION TEMP POWER oep FIREPLACE BOND BEAM WATER SERVICE~ MID HT. BOND BEAM . ROOF SHEATHING B FT. BOND BEAM _ FRAMINGNENTILIATION 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 FINAL CONST. FIRE DEPT. FINAL FINAL HEATING FINAL ELECTRIC -3—�7 HEALTH DEPT. FINAL — flEV.FEESP9ID FINAL PLUMBING JENERGY COMMENTS K SEPTIC TANK SIZE SEEP PIT/U SIZE -