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HomeMy WebLinkAbout14967 (34)L77: t,1G i CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 (909)860-3195 Fax(909)851-3117 BUILDING PERMIT APPLICATION JOBSITE ADDRESS 0 1ItAAJ APN LOT TRACT OWNER a ADDRESS 1 W yea" CITY I ZIP TEL. O Q- a APPLICANT TEL CONTRACT R ADD S i,Ad CITY IP TEL ARCH/ENG/ ' DESIGNER L- 1 ADD ESS b CITY ZIP 22ZEj TEL 0 OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM LINDER PENALTY OF PERJURY THAT I ALI EXEMPT FROM THE CONTRACTORS U. CENSE UW FOR THE FOLLOWING REASON (SEC. 7051.6 BUSNESSAND PROFESSIONS CODE ANY CITY OR COUNTY WFBCH REOLARESAPERMRTOCONSTRUCT, ALTE0.1MPADVE, DEMOLISH, OR REPAIR ANYSTRUC- TUBE, PRIOR TO ITS RSUANCE, ALSO REOUPES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT 70 THE PROVISIONS OF THE CONTRACTORS U• CENSE LAW (04APTER S (COMMENCING WITH SECTION 7000) OF DIVISION 3 O THE BUSINESS AND PRO- FESSIONS CODE) OR THAT HE OR SHE 15 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 COVIIQENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS 15500).1: . AS OWNER OF THE PROPERTY, OR MY EMPLOYEES VAIN WAGES AS THEIR SOLE COMPENSATION, WILL THE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, BUSI- NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOTAPPLY TO AN OWNER OF PROPERTY WAW BUILDS OR IMPROVES THEREON, AND WHO DOES SUCH WORKHIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IM PROVEMENTS ARE NOT WENDED OR OFFERED FORSALE W,, HOWEVERTHE BUILDING ORIMPROVEMENT IS SOLD WITHIN ONE YEAR OFCOMPLE- TON, THE OWNE"LIODER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DO NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). D L AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE UW DOES NOT APPLY TO AN OWNER OFA PROPERTY WHO SUILDS OR IMPROVES THEREON, AND WHOCCNTRACTSFOR SUCH PROJECTS WITH ACONTRACTOR(S) LICENSED PURSUANT TO THE CONT RAC - TOM LICENSE LAW.). ❑ 1 AM EXEMPT UNDER SEC. B. B P.C. FOR THIS REASON DATE OWNER C LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM TINDER PENALTY OF PERJURY THAT 1 AM LICENSED UNDER PROVISIONS OF CHAPTER P (CUMMENCNG WITH SECTION 7000) OF DIVISION 5 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT. LICENSE CLASS _ C _!S3 LIC. NO. DATE_7- CO CONTRncTOFI V_AC01 EW_ WORKERS' COMPENSATION DECLARATION�7 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' COMPENSATON,AS PROVIDEDBY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF TFIE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WILL MAINTAIN WOPoTERB' COMPENSATION INSURANCE, AS REQUIRED BY SECTION 5700 OF THE LABOR CODE. FORTHE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' COMPENSATION INLSURE CARRIER AND POLICY NUMBER ARE: CARRIER POLICY NUMBER _Z C__��`� +' FOBS SECTION NE®HOT SECOMPLETEDOFTHE PEFWST IS PORCINE H UNDFIEDDOUALS ($100)OR LESS) I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CAUFORNIA, AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 5700 OF THE LABOR CODE, 1 SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE: APPLICANT: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 16 UNLAWFUL, AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (S 100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 5706 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 WHICH TMS PERMIT IS ISSUED (SEC. 3"7, CIV. C.). LENDERS NAME LENDER'S ADDRESS 1 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY "T" ALL CRY AND COUNTY ORDINANCES AND STATE LAWS RELATM TO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. e4 r"At PERMITTE E (PRINIT SIGNATURE OF PERMITTEE DAY I WHITE—DeparanenF COW YELLOW—Flnanos Copy, PINI PRESS FIRMLY r APPLICATIO PERMIT % P/C 06431' a DATE NUMBER 0 ISSUE TYPE . OCC OATE�5.1 CONST. GROUP ZONING SETBACKS FRONT RW E3 REAR p SIDE/SIDE STREET RW ❑ SIDE PROPOSED USE n f /wqtt NO. DWEL. NO.NO. UNITS STORIES EDROOMS DESCRIPTION SO. FT. FACTOR ADJ. AREANALUATION SFRIADD/REM N GaInge/CalpoR LU Patio/Dock LL POOVSPa Z Re -Roof Commercial 5 m Valuation ADJ.AREA QUANTITY DESCRIPT16V FEE U it . H U 2 z m a U_ Z Z U LOU CONSTRUCTION IrV ---- PLAN REVIEW 1 ELECTRIC PLUMBING MECHANICAL INSPECTION FEE ISSUANCE SMIP DIAMOND BAR ENERGY P/Ci�r� r 4 ANDS + T� ENERGY PERMIT RETENTION FEE: PRE• T kie TOTAL FEES qqeJ�5 fn�Py(�} C COMMENTS ,! I r I I v' "`'�© RECPT. NO. PAID BY Cf VALIDATION w%w, um=r4—Appllcwrs LApy CITY OF DIAMOND BAR INSPECTION RECORD '" fir•• �, [ , _ BACK E � � , ; FLOOR JOIST �. . 7SET _ _ _ FTGS/FORMS/STEEL —� _ FH_A_REQM_TS _ ELECTRIC GROUND _ UNDER FLOOR DUCT _ GROUND PLUMBING — UNDER FLOOR CONDUIT: SLAB GRADE I FIREPLACE FOUNDATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICE i I MID HT. BOND BEAM ROOF SHEATHING ��_ 8 FT. BOND 6EAM FR_AMINGNENTILIATIO_N FINAL BOND BEAM _ ROOF COVER PRE -GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC _ ROUGH PLUMBING ROUGH GRADING FINISH GRADING j SHOWER.ITUB TEST —_ POOL ELECTRIC EXT. LATH/SIDING j POOL FENCING WALL INSULATION— �— —� j POOL FINAL CEILING INSULATION I OFF SITE IMPS. DRYWALL NAILING— _ DEDICATIONS FINAL ENG. SEPTICTANK { I LANDSCAPE/IRRIG. j SEEP PITlL.L. t ON SITE IMPS. GAS AIR _TEST FINAL CONST_._—�..��pp I -,^ FINAL HEATING I _ ;i FINALZ-ONING -� FIRE DEPT. FINAL DEPT. FINAL — FINAL ELECTRIC I _HEALTH DEV. FEES PAID FINAL PLUMBING E ENERGY i- _' COMMENTS rem - 11j 1 SEPTIC TANK SIZE SEEP PIT/U SIZE