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Home My WebLink About11-886 (5) �' ' � � CITY OF DIAMOND BAR � _7��?�.— -- -- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES ... 21825 Copley Drive,Diamond Bar,CA 91765 � (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS �'hp'� BUILDING PERMIT APPLICATION ' �i FIRMLY oN JOBSITE �^ , y4;�_Q� C 1� APPLICATION PERMfT p/C ADDRESS �•-R DATE_ NUMBER� # 4� ISSUE TYPE � OCC � APN LOT. TRAC� DATE O CONST�C� GROUP p OWNER ��-- p ADDR SS � ZONING SETB CKS z CITY TEL. dt 1 � FRONT qyy � o APPLICANT 1 TEL. SIDFJSIDE STREET qyy p � CONTRACTOR SIDE p ADDRESS � CITY ZIP TEL. PROPOSED USE C�� o ARCH/ENG/ z DESIGNER � ADDRESS NO.DWEL. NO. NO. � CITY ZIP TEL. UNITS STORIES BEDROOMS � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADD/REM O • p I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT I AM EXEMPT FROM THE CONTRACTORS LI� G8f8gB/C6fpOf1 W CENSELAWFORTHEFOLLOWINQREASON(SEC.7031.5BUSINESSANDPROFESSIONSCODE:ANYCITYOF (n U CAUNryWF11CHRE0UIRESAPERMRTOCONSTAUCT,AITER,IMPROVE,DEMOLISH,ORREPAIRANVSTRUG w w NRE.PRqR TO ITS ISSUANCE,ALSO REOUIRES THE APVLICANT FOR SUCH PERMIT TO FILE A SIQNED w Petia/Deck � STATEMEN7 THAT HE OR SHE IS IJCENSED PURSUANT 70 THE PROVISIONS OF 7HE CAN7RAC70H5 LI- � CENSE UW(piAPTER D(COMMENCING WITH SECTqN 7000)OF DIVISqN 3 OF THE BUSINESS AND PRO� � POOUSPO ^ FESSIONS COD�OR THAT HE OR SHE IS EJ(EMPT THEREFROM M!D THE BASIS FOR THE ALLEGED E%EMP- (� V TION. VIOUTKKJ OF SECTION 7031.5 BV ANV APPLICANT FOR A PERMIT SU&lECTS THE APPLICANT TO Z Re-Roof � A ENALTV OF NOT AqRE THAN FIVE HUNDRED DOLLARS(i500).): � I,ASONMEROFTHEPROPER7V,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, 0 COf11RIefCI9I . THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7Ma,BUSI� J N NESS D PROFESSIONS CODE:THE CONTMCTORS LICENSE UW DOES NOT A7PLV TO AN OWNER OF � PROPER7V VhiO BUILDS Oq IMPROVES TMEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR Q THROUGH HIS OR HEfi OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m Q OFFEAEDWRSALEIF,HOWEVERT7EWILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCAMPLE� Z TION.THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVINQ THAT HE OR SHE DID NOT BUILD OR � IMPROVE FOR 7HE PURPOSE OF SALE). w OI,ASONRlEROFTHEPROPERIY,AME%CLUSIVELVCONTRACTIN6WITHLICENSEDCONTRACTORS Q TO CONSTpUCT THE PR0.IECT(SEC.70N,BUSINE55 ANO PROFESSIONS CODE:TNE CONTMCTOHS LI- V81U0flOn ADJ.AREA W CENSE UW DOES NOTAPPLV TOAN OWNER OF A PROPERTV WHO BUILAS OR IMPROVES THEREON,AND � WFIOCANTRACTSFORSUCHPROJECTSWI7HACONTRACTOR(S)UCENSEDPURSUANTTOTHECANTRAG QUANTITY DESCRIPTION Y TORS LICENSE LAW.�. FEE QO I AM E%EMPT UNDER SEC. B.6 P.C.FOR THIS REASON Q � � U , � DA O H • Z U �Q I E SED CONTRACT S D LARATION w � 2 I HEREBY AFFIHM UNDER PEN�LTV OF PERIURY THA7 I AM LICENSED UNDER PROVISIONS OF CHAPTER � �/ � o(OOMMENCINO WITN SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z Iv �� YV LICENSE IS IN FULL FORCE AND EFFECT. m � . _� •� ln � LICENSE CLASS LIC.NO. � U DATE CONTRACTOR � W � WOFKERS'COMPENSATION DECLARATION Q � U � I HEREBV AFFIRM UNDER VENALTY OF PERJURV ONE OF THE FOLLOWING DECLARATIONS: Z � _I HAVE AND WILL M/JNTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WOfiKERS' a 2 C0IAPENSATION,AS PROVIDED BV SECTION 370o OF THE LABOR CODE,FOP THE PERFORMANCE U OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. w � � � _I HAVE ANO WILL MAIMAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTqN Q 370o OF THE UBOH CODE,FOR THE PERFORMANCE OF THE WOfiK FOR WHICH THIS PERMIT IS ISSUE�.MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION � CARRIER PLAN REVIEW � POLICV NUMBEN Zd ELECTRIC � fG� � (�F65SECTqNNE�NDTBECOAPLEfEDOFTiEPEAAQiISfaRpNEHIy�OqEDDOUAAS(5100�OqLESSA PLUMBING T S.S / W Z I CERTIFV THAT IN THE PERFO{iMANCE OF THE WOR1C FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL , C} SHALL NOT EMPLOV ANY PERSON IN ANV MANNER SO AS TO BECAME SU&IECT TO THE (n WORKERS'COMPENSATIONIAWSOFCALIFORNIA,ANDAGREETHATIFISHOULDBECOME INSPECTIONFEE SU&IECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 370o OF THE LABOR � O CODE.I$HALL FOR7HWITH COMPLV WITH THOSE PROVISIONS. ISSUANCE - . , p DATE: APPLICANT: SMIP W J WARNINO:FAILURE TO SECURE WORNEFS'COMPENSATION CAVERAGE IS UNUWFUL,AND SHALI BE ENERGY P/C J � SU&IECTANEMPLOYEFTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT DOlLARS(5700.000).IN ADDITION TO THE COST OF COMPENSATION,DAMAOES AS PROVIDED f-0R IN J SECTION 37oe OF 7HE LABOR CODE,INTEREST,AND ATTORNEYS FEES. -1 w RETENTION FEE: ��V I O CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � I HEREBY AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS A CONSTRUCTION LENDINO AOENCY FOR THE PEHFORMANCE OF THE WORN FOR WHICH THIS PERMR IS ISSUED(SEC.3oe7,CIV.C.). Z W � LENDERS NAME H LENDER'S ADDRESS w I CERTIFY THAT 1 HAVE READ THIS APPLICATION AND STATE hIAT THE ABOVE INFORMATqN IS CORAECT. TOTAL FE ES • �/ � 1 AGREE TO CAMPLV WITH AlL CITY AND COUNTY ORDWMlCES AND STATE UWS REUTING TO BUILDINO � CONSTRUCTION,AND HEREBY AUTViOR12E REPRESENTATNES OF THIS COUNTV TO ENTEF UVON THE ' Z ABOVE�MENTpNED PROPERTV FOR INSPECTIDt�7URPOSES. COMMENTS ' o -p►�e�N� � m PERMI AME(PRI ' � � .� DI;( N SN3NANR PE EE ATE � � RECPT.NO. � PAID BY VALIDATION ' WHITE—Depertment Copy,YELLOW—Finance Copy,PINK—Aasessor Copy,GOLDENROD--File Copy,GREEN—Applicant's Copy � CETY C3� DIAf1AOND ��►R . . � , . • � p� ,�+4 p� /+ •` , �ItlS��'lr 0 �Qltl ��r�� ,r . . .. -, :�. .. - . - h..��GY1�3pGC�40�[� �., p , � �,�(��C�C�' G�I�C C�i 0 f�� .��1� C��u .. , � , . ._ . ,� ; . _ , �, : , v o „,fo �: , o o . : :. �. �.. _ :; . � _. OG.J �f�;` SET BACK FLOOR JOIST FTGS/FORMS/STEEL FHA REQMTS ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR CONDUIT SLAB GRADE FIREPLACE FOUNDATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICE MID HT. BOND BEAM ROOF SHEATHING 8 FT. BOND BEAM FRAMINGNENTILATION FIfVAL BOND BEAM ROOF COVER PRE-GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC 7��j�� _ 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 OEPT. FINAL FINAL HEATING HEALTH DEPT. FINAL � � � F�NAL ELECTRIC DEV. FEES PAID FINAL PLUMBING • ENERGY C�.��o COMMENTS SEPTIC TANK SIZE SEEP PIT/U SIZE a � � :� a ` ' � _ CITY OF DIAMOND BAR � ---`��— DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 Copley Drive,Diamond Bar,CA 91765 pR�$$ � �� '� (909}839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 `��fw BUILDiNG PERMIT APPLICATION FIRMLY � JOBSITE %.�{�j �/��i! //�a� APPLICATIO S �a PERMIT �• P(C oADDRESS ✓ «�lN� ��- DATEu NUMBER��-'S� q ��- � � � ISSUE . TYPE OCC � APN OT TRACT DATE �/a 4"/�1 CONST. GROUP p OWNER � - ZONING SEfBACKS ' 'p ADDFa£SS � - �� G FRONT RW ❑ Z C�Ty ZIP TEL. REAR ❑ o APPLICANT TEL. SIDFJSIDE STREET RW ❑ ¢ SIDE O � CONTRACTOR � � ADDRES PROPOSED USE � � � O C�Ty ZIP TEL. w ARCH/ENG/ z DESIGNER NO.DWEL. NO. ' NO. a ADDRESS UNITS L STORIES Z� BEDROOMS � C1TY ZIP TEL. � pESCRIPTION SQ.FT.' • FACTO PSF ADJ.AREANALUATION � Q OWNER-BUILDER DECLARATION SFR/ADD/REM � • O � I HEREBY AFFIRM UNDER PENALTY OF PERri1RV THAT I AM E%EMPT FROM THE CONTMCTORS LI- GBfe(JB/C8lPOfl W CENSEUWFOHTHEFOLLOWINOREASON(SEC.70.31.SBUSINESSANDPROFESSIONSCOOE:ANYCITVOR (n I U CWNTYWHICNREQUIRESAPERMITTOCONSTRUCT.AITER,IIAPR�VE,�EMOIISH,ORREPAIRANYSTqUC� W P0I10/DBCK wNRE,PR�OR TO ITS ISSUANCE,AL50 REOUIRES THE APPLICANT FOfl SUCH PERMIT 70 FILE A SIONED w , � STATEMENT TF1AT HE OR SHE IS UCENSED PURSUANT TO THE PROVISIONS OF TNE CONTRACTOPS LI- � POOVSPB � CENSE UM�(CMAPTEA�(C�MMENCING WITH SECTION 7000)OF DIVISION 3 OF 7HE BUSfNE55 AND PRO- � FESSIONS CODE)OP 7}U7 HE OR SHE IS E%EMPT TNEREFROM AND THE BASIS FOR THE ALlEOED EXEMP- TqN./JJY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOF A PERMIT SU&lECTS THE A7PLtCNJT T0 Z Re-Roof � A GML VENALTY OF NOT MORE TNAN FIVE HUNDRE�DOLLARS(5500).): � ❑I,ASONMEROFTHEPROPERTV,ORAIVEMPLOVEESWITHWAOESASTHEIRSOLECOMPENSATION, � COrtIffIBfC19I � Z WILL DO TNE WORK,AND 7HE STRUCTURE 75 NOT�NTENDED oR OFFERE�FOR SALE(SEC.7ou,BUSI� J � NESS AND VROFESSIONS CODE:THE('ANTRACTORS LICENSE UW DOES NOT APPLY TO AN OWNER OF � PROPERTY WF�O BUIlDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR [[ 7HROUGH HIS OR HER ONTJ EMPLOVEES,PROVIDED THAT SUCH IMPROVEMEMS ARE NOT INTENDED OR m QOFFEREDFORSALEIF,FIOWEVERTMEBUILDINGOFIMPROVEMENT�SSOLDWITHINONEVEAROFCOMPLE� Z TqN,THE OWNER�BUILDEfl WILL NAVE TFIE BURDEN OF PROVWO TNAT HE OR SNE DID NOT BUILD OR � IMPROVE FOR THE PURPOSE OF SALE). w ❑I,ASOWNEROFTHEPROPEHTY,AME%CLUSIVELVCONTMCTINOWITHLICENSEDCONTi7ACTORS TO CONSTRUGT THE PRQIECT(SEC.70U,BUSINESS AND PROFESSIONS CODE:TTIE CONTMCTORS LI- V0IU0110fi ADJ.AREA W CENSEUWDOESNOTAPPLVTOANOWNEROFAPROPERTVWHOBUILDSORIMPROVESTHEREON,AND Z NM1IOCONTRACTSFORSUCHPROJECTSWIhiACONTRACTOH(S)LICENSEDPURSUANTTOTHECONTRAP OUANTITY DESCAIPTION FEE � TORS UCENSELAW.�. L ❑IAM EXEMP7UNDERSEC. B.8 P.C.FORTHIS REASON � �V TI� (,�� o c� � t��.2. a.. � Q LL DATE OWNER U . Z W � LICENS£D CONTRACTORS DECLARATION -� ¢ W , OC 1 HEREBY AFFINAI UNDER PEN�LTY OF PEFJUFlY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTEfi � ' %Q/ r�"� � i(COMMENCINa WITN SECTION]000)OF DIVISION 3 OF THE BUSINE55 AND PROFESSIONS CODE,M1D Z �f �� MV UCENSE IS M FULL E AND EFFECT. m S�N I� � � � LICENSE GLASS LIC.NO. / J �^'� V pp� _ CONTRACTOR a W � WORKERS'COMPENSATION DECLARATION Q � O� '� ti V N 1 HEREBV AfFIPM UNDER PENALTY OF VERJURY ONE OF h1E FOLL6WiNG DECURATIONS: Z Q 0 IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF�INSUREFORWORNEfiS' 2 ' � COMPENSATION,AS PROVIDED BV SECTION 3100 OF THE LABOR CODE,FOR THE PERFORMANCE W OF THE WORK FOR WHICH THIS 7ERMIT IS ISSUED. � � W _I HAVE AND WILL MAINTAW WORNERS'COMPENSATION INSUFANCE,AS REDUIRED BV SECTION Q 3700 OF THE I.ABOF CODE.FOF THE PERFORMANCE OF THE WORK FOR WHICH THIS PEAMIT IS � a G�� " ISSUED.MY WOflKERS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION / '� jCARRIER PLAN REVIEW �b a �Z �� , q r � � POLICV NUMOER ELECTRIC `r�� . Z ¢ `�'S- S`-1 � (iHISSECTqNN�NOTBE00MP�EfFDOFTFVEPER�ISFOHONEM�DRE�00LlA�.�`(5��1�L`EuS� PLUMBING w MECHANICAL ��"�' �, Z 1 CERTIFV THAT IN 7HE PEAFORMANCE OF THE WORK FOR WHICN THIS PERMIT IS ISSUED.I , () SHALL NOT EMPLOY ANY PERSON IN ANY MANNEH SO AS TO BECOME SU&IECT TO THE Uj WORNERS'COMPENSATION UWS OF CALIFORNIA.AND AGREE TMAT IF I SHOULD BECOME INSPECTION FEE SU&IECTTOTHEWORKERS'COMPENSATIONPROVISIONSOFSECTIDN77000FTHELABOR ld� �j0 � E =ALL RTHWITHCOMPIYWITHT�Q� ISSUANCE O SMIP a �� p DATE: APPLICANT: � w �NERGY P/C ��r o�S J WARNIN6:FAILURE TO SECURE WORNERS'CAMPENSATION CAVERAGE IS UNLAWFUL,AND SHALL BE J SUB.IECT Pfi EMP�OYER TO CRIMINAI PENALTIES MlD CM�FWES UP TO ONE HUNORED TNAUSAND �� ` � DOLLARS(f100.a0a),�N�DDITION TO 1HE COST OF GOMPENSATION,DAMAGES AS VROVIDED FOR IN ENERGY PERMIT J SECTION 3708 OF THE LABOF CODE,INTERE57,ANO ATTORNEV'S FEES. RETENTION FEE: 1 ` ' � . � w CONSTRUCTION LENDING AGENCV PRE-ALT FEE: � O ��{�� •1,�^J � I HEREBY AFFIRM UNDER PENALTV OF PERIURV THAT THERE IS A CONSTRUGTION LENDINO AGENCV FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3077.C�V.C.�. Z W � LENOER'S NAME F- LENDER'S AD�RESS /a.�� \ � I CERTIFV THAT I HAVE READ THIS APPUCATION AND STATE THAT hIE ABOVE INFOR/AATION IS CORRECT. TOTAL FE ES �� 1 ' 1� S�S� �1 w I AGREE TO CAMPLV WITH ALL CITV AND COUNTV ORDINANCES AND STATE IAWS PEUTING TO OUILOING � CANSTRUCTION,AND HEREBV AVTNORIZE REPRESENTA71VE5 OF THIS COUNTV TO ENTER UPON THE � ABOV- ED 7ROPERTV FOR I PECTION PURPOSES. . Z COMMENTS � � �� ¢ PERMITTEE PRI �w �� `�� C/� � [�� ,� sw UREOFPERM�TfEE ��T fiECPT.NO. ��P " PAID BY �� _ YALIDATION �Y 1 - � WHITE—Depertment Copy,YELLOW--Finence Copy,PINK—Assessor Copy,GOLDENROD--File Copy,GREEN—Applicant's Copy CITV O� DBAiViO(�D �,a►0� ,� � � .� • .. � INSP�C�'90�1 6��CORD '� � ,�::,. � �:. � � . � - e e � • ' , _ _. .r�_ SET BACK FLOOR JOIST FTGS/FORMS/STEEL -!��l� FHA REQMTS ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBING �I/ UNDER FLOOR CONDUIT � SLAB GRADE FIREPLACE FOUNDATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICE MID HT. BOND BEAM ROOF SHEATHING 8 FT. BOND BEAM FRAMINGNENTILATION FINAL BOND BEAM ROOF COVER PRE-GRAD�NG -- 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 HEALTH DEPT. FINAL FINAL ELECTRIC DEV. FEES PAID FINAL PLUMBING ENERGY � � ' 9 • �w�- COMMENTS S �� SEPTIC TANK SIZE SEEP PIT/U SIZE ��,� �,��,� . � ��r �� y.� � � �`�` u sr:' ,, d, g.: �r�� "�' ��, ��13 ��--��.� ,��,�,�_ CITY OF DIAMOND BAR -- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21825 Copley Drive,Diamond Bar,CA 91765 (909)839-7020 Fax(909)861-3ll7 Building Inspection Hotline(909)839-7027 PRESS �'��'� BUILDING PERMIT APPLICATION FIRMLY I � JOBSITE � �� f u�� ) � � ADDRESS L��I�L��^TO �' '"�L� DATE CATION� / � r� NUMB R g/C/ � -��j � I � ISSUE 'ryPE �C AP LOT1� TR CT d DATE CONST. GROUP p OWNER . I� o ADDRESS� ZONING SETBACKS Z CITY ZIP TE . FRONT qyy � g APPLICANT TEL. -+ SID SIDE STREET RW ❑ � CONTRACTOR SIDE � ADDRESS � CITY ZIP TEL. PROPOSED USE w ARC z SIGNE � a ADD S NO.DWEL. � NO. NO. � CITY I TEL. UNITS STORIES �_ gEDROOMS � � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION p SFR/ADD/FiEM p I HEREBV AFFIRM UNDER PENALTY OF PERIURV THAT I AM EXEMPT FROM THE CAMRACTORS ll- G0f8 0/C8 fS W CENSEUWFORTHEFOLLOWINOREASON(SEC.7031.68USINESSANDPROFESSIONSCODE:ANVqTVOR (f� 9 � ZCOUNTVWHICHREOUIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC- W Patio/Deck w NRE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w � STATEMEM TiAT HE OR SHE IS LICENSED PUFlSUANT TO THE PROVISIONS OF THE CONTRACTORS LI� � CENSE LAW(CHAPTER e(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� u' Pool/Spa ^ FESSIONS CODE)OR h1AT ME OR SHE IS E%EMPT THEREFROM AND THE BASIS FOR THE ALLEOED E%EMP- (� � TION.ANV VpUT10N OF SECTION 7031.5 8V ANY APPLICANT FOR A PERMIT SU&lECTS THE APPLICANT T0 Z qe-Roof ACML VENALTV OF NOT MORE THAN FIVE HUNDRED DOLLARS(S60o)J: � OI,ASOWNEROFTHEPROPERTY,ORA/VEMPLOYEESWITHWAOESASTHEIRSOLECOMPENSATION, � COrtIR18fCI8I Z WILL DO 7HE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7011,BUSI� J ' N NESS AND PROFESSlONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF ? PROPEHTV NR10 BUILOS OR IMPROVES THEREON,AND WHO OOES SUCN WORK HIMSELF OR HERSELf OR Q THRIXIOH HIS OR HER OWN EMPLOVEES,PFOVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m w OFFEREDWRSALEIFHOWEVERTMEBUILDINGORIMPROVEMENTISSOLDWRHINONEVEAROFCOMPIE� �� TION,THE OWNER-BUILDER WILL HAVE THE BUHDEN OF PROVINQ T}WT HE OR SHE DID NOT BUILD OR IMPROVE FOR TF{E PURP0.SE OF SALEj. - w O I,AS ONMER OF THE PROPER7V,AM E%CLUSIVELV CONTRACTIN6 WfTH UCENSED CONTRACTORS [[ TO CONSTRUCT THE PR0.IECT(SEC,7011,BUSINESS AND PROFESSIONS CODE:THE CONTMCTORS LI- V01U8f1Of1 ADJ.AREA W CENSE LAW DOES NOTAPPLY TO AN ONRJER OF A PROPERTV Wl10 BUILDS OR IMPROVES THEREON,AND � NTIOCONTRACTSFORSUC}1PRQIECTSWITHACONTRACTOR�S)LICENSEDPURSUANTTOTHECONTRAG qUANT1TY DESCRIPTION Y roas ucENse uw.�. FEE QO I AM E%EMPT UNDER SEC. B,8 P.C.FOR THIS REASON Q � U LL DATE pWNEq ¢ �Q LICENSED CONTfiACTORS DECLARATION w CC 1 HEREBY AFFIRM UNDEfl PENALTV OF PERIURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � � Y(COMMENCINCi WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE.AND Z �� MV UCENSE IS IN FULL FORCE AND EFFECT. m � LICENSE CLASS LIC.NO. � V DATE CONTRACTOR a. W � WORKERS'COMPENSATION DECLARATION � � I HEREBV AFFIRM UNDER PENALTY OF PERIURV ONE OF THE FOLLOWING DECU{UTIONS: V � Z �Z I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORKERS' a Q = COMPENSATqN,AS PROVIDED BV SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMANCE U OF THE WOqN FOR WHICH THIS PERMIT IS ISSUED. w 0 � _I HAVE AND WILLMAWTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION Q 370a OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS J ISSUED.MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER AAE: CONSTRUCTION r� j CAARIER PLAN REVIEW �.C�� 5 rf� Z POLICYNUMBER ELECTRIC Q � (RBSSEC�qNN�NOTBE00A1RFfIDOFTFiEPERMfTISFOqONEHU�DRmDOl1/��S10o)OqLE55} PLUMBING W Z I CERTIFV 7HAT IN hiE PEFFORMANCE OF TNE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL C.�} SHALL NOT EMPLOV ANV PERSON IN ANY MANNER 50 AS TO BECOME SUBJECT TO THE (/� WORICERS'COMPENSATqNLAWSOFCALIFORNIA,ANDAGREETHATIFISHWLDBECOME INSPECTIONFEE SU&IECT TO THE WORKERS'COMPENSATION VROVISIONS OF SECTION 3700OF THE LABOP S CODE,1 SHALL FORTHWITH COMPIV WITH THOSE PROVISIONS. ISSUANCE 0 p DATE: APPLICANT: SMIP w ENERGY P/C � J WAHNING:FAfLURE TO SECURE WORNERS'CAMPENSATtON CAVERAGE IS UNLAWFUL,AND SHAIL 8E � � � SU&IECTAN EMPLOVER TO CRIMINAL PENAlTIES AN�CIVIL FINES UP TOONE HUNDRED THOUSAND ENERGY PEAMIT DOLURS(5100.000),IN ADDITION TO TNE COST OF CAMPENSATqN,DAMAGES AS PROVIOED FOR IN w SECTqN 3]OB OF THE LABOR CODE,MTEREST,AND ATTORNEI^S FEES. RETENTION FEE: O CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � I HEREBYAFFIRM UNDER PENALTV OF PERJURV THAT THERE IS ACONSTRUC710N LENDINQ AGENCV FOR THE PEFFORIAlWCE OF THE WORN FOF WHICN THIS PERMIT IS ISSUED(SEC.308�,CIV.C.). Z W � LENDER'S NAME � 1— LENDER5ADORESS �) w I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE WFORMATqN IS CORRECT. TOTAL FE ES � /��O � I AOREE TO COA/PLV WfTH ALL CITV AND COUNTV ORDINANCES AND STATE LAWS PEUTINO TO BUILDING � CANSTRUCTION,ANDHEREBYAUTHORIZEREPRESENTATIVESOFTHISCOUNTYTOENTERU70NTHE Z ABOVE-MEN7qNED PROPEqTY FOR INSPECTION PURVOSES. COMMENTS � J � m PERMR7EENAME(PWN'� ' � Q � `�29 9 / � SI(3NANREOFPERMITfEE DATE � RECPT.NO. PAID BY VALIDATION WHITE—Department Copy,YELLOW�inance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GFiEEN—Appllcanl's Copy C9TY O� DI�i1�OND �AR � ' INS��TEOft! �iECOF6D � _ �.: - �� :� ot��r��ooa ��. .r o �� a _- �., aq��c�ooa,. , :Da4� aa�p�c��a�. SET BACK • '. FLOOFf JOIST ' ' � FTGS/FORMS/STEEL FHA REQMTS • ' ELECTRIC GROUND UNDER FLOOR DUCT " GROUND PLUMBING UNDER FLOOR CONDUIT ' ' SLAB GRADE FIREP_LACE FOUNDATIOM � TEMP POWER FIREPLACE BOND BEAM WATER SERV.ICE • MID H'T. BOND BEAM ROOF SHEATHINU ' 8 FT. BOND BEAM ' FRAMINGNENTILATION ' FINAL BOND BEAM • • � ROOF GOVER PRE-GRADING ' � ROUGH HEATING BEN(�HING- � ROUGH ELECTRIC ' ROUGH GRADING ROUGH PLUMBING FINISH GRADING SNOWERrfUB TEST POOL ELECTRIC EXT. �ATH/SIDING POOL FENCING WALL INSULATION POOL FINAL CEILING INSULATION OFF SITE IMPS. DRYWALL NAILING DEDICATIONS SEWER F►NAL ENG. SEPTIC TANK LANDSCAPE/IRRIG. 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 (�"�!l �� COMMEfVTS _�� _ �� ,,, �,�„--��I� SEPTIC TANK SIZE SEEP PIT/U SIZE a � � •YS.Y�, .��.