HomeMy WebLinkAbout13480 (24)CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY do DEVELOPMENT SERVICES
21660 E. Copley Drive Suite 190
(909) 860-3195 Fax (909) 861-3117
BUIIAING PERMIT APPLICA
DATE NUMBER �'j V0 N
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DATE CONST. GROUP
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UNITS STORIES BEDROOMS
ADDRESS
DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION
CITY ZIPf2-" TEL. I
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APPLICANT TEL.
Garage/Carport
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OWNER -BUILDER DECLARATION
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I HEREBY AFFWM PENALTY PERJURY THAT I EXEMPT FROM THE CONTRACTORS
LLUNDER
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CENSE LAN' FOR THE FOLLOWING REASON (9EC. 7041.8 BUSNE49AND PROFESSIONS CODE: ANY CITY OR
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COMMWMICHREQUNESA PERMITTO CONSTRUCT,ALTER, IMPROVE. DEMOLISH. ORREPAIRANYSTRUC-
TURE, PFSOTi 1D ITS184UANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS U-
C
CENSE LAW (CHAPTER 8 ICOMME NCNG WITH SECTION 7000) OF DIVISION 4 OF THE BUSINESS AND PRO-
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FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFRDMANDTHE BASIS FOR THE ALLEGED EXEMP-
TION. ANY VIOLATION OF SECTION 7041.8 BYANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO
ACIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS 18600).1:
O L ASOWJNER OF THE PROPERTY, ORMY EMPLOYEES WITH WAOESAS THEIR SOLE COMPENSATION,
12
WILL DO THE WORK. AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC, 7044, BUSI-
NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF
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PROPEATYWHO BUILDS OR IMPROVES THEREON, AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTSARE NOT INTENDED OR
OFFEREDFORSLEIF. HOWEVER THEBUILDING ORIMPROVEMENT SSW WITHIN ONE YFAROFCOMPLE-
TION, THE OWNERAIJILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DO NOT BUILD OR
IMPROVE FOR THE PURPOSE OF SALE).
O L AS OWNER OF THE PROPERTY. AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS
CONSTRUCTION
To CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PFIOR53IONS CODE: THE CONTRACTORS LI-
PLAN REVIEW
CENSE LAW DOES NOTAPPLY TOAN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON. AND
ELECTRIC
W HOOONTRACTS FOR SUCH PROJECTS WITHACOMMCTOR(S) LICENSED PURSUANTTOTHE CONTRAC-
PLUMBING - s
TORS LICENSE LAW.).
MECHANICAL
O 1 AM EXEMPT UNDER SEC. B. S P.C. FOR THIS REASON
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DATE OWNER
ISSUANCE E ° '' ` d'•' ^ rl I
SMIP CIT;, _
LICENSED CONTRACTORS DECLARATION
1
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I HEREBY AF'FSIM TINDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER
ENERGY PERMIT"
0 (COMMENCING WITH SECTION 7000) OF DIVISION 3 O THE BUSINESS AND PROFESSIONS CODE, AND
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MY LICENSE IS IN FULL FORCE AND EFFECT.
LICENSE CLASS LIC. NO. 6 k 07-1 /
PRE -ALT FEE:
DATE 1 ' / 1" QQ CONTRACTORRAI &I,f .
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WORKERS' COMPENSATION DECLARATION
COMMENTS
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I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
RECPT. NO. PAID BY VALIDATION
I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS'
C
COMPENSATION. AS PROVIDED BY SECTION 9TOD OF THE LABOR CODE, FOR THE PERFORMANCE
OF THE WORK FOR WHICH THIS PERMTT 19 ISSUED.
-94� HAVE AND WILL MAINTAIN WORKERSOOMPENSATION INSURANCE, AS REQUIRED BY SECTION
3700 OF THE LABOR COOS FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
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159UEO. MY NO__ j;' C7�IPEN IN9U CAr AND POLICY NUMBER ARE:
CARRIER 1/ 17 v IF G�.1i 4
POLICY NUMBER ui 4_(- ! ti
M488GCTICINWM NOT BEmLRETEDOFTHE PERMIT IS FORCNE FUFDR EDLKUARS MMORLFS4
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I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS IRSUEO, I
SHALL NOT EMPLOY ANY PERSON N ANY MANNER $O AS TO BECOME SUBJECT TO THE
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WORKERS' COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF I SHOULD BECOME
SUBJECT TO THE WORKERS' COMPENSATION PROWSIONSOF SECTION 3700 OF THE LABOR
S
0
CODE• I SHALL FO WITH COMPLY WITH THOSE PIIOVISIOMS.
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DATE: APPLICANT: F q-
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL_ AND SHALL BE
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SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP 70 ONE HINDRED THOUSAND
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DOLLARS (6100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
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CONSTRUCTION LENDING AGENCY
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CC
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS ACONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. SGPT, CIV. C.).
63
LENDERS NAME
LE•NDERSADDRESS
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I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THEABOVE INFORMATION 13 CORRECT.
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I AGREE TO COMPLY WITH ALL CT' AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
CONSTRUCTION. AND NEREBYAUTHORIZE REPRESENTATIVES OF THIS COUNTYTO ENTER UPON THE
ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES.
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PERMTTTEENAM 41
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APPLICATION PERMIT(fir I Qll PIC
DATE NUMBER �'j V0 N
ISSUE `4_ CjLl TYPE OCC
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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
SFRIADDIREM
U3
Garage/Carport
W
Patlo/Deok
V-
POOVSpa
ZRe
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Commercial
CD
Valuation ADJ.AREA
QUANTITY DESCRIPTION FEE
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CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING - s
MECHANICAL
INSPECTION FEE
ISSUANCE E ° '' ` d'•' ^ rl I
SMIP CIT;, _
ENERGY P/G
ENERGY PERMIT"
RETENTION FEE:
PRE -ALT FEE:
^
TOTAL FEES
COMMENTS
RECPT. NO. PAID BY VALIDATION
WHITE --Department Copy, YELLOW—Finenoe COW PINK—Assessor Copy, GOLDENROD --File COW GREEN=Applicetnt's Copy
CITY OF DIAMOND BAR
INSPECTION RECORD
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FIREPLACE FOUNDATION
FIREPLACE BOND BEAha
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1 MID HT. BOND BEAM
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Dr -%I FEES PAID
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