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HomeMy WebLinkAbout15082 (24)1)I,1110JU 11,11'9'11III& CITY OF DIAMOND BAR EXPIRED DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION _ e JOBSITE ADDRESS h CA h G- APN LOT TRACT OWNER PLAID ADDRESS IS "1�►J m CITY p:a , n lgQ+r^IPqt 7�.r TELI —07a2 APPLICANT _j_'✓L�. TEL.(rlg(� -dozo CONTRACTOR (1hr ec ADDRESS Z ` CITY em,plauj l4k zipqIZ14 6 TEL. Q! ki�e2� ARCH/ENG/ DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE: ANY CITY OR COUNTY WHICH REWIRES A PERMIT TO CONSTRUCT, ALTER, IMPROVE, DEMOLISH, OR REPAIR ANY STRUC. TURE, PRIOR TO ITS ISSUANCE, ALSO REWIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI - 00 CENSE LAW (CHAPTER 9 (COMMENCING WITH SECTION 70) 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 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS ($SOD).): O I, AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WALL 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 PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO 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 WALL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). ❑ I, 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 LAW DOES NOTAPPLYTO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAG TORS LICENSE LAW). ❑ 1 AM EXEMPT UNDER SEC. B. 6 P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM LICENSED UNDER PROVISIONS OF CHAPTER 91 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT. LICENSE CLASS 6—Z7 7 LIC. NO. 7 r l �7 � t. ID DATE 4 ! ?' ��' CONTRACTOR WORKERS' COMPENSATION DECLARATIO 1 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' COMPENSATION, AS PROVIDED BY SECTION 370OOF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. _'HAVE AND WILL MAINTAIN WORKERS' COMPENSATION 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 INSURANCECARRIER AND POLICY NUMBER ARE: CARRIER 1'4 a D✓�! �- • _f wfiC_. POLICY NUMBER L R Z/ D T-7 40 (TFOS SECnCN NE® NOT BE OCI.IPLETED OFTHE PERMIT IS FOR ONE HUNDRED DWARS ($100)OR LESS). I CERTIFY THAT IN 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 CALIFORNIA, AND AGREE THAT IF I SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PRO VIS NS OF SECTION 3700 OF THE LABOR ,IS HALL FORT�IWI�COMPLY WITH P VISIONS,. Xn DATE�gAPPLICANL �✓ C WARNI O: FAILURE TO SECURE WORKERS' MPENSATION C ERAGE IS UNLAW . AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PEN TIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (51 00,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 370E OF THE LABOR CODE. INTEREST AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 30917, CIV. C.). LENDER'S NAME LENDERSADORESS I CERTIFY THAT I 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. IJ.&I PERMITTEE i Z LQ SIGNATUR OF PERMITTEE DAVE OCT 25 2002 PRESS FIRMLY APPLICATION �� PERMIT 4 - �o P/C /s/' � 1 DATE NUMBER # '2 ISSUE /Tj \ TYPE OCC DATE V CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ 18 0" PROPOSED USE NO. DWEL. NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SQ. FT. FACTOR PSF ADJ. AREANALUATION SFR/ADD/REM W Garage/Carport Patio/Dock LwL.I LL. Pool/Spa 4416 0 Z Re -Roof CI CommercialUn X CTUV Fn CA Valuation ADJ.AREA QUANTITY DESCRIPTION FEE . J U cca F U W LU W 0 Z_ 00 J o_ J Q U_ Z Q S W CONSTRUCTION PLAN REVIEW " ELECTRIC PLUMBING MECHANICAL TOA 75ro INSPECTION FEElu�/ ISSUANCE ppppp // 0 SMIP .391 I )nnn ENERGY P/C �-A d 1[ Iii1`" ENERGY PERMIT_-_-i111��d©L tl df' ITg: 441 ' AND SA RP'R'FP RETENTION FEE: _ F PRPR 4 , O i TOTAL FEES CO NTS 4 1 7 RECPT NO. PAID BY VALIDATION WHITE—Dep4Vment Copy, YELLOW --Finance Copy, PINK—Assessor Copy, GOLDENROD--I-IIe L:Opy, GHttN—Appllcam"s uopy CITY OF DIAMOND BAR -INSPECTION RECORD MIT SET BACK FTGS/FORMS/STEEL FLOOR JOIST ' FNA 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 FRAMINGNENTILIATION ' FINAL BOND BEAM _ ROOF COVER PRE -GRADING ROUGH HEATING BENCHING ROUGH ELECTRIC ROUGH GRADING _ ROUGH PLUMBING FINISH GRADING SHOWERITUB 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 COMMENTS - SEPTIC TANK SIZE --------- SEEP PIT/U SIZE -- ---- -