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HomeMy WebLinkAbout23489CITYOFDIAMONDBAR DEPARTMENTOFCOMMUNITY & DEVELOPMENTSERVICES21825CopleyDrive, DiamondBar, CA91765 909) 839-7020Fax (909) 861-3117BuildingInspectionHotline (909) 839-7027BUILDINGPERMITAPPLICATION AJODBDSRIETsEs 2G-7(05-kee47leckes-er,)(, APNLOTTRACT OWNERAc ADDRESS2 (p' 6s4feprecvc.1KA CITY'•1-ZIP91bTEL% Mil0.- 150(i APPLICANTTEL. CONTRACT' R •.. Ill..IMIVON. .^ A•DDRESSt41.12tqlE6 I_ CITYZIPorwir.TEI3- ARCH/ENG/ DESIGNER ADDRESS CITYZIPTEL. OWNER-BUILDER DECLARATION IHEREBYAFFIRM UNDERPENALTYOFPERJURYTHATIAMEXEMPTFROMTHECONTRACTORS LI- CENSELAWFORTHEFOLLOWINGREASON (SEC70315BUSINESSANDPROFESSIONSCODEANYCITYOR COUNTYWHICH REQUIRESAPERMITTOCONSTRUCT, ALTER, IMPRO/E, DEMOLISH, ORREPAIRANYSTRUC- TURE, PRIORTOITSISSUANCE, ALSOREQUIRESTHEAPPLICANT FORSUCHPERMITTOFILEASIGNED STATEMENTTHATHEORSHEISLICENSEDPURSUANTTOTHEPROVISIONSOFTHECONTRACTORS LI. CENSELAW (CHAPTER9 (COMMENCINGWITHSECTION70001OFDIVISION3OFTHEBUSINESS ANDPRO- FESSIONSCODE) ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP- TIONANYVIOLATIONOFSECTION70315BYANYAPPLICANT FORAPERMITSUBJECTSTHEAPPLICANTTO ACIVILPENALTYOFNOTMORETHANFIVEHUNDREDDOLLARS ($5OO) y 0I. ASOVVNEROFTHEPROPERTY, ORMYEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, WILLDOTHEWORK, ANDTHESTRUCTUREISNOTINTENDEDOROFFERED FORSALE (SEC7044, BUSI- NESSANDPROFESSIONS CODETHECONTRACTORSLICENSE LAWDOESNOTAPPLYTOANOWNEROF PROPERTYWHOBUILDSORIMPROVES THEREON, ANDWHODOESSUCHWORKHIMSELFORHERSELFOR THROUGHHISORHEROWNEMPLOYEES, PROVIDEDTHATSUCHIMPROVEMENTSARENOTINTENDEDOR OFFEREDFORSALEIF, HOWEVER, THEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE- PON. THEOWNER-BUILDEFiWILLHAVETHEBURDENOFPROVINGTHATHEORSHEDIDNOTBUILDOR IMPROVEFORTHEPURPOSEOFSALE) 01, ASOWNEROFTHEPROPERTY, AMEXCLUSIVELY CONTRACTINGWITHLICENSEDCONTRACTORS TOCONSTRUCTTHEPROJECT (SEC. 7044, BUSINESSANDPROFESSIONSCODE. THECONTRACTORSLI- CENSELAWDOESNOTAPPLYTOANOVVNEROFAPROPERTYWHOBUILDSORIMPROVESTHEREON, AND WHOCONTRACTSFORSUCHPROJECTSWITHACONTRACTOR(S) LICENSEDPURSUANTTOTHECONTRAC- TORSLICENSELAW ) 0IAMEXEMPTUNDERSEC.B & PCFORTHISREASON DATEOWNER LICENSEDCONTRACTORSDECLARATION IHEREBYAFFIRMUNDER PENALTYOFPERJURYTHATIAMLICENSEDUNDER PROVISIONSOFCHAPTER 9 (COMMENCINGWITHSECTION7000) OFDIVISION3OFTHEBUSINESSANDPROFESSIONS CODE, AND MYLICENSEISINFULLFORCEANDEFFECT. LICENSECLASS /<,63 (")LICNOt51g3 DATE _L3 - 31 - 07CONTRACTOR. ti. Ii-AINKlarli' WORKERS' COMPENSATION DECLARATION IHEREBYAFFIRMUNDERPENALTYOFPERJURYONEOFTHEFOLLOWINGDECLARATIONS IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' COMPENSATION, ASPROVIDEDBYSECTION3700OFTHELABORCODE, FORTHEPERFORMANCE OFTHEWORKFORWHICHTHISPERMIT ISISSUED IHAVEANDWILLMAINTAINWORKERS' COMPENSATIONINSURANCE, ASREQUIREDBYSECTION 3700OFTHELABORCODE, FORTHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMITIS ISSUEDMYWORKERS' COMPENSATIONINSURANEC1RRIERANDPOLICYNUMBERARE CARRIERcc.,re- 0,,rlaq--1, POLICYNUMBER1% A THISSECDONNEEDNOTBECOMPLETEDOFThEPERMITISFORONEHUNDREDCOLLARS ($100)ORLESS). CEPTIFYTHATINTHEPERFORMANCE OFTHEWORKFORWHICHTHISPERMITISISSUED, I SHALLNOTEMPLOYANYPERSONINANYMANNERSOASTOBECOMESUBJECTTOTHE WORKERS' COMPENSATION LAWSOFCALIFORNIA, ANDAGREETHATIFISHOULDBECOME SUBJECTTOTHEWORKERS' COMPENSATION PROVISIONSOFSECTION3700OFTHELABOR CODE, 1SHALLFORTHWITHCOMPLYWITHTHOSEPROVISIONS DATE )-4-11-0 (2APPLICANT, 4:14,1t2:__________ WARNINGFAILURETOSECUREWORKERS' COMPENSATIONCOVERAGEISUNLAWFUL, ANDSHALLBE SUBJECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND DOLLARS (6100,000), INADDITIONTOTHECOSTOFCOMPENSATION, DAMAGESASPROVIDEDFORIN SECTION3708OFTHELABORCODE. INTEREST. ANDATTORNEY'SFEES CONSTRUCTION LENDINGAGENCY IHEREBYAFFIRMUNDER PENALTYOFPERJURYTHATTHEREISACONSTRUCTIONLENDING AGENCY FORTHEPERFORMANCE OFTHEWORKFORWHICHTHISPERMITISISSUED (SEC3097. CIVC ) LENDER'SNAME LENDER'SADDRESS ICERTIFYTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATION ISCORRECT IAGREETOCOMPLYWITHALLCITYANDCOUNTYORDINANCESANDSTATELAWSRELATINGTOBUILDING CONSTRUCTION, ANDHEREBYAUTHORIZEREPRESENTATIVES OFTHISCOUNTYTOENTERUPONTHE ABOVE-MENTIONEDPROPERTYFORINSPECTIONPURPOSES Grit,4101010 PERMITTEENAME (PRINT) 1-19-0C,, SIG1XYURE0PERMMTEEDATE APPLICATION/ DATEPERMITfi ,weiP /C 02a0/., LA-NUMBERX.,/# ISSUEi; ,,,TYPEOCC DATEr11-0toCONST.GROUP ZONINGSETBACKS SIDEFRONTRW0 REAR0 SIDE/SIDESTREETRW0 PROPOSEDUSEIMingfiriZglir NO. DWEL.NO.NO. UNITSSTORIESBEDROOMS UJDESCRIPTIONSQ. FT.FACTORPSFADJ. AREANALUATION CO SFR/ADD/REM Garage/Carport ILIPatio/Deck LI-PooVSpa zRe-Roof I 5ECommercial m ValuationADJ.AREA QUANTITYDESCRIPTIONFEE J 6 CC I- UJ J til 0 Z D J D. 2wc,--veir--11--- 3 0 2 i 0 LU 2 CONSTRUCTION PLANREVIEW ELECTRIC MECHANICAL INSPECTIONFEE SMIP ENERGY P/C ENERGYPERMIT PRE-ALTFEE. PLUMBING(9/ ro ISSUANCE7.S:- Ifii RETENTIONFEE:, t COMMENTSTOTALFEES•a7C-' RECPT. NO.PAIDBYeiSYVALIDATION '7f7g"--- WHITE—DepartmentCopy, YELLOW—FinanceCopy, PINK—AssessorCopy, GOLDENROD—FileCopy, GREEN—Applicant'sCopy CITYOFDIAI-1JIONDBAR INSF'ECTIONRECORD CLECTRICGROUND GROUND PLUMBIN`j.. SLABGRADE FIGSIFORMSISTELL I-- PAT:frINSPECTOFI FLOORJOIST FHAREOMTS UNDERFLOORDUCTUNDERFLOORCONDUITFIRERACEFOUNDAT0NFIREPLACEBONDBEAMMIDHIP,ONO 8FT. BONDBEAM FINAL. BONOPRE-`131-3A.OiNG2ENCHINGCrUC(.3rIAIDING -If`.113I-1GRADING ROCA' ELECTP.IC 1300LFENCING PCOL OFFSITEHOPS. DEDIC.ATIONS FINALENG. ANDSCAPE/IRRIG ON :-.>:TEIMPS zONING FIALDEPTFINAI HEL".LIi-iDEPTFINALDE ;TESPA!T.': ENERGY POIV1.-.1" SETBAG& alai/ EMPPOWER IWATFR ROOFSHEP,T1-1;t'.:;), FRAMING."../E%Ti \\T ;Crs'4 1'.r)(..;F C;OrAllNilENT