HomeMy WebLinkAbout25722PRESS FIRMLY
CITY OF DIAMOND BAR
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 BUILDING PERMIT APPLICATION
JOBSITE
ADDFIESS / 0 / 4 4 i..i Ho-ftr AiDc1.._ 0
APN LOT 175143T
OWNER I' 6, It4,'1.-. I
ADDRESS 1 c, f b .5-ti 16f Mir 1210 0.lok.
art D -- 6 .9.x ZIP TEL.
APPLICANT TEL MEW
CONTRACTOR .P14-iC.i ,•
ADDRESS RZSINIMIOP.i
CITY _ JO ..ZIP • ' TEL. 4r,• r _
ARCH/ENG/
DESIGNER
ADDRESS
CITY ZIP TEL.
OWNER-BUILDER DECLARATION
t 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 REQUIRESAPERMITTO CONSTRUCT, ALTER, IMPROVE, DEMOLISH, OR REPAIRANY STRUC-
TURE, PRIOR TO ITS ISSUANCE, 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 LI-
CENSE LAW (CHAPTER 9 (COMMENCING WITH SECTION 7000) 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 CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS MOD) )
01, AS OWNER OF THE PROPERTY, OR MY EMPLOyEES WITH WAGES AS THEIR SOLE COMPENSATION,
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
PROPERTY WHO BUILDS OR IMPROVES THERE0N, 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 SOLDWITHIN ONEyEAROF COMPLE.
TION, THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
IMPROVE FOR THE pURPOSE OF SALE)
0 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 NOT APPLY TO AN OWNER OF A pROPERTY WHO BUILDS OR IMPROVES THEREON, AND
WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC-
TORS LICENSE LAW.)
0 IAM EXEMPT UNDER SEC B & P C FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF pERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER
9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND
MY LICENSE IS IN FULL FORCE AND EFFECT
LICENSE CLASS 8 e._ 27 LIC NO 5.-- 2 4/e) 4,41
DATE CONTRACTOR
WORKERS' COMPENSATION DECLARATION
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'
COMPENSATION, AS PROVIDED By SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED
I 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 INSURANCE CARRIER AND POLICY NUMBER ARE
CARRIER 47.114 "rg.,0.9
POLICY NUMBER 0 t 316 ...5" - y-oll
THIS SECTION NEEDNOT BE CCMFtETED OF THE PERMIT LS FOR ONE HUNDRED COLLARS ($100)OR LESS)
I CERTIFY THAT IN THE PERFORMANCE OF THE WOFIK 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 pROVISIONS OF SECTION 3700 OF THE LABOR
coDE, I SHALL FORTHWITH COMPLY WITH THOSE PROVISI S ..•
1 \,,
DATE.APPLICANT.,t/1._, 2.-1/4,_
WARNING FAILURE TO SECURE WORKERS' COMPENSATION COVERA1E1 UNLAWFUL, AND SHALL BE
SUBJECT AN EMPLOYER TO CRIMINAL pENALTiEs AND CIVIL FINES UP'TG ONE HUNDRED THOUSAND
DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3708 OF THE LABOR CODE. INTEREST, AND ATTORNEYS 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 3097, CIV C )
LENDER'S NAME
LENDER'S ADDRESS
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
Z.) I 31.110 0,413t'461-
PERMITTEE NAME (FAINT)
Li
SIGNATURE OF PE EE DATE
APPLICATION
DATE
am ,PERMIT P/C
6 7 NUMBER Q S-1 a). #(CrTC.-
ISSUE
DATE
TYPE OCC (2...,2/
f 16 /0 /CONST.Uf tV GROUP
FRONT SETBACKS
ZONING REAR
SIDE RW 0
0
SIDE/SIDE STREET RW 0
0
PROPOSED
NO.t
UNITS /4 X 3 8 i p rle k
USE
DWEL.
NO.NO,
STORIES BEDROOMS
I-1-1
w DESCRIPTION SQ. FT.FACTOR PSF ADJ. AREA/VALUATION
1-1-
0
z
SFFVADD/REM
Garage/Carport
Patro/Deck
PooVSpa
Re-Roof
Ei
J Commerctal
5
CO
Valuation 4._ADJ AREA
QUANTITY DESCRIPTION FEE
0 7:Cj
c-e
a
0
J
LU 40 s..
tz-k-
7
Z
Erg
M
1
a_
a
o
2
a
til
M
CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
SMIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE:-8-1
PRE-ALT FEE:, c,..4
14,
44S:9 -
C)491Z)
1 C.Z.1
5 , 00
2c- 'L--c) —7 4.30S et :5Q. C3c:)
TOTAL FEES -74-- 1 ---i SS ,Qcz
COMMENTS
RECPT. NO. 0 4:3 .2,S PAID BY 1 tRt9c? 1 VALIDATION 41g-VVI.
WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD—File Copy, GREEN—Applicant's Copy
I/
CITY OF DIAMOND BAR INSPECTION RECORD
7.11071'7."`MAtF, ,,1:41),Warrf41141';Wilite,511,6tRikr
41:4
FLOOR JOIST
FHA REOMTS UNDER ELOOH DUCT UNDER FLOOR CONDUIT FIREPLACE FOUNDATION FIREPLACE BOND BEAM MID HT,
BOND BEAM
8 FT. BOND BEAM
FINAL BOND BEAM
PRE-GRADING
I BENCHING
ROUGH GRADING
FINISH GRADING
POOL ELECTRIC POOL FENCING POOL FINAL LOFF SITE IMPS. DEDICATIONS [FINAL ENG.
LANDSCAPEARRIG. ON !.:;:ITE IMPS. FINAL ZONING
iltS•.-4.&4.4,-.0-•^••
SET BACK FTGS/FORMS/STEEL ELECTRIC GROUND GROUND PLUMBING AB GRADE EMP POWEfR VVATER SERVICE
ROOF SHEATHING FRAMING/VENTILATION ROOF COVER ROUGH HEATING ROUGH EI_ECTRIC
int?"1:447), ir:;
Ilitgte
1:INALF-47,ATING FINAL ELECTRic FINAL PLUMBING
EIRE DEPT. FINAL HEALTi i DEFT F!RIAL
DEV FFK3 PA!D I ENFFACV
COMMENTS frAA-61c.444 —e-t°6't^-= -(CrOff
go t 50APIg.
P-77-07 oar_
ROUGH PLUMBING SHOWER/TUB IRS{ EXT. LATH/SIDING 'WALL INSUI !ON GELING iNSUL ;VI ^ON DRYWALL NAILING SEWER
SEPTC
L',EEP PIT/I
GAS AIR -1 ES-T
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