HomeMy WebLinkAbout14990 (666)CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
21660 E. Copley Drive Suite 190
(909) 860.3195 Fax (909) 861-3117
BUILDING PERMIT APPLICATION
ADDRIESS 2d / �I 1i21- Illi
APN LOT TRACT
OWNER f'-., r IES. DOZ 1/4 -
ADDRESS BEE.
CITY U, I G TEL.
APPLICANT
CONTRACTOR
ADDRESS CLQ N ILAC tR- /
CITY_CL [>,'— ZIP ,�t/77 U TEL Vj2L72 L/
ARCWENCJ
DESIGNER pllil Let,621
ADDRESS / ] — 41 uG
CITY 101111 E�If r ZIP TELT3lTCJZ�
OWNER -BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS L4
CENSE UW FOR THE FOLLOWING REASCN (SEC. 7031.6 BUSINESS AND PROFESSIONS CODE: ANYCITY OR
COUNITYYWRCI REQUIRES A PERMIT TO CONSTRUCT.ALTER IMPROVE. DEMOUSH, OR REPAIRANY STRUNG
TURF, PRIOR TO 175 ISSUANCE. ALSO REWIRES THE APPLICANT FOR SUCH PERMIT TO FRE A SIGNED
STATEMENT THAT HE OR SHE IS LICENSED PUF15UANT TO THE PROVISIONS OF THE CONTRACTORS L4
CENSE LAW (CHAPTER a (COMMENCING WITH SECTION 7000) OF DIVISION a OF THE SUS'NESS AND PRO.
FESSIONS CODE) ORTHAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP.
TION. ANY VIOLATION OF SECTION 7071.6 BY ANYAPPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO
A CML PENALTY OF NOTMORE THAN FIVE HUNDRED DOLLARS (5500) I
CIL AS OWNER OFTHE PROPERTY, OR MY EMPLOYEES WITH WAGESAS 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
PROPERTYWWHO 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 MENDED OR
OFFERED FOR SALE IF. HOWEVER THE SUILMG OR IMPROVEMENT tSSOLD WRHN ONEYEAROF COUPLE.
TION. THE OWNER41WILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
IMPROVE FOR THE PURPOSE OF SALE)
O L AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTINGWTTH LICENSED CONTRACTORS
TO CONSTRUCT THE PROJECT (SEC. 70N, BUSINESS AND PROFESSIONS COCE: THE CONTRACTORS U.
CENSE LAW DOES NOTAPPLY TORN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON. AND
YAIO CONTRACTS FOR SUCH PROJECTS WITH A COW RACTOR(SILIOENSED PURSUANT TO THE CONTRAG
TORS LICENSE LAW).
EO I AM EXEMPT LINDER SEG B. A P.C. FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
I HEREBYAFFIRM LINDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER
a (COMMENCING WITH SECTION TOM) OF DIVISION S OF THE BUSINESS AND PROFESSIONS CODE. AND
W LICENSE IS N FULL FORCE AND EFFECT. p
LICENSE SS C- ~ J LIC. NO. D 2 y0 N�n
DATE x%176 ej CONTRACTOR
WORKERS' COMPENSATION DECLARATION
1 HEREBY AFFIRM LINDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECIMATIONS.
I HAVE AND WILL MAINTAIN A CEFTTIrICATE OF CONSENT TO SELFMNSURF FOR WORKERS'
COMPENSATION.AS PROVIDED BY SECTION 27000F THE LABOR CODE, FOR THE PERFORMANCE
CF THE WORK FOR WHK>i THIS PERMIT 15 ISSUED.
I HAVE AND WILL MAWAN WORKERS' COMPENSATION INSURANCE. AS REWIRED BY SECTION
3700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED. MY WORKERS' C PEN ATION JJWSUMNcc C(A/yi :ER AND POLICY NUMBER ARE:
CARRIER _�/I 7s:` �-f
POLIO/NUMBER- !M03 5-7 4,
MitS SECDON NEED NDTBC Cd.PE£TEDOFTIE PCMM-ISFCRONE RIOrDIXXIARS (zero) ORLESSI
1 CERTIFY THAT N THE PERFORMANCE Or THE WORK FOR WHICH THIS PERMIT IS ISSUED. I
SHALL NOT EMPLOY ANY PERSON INANY MANNER SO AS TO BECOME 5U0.'ECT TO THE
WORKERS COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF I SHOULD BECOME
SUBJECTTO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 37000F THE LABOR
CODE..I/I SHALL FORTHWI COMPLY WITH THOSE PROMS
DATE. J„! PLICANT
WARNING, FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL BE
SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TOONE HUNDRED THOUSAND
DOHA e(S1oo.OW, N ADORIONTO THE COSTOF COMPENSATION. DAMACESAS PROVIDED FOIL IN
SECTION 570e OF THE LABOR CODE. INTEREST. AND ATTORNEYS FEES.
CONSTRUCTION LENDING AGENCY
I HEREBYAFRPAI LINDER PENALTYOF PERJURY THATTHEAE IS A CONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. SOe7, CIV. C.).
LENDERS NAME
LENDERSADDRESS
1 CERTIFY THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE NFORMATKON IS CORRECT.
1 AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDNANCES AHD STATE LAWS RELATING TO BUILDING
CONSTRUCTION. AND HEREBY AUTHORIZE REPRCSENTATNES OF THIS COUNTY TO ENTER UPON THE
ABOVEaAE ED PROPERTY FOR
INSPECTION PURPOSES,
PER EE NAM P
1�9nc l%U
SIGMA PER DATE
PRESS
FIRMA V
APPLIC N ^ PERMIT. p/O/17�� (^
DATE `/ NUMBER D i
ISSUE TYPE OCC
DATE CONST. GROUP
ZONING SETBACKS
FRONT RW
REAR 0
SIDEISIDE STREET RW 0
SIDE 0
PROPOSED USE
Q
NO. DWEL. NO. NO.
UNITS STORIES BEDROOMS
DESCRIPTION SO. FT FACTOR PSF ADJ. AREAIVALUATION
SFR/ADDIREM
Ln
Garage/Carport
WPatio/Dock
LL-
0
PooVSpa 3 ��
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no -Roof
Commercial
ca
Valuation ADJ.AREA
QUANTITY DESCRIPTION FEE
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CONSTRUCTION to
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ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE "I l OZ1-D
SMIP
ENERGY P/C �` ( ' ' / . L) t9 [\ •
ENERGY PERMIT
RETENTION FEE:.\ b nr
FEE:
rPREE--ALLT
SEIP
TOTAL FEESyy��yy��
fS
COMMENTS
RECPT NO. PAID BY VALIDATION
WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD—File Copy, GREEN—Applicant's Copy
4
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CITY OF DIALlOND BAR
. INISPECTION RECORD
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FTGS/FORIM';,STEEL
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'ELECTRIC GROUND
. - I I — UNDER FLOOR DJCT _
GROUND PLUMBING
I UNDER FLOORCONDUIT—
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SLAB GRADE -
SLAB
I FIREPLACE FOUNDATION
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TEMP POWER
FIREPLACE SOND BEAM
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WATER SERVICE_
MID H T. BOND BEAtA
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ROOF SHE'VFHING =
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8 FT. BOND.BEAM
FRAMING.A'ENTILIATIOtJ
I FINAL BOND BEAM,
ROOF COVER
ROUGH HEATING
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PRE-,:�G
I BENCHIIJG.', .
ROUGH ELECTRIC ..
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ROUGH GRADING
ROUGE{ PLUMBING
SHOWER/TUB TEST
I
FINISH GRADING
j POOL ELECTRIC �r Qb
EXT. LATH!SIDING
I POOL FENCING
VlALL INSULATION
I POOL FINAL
;CEILING INSULATION
I
OFF SITE IMPS. -
DRYWALL NAILING
(
DEDICATIONS
SEWER
I
FINAL ENG.
;SEPTIC TANK
LANDSCAPE/IRRIG• I
.SEEP PIT/L.L.
'•'�
ONI SITE IIAPS.
GAS AIR TEST
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FINAL. ZONING
FVNAL CONST,
—
FIRE DEPT. FINAL
HNIAL HEATING
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HEALTH DEPT. FINAL j
DEV. FEES PAID
FINAL ELECTRI.^,
I
FIP:AL PLUMBING
! ENERGY
COMMENTS
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SEPTIC TANK SIZE
SEEP PIT/U SIZE
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