HomeMy WebLinkAbout16904 (664) � ..� _----��_.--- C1TY OF DIAMOND BAR
� DEPARTMENT OF COMMUNIT'Y&DEVELOPIvfENT SERVICES ��P I���
� 21825 E.Copley Drive
- (909)860-3195 Fax(909)861-3117 PRESS
`�'%»���" BUILDINGPERMITAPPLICATION JUN 19 2002 FIRMLY
� JOBSITE � / ��7 l � / APPLICATION �(,� PERMIT � ` _ P/C
o ADDRESS�3�-�! !/�! � ` ' DATE y �/ �/ NUMBER�� #
� ISSUE TYPE OCC
APN L�OT TRACT DATE CONST. GROUP
p OWNER �J G[G � _/ i
o ADDRE � � ZONING SETBACKS
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o APPLICANT ��� , TEL. (�' AEAR ❑
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� ADDRESS �-
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z DESIGNER
w NO.DWEL. NO. NO.
a ADDRESS
� CITY ZIP TEL. UNITS STORIES BEDROOMS
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cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
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I HEREBY AFFIRM UNDER PENALTV OF PERJURV THAT I AM E7(EMPT FROM THE CONTRACTORS LI- Gef89B/CBfPOR
W CENSE UW FOR THE FOLLOWING REASON(SEC.7o31.5 BUSINESSAND PROFESSIONS CODE:ANYCI7V OR (n
U CAUN7YWHICHREOUIRESAPERMITTOCANSTRUCT,ALTER,IMPROVE.DEMOLISH,ORREPAIRANYSTRUC- W Pet10/DBCk
Z TURE.PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FIIE A SIGNED
w STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI� W
� CENSE LAW(CHAPTER 9(CAMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� u" POOVSPB •
FESSIONSCADE)OR7HATHEORSHEISEXEMPTTHEREFROMANOTHEBASISFORTHEALIEGEDE%EMP- (!j
� TION.ANY VIOUTION OF SECTION 7031.5 BY ANV APPLICANT FOR A PERMIT SU&lECTS THE APPLICANT TO Z Re-Roof
A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(f500).):
i Z ❑I,ASOWNEROFTHEPROPERTY,ORMYEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, 0 COfOR18fCldl �
WILL DO THE WORK,AND THE STRUCTUfiE IS NOT INTENDED OR OFFERE�FOR SALE(SEC.70�a,BUSI- J
N NESS AND PROFESSIONS CODE:THE CONTRACTORS UCENSE LAW DOES NOT APPLV TO AN OWNER OF �
, PflOPERTVWHOBUILDSORIMPROVESTHEREON,ANDWHODOESSUCHWORKHIMSELFORHERSELFOR
� 7HqOUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMEN7S ARE NOT IN7ENDED OR m
� OFFEREDFORSALEIF,HOWEVERTMEBUILDINGORIMPROVEMEN71550LDWITHINONEYEAROFCOMPLE-
Z TION,THE OWNER�BUILDEH WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
� IMPFOVE FOR THE PURPOSE OF SALE).
W ❑I,ASONRJEROFTHEPROPERTV,AMEXCLUSIVEIVCONTRACTINGWITHLICENSEDCONTRACTORS
Q TO CANSTRUCT THE PR0.IECT(SEC.70��,BUSINESS AND PROFESSIONS CODE:THE CONTRAC70R5 LI- ValUO�lOf1 ADJ.AREA
W CENSELAWDOESNOTAPPLYTOANOWNEROFAPROPERTVWHOBUILDSORIMPROVESTHEREON,AND
� WHOCANTRACTSFORSUCHPRQIECTSWITHACONTRACTOR(S)LICENSEDPURSUANTTOTHECAN7RAC- QUANTITY DESCRIPTION FEE
Y TOFS UCENSE LAW.).
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� ❑I AM EXEMPT UNDER S . 8.8 P.C.FO IS R N Q
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DATE o s V
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� LICENSED CON� CTC} ECLARATION w �
� I HEHEBY AFFIRM UNDEH PENAITY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
� O(COMMENCING WITH SECTION 7000)OF DIVISION 30FTHE BUSINESSAND PROFESSIONS CODE,AND Z
`X IAY UCENSE IS IN FULL fORCE ANO EFFECT, m
� LICENSE CLASS LIC.NO. j
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. V DATE CONTRACTOR a
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� WORKERS'COMPENSATION DECLARATION Q
� I HEREBYAFFIRM UNDER PENALTY OF PERIURV ONE OFTHE FOLLOWING DECURA710NS: Z
Z _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CqNSENT TO SELF-INSURE FOR WORKERS' _
a CAMPENSATION,AS PROVIDED BY SECTION 37000FTHE UBOR CODE,FOR THE PERFORMANCE w
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. � �
�
W _I HAVE AND WILL MAMTAIN WORKERS'COMPENSATION INSURANCE,AS RE�UIRED BV SECTION
Q 37000F7HELABORCADE.FORTHEPERFORMANCEOF7HEwoRKFORWHICH7HISPERM1715
� ISSUED.MY WORKERS'CAMPENSATION INSURANCE CARFIER AND POLICY NUMBER ARE: CONSTRUCTION
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j CARRIER PLAN REVIEW
ZPOLICV NUMBER ELECTRIC
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� (fHISSECf10NNE�NOTBENMPLEfEDOFhIEPEWMISFORONEHUhDRED00UAiLS(E100)ORLESS} PLUMBING .\ �
Z I CERTIFV THAT IN THE PERFOflMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I MECHANICAL . ..
C7 SMALL NOT EMPLOY ANV PERSON IN ANV MANNER SO AS TO BECAME SUBJECT TO THE -}��� ^ l f �
� WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FE6 I C �i'"�� -.I `. .I.�..�i� .
-•� SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 370o OF THE LABOR •�,�
� � �CODE.I SHALL FORTHWITH COMPLV WITH THOSE PROVISIONS. ISSUANCE I �) oO�
� �'. O 1 i
p DATE: APPLICANT: SMIP
� ENERGY P/C I
J WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERA�E IS UNLAWFUL,AND SHAILBE �
� SU&IECTAN EMPLOYER TO CFIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND ENERGY PERMI
DOLURS(S70o.o00).IN ADDITION 70 THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOH IN
J SECTION 3708 OF THE LABOR CODE.INTEREST,AND ATTORNEV'S FEES. - �'��---• "=�''.'"__�"'A�'.:.:+.-� q
p� RETENTION FEE: -- 1 C �
a CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� I HEREBY AFFIf1M UNDER PENALTV OF PEFiJURV THAT THERE IS A CONSTRUCTION LENDING AGENCY
FOR TME PERF-0RMANCE OF 7HE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3oe7,CIV.C.). .
Z
W
? LENDER'S NAME
�
� IENDER'SADDRESS L
� ICERTIFVTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFOHMATIONISCORRECT. TOTAL FEES 1 (�� �V
w I AGREE 70 COMPLV WITH ALL qTY AND CAUNTV ORDINANCES AND STATE LAWS REU7ING T ILOING t,�r v
� CANSTRUCTION,AND HEREBV AUTHORRE REPRESENTATIVES OF THI OUNTV TO ENT ON THE
� ABOVE-MENTI NED PROPERTV FO SPECTION WRPOSES.
Z COMMENTS
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� IGNATUREOF,-PERMITTEE DATE
= RECPT.NO. PAID BY VALIDATION
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ELECTRIC GROUNG ' UNDEFi FLOOR DI�CT __
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GROUND PLUMBING _ � UNDER FLOOR CUt�IDUIT _ � �
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SLAB GRADE ___ ___ FtREP�AGE_FOUNDATi�N_�___ �
TEMP POWER FIREPLACE BOND BERM (
WATER SERVICE i ; MID t�T. BOND SEkM _ _ ___
ROOF SHERTHING � 8 FT. BO�'D BEAM � I
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FRAMINGNENTILIATION FIiVAL BOND BEAM ;
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ROOF COVER PRE-GRADING I
ROUGH HEATING BENCHING I
ROUGH ELECTRIC , ROUGH GRADING �
---._._ _.�__ �__.-- —..----- --
ROUGN PLUMBING i ! FINISH GRADING .
—�- --- -- -----
SHOWER/TUB TEST I ; POOI.ELECTRIC
EXT. LATH/SIDING POOL FENCING �
WALL IiVSVLATIOf� POOL FINAL � --__._______
CFILIfVG IIV�ULATI�fV �FF SITE IMPS. �
pRYWALL NAILING DEDICATlONS
SEWER FINAL ENG. � `_..- --- --
SEPTIC TANK LANDSGAPE/IRRIG.
SEEP PIT/LL. ON SITE lMPS. �
GAS AIR TEST FINA�ZONING
FINAL CO�IST. � �IRE DEPT. FINAL V �
FINAL HEATING � i-IEALTH DEPT. FINAL
FINAL ELECTRI(, i DEV. FEES PAID
FINAL PLUMBING �. ENERGY
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