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HomeMy WebLinkAbout10811CITY OF DIAMOND BAR COMMUNITY DEVELOPMENT DEPARTMENT 21660 E. Coplcy Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 BUILDING PERMIT APPLICATION JOBSITE ADDRESS APN T T CT OWNER ADD S C ZIP :TEL..APPLICANT CONTRACTOR i? IQ 1 Iww ADDRESS CITYV ,71 ri1 TEL 11 ARCWENG/ W8 i, rA 917$9 DESIGNER ADDRESS CITY ZIP TEL OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY TRAY 1 AM EXEMPT FROM THE CONTRACTORS LI- CENSE LAW FOR THE FOLLOWING REASON ISEC, 7MI A BUSINESS AND PROFESSIONS CODE. ANY CITYOR COUNTY WHICH REOUIRESA PERMITTO CONSTRUCT, ALTER. IMPROVE, DEMOLISH, OR REPAIRANY STRUC• TUBE, PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT ME 0 SHE 19 LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LF DENSE LAW (CHAPTER a (COIAMENCNG WITH SECTION 7000) OF DIVISION S OF THE BUSINESS AND PRO- FESSIONS CODE) ORTHAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION.ANY VIOLATION OF SECTION 703 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (IIS00)_): ❑ L ASOWNEROFTHE PROPERTYOR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, W01 DO THE WORK. AND THE STRUCTURE IS NOT INTENDED OR OFFERED FDA 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 THROWN HIS OR HER OWN ID EMPLOYEES. PROVED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR FIO OFFERED RSALE IF, HOWEVER THE BUILDING OR IMPROVEMENT B SOLD WTRN ONE YEAR OFCOMPLE- TKON, THE OWNE"UI DEP WILL HAVE THE BURDEN OF MOVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). O L AS OWNEROF THE PROPERTY. AM EXCLUSIVELYCONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 70U, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI- CENSE LAW DOES NOT APPLY TO AN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON. AND WHO CONTRACTSFOR SUCH PROJECTIS WITH LICENSED PURSUANT TO THE CONTRAC- TORS LICENSE LAW.). 0 ]AM EXEMPT UNDER SEC. a & P.C. FOR THIS REASCN DATE OWNER LICENSED CONTRACTORS DECLARATION 1 HERERY AFFIRM UNDER PENALTY OF PENURY THATI AM LICENSED UNDER PROVISIONS OFCMAPTER a (COMMENCING WITH SECTION 7000) OF DIVISION S OF THE BUSINESS AND PROFESSIONS OWE. AND MY LICENSE IS N FULL FORCE AND EFFECT. LICENSE CLASS � , M. NO. DATE /D'�eV' / CONTRACTOR WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PENURY ONE OF THE FCLLOWNO DECLARATIONS: _ I HAVE AND WILLMAINTAIN A CERTIFICATE OF OONSENTTO SELF -INSURE FOR WORKERS' GOMPENSATK)N, 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' OOMPENSATKNI INSURANCE, AS REQUIRED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOP WHICH THIS PERMIT IS ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER POLICY NUMBER (THIS SECTION NE®NOT BE COMP ETEDOFTE PERMIT IS FOR ONE HUhDREDDSXIARS01MOR LESSI 1 CERTIFY THAT N 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 ME WORKERS' COMPENSATION PROVISIONS OF SECTION 5700 OF THE LABOR CODE. I SHALL FORTHWITH COMP LY WUTMT EPHOVISIONS PATE:9� APPLICANT: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SMALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS (5100.010). N ADDITION TO THE CAST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 1708 OF THE LABOR CODE. INTEREST. AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM LINDER PENALTY OF PENURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3007, CIV C). LENDER'S NAME LENDEWSADDRESS 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 OONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTMEO PROPERTY FOR INSPECTION PURPOSES. PERMITTEE NAME[PRINT) AV -A, SWNATUREOF PERMITTEE DATE WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assesux Copy, GOLDENROD—File COW, GREEN—Appllc , 4 CGpy rtPRESS , , D FIRMLY APPUCATION Z PERM 0 &a P/C DATE_ NUMBER t ISSUE TYPE OCC DATE CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR❑ SIDEISIDE STREET RW ❑ SIDE ❑ o ®k't PROPOSED USE NO. DWELL NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREANALUATION SFFVADDMEM Garape/Carpolt Co WPatioNDedt LL pGOVSpa ZRe -Root Commercial M Valuation ADJ.AREA QUANTITY DESCRIPTION FEE J U_ W J w 0 _Z J� .0.,I Q U aZ i U W CONSTRUCTION PLAN REVIEW ELECTR SING PWM"' L M ANICAL PAIn INSPECTION FEE ISSUANCE B' SMTP ENERGY PIC, ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: TOTAL FEES COMMENTS RECPT. NO PAID BY VALIDA L J .. ... -.. .. ... ._ ,. ;c -r, .,.. .,+*,,, rrc: .a.. •Fi... rr^. �. ..u��a+'.,�^�.• rr:i', ^.�:,.:�:�::, ws-:. ��q-c - - .. .. � .. � �. ,, CITY OF DIAM. OND OAR INSPECTION RECORD A , SETBACK _ 1 FLOOR JOIST FTGS/FORMS/STEEL _ - - ' FHA REOMTS ELECTRIC GROUND UNDER FLOOR DUCT_ , GROUND PLUMBING _ UNDER FL_OOR_CONDU1T :' -`• - .- - - - - -� SLAB GRADE_ FIF_#EPLACE_FOUNDATION _ TEMP POWER FIREPLACE BOND BEAM__ WATER SERVICE _ j MiD HT. BOND BEAM, ti71.1:.bVi9 ©�E>vV 4�E8 ROOF SHEATHING 8 FT. BOND BEAM _ - I � ti' AQ tLO FRAMiNGNENTILiATION 'FINAL BOND BEAM ROOF COVER PRE -GRADING f, ROUGH HEATING BENCHING - ROUGH ELECTRIC -_ - - __— - -- ROUGH GRADING - ROUGH PLUMBING FINISH GRADING SHOWER/TUBTEST POOL ELECTRIC EXT. LATH/SIDING -�- _ - _ _-_ POOL FENCING- -- —y WALL INSULATION I POOL FINAL CEILING INSULATION 1 _ _ _ __• I OFF SITE IMPS. DRYWALL NAILING _ DEDICATIONS SEWER FINAL ENG. SEPTIC TANK LANDSCAPE/IRRIG. SEEP PIT/L.L. �I- _ - - TJ ON SITF IMPS. GAS AIR TEST — -- - FINAL ZONING - -_-_.-_---_ - -- -' FINAL CONST- FIRE DEPT. FINAL FINAL HEATING - - - -------- -- ---- HEALTH DEPT. FINAL. I FINAL ELECTRIC _ _ DEV. FEES PAID_-- •_- . _ j FINAL PLUMBING - -- LNERGY — COMMENTS — -- --- -- — -- ---------- I SEPTIC TANK SIZE _ ------------------------ • SEEP PIT/U SIZE - - - - ._ -- ----- ------ - ------