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HomeMy WebLinkAbout13175CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES 21660 E. Copley Drive Suite 190 (909) 860-3195 Fax (909) 861-3117 I BUILDING PER/MIT APPLICATION JOBStTE ADDRESS gam% / S7' �✓ �r odic. �-G APN LOT TRACT OWNER ADDRESS 0 t-L���" CITY /1 ZIP TEL,/ APPLICANT TEL. CONTRACTO ADDRESS CITY ZIP! TEL ARCWEN / DESIGNER ADDRESS CITY ZIP TEL. OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS U - CENSE LAW FORTHE FOLLOWING REASON (SEC. 7031.5 BUSINESSAND PROFESSIONS CODE: ANY CRY OR COUNTY WHICH REQUIRES A PERMrTTO CONSTRUCT.ALTER MPFNOVE DEMOUSH.OR REPAIR ANY STRUC. TUBE, PRIOR TO ITS ISSUANCE, ALSO REWIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OF] SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- CENSE LAW (CHAPTER 0 (COMMENCING WITH SECTION 7WD) OF DIVISION S OF THE BUSINESS AND PRO- FESSIONS CODE) OR THAI HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED E%EMP. TION.ANYVI.TON OFSECTKONTM .8 BY ANY APPLICANT 'ORA PERMIT SUBJECTS THE APPLICANT TO A CML PENALTY OF NOT MORE THAN FIVE' DOLLARS (5500).): O LAS OWNEROFTHE PROPERTY. OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED CR OFFERED FOR SALE (SEC. 7044, BUSK NESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTYM010 BUILDS OR IMPROVES THEREON, AND WHO DOES SUCH WORK MMSELFOR 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 LS SOLD WITHIN ONEYEAR OF COMPLE- TION, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SAL" 0 L AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEG 7044, BUSINESS AND PROFESSION$ CODE: IH.E CONTRACTORS LM CENSE LAW DOES NOTAPPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AVD WMO CONTRACTS FOn SUCH PROJECTS WITHACONTRACTOR(S) LICENSED PURSUANT TO THE OONTRAC. TORS LICENSE LAW.). O 1 AM EXEMPT UNDER SEC. B. 5 P.C. FOR THIS REASON DATE OWNER LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT NUM LICENSED UNDER PROVISIONS OF CHAPTER I (OOMMENCNO WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE. AND MY UCENSE IS N FULL FORCE ANNDD`EFFECT. -7q 7 /e LICENSEr�CUSS `� UC. NO. DATEX7"7--r- d CONTRACTO 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-NSURE FOR WORKERS' COMPENSATK7N. AS PROVIDED BY SECTION 7700 OF THE LIBOR CODE. FOR THE PERFORMANCE 0F111E WORK FORWA/ICH THIS PERMIT 19ISSUED. V_/1 HAVE IUD WILL MAINTAIN WORKERS' COMPENSATION INSURANCE. AS REQUIRED BY SECTION 37000E THE LABOR CODE FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. MY WORKERS' PENSATION INSURANCE CATAER AND POLICY NUMBER ARE: CARRIER;, POLICY NUMBER (TEC SECTION NEMNOT BE ON"LETED OF THE PERMIT 0 PORONE HLX)nM DOLLARS 01M)ORLES4 ICERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON N AN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS' COMPENSATION LAWS OF CALIFORNIA AND AGREE THAT IF 1 SHOULD BECOME SUEUECT TO THE WORKEFIT COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR CODE,1 SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. DATE: APPLICANT: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE O UNLAWFUL. AND SHALL BE SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS LS1 D0.000). N ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES, CONSTRUCTION LENDING AGENCY 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR TIE PERFORMANCE OF WE WORK FOR WHICH THIS PERMIT IS ISSUED (SEG 3W7, CIV. G). LENDERS NAME LENDER'SADDRESS 1CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE NFORMATON IS CORRECT. IAGREE 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. n U C 15" �. 1 Tent PERMITTEE NAME 14 I SgNATUR PE DATE EXPIRED MAY 3 0 2001 PRESS FIRMLY APPLICATION PERMIT1 P/C �� DATE NUMBER' K ISSUE-�01 DATE x CONST. GROUP ZONING SETBACKS FRONT RW ❑ REAR ❑ SIDE/SIDE STREET RW ❑ SIDE ❑ PROPOSED USE.' 'e NO. DWEL NO. NO. UNITS STORIES BEDROOMS DESCRIPTION SO. FT. FACTOR PSF ADJ. AREANALUATION SFR/ADD/REM - Gamge/Carpott WPatio/Deck POOUSpa Z Re -Roof OJ Commercial - 5 m Valuation ADJ.AREA OUANTITY DESCRIPTION FEE J Q U F- U W J w a Z ES J a J 4 U Z Q S U W L r CONSTRUCTION PLAN REVIEW `M. A�R ELECTRIC KI ` 1 , 1� PLUMBING ,, �(Y4� MECHANICAL INSPECTION FEE j%`t �L ISSUANCE �] A y SMIPL ENERGY PIC ENERGY PERMIT RETENTION FEE: PRE -ALT FEE: C TOTAL FEES COMMENTS RECPT. NO. - PAID BY VALIDATIO N / WHITE—Department Copy. YELLOW—finance Copy, PINK --Assessor Copy, GOLDENROD—File Copy, GREEN—Applicants Copy CITY OF DIAMOND BAR INSPECTION.RECORD : . _■■II v r'� C'� �. F �° 1 �� � •�l�Y����� .....? SETBACK ; ' _�.! ` � -�. �.� _ - :� ' 1-I• � C �© � P uT+(6� � : T � � � i� 'j� ( ([(� £ ../_/.,1� y�'y.� �� �.�3it �A ���r��.sl�'..1,.pN�1_ � I�`C�.� _.�'.1►vi��vl�,..i1F�Ir1 FLOOR JOISTS- FTGSIFORMS/STEEL FHA REQ�dYS` :. ELECTRIC GROUND - ! UNDER FLOOR DUCT GROUND PLUMBING UNDER FLOOR CO''JIT.' • I L � (SLAB GRADE - — ` - FIREPLAG 'FOUNDATION': _ TEMP POWER FIREPLACE BOND BEAM _ WATER SERVICE - - - MID HT. BOND BEAM 'ROOF SHEATHING -!(-9q Dy, 8 FT.-BOND,BEAM ,FRAM!NGNENTILIAT!ON - FINAL BOhID BEAM ' ROOF COVER . " ' PRE -GRADING ROUGH HEATING BENCHING 'ROUGH ELECTRIC_ '. _ _ ROUGH GRADING ROUGH; PLUMBING -- -- FINISH GRADING SHOWER/TUB TEST - POOL ELECTRIC FXT, LATH/SIDING - POOL FENCING VALL-tNSULATION — - - POOL FINAL iCEILiNG INSULATION - OFF SITE IMPS. DRrIALCNAILING - - DEDICATIONS iSEV,tER FINAL ENG. . SEPTICTANK LANDSCAPE/IRRIG. j. Sty P P;T/LL. ON SITE IMPS. T EST FINAL ZONING FIRE DEPT. FINAL HEALTH DEPT. FINAL JDEV. _ ELECTRIC FEES PAID - - r ;__ .:.. •PLUMBING - I _ ENERGY - i ; lr�MMEWS V SEPTIC TANK SIF E ;SEEP PIT/U SIZE I