HomeMy WebLinkAbout8512 (20).pdfCITY OF DIAMOND BAR
InhwumillAuf COMMUNITY DEVELOPMENT DEPARTMENT
C 21660 E. Copley Drive Suite 190
909) 8603195 Fax (909) 861.3117
BUILDING PERMIT APPLICATION
JOBSEss
APN -LOT TRACT
OWNER
ADDREA 46q
CITY ZIP TEL.
APPLICANT TEL.
CONTRACTO
ADDRE
CITY Ow TEL
ARCRENG/
DESIGNER
ADDRESS
CITY ZIP TEL.
OWNER -BUILDER DECLARATION
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM EXEMPT FROM THE CONTRACTORS U.
CENSE LAW FORTHE FOLLOWNO REASON (SEC 7071.6 BUSNESSAND PROFESSIONS CODE, ANY CITYOR
COUNTY W"CH REOl)IRES APERL/1TTO CONSTRl1CT, ALTER. MPROVE, DEMOUSK OR REPAIR ANYSTRUC.
TURF, PRIOR TO ITS ISSUANCE, ALSO REOUmcs THE APPLICANT FOR SUCH PERMIT TD FILE A SIGNED
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS L4
CENSE LAW CHAPTER a (COMMENCING WITH SECTION7000) OF DIVISIONS 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 7071.6 BYANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANTTO
A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (SWO).):
O LAS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION,
WILL 00 THE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR BALE (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
THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR
OFFERED FOR SALE IF. HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OFCOMPLE.
TION. THE OWNER -BUILDER WALL HAVE THE BURDEN OF PROVING THAT HE OR SHE DO NOT BUILD OR
IMPROVE FOR THE PURPOSE OF SALEL
O L AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS
TO CONSTRUCT THE PROJECT (SEC 7014, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS U -
CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THE RECN, AND
WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTORS) LICENSED PURSUANT TO THE CONTRAO
TORS LICENSE LAW.).
C 1 AM EXEMPT UNDER SEC. B. S P.C. FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROW SINS OF CHAPTER
a (COMMENCING WITH SECTION 7000) OF DIVISION S OF THE BUSINESS AND PROFESSIONS CODE, AND
MY LICENSE IS IN FULL FORCE AND EFFECT.
L aLICENSECLASS
I
6 LI:. NO. 4!f4107
DATE 'J CONTRA
WORKERS' COMPENSATION DECLARATION
I HEREBY AFFIRM LINGER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELFaNSURE 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' COMPENSATIONINSURANCE, AS REQUIREDECTIBYSON
5700 OF THE LABOR COOS- FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE:
CARRIER
POLICY NUMBER
Da5 SECTION NEEDNOT BE CCMIETED OF THE PEiMR6 FORONE HUNDRED DOLLARS (S100)OR LESSI
I CERTIFY THAT N THE PERFORMMCE OF THE WORK FOR WHICH THIS PERMIT S ISSUED, I
SHALL NOT EMPLOY ANY PERSON N 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 7700 OF THE LABOR
DATE: APPLICANT.
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL BE
SUISJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (6100,0001. N ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 5706 OF THE LABOR CODE. INTEREST, AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I HEREBYAFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORE FOR WHICH THIS PERMIT IS ISSUED (SEC 30I7. CIV. C.),
LENDER'S NAME
LENDERTSADDRESS
1 CERTIFYTHAT 1 HAVE READ THIS APPLICATION AND STATE THATTHE ABOVE INFORMATION IS CORRECT.
1 AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDNANCES AND STATE LAWS RELATING TO BUDDING
CONSTRUCTKOU AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
ABOVE-MENTIONM PROPERTY FOR INSPECTION PURPOSES.
N • 4
PERMITTEE NAME WRIr
SIONATUREOF PEMPTTSIONATUREOFEEDATE
PRESS
FIRMI V
APPLICATION PERMITPIC
DATE UMBER, S/L N
ISSUE / TYPE OCC
DATE CONST. GROUP
ZONING SETBACKS
FRONT RW
REAR
SIDE/SIDE STREET RW O
SIDE
PROPOSED USS lJl/iX,c-
NO, DWEL NO. NO.
UNITS STORIES BEDROOMS
DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION
SFR/ADDIREM
Garageicarport
W PatafDaek
LL PDOVSpa
0
Z Re -Root
Commercial
m
Valuatlon ADJ.AREA
QUANTITY DESCRIPTION FEE
QU_
U
us
w
UZ
Do
a
U
a2
2UW
CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING F
MECHANICAL
INSPECTION FEE
ISSUANCE J
SMIP
ENERGY PIC
ENERGY PERMIT
RETENTION FEE.
PRE -ALT FEE:
TOTAL FEES
COMMENTS
RECPT. NO 9% PAID BY L11 2-1 VALIDATION
WWI I C--LMpaRmBm WW. T CLLUYY-rmancs ,oW, 7-INI%--ASSSS5W 6M. WU WtNMUU—YINB LiOW. LiHLLN--Applimnia C -Ropy
CITY OF I,, ,.
II4SPECTION RECORD" ;
11 k- =f {i J; ti . t 446 1 0`0-;t AM
SET BACK:... . j FEOOR JOIST---- I ..- - - -----
FTGS/FORMS/STEEL--- - - - -- 'FHA REQMTS -
ELECTRIC GROUND UNDER FLOOR DUCT,
GROUND PLUMBING - - _. . _ I U DILR L ON
SLAB GRADE - - -- ,.,. _ _ r; .r- .: ': FIREPLACE FOUNDATION t -
tTEMP.POWER-.--. _ -_ = ;_: - FIREPLACE BON AM
MID HT. RCiND;BEi N' . `\
ROOF SHEATHING---_. _.. __.._.... .__-.- -- .__-- . _. 8 FT.'BOND BEAM
FRAMING/VENTILIATION = `FINAL. BOND BEAM -- - - -- ""-
ROOFCOVER -- _ :::..:- - - - _. - -- PRE -GRADING --
ROUGH HEATING...; BENCHING
ROUGH ELECTRIC--• --------------..._._ . _..._.. - .-- -.. . . ROUGH GRADING ,
ROUGH PLUMBING- - - - -- __ - --...... FINISH GRADING
SHOWERIfUB TEST! .__. -.__ ....i ---. _.... __... .. POOL ELECTRIC
EXT LATH/SIDING - i- tPOOLFENCING;: ' ..:.' , •..: ' . ,..- •, .., -
WALL INSULATION .f POOL FINAL
CEILING INSULATION ! OFF SITE IMPS. i
DRYWALL NAILING I DEDICATIONS I r.
SEWER, - - - - - -- -- ..! - FINAL ENG. ,
SEPTIC.TANK -. -_ __ _ _ _ _; .- LANDSCAPE/IRRIG.' ..
ON SITE IMPS.
GAS AIR TEST-!--- --- - - --- - _._ .. _FINAL ZONING
FINAL-CONST; --- --- - - - -- -- FIRE DEPT. FINAL - - -
FINAL HEATING --- - ---.....__......----'..----- -- - / HEALTH DEPT."FIN 1
FINAL EL'ECTRIC.... - - .. : :: ; .. _ -DEV. FEES PAID
FINAL PLUMBING -- - - - ENERGY .
t1
COMMENTS
77 77
SEPTIC -TANK SIZE -
SEEP PIT/U SIZE- I'