HomeMy WebLinkAbout18547\ CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
21825 E. Copley Drive
(909) 860-3195 Fax (909) $61-3117
.. BUILDING PERMIT APPLICATION
JOBSITE /S y� �Qer-�Ool'�
ADDRESS
APN LOT TR CT
OWNER '� h C
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S ADDRESS
CITY Owl 6 IP TEL
APPLICAN f� A ,% Cam_ TEL.
CONTRACT 60 P
ADDR S
CITY ZIP TEL
ARCHIENG/
DESIGNER
ADDRESS
CITY ZIP TEL.
OWNER -BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI-
CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE. ANYCITYOR
COUNTY WHICH REOUIRESA PERMIT TO CONSTRUCT, ALTER IMPROVE, DEMOLISH, OR REPAIR ANY STRUC•
TUBE. PRIOR TO ITS ISSUANCE. ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS U•
CENSE LAW (CHAPTER 9 (COMMENCING PATH SECTION 7000) OF DMSCN 3OF THE BUSINESS AND PRO•
FESSIONSCODE) OR THATHEORSHE IS EXEMPT THCRE FROM AND THE BASIS FOR THE ALLEGEDEXEMP•
T)ON. ANY VIOLATION OF SECTION 7031.5 BY ANYAPPLICANT FORA PERMIT SUBJECTS THE APPLICANT TO
A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (SS00) ),
D L AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION,
WILL DO THE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, BUST-
NESSAND 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 CR
THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR
OFFERED FORSALE IF, HOWEVER THE BUILD'NO OR IMPROVEMENT IS SOLO WITHIN ONE YEAR OF COMPLE-
TON, THE OWNER -BUILDER 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 CONTRACTING WITH LICENSED CONTRACTORS
TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI-
CENSE LAW DOES NOTAPPLY TO AN OWNER OF A PROPERTY WHO aVILDS OR IMPROVES THEREON. AND
LV)O CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTORS) LICENSED PURSUANT TO THE CONTRAC-
TORS UCENSE LAW).
O IAM EXEMPT UNDER SEC. 6. L P.C. FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER
9 (COMMENCING WITH SECTION 7N10) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE. AND
MY LICENSE 19IN ML FORCE AAyN1 O EFFECT.
LICENSE CLASS 3 / LIC. NO.
DATE n CONTRACTOR
3 �11� KERS' COMPENSATION DECLARATION
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
—1 HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS'
COMPENSATION, AS PROVIDED BY SECTION 37M OF THE LABOR CODE. FOR THE PERFORMANCE
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.
HAVE AND WILL MAINTAIN 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 WOpLER3' COM^ENSATIDN BNSUCARRIEp AND POLICY NUMBER ARE:
CARRIER S �GJ�
POLICY NUMBER
RHISSECTION NEED NOT BE COMPLETEDOF TIE PERLLTIS FORONE HIPDRED OCl1ARS (FI00) OR LESS)
I CERTIFYTHAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED, 1
SHALLNOTEMPLOY ANY PERSON IN ANY MANNER SOAS TOBECOME SUBJECT TO THE
WORKERS' COMPENSATION LAWS OF CALIFORNIA. AND AGREE THAT IF I SHOULD BECOME
SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR
CODE. I SHALL FORTHWITH COMPLY WITH HO PROVISO
DATE: �ro APPLICANT
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL BE
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP 10 ONE HUNDRED THOUSAND
DOLLARS (S 100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 37050F THE LABOR CODE. INTEREST, AND ATTORNEYS FEES.
CONSTRUCTION LENDING AGENCY
1 HEREBYAFF WM UNDER PENALTY OF PERJURY 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
LENDER'S ADDRESS
I CERTIFY THAT 1 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
CONSTRUCTION. AND HEREBY AUTHORIZE PEPRESENTATNES OF THIS COUNTY TO ENTER UPON THE
ABOVE-MENT EDPROPERTY ORINSPECT0NPLF4.VSES.
� PERM(/Iy�Ep/fA��ME: (PAINTy3
) SIGNA,URE OF PER TEES-
OPRESS
FIRMLY
APPLICATION - 3-u� PERMIT P/C
DATE NUMBER q
ISSUE TYPE OCC
DATE CONST. GROUP
ZONING SETBACKS
FRONT RW ❑
REAR ❑
SIDE/SIDE STREET RW ❑
SIDE p
PROPOSED USE ^ ti"2
NO. DWEL. NO. NO.
UNITS STORIES BEDROOMS
DESCRIPTION
SO. FT.
FACTOR PSF
ADJ. AREAIVALUATION
SFR/ADD/REM
CD
Garage/Carport
WPatio7Deck
LL
Pool/Spa
ZRe
-Root
a QA
Commercial
5
m
Valuation _ ADJ.AREA
QUANTITY
DESCRIPTION
FEE
J
d
U
CC
h
U
W
-J
W
2
m
a
4
U
a
d
W
CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE T
SMIP V
ENERGY P/C
ENERGY PERMIT
V
RETENTION FEE:
PRE-ALT FEE: '
TOTAL FEES S O
COMMENTS
RECPT. NO. PAID BY VALIDATION
WHITE —Department Copy. YELLOW —Finance Copy, PINK —Assessor Gopy, GVwtNHVu—tne wpy uhttN—Appit ;ant s copy
CITY OF DIAf&OND BAR
INISPECTION RECORD
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FTGSIFORMS/STEEL--_ -
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ELECTRIC GROUND
UNDER FLOOR -DUCT.
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GROUND PLUMBING i -- --
SLAB GRADE `^
_ _
UNDER FLOOR CONDUIT
- —
FIREPLACE FOUNDATION
i
TEMP POWER
i
I J FIREPLACE BOND BEAM
_
WATER SERVICE _ 1 _-
ROOF SHEATHING CaU
FRAMINGNENTILIATION
ROOF COVER �D d Z
ROUGH HEATING
ROUGH ELECTRIC
ROUGH PLUMBING _
SHOWER/TUB TEST 1 _
EXT. LATH/SIDING
l _
_ _ I MID HT. BOND BEACH
! 8 FT BOND BEAM
1 FINAL BOND BEAM
PRE-GRADIN_ G
BENCHING
ROUGH GRADIt-
_FINISH GRADING
i POOL ELECTRIC
j { POOL FENCING
—
!
_
WALL INSULATION)
_
1 POOL FINAL
i
CEILING INSULATION
DRYWALL NAILINJG
SEWER
-
�-
_
FF SITE IMPS.
�-'DEDI CATIONJS
FINAL ENG.
SEPTIC TANK
1
LANDSCAPE/IRRIG.
j
SEEP PIT/L.L.
GAS AIR TEST
1-
!
TON SITE IMPS.
--
1 FINAL ZONING
FINAL CONST.
FINAL HEATING
1 FIRE DEPT. FINAL
HEALTH DEPT. FINAL
FINAL ELECTRIC
fbEV. FEES PAID
FINAL PLUMBING
I
ENERGY
COMMENTS
SEPTIC TANK SIZE
SEEP PITH SIZE —
i
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