HomeMy WebLinkAbout11-732 �� CITY OF DIAMOND BAR ��>
DEPARTMENT OF CC�A4L•,'V"�TY&DEVELOPMENT SERVICES � �
21825 Copley Drive,Diamond Bar,CA 91765
� (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-70 PRESS
�'��'�W BUILDING PERMIT APPLICATION �� FIRMLY
o� JOBSITE � x - APPL�CATIONA PERMIT j', �Q,.� p/C �/
ADDRESS DATE V O NUMBER � �JDC•ry
� ISSUE � �!� TYPE �f�� OCC
APN LOT TRACT DATE CONST. GROUP
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o ADDRESS ZONING SETBACK
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o APPLICANT TEL. SIDE/SIDE STREET qyy ❑
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� CITY ZIP��TEL. - PROPOSED USE j -
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� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION
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W CENSE UW FOR THE FOLLOWINO REASON(SEC.7031.5 BUSINESS AND PROFESSIONS CODE:PNY qTV OR (n g �
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� TURE,PRIOR TO ITS ISSUANCE,AL50 REQUIRES THE APPUCANT FOR SUCH PERMIT TO FILE A SIGNED w PatldDeck
STATEAIENT THAT HE OR SHE IS IJCENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS Lb
� CENSE LAW(CHAPTER Y(COAIMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � Poal/Spe
, Q FESSIONS CODE)OR TMAT HE OR SHE IS EXEMPT THEREFROM AND 7HE BASIS FOR 7HE ALLE6ED E%EMP• (�
V TION.ANV VIq.AT10N OF SECTION 7031.5 BV ANY APPUCANT FOR A PERMIT 5U&IECTS THE APPLICANT TO Z Re-Rao}
A CML PENALTV OF NOT MORE THAN FIVE HUNDRED DOLURS(f500).):
� ❑I,ASOWNEROFTHEPROPERTV,ORMYEMVLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, 0 CORIrt18fC101
Z MALL DO THE WORK,AND THE STRUCNRE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7Ma,BUSI� J � '
� HESS AND PROFESSIONS CODE:THE CANTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF � ,
PROPERTY MM1iO BUILDS OR IMPROVES THEREON,AND NMO DOES SUCH WORK HIAISELF OR HERSELF OR
wTHROUaH HIS OR HER ONTI EMPLOYEES,PROVIDED THAT SUCN IMPROVEMENTS ARE NOT INTENDED OR m
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Z TION,7HE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUIID OR
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W ❑I.AS OWNER OF h1E PROPERTV,AM E%CIUSIVELV CONTRACTINO WfTH LICENSED CO!lTRACTORS ^^
[C TO CONSTRUCT TME PR0.IECT(SEC.7011,BUSINE55 AND PROFESSIONS CODE THE CONTRACTORS LI- V8IU8�1Of1 �'J Ol N � qDJ.AREA '
W CENSE LAW DOES NOTAPPLV TO AN ONRJER OF A PROPERTV WF10 BUILDS OR IMPROVE9 THEREON,AND
� NMOCONTRACTSFOqSUCHPROJECTSWITIACONTRACTOq�S)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION �
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� ❑1 M1 E%EMPT UNDER SEC. B.8 P.C.FOR THIS REASON �
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� DATE OWNER H
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�Q LICENSED CONTRACTORS DECLARATION W
2 I HEREBV AFFIqAI UNDER PENALTV OF PERJURV TNAT I AM LICENSED UNDER PROVISIONS OF CHAPTEF �
� D(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 ANO PROFESSIONS CODE.AND Z
X MY LICENSE IS IN FUL�FORCE AND EFFECT. m
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LICENSE CIA S LIC.NO.
V DATE CONTRACTOR_ SI/�� �p WJ, a
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� WORKERS'COMPENSATION DECLARATION � .,
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N I HEREBY AFFIRM UNDER PENAL7Y OF PERJURV ONE OF THE FOLLOWING DECURATIONS: Z
� _IHAVEANDWIILAWNTAINACERTIFICATEOFCONSENTTOSELF•INSUREFORWORKERS' a
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Q COMPENSATqN,AS PROVI�ED BV SECTION 3700 OF THE UBOR CODE,FOR THE PERFORMANCE W
Q OFTHE WORN FOR WHICH THIS PERMIT IS ISSUED. �
w �1 HAVE AND WILI MAINTAIN WORKERS'COMPENSATION INSURANCE,AS FEOl11RED BV SECTION
Q 3700 OF THE LABOR CODE,FOR THE PERFORIAAIJCE OF THE WORK FOR WHICH THIS PERMIT IS � ��/
ISSUED.MV WORKERS,/'yC�O/M�P�ENyS�t�TIO/N�,IN�SU CARRIER AND POLICV/N`UMBER ARE: CONSTRUCTION
� CARRIER��I III A.�I!I�IV�/-�1 ��l-�LG'� �D�+ - p1./W REVIEW
� POLICVNUMBER �,�JC��� !J� -�� '�'� ' _.�� ELECTRIC
� (iHISSECiK7NNE�NOTBE07MFtE�EDOF7HEPEPMfTISFOHONEHlAlJfimpqJJ3L5�5100)ORLESS} PLUMBING
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Z I CERTIFV 7HAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,1 MECHANICAL
C.�S SHALL NOT EMPLOV ANV PEHSON IN ANV MANNER 50 AS TO BECOME SUBJECT TO THE
(/� WORKERS'COMPENSATION IAWS OF CALIFORN10.�ND AGREE THAT IF I SHOULD BECAME INSPECTION FEE
SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR �
S COOE I SHALL FOHTHIMTH COMPLV WITH THOSE PROVISIONS. � / ISSUANCE _ �
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p DATE: APPLICANT. . SMIP _
w I ENERGY P/C
� WARNING:F LUR TO SECURE WORKERS'COMPE ION CAVERAGE IS UNLAWFUL,AND SHALL BE
�y SU&IECT Ml MPLOVEH TO CRIMINAL PENALTIE qVIL FMES L1P TOONE HUNDRED TNOUSAND ENERGY PERMIT
DOLURS(f100,000�,IN ADDITION TO THE COST COMPENSATION,DAMhGES AS PROVIDED FOR IN
J SECTION 3]OB OF THE LABOR CODE,WTEREST,AND ATTORNEV'S FEES.
w RETENTION FEE: �Z.�I�
O CONSTRUCTION LENDING AGENCY P ALT FE
� I HEREBV AFFIRM UNDEF PENALTY OF PERlURV THAT THERE IS ACONSTRUCTION LENDINa AOENCY ��� �O O
Z FOR THE PERFORMANCE OF 7HE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3ao7,CIV.C.�.
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� LENDER'S NAME
H LENDERSADDRE55
� I CERTIFV THAT I HAVE fiEAD THIS APPLICATION AND STATE T1iAT THE ABOVE INFORMATION IS CORRECT. TOTAL F E ES � � y?�D��
w I AGREE TO CAMPLV WITH ALL CITV AND COUNTV ORDINANCES AND STATE UWS PEUTING TO BUILOIN6
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS CWNTV TO ENTER UPON 7HE
Z ABOVE�MENTIONED PROPERTV FOR INSPECTION PURPOSES.
o f COMMENTS '
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m PERMITTEE NAME(PR //! � �
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� SN3NATUR ERMITTEE DA7E T
= RECPT.NO. � PAID BY ✓ vni innrinN
~ WHITE—Department Copy,YELLOW�inence Copy,PINK—Assessor Copy,GOLDENROD—Flle Copy,GREEN—Applk;anYs Copy
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SET BACK FLOOR JOIST � - �
FTGS/FORMS/STEEL FHA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID HT. BOND BEAM
ROOF SHEATHING 8 FT. BOND BEAM
FRAMINGNENTILATION FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC
EXT.LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST FINAL ZONING -
FINAL CONST. � // FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY
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COMMEIVTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
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