HomeMy WebLinkAbout1165 CLEAR CREEK CANYON DR ,
CITY OF DIAMOND BAR
-----1��`— DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21825 Copley Drive,Diamond Bar,CA 91765 � I
� (909)839-7020 Fax(909)861-3117 Bmldmg Inspect�on Hotlme(909)839-7027 PRESS
�'��' BUILDING PERMIT APPLICATION FIRMLY I
o� JOBSITE APPLICATION `' /� �-�/PERMIT �� p/C
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APN LOT TRACT DATE CONST. GROUP
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p� OWNER-BUILDER DECLARATION SFR/ADD/REM
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p I HEREBV AFFIRM UNDER PENALTV OF PERIURV THA7 I AM EXEMPT FROM THE CONTRACTORS LI� Gdfe9B/CBfpOR
W CENSE LAW FOR THE FOLLOWING REASON(SEC.7031.5 BUSINESS AND PROFESSIONS CADE:ANV CITV OR (n
U CAUNTYWHICHREOUIRESAPERMI7TOCANSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC-
w TURE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMI7 TO FILE A SIGNED w Patio/Deck
� STATEMENT THA7 HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CON7RAC70RS ll� �
� CENSE LAW(CHAPTER B(CAMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- POOUSpO
Q FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP� (�
V TION.ANV VIOUTION OF SEC710N 7031.5 BY ANV APPLICANT FOR A PERMIT SU&lECTS THE APPLICANT TO Z Re-Roo(
A CIVIL PENALTY OF NOT MORE hiAN FIVE HUNDREO DOLLARS(5500).):
� ❑I,ASOWNEROFTHEPROPERTY,ORMYEMPLOYEESWITHWAGESAS7HEIRSOLECOMPENSA710N, � COrt1rtIBfCi81
Z WILL DO THE WORK,AND THE STRUC7URE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7odt,BU51- J
� NESS AND PROFESSIONS CODE:THE CON7FiAC70RS LICENSE LAW DOES NO7 APPLV TO AN OWNER OF �
PROPERTY WHO BUILDS OR IMPROVES THEREON,AND NM110 DOES SUCH WORN HIMSELF OR HERSELF OR
CC THROUGH HIS OR HER OVM EMPLOYEES,PROVIDED 7HA7 SUCH IMPROVEMENTS ARE NO7 IN7ENDED OR m
� OFFERE�FORSALE.IF,HOWEVER,THEBUILDINGORIMPROVEMENTISSOLDWI7HINONEYEANOFCOMPLE-
Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING 7HAT HE OR SHE DID NO7 BUILD OR
� IMPROVE FOR THE PURPOSE OF SALE).
w O I,AS ONMER OF 7HE PROPERfV,AM EXCLUSIVELY CON7RAC71NG WITH LICENSED CONTRAC70qS
� 70 CONSTRUCT THE PRQIECT(SEC.7o�I,BUSINESS AND PROFESSIONS CODE:THE CONTRAC70RS LI- V81U8SIOf1 ADJ.AREA
W CENSE LAW DOES NO7APPlV 70AN OWNER OFA PROPERTY WHO BUILDS OH IMPFiOVES THEREON,AND
� N?IOCANTRACTSFORSUCHPROJECTSWITHACONTHAC70R(5)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE
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� ❑I AM EXEMPT UNDER SEC, B.8 P.C.FOR THIS REASON J
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DATE OWNER �
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� LICENSED CONTRACTORS DECLARATION W
� I HEREBY AFFIFM UNDER PENALTV OF PE{iJURV THAT I AM LICENSED UNDER PROVISIONS OF CHA7TER � /''�/ /�/
d e(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z i vL �'
X MY LICENSE IS IN FULL FOHCE AND EFFECT.
� LICENSE CLASS G���.��/ LIC.NO. /oJ /G.� j . ♦
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� WORKERS'COMPENSATION DECLARATION Q
� I HEREBY AFFIRM UNDER PENAL7V OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: Z
Z _I HAVE AND WILL MAINTAIN A CER7IFICA7E OF CONSEN7 TO SELF�INSURE FOR WORKERS' a
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¢ CAMPENSATION,AS PROVIDED BY SECTION 3700 OF TME UBOR CODE,FOR THE PERPoRMANCE U
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. w
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w �I HAVE AND WILL MAINTAIN WOFKERS'COMPENSATION INSURANCE,AS fiEOUIRED BV SEC710N
Q 370a OF THE LABOF CODE,FOR THE PERFOfiMANCE OF THE WORK FOR WHICH THIS PERMI7IS
ISSUEO.MV W/ORKERS'CAMPENSA710N INSURANCE CARRIER AND POLICY NUMBERARE: CONSTRUCTION
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ZPOLICV NUMBER I �D� ELECTRIC
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Z I CERTIFV THAT W THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUEO,I MECHANICAL
�} SHAIL NOT EMPLOY ANV PEHSON IN ANV MANNER SO AS TO BECOME SUBJECT TO THE
�/j WORKERS'COMPENSATIONLAWSOFCALIFORNIA,ANDAGHEETHATIFISHOy1LDBECOME INSPECTIONFEE
= SUBJECT TO THE WORKERS'COMFENSATION PROVISIONS OF SECTION 460F THE LABOR
CADE,�SHALL FORTHWITH COMPLV WI THOSE PRO`VISIONS. ISSUANCE
p DATES/�D� qppLICANT. C�iQ/` SMIP �•
J WARNING:FAILURETOSECUflEWOflKERS'COMPENSAIONCAVERAGEISUNLAWFUL,ANDSHALLBE ENERGYP/C
� SUBJECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFWESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
DOLURS(f100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
� SECTION 3708 OF THE LABOR CADE,INTEREST,AND ATTORNEV'S FEES. RETENTION FEE: ,
� CONSTAUCTION LENDING AGENCV PRE-ALT FEE:
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� I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS A CONSTRUCTION LENDING AGENCV
FOR THE PERF-0RMANCE OF THE WOHK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.). .
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� LENDER'S NAME
F- LENDER'SAD�RESS /
w I CERTIFV THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFOqMATION IS CARRECT. TOTAL FE ES /33� ✓
� I AGREE TO COMPLY WITH ALL qTV AND COUNTY ORDINANCES AND STATE LAWS REUTING TO BUILDING
� CANSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF 7HIS COUN7V TO EN7ER UPON 7HE
Z ABOVE�MEN710NED PROPERTv FOR INSPEC710N PURPOSES. COMMENTS �
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� SIGNAT R OF PERMI DATE � \
= RECPT.NO. PAID BY VALIDATION
~ WHITE—Department Copy,YELLOW�inance Copy,PINK—Assessor Copy,GOLDENROD--File Copy,GREEN—Applicant's 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 H'L BOND BEAM
ROOF SHEATHING 8 FT. BOND BEAM
FRAMINGNENTILATION FINAL BOND BEAM
ROOF COVER PRE-GRADWG
ROUGH HEATING BENCHING
ROUGH ELECTRIG ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC _
EXT. LATH/SIDING P�OL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATION OFF SITE�MPS. ____ _
DRYWALL NAILING DEDICATIONS .
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG. _ _
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. (rlZy G�����!�`� FIRE DEPT. FINAL ---
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC �7j''' G DEV. FEES PAID
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FINAL PLUMBING � ENERGY
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COMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
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