HomeMy WebLinkAbout18690CITY OF DIAMOND BAR
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DEPARTMENT OF COMMUNTFY & DEVELOPMENT SERVICES
21825 E. Copley Drive
(909) 860-3195 Fax (909) 861-3117
BUILDING PERMIT APPLICATION D A I
JOBSITE ��
ADDRESS
APN LOT i TRACT _
OWNER
ADDR S 3 S
CITY
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APPLICANT
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CONTRACT R vbpls
ADDRE S
CITY ZIP 1 4 TEL. 1
ARCH/ENG/
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: ANY IT CY OR
COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT, ALTER, IMPROVE, DEMOLISH, OR REPAIR ANY STRUC.
TURF. 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 LI-
CENSE LAW (CHAPTER 0 (COMMENCING WITH SECTION 7000) OF DIVISION 3 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 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO
A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS
❑ I, AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS 1 HEIR SOLE COMPENSATION,
WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044. BUSI.-
NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES N07 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 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 SALE).
❑ I, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS
TO CONSTRUCT THE PROJECT (SEC. 70". BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI-
CENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON, AND
WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC-
TORS LICENSE LAW.).
❑ 1 AM EXEMPT UNDER SEC. B. 8 P.C. FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER
Y (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND
MY LICENSE IS IN FULL FORCE AND EFFECT.
LICENSE C SS LIC. NO.
02
DATE - CONTRACTOR
WORKERS' COMPENSATION DECLARATION
I HEREBYAFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
-I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF,INSURE FOR WORKERS'
COMPENSATION, AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE
OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED,
I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REGUIRED BY SECTION
3700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
CHAR ER Y WORK E S' COf N ATION yfytlRANCE CARRIER f1 POyICY NUMBER ARE:
POLICY NUMBER
(THIS SECTION NEED NOT BE 03 R-ETEDOF THE PERMIT IS FOR ONE HUNDRED DXL RS(ft00)OR LESS),
I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, 1
SHALL NOT EMPLOY ANY PERSON IN 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 37M OF THE LABOR
DE, I SHALL FORTHWITH COMPLY y�MP1yTFgSE PgpyI510)IS>
DATE: _ APPLICANT:: in 17
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL BE
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (f 100.000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
CONSTRUCTION LENDING AGENCY
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3097, CIV. C.).
LENDER'S NAME
LENDERS ADDRESS
I CERTIFY THAT I 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 REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
ABOVE -MENTIONED PROPERTYFO INSPECTION PURPOSES.
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PE TT (PRINT) -
SIGNATURE OF PERMITTEE DATE
WHITE —Department Copy, YELI.OW—Finance Copy, PINK
tarty k PRESS
FIRMLY
APPLICATION
PERMIT
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DATE
NUMBER61f
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ISSUE
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DATE
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GROUP
ZONING SETBACKS
FRONT RW
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SIDE
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PROPOSED USE
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NO. DWEL.
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NO.
NO.
UNITS
STORIES
BEDROOMS
DESCRIPTION
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Garage/Carport
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CONSTRUCTION
PLAN REVIEW
ELECTRIC
147
PLUMBING
MECHANICAL
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INSPECTION FEE
ISSUANCE
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SMIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE:
PRE-ALT FEE:
TOTAL FEES
P
MENTS
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RECPT NO.
PAID BY
VALIDATION
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3i1.16
CITY OF DIAMOND BAR
INSPECTBON RECORD
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SET BACK-
FTGS/FORM EEL
FLOOR JOIST
FHA REOMTS
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
FRAMING/VENTILIATION
FINAL BOND BEAM
ROOF COVER
PRE -GRADING
ROUGH HEATING
BENCHING
ROUGH ELECTRIC
-
ROUGH GRADING
_
ROUGH PLUMBING
SHOWER/TUB TEST
EXT. LATH/SIDING
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FINISH GRADING
POOL ELECTRIC
POOL FENCING
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WALL INSULATION
POOL FINAL
CEILING INSULATION
OFF SITE IMPS.
DRYWALL_ NAILING
DEDICATIONS
SEWER
_
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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
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HEALTH DEPT. FINAL
FINAL ELECTRIC
DEV. FEES PAID
FINAL PLUMBING
ENERGY
COMMENTS
SEPTIC TANK SIZE
-SEEP PIT/Ul SIZE
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