HomeMy WebLinkAbout13668CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
21660 E. Copley Drive Suite 190
(909)860-3195 Fax (909) 861-3117
BUILDING PERMIT APPLICATION r
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DESIGNER
ADDRESS
CITY ZIP TEL.
OWNER -BUILDER DECLARATION
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1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS U-
CENSE LAW FOR THE FOLLOWING REASCN (SEC.7031.6 BUSINESS AND PROFESSIONS CODE: ANY CITY OR
COUNTY WHICH REGUIRESA PERMIT TO CONSTRUCT,ALTER IMPROVE. DEMOUSK OR REPNRANY STRUC-
TURE, PRIOR TO RS ISSUANCE. ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
TATFJAQNT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS U-
CENSE LAW (01APTER B (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PFO-
SESSIONS COM ORTHAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP-
PTION. ANY VIOLATION OF SECTION 7031.6 BY ANYAPPLICANT FOR A PERMIT SUBJECTS THEAPPLICANT TO
A CML PENALTY OF NOT MORE TWW FIVE HUNDRED DOLARS($W0).y.
D LAS OWNER OFTHE PROPERTY, OR MY EMPLOYEES WITHWAGESAS THEIRSOLE COMPENSATION,
WILLDO THE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE ISEC, 704-4, BUSI-
NESS AND PROFESSIONS COOS THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF
PROPERTY WHO BUILDS OR IMPROVES THEREON, AND V 440 DOES SUCH WORK HIMSELF OR HERSELF OR
THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR
OFFEREDFORSALE IF.W WLVERTHEBUtMNGORIMPROVEMETNTISSO(DWrTHNONEYEAROFCOMPLE-
TION, THE CWNERBULDER MALL FIVE THE BURDEN OF PROVING THAT HE OR SHE DO NOT BUILD OR
IMPROVE FOR THE PURPOSE OF SALEI
O LAS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS
TO CONSTRUCT THE PROJECT (SEG 70N, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI.
CENSE LAW DOES NOTAPPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND
WHO CONTRACTS FOR SUCH PROJECTS NTH ACONWCTCA S) LICENSED PURSUANT TO THE CONTRAC-
TORS UCENSE LAW.).
O I AM EXEMPT UNDER SEC. B. S P.C. FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
1 HEREBY AFFIRM TINDER PENALTY OF PERJURY THAT I AM LICENSED VNDE R PROVISONS OF CHAPTER
6 (COMMENCING WITH SECTION?'" OF DIVISION S OF THE BUSINESS AND PROFESSIONS CODE. AND
MY LICENSE 15 IN FULL
FORCE AND EFFECT.
LICENSE CLA r 'S LTC. NO. -37 6 0
DATE CONTRACTOR
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WORKERS' COMPENSATION DECLA ON Q
I HEREBYAFFIRM UNDER PENALTY OF PERJURY CNE OF THE FOLLOWING DECLARATIONS:
_I HAVE AND WILLMAINTAIN A CERTIFICATE OF CONSENT TO SELFINSURE FOR MARKERS'
COIAPENSATION, AS PROVIDED BY SECTION I7000F THE LABOR CODE, FOR THE PERFORMANCE
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.
_,1 HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS RECUIRED BY SECTION
3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED. MY WORKERT COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE:
CARRIER
POUC/NUMBER
L"SECRCNNEMNOTBE00H,RFTEDOFTFEPEMCrFCRONCH.IOMMLARS(SIMCRLM
1 CERTIFY THAT N THE PERFORMANCE OFTHE WARN FOR YYI/ICJN THIS PERMIT 5 ISSUED. 1
SHALL NOT EMPLOY ANY PERSON INANY MANNER SO AS TO BECOME SUBACT TO THE
j WORKERTCOMPENSATKXN LAWS OF CALIFORNIA. AND AGREE THAT IF I SHOULD BECOME
SUBJECT TO THE WORILEFLS'COMPENSAT yROVISKXNSOFSECTON37000FTHELABOR
i CODE WALL WRFI COMPLY WITH SE PF ONS.
1 DATE: � � APPLICANT: _
WARNING: FALURETO SECURE WORKERTCOMP AT COVERAGE IS UNLAWFUL. AND SHALL BE
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIESYIL EWES UP TO ONE HUMORED THOUSAND
DOLLARS(31ao.000), N ADDITION TO THE COST OF PENSATICN, DAMAGES AS PROVIDED FOR IN
t SECTION 3708 OFTHE LABOR CODE. INTEREST, AND ATTORNEYS FEES.
1 CONSTRUCTION LENDING AGENCY
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1 HEREBYAFFIRUA UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION (ENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3097. CIV. Q.
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LENDER'S NAME
LENDERS ADDRESS
1 CERTIFY THAT 1 HAVE READ THIS APPUCATION AND STATE THAT THE ABOVE INFORMATION IS EDRRECT.
1 AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
7- CONSTRUCTION. AND HEREBYAUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
` ABOVE -MENTIONED PROPERTY FOR INSPECTION PURPOSES.
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DATE NUMBE
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DATE CONST.
GROUP
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FRONT RW
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SIDE/SIDE STREET RW
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PROPOSED USE
NO. DWEL NO.
NO.
UNITS STORIES
BEDROOMS
DESCRIPTION
SO. FT.
FACTOR PSF
ADJ. AREAIVALUATION
SFR/ADD/REM
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ENERGY P/C
ENERGY PERMIT
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TOTAL FEES
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COMMENTS
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RECPT. NO.
PAID BY
AUDATION
WHITE —Department Copy, YELLOW—Finenoe Copy, PINK—ASSOSSOF L:OPY. LiULUtrvHUU 110 LAW, aanttrv—npplraNl S wpy
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CITY OF DIAMOND.BAR , ...
INSPECTION RECORD r
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UNDER FLOOR DUCT
GROUND PLUMBING
UNDER FLOOR CONDUIT
SLAB GRADE
FIREPLACE FOUNDATION
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TEMP POWER
FIREPLACE`ab�D BEAM'. '
=
WATER SERVICE
MID HT. BOND BEAM
:ROOF SHEATH_If1
a FT. BOND,BEAM
-
,FRAMING/VENTILI TION
FINAL BOND BEAM
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PRE -GRADING
ROUGH HEATING
BENCHING
ROUGH ELECTRIC
ROUGH GRADING
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FINISH GRADING
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SHOWER/TUBTEST
POOL ELECTRIC
EXT. LATH/SIDING
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UVIALL INSULATION
POOL FINAL
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DRYWALL NAILING
-DEDICATIONS
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SEWER
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FINAL'ENG.
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LANDSCAPE/IRRIG.
SEEP PIT/L.L.
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ON SITE IMPS.
GAS AIR TEST
FINAL CONST. ,��
FINAL HEATING
FINAL ZONING
FIRE DEPT. FINAL
;
HEALTH DEPT. FINAL
FINAL ELECTRIC
I `-INAL PLUMBING
DEV. FEES PAID
ENERGY
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COMMENTS- - - .., . T�:;
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ISEPTIC TANK SIZE
SEEP PIT/U SIZE
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