HomeMy WebLinkAbout16655CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
C\\ � (909) 6 -3195 Drive
(909) 860-3195 Fax (909) 861-31 l7
BUILDING PERMIT APPLICATION
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TRAOWNER y4 ��ADDRESSCITY ZIP TEL. Z�y�A9
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ADDRESS
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DESIGNER
ADDRESS
CITY ZIP TEL.
OWNER -BUILDER DECLARATION
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI-
CENSE LAW FOR THE FOLLOWING REASON ISEC. 7031.5 BUSINESS AND PRCFE SSONS CODE. ANY CITY OR
COUNTY WHICH REQUIRES A PERMIT TOCONSTRUCT-µTER. AI PROVE. DEMOLISH, OR REPAIR ANY STRUC-
TURE, 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 Y ICOMMENCING WITH SECTION 700C)OF DIVISION S OF THE BUSINESS AND PRO.
FESSIONS CODE) OR THAT I,E OR SHE IS EXEMPT THEREFROM AND THC BASIS FOR THE A.LEGCD EXEMP-
TION. ANY VIOLATION OF SECTION 7001 5 BY ANY APPLICANT FOR A PERMIT SUIDJEGTS IHE APFLICAVT TO
A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (7500) ):
O 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, BUSI.
NESSAND PROFESSIONS CODE: THE CONTRACTORS UCENSE LAW DOES NOTAPPLY TO AN OWNER OF
PROPERTY WHo BUILDS OR IMPROVES THEREON, A.NO WHO DOES SUCH WORK RIMS ELF OR HERSELF OR
THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH WPROVEMENTS ARE NOT INTENDED OR
OFFERED FOR Sµ E. IF, HOW EVER 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. 7044. BUSINESS AND PROFESSIONS CODE. THE CONTRACTORS LI-
CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON. AND
WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTONS) LICENS ED PURSUANT TO THE QONTRAC•
TORS LICE NSE LAW).
O I AM EXEMPT UNDER SEC. B. { P.C. FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
1 HERESY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM LICENSED UNDER PROVISIONS OF CHAPTER
• (COMMENCING WITH SECTION 7000) OF DIVISION 0 OF THE BUSINESS AND PROFESSIONS CODE, AND
MY LICENSE IS N FULL FORCE AND EFFECT. L` QQQ
LICENSE CUS LIC. NO.
DATE � CONTRACTORyCA(I
WORKERS' COMPENSATION DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS.
_I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT 70 SELF -INSURE FOR WORKERS'
COMPENSATION, AS PROVIDED BY SECTION 0700OF THE LABOR CODE. FOR THE PERFORMANCE
�F THE WORK FOR WHICH THIS PERMITIS ISSUED.
I 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 PERMITIS
ISSUED. MY WORKERSCOMPE "CATION INSU j:.^,E CARRIER .D POLICY NUMBER ARE:
CARRIER _s
POLICY NUMBER
(THIS SECTION NEEDNOTBE COMPLETED OF TIE PERM T l5 FORONE HUNDRED DCL1ARS R'00) OR LESS)
I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I
SHALL NOT EMPLOY ANY PERSON N ANY MANNER SO AS TO B E COME SURJEC7 TO THE
WORKERS' COMPENSATION LAWS OF CALIFORNIA. AND AGREE THAT IF I SHOULD BECOME
SU0.:ECCT/TTOTHEWORKERS'COMPENSATIONPROV IONSOFSEC`ON0700OF: LABOR
DATE: DAPPLCANT.W.TM TNOS .OV15KX+5
WARNING. FAILURE TO SECURE WORKERS'COMPENSATON COVERAGE IS UNLAWFUL. AND SHALL BE
SU13JECT AN EMPLOYER TO CRIMINAL PENALTIES AND CiVII FINES UP TOONE HUNDRED THOUSAND
DOLLARS IS W,000), INADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FORM
SECTION 0708 OF THE LABOR CODE, INTEREST. AND ATTORNEYS FEES,
CONSTRUCTION LENDING AGENCY
I HEREBY AFFIRM UNDER PENALTY OF PEFiR1R THA THERE IS ACONSTRUCTKON LENDING AGENCY
FOR THE PERFOnMANCE OF THE WORK f�'T 1 .IC HIS PERMIT IS ISSUED (SEC. 0097, CIV C ).
LENDERS NAME N
LENDERS ADDRESS
1 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
1 AGREE TO COMPLY WITH ALL CITY ANO COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
CONSTRUCTION. AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
ABOVE MENTIONED PROPERTY FOR INSPECTION PURPOSES.
:PE,-ITTE AME (R^ .LOr rIRMITTEE
i
PRESS
FIRMLY
APPLICATION /�
PERMIT P/C
1
DATE
NUMBER
p
ISSUE /h�
TYPE
OCC
DATE l.'
_ CONST.
GROUP
ZONING SETBACKS
FRONT
RW
❑
REAR
❑
SIDE/SIDESTREET
RYV
❑
SIDE
❑
PROPOSED USE
NO. DWEL. NO.
NO.
UNITS STORIES_
BEDROOMS
DESCRIPTION
SO. FT.
FACTOR PSF
ADJ.AREA/VALUATION
SFRIADD/REM
co
GaragelCarport
WPalio/Deck
V-
Pool/Spa
Z
Re-Rocl
C)
Commorcia!
5
m
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y
Valuation"
ADJ.AREA
QUANTITY
DESCRIPTION
FEE
J
Q
U
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H
U
W
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0
Z
J
a
4
U_
Z
Q
S
U
W
CONSTRUCTION
V v
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INS?ECTION FEE
ISSUANCE l L7
4T 'S r" -P
SMIP ��
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l ��:•
1 �J�
ENERGY P/C
N 4 2001
i
ENERGY PERMIT
E
RETENTION FEE:
I
PRE-ALT FEE:
TOTAL FEES
Q .
COMMENTS
RECPT NO. PAID
BY
VALIDATION
WHITE —Department Copy. YELLOW —Finance Copy. PINK —Assessor Copy. GOLDENROD —File Copy. GREEN —Applicant's Copy
CIT", OF DIAMOND BA�R
INSPECT ION RECORD
r ic-i o i
SETBACK
f; r c I -.i IZ-JLN'.'
FLOOR JOIST
r
IFTGS/FORMS/STEEL
I
I FHA REQ'ilTS
ELECTRIC GROUND
UNDER FLOOR DUCT
GROUND PLUMBING
U NDER FLOOR COINDUIT
SLAB GRADE
FIREPLACE FOUNDATIOt'l
FIREPLACE BOND BEAM
_-
TEMP POWER
WATER SERVICE
MID HT. BOND BE:::A%l
_8_FT, BOND CEA,'.l
FINAL 607,jb BEAM
ROOF SHEATHING
Ell
FRAMINGIVENTILIATIONI
I
ROOF COVER
ROUGH HEATING I
PRE -GRADING
BENCHING
ROUGH ELECTRIC
I
ROUGH GRADING
ROUGH PLUMBING�
f
FINISH GRADING
SHOWER/TUB TEST
POOL ELECTRIC
EXT. LATH/SIDING
POOL FENCING
WALL INSULATION
POOL FINAL
CEILING INSULATION
OFF SITE IMPS.
DRYVJALL NAILING
I
I DEDICATIONS
SEWER
I FINAL ENG.
SEPTIC TANK
I LANDSCAPE/IRRIG.
SEEP PIT/L.L.
L
I 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
II
I ENERGY
COMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE