HomeMy WebLinkAbout26560ri,08MIA11i
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CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
21825 Copley Drive, Diamond Bar, CA 91765
(909) 839-7020 Fax (909) 861-3117 Building Inspection Hotline (909) 839-71(7
BUILDING PERMIT APPLICATION
JOBSITRP3-16-3
ADDRESS
APN LOT TRACT
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OWNER
ADDRESS
'CITY ZIP T E L. 7
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APPLICANT &0k TEL.
CONTRACTOR J j1Z e -
ADDRESS *ezt �-3 r
CITY C4fIlAto ZIP '9/ZE!!3 TIf1L. S_V-76-10
ARCH/ENG/
DESIGNER
ADDRESS
CITY ZIP — TEL.
OWNER -BUILDER DECLARATION
I HERE13Y AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS Ll-
CENSELAWFORTHE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE: ANY CITY OR
COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT. ALTER. IMPROVE, 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 LI-
CENSE LAW (CHAPTER 9 (COMMENCING WITH SECTION 7�) OF DIVISION 3 OF THE BUSINESS AND PRO.
FESSIONS CODE) OR THAT HE OR SHE IS EXEMPTTHERrFROM AND THE BASIS FOR THEALLEGED EXEMP-
T`QN- ANY VIOLATION OF SECTION 7WI. ' BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO
A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS ($600).):
Cj 1. AS OWNER OF THE PROPERTY. OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPGNSATION.
WILL DO THE WORK. AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 70", BUSI-
NESS AND PROFESS IONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT 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 MTHINONE YEAROFCOMPLE-
TK)N. THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
IMPROVE FOR THE PURPOSE OF SALE).
01 . AS OWNER OF THE PROPERTY. AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS
To CONSTRUCT THE PRCUECT (SEC. 7044. BUSINESS AND PROFESSIONS ODDE: THE CONTRACTORS LI-
CENSE LAW DOES NOTAPPLY TOAN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREO.J. _
V040 CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S) LICENSED PURSUANTTOTHE CONTRAC-
TORS LICENSE LAW.).
0 1 AM EXEMPT UNDER SEC. B. & P.C. FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PEFUURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER
9 (COMMENCING WITH SECTION 7") OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE. AND
MY LICENSE IS IN FULL FORCE AND EFFECT
LICENSE CLASS LIC. NO.
4t�__t� II I . k, , 0 o of
DATE CONTRACTOR
WORKERS'COMPENSATION DECLARATION
I HEREBYAFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DEGLARATIONS:
- 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
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.
- I HAVE AND WILL MAINTA114 WORKERS'COMPENSATION INSURANCE. AS REQUIRED BY SECTION
370D OF THE LABOR CODE, FOR THE PERFORMANCE OF THE W014K FOR WHICH THIS PERMIT IS
ISSUED. MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE:
CARRIER
POLICY NUMBER
(rHtSSECTK)N NEED NOT BE COMPLETEDOFTHE PERMIT IS FOR ONE HUNDREDDOLLARS ($100)OR UESS�
I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I
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 WOFIKERS'COMPENSAT'ON � TION 3700 OF THE LABOR
OR TH THO.
jWTH COMPLY WI
DATE: APPLICANT., 9�6p
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 ($10D,000), IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN
SECTION 37M 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
CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
AGREE TO COMPLY WITH ALL CITYAND 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,
*V1/`/J._/ 41711 �� A -
PERMITTEE NAM:,(,PRINT
SIGNATURE OF QZ5WTTEr - W I DATE
WHITE—Department Copy, YELLOW --Finance Copy. INP
PRESS
FIRMLY
APPLICATION PERMIT OZ P/C
DATE NUMBER kOS&O #
ISSUE TYPE OCC
DATE CONST. _ GROUP
ZONING SETBACKS
FRONT RW E]
REAR 0
SIDE/SIDE STREET RW EJ
SIDE 0—
PROPOSED USE
NO. DWEL. NO. NO.
UNITS STORIES —.BEDROOMS
DESCRIPTION FACTOR PSF ADJ. AREAfVALUATION
SFR/ADD/REM
U)
Garage/Carport
LU
LU
Patio/Deck
LL
Pool/spa
0
Z
Re -Roof
0
Commercial
M
ADJ.AREA
QUANTITY DESCRIPTION FEE
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LA U.
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UU
0
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CONSTRUCTION
PLAN REVIEW
ELECTRIC a C-0
PLUMBING 1-7 . 3_t)
MECHANICAL LA:2 -:�Q
INSPECTION FEE
ISSUANCE oz'
SMIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE:
PRE -ALT FEE:
TOTAL FEES C:)
COMMENTS
e; Ing
L
'7'-t �L_ PAID
RECPT NO. BY j15'-j-)4:::tALIDATION
�upy, �uiuJt:NmvLk--t-ue topy. LiHhhN—Applicant's Copy
CITY OF DIAMOND BAR
INSPECTION RECORD
CT9 GH@?§@VG@H'
DGWI�@Mm P&
SETBACK
FLOOR JOIST
FTGS/FORMSISTEEL
FHA REOMTS
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
3 FT. BOND BEAM
FRAMING/VENTILATION
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, 4%
SEPTIC TANK
-LANDSCAPE/IRRIG.
SEEP PIT/L.L.
ON SITE IMPS.
GAS AIR TEST
FINALZONING
FINAL CONST.
FIRE DEPT FINAL
FINAL HEATING
HEALTH DEPT FINAL
FINAL ELECTRIC
FINAL PLUMBING
DEV. FEES PAID
ENERGY
COMMENTS
A
a
c
6a
Lo
SEPTIC TANK SIZE
,SEEP PIT/U SIZE