HomeMy WebLinkAbout10-1146 . _ _ _
CITY OF DIAMOND BAR L..� X �
--"-�� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � I
21825 Copley Drive,Diamond Bar,CA 91765
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS
'°"'� BUILDING PERMIT APPLICATION FIRMLY
� JOBSITE
o ADDFlESS �oI7 �C�L�C/A /�fCL /Z APPLICATION PERMIT p/C I
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DATE � CONST.�� GROUP
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� DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION
� OWNER-BUIIDER DECLARATION SFR/ADD/REM
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0 I HEREBV AFFlRM UNDER PENALTV OF PERIURV THAT I AM EXEMPT FROM THE CONTRACTORS ll� Gef8g0/CBfpOf1
W CENSEUWFORTHEFOLLOWWOREASON(SEC.7031.SBUSMESSMlDPROFESSIONSCODE:ANYCIlYOR (n
C.� CWHTVWHICHREOUIRESAPERMITTOCANSTRUCT,ALTER,IMPFOVE.OEMOLISH,ORREVAIRANVSTRUC- w
w NRE,PRqR TO ITS ISSUANCE,AL50 REQUIHES THE APPLICANT FOR SUCN PERMIT TO FILE A SIONED w P8�10/DBCK
� STATEMENT THAT HE OR SHE IS UCENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI�
� CENSE UW(CHAPTER e(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF 7HE BUSINESS AND PRO- V- Pool/Spa
� FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BA515 FOR THE ALIEGED EXEMP� (!�
TION.ANV VIOLATION OF SECTION 7031.5 BV ANV APPLICANT FOR A PERMIT SU&IECTS THE APPUCANT TO Z Re-Roof
A CML�ENALTY OF NOT MORE hiAN FNE HUNDRED DOLURS(f500).):
Z ❑I,ASON?JEROFTHEPiiOPERTV,ORMYEMPLOVEESWIhIWAQESASTHEIR50LECOMPENSATION, 0 CpmmBfC18I
VALL DO THE WORI(AND THE STRUCTURE IS NOT INTENDED Oq OFFEPED FOR SALE(SEC.7Wt,BUSI- �J
� NE55 AN�PROFESSIONS CODE THE CONTFACTORS LICENSE lAW DOES NOT APPLV TO AN OWNER OF � �
PpOPERTV NTiO BUILDS OR IMPROVES TMEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
Q THROUGH HIS OR HER ONRJ EMPLOVEES,PROVIDED THAT SUC}1 IMPROVEMEMS ARE NOT INTENDED OR m
� OFFEREDFORSALEIF,FqWEVER7TiE8UILDWGORIIAPFOVEMENTISSOLDWITHINONEYEAROFCOMRE�
Z TION,THE OWNEF�BUILDER WILL HAVE THE BURDEN OF PROVINa THAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF SAL�.
W ❑I,AS OWNER OF THE PROPEHiY,AM EXG.USIVELY CONTRACTINO WfTH LICENSED CONTRACTOPS
� TO CONSTRUCT THE PRQIECT(SEC.70a1,BUSINESS AND PROFESSfONS CODE:THE CONTMCTOR9 LI- V8IU8SIOf1 ADJ.AREA
CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY N7i0 BUILDS OF IMPROVES THERC-0N,AND
� WHOCONTRACTSFORSUCHPR0.IECTSWITHACONTMCTOR(5)LICENSEDPURSUANTTOTHECONTRAG QUANTITV DESCRIP770N '
rau ucENSE uw.�. FEE
� O I AM E%EMPT UNDER SEC. B,8 P.C.FOR THIS REASON Q
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� LICENSED CONTqACTORS DECLARATION w
� I HEREBY AFFIRM UNDER PENALTV OF PERJURV THAT I AM UCENSED UNDER PROVISIONS OF CHAPTER
� D(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z �� _
XL' MY UCENSE IS IN FULL FORCE AND EFFECT, m
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V DATE�f—I F-�"/� CONTRACTOR�iCk I1D/ZL/I�I�/Ly d
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� WORKERS'COMPENSATION DECLARATION �
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� I HEREBY AFFIRM UNDER PENALIY OF PERIURY ONE OF THE FOLLOW WG DECURATqNS: Z
� _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSEM TO SELF-INSURE FOR WORKERS' ¢
2
Q COMPENSATION,AS PROVIOED BV SECTION 3700 OF THE U�BOR CODE,FOR THE PERFORA/ANCE U
OF THE WORK FOR WHICH TNIS PERMIT IS ISSUED. �
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� _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATbN INSURANCE,AS REOUIRED BV SECTION
Q 370o OF THE L/�BOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH TMIS PERAIIT IS
ISSUED.MY WORKERS'CAMPENSATION INSURANCE CARRIER AND POLICY NUMBERARE: CONSTRUCTION
jCAARIER PLAN REVIEW
Z POLICVNUMBER ELECTRIC '
¢ / ��'
0 (iHlssEclqNNE�Mo7eE00AWlEfIDOF7liEFEaMisFOaOt+EFilFDfi�DOL1ARS(f�aolOR�ESSl UMBI ,
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Z t CERTIFV THAT IN THE PERFORMANCE Of THE WORK FOR WHICH THIS PERMIT IS ISSUED,1 MECHANICAL
C'_S SHALL NOT EMPLOV ANV PERSON IN ANY MANNER SO AS TO BECOME SU&IECT TO THE
(/� WORNERS'COMPENSATION LAWS OF CALIFORNIA,AN�AGREE THAT IF I SHOUt98ECOME INSPECT N FEE
O SUBJECTTOTHEWORKERS'fAMPENSA NPROVISIONSOFSECTION37000FTHEUBOR �`�
CODE,I SHALL FORTHWITH COMPIY WI HOSE PROVISION ANC
p DATE:�I%G /� APPLICANT: SMIP
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"'� WARNIN�:FAILURETO SECURE WORKERS' MPEN ION CAVER UNLAWFUL,AND HALL BE ENERGY P/C �
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� SU&IECTAN EMPLOYEF TO CRIMINAL PENALTIES AN CIVIL FINES P ONE HUNDRED T OUSAN� ENERGt`Cy��Li
DOLLARS(5100,000),IN/�DDITION TO THE COST OF COMPENSATqN,DAMAGES AS PROVIDED FOR IN
� SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. TION F
OCONSTRUCTION LENDING AGENCY PRE•ALT FEE:
� I HEREBYAFFIqM UNDER PENALTY OF PERJURV THAT THERE IS ACONSTRUCTION LENDING AGENCY
� FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.30G7,CIV.C.).
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� LENDER'S NAME
1— LENDER'SADDRE55
W I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATqN IS CARRECT. TOTAL FE ES .� �/
� 1 A6flEE TO COMPLV WITH ALL CITV AND CAUNTY ORDINANCES ANO STATE UWS RELATINO TO&11LDIN0
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF 7HI5 COUNTV TO ENTER UPON THE
Z ABOVE�MEMIONED 7ROPERTV FOR INSPECTbN VURPOSES. COMMENTS '
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C/�
(n E ER I7TEE DATE
� RECPT.NO. PAID B VALIDATION
WHITE=Department Copy,YELLOW--Finence Copy,PINK—Assassor Copy,GOLDENROD—File Copy,GREEN—Appl t'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 BQND BEAM
WATER SERVICE MID H'T. BOND BEAM
ROOF SHEATHING 8 FT. BOND BEAM
FRAMINGNENTILATION FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWER�T'UB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPElIRRIG.
SEEP PIT/L.L. 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 ENERGY
C��OC�.�:
,
COMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
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