HomeMy WebLinkAbout18977CITY.OF DIAMOND BAR
DEPARTMENT OF CONMJNTIY & DEVELOPMENT SERVICES
21825 E. Copley Drive
(909) 860.3195 Fax (909) 861-3117 PRESS
BUILDING PERMIT APPLICATION . FIRMLY
JOBSITE
ADDRESS I G 447 ACACIA tj/GRIL
APN LOT TRACT
OWNER -R
ADDRESS 1
CITYD Eli - ZIP C1 1% TEL
APPLICANT TEL
CONTRACTOR WGG R -
ADDRESS 90 /
CITY WAW(fr ZIP 5j-= TEL _
ARCH/ENG/
DESIGNER
ADDRESS
CITY ZIP TEL
OWNER -BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LL
CENSE LAW FORTHE FOLLOWING REASON (SEC. 7031.6 BUSNESSAND PROFESSIONS COOE:ANYCITY OR
COUNTY VM04 REQUIRES APERMITTO CONSTRUCT,ALTER IMPROVE. DEMOLISH, OR REPAIR ANY STRUG
TURF PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
STATEMENT THAT HE ORION
IS LICENSED PURSUANT TO LINE PROVISIONS OF THE CONTRACTORS LL
CENSE LAW (CHAPTER 5 (COMMENCING WITH SECTION 7000) OF DIVISION S OF THE BUSINESS AND PRO.
FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP-
TIGN. ANY VIOLATION OF SECTION TM 1.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO
A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS
13LASOWNER OFTHE 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. BUSF
NESS AND PROFESSIONS 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 FOFISALF IF, HOWEVER, THE BVDINGOR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE-
TION. THE OWNEMALDER WALL HAVE THE BURDEN OF PROVING THAT HE OR SHE DO NOT BUILD OR
IMPROVE FOR THE PURPOSE OF SALE).
O L AS OWNEROF THE PROPERTY,AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS
TO CONSTRUCT THE PROJECT (SEC. 7044. BUSINESS MIO PROFESSIONS CODE: THE CONTRACTORS LI.
CENSE LAW DOES NOTAPPLY TO AN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON, AND
WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC-
TORS LICENSE LAW.}
O 1 AM EXEMPT UNDER SEC. B. i P.C. FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
1 HEREBY AFFIRM UNDER PENALLY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER
P (COMMENCING WITH SECTION 7000) OF DIVISION 5 OF THE BUSINESS AND PROFESSIONS CODE, AND
MY LICENSE IS N FULL FORCE AND EFFECT. 9
LICENSE6C�U 5 6 LIC. NO.
DATE 7 �3 C 2C)U�j CONTRACTORI C c_
WORKERS' COMPENSATION DECLARATION
I HEREBY AFFIRM 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 5700 OF THE LABOR CODE. FOR THE PERFORMANCE
V_,**'6F THE WORK FOR WHICH THIS PERMIT IS ISSUED.
_I HAVE AND WILL MAINTAIN WOPoCERS' COMPENSATION INSURANCE, AS RE WIRED BY SECTKON
5700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE:
CARRIER STATE FAN D
POLICY NUMBER -I _ _
(DIS SECTION NEED NOTSE ooMT ETEDCFTHE PERMIT IS FOR ONE HIPOREDOOLARLS 1110D)OR LESS}
I CERTIFY THAT N THE PERFORMANCE OF THE MONK FOR WHICH THIS PERMIT IS ISSUED. I
SHALL NOT EMPLOY ANY PERSON N ANY MANNER SO AS TO BECOME SUBJECT TO THE
WORKERS'COMPENSATION LAWS OF CALIFORNIA, AND AGREE THATIFIS BECOME
SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF BEMKON A OF THE LABOR
CDD I FORiIMITH COMPLY WI O PROM KN r�
DATE: U e DZ APPLICANT.
WARNING: FAILURE TO SECURE WORKERS, CC NSATION COVERAGE IS UNLAWFUL AND SHALL BE
SUBJECTAN EMPLOYER TO CRIMNAL PENALTI ANDCML FINES UPTO ONE HUNDRED THOUSAND
DOLLARS (5100.000), N ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 57DB OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
CONSTRUCTION LENDING AGENCY -
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHIN THIS PERMIT IB ISSUED (SEC. W97.CN. C.).
LENDERS NAME
LENDER'S ADDRESS
1 CERTIFY THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT
1 AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF TW S COUNTY TO ENTER UPON THE
ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES.
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APPLICATION
2 PERMIT
P/C oi-
DATE
v_NUMBER
A V
ISSUEI
TYPE
OCC
(� CONST.
GROUP
ZONING SETBACKS
FRONT
RW
❑
REAR
0-
SIDE/SIDE
STREET RW
❑
SIDE
❑
PROPOSED USE
f
NO. DWEL
NO.
NO.
UNITS
STORIES
BEDROOMS
DESCRIPTION
SO. FT. FACTOR PSF
ADJ. AREAIVALUATION
SFR/ADD/REM
C/)
Garaya/Carport
Wat
U-
Poovspa
ZRe
-Root
JO
Commercial
m
Valuation
ADJ.ARFJL
QUANTITY DESCRIPTION
FEE
U_
U
w
W
0
2
U
Z
Q
U
W
0v
CONSTRUCTION
PLAN REVIEW
1
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
SMIP
A S
ENERGY P/C
ENERGY PERMIT
RETENTION FEE:
.
PRE -ALT FEE:
TOTAL FEES
COMMENTS
RECPT. NO.
PAID BY Z1,41
VALIDATION
WHITE—Department Copy, YELLOW—Finance COW PINK—Assessor Copy. GOLDENROD—File Copy. GREEN—Applicantis Copy
CITY OF DIAMOND BAR
INSPECTION RECORD
SET BACK
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
8 Fr. BOND BEAM
FRAMINGNENTILIATION
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.
SEPTIC TANK
LANDSCAPE/IRRIG.
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
COMMENTS /-645 AIS IAA ,0�111,11
Zhis 7 -
4,1=-
SEPTIC TANK SIZE
SEEP PIT/U SIZE