HomeMy WebLinkAbout13022•
ftdCITY OF DIAMOND BAR �
DEPARTMENT OF COMMUNITY & DEVELOP NT SERVICES
21660 E. Copley Drive Suits 190
(909) 860-3195 Fax (909) 861-3117 PRESS
BUILDING PERMIT APPLICATION FIRMLY
JOBSITE (/ 2
ADDRESS i
APN LOT TRACT
OWNER
ADDRES 7/
CITY ZIP TE_L. /-177-)
APPLICANT TEL.
CONTRACTOR
ADDRESS �-
CITY ZIP Z8 TEL t57
ARCWENG/
DESIGNER
ADDRESS
CITY ZIP TEL.
OWNER -BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI.
CENSE LAW FOR THE FOLLOWING REASON (SEC. 70313BUSINESSAND PROFESSIONS CODE:ANY CITY OR
COUNTYW ICIH REOIARESAPERMITTO CONSTRUCT, ALTER IMPROVE,DEMOLISH,ORREPAIRANYSTAUC-
TURE. PRIOR TO ITS ISSUANCE. ALSO REIXaRES 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 I (COMMENCNG WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PRO-
FESSIONS CODE) ORTHAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THEALLEGED EXEMP-
TION. ANY VIOLATION OF SECTION 7031.6 ByAWAPPLMANNT FOR A PERMIT SUBJECTS THE APPLICANTTO
ACNJ. PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS
O L AS OW NEROFTHE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION,
WALL CO RK
THE WO, MIO THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7041, BUSI-
NESS AND PROFESSIONS CODE; THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF
PROPERTYWHOSUIL BOR IMPROVES THEREON. AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
TiNOUO111BS OR IERCWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR
OFFERED FOR SALE IF.NOWEVERTHE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONEYEJAROFOOMPLE.
TON, THE OWNEPHIRRI.DEH WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE OO NOT BUILD OR
IMPROVE FOR THE PURPOSE OF SALEy
O L AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS
TO CONSTRUCT THE PROJECT (SEC. 7D44. BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI-
CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BULDS OR IMPROVES THEREON, AND
WHO CONTRACTS FOR SUCH PROJECTS NATHACOHTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC-
TORS LICENSE LAW),
O 1 AM EXEMPT UNDER SEC. B. a P.C. FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
1 HEREBYAFFUMA LINGER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER
0 (COMMENCINGWITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND
MYLICENSE IS INFULL FgNCE
LICENSE CUSS L1 LIC. NO. {�+
DATE CONTRACTOR
WORKERS' COMPENSATION DECLARATION
1 HEREBY AFFIRM URGER PENALTY OF PERJURY ONE OFTHE FOLLOWING DECLARAT11 .
I HAVEAND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF4NSURE 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 MASITAN WORKERS COMPENSATION INSURANCE, AS RFOIIIRED BY SECTION
3700OF THE LABOR MOE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED. MY WORKERS COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE:
CARRIER
POLICY NUMBER
"SECTION NEED NOT BE COMPLETED OF1FfMAW FOR ONEHUDIEDOCUAIS (5I00)ORLESS.
I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I
SHALL NOT EMPLOY ANY PERSON IN ANY MAKER SO AS TO BECOME SUBJECT TO THE
WORKERS' COMPENSATION LAWS OF CALIFORNIA AND AGREE THAT IF I SHOULD BECOME
SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR
COOS. I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS.
DATE: APPLICANT:
WAR NIN& FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL BE
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO CINE HUNDRED THOUSAND
DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3705 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS ACONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3057, CIV. C.).
LENDER'S NAME
LENDERS ADDRESS
I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS FG ATING TO BUDDING
CONSTRUCTION. AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO
ENTER
' UPON THE
ZRTY FOR ABOVE/II/ /� INSPECTION`U�
SKMTUREOFPERUFTTEE CATE
APPLICATION
PERMITPIC
DATE
NUMBER
ISSUE
TYPE
OCC
DATE
CONST.
GROUP
ZONING SETBACKS EXPIRED
FRONT
RW ❑
REARp
SIDE/SIDE STRE
RW ❑
SIDE
p
PROPOSED USE T
C_44 -"J1
NO. DWEL. NO,
NO.
UNITS STORIES
BEDROOMS
DESCRIPTION SO. FT.
FACTOR PSF ADJ. AREANALUATION
SFR/ADD/REM
Garage/Carport
WPatWDe(*
LL
PooVSpa
ZRe
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Commercial
-
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Valuation Z %i[y' . 00
ADJ.AREA
QUANTITY DESCRIPTION
FEE
Q
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IZ
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U
W
LU
0
Z
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Q
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Z
Q
2
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CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING 4
MECHANICAL
.ate
A
INSPECTION FEE
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ISSUANCE � l qtr
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SMIP Q*T�
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ENERGY P/C
ENERGY PERMIT
RETENTION FEE:
PRE -ALT PEE:
ILf .20
TOTAL FEES
COMMENTS
RECPT. NO. PAID BY
VALIDATION
WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD --Fie Copy, GREEN—Applicants Copy
DIAMOND BAR
INSPECTION RECORD
SET SACK
"FLNFTGSIFORMS/STEEL
ELECTRIC GROUND
FLOOR DUCT
GROUND PLUMBING " ' ` `-'
��NDER
UNDER FLOOR COND7UIT
SLAB GRADE
FIREPLACE FOUNDATION
TEMP POWER
FIREPLACE BOND BEAM
WATER SERVICE
MID HT. BOND BEAM
ROOF SHEATHING
8 FT. 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
LANDSCAPEAIRRIG.
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
SEPTIC TANK SIZE
SEEP PITIU SIZE