HomeMy WebLinkAbout10-997 ' � t �' ..^ ��_ CITY OF DIAMOND BAR �•��lQ LL
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
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
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� ISSUE /D � � �./� TYPE OCC
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p OWNER �"I/�P i,7��1 S1��L�'�C.4 �
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z DESIGNER ��G�-r+�r� /�-�,�'��,�,� 4 � '�-- ` • �y rLn ►= 2 7� $
a ADDRESS / t.� �` �. NO.DWEL. NO. NO.
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� DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION �
p SFR/ADD/REM ��
p I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT I AM E%EMPT FfiOM THE CONTRACTORS LI- G8fe90/CBfPOA
W CENSEIAWFORTHEFOLLOWINOREA50N(SEC.7031.5BUSINESSANDPROFESSIONSCODE:ANYCITVOR (n
ZCOUNTVHMICHREWIqESAPERMRTOCONSTRUCT,ALTER,IMPROVE.DEMOLISH,ORREPAIRANVSTRUC� W P8110/DBCK
W TURE,PRIOR TO ITS ISSUANCE,AL50 REWIRES THE APPUCANT FOR SUCH PERMIT TO FILE A SIONED W
� STATEMENT THAT HE OR SHE IS LICENSED PURSUAN7 TO THE PROVISIONS OF THE COMRACTOiiS ll�
� CENSE LAW(CHAPTER B(COMMENCINO WITH SECTION 7000)OF DIVISION 7 OF THE BUSINESS AND PRO� � POOUSPB �
, Q FESSIONSCODE)ORTHATHEORSHEISE%EMPTTHEREFROMANDTHEBASISFORTHEALLEGEDE%EMP� (�
U TION.ANV VIOLATION OF SECTION 703t.5 BV ANY APPLICANT FOR A PERMIT 5U&IECTS THE APPUCANT TO Z Re-Roof
� A CML PENALTY OF NOT MORE 7HAN FIVE HUNDRED DOlLAflS(f500)J:
� ❑I,ASOWNEROFTHEPROPERTV,ORMVEMPLOVEESWITHWAOESASTHEIRSOLECOMPENSATION, COrtIfilBfCl81
WIIL DO THE WORN,AND THE STRUC7URE IS NO7 INTENDED OR OFFERED FOR SALE(SEC.7ou,BU51- �
� NESS M1D PROFESSIONS CODE:THE CONTRACTORS IICENSE LAW DOES NOT APPLV TO AN OWNER OF j '
VROPERTY WF10 BUILAS OR IMGROVES THEREON,AND VAiO OOES SUCN WORK HIMSELF OR HERSELF OR
CC THHOUGH MIS OR HER ONR!EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
� OFFEREDFORSALEIF,HOWEVERTMEBUILDINGORIM7ROVEAIENTISSOLDWITHINONEVEAROFCAMPLE�
Z TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD Oq
� IMPROVE F-0F THE PURPOSE OF SALE). '
W ❑I,AS OWNER OF THE PROPEH7V,AM E%CLUSIVELV CONTRACTING WITH LICENSED CONTMCTORS O D
� TO CON T UCT TME 7R0.1ECT(SEC.70I1,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS ll- V8IU8fiOf1 qp�.qqEq
W CENSE DOESNOTAPPLVTOANONMEROFAPROPERTVWHOBUILDSORIMPROVESTHEREON,AND
� N510 MCTSFORSUq1PRP1ECTSWITHACONTRACTOR�S)LICENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION
Y r/ sEuw.�. FEE
QE%EMPT UNDER SEC. B.8 P.C.FOR THIS REASON �
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� LICENSED CONTRACTORS DECLARATION W
I � 1 HEHEBY AFFIRM UNDER PENALTV OF PERIURY THAT I AM UCENSED UNDER PROVISKKJS OF CHAPTER �
� Y(COMMENCINO WITH SECTION 7000)OF DNISION 3 OF THE BUSW ESS AND PROFESSIONS CODE,AND Z '
��� MY LICENSE IS W FULL FORCE AND EFFECT. m
� LICENSE CLASS �IC.NO. �
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V DATE CONTRACTOR a
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� WOFKERS'COMPENSATION DECLARATION �
� I HEREBYAFFIHM UNDER PENALTY OF PERIURY ONE OF THE FOLLOWING DECURATIONS: �
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Z0 _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORNERS' ¢
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COMPENSATION,AS PROVIDED BV SECTION 3700 OF TNE LABOR CADE,FOR THE PERFORMANCE U
OF T1E WORK FOR WHICH THIS PERMIT IS ISSUED. W
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� _1 HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS RE�UIRED BV SECTION '
Q3700 OF 7HE L/�BOR CODE.FOR THE PERF-0flMANCE OF THE WOHK FOR WHICH THIS PERMIT IS ��/�1 �.. w
ISSUED.MV WORKERS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBER AAE: ONSTRUCTION `«�
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j CARRIER PLAN REVIEW �J� e O Y �
� POLICY NUMBER �
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Z I CERTIFYTHAT IN THE PERFOFiMANCE OF THE WORK FOq WHICH THIS PERMIT IS ISSUED,I MECHANICAL
C7 SMAIL NOT EMPLOY ANV PERSON IN ANV MANNER SO AS TO BECOME SU&IECT TO THE
(/) WORKERS'COMPENSATqNI.AWSOFCALIFORNIA,ANDAGREETHATIFISHWIDBECAME INSPECTIONFEE '
S SU&IECT TO THE WOH!(ERS'COMPENSATION PROVISIONS OF SECTqN 3700 OF THE LABOR
CODE.I SHALL FOR7HWITH COMPLV WITH THOSE PROVISIONS. S AN
� - � �
p DATE: APPLICANT: IP
Jw ENERGY P/C ��/ �
J WARNINO:FPJLURE TO SECURE WORKERS'COMPENSATION CAVERAGE IS UNUWFUL,AND SHALL BE
�y SUaIECTANEMPLOYERTOCFIMWALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHWSMID ENERGYPERMIT
DOILARS(5100,000).IN/�DDITION TO TNE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
� SECTpN 37080FTHE LABOfl COOE.MTEREST,ANDATTORNEV'S FEES. I FEE: �-� �
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O CONSTRUCTION LENDING AGENCY � pF�A
� 1 HEREBV AFFIRM UNDER PENALTV OF PERIURY THAT THERE IS A CANSTRUCTION LENDINO AGENCY ' i/N,S 2 �rn
FOF THE VERf-0RMANCE OF THE WOFK FOR WHICN 7HI5 PERMIT IS ISSUED(SEC.3087,GV.C.). �f�
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� LENDER'S NAA/E
H LENDER'SADDRESS
w ICERTIFVTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINFORMATIONISCARRECT. TOITAL FEES ��� ,7 [ Q ��� ��
� I AOREE TO COMPLV WITH AI.L CITY AND COUNTY ORDINANCES AND STATE LAWS REIATING TO BUILDING [L !J./I
CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTEF UVON THE n -� ��'�
Z ABOVE-MENTIONED PROPEHTV FOR INSPECTION PURVOSES. �/ ����A
0 /� COMMENTS� ��9��
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� 5113p OF RMITTEE . DA7E - �
� RECPT.NO. PAID BV VALIDATION
WHITE—Department Copy,YELLOW�inar�ce Copy,PINK—Assessor Copy,GOLDENROD--File Capy,GREEN—ApplicanYs 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 BOND BEAM
WATER SERVICE MID H'T. BOND BEAM
ROOF SHEATHING 8 FT. BOND BEAM
FRAMINGNENTILATION FINAL BOND BEAM
ROOF COVER /���/d PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC
EXT.LATH/SIDING / ho PQOL FENCING
WALL INSULATION ��', POOL FINAL
CEILING INSULATION � /V 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 C�NST. F1RE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY
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SEEP PITJU SIZE
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