HomeMy WebLinkAbout10251 (5)CITY OF DIAMOND BAR
COMMUNITY DEVELOPMENT DEPARTMENT
:.� 21660 E Copley Drive Suite 190
(909)860.3195 Fax (909)861-3117
BUILDING PERMIT APPLICATION
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ADDRESS IqL' -!
APN LOT TRACT J
OWNER a RIG -V,-' C
ADDRE S C. It% &o
CITYC' ZIP!?Q "4I TEL
APPLICANT TEL
CONTRACTOR rjCtsl'+�G �t
ADDRESS
CITY ZIP TEL
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. 7031.5 BUSINESS AND PROFESSIONS CODE ANY CITYOR
COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT. ALTER IMPROVE, DEMOLISH, OR REPAIRANY 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 LF
CENSE LAW (CHARTER 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•
TIM.
ANY VIOLATION OF SECTION 7031.5 BY ANYAPPOCANT FOR A PERMIT SUBJECTS THE APPLICANT TO
A C1VL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (3W00))'
O L AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION,
WILL
DO 114E WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SME (SEC. 7044, "IL
NESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF
PROPERTY WHO BUILDS WH
OR IMPROVES THEREON. AND O DOES SUCH WORK HIMSELF OR HERSELF OR
THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT MENDED OR
OFFERED FOR SALE IF. HOWEVER THE BUILDING OH IMPROVEMENT IS SOLD WITH LONE YEAR OFCOMPLE.
TION. THE OWNERAURDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DD NOT BUILD OR
IMPROVE FOR THE PURPOSE OF SALEL
O L AS OWNER OFTHE PROPERTY. AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS
TO CONSTRUCT THE PROJECT (SEG 700, BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LI-
CENSE LAW DOESNOT APPLY TO AN OWNER OF APROPERTY WHO BUILDS OR IMPROVES THEREON, AND
WHOCONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC-
TORS UCENSE LAW).
O 1 AM EXEMPT UNDER SEG B. S P.C. FOR THIS REASON
DATE — OWNER C
LICENSED CONTRACTOFIfDECLAFfTION
1 HEREBY AFFIRM TINDER PENALTY OF PERIURYTHAT I AM LICENSED UNDER PROVISIONS OF CHAPTER
I (COMMENCING WITH SECTION 70001
OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE. AND
MY LICENSE IS N FULL FORCE AND EFFECT.
LICENSE (LASS UC. NO.
DATE CONTRACTOR
WORKERS' COMPENSATION DECLARATION
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY ONEOFTHE FOLLOWING DECLARATIONS:
—I HAVE AND WILL MAINTAIN ACERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS
COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE. FORTHE PERFORMANCE
OF THE WORK FOR WHIG1 THIS PERMIT IS ISSUED.
_I HAVE AND WILL UANTAN WORKERS' C OMPENSATION INSURANCE AS REUVNED BY SECTION
3700 OF THE LABOR CODE FORME PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED. MY WORKERS COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE
CARRIER
POLICY NUMBER
(Ra5 SECDJN NEED N OTITE COMP ETEDCFTHE PERMITIS FORONEH.R0RFDDCt1Ai4 IFIMCRLEM
1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WMON THIS PERMIT IS ISSUED, I
SMALL NOT EMPLOY ANY PERSON IN ANY MANNER $O AS TO BECOME SUBJECT TO THE
WORKERT COMPENSATION LAWS OF CALIFORNIA AND AGREE THAT IF I SHOULD BECOME
SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR
CODE I SMALL FORTHWITH COMPLY WITH THOSE PROVISIONS.
DATE APPLICANT:
WARNING: FAILURE TO SECURE IWRKERTCOMPENSATION COVERAGE IS UNLAWFUL. AND SMALL BE
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (1100.000). N 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
I HEREBY AFFIRM TINDER PENALTYOF PERJURY THAT THERE IS A CONSTRUCTION LENDNG AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEG 3057, CIV. C.).
LENDER'S NAME
LENDERSADDRESS
I CERTKYTHAT 1 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 RELATING TO BUILDING
CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. J
W_( AL-�I ia��a•'
PERMRTEE NAME (PRINT) /
SKIWAATUREOFPE E DATE
YVHITE—DePBnmBDt Copy, YELLOW --Finance Copy, PINK—Ausnor COW GOLDENROD—RIG Copy, GREEN—AppllomWs Copy
PRESS
FIRMLY
APPLICATION
I . PERMITP/C
DATE J.
I q f NUMBER
M
ISSUE
TYPE
OCC
DATE
CONST.
GROUP
ZONING SETBACKS
FRONT
RW'
❑
REAR
❑
SIDEISIDE
STREET RW
O
SIDE
❑ '
PROPOSED USE
NO. DWEL
NO.
O. .
UNITS
STORIES
BEDROOMS
DESCRIPTION
SO. FT, FACTOR PSF
ADJ. AREAIVALUATION
SFR/ADD/REM
cn
GaragaNCelpon
W
Patb/Deck
Pool/Spa
Z
Re -Roof
Commercial
E5
Valuation
ADJ.AREA
QUANTITY
DESCRIPTION
FEE
J
U
2
F --
U
w
J
LU
Z
m
J
CIL
U
2
Q
2
U
W
CONSTRUCTION
PLAN REVIEW
ELECTRIC
LR
PLUMBING
MECHANICAL
-INSPECTION FEE----
"------" -
ISSUANCE—
SMIP
ENERGY P/C
`
ENERGY PERMIT
RETENTION FEE:
PRE -ALT FEE:
TOTAL FEES
COMMENTS
RECPi N0.
PAID BY
VALIDATION
b
SETBACK--)-- 7-1-:
CITY OF DIP,
INSPECTION RECORD"'.-.,
17, 1 u i,
f: W IT Y71 -iIT-::,
-FLOOR JOIST--,
FTGS/FORfvlSlSTEEL
FHA REQMTS
ELECTRIC GROUND
UNDER FLOOR DUCT
GROUND PLUMBING
UNDER-FLOOR-r-DiiDUIT IV'
I
SLAB GRADE
FIREPLACE FOUNDATION:
-TEIvIP- POWER
FIREPLACE BOND BEAM
WATER SERVICE
MID HT. BOND BEAM
ROOF SHEATHING
FRAIVIINGNENTILIATION
ROOF COVER
1,
0/0-�� -
8 FT. BOND BEAM
'FINAL BOND BEAM------
------ PRE -GRADING
ROUGH HEATING
BENCHING
ROUGH ELECTRIC
ROUGH GRADING
ROUGH PLUMBING
-FINISH GRADING' -
SHOWERITUB TEST
PCOL ELECTRIC
-777777=
EXT. LATH/SIDING
POOL FENCING'
WALL INSULATION
POOL FINAL
CEILING INSULATION
OFF SITE IMPS.,
DRYWALL NAILING
IDEDICATIONS
SEWER
FINAL ENG.
LANDSCAPEIIRRIG.
SEEP MILL—
ON SITE IMPS.
.GAS AIR TEST ,
FINAL ZONING
FINAL CONST.
FIRE t)EP-i-\Flf
FINAL HEATING
HEALTH DEPT. FINAL-\-
FINAL ELECTRIC
-DEV. FEES PAID
FINAL PLUMBING-!
ENERGY
COMMENTS
YAN I
�SEPTIC TANK SIZE -
SEEP PIT/U SIZE
7
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