HomeMy WebLinkAbout10-1035 . �
_��_ CITY OF DIAMOND BAR
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� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
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(909)839-7020 Fax(909)861-3117 Building Inspection H�����3�� =P � PRESS
�'"�' BUILDING PERMIT APPLICATION FORMLY
o� JOBSITE �'��� t p�,� �roov� b APPLICATION PERMIT p/C
ADDRESS )�C�� DATE NUMBER �.� #
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� v� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
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I HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT I AM EXEMPT FROM THE CONTRACTORS LI- G8f2JBICBfPOII
W CENSE UW FORTHE FOLLOWINO REASON(SEC.7031.5 BUSINESSAND PROFESSIONS CODE:ANV CI7V OR (n
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W lURE,VRIOR TO I75 ISSUANCE,AL50 REOUIRES THE APPLICAN7 FOR SUCH PERMIT 70 FILE A SIGNED w Patio/Deck
� S7A7EMENT THA7 HE OR SHE IS LICENSED PURSUANT 70 THE PROVISIONS OF THE CONTRAC70RS LI- �
� CENSE LAW(CHAP7ER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- POOUS(10
� � FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP- (�
710N.ANYVIOLATIONOFSECTION7a31.58YANYAPPLICAN7FORAPERMITSU&IEC75THEAPPLICANTTO Z R8-ROOi
A CIVIL PENALTV OF NO7 MORE THAN FIVE HUNDRED DOLLARS(f5o0�.):
� ❑I,ASONMEROFTHEPROPERTY,ORMYEMPLOYEESWITHWAGESAS7HEIRSOLECAMPENSA710N, � COrtIrtIOfClal �
Z WIIL DO THE WORK,AND THE STRUCTURE IS NO71N7ENDED OR OFFEfiED FOR SALE(SEC.7ou,BU51- J
� NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV 70 AN OWNER OF �
PROVERTV WHO BUILDS OR IMPHOVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
� 7HROUGH HIS OR HER ONM EMPLOVEES,PROVIDED 7HA7 SUCH IMPROVEMENTS ARE NOT INTENDED OR m
Q OFFEREDFORSILE.IF,HOWEVER,7HEBUILDINGORIMPHOVEMENTISSOfDWITHINONEVEAROFCOMPLE�
Z TION,THE OWNER-BUILDER WILL HAVE 7HE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF SALE).
w ❑I,AS ONRJER OF 7HE PROPEHTV,AM E%CLUSIVELV CON7RACTING WITH LICENSED CANTRACTORS
¢ TO CANSTRUCT THE PROJECT(SEC,70�6,BUSINE55 AND PROFESSIONS CADE:THE CONTRACTOqS LI- V81U81i0f1 � ADJ.AREA
W CENSE UW DOES NOTAPPLV TO AN OWNEH OF A PROPER7V WHO BUILDS OR IMPROVES THEREON,AND
� WHOCONTRACTSFORSUCHPRQIECTSWITHACONTRACTOR(5)LICENSEDPURSUANTTOTHECANTMC- QUANTITY DESCRIPTION FEE
Y TORS LICENSE IAW.).
� ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q ` ' 1
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DATE OWNEH F'� �
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�Q LICENSED CONTFiACTORS DECLARATION w . �
2 I HEREBY AFFIRM UNDER PENALTY OF PERJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAP7ER � � �
� 9(COMMENCING WITH SECTION 7000)OF DIVISION 30F 7HE BUSINESSANO PROFESSIONS CODE,AND Z '
��� /AV UCENSE IS IN FULL FOFiCE AN ECL (([��� �{ m - '
� UCENSE C^LASS ^ LIC.N0._�7� 1� j . ,
WDATE 1VT�I"V CONTRACTOR d
� WORKERS'COMPENSATION DECLARATION Q
� I HEREBV AFFIRM UNDER PENALTV OF PERJURV ONE OF THE FOLLOWING DECURATIONS: Z
Z _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CANSENT TO SELF�INSURE FOR WORKERS' _
Q CqMPENSATION,AS P{iOVIDED BY SECTION 370o OF 7HE LABOR CODE,FOR THE PERFORMANCE U
Q OF THE WORK FOR WHICH THIS PE(iM1T IS ISSUED. �
Qw �I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIR BV SECTION
370o OF THE LABOR CODE,POR THE PER ORMANCE OF THE WORK FOR WHIC IS PERMI715 t�`�
ISSUED.MV WORKERS'CAMPEN TION I SU CE CARRI POLICV NU ER ARE: STR Z
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� (iHISSECiIONNE�NOTBEO�MPLE�EDOFT}iEPEWMISWRONEHUI�DfiED (5100)ORLESS) ���7�
Z I CERTIFV 7HAT IN 7HE PERFORMANCE OF 7HE WORK FOR WHICH THIS IS ISSUED.I MECHANICAL
C7 SHALL NOT EMPLOY ANV PERSON IN ANY MANNER 50 AS TO BECOME 5 TO THE ���
� WORKERS'COMPENSATION LAWS OF CALIFORNIA,ANDAGHEE THAT IF D BECOME � SPECTIN ON FEE
� SU&IECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTIO 0 �HE LABOR �^��j�
� CADE. SHA FORTHWITH COMPLV WITH'fHOSE PROVISIONS. SS ANC � __ �JaVV
p DATE: ,� I� 'O APPLICANT: M�P �.��J
J WARNING FA URE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C
� SUBJECTAN EMPLOVER TO CRIMINAL PENALTIES AN�CIVIL FINES UP TOONE HUNDRED THOUSAND ENERGY PE
DOILARS(f 700,0o0J,IN ADDITION TO THE COST OF CAMPENSATION,DAMAGES AS PROVIDED FOR IN
J SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. E � ��
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OCONSTRUCTION�ENDING AGENCY p F •
� I HEREBYAFFIRM UNDER PENALTY OF PERJURV THAT THERE IS ACONSTRUCTION LENDING AGENCV (
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.C.). ,
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� LENDER'S NAME
H LENDER'SADDRESS
� TOTAL FEES ������• SF�O
� I CER7IFV THA7 I HAVE READ THIS APPLICA710N AND STATE THAT THE ABOVE MFORMATION IS CARRECT.
w I AGREE TO COMPLV WITH ALl CITV AND COUNTY ORDINANCES AND STATE IAWS REUTING TO BUILDING
� CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE
� ABOVE�MENTIONE P PERTY FOR INSPECTION PURPOSES.
Z COMMENTS � �
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ELECTRIC GROUND UNDER FLOOR DUCT � ' •
GROUND PLUMBING UNDER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUNDATION �
TEMP POWER FIREPLAGE BOND 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�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
FI AL HEATING "U HEALTH DEPT. FINAL
� FINAL ELECTRIC ��� � _ DEV. FEES PAID
FINAL PLUMBING . � ENERGY
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COMMEIVTS �� !� �o���/��
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SEEP PIT/U SIZE
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