HomeMy WebLinkAbout18248CITY OF DIAMOND BAR
DEPARTMENq OF COty muNTIY & "DEVELOPMENT SERVICES
21825 E. Copley Drive
(909) 860-3195 Fax (909) 861-3117
BUILDING PERMIT APPLICATION
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CONTRACTOR
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DESIGNER
ADDRESS
CITY ZIP TEL.
OWNER -BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM EXEMPT FROM THE CONTRACTORS LI-
CENSE LAW FOR THE FOLLOWING REASON (SEC.70315 BUSINESS AND PROFESSIONS CODE. ANY CITY OR
COUNTY WHICH RECUIRESA PERMIT TO CONSTRUCT, ALTER, IMPROVE. DEMOUSH.CR REPMRANY 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 U.
CENSE LAW (CHAPTER 0 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PRO-
FESSIONS CODE) OR THAT HE OR SHE IS EXEMPTTHEREFROM AND THE BASIS FOR THE ALLEGED EXEMP-
TON. ANY VIOLATION OF SECTION 7031.5 BY ANY APPOCANT FOR A PERMIT SUBJECTS THE APPLICANT TO
A CML PENALTY OF NOT MORE THAN FNE HUNDRED DOLLARS (5500) Y.
O LAS OWNEROF THE PROPERTY• OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION,
WILL DO THE WORK AND THE STRUCTURE 15 NOT INTENDED OR OFFERED FOR SALE (SEC. 7044. BVSI-
NESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DOES NO. -APPLY TO AN OWNER OF
PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO DOES SUCH WORK HIMSELF OR HERSELF CR
THROUGH HIS OR HER OWN EMPLOYEES. PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED DR
OFFERED FOR SALE IF, HOWEVERTHE BUILDING OR IMPROVEMENT IS SOLD YnTH1N ONE YEAR OFOOMPLE•
TION. THE OWNER -BUILDER WILLHAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
IMPROVE FOR THE PURPOSE OF SAL"
D I. AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS
TO CONSTRUCT THE PROJECT (SEC. 7044. BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS U.
CENSE UW DOES NOTAPPLY TO AN OWNER OF A PROPERTY WHO aVNOS OR IMPROVES THEREON, AND
WHO CONTRACTS FOR SUCH PROJECTS WITHACONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC-
TORS LICENSE LAW).
D 1 AM EXEMPT UNDER SEC, B. A P.C. FOR THIS REASON
DATE D ZL OWNER Fc0
LICENSED CONTRACTORS DECLARATION
I HEREBYAFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISKNS OF CHAPTER
0 (COMMENCING WITH SECTION 70001 OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND
MY LICENSE IS N FULL FORCE AND EFFECT.
LICENSE CLASS LIC. NO.
DATE CONTRACTOR
WORKERS' COMPENSATION DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
I HAVE ANO WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS'
COMPENSATION. AS PROVIDED BY SECTION 37000F THE LABOR CODE, FOR THE PERFORMANCE
OF TME WORK FOR WHICH THIS PERMIT IS ISSUED.
_I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY SECTION
]700 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
POLICY NUMBER
(THIS SECTION NEED NOT BE COMPLETED OF THE PERMIT IS FOR ONE HUNDRED OCULARS (SIM) OR LESS(
I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUE D. 1
SHALL NOT EMPLOY ANY PERSON IN ANY MANNER $0 A5 TO BECOME SUBJECT TO THE
WORKERS' COMPENSATION LAWS OF CALIFORNIA. AND AGREE THAT IF 1 SHOULD BECOME
SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR
CODE, I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS.
I
DATE: APPLICANT.
I
WARNING: FAILURE TO SECURE WORKERS' COMPENSATON COVERAGE IS UNLAWFUL. AND SHALLBE
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (5100.000). IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN
1 SECTION 3708 OF THE LABOR CODE, INTEREST. AND ATTORNEYS FEES.
1 CONSTRUCTION LENDING AGENCY
i
(HEREBYLINGER PENALTY OFPENURYTHAT EIS ACONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THISISPERMIT IS ISSUED (SEC. 3097, CIV. C.).
3
TENDER'S NAME
LENOERSADDRESS
I CERTIFY THAT MANE READ THIS APPLICATION AND STATE THATTHE ABOVE INFORMATION IS CORRECT.
(AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
sCONSTRUCTION. AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
M30VE•MENTIGNED PROPERTY FOR INSPECTION PURPOSES.
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D PERM( NAME (PRI
7
0 IGNATUREOF PERMITTEE DATE
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PRESS
FIRMLY
APPLICATION �Q! U ERMIT
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DATE ((�1 �� �DjjUUMBR 1 M
ISSUE TYPE OCC
DATE CONST. GROUP
ZONING SETBACKS
FRONT RW ❑
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SIDE/SIDE STREET RW ❑
SIDE ❑
PROPOSED USE/ 7-
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NO. DWEL. NO. NO.
UNITS STORIES BEDROOMS
DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION
SFPJADD/REM
Garage/Cawn
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QUANTITY DESCRIPTION FEE
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ENERGY P/C
ENERGY PERMIT
RETENTION FEE:
PRE -ALT FEE: '
TOTAL FEES LA
COMMENTS --
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RECPT. 440. PAID BY VALIDATION
WHITE—Department Copy. YEUAW—Finance Copy, PIINK—Assessor L CPy, uvwcrvnulrrHe -VY. . wM7
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FIREPLACE FOUNDATION
I FIREPLACE BOND BEAM
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1 FINAL BOND BEAM,
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ELECTRIC GROUND
GROUND PLUf.1BING
SLAB GRADE
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TEMP POWER
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WATER SERVICE
ROOF SHEATHING
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FRAMING/VENTILIATION
ROOF COVER
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' PRE -GRADING
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ROUGH HEATING
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BENCHING
ROUGH ELECTRIC
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ROUGH GRADING
ROUGH PLUMBING
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FINISH GRADING
TEST
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POOL ELECTRIC
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EXT. LATH/SIDING
WALL INSULATION
CEILING INSULATION
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; POOL FENCING__
i POOL FINAL
i OFF SITE IMPS.
DRYWALL NAILING
SEWER
SEPTIC TANK
SEEP PIT/LL.
GAS AIR TEST
DEDICATIONS
FINAL ENG,
LANDSCAPE/IRRIG.
ON SITE IMPS.
FINAL ZONING
i FIRE DEPT. FINAL
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FINAL CONST.
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FINAL HEATING
j HEALTH DEPT. FINAL
FINAL ELECTRIC
j DEV. FEES PAID
FINAL PLUMBING
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I ENERGY
COMMENTS
SEPTIC TANK SIZE
SEEP PITH SIZE
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