HomeMy WebLinkAbout10301 (5)CITY OF DIAMOND BAR
COMMUNITY DEVELOPMENT DEPARTMENT
21660 E. Copicy Drive Suite 190
(909) 860-3195 Fax (909) 861.3117
w BUILDING PERMIT APPLICATION
JOBSITE
DDR
ADDRESS
APN LOT TRACT LS-�Sr
OWNER IiJ G L` f� G?i4
ADDRE b 0
CITY 'yam ZIP TEL. `
APPLICANT TEL.
CONTRACTOR C%`CiKr
ADDRESS
CITY ZIP TEL
ARCH/ENG/
DESIGNER
ADDRESS
CITY ZIP TEL
OWNER-EIVILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AIA EXEMPT FROM THE CONTRACTORS L4
CENSE UW FOR THE FOLLOWING REASON (SEG 7001.5 BUSINESS AND PROFESSIONS CODE: ANY CT' OR
COUNTY WHICH REOUIRE5A PERMR TO CONSTRl1CT, AL7ER. IMPROVE. DEMOLISK OR REFURANY STRU _
TORE. PRIOR TO ITS ISSUANCE, ALSO REoUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS L4
CENSE LAW (CHAPTER s SHE
WITH SECTION ?NO) OF DIVISION S OF THE BUSINESS AND PRO.
FESSIONS OWE) OR THATHE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP.
TION. ANY VIOLATION OF SECTION 7071.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT To
A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (SSDO) ):
O LASOWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGESAS THEIR SOLE COMPENSATION,
WILL DO THE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044. BUST.
NESS Aho PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES N07 APPLY TO AN OWNER OF
PROPERTY WHO BUILDS OR IMPROVES THEREON. AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
THROUGH W S OR NCR OWN EMPLOYEES. PROVIDED THAT SUCH IMPROVEMENTS ARE NOT MENDED on
OFFERED FOR SALE IF. HOWEVERAHE BUILDING OR IMPROVEMENTIS SOLD WITHIN ONE YEAROF COMPLE•
TION, THE OWNERBUILDERWILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DO NOT BUILD OR
IMPROVE FOR THE PURPOSE OF SALEL
O L AS OWNER OF THE PROPERTr,AM EXCLUS VELYCONTFRACTNG WITH LICENSED CONTRACTORS
TO CONSTRUCT ME PROJECT (SEG 7044. BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI.
CENSE LAW DOES NOT APPLY TO AN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON. AND
WHO CONTRACTS FOR SUCH PROUECTS WITHACONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC
TORS LICENSE LAW.L
O I IAM EXEMPT UNDER SEC. . a P.C. FOR THIS REASON
DATE jj1-3- 9 OWNER L
LICENSED CONTRACTORS DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IATA LICENSED UNDER PROVISIONS OF CHAPTER
s (COMMENCNG WITH 5ECTION 70001 OF DIVISION 7 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 AND WILL MAINTAIN A CERTinCATE OF CONSENT TO SELF -INSURE FOR WORKERS,
COMPENSATION. AS PROVIDED BY SECTION 7700 OF THE LABOR CODE. FOR THE PERFORMANCE
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.
I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE. AS REOUIRED BY SECTION
7700 OF THE LABOR CODE, FOR ME PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE,
CARRIER
POLICY NUMBER
(THIS SECTION NEEONOTBE autrmOFT E PEAMf 6 FORCNERAD REDOOLIARS (510D)ORLamS
I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED, I
SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE
WORKERS' COMPENSATION LAWS OF CALIFORNIA. AND AOREE THAT IF I SHOULD BECOME
SUBJECT TO THE WORKERS' IO
OOMPENSATION PROVISIONS OF SECTION 5700 OF THE LABOR
CODE, I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS.
DATE: APPLICANT
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL BE
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (FI00.000L IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN
SECTION 7705 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
CONSTRUCTION LENDING AGENCY
I HEREBY AFFIRM LINGER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED (SE C. 3W7, CN. C.).
LENDERS NAME
LENDERS ADDRESS
I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
1 AGREE TO COMPLY WITH ALLCRY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
CONSTRUCTION, AID HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES.
p_C-P C-44,1 0¢c,,%zr w
PERMITTEENAME(PRBR)
Ile
SIGNATURE OF PERM EE DATE
Q \ I
PRESS
/ FIRMLY
APPLICATION l
PERMIT O
PJC
DATE
NUMBER
M
ISSUE
TYPE
OCC
DATE
CONST.
GROUP
ZONING SETBACKS
FRONT
RW
0
REAR
0
SIDE/SIDE STREET RW
CJ
SIDE
0
PROPOSED USE
U�''�►+�G
NO. DWEL fes"
NO.
NO.
UNITS 8
STORIES
BEDROOMS
DESCRIPTION
SO. FT, FACTOR PSF
ADJ. AREAIVALUATION
SFRIADD/REM
U)
Garage/Carport
WPat)oVeck
,
L=-
POGVSpa
ZRe
-Roof
Commercial
m
Valuation
ADJ.AREA
OUANTITY DESCRIPTION
FEE
J
Q
U
U
W
W
_Z
m
7
J
a
U
2
Q
x
U
W
CONSTRUCTION
EVIEW
pPLAN
ELEf -
MECHANICAL
INSPECTION FEE
A•I I
ISSUANCE
SMIP
ENERGY P/C
/
ENERGY PERMIT
RETENTION FEE:
PRE -ALT FEE:
TOTAL FEES
_
F
COMMENTS
RECPT. 440.
PAID BY
eon
VALIDATION
WHITE—DeparuRsnt Copy. YELLOW—Finance Copy, PINK—Assessor Copy. GOLDENROD—FIM Copy, GREEN--AWicant's Copy
.. � .. ,. . �� .. -'i' .. , ��p , . _ ,;a• 1. �.. 4'... '. Ir, jt..,.o : q. l l..r.: r } � � - .. 7 �..._. +•� ;.. .. . , . .
CITY. Of DIAMONID 0 -AR
._.. INSPECTION RECORD :.
li`l=iC1-iC,.l['Igl► Utd= ri I+ «. }r:Z•.5c,:
SET BACK-, I I FLOOR JOIST._. -- —
FTGS/FORMS/STEEL-- FHA REQ -,ATS •- `' ,� ., ; � �; , j
ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING '
-
UNDER-FC,6O } d,,VNbU1T 11,
SLAB GRADE
FIFiEPLACE.FOUNDATION
-TEt.IP-POWER= ' _--
._ .-_ ..:;.::.._._;.
FIREPLACE -BOND BEAM
�� �.
\._>.�; :,• .: I
WATER SERVICE --MID
HT. BUND BEAM
ROOF SHEATHING
8 FF. 13OND BEAM
'
FRAMINGNENTILIATION
'FINAL BOND BEAM
ROOF -COVER: ..-__:
- -'
_ __...: _
..__.
-PRE.GRADING- -
ROU H HEATING
- '-
-
BENCHING
ROUGH ELECTRIC -
--------
- - -
�C�i
I I ROUGH GRADING ..
-
.
ROUGH PLUNIBING
SHOWERITUB TEST
EXT. LATH/SIDING
-'
-
/'
- -- :
FINISI'I GRADING
POOL! ELECT RIC.
POOL FENCING
1 _POOL FINAL
OFF SITE IMPS"
,
.
WALL INSULATION
CEILING INSULATION
��
DRYWALL NAILING
SEWER.. -_-
I DEDICATIONS
FINAL ENG.
.'
SEPTICTANK ..
-
LANDS CAPEARRIG.
SEERPIT/L.L. _._ _
_.. ._
....• ._
ON SITE IMPS.
GAS AIR TEST -_ _
_...
FINAL ZONING
FINAL CONST.-
FINAL HEATING - -
FINAL ELECTRIC - :
FINAL -PLUMBING
COMMENTS
-
_ .. --
"' -
FIRE-mf'T'F,j1�7� '•�., -`. a ..':.. �,1=
_
HEAL1 H DEPT. FINAL
DEV. FEES PAID_ ;
-PIE:RGY � I}
— i r•F-•sem.= �-w-_.��_.._..r._.._._._—J
i
SEPTICTANKSIZE
SEEP PIT/U SIZE
—
i �