HomeMy WebLinkAbout18179J� CITY OF DIAMOND BAR p�
DEPARTMENT OF COMMUNITY OI. DEVELOPMENT SERVICES
21825 E. Copley Drive
(909) 860-3195 Fax (909) 861.3117
BUILDING PERMIT APPLICATION
JOBSITE
ADDRESS P_
APNLOT TRACT
OWNER
it—
ADDRESS
CIN ZI TE
APPLICANT TEL,
CONTRACT
ADDRESS i'•
CITY ZI _ TEL
ARCFVENG/
DESIGNER
ADDRESS
CITY ZIP TEL
OWNER -BUILDER DECLARATION
IH
AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI-
CENSE UW FOR THE FOLLOWING REASON (SEG 7031.5 BUSINESS AND PROFESSIONS CODE:ANY CITY OR
COUNTY WHICH REO%RESA PERMITTO CONSTRUCT.ALTER, IMPROVE, DEMOLISH, OR REPAIRANYStRUC-
TURE. PRIOR TO ITS ISSUANCE. ALSO REWIRES 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 UW (CHAPTER 8 (COMMENCING WITH SECTION 70001 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.
TION. ANY VIOLATION OF SECTION 7071.5 BYANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO
A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (1500).):
O L AS OWNER OF THE PROPERTY. OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION,
WILL DO THE WORK ANO THE STRUCTURE IS NOT INTENDED DR OFFERED FOR SALE (SEC. 7044, BUSI.
NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF
PROPERTY Z.O BUILDS OR IMPROVES THEREON, AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
THROUGH HIS OR HER —EMPLOYEES. PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR
OFFERED FOR SALE. IF. HOWEVERTHE BUILDING OR IMPROVEMENT IS SOLD WI THIN ONE YEAR OF COMPLE-
TION, THE OWNER-0UILDER VALL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
IMPROVE FOR THE PURPOSE OF SALE(.
O L AS OVMER OF THE PROPERTY, AM EXCLUSIVELY CONTRACT WG WITH LICENSED CONTRACTORS
TO CONSTRUCT THE PROJECT (SEC.7041, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS U.
CENSE UW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON. AND
WHOCONTRACTS FOR SUCH PROJECTSVATHACONTRACTOR(S)UCENSEDPURSUANTTOTHECONTRAC-
TORS LICENSE LAW).
O 1 AM EXEMPT UNDER SEC B. & P.C. FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
1 HEREBYAFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER
8 (COMMENCING WITH SECTION 7000) OF DIVISION 30F THE BUSINESS AND PROFESSIONS CODE, AND
MY LICENSE IS IN FULL FORCE AND EFFECT.
LICENSE CWS UC. NO. �
DATE d •� rZ� a��— CONTRACTO
WORKERS' COMPENSATION DECLARATION
1 HEREBYAFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
_I HAVE AND WILLMAINTAIN ACERTIFICATE OF CONSENT TO SELFINSURE FOR WORKERS'
COMPENSATION.AS PROVIDED BY SECTION 37000FTHE LABOR CODE. FOR THE PERFORMANCE
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.
_1 HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS RECUIRED BY SECTION
3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUEMMYWORKER MPENSATI INSURANC BR�IER�O�j Nn OOLOGY NUMSER ARE:
CARRIER - �/IE J n
POLICY NUMBER �� 4
(THIS SECTION NEED NOT BE COMPLETED OFTHE PEPMTS FOR ONE H DREDOOUARS($100)OR LESS),
1 CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I
SHALL NOT EMPLOY ANY PERSON IN ANY MANNER 50 AS TO BECOME SUBJECT TO THE
WORKERS' COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF 1 SHOULD BECOME
SUBJECT TO THE WORKERS' IO
COMPENSATN PROVISIONS OF SECTION 3700 OF THE LABOR
CODE, I SHALL FORTHWITH COMPLY WITH THO ISIONS,
DATE APPLICANT:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION CCVER IS UNLAWFULANDSHALLBE
SUBJECT AN EMPLOY CRIMINAL PENALTIES ANO CMLFWESU O ONE HUNDRED THOUSAND
DOLLARS (11100.000). IN ADDRKON TO THE COST OF COMPENSATION, AMAGES AS PROVIDED FOR IN
SECTION 3708 OF THE LABOR CODE. INTEREST, AND ATTORNEYS FEES.
CONSTRUCTION LENDING AGENCY
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE S A CONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED (SEC. 3081. CIV C.).
LENDER'S NAME
LENDERS ADDRESS
1 CERTIFY THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
1 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.
PERMITTEE E(PRINT)
I
SIGNATURE OF PERMIVEE DAT
(PI
PRESS
FIRMLY
APPLICATIONPERMIT G
PIC DATE y NUMBER 3 N
ISSUE TYPE OCC
DATE CONST. GROUP
ZONING SETBACKS
FRONT RW 0 -
REAR 0-
SIDE/SIDE STREET RW O
SIDE p
PROPOS DU
4t
NO. DWEL. NO. 0.
UNITS STORIES BEDROOMS
DESCRIPTION SO. FT. FACTOR PSF ADJ. AREANALUATION
SFR/ADD/REM
Garage/Carport
WPatio/Deck
LL
PcoVSpa
ZRe
-Roof
QCommercial
a
m
Valuation _ ADJ.AREA
QUANTITY DESCRIPTION FEE
..L
Q
U
It
U
W
J
W
0
Z
m
J
a
U
2
4
S
U
W
�
,1q
CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE [ ---•----•�(
�L 1� J.1_ J
SMIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE:
PRE -ALT FEE: B�•
TOTAL FEES
COMMENTS
RECPT. NO.PAID BY VALIDATION
_04
WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD—File Copy, GREEN—Applicant's Copy
Tf
CITY OF DIAMOND BAR
INSPECTION RECORD
SET BACK
FLOOR JOIST
,FTGS/FORMS/STEEL
FHA REOMTS
ELECTRIC GROUND
UNDER FLOOR DUCT
GROUND PLUMBING
UNDER FLOOR CONDUIT'
SLAB GRADE
FIREPLACE FOUNDATION
TEMP POWER
FIREPLACE BOND BEAM
WATER SERVICE
ROOF SHEATHING
_ I
MID HT BOND BEAM
8,FT. BOND BEAM
FRAMINGNENTILIATION
'FINAL BOND BEAM
ROOF COVER
ROUGH HEATING
'
1 PRE -GRADING
BENCHING
ROUGH ELECTRIC
I
ROUGH GRADING
ROUGH PLUMBING
j
j I FINISH GRADING j
SHOWER/TUB TEST
POOL ELECTRIC
EXT LATH/SIDING
j POOL FENCING j
WALL INSULATION
POOL FINAL j
CEILING INSULATION
j OFF SITE IMPS.
DRYWALL NAILING
I
j j DEDICATIONS
SEWER
j FINAL ENG.
SEPTIC TANK
j
LANDSCAPE/IRRIG. j
SEEP PIT/LL.
I I
ON SITE IMPS.
GAS AIR TEST
FINAL CONST.
FINAL HEATING
j
_
FINAL ZONING i
FIRE DEPT. FINAL j
HEALTH DEPT. FINAL I
FINAL ELECTRIC
I
DEV. FEES PAID i
FINAL PLUMBING
ENERGY
!
COMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
_
I
I