HomeMy WebLinkAbout18178 (19)CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
21825 E. Copley Drive
(909) 860-3195 Fax (909) 861-3117
%. BUILDING PERMIT APPLICATION L
JOBSITE h `
ADDRESS�3 �3t!�_S ", jh� /
APN OT T A T
OWNER
ADDRESS .%
PTYlg;b• ZIP TEL
APPLICANT TEL. to
CONTRACTOR
ADDRESS0,0
CITY ZI TEL 0
ARCWENG/
DESIGNER
ADDRESS
CITY ZIP TEL
OWNER -BUILDER DECLARATION
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM EXEMPT FROM THE CONTRACTORS LI-
CENSE LAW FORTHE FOLLOWING REASON (SEC. 7031.6BUSINESS AND PROFESSIONS CODE ANY CITY OR
COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT ALTER. WPADVE,DEAIOUSH,ORREPAIR ANY STRUC•
TORE, PRIOR 70 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 LI-
CENSE LAW (CHAPTER 6 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PRO-
FESSIONS OWE) OR THAT HE OR SHE 15 EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP-
TION. ANY VIOLATION OF SECTION 7031.6 BYANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO
A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (ISOO).):
O L AS OWNER OF THE PROPERTY.OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION.
WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044. BUSI-
NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF
PROPERTY WHO BUILDS OR IMPROVESTHEREON, AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
THROUGH HIS OR HER= EMPLOYEES. PROVIDED THATSUCH IMPROVEMENTS ARE NOT INTENDED OR
OFFERED FOR SALE CHOWEVER.THE BUILDNGOR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE-
TION, THE OWNER -BUILDER WnLL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
IMPROVE FOR THE PURPOSE OF SALE).
O L AS OWNER OF THE PROPERTY. AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS
TO CONSTRUCT THE PROJECT (SEC. 7011, BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LI-
CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND
WHO CONTRACTS FOR SUCH TO
WITH A CONTRACTOR($) LICENSED PURSUANT 70 THE CONTRAC-
TORS LICENSE LAW.).
O 1 AM EXEMPT UNDER SEC. B, i P.C. FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
I HEREBYAFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER
a (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND
MY LICENSE IS N FULL FORCE AND EFFECT.
LICENSE ZSS _ LIC. NO. '–,[•�,_�._/___—G
DATE CONTRACTOR !SV;jEF1{�gF
WORKERS' COMPENSATION DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELFaNSURE FOR WORKERS'
OOMPENSATGON, AS PROVIDED BY BECTON 3700 OF THE LABOR CODE, FOR THE PERFORMANCE
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.
^_I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REOLIMED BY SECTION
3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED. MY WO CER$' OMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE:
CARRIER
POLICY NUMBER
G
(THIS SECTION NEED NOT BE COMPLETIODOF THE PERMIT IS FOR ONE HUNDRED DOLLARS (31001OR LEM
1 CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. 1
SHALL NOT EMPLOY ANY PERSON N ANY MANNER 50 AS TO BECOME SUBJECT TO THE
WORKERS' COMPENSATION LAWS OF CALIFORNIA. AND AGREE THAT IF I SHOULD BECOME
SUBJECT TO THE WORKERS COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR
ca0 1 SHALL FORTHWITH COMPLY WITH THOSE PgpVII S.
1 DATE: " PPLICANT.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. AND SHALLBE
SUaJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINE$ UP TO ONE HUNDRED THOUSAND
DOLLARS ($100.000), N ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN
i SECTION 37060F THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
i
FOR THE ERFO UNDER PENALTY OFK FOR PERJURY THATTHERE LSACONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15ISSUED (SEC. 3097, CN. C.I.
3
LENDERS NAME
LENDEWSADDRESS
I CERTIFY THAT I 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
3 CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES.
It
C PERMITTEE NAME (PRINT)
L(J
2 SIGNATURE OF PERMIT? DATE
PRESS
FIRMLY
APPLICATIO PERMIT P/C
DATE NUMBER #
ISSUE TYPE OCC
DATE CONST. GROUP
ZONING SETBACKS
FRONT RW ❑
REAR ❑
SIDEISIDE STREET RW ❑
SIDE ❑
PTOP§VE SE
MR
RO. DWEL.LLG�
NO.- NO.
UNITS STORIES BEDROOMS
DESCRIPTION SO. FT. FACTOR PSF ADJ. AREA/VALUATION
SFRIADD/REM
Garape/Carpon
Patlo/Deck
LWU
V-
Pool/Spa
Z
Re -gaol
Commercial
m
Valuati ADJ.AREA
OUANTITY DESCRIPTION FEE
U_
U
w
J
w
z
2
m
J
'
a
_U
Z
Q
2
W
CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
M,
�J I_ J 7.)
ISSUANCE ' U V
SMIP
ENERGY P/C
ENERGY PERM] B< s
RETENTION FEE: i �----
PRE -ALT FEE:
TOTAL FEES -�
COMMENTS
71
RECPT. NO. PAID BY VALIDATION
WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy, G(NotNHUL), -rae L:opy. UHhEN—Appllcam s wpy
CITY OF DIAMOND BAR
INSPECTION RECORD
C - IV, vI1��
T
SETBACK W..�
wf FLOOR JOIST--
FTGS/FORMSlSTEEL
FHA REOMTS
ELECTRIC GROUND
UNDER FLOOR DUCT j
GROUND PLUMBING
i UNDER FLOOR CONDUIT',
SLAB GRADE
FIREPLACE FOUNDATION
TEMP POWER
FIREPLACE BOND BEAM
WATER SERVICE !
ROOF SHEATHING l�z
FRAMINGlVENTILIATION _
MID HT. BOND BEAM
8 FT BOND BEAM
FINAL BUND BEAM
ROOF COVER ��_
ROUGH HEATING
PRE -GRADING ! i
BENCHING
ROUGH ELECTRIC
ROUGH GRADING
ROUGH PLUMBING
FINISH GRADING
SHOWER/TUB TEST
j POOL ELECTRIC
EXT. LATH/SIDING
I i POOL FENCING
WALL INSULATION
POOL FINAL
CEILING INSULATION
OFF SITE IMPS.
DRYWALL NAILING
j DEDICATIONS
SEWER
FINAL ENG.
SEPTIC TANK !..
LANDSCAPE/IRRIG.
SEEP PIT/L.L.
i ON SITE IMPS.
GAS AIR TEST
i I FINAL ZONING
FINAL CONST. I
I FIRE DEPT. FINAL I
FINAL HEATING
HEALTH DEPT. FINAL
FINAL ELECTRIC
DEV. FEES PAID
FINAL PLUMBING
ENERGY
COMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
f