HomeMy WebLinkAbout16892 � � `_ �� CITY OF DIAMOND BAB
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES � i
' 21660 E.Copley Drive Suite 190 �
(909)860-3195 Faz(909)861-3117 � C`(���, � I� PRESS
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p DATE: �� APPUCANT. �I� ����_ �SMIP ` � _ ���
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► DEPARTMENT OF COIvIIvfUNTI'Y 8c DEVELOPMENT SERVICES
�,.w 21825 E.Copley Drive
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BUILDING PERMIT APPLICATION FIRMLY
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ADDRESS � I DATE � �� O NUMBER«� � �
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� I AGREE TO COMPLY WITH ALL GTY AND COUNTY ORDINANCES AND STATE UWS REUTING TO BUILDING
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• - • • CITY OF DIAMOND BAR �� ` _��` I �
� --��` -- DEPARTIv1ENT OF COIvIIvfUNITY 8c DEVELOPIv�NT SERVICES
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� 21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 PRESS
`�'������`' BUILDING PERMIT APPLICATION FIRMLY !
� JOBSITE , APPLICATION
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� ISSUE TYPE OCC
APN LOT TRACT DATE CONST. GROUP
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p ADDRESSi O ZONING SETBACKS
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1 HEREBV AFFIRM UNDER PENALTY OF PERIURV THA7 I AM EXEMPT FROM THE CON7RAC70RS LI� G8f8(JB/CBfPOA
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STATEMENT THAT HE OH SHE IS LICENSED PURSUAN7 70 THE PROVISIONS OF THE CONTRAC70R5 LI�
� CENSE UW(CHAPTER 8(CAMMENCING WI7H SECTION 700a)OF DIVISION 3 OF THE BUSINESS AND PRO- � POOVSpB
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� TION.ANVVIOUTIONOFSECTION7031.SBVANYAPPLICANTFORAPERMITSUBJECTSTNEAPPLICANTTO Z Re-Roof
� A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLIARS(5500).):
❑I,ASOWNEROFTHEPROPERTY,ORMYEMPLOVEESWITHWAGESASTHEIRSOIECOMPEN5A710N, �
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Z WILL DO THE WORK,AND 7HE STRUCTURE IS NO7 INTENDED OR OFFERED FOR SALE(SEC.704�,BU51- J
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PROPERTV WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
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, w OFFEREDFORSALEIF,HOWEVER,TiEBUILDINGORIMPROVEMENTI550LDWITHINONEYEAROFCOMPLE-
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� OI,ASOWNEROF7HEPROPER7Y,AMEXCLUSIVELYCONTRACTINGWITHLICENSEDCONTRAC70R5
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� TO CANSTRUCT THE PR0.IECT(SEC.70�4,BUSINESS AND PROFESSIONS CODE:7HE fAN7RAC70RS LI� V81U2�1Of1 ADJ.AREA
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¢ ❑I AM ExEMPT UNDEF SEC. B.8 P.C.FOR THIS REASON Q
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DATE OWNER U
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� LICENSED CONTRACTORS DECLARATION W
� I HEREBY AFFIRM UNDER PENALTY OF PERJURV 7HA7 I AM LICENSED UNDER PROVISIONS OF CHAPTER � Yp �
d �(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS ANO PROFESSIONS CADE,AND Z l.�'
`X MV IICENSE IS IN FULL FORCE AND EFFECT. m
� LICENSE CLASS LIC.NO. j
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V DATE CONTRACTOR a
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� WORKERS'COMPENSATION DECLARATION �
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� I HEFEBV AFFIHM UNOER PENALTV OF PERIURY ONE OF THE FOLLOWING DECLARATIONS: Z
Z _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CANSENT TO SELF-INSURE FOR WOHKERS' _
Q COMPENSA710N,AS PROVIDED BY SECTION 770o OF THE UBOR CODE,FOR THE PERFORMANCE W I
OF THE WORK FOR WHICH 7HI5 PERMI7IS ISSUED. �
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w _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION
Q 370o OF THE LABOfl CODE,FOR THE PERFOPMANCE OF THE WORN FOR WHICH THIS PEPMIT IS
ISSUED.MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBEH ARE: CONSTRUCTION
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ZPOLICY NUMBER ELECTRIC
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� (iHISSECf10NNE�NOTBE00MR_EfIDOFhiEPERAAfTISR�RONEFNPDREDDOLLPAS(f100)ORLESS} PLUMBING
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Z 1 CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
(,'} SHAIL NOT EMPIOY ANY PERSON IN ANY MANNER 50 AS TO BECAME SUBJECT TO THE i
Uj WORKERS'COMPENSATIONLAWSOFCAUFOHNIA,ANDAG{iEETHATIFISHOULDBECOME INSPECTIONFEE
? SU&IECTTOTHEWORKERS'CAMPENSATIONPROVISIONSOFSECTION37000FTHEUBOR '
CO�E,I SHALL FORTHWITH COMPLV WITH THOSE PqOVI510N5. �SSUANCE �. �
p DATE: APPLICANT: SMIP I
J WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNUWFUL,AND SHALL BE ENERGY P/C
� SU&IECTANEMPLOYER70CRIMINALPENALTIESANDCIVILFINESUP700NEHUNDHEDTHOUSAND ENEFGYPERMIT
DOLLARS(S70o,o00),IN ADDITION TO THE COS70F COMPENSATION,DAMAGES AS PfiOVIDED FOR IN
� SECTION37a80FTHEUBORCODE,MTEREST,ANDATTORNEY'SFEES. RETENTIONFEE:
� CONSTRUCTION LENDtNG AGENCY PRE-ALT FEE:
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� I HEREBV AFFIqM UNDEH PENALTY OF PERJURV 7HA7 7HERE IS A CONSTRUCTION LENDING AGENCY
� FOR THE PERFORMANCE OF 7HE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.C.). . I
Z
W
� LENDER'S NAME i
F- LENDER'SADDRESS /',�
� I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE MfORMATION IS CORRECT. TOTAL F E E � ," 1 ) '
w I AGHEE TO COMPLV WITH ALL CITY AN�COUNTV OR INANCES AND STATE LAWS RELATING TO BUILDING V( ���/
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRES TATIVES OF THIS COUNTY TO ENTER UPON THE
� ABOVE-MENTIONEDPROPERTVFORINSPECTI N RPOSES.
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Uj SIGNATU RMITTEE �ATE
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~ WHITE—DepaAment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy
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GROUND PLUMBING � UNDER FLOOR CUf�IDUIT j
SLAB aRADE FIREPLACE FOUNDATION � _
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_ _._._.__.. �.--_._. -__ _______._.__._._____. __.---
WATEFi SERVICE i : � MID HT. Bt7ND BEAM
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ROOF SHEATHIPdG ' 8 FT. BOND BEAM ____
FRAMIIVGNENTILIATION � FINAL BOND BEAM _ � _____
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ROOF COVER ___ �PRE-GRADING
ROUGH HEATING � BENCHIN� ---------�a ---_.�_
ROUGH ELECTRIC � ROUGH GRADING ' _ ____
ROUGH PLUNIBItVG ! FINISH GRADING
SHOWEFi/TUB TEST ; PUOL ELECTRIC
-- -- -- _ �_._...- --..._..._..--
EXT. LATH/SIDING ` , POOL FEi�CING
WALL INSULATION j POOL FINAL i
CEILING INBULATION � OFF SITE IMPS.
DRYUVALL NAILIIVG � DEDICATIONS
SEWER FINAL ENG. ---------- -
SEPTIC TAIUK LANDSCAPElIRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FIIVAL COM1IST. ' � E �!RE DEPT. FIIVAL
FINAL H�=ATING � NEALTH DEPT. FINAL � � �
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FINAL ELECTRIC j DEV. FEES PAID
FIPVAL PLUMBING ! ENERGY �
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