HomeMy WebLinkAbout17740 �x p'�r�
_��_ CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNTI'Y&DEVELOPMENT SERVICES
21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 PRE$$
�'���� BUILDINGPERMITAPPLICATION FIRMLY
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o ADDRESS ��/ �� DATE d 2�' NUMBER � # �aZ'
� ISSUE TYPE OCC
APN LOT TRACT DATE � CONST. GROUP
p OWNER $ N'W;. �Ii
o ADDRESS —���— ZONING RONT KS Ryy ❑
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W CENSEUWf-0RTHEFOLLOWINOREASON(SEC.7031.68USINESSANDPROFESSIONSCODE:ANYCITVOR (n
Z COUNTVN?iICHRC-0UIRESAPERMRTOCONSTRUCT,ALTER,IMPROVE,DEMOUSH.OPREPAIRANYSTRUG W Patlo/Oeck
w TURE,PR10R 70 ITS ISSUANCE,ALSO REW IRES THE APPUCANT FOp SUCH PERMIT TO FILE A SIONED w
� STATEMENT THAT HE OR SHE IS LICENSED WFSUANT TO THE PROVISIONS OF THE COMRACTORS LI� .
� CENSE UW(CHAPTER Y(COMMENCINO WITH SECTION 7000)OF DIVISION 3 0F THE BUSINE55 AND PRO� � PaoUSpe y�
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TqN.AN'I VIOLATION OF SECTION 7031.5 BV ANV APPLICANT FOR A PERAl1T SU&IECTS THE APPLICANT TO Z Re-Roof
A CIVIL PENALTY OF NOT MORE THAN FfVE HUNDRED DOLURS(f500)J:
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Z WILL DO THE WORK�D THE STRUC7URE IS NOT INTEN�ED OR OFFERED FOR SALE(SEC.70N,BU51� J
� NESS AND PROFESSIONS CODE:h1E CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF �
PROPERTY WFq BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELG OR HERSELF OR
Q THROUGH HIS OR HER OWN EMPLOVEES,7qOVIDED THAT SUCH IMPFOVEMENTS ARE NOT MTENDED OR m
Q OFFEREDFORSALEIF,HOWEVERTNEBUILDINOORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE-
Z TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PURVOSE OF SALE).
W ❑I,ASOWNEROF7HEPROPEHTY,AMEXCLUSIVELYCAMMCTINGWfTHLICENSEDCONi{7ACTORS
[t TO CONSTRUCT THE Pq0.1ECT(SEC.7oI�,BUSINESS AND PROFESSIONS CADE:7HE CONTRACTORS LI� V01UflflOfl 0� ADJ.AREA
W CENSE L�W DOES NOTAPPLV TO AN ONTJER OF A PROPERTV WHO BUILDS OR IMPROVES THEREON,AND
� WIiOCOMRACT5FOR5UCHPR0.JECT5WITHACONTRACTOR(S)LICENSEDPURSUANTTOTHECOfJTRAG QUANTITY DESCRIPTION FEE
Y TORS LICENSE LAW.�.
� O I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q
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� LICENSED CONTRACTORS DECLARATION w
� I MEREBV AFFIRH UNDER PENALTV OF PERIURY THAT 1 AM UCENSED UNDER PROVISIONS OF CHAPTER � ' �
� Y(COMMENCINO WITH SECTION 70a0)OF DIVISKKJ 3 OF THE BUSINESS AND PROFESSIONS CADE,AND Z �
�l� MV UCENSE IS IN FULL FOFCE AND EFFECT.
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U DATE �`�i'�OZ CONTRACTOR �1.r� �C�� d
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� WORKERS'COMPENSATION DECLARATION Q
� I HEREBV AFFIRM UNDER PENALTV OF PERIURV ONE OF THE FOLLOWING DEClAMT10N5: U
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Z0 _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORICERS' a
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COMPENSATION,AS PROVIDED BV SECTION 3700OF THE LABOR CODE,f-0R THE PERFORMANCE U
OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED. �
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w �I MAVE M1D WILL MAINTAIN WORNERS'COMPENSATION INSURANCE,AS REQUIqED BV SECTION
Q 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMR IS 7 v
ISSUED.MY WORKERS' MPE SATION INSURANCE CARRIER AND POLICV NUMBEfiARE: CONSTRUCTION ��?
� CARRIER h ' PLAN REVIEW � ��
Z POLICYNUMBER 0 � ELECTRIC Q
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Z I CERTIFV THAT IN TME PERFO{iMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
U' SHALL NOT EMPLOY ANV PERSON IN ANV MANNER SO AS TO BECOME SUBJECT TO THE
� WORNERS'CAMFENSATION UWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE
� SUBJECT TO THE M/ORKERS'CAMPENSATION PROVISIONS OF SECTION 7700 OF THE LABOR
� CODE,I SHALL FORTHWITH COMPLV WITH THOSE PROVISIONS. ISSUANCE
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p DATE: ^ '�D�- qppLICANT: _ SMIP �
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J WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERA(3E IS LAWFUL ND SHALL BE ENERGY P/C
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� SU&IECTANEMPLOYERTOCRIMWALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
DOLURS(f10o.000).IN/�DDITION TO THE COST OF CAMPENSATION,DAMAOES AS PROVIDED FOR IN -r
J SECTqN 37oB OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES.
OC RETENTION FEE:
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBV AFFIqM UNDER PENALTY OF PERIURV THAT THERE IS A CONSTRUCTION LENDING AGENCY
� FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.).
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� LENDER'S NAME
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w I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT TNE ABOVE INFORMATION IS CORRECT. TOTAL FE ES �S��� �.
� I AGREE TO COMPLV WITH ALL CITY ANO CWNTV ORDINANCES AND STATE UWS RELATINO TO BUILDING
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE
Z ABOVE-MENTIONED PROPERTV FOR INSPECTION PURPOSES. COMMENTS
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m PEFMITTEE NAME(PRINT)
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� SIQNANREOFPERMITfE DATE -
� RECPT.NO. PAID BY� VALIDATION
WHITE—Depertment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—Applicant's Copy
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SLAB GRADE FIREPLAGE FOUNDATION
TEMP POWER FIREPLAGE BOND BEAM
WATER SERVICE Pv11D HT. BOND BEAM
ROOF SHEATHIPVG 8 FT. BOND BEAM
FRAMING/VENTILIATION FINAL BOND BEAM
FIOOF COVER PRE-GRADING
ROUGH HEATIiVG SENCHIiVG
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUNIBING FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC �
EXT. LATH/SIDING POOL FENCING �
WALL INSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE fMPS.
GAS AIR TEST FINAL ZUNING
Fli�,4L CONST. FIRE DEPT. FINAL
FlNAL HEATIlVG HEALTH DEPT. FINAL
FINAL ELECTRIC , DEV. FEES PAID
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