HomeMy WebLinkAbout10-1120 CITY OF DIAMOND BAR
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21825 Copley Drive,Diamond Bar,CA 91765 ��
(909)839-7020 Fax(909)861 3117 Building Inspect�F,�dZI��(9�Q���39�27 PRESS
,"�^' BUILDING PERMIT APPLICATION � UUVl�I�I� ,L� FIRMLY
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p ADDRESS 20�32 �Vt�-1\FJCC'F1 PR-• ZONING SETBACKS
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� APPLICANT �Oc�O � TE�.9o9 U7�2�°I`j REAR ❑
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cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNER•BUILDER DECLARATION SFR/ADD/REM
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I HEREBV AFFIRM UNDER PENPLTV OF PERIURV THAT I AM EXEMPT FROM 7HE CONTRACTORS LI� Gef89B/CBfpOA
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U COUNTVWHICHREOUIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC-
w TURE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOP SUCH PERMIT TO FILE A SIGNED w Patio/Deck
� STATEMENT 7HA7 HE OR SHE IS LICENSED PURSUAN7 TO THE PROVISIONS OF THE CON7RACTORS LI- �
CENSE UW(CHAPTER 9(COMMENCING WI7H SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO• POOVSpB
FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMAf1DTHE8ASISFORTHEALLEGEDEXEMP� C7
� � TION.ANV VIOUTION OF SECTION 7091.5 BV ANV APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO Z Re-Roof
� A CIVII PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(SSao)J:
Z ❑I,ASOWNEROFTHEPROPERTV,ORMYEMPLOVEESWITNWAGESASTHEIRSOIECOMPENSATION, � Commercial
WIIL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70aI,BU51� J
� NE55 AND PROFESSIONS CODE:THE CONTRACTORS UCENSE LAW DOES NOT APPLV TO AN OWNER OF �
� PROPERTVWHOBUILDSOPIMPROVESTHEREON,ANDWHODOESSUCHWORKHIMSELFORHERSELFOR
2 THROUGH HIS OR HER OWN EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDEO OR m
Q OFFEREDWRSALEIF,HOWEVERTMEBUILDINGORIMPROVEMENTISSOLDWI7HINONEYEAROFCOMPLE�
Z TION,7HE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVING 7HA7 HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF SALE).
OI,ASOWNEROFTHEPROPEHTV,AMEXCLUSIVELVCONTRACTINGWI7HLICENSEDCONTRACTORS � 5��
� TO CONSTRUCT THE PROJECT(SEC.704�,BUSINESS ANO PROFESSIONS CODE:THE CONTRACTORS LI� V81U8fI0f1 � ADJ.AREA
W CENSE UW DOES NOTAPPLV TOAN ONRJER OF A PROPERTV WHO BUILDS OR IMPROVES 7HEREON,AND
� NM1IOCONTRACTSFORSUCHPROJECTSWITHACONTRACTOR(Sj�ICENSEDPURSUANTTOTHECANTRAG QUANTITY DESCRIPTION FEE
Y 70R5 LICENSE LAW.).
3� ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q '
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DATE OWNER �
Z w
� LICENSED CONTRACTORS DECLARATION W
� 1 HEREBY AFFIRM UNOER PENALTV OF PERJURY 7HAT I AM LICENSED UNDER PROVISIONS OF CHAP7ER �
d B(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z
X YY LICENSE IS IN FULL FORCE AND EFFECT. m
� LICENSE�_SSI2G_� 1 ���.No. 55�"I 3 � ,
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V DATE 7 JU �C. CONTRACTOR_ a
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� WORKERS'COMPENSATION DECLARATION Q
NI HEREBV AFFIRM UNDER PENAL7Y OF PERIURV ONE OF THE FOLLOWING DECLARATIONS: Z
Z _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORKERS' _
Q CAMPENSATION,AS PROVIDED BV SECTION 37000F THE LABOR CODE,FOR THE PERFORMANCE �U
Q A � OF THE WORN FOR WHICH THIS PERMIT IS ISSUED. �
W w I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION
O 37000F THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS qJ,/� (�,
ISSUED.MV WORKERS'CAMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: ON TRUCTI ���{/�.�(J
� CARRIER S'C'AT'�G FvNb �/� PLAN REVIEW
Z POUCV NUMBER OOO 1,�S� Zw ELECTRIC
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� (IHISSEC�qNNE�NOTBECOA1R.EfEDOF7HEPEPMfTISFORONEHUt�DREDDOl1/RS(f100�ORLESS). PLUMBING
Z 1 CERTIFY THAT IN 7HE PERFORMANCE OF THE WORK FOR WHICH 7HI5 PERMIT IS ISSUED,I MECHANICAL
(,'J SHALL NOT EMPLOY ANV PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE
� WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOUL�BECAME INSPECTION FEE
= SUBJECTTOTHEWORKERS'COMPENSATIONPROVI NSOFSECTION37000FTHELABOR
COD,I ALLFORTHWITHCOMPLVWI O E O SIONS. �SS A C�Q
� DATE: �1 2U�� MIP �Tp
p APPLICANT:
J WARNING:FAILURETOSECUREWORKERS'COMPENSATIONCOVERAGEISUNLAWFUL,ANDSHALLBE ENERGYP/C
� SU&IECTAN EMPLOYER TO CRIMINAL PENALTIESAND CIVIL FINES UP 700NE HUNDRED 7HOUSAND ENERGY PERMIT
DOLLARS(5100,000�.IN ADDITION TO THE COST OF CAMPENSATION,DAMAGES AS PROVIDED FOR IN
� SECTION 3708 OF THE LABOR CODE.INTEREST,AND ATTORNEV'S FEES. ETENTI FEE: ' r�
d CONSTRUCTION LENDING AGENCY PRE- LT FEE: �
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� I HEREBV AFFIRM UNDER PENALTY OF PERJURV THAT THERE IS A CONSTRUCTION LENDING AGENCY �� �
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMR IS ISSUED(SEC.3097,CIV.CJ. �D
Z
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� LENDER'S NAME
F_ LENDER'SADORESS / �
� TOTAL FEES / '
� I CERTIFV THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATpN IS CARFiECT.
w I AGREE TO COMPLV WITH ALL qTV AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
� CANSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
� ABOVE-MENTIONED 7ROPER7V FOR INSPECTION PURPOSES.
Z COMMENTS
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m P MITTEE (PRINT) ' �
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= RECPT.NO. ' /L PAID BY VALIDATION
~ WHITE—Department Copy,YELLOW--Finance Copy,PINK—Assessor Copy,GOLDENF D—File Copy,GREEN—Applicant' opy
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FTGS/FORMS/STEEL FHA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT ' •
GROUND PLUMBING UNDER FLOOR CONDUIT' "
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID H'T. BOND BEAM
ROOF SHEATHING 8 FT. BOND BEAM �_
FRAMINGNENTILATION � FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING �
SHOWER/TUB TEST POOL ELECTRIC
EXT. �ATH/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 IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY
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SEPTIC TANK SIZE
SEEP PIT/U SIZE
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