HomeMy WebLinkAbout11-381 ' �'' _���_ CITY OF DIAMOND BAR � �
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
' 21825 Copley Drive,Diamond Bar,CA 91765
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(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS
��'"�' BUILDING PERMIT APPLICATION FIRMLY
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<n DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER•BUILDER DECLARATION SFR/ADD/REM
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I HEREBV AFFIRM UNDER PENAL7Y OF PERIURV 7HAT I AM EXEMPT FROM THE CONTRACTORS LI� G8f8gB/CBfpOR
W CENSE lAW FOR THE FOLLOWING REASON(SEC.7031.5 BUSMESS PND PROFESSIONS CODE:ANV CITV OR (n
U COUNryWHICHREDUIRESAPEiiMITTOCANSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC- �
w NRE,PRIOR 70 I7S ISSUANCE,ALSO REOUIRES THE APPLICAN7 FOR SUCH PERMIT TO FILE A SIGNED W Patio/Deck
� STATEMENT TiAT HE OR SFIE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CAMRAC70RS ll� �
� CENSE UW(CHAPTER B(COMMENCING WI7H SEC710N 7000)OF DIVISION 3 OF 7HE BUSINESS AND PRO- POOUSPB
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V TION.ANYVIOUTIONOFSEC710N7031.SBYANVAPPIICANTFORAPERMI75U&IECTSTHEAPPLICANTTO Z Re-Roof
A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLLARS(S5o0).):
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Z WILL DO THE WORN,AND 7HE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7oa�,BUSI- J
� NESS/J!D 7ROFESSIONS CODE:THE CONTFACTORS UCENSE LAW DOES NOT APPLV TO AN OWNER OF �
PROPERTV WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
CL THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
Q OFFEREDFORSILEIF,HOWEVERTNEBUILDINGORIMPROVEMEN7ISSOLDWITHINONEYEAROFCOMPLE-
Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUIID OR
� IMPROVE FOR TME PURPOSE OF SALE).
w ❑I,AS OWNER Of THE P{iOPEH7V.AM E%CLUSIVELY CANTMCTING WI7H LICENSED CONTRACTORS
� TO fANSTRUCT THE PR0.1EC7(SEC.70�/,BUSINE55 AND 7ROFESSIONS CODE:THE CONTRACTORS LI- VelU3tiOf1 ADJ.AREA
W CENSE LAW DOES NOT APPLV TO AN OVMER OF A PROFERTV WHO BUILDS OR IMPROVES 7HEREON,AND
� WHOCONTMCTSFORSUCHPROJECTSWI7HACAN7RAC70R(5)LICENSEDPURSUAN770THECANTRAC- QUANTITV DESCRIPTION FEE
Y TORS LICENSE LAW.).
� ❑1 AM EXEMPT UNDER SEC. B.8 P.C.FOR 7HIS REASON Q
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DATE OWNER v
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� LICENSED CONTRACTOAS DECLARATION W
� 1 HEREBY AFFIRM UNDER PENALTY OF PERJURV TNAT 1 AM IICENSED UNDER PROVISIONS Of CHAPTER � �./_ J_ � � O
d B(COMMENCMCa WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z W wr
X AIY LICENSE IS IN FULL FORCE AND EFFECT. m � I
`� LICENSE CLA ��� LIC.NO. 10�0 y j ,
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� WORKERS'COMPENSATION DECLARATION Q
� I HEREBYAFFIRM UNDER FENALTY OF PERJURV ONE OFTHE FOLLOWING DECURA710N5: Z
� _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' a i
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Q COMPENSATION,AS PROVIDED BV SECTION 3700OFTHE LABOR CODE,FOR THE PERFORMANCE U
Q OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. � I
w �I HAVE AND WILL MAINTAIN WORKERS'CAMPENSATION INSURANCE,AS REOUIRED BY SECTION i
Q 3700 OF THE LABOR CO�E,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED.MY Wq,�RNERS'CAMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION
j CARRIER 'J'Pi�`J =NS PLANREVIEW
Z POUCY NUMBER���I�iZDO Z"�.SS�S ELECTRIC
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� (iHISSEC�qNNE�NOTBEOJMPLETEDOF71iEPERMfTISFORONEHUI�DREDDOLIJAS(5100)ORLESS). PLUMBING ��ST
Z I CER7IFV THAT IN THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED,1 MECHANICAL
' (} SHALL NOT EMPLOV ANV PERSON IN ANV MANNER SO AS TO BECOME SUBJECT TO THE
� WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOUID BECOME INSPECTION FEE
. = SUBJECTTOTHEWOHKERS'COMPENSATIONPROVISIONSOFSECTION37000FTNEUBOR ,
CADE,I SHALL F RTHWITN COMPLY VISIONS. � ISSUANCE ��• ��
p DATE: �Z.�S��� APPLICANL ��� \ SMIP
J WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNUWFUL,AND SHALL BE ENERGY P/C
LL SU&IECTANEMPLOVERTOCRIMINALPENALTIESANDCNILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT �
DOLLARS(5100.000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIOED FOR IN
� SEC710N 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. RETENTION FEE: ��
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEPEBY AFFIRM UNDER FENALTY OF PERJURY THAT THEf1E IS A CONSTRUCTION LENDING AGENCY
FOR THE PERFOiiMANCE OF 7HE WORK FOR WHICH THIS PERMI715ISSUED(SEC.3087,CIV.C.).
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� LENDER'S NAME
F— LENDER'SADDRESS
� TOTAL FEES
� I CERTIFY THAT I HAVE fiEAD THIS APPLICATION AND STATE TFIAT THE ABOVE INFORMATION IS CORRECT.
w I AGREE TO COMPLY WITH ALL CITY AND COUNTV ORDINANCES AND S7A7E LAWS REUTING TO BUILDING
� CANS7RUCTION,AND HEREBY AUTHORIZE REPRESENTA71VE5 OF THIS COUN7V 70 EN7Efi UPON 7HE
� ABOVE�MENTIONED PROPERTY FOR INSPECTION PURGOSES.
Z COMMENTS
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y SIGNA REOFPERMITTEE DATE /
= RECPT.NO. PAID BY VALIDATION
~ WHITE—Department Copy,YELLOW�inance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy
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SET BACK FLOOR JOIST
FTGSlFORMS/STEEL - FHA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BQND 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. LATHlSIDING 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 QEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY
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COMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
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