HomeMy WebLinkAbout18346J CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
< 21825 E. Copley Drive
(909) 860-3195 Fax (909) 861-3117
BUILDING PERMIT APPLICATION
JOBSITE
ADDRESS
APNLOT TRACT
OWNER • 45
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CITY �/%/ �l+w. �C/ a-= ZIP TEL. .�
APPLICANT7'iir►��„t� TEL.
CONTRACTOR' r
ADDRESS
CITY ZIP TEL.
ARCH/ENG/
DESIGNER
ADDRESS
CITY ZIP TEL.
OWNER -BUILDER DECLARATION
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS U.
CENSE LAW FOR THE FOLLOWING REASON (SEC. 70.71.5 BUSINESS AND PROFESSIONS CODE: ANY CITYOR
COUNTY YIIICM REQUIRES A PERMI7T0 CONSTRUCT, ALTER, IMPROVE, DEMW SH,OR REPAIRANY STRLK;-
TURE. PRIOR TO ITS ISSUANCE, ALSO REWIRES THE APPLICANT FOR SIKH PERMIT TO RLE A SIGNED
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI-
CENSE UW (CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 0 OF THE BUSINESS AND PRO.
FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP.
TION. ANY VIOLATION OF SECTION 7081.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO
A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (1500).4
D L AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES ASTHEIR SOLE COMPENSATION,
WILL DO THE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FCR SALE (SEC. 7044, BUSI-
NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF
PROPERTY WHO BUILDS OR IMPROVES THEREON. AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
THROUGH HIS OR HEIMPROVEMENTSM
R OWN EMPLOYEES. PROVIDED THAT SUCH IMPROVEMENTS ARE NOT ENDED OR
OFFERED FOR SALE IF, HOWEVERTHE BUILDING OR IMPROVEMENT AS SOLD WITHIN ONE YEAR OF COMPLE
TION, THE OWNER-OUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
IMPROVE FOR THE PURPOSE OF SALE}
O LAS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS
TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS U.
CENSE UW DOES NOTAPPLY TO AN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON, AND
WHO CONTRACTS FOR SUCH PROJECTS WITHACONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC•
TORS UCENSE LAW.).
O IAM EXEMPT UNDER SEC. B.1 P.C. FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER
P (COMMENCING WITH SECTION 7000) OF DIVISION J OF THE BUSINESS AND PROFESSIONS COOS. AND
MY LICENSE IS IN FULL FORCE AND EFFECT
LICENSE CUSS LIC. NO.
DATE CONTRACTOR
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 SELF -INSURE FOR WORXERS'
COMPEIO
NSATN. AS PROVIDED BY SECTION 0700 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 REWIRED BY SECTION
5700 OF THE LABOR CODE, FORTHEPERFORMANCEOFT E WORK FOR WHICH THIS PERMTIS
ISSUED.MYWORRKE COMPENSATION WS CE CA LER ANO POLICY NUMBER ARE:
CARRIER /y,"/JY7�•r _
POIICYNUMBER g V J
(THIS SECTIONNEED NOTBE awmETEDDFTIE PER.R a FORONE HIDRmmuAR5 (stoo)OR LESS}
1 CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMITS ISSUED, I
SHALL NOT EMPLOY ANY PERSON N ANY MANNER SO AS TO BECOME SUBJECT TO THE
WORKERS' COMPENSATION LAWS OF CALIFORNIA. AND AGREE THAT IFI SHOULD BECOME
SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 1700 OF THE LABOR
CODE, I SHALL FORTHWITH COMPLY WITH
DATE APPLICANT.
WARM FAILURE TO SEWRE WORKERS! COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL BE
S I TAN EMPLOYER TO CRMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND
DOLLARS (1100,000). N ADOMON TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN
SECTION 3700 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
CONSTRUCTION LENDING AGENCY
1 HEREBYAFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3W7, GV O).
LENDERS NAME
LENDER'S ADDRESS
I CERTIFY THAT 1 HAVE READ THIS APPLICATION AND 57ATE THAT THE ABOVE INFORMATION IS CORRECT.
I AGREE TO COMPLY WITH ALL CRY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
CONSTRUCTION. AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON ME
ABOVE-MENTIONED PROPERTY FOR INSPECTION PORP ES,
PERMI EE E (PRINT)
NATURE OF PERMITTEE DATE
v
PRESS
FIRMLY
APPLICATION , 0 ERMTT � P/C
DATE NUMBER 8
ISSUE TYPE OCC
DATE CONST, GROUP
ZONING SETBACKS
FRONT RW ❑
REAR ❑
SIDE/SIDESTREET RW ❑
SIDE ❑
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PROPOSED USE 1 ✓- JJ1 ti AkX
IS'dsyu•
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NO. DWEL. NO. NO.
UNITS STORIES BEDROOMS
DESCRIPTION SO. FT. FACTOR PSF ADJ. AREA/VALUATION
SFRIADD/REM
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Garage/Carport
WPatio/Deck
LL
Pool/Spa
0
Z
Re -Roof
Commercial
m
Valuation I O ADJ.AREA
QUANTITY DESCRIPTION FEE
J
a
U
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U
W
J
W
U
Z
M
J
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U
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4
2
U
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CONSTRUCTION Q �r
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
SMTP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE: O
PRE -ALT FEE:
TOTAL FEES
COMMENTS
RECPT. NO. PAID BV VALIDATION
WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy. GOLDENROD—File Copy, GREEN—Applicant's Copy
CIT'l.'CF DIALIOND BAR
INSPECTIOr'J RECORD
I cl)N
SET BACK
FLOOR JCIST
FTGSIFORMSISTEEL
FHA REQrATS
ELECTRIC GROUND
UNDER FLOOR DUCT
GROUND PLUMBING
I UNDER FLOOR CONDUIT
SLAB GRADE
FIREPLACE FOUNDATION
TEMP POWER
FIREPLACE BOND BEAM
WATER SERVICE
MID HT. BOND BEAM
ROOF SHEATHING
8 FT. BOND BEAM
FRAMINGNENTILIATION
ROOFCOVER
ROUGH HEATING
FINAL BOND BEAM
PRE -GRADING
BENCHING
ROUGH ELECTRIC
ROUGH GRADING
ROUGH PLUMBING
FINISH GRADING
SHOWER/TUB TEST
POOL ELECTRIC
EXT. LATH/SIDING
POOL FENCING
WALL INSULATION
POOL FINAL
CEILING INSULATION
l
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
COMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE