HomeMy WebLinkAbout12156- - J CITY OF DIAMOND BAR '
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
21660 E. Copley Drive Suite 190
(909) 860-3195 Fax (909) 861-3117 PRESS
BUILDING PERMIT APPLICATION FIRMLY
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APN LOT TRACT
OWNER Al J'
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CITY W X49 ZIP TEL
APPLICANT I&V TEy.Q9 r 7*
CONTRACTO 1AIC eV �� 627414-f-7
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CITY , ZIP TEL
ARCFVENG/
DESIGNER
ADDRESS
CITY ZIP TEL
OWNER -BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LI-
CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE: ANY CITY OR
COUNTY WHICH REQUIRES A PERABTTO CONSTRUCT.ILLTER. IMPROVE DEMOLISH, OR REPAIRANY STRUC•
TUBE PRIOR TO ITS ISSUANCE. ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTACTORS LI-
CENSE
FCENSE LAW (CHAPTER 5 (COMMENCING WITH SECTION 7000) OF DNISON S OF THE BUSINESS AND PRO-
FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP-
TON. ANY VIDLATM OF SECTION 7W 1.5 BY ANY APPLICANT FORA PERMIT SUBJECTS THE APPLICANT TO
A CML PENALTY OF NOT MORE THAN FIVE ANY DOLLARS (5500).$
O L AS OWNER OFTHE PROPERTY. OR MY EMPLOYEES WITH WAGESAS THEIR SOLE COMPENSATION.
WILL DO THE WORK. AND THE STRICTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, BUST.
NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF
PROPERTY VAIN BUILDS OR IMPROVESTHEREON, AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
THRWN/ HIS OR HERCAH EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR
OFFERED FOR SALE IF. HOWEVER, THE BUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE-
`TON, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
IMPROVE FOR THE PURPOSE OF SALE)
❑LAS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS
TO CONSTRUCT THE PROJECT (S EC. 7DU. BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI-
CENSE LAW DOES NOT APPLY TOAN OWNER OF A PROPERTY V640 BUILDS OR IMPROVES THEREON. AND
WHOCOHTRACTSFOR SUCH PROJECTS WITH A CONTRACTOR(S)LOENSE7PURSUANTTOTHE CONTRAC-
TORS LICENSE LAW.).
O 1 AM EXEMPT UNDER SEC. B. 5 P.C. FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
1 HEREBY AFFIRM UNDER PENALTY OF PERAUIY THAT IAM LICENSED LINGER PROVISIONS OF CHAPTER
5 (COMMENCING WITH SECTION 7000) OF DIVISION S OF THE BUSINESSAND PROFESSIONS CODE. AND
MY LICENSE IS N FULL FORCE AND EFFECT.
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LICENSE CLASS LIC. N0. IM
,AL1
DATE r0 CONTRACTOR
WORKERS' COMPENSATION DECLARATION
1 HEREBY AFFIRM 11W ER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
_I NAVE AHD WILL MMNTAN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS'
O
COMPENSATN,AS PROVIDED BY SECTIO! 37D0 OF THE LABOR CODE, FOR THE PERFORMANCE
SIF THE WORK FOR WHICH THIS PERMIT IS ISSUED.
I HAVE AND WALL MAINTAIN WORXERS' COMPENSATION INSURANCE. AS REQUIRED BY SECTION
37000E THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMrT IS
ISSUED. MY WORKERS COMPENSATX* INSURANCE GARNER AND POLICY NUMBER ARE:
GARNER vote&Jwx
POLICY NUMB ER + ` :70 /
(THIS SECTION NEED NOT BE COME ETEDOFTIE PERMTSFOR CNE FIMCDDOLLARS (1100)ORLESS)
I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT S SSUED.I
SHALL NOT EMPLOY ANY PERSON N ANY MANNER SO AS TO BECAME SUBJECT TO THE
WORKERS' COMPENSATION LAWS OF CALIFORNIA AND AGREE THAT IF 1 SHOULD BECOME
SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR
CODE.I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS.
DATE: - APPLICANT.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL BE
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (I100,000), IN ADDITION TO THE COST OF COMPENSATION
. DAMAGES AS PROVIDED FOR IN
SECTION 3705 OF THE LABOR CODE. INTEREST. AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
1 HEREBY AFFIRM UNDER PENALTY OF PERUIRY THAT THERE S A CONSTRUCTION LENDW G AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED (SEG 3007• CIV. C.L
LENDERS NAME
LENDERS ADDRESS
1 CERTIFY THAT 1 HAVE READ THIS APPLICATION AND STATE T ATTHE ABOVE INFORMATION IS CORRECT.
1 AGREE TO COMPLY WITH ALL CRY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
CONSTR)CTION.AND HEREBYAFTHDRIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE .
ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES.
PE NAME INT)
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SIGNATURE OF PERMIrT DATE
DATECATIO -NI - O
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NUMBER1PERMIT �'1E9
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TYPE
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PROPOSED USE 1- _
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NO. DWEL NO.
NO.
UNITS STORIES
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DESCRIPTION SO. FT.
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PLUMBING
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INSP CTION FEE
ISSUANCE
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ENERGY P/C
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ENERGY PERMIT
RETENTION FEE:
PRE -ALT FEE:
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TOTAL FEES
COMMENTS
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RECPT. NO. PAID BY VALIDATION
WHITE—Department Copy, YELLOW—FiRsnee Copy, PINK—Assessor Copy, GOLDENROD—Filo Copy, GREEN—Applicant's Copy
A3_i l It u•rtl� :_
SET BACK• 1 � r L 1.
INSPECTION RECORD
mDATE ANSPECTOR., INSPECTION DATE INSPECTOR"
_ FLOOR JOIST-', \ .. q -
FTGS/FORMS/STEEL
; FHA REQMTS - - --
ELECTRIC GROUND �
_:::: '-:�.:_: _
_ _.� \ UNDER FLOOR DUCT.
GROUND PLUMBING
_
" ' UNDER FLOOR CONDUIT:
SLAB GRADE - -
FIREPLACE FOUNDATION
TEMP POWER --
FIREPLACEBOND BEAM -
WATER SERVICE _- - -
- ::.
` ...:. _: - MID HT BOND BEAM
ROOF SHEATHING -%
- r' i. r: ~•
8 FT BOND BEAM
FRAMINGNENTILIATION
FINAL BOND BEAM
ROOF COVER ,- .
'PRE -GRADING 1
ROUGH HEATING -- .
-
- - - - - BENCHING
ROUGH ELECTRIC i
-
-ROUGH GRADING
ROUGH PLUMBING ..
- -- - -
- FINISH GRADING. ,
SHOWER/TUB TEST
POOL ELECTRIC
EXT LATH/SIDING t
- POOL FENCING
WALL INSULATION
POOL FINAL i
CEILING INSULATION
OFF SITE IMPS.
DRYWALL NAILING
DEDICATIONS
.SEWER_
FINAL ENG..
.SEPTIC TANK _ ... _
_.. _ ..... ..
~ , __ , • C__. LANDSCAPE/IRRIG,.
SEEP-PITlL.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 1 '
COMMENTS
SEPTIC TANK -SIZE
SEEP PIT/(j SIZE..
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