HomeMy WebLinkAbout13391J� CITY OF DIAMOND BAR r
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES r
21660 E. Copley Drive Suite 190
(909) 860.3195 Fax (909) 861-3117
WELDING PERMIT APPLICATION
JOBSITE
ADDRESS
APN LOT TRACT
OWNER
ADDRESS
CITY IP TE -0 - 0
APPLICANT _ TE610 52
CONTRACTO
ADDRESS
CITY . ZIP TEL
ARCH/ENG/
DESIGNER
ADDRESS
CITY ZIP TEL
OWNER -BUILDER DECLARATION
I HEREBY AFFIRM LINDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS U.
CENSE LAW FOR THE FOLLOWING REASON (SEC. 7071.6 BUSINESSAND PROFESSIONS CODE: ANY CITYOR
COUNTYWHdi REQURES ATfTO CONSTR .ALTEFLIMPROVE. DEVOUSILOR REPA:RANY STRUC.
TURE PRIOR TO RS 6SUANCE, ALSO REWIRES THE APPLMJNT FOR SUCH PERMIT 70 FILE A SIGNED
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS U.
CENSE UW (CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION S 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 7071.5 BYANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO
A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (5500)):
O L AS OWNEROF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION,
WILL DO THE YIORIC AND THE STRUCTURE IS NOT MENDED OR OFFERED FOR SALE (SEC. 7044, BUST.
NESS AND PROFESSIONS CODE: THE CONTRACTORS UCENSE LA'N DOES NOT APPLY TO AN OWNER OF
PROPERTY VA/0 BUILDS OI IMPROVES THE
REON.AND VAO DOES SUCH WORK HIMSCLF OR HERSELF OR
THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT NTENDED OR
OFFERED FORSALE IF, HOWEWRTHE BUILDING OR THAT
IS SOLD WITHIN ONE YEAR OFCOMPLE-
TION. THE OWNERBUILDER WILL HAVE THE BURDEN OF PREYING THAT FIE OR SHE DID NOT BUILD OR
IMPROVE FOR THE PURPOSE OF SALE).
D L AS OWNER OF THE PROPERTY.AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS
TO CONSTRUCT THE PROJECT (SEC. 7044. BUSINESS AND PROFESSIONS COLE: THE CONTRACTORS LI-
CENSE LAW DOESNOTAPPLY TO AN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON, AND
MATO CONTRACTS FOR SUCH PROJECTS WITHA CONTRACTORS) LICENSED PURSUANT TO THE CONTRAC-
TORS LICENSE LAW.}
D IAM EXEMPT UNDER SEG B. A P.C. FOR THIS REASON
DATE OWNER
UCENSED CONTRACTORS DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED LINDE R PROVISIONS OF CHAPTER
I (COMMENCING WITH SECTION 7000) OF DIVISION SOF THE BUSINESS AND PROFESSIONS CODE. AND
MY LICENSE tS N FULL FORCE ANDDf EFFECT.
LICENSE CLASS
V UC. NO. ��AWA
DATE 16'
. =.7— CONTRA
WORKERS' COMPENSATION DECLARATION
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLCWNG DECLARATIONS:
I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS'
COMPENSATION, AS PRONGED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,
HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE. AS REQUIRED BY SECTION
7700 OF THE LABOR CODE. FOR THE PERFORMANCE QF THE WORK FOR WHICH THIS PERMIT IS
ISSUED. MY SA• ' �SURAICE(fARfUERAND FOLICY NUMSERAAE:
CARRIER
POLIC^f NUMBER
(RISWCMNNEMNOTBECCLmoMOFT)EPERMITBFORONEIa "n MUAFtSRIODICRLESS}
I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I
SMALL NOT EMPLOYANY PERSON N ANY MANNER $OAS TO BECOME SUBJECT TO THE
WORKERS! COMPENSATION LAWS OF CALIFORNIA AND AGREE THAT IF I SHOULD BECOME
Tr- Ti THE WORKERS' APPLICANT VSAT gON, /�SECTON2700 OF THE /
CODE, I sHALL O HWITH COMPLY WITH PROVIS S. ,
DATE: _ APPLICANT:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL BE
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 15100,000), N ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 9706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
CONSTRUCTION LENDING AGENCY
1 HEREBY AFFIRM LINGER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WH ICH THIS PERMIT IS ISSUED (SEC. 9097, CM C.),
LENDER'S NAME
LENDER'S ADDRESS
I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
CONSTRUCTION•AID HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
AR10'VEJMENTIONED PROPERTY FOR INSPECTION PURPOSES.
PERM E (PRI L `
SIG UR OF PERVITTEE DATE
PRESS
FIRMLY
APPLICATION PERMIT I P/C
DATE NUMBER tY
1q
ISSUE TYPE OCC
DATE . l CONST. GROUP
ZONING SETBACKS
FRONT RW ❑
REAR ❑
SIDEISIDE STREET RW ❑
SIDE ❑
PROPOSED USE
NO. DWEL NO. NO.
UNITS STORIES BEDROOMS
DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION
SFR/ADDIREM
U)
Garego/Carport
WPa(io(Deck
U-
PDOVBpa
0
Z
Re -Roo(
Commercial
In
Valuation ADJ.AREA
QUANTITY DESCRIPTION FEE
Q
U
CC
H
U
W
w
CS
Z
a
Q
U_
Z
Q
2
U
W
CONSTRUCTION
PLAN REVIEW
ELECTRIC In
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
SMIP , T7
��1�
ENERGY P/C v k1 " V . yT
ENERGY PERMIT L r.T+�v��►.�1✓
RETENTION FEE: �Y
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PR � LT .,C:
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Z31 1
TOTAL FEES
COMMENTS
RECPT. NO. PAID BY VALIDATION
WHITE-0epartment Copy. YELLOW—Franca Copy, PINK--Assesw Copy, GOLDENROD—File Copy, GREEN—Applicant's Copy
CITY OF DIAMOND,BAR . .
...,INSPECTION RECORD .
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SET BACK
FLOOR JOIST~ '..
,FTGSIFORMS'STEEL `
, -
FHA REQPATS `_ :. ..._.
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ELECTRIC GROUND
�
UNDER FLOOR DUCT..
,GROUND PLUMBING
_
UNDER FLOOR GONDUIT
'SLAB
-
TEMP POWER { iCj_�__
FIREPLACE FOUNQAION t.
FIREPLAC T BOND`BEA 1
.
WATER SERVICE-
r
MID HT. BOND.BEAM : -
ROOr, :4T;ATHING,
_-
{ 8 FT. BOND EAM; -�
•
I _
'FFiAhAING"VENTILIATION-l-'%., • ' `'
FINAL BOND BEAM
ROOF COVER
PRE -GRADING
ROUGH HEATING
BENCHING
:ROUGH ELECTRIC
ROUGH GRADING _
-
ROUGH PLUMBING -
FINISH GRADING
SHOVVER/TUBTEST
POOLELECTRIC
.EXT: LATH!SIDING .
POOL FENCING
MALL- INSULATION
POOL FINAL
CEILING INSULATION {
OFF SITE IMPS.
DR'i'L'!ALL.IJAILING {
DEDICATIONS
FINAL ENG.
_SEWER
SEPTIC TANK
LANDSCAPE/IRRIG.
I
PIT/L.L. !
ON SITE IMPS.
_SEEP
G.AS AIR TEST
FINAL ZONING
r,FINY•L CONST,
FIRE DEPT. FINAL
FINAL HEATING
HEALTH DEPT. FINAL
IFI'JAL ELECTRIC
DEV. FEES PAID -
j --
-INIAL PLUMB!NG
ENERGY
-._ �� .. _ _.
IL
..
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•gra-•rwno—,o} n:�.j-s�^^ r�•. ,-. .i
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AMENTS
`SEPTIC TANK SIZE
-SEEP PIT/U SIZE
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