HomeMy WebLinkAbout11-947 �x��.r�
�„` CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21825 Copley Drive,Diamond Bar,CA 91765
� (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 n PRESS
'°^'�W BUILDING PERMIT APPLICATION �/� FIRMLY
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� ISSUE TYPE /�� ��+ � OCC
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N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREA/VALUATION
¢ OWNER•BUILDER DECLARATION
p SFR/ADD/REM
p I HEREBV AFFIRM UNDER PENALTY OF PERIURV hIAT I AM EXEMPT FPOM THE CONTRACTORS LI� G8f8 B/C8 !I
W CENSE lAw FORTHE FOLLON/INO REASON(SEC.7o3t.5 BUSINESS AND PROFESSIONS CODE:ANV CITY OR (n 9 �
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W NRE,PHpR TO ITS ISSU�flCE,ALSO REQUIRES THE APPLICAM FOR SUCH PERMIT TO FILE A SIONED W
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE VROVISIONS OF THE CONTRACTORS LI�
� CENSE UW(CHAPTER e(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� � POOI/SP8
, O FESSIONS COOE)OR THAT HE OR SHE IS EXEMPT THEREFFOM AND THE BASIS FOR THEALLEGED E7CEMP� (rJ
V TpN.ANV VIOLATION OF SECTION 7031.6 BY ANV APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO Z Re-Roof
� A CML PENALTV OF NOT A/ORE THAN FIVE HUNDRED DOLLARS�f5oo)J:
0 ❑I.ASOWNEROFTHEPROPERTY,ORIAVEMPLOVEESWITHWAGESAS7HEIRSOLECOMPENSATNJN, � CommOrCiel
Z WILL DO THE WORN,AND 7HE STRUC7URE IS NOT IKTENDED OR OFFERED FOR SALE(SEC.7aa,BU51- J -
� NE55 M1D PROFESSIONS CODE:THE CONTRACTORS UCENSE LAW DOES NOT APPLV TO AN OWNER OF �
VROPERTY WHO BUILOS OR IMPROVES THEREON.M1D WHO DOES SUCH WORK HIMSELF OR HERSELF OR
� THROUGH HIS OR HER OWN EMPLOVEES,VqOVIDED THAT SUCH IMPROVEMENTS ARE NOT WTENDED OR m
Q OFFEREDWRSALEIF,HOWEVERTMEBUILDINOORWPROVEMENTISSOLDWITHINONEVEAAOFCOMPLE-
Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SNE DID NOT BUILD Ofl
� IMPROVE FOH 7HE PURPOSE OF SAL�.
w OI,ASOWNEROFTHEPROPERTV,AMEXCIUSNELYCANTRACTINOWITHLICENSEDCONTRACTORS
� TO CONSTRUCT THE PRQIECT(SEC.7oN,BUSINE55 AND PROFESSIONS CODE:THE CONTRACTORS LI� V8I118(IOfI ADJ.AREA
W CENSEUWDOESNOTAPPLVTOANOWNEROFAPROPERTVWHOBUILDSORIMPROVESTHEf7EON,AND
� WFIOCAMRACTSFORSUq1PROJECTSWITHACONTRACTOR(5)UCENSEDPURSUANTTOTHECONTfUG QUANTITY DESCRIPTION FEE �
Y TORS LICENSE UW.).
� ❑I AM EXEMPT UNDER SEC. B,8 P.C.FOR THIS REASON Q I dO � —
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� DATE OWNER ~
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� LICENSED CONTRACTORS DECLARAT�ON w
� I HEREBY AFFIRM UNOER PENALTY OF PERIURV THAT 1 AM LICENSED UNOER PROVISIONS OF CHAPTER �
� 9(COMMENCINO WITH SECTION 70ao)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z
��� W LICENSE IS M FULL FORCE AND.FEF�FECT. m
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V DATE �•L. �.Z --..lO 3 CONTRACTOR ,SIA k W• N�� d
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� WORKERS'COMPENSATION DECLARATION Q
N I HEREBY AFFIRM UNDER PENALTY OF PERIURV ONE OF THE FOLIOWING DECURATIONS: �
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� �I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORNERS' _
Q COMPENSATpN,AS PROVIDED BV SECTION 3700 OF THE LABOR fADE,FOR THE PERFORMMICE U
OF 7HE WOfiK FOR WHICH THIS PERMIT IS ISSUED. W
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� _I HAVE AND WILL MAMTAW WORKERS'COMPENSATION INSURANCE.AS REOUIRED BV SECTION
Q 370o OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED.MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION
jCARRIER PLAN REVIEW
� POLICY NUMBER
� ELECTRIC -rj
p (�}iI55ECilONNE�NO7BE00f.�ETEDOFTHEPEPMfi�SFOR�NEHlNi7RED00U,WS�S/00)OqLESS} PLUMBING
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Z 1 CERTIFV THAT IN THE PERFORMANCE OF THE WORN FOq WHlqi THIS PERMIT IS ISSUED.I MECHANICAL
C} � SHqLLNOT EMPLOV ANV PERSON INANV MANNER SOAS TO BECOME SU&IECTTO TFiE �7
(,/) WORKERS'COMPENSATqNLAW50FCALIFORN10.NdDA0REETHATIFISHOULDBECOME INSPECTIONFEE �— / � SL
� SUBJECTTOTHEWORKERS'COMPENSATIONPROVISIONSOFSECTION37o00FTHELABOR
� CODE,1 SHALL FORTHWITH COMPLV WITH TFIOSE PROVISIONS. /�� ISSUANCE
p DATE: ��'�I���I APPLICANT: SI/t� �� C,`�=�'% SMIP
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J WARNING:FAILURE TO SECURE WORKEPS'CAMPENSATqN fAVERAOE IS UNUWFUL.AND SHALI BE ENERGY P/C �
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� SU6IECTANEMPLOVERTOCFIMINALPENALTIESANDCIVILFINESUPTOONEHUNOREDTHWSAND ENERGYPERMIT
DOLLA{iS(f 1ao,o00),IN�ODITION TO THE C0.ST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
J SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES.
w RETENTION FEE: � ����
O CONSTF7UCTION LENDING AGENCY PRE-ALT FEE:
� I HEFEBV AFFIRM UNOEF7 PENALN OF PERJURY THAT THEFE IS A CONSTRUCTION LENDINO AGENCY
� FOR THE PERF-0RMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.�.
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� LENDER'S NAME
H LENDEH'SADDRESS
w I CERTIFY TMAT I HAVE READ THIS APPIICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTAL FE ES ` g ��I�
� I AGREE TO COMPLV WITH ALL CfTY AND COUNTV ORDINANCES AND STATE LAWS RELATINO TO BUILDINO
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE -
Z ABOVE-MENTpNED PROPERTV FOR INSPECTION PURGOSES. COMMENTS '
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m PERMITTEE NAME(PRIM] ' �
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� SIGNATUREOFPERMITTEE DATE /.
� RECPT.NO. PAID BV VALIDATION
WHITE—Department Copy,YELLOW—Flnance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN--Applicant's Copy
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SET BACK FLO�R JOIST
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
FRAMlNGNENTILATlON FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC Z; RQUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSULATION PQOL FINAL
CEILING INSUL,4TION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTlC TANK LANDSCAPE/lRRIG.
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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COMMEfVTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
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