HomeMy WebLinkAbout12-49 • � � , ��_ CITY OF DIAMOND BAR � J
� DEPARTMENT OF COMMUNITY &DEVELOPMENT SERVICES
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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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� JOBSITE ��b e � DATE GATION I 3 �Z NUMBER i Z �I #/C
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a ADDRESS NO.DWEL. NO. NO.
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� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
� OWNEA-BUILDER DECLARATION SFR/ADD/REM
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I HEREBV AFFIRM UNDER PENALTY OF PERRIRY THAT I AM E%EMPT FHOM THE CONTRACTORS LI� G8f0g0/CBfPOR
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w TURE.PRIOR TO ITS ISSUANCE,AL50 REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w
� STA7EMENT hIAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS ll-
� CENSE LAW(CHAPTER B(CAMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � POOVSPO
Q FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEAL�EGEDE%EMP- (�
V 710N.ANVVIOLATIONOFSECTION7o37.5BVANVAPPLICANTFORAPERMITSUBJEC757HEAPPLICANTTO Z Re-Roof
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Z N7LL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70��,BUSI- J
� NESS AND PROFESSIONS CODE:THE CAN7FiAC70R5 LICENSE LAW DOES NOT APPLV TO AN OWNER OF �
PROPERTY NMO BUILOS OR IMPROVES 7HEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
Q THROUGH HIS OR HER ONM EMPLOVEES,PROVIDED 7HAT SUCH IMPROVEMENTS ARE NOT INTENDED Oq m
Q OFFEREDFORSALE.IF,HOWEVER,7HEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE�
Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PqOVING 7HA7 HE OR SHE DID NOT BUILD OR
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[[ TO CONSTRUCT THE PR0.IECT(SEC.7oa1,BUSINE55 AND PFOFESSIONS CODE:THE CONTRACTORS LI� V81U8HOf1 ADJ.AREA
W CENSEUWDOESNO7APPLYTOANOWNEROFAPROPERttWHOBUILDSORIMPROVE57HEREON,AND
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Y TORS LICENSE LAW.).
� ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q
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� DATE OWNER �
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LICENSED CONTRACTORS DECLARATION �
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1 HEREBY AFFIRM UNDER PENALTV OF PERJURY THAT I AM LICENSED UNDER PROVISIONS Of CHAPTER �
� �9(COMMENCINGWITHSECTION7oo0)OFDIVISION30FTHEBUSINESSANDPROFESSIONSCODE,AND Z
OMY UCENSE IS IN FULL FOpC.�AN�T. {'� �
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� WORKERS'COMPENSATION DECLARATION,v 1•w`� Q ✓7. r yq.A � �
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NI HEREBV AFFIRM UNDER PENALTV OF PERIUHV ONE OF THE FOLLOWING DECLAHATIONS: Z �`--'���� Z y OO
� _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' a �/J`� � �
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MPENSA710N,AS PROVIDED BY SEC710N 3700 OF THE LABOR CODE,FOR THE PERFORMANCE U �I"
Q THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
w I HAVE AND WILL MAINTAIN WORKERS'CAMPENSATION INSURANCE,AS REOUIRED BV SECTION
Q37000F THE LABOR COOE,FOR THE PERFORMANCE OF THE WORK FOF WHICH THIS PERMIT IS
ISSUED.MY WORK 5'COMPENSA710 INSURANC CAR ER AND POLIC UMBER ARE: CONSTRUCTION
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� (IHU"SECiIONNE�NDTBE�AAR.EfEDOFTHEPEAAYTISFORONEHUDDREDDIXIARS(5100)ORLESS} PLUMBING
Z 1 CERTIFV THAT IN THE PERFOPMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL � ��pZ
C7 SHALL NOT EMPLOY ANY PEHSON IN ANV MANNER SO AS TO BECOME SUBJECT TO THE
� W RKERS'COMPENSATIONLAWSOFC ORNIA,ANDAG ETHAT ISHOULDBECOME INSPECTIONFEE
� S ECTT THEWOFKERS'COMPENS I PROVISIONS ION OOOFTHELABOR
� E,I SH FOiiTHWI7N COMPLV OS ROVI51 ISSUANCE � _ , � U
p DATE:1 � C.i qPPUCANT: � SMIP
J WARNING: AILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUI,AND SHALL BE ENERGY P/C
� SU&IECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDHEDTHOUSAND ENERGYPERMIT
DOLLARS(f100.000�,IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN ,(� '(�
� SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. RETENTION FEE: � �+ �./
OCONSTRUCTION LENDING AGENCY pBE-ALT E� �
� I HEREBY AFFIRM UNDER PENALTV OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY r�� i O�
FOR THE PERFORMANCE OFTHE WORN FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV,CJ.
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� LENDER'S NAME
F— LENDER'SADORESS
w I CERTIFV THAT I HAVE READ THIS APPLICA710N AND STA7E THAT THE ABOVE INfORMATION IS CARREC7. TOTAL FE ES / / � ��
� I AGREE TO COMPLY WITH ALL CITV AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
� CONSTRUCTION,AND HEREBY AUTHORIZE REPRESEN7ATIVES OF 7HIS COUNTV TO EN7ER UPON 7HE
Z ABOVE-MENTIONED PROPE�TV FOR I PECTION PURPOSES. COMMENTS �
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~ WHITE—Department Copy,YELLOW—Finance 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. BQND 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. LATH/SIDING 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 Y' HEALTH DEPT. FINAL
FINAL ELECTRIC � DEV. FEES PAID
FINAL PLUMBING ENERGY
C�G"lU���
COMMENTS _
SEPTIC TANK SIZE
SEEP PIT/U SIZE
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