HomeMy WebLinkAbout14965 (34)CITY OF DIAMOND BAR '
J —;I DEPARTMENT OF. COMMUNITY & DEVELOPMENT SERVICES
> 21660E.Copley DrinSuite790 PRESS
(909) 860-3195 Fax (909) 861-3117
- BUILDING PERMIT APPLICATION _: j 1. FIRMLY
JOBSITE
ADDRESS riI-oc.Df��./
APN LOT TRACT
OWNER
ADDRESS
CITY ZIP TE D
APPLI ANT TEL
CONTRACTOR
ADDR S L GL
CITY 1 t -A^0 ZIP 4'Y TEL C Y-
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DESIGNER
ADDRESS
CITY ZIP TEL
OWNER -BUILDER DECLARATION
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LI-
CENSE LAW FOR THE FOLLOWING REASON (SEG 70.71.5 BUSINESSAND PROFESSIONS CODE: ANY CITY OR
COUNTYYMKHREOMESAPERMRTOWNSTRUCT.ALTER IMPROVE. DEMOUSH.ORREPAIRANYSTRUC-
TURE 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 CONTRACTORS LI.
CENSE LAW (CHAPTER 0 (COMMENCING WITH SECTION 7000) OF DIVISION 3 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 7001.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO
A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (SSW).): ' -
O L ASOWNER OF THE PROPERTY.OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION.
WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044. BUSI-
NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF
PROPERTY W40 BUILDS OR IMPROVES THEREON. AND WINO DOES SUCH WORKHMSELF OR HERSELF OR
THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH MPROVEMENTS ARE NOT WENDED OR
OFFERED FOR SALE IF, HOWEVER THE SULDNOOR IMPROVEMENT IS SOLD WITHIN ONEYEAROF COMPLE.
TION, THE OWNER -BUILDER WALL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
IMPROVE FOR THE PURPOSE OF SAL"
O L AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING MATH LICENSED CONTRACTORS
TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE THE CONTRACTORS U -
CENSE LAW DOES NOT APPLY TOAN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON. AND
WHO COffT . FOR SUCH PROJECTS WITH ACOHTRACTOR(S) LICENSED PURSUANT TO THE CONTRA,
TORS LICENSE LAW.}
O IAM EXEMPT UNDER SEG B. A P.C. FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
KAFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER
CNCNG WITHSECTION 70001 OF OMSION 7 OF THE BUSINESS ANO PROFESSIONS CODE AND
SE IS N FULL FORCCE ANO EFFECT.�r, 7SE CLAS e`er 0 LIC. NO. 6"L D7
DATE Z!!f6, GTC� CONTRACTOR_( �t
WORKERS' COMPENSATION DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
_1 HAVE AND WILL MAINTAIN ACERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS'
COMPENSATION. AS PROVIDED BY SECTION 3700 OF THE LABOR CODE FOR THE PERFORMANCE
9f THE WORK FOR WHICHTMS PERMIT IS ISSUED.
I .V/
_I VE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE. AS REQUIRED BY SECTION
3 OF THE LABOR CODE FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISS ED. MY WORKERS COMPENSATION INSURANCE CASRIER AND POLICY NUMBER ARE
A HER
(TIS SECTION HEED NOT BECOI11PlE7EDOF71[ PERMIT IS FOR ONE HIORED DOUARSIIS1001 ORLESSI
I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I
1 SHALL NOT EMPLOY ANY PERSON N ANY MANNER WAS TO BECOME SUBJECT TO THE
j
WORKERS' COMPENSATION LAWS OF CALIFORNIA AND AGREE THAT IF I SHOULD BECOME
SUBJECT TO THE WORKERS COMPENSATON PROVISIONS OF SECTION 3700 OF THE LABOR
CODE, 1 SHALL FORTHWTH COMPLY WITH THOSE PROVISIONS.
3 DATE: " APPLICANT.
WARNING: FALURE TO SECURE WORXERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL BE
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES ANO CML FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (SI00.000). N ADDITION TO THE COST OF COMPENSATION, DAMAGE) AS PROVIDED FOR IN
J
SECTION 3708 OF THE LABOR 000E INTEREST. AND ATTORNEYS FEES.
J CONSTRUCTION LENDING AGENCY
1 MEREBYAFFINA UNDER PENALTY OF PERJURY THAT THERE 6 ACCNSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEG SOW. CIV. C.).
- LENDER'S NAME
LENDERS ADDRESS
I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
•J I AGREE TO COMPLY WITH ALL CRCOUNTY Y AND COORDINANCES AND STATE LAWS RELATING TO BUILDING
CONSTRUCTION. AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
ASOVE.MENTIONED PROPERTY FOR INSPECTION PURPOSES.
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APPLICATIONLS / „fes PERMR/,W6s P/C
'DATE �V
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ISSUE TYPE OCC
DATE J CONST. GROUP
ZONING &ETBACKS
FRONT RW ❑
REAR ❑
SIDE/SIDE STREET RW ❑
SIDE ❑
PROPOSED USE
NO. DWEL NO. NO.
UNITS STORIES BEDROOMS
DESCRIPTION SO. FT FACTOR PSF ADJ. AREANALUATION
SFR/ADD/REM
Garaga/Carport
WPatic/Deck
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RETENTION FEE: T I " i
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TOTAL FEES
COMMENTS '
RECPTRECPT NO. PAID BY VALIDATION
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- CITY OF DIAMOND BAR.;,
--INSP'ECTION RECORD'
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SET BACK
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DATE INSPECTOR
FLOOR JOIST,
FTGS/FORMS/STEEL •
FHA REQMTS - - -
ELECTRIC GROUND - - : " ,•`.•
UNDER FLOOR DUCT -
GROUND PLUMBING ------------
UNDER FLOOR CONDUIT
SLAB GRADE r:
FIREFLA7CE`Fb0NDATION '_ '
TEMP POWER -
FIREPLACE BOND BEAM -
WATER SERVICE - -
'MID HT BOND BEAM
ROOF SHEATHING - -
8 FT. BOND BEAM -
FRAMINGNENTILIATION
FINAL BOND BEAM
ROOF COVER
PRE -GRADING
ROUGH HEATING
BENCHING --
ROUGH ELECTRIC -
ROUGH GRADING
ROUGH PLUMBING
FINISH GRADING
SHOWER/TUB TEST -
POOL ELECTRIC
EXT.IATH/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
HEALTH DEPT. FINAL
FINAL ELECTRIC -
DEV. FEES PAID I
FINAL PLUMBING
ENERGY
COMMENTS
SEPTIC TANK SIZE
SEEP-PIT/0 SIZE '
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