HomeMy WebLinkAbout10580 (5)t CITY OF DIAMOND BAR
COMMUNITY DEVELOPMENT DEPARTMENT
4 t 21660 E. Copley Drive Suite 190 _r)
(909) 860-3195 Fax (909) 861-3117
1w, BUILDING PERMIT APPLICATION 6
JOBSI'm
ADDRESS r
APN LOT TRACT
OWNER R7�r� �r :�� WLA C;n A
ADDRESS 6,-dPe 01%
CITY 441 Wa )e ZIP 7A/.e TEL Ik -1 -2 .
APPLICANT t
CONTRACTOR PC; - soj4j
ADDRESS 13'5 SeeLoAc bg3 4,1
CITY _ I. I ZIP o00 ' TEL iIS13 _4 s
ARCWENG/
DESIGNER
ADDRESS
CITY ZIP TEL.
OWNER -BUILDER DECLARATION
1 HEREBY AFFIRM TINDER PENALTY Of PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LH
CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.3 BUSINESS AND PROFESSIONS CODE ANY CRY OR
COUNTY WHICH REOUIRESAPERMIT TO CONSTRUCT.ALTER IMPROVE, DEMOLISH, OR REPANANY STRIJC.
TORE. PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FRE A SIGNED
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT ED THE PROVISIONS OF THE CONTRACTORS LI-
CENSE
4
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 ALLIED ED EXEMP-
TION. ANY VIOLATION OF SECTION 7031.3 BY ANY APPLICANT FORA PERMIT SUBJECTS THE APPLICANT TO
A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (S Soo).):
O L AS OWNER 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 WHO BUILDS OR IMPROVES THEREON. AND VMO DOES SUCH WORK HIMSELF OR HERSELF OR
THROUGH HIS OR HER OWN EMPLOYEES. PROVIDED THAT SUCH IMPROVEMENTS ARE NOT MENDED OR
OFTERED FOR SALE IF. HIOWEVEILTHE BUADINOOR IMPROVEMENTIS SOLID WTTHN ONE YEAR OF OOMPLE•
TION. THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE 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. 7D44. BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI•
CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON. AND
WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTORS) LICENSED PURSUANT TO THE CONTRAC-
TORS LICENSE LAW.), .
Oil NA EXEMPT UNDER SEC. B. S P.C. FO HIS REASMI
DATE E' OWNER I�
LICENSED CONTRACTORS DECLARATION
1 HEREBYAFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED TINDER PROVISIONS OF CHAPTER
a (COMMENCNO WITH SECTION TOM) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE. AND
MY LICENSE IS N FULL FORCE AND EFFECT. Z
LICENSE CLASS y LIC. NO. 1 1 r C
DATE -7 -3c I CONTRACTOR CL- % f
WORKERS' COMPENSATIONDECLARAT N t
I HEREBYAFFIRM LINDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
_I HAVE AND WALL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-NSURE FOR WORKERS
COMPENSATION, AS PROVIDED BY SECTION 3700 OF THE LABOR CODE. FOR THE PERFORMANCE
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,
I HAVE AND WILL MAINTAIN WORKERS COMPENSATION INSURANCE. AS REOUIRED BY SECTION
3700 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:
CARRIER
..POLICY NUMBER
(OLS BECTIENifm NOT BE COMPLETED OFTHE PERMIT IS FOAONC HEIDRIDDUUAR9 (SIM ORLM%
., (CERTIFY THAT IN PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 6ISSUED, 1
SHALL NOT EMPLOY ANY PERSON N ANY MANNER BOAS TO BECOME 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 THOSIrl, PONS. 7
DATE: - APPLK:ANT G
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLA AND SHALL BE
SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES MIO CMLFNESUPTOONE ILLI RED T/OUSAND
DOLLARS (11W.OWL N ADDITION TO THE COSTOF COMPENSATION. DAMAGES AS PROVIDED FOR IN
SECTION 37Oa OF THE LABOR CODE, INTEREST. AND ATTORNEYS FEE S.
CONSTRUCTION LENDING AGENCY
1 HEREBYAFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3007. CIV G).
LENDERS NAME
LENDER'SADORESS
I CERTIFY THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
I AGREE TO COMPLY WITH ALL CRL' AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
CONSTRUCTIXJ, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTYTO ENTER UPON THE
ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES.
G6
PERMITTEE R
I
ATURE OF PERMITTEE DATE
PRESS
FIRMLY
APPLICATION I 3 / PERMIT /47J'80 P/C
l
DATE
NUMBER
N
ISSUE 3l
TYPE
OCC
CONST.
GROUP,
ZONING SETBACKS
FRONT
RW
❑
REAR
❑
SIDFJSIDE STREET
RW
❑
SIDE
❑
PROPOSED USE
g,
v orr
NO. DWEL. NO.
a
NO.
UNITS STORIES
BEDROOMS-
EDROOMS-DESCRIPTION
DESCRIPTIONSO. FT.
FACTOR PSF
ADJ. AREAIVALUATION
SFIVADDIREM
CO
Garage/Carport
WPatioMock
LL-
PooVSpa
Z
no -Soot
OJ
Commercial
m
Valuation
ADJ.AREA
QUANTITY DESCRIPTION
FEE
Q
l'—
U.1 w
Z
m
ni
.
U
U
W
CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
UA
r
ENERGY P/C
ENERGY PERMIT
RETENTION FEE:
Ii 1 L
PRE -ALT FEE:
j
L 8
TOTAL FEES
COMMENTS
RECPT. NO. PAID BY
VALIDATION
WHITE--06'Partment Copy, YELLOW—Flnanee Copy, PINK—Assessor Copy, GOLDENROD—File Copy. GREEN—Applicant's Copy
CITY OF DIAMOND BAR
INSPECTION RECORD
SETBACK
'A 4
-FLOOR 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 HT.IBDND'13EAM
ROOF SHEATHING
8 FT, BOND BEAM
FRAMINGIVENTiLIATiON
:FINAL BOND BEAM
ROOF -COVER
-PRE-GRADING.
ROUGH HEATING
BENCHING
ROUGH ELECTRIC
ROUGH GRADING
ROUGH PLUMBING
-FINISH GRADING
SHOWER,ITUB TEST
POOL ELECTRIC
EXT. LATH/SIDING
POOL FENCING
WALL INSULATION
POOL FINAL
CEILING INSULATION
OFF SITE IMPS.'
DRYWALL NAILING
DEDICATIONS
SEWER
FINAL ENG.,
SEPTICTANK,-_
LANDSCAPE/IRRIG.
79E-EP-PIT/L.L.
ON SITE IMPS.
GASAIRTEST-
FINAL CONST.
FINAL ZONING
\L. -
FIRE DEPT. FJNA
FINAL -HEATING
HEALTH DEPT. FINAL
FINAL ELECTRIC
DEV. FEES PAID
FINAL PLUMBING
ENERGY
1
-7
COMMENTS
SEPTIC TANK SIZE
SEEP, P.lT/U SIZE
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