HomeMy WebLinkAbout11-302 CITY OF DIAMOND BAR �� � �
^ . ------��`— DEPARTMENT OF COMMUNITY&DEVELOPMENT SE S � �� �
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21825 Copley Drive,Diamond Bar,CA 91765 PRESS
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027
��9�� BUILDING PEKMIT APPLICATION FIRMLY
o� JOBSITE �I� /� DATE CATIOf�1`� � 11 NUMBER 1 �-/ ��#/C �1' ��ol.
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ISSUE TYPE OCC
� APN LOT TRACT DATE Z- / CONST.�_ GROUP
p OWNER S I ZONING SETBAC S
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Z C17Y�[�y�_ ZIP TEL. REAR ❑ i
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� CONTRACTOR E�-Z SIDE �
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� DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDER DECLARATION SFWADD/fiEM �
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� I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT I AM EXEMPT FROM THE CONTMCTORS LI- GHf89B/CBfPOh
W CENSEIAWFONTHEFOLLOWINOREASON(SEC.7031.60USINESSANDPROFESSIONSCODE:ANVCI7YOF (n
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�ZnqE,pR10R TO ITS ISSUANCE,ALSO RE�UIRES THE APPUCANT FOR SUG1 PERMIT TO FILE A SIONED w
� STATEMENT THAT HE OR SHE IS IICENSE�PURSUANT TO iHE PROVISIONS OF THE CONTMCTORS LI-
CENSE UW(CHAPTER e�COMMENGNG W ITH SECTION 70DD)OF DIVISION 3 OF TME BUSINE55 M!D PRO- � POOVSPB
QFES910NS CODE)OR THAT HE OR SHE IS EXEMPT 7HEREFROM AND THE BA515 FOR THE ALLEGED EXEMP� . •
U TqN.ANV YfOUTqN OF SECTION 70.�1.5 BV ANV APPLICANT FOP A VERMIT SU&1EC75 TNE APPUCANT T0 Z Re-Root
� A CML 7ENALTV OF NOT MORE TIIAN FIVE HUNDRED DOLURS(f6ao�.):
� ❑I.ASOWNEROFTHEPROPERTV,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, � COlI1R16fCI81
WILL DO THE WORK,AND THE STRIJCNi3E IS NOT INTENDED OA�FFEflED FOR SAIE(SEC.70u,BUSI� J
N NESS AND PqOFESSIONS CODE:THE CONTRACTORS LICENSE UW DOES NOT APPLV TO AN OWNER OF �
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[� 7}1ROU(L1 HIS OR HER OWN EMPLOYEES,7ROVIDED THAT SUCN IMPROVEMEHTS ARE NOT INTENOED OR
Q OFFEREDFORSPLEIF,FqWEVERTMEBUILDINGORIMPROVEMENTI550LDWITHINONEVEAROFCOMPLE�
TION,7HE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVINO TFIA7 HE OR SHE DID NOT BUILD OR �
Z IMPROVE FORTHE PURPOSE OF SALE),
w ❑I,ASONRJEROFTHEPROPERTV.NAEXCLUSNELVCAMRACTMaWfTHLICENSEDWNTFAC70RS ,.� .
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� CENSELA�MDOESNOTMPLVTOMIOWNEROFAPROPERTVWNOBUILDSORIMPROVESTHEREON,AND � ' '
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70R5 LICENSE UW.).
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� LICENSED CONTRACTORS DECLARATION �j
' 2 I HEREBY AFFIRM UNDER PENALTY OF PERIURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTEH �.
d B(COMMENCIN(3 WITH SECTION�D00)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE.AND Z
X W LICENSE IS W FULL FORCE ANO EFFECT. m
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V DATE CONTRACTOR a � '
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� WORKERS'COMPENSATION DECLARATION � , I O �
� 1 HE V AFFIqM UNDER VENALTV OF VERIUAV ONE OF THE FOLLOW{NG DECURAT10N5:
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0 IHAVEANDWIILMAINTAINACERTIFICATEOFCONSENTTOSELF�INSUREFORWORNERS' S
� (',OMPENSATION,AS PFOVIDED B�SECTION 3�00 OF THE LABOH CODE,FOR THE PERFORMANCE `U
OF TNE WORK FOq WHICH THIS PERMIT IS ISSUED. �
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w _I HAVE AND WILL MAINTAM WORKERS'COMPENSATION INSURANCE,AS RE�UIRED BY SECTION
Q 9700 OF THE IABOR CODE.FOR THE PERFORM/JJCE OF THE WORK FOR WHICH TNIS PEFMIT IS � ��o
ISSUED.MV WORKERS'CAMPENSATION INSUflANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION p �
� � CARRIER PLAN REVIEW `'�-��
0 POLICY NUMBER ELECTRIC
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� (�HISSECfpNNEmNOTBECOP.PLEIED�F71-EPEPMTISFa10NEM11�DNEDDCLLAHS(S�Oo)�RLESS? PLUMBING /�
w MECHANICAL r
Z I CERTIFV THAT IN THE PERFORMANCE OF TNE WORK FOR WHICH THIS PERMIT IS 45SUE0.I
�} SHALL NOT EMPLOV ANV PERSON IN ANV MANNER SO AS TO OECAME SUBJECT TO THE
� WORNERS'fAMPENSATION lqWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE +�
S SU&lECT TO THE WORKERS'COMPENSATKKJ PROVISKKJS OF SECTION�7000F THE LABOR ISSUANCE '�^ �
DE,I SHALL PoF7HWITH COMPLV WITH SE PROVISIONS, r-� /A
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p DATE: �'� � APPLICANT: „ �
w ENERGY P/C �
J WARNIN6:FlJLURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE
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� SUBJECT AN EMPLOVEP TO CRIMINAL PENALTIES AND CMl FINES UP TO ONE HUNDRED THOUSAND ENERGY PERMIT
DOLLARS(f100,o00�.IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN „ ,O�
¢ SECTION 3�08 OF THE LABOR COOE,INTERES7,AND ATTORNEV'S FEES. flETENTION FEE:
w CONSTRUCTION LENDING AGENCY P ALT FE
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� 1 HEREBV AFFIRM UNDER PENALTY OF PERJURV THAT THERE IS ACONSTRUCTlON LENDING AGENCY �� � �"` v
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERIAIT IS ISSUED(SEC.30Y7,CIV.C.).
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� LENDER'S NM1E
F_ LENDEH'SADDRESS
� I CERTIFV THAT I HAVE READ THIS APPLICATlON AND STATE THAT 7HE ABOVE INFORMATqN IS CARRECT. TOTAL F E ES ���' �� . ��
w I AGREE T�CAMPLV WITH ALL CRY AN�COUNTV ORDINANCES AND STATE LAWS PELATINO TO BUIlDINO '
� CONSTRUCTION.AND HEREBY AUTHORIZE REPRESENTATIVES OF T S CWNTV TO ENTEF UPON THE '
Z ABOVE-MEMIONED PROPERTV FOi71N5PECTION PURPOSES. COMMENTS
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N SIGNATUR F PERMITTEE DATE
RECPT.NO. PAID BY VALIDATION
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~ WHITE—Deparlment Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLAENR D--File Copy,GREEN—Applicant's Copy
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SET BACK ' ' 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. BOND BEAM
ROOF SHEATHING 8 FT. BOND BEaM •
FRAMINGNENTILATION FINAL 80ND 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 FIP1A� �
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDfCATiONS
SEWER FINAL ENG.
SEPTlC TANK � LANDSCAPE/IRRIG:
SEEP PIT/L.L. . ON SITE IMPS. •
GAS AIR TEST FINAL ZONIIVG
FINAL CONST. FIRE DEP.T. FINAL � '
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY
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