HomeMy WebLinkAboutPR 10-854L
11 CTTY OF DIAMOND BAR j I`
i-- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21825 Copley Drive,Diamond Bar,CA 91765
909)839-7020 Fax(909)861-3ll7 Building Inspection Hotline(909)839-7027 PRESS
BUILDING PERMTT APPLICATION Z FIRMLY
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JOBSITE APPLICATION PERMIT Q!p/C ,—ADDRESS DATE V NUMBER
ISSUE 7yPE CAPNLOT— TRACT DATE CONST. GROUPpOWNER1)/(
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ZONING SETBACKS
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CITY ZIP TEL.PROPOSED USE
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ADDRESS NO.DWEL. NO.NO.
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DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNEF•BUILDER DECLARATION
SFR/ADD/REMO
p I HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT I AM EXEMPT F{70M THE CONTRACTORS LI G0f8gB/CefP01SWCENSELAWFORTHEFOLLOWINOREASON(SEC.7031.5 BUSMESS M!D PROFESSIONS CODE:ANV CIiY OR (nC- CWNTVWHICHRE UIRESAVEfUAITTOCONSTRUCT,ALTERIMPROVE,DEMOUSH,ORREPAIRANVSTRUC- wWTURE.PRqR TO ITS ISSUANCE./LSO FEOUIHES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Petio/DeckSTATEMENTTHATHEORSHEISLICENSEDFURSUANTTO7HEPROVISIONSOFTHECANTRACTORSLI
CENSE UW(CHMTER Y(COMMENCWG WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- LL PooUSpe
FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFFOM AND THE BASIS FOR THE ALIEGED EXEMP C7TION.ANYVIOLATKKJOFSECTION7031.SBVANVAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-RoofACMLPENALTVOFNOTMORETIUNFIVEHUNDREDDOLURS(f500).):
I,ASOWNEROFTHEPROPERTV,ORMYEMVLOYEESWITHWAGESASTHEIRSOIECAMPENSATION, COfTIrtl0fCi8IWILLDOTHEWORK,AND THE STRUCTURE IS NOT INTENDED OP OFFEFED FOR SALE(SEC.7aa,BU51- J
NESS AND PHOFESSIONS CODE:THE CONiRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF
PROPERTY NR10 BURDS OR IMFROVES TMEREON,AND NM110 DOES SUCH WORK HIMSELF OR HERSELF OR
THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT WTENDED OR m
OFFEREDFOR9ALEIF,FqWEVERTMEBUILOWOORIA/PROVEMINTISSOLDWITHINONEVEAqOFCAMFLE-
z TION,THE OWNER UILDER WILL H VE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR
IMPROVE FOR THE PURPOSE OF SALE).
W 1,AS OWNER OF THE PROPERTV,AM E%CLUSNELV CONTRACTING WfTH LICENSED COHTqACTORS
Q TO CONSTRUCT 7HE PRQIECT(SEC.70N,BUSINESS AND PROFESSIONS CODE:THE COMMCTORS LI- V61U8110f1 ADJ.AREAWCENSEUWDOESNOTAPPIVTO/W OWNER OF A 7ROPERTV NRiO BUILDS OR IMPROVES THEREON,AND
NM1IOCONTRACTSFOHSUCHPRQIECTSWITHACONTRACIOR(S)LICENSEDPURSU ECONTRAG UANTITY DESCRIPTION
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rau ucENse uw..FEE
EXEMPT UNDER SEC. FpR THIS REASON JQ
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LL DATE OWNER H
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LICENSED CbNTRACTORS DECLARATION w
2 1 HEREBY AFFIRM UNOER PENALTY OF PERIURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTEP
o(OOMMENCIM(3 WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND ZWLICENSEISINFUILFORCEANEFFECT.
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LICENSE CLASS LIC.NO.
V DATE CONTRACTOR a
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WORKEAS'COMPENSATION DECLARATION Q
UIHEREBVAFFIRMUNDERPENALTVOFPEHJURYONEOFTHEFOLLOWINGDECLARATIONS: Z
Z _IHAVEANDWILLMAMTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWORKERS'
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Q C0IAPENSATION,AS PROVIDED BV SECTION 3700 OF THE LABOF CODE,FOR THE PERFORMMICE U
OF THE WOPK FOR WHICH THIS PERMIT IS ISSUED. W `
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I HAVE AND WILL MAINTAW WORKERS'COMPENSATION INSURANCE.AS REOUIRED BY SECTION
Q 370o OF THE LABOR CADE,FOR THE PERFORMMICE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED.MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION
CARqIER PLAN REVIEW
POLICV NUMBERZ cTRi r. c
IYUSSEC IONNE NDTBECOAPLETEDOFhEpE{i.T(1&FpqpryEMJ DfiE ppq1qqgK100)ORLFSS} PLUMBING
WZ I CERTIFV THAT IN THE PERFORMANCE OF h1E WORK FOq WHICH THIS PERMIT IS ISSUED,I MECHANICAL
C7 SHALL NOT EMPLOV ANV PERSON IN ANV MANNER 50 AS TO BECAME SU&IECT TO THE
WORKERS'COMPENSATION AWS OF Cl IFORNIA AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE
SU&IECT TO THE WORNERS'COM7ENSATION PROVISIONS OF SECTION 37000F THE LABOq J 'OOCADE,1 SHALL FORTHWITH COMPIV WITH THOSE PROVISIONS.SUANCE
p DATE:APPLICANT: SMIP
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WARNIN:FAILURE TO SECURE WORKERS'COMPENSATION COVERAOE IS UNLAWFUL,AND SHALL BE ENERGY P/C
y SU&IECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
ENERG ITDOLLARS({100,000),W ADDITION TO THE COST OF COMPENSATION,DAMAOES AS PROVIDED FOH INJSECTqN37oeOFhIELABORCODE,INTEREST,AND ATTORNEV'S FEES.
OOwRETE:
O CONSTRUCTION LENDING AGENCY PpE-AlT FEE:
I HEREBV AFFIflM UNDER GENALTY OF PERJURV THAT THEFE IS A CONSTRUCTION LENDINO A6ENCV
FOR THE PERFORMANCE OF 7HE WORK FOF WHICH THIS PERMIT IS ISSUED(SEC.3007,CIV.C.).
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LENDER'S NMIE
F— LENDER'SADDRESS
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W I CERTIFV THAT I HAVE READ THIS APPUCATION AND STATE THAT THE ABOVE INFORMATqN IS CORRECT. TOTAL F E ES C OIAGREETOCOMPLVWITHALLCITYANDCOUNTYORDINANCESANDSTATELAWSREI.ATINO TO BUIlDINO
CONSTR CTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO EMER UPON THE
Z ABOVE- ENTKKJED VROPERTV FOR INSPECTION PUR E
COMMENTS0 ti'•'
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l/ E DATE
RECPT.NO. PAID BY IXIS N'VALIDATION
WHITE—DepaRment Capy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROQ–File Copy,GREEN—Applicant's Copy
CITV O D1,4MO D AR
Ii S(CToOi RECORD
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SET BACK FLOOR JOIST
FTGSlFORMS/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$HEATHING 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.
SEPT C 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
FINAL PLUMBING ENERGY
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COIVIfVIENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
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