HomeMy WebLinkAbout18377 _�� CITY OF DIAMOND BAR
� --� DEPAR'I'ME?`ri'OF COMMUNTfY&�DEVELOPMENT SERVICES ���d�,��
21825 E.Copley Drive
'�" (909)860-3195 Fax(909)861-31 l7 PRESS
������ BUILDING PERMIT APPLICATION SET� X O i• ?+�. FIRMLY
o� JOBSITE 11r. APPLICATION'n ��Q_�1 NUMB R ��`� #/C
ADDRESS 4� DATE 1 l �
� APN LOT � � TRliCT I O ISSUE TYpE p��
DATE CONST. GROUP
p OWNER 'L�'/ S -NGH Z
p ADDRESS Z I^ �"l ZONING SETBACKS
Z CITY �1P aIl65TEL.�"S(oOS�39 FRONT q�n/ ❑
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N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILAER DECLARATION SFR/ADD/REM
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p I MEREBV AFFIqM UNDER PENhLTV OF PERJURV THAT I AM E%EMPT FROM THE CONTfUCTOqS LI- G8f89B/COfpOfS
W CENSEUWFORTHEFOLLOWINGREASON(SEC.7037.SBUSMESSANDFAOFESSIONSCODE:ANVCITYOR (n
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w NRE,PPIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIONED w Patio/Deck
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI� � �
. , � CENSE LAW(CHAPTER G(COMMENCIN6 W1TH SECTION 7000)OF DIVISION 3 ClF THE BUSINESS AND PRO� POOUSPB
O FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMMlDTHEBASISFORTHEALLEGEDE%EMP- (�
V TbN.ANVVIOLATIONOFSECTION7031.5BYANVAPPLICMI�FOR�PERMITSUBJEC'(STHEAPPLICANTTO Z Re-Roof ,
� A CM�PENALTV OF NOT MORE THAN FNE HUNDRED DOLURS(f500).): �
I Q 4ASOWNEROFTHEPROPERN,ORMVEMPLOVEESWITHWAGESASIHEIRSOLECOMPENSATiON, 0 COR1rt10fCi81
Z WILL�THE WORK,AND THE STRUCTURE IS NOT IN i ENDED OR OFFERED FOR SALE(SEC.704�,BUSI� J
� NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NO'APPLV TO AN OWNER OF �
PROPERTV NMO BUILDS OR IMPROVES THEREON,AND WHO OOES SUCH VIORK HIMSELF OR HERSELF OR
� THROU(iH HIS OR HER OWN EMPLOVEES,PROVIDED THAT�UCH IMPROVEMENTS ARE NOT INTENDED OR m
� OFFEREDFORSALEIF,HOWEVERTMEBUILDINOORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPIE-
Z TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVINO'HAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PUHPOSE OF SALE).
w ❑I,ASOWNEROFTHE PROPEHTV,AM E%CLUSIVELV CONTRACTINa WI7H LICENSED CON7RACTORS
[C TO CANSTRUCT h1E PROJECT(SEC.7oN,BUSINE55 AND PROFESSIONS CODE:THE CONTRACTORS LI� VelUBfiOfl � ADJ.AREA
W CENSEUWDOESNOTAPPLVTOANOWNEROFAPROPEFTVWV103UII.DSORIMPROVESTHEREON,AND
� WHOCONTRACTSFORSUCHPROJECTSWITHACONTMCTOR(5)LICEtJSEDPURSUANTTOTHECANTRAG QUANTITY DESCRIPTION FEE
TORS UCENSE LAW.).
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� I HEREBY AFFIRM UNDEF PENALTV OF PERIURY TMAT I AM LICENSED UNDER PROV�SIONS OF CHAPTER � '
� Y(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND FP.OFESSIONS CADE,AND Z
�� AIV LICENSE IS IN FULI FORCE AND EFFECT. m
� LICENSE CLASS LIC.NO. �
U OATE CONTRACTOR ' d ,
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� WORKERS'COMPENSATION DECLARATION Q
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� I HEREBV AFFIRM UNDER 7ENALTV OF PERJURV ONE OF THE FOLLOWING DECIARAT10N5: Z
� I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSEMTO SELF�INSURE FOR WORKERS' a
� COMPENSATION,AS PROVIDED BV SECTION 370o OF THE LABOR CODE,FOR TME PERFORMANCE U
OF THE WORK FOR WHICH 7NIS PERMIT IS ISSUED. w
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W _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE.AS REOUIRED BV SECTION
Q 3700 OF THE LABOR CADE,FOR THE PEHFORMANCE OF THE WORK FOR WHICH 7HI5 PERMIT IS
ISSUED.MV WORKERS'COMPENSATqN INSURANCE CARRIER AND POLICV NUMBERAAE: CONSTRUCTION
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� CARqIER PLAN REVIEW �
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Z I CERTIFV TNAT IN THE PERFORMANCE OF THE WORK FOR WHICH LHIS PERMIT IS ISSl1ED,I MECHANICAL �
C}' SMALL NOT EMPLOY ANV PERSON IN ANV MANNER 50 AS TO BECOME SUBJE�T TO THE
(/� WORKERS'COMPENSATION LAWS OF CAIIFOHNIA,AND AGREE THAT IF I SHOULO 9ECAME INS?ECTION FEE
SU&IECT TO THE WORKERS'COMPENSATION PROVI51ON5 OF SECTpN 37ao OF THE LABOR
�j CODE,1 SHALL FORTHWITH COMPLY WITN THOSE PROVISIONS. ISSUANCE �(O�
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p DATE: APPLICANT: SMIP
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—� WARNING:FAILURE TO SECURE WORNERS'COMPENSATION COVERAGE IS UNUWFUI,AND SHALL 6E ENERGY P/C
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� SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FMES UP TO ONE HUNDRED THOUSAND ENERGY PERMIT
DOlLAA9(f100,000).IN ADDITION TO THE COSTOF COMPENSATqN,DAMAGES AS PROVIDED FOR IN
J SECTION 3708 OF TNE LABOR CODE,INTEREST,AND ATTORNEVS FEES. � ��
w RETENT�ON FEE:
O CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � '
� 1 HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT THERE IS ACONSTRUCTION LENDING AGENCV
� FOR THE PERFORMANCE OF THE WORK FOF WHICH THIS PERMIT IS ISSUE�(SEC.30Y7,CIV.C.�.
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� LENDER'S NAME .
F— LENDER'SADDRE55 ` /�
wI CERTIFY TMAT 1 HAVE READ TMIS APPLICATION ANO STATE THAT TME ABOVE INFORMATION IS CORRECT. TOTA L FE ES � v � LJ
� I AGREE TO COMPLV WITH ALL CITY ANO COUNTV ORDINA7JCE5 AND STATE UWS flELATING TO BUILDING .
� CANSTRUCTION,AND MEREBY AUTHORRE REPRESENTATNES OF THIS CWNTY TO ENTER UPiJN THE
Z ABOVE-MEMIONED PROPERTV FOR INSPECTION PURPOSES. COMMENTS
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� SIGNA U MI DATE ` �
� RECPT.N0. � PAID BY VALIDATION
WHI epartment Copy,YELI.OW—Finance Copy,PINK—Assessor Copy,.GOLDENROD—Fle Copy,GREEN—Applicant's Copy .
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ELECTRIC GROUND ! � J UNDER FLOGR DUCT -
GROUND PLUMBING UNDER FLOOR CUt�!DUIT '
SLAB GRADE _____� � FIREPLACE F�UNDATION
TEMP POWER j FIREPLACE B�N� BEAM
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ROOF SHEATHING , , 8 FT. BOND f3EAM
FRAMINGNENTILIATIQN ___ v ____ r FINA�BOND BEAM
ROOF COVER PRE-GRA�ING
ROUGH HEATING BENC;HING
ROUGH ELECTRtC FiOUGH GRADlNG
ROUGH PLUM8ING I � V I FINISH uRADING
SHOWER/TUB TEST _ � PdOL ELECTRIC
EXT. LA7H/SIDING � POOL FENCING
WALL INSUi..ATION POOI FINAL
CEIUNG INSUTATION OFF SITE IMPS. �
DRYWALL NAIUNG DEQICATIONS "
SEWER FINAI_ENG.
SEPTIC TANK LANQSGAPE/iRRIG. �
SEEP PIT/L.�. ON SiTE IMPS.
GAS AIR TEST FIt�JAL Z�NING
FINAL CONST. FIRE DEPT. FINAL �
FINAL HEATING HEALTH DEP"f. F1NAL
FiNAL ELECTRlC � DEV. FEES PAID � �
FlNAL PLUMBING I ENERGY ��
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