HomeMy WebLinkAbout11-1301 ��_ CITY OF DIAMOND BAR � ' /
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES V
21825 Copley Drive,Diamond Bar,CA 91765
� (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-70 n PRESS
'°^' BUILDING PERMIT APPLICATION • K FIRMLY �
� JOBSITE
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� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
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Z TURE.PRIOR TO ITS ISSUANCE,ALSO REW IRES THE APPLICANT FOR SUCH PERMIT TO fILE A SIQNED w P8�10/DBCk
w STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTMCT00.4 L4 W
�� CENSE UW(CHAFTER D(COMMENCING WITH SECTKKJ 7000)OF DIVISION 3 OF THE BUSINE55 ANO PR6 � POOVSpB '
FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP� (�
U TION.ANVVIOLATIONOFSECTION7031.SBVANVAPPLICANTFORAPERMITSU&lECT57HEAPPLICANTTO Z Re-Roof
A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLURS(t600�.):
� ❑I,ASOWNEROFTHEPROPERTV,ORMYEMPLOVEESWI7HWAOESASTHEIRSOLECOMPENSATION, O COfI1R1BfCI91
Z WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7M�,BUSI- J
N NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF � ,
PROPERTV WHO BUILDS OR IMPROVES THEREON,AND NM1iO DOES SUCH WORN HIMSELF OR HERSELF OR
CL 7HROU(LI HIS OR HER OWN EIdVLOVEES,PROVIDED THAT SUCH WPROVEMENTS ARE NOT INTENDED Oq m
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Z TION,TME OWNER-BUILDER WILL HAVE 7HE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR
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� W/7000NTRACTSFORSUCHPRQIECTSWITHACONTRACTOfl(S)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION
70RS IJCENSE IAW.J. FEE
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� DATE OWNEF ¢ `y��� �
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FQ LICENSED CONTRACTORS DECLARATION W I Yl r
2 I HEREBV AFFIRAI UNOER PENALTV OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � .
� e(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CADE.AND Z
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� �IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF�INSUPEFORWORKERS' _
� COMPENSATION,AS GROVIDED BV SECTION 37000F THE LABOR CODE,FOR THE PERFORMANCE U
OFTHE WORK FOR WHICH THIS PEFMIT IS ISSUED. w
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w �,I NAVE AND WILL MAINTAW WORKERS'COMPENSATION INSURANCE,AS REOIJIHED BV SECTION
Q 370a OF THE UBOR CODE.FOR THE PERFORMANCE OF THE WORK f-0R WHICH THIS PERMIT IS �
ISSUED.MV WORNERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION f
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� POUCV NUMBER �JGG G g� � ELECTRIC _ �
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� (IFESSECfKXJNE�NOTBEWMPLE7FDOFhEPERARiSFOqpryEFpWf7Eppq1qqg(f�pp�pq�ESSl PLUMBING
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Z �CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
C,�} SHALL NOT EMPLOY PNV PERSON IN ANV MANNER 50 AS TO BECOME SU&IECT TO THE
[/� WORKERS'COMPENSATION LAWS OF CALIf-0RNIA�ND AGHEE THAT IF I SHOUID BECAME INSPECTION FEE
SUBJECT TO THE V10RKER5'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOq ��
O CODE,I SHALL FORTHWITH COMPLY WITH�T/HOSE PFOVISIONS. ISSUANCE
'p OATE: ZZ APPLICANT: VI`NCENZU �Jyjr� SMIP
� WARNING:FPJWRE TO SECURE WORKERS'COMPENSATION CAVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C �
� SU&IECTAN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAN� ENERGY PERMIT
DOLLARS(f10o,000),IN�ODITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOq IN ']
w SECTION 37oe OF THE LABOR CODE.INTEREST,ANO ATTORNEV'S FEES. RETENTION FEE: p'L D�
O CONSTRUCTION LENDING AGENCY P -ALT FEE:
� 1 HEREBY AFFIRM UNDER PENALTV OF PERJURY THAT THERE IS A CONSTRUCTION LENDINQ AOENCV �
� FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3ao7,CIV.C.).
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� LENDER'S NAME ,
f'— LENDER'SADDRESS
w I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTA L FE ES T O � v
� 1 AaREE i0 COMPLV WITH ALL CITV AND COUNTY ORDINANCES AND STATE UWS RELATWO TO BUILDINO
� CONSTRUCTION,ANDHEREBYAUTHORIZEREPRESENTATNESOFTHISCWNTVTOENTERUPONTHE - .
Z ABOVE-MENTIONED PROPERTY FOR INSPECTqN PURPOSES. COMMENTS �
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WHITE—Depertment Copy,YELLOW�inance Copy,PINK—Assessor Copy,GOLDENROD--F(le Copy,GREEN—Applfcant's Copy
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INS�EC�'EC7i� RECORD
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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 BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ►+����� ROUGH GRADING
ROUGH PLUMBING FINISH GRAD►NG
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.
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 _
FINAL PLUMBING ENERGY �V+� O(� 11 � 11.
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