HomeMy WebLinkAbout12-1026 _�� CTTY OF DIAMOND BAR �
' ' � DEPARTMENT OF COMMUNPI'Y&DEVELOPMENT SERVICES
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�. 21810 Copley Drive,Diamond Bar,CA 91765
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-702 PRESS
��'A^' BUII.DING PERMIT APPLICATION FIRMLY
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a ADDRESS `��T -I '�T �`�'� DATE •��
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a ADDRESS NO.DWEL. NO. NO:
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� DESCRIPTION Sa.FT. FACTOR PSF AW.AREANALUATION
p� OWNER-BUILDER DECLARATION � SFR/ADD/REM
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p I HEAEBV.AFFlqAI UHDER-7ENALiY.OF PERJURV THA7 I AM EXEAIPT FROu 7HE COPlTRAC70R3 ll. GHfBge/CBfpOff I
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W TURE,PRIOR TO RS bSUANCE,ALSO REWiRES THE APPLICANT FOR SUCH PERMIT TO FlLE A SIONED W P8Ii0/DOdc
� STATEMEHT THAT HE OR SHE IS LICENSED WRSUANT TO THE PROVLSIDNS�OF THE CONiRACTORS LI- �
� CENSE UW(CHMTER Y(COMMENClNO N7TH SECTION 7D00)OF DIVISION 3 OF THE BUSINE53 AND PRO� POOUSPB
FESSIONSCODE�OR7YIATHEOfiSHEISEXEAIPTTHEREFROMANDTHEBA515FORTHEALLEOEDF�cEMP- C7
TION.ANYVIOLA710NOFSECTION703t.6BYANYMVLICANTFpqApERMI7SU&IECTSTHEAPPLICANT70 Z R@-ROOf
� A CML VENKTY OF NO7 MORE RiAN FIVE/AINORED DOl1ARS(t6ao�.Y . .
0 ❑4ti.^OWNEROFTHEPROPERTY,ORMYEMPLOYEESWITHWAGESASTHEU150LECOMPENSA7pN, � � �mmercial
Z WILL DO THE WORI(,AND THE STRUCNRE IS NOT INTENDEO OR OFFEREO FOR 9ALE(SEc.��Du,BUSI• J �
� NESS'ANO PROFESSIONS CODE:THE COHTAACTORS LICENSE WM DOES NOT APPLV TO AN OWNER OF j �
FROPERfY W/i0 BUILOS OR IIdPROVES THEREON,M1D WHO DOES SUCH 1MDRK HIAISELF OR HERSELF OR '
� THROUGHHI90RHERONMEMPLOYEES.PROVIDED7HAT3UCN14PROVEMENTSARENOTPlTENDEDOR . m - .
� OFFFAFDFOR9ALEIF,HON�EYEf1TiEWHDINOORIMPROVEMENTISSOLpWfTMWpNEVEAHOFCOMGIE
Z TION.THE�OWNEA-BUILDER WILL HAVE TF7E BURDEN OF PROVPlO THAT HE OR SHE DID NOT BURD Oq . .
= WPROVE FOR THE NRPOSE OF SALE} �
W ❑I,ASOWNEROF7HEPROPERfV,�AAIIXq.U51VELYCONTRACTP1UNrtTHLN�NSEDCAHfRAC70R3
� TO CONSTRUCT TME 7HOJECT(SEC.70N,BUSINE53 AND PROFESSIONS CODE:THE CONTflACTOR3 LI- V01UaIIDf1� ADJ.AREA'. �
CENSE UW OOES NOTAPPLYTOAN ONRlER OFA VROPERTV NM110 BUILDS OR UIPROVES THEREON,M1D ' '
� NM1iOCONTfUCTSFOR8Uq1PROJECfSWIT1ACONTMCTOR(S)UCENSEDPURSUAHTTOTHECONTqAC p�qN7�7Y � DESCRIPT70N
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� ❑1 AY EI(EMPT INJpER SEC. B.8 P.C.FOR THIS REASON � . .
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� � DATE OWNER ¢
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� LICENSED CONTRACTORS DECLARATION �W � - -
� I HEREBI'AFRPoJ UNDER PENALTY OF PERNRV 7FIAT IAu�LICENSED UNDER PROVISIONS OF GUFTER � - � �
� D(COMAIE!lCPIO WfTH SECfION 7000)OF DIVISION 30F iHE BUSWESS�ND PROFESSIONS CODE,AND Z
�� MY LICENSE IS Pl iULL FORCE AND EFFECT.
� LICENSE C S �✓v LIC.NO. � /�� �
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� WORKERS'COMPENSATION D LARA pN - / � G p- � �
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N I HEREBV AFFIRM UNDER PENAL7V OF PERNHv ONE Of THE FOLLOW W(i DEa.FqAT10N3: r .
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� _I/IAVE�AND WILL MAINTAW A CERT�IFlCATE OF CONSENf TO SELF-INSURE FOp NpRNFAS' � . .
� COMPENSATION,AS VROVmm BY SECTION 37000F TNE UBOR COpE,FOR TME pEqFpq�1�WC,� W�
Q OF THE N/ORK FOR WHICH THI9 PERMIi 19 155UED. � ,
Qw �I HAVE AND VlILL M/JNTAW WOPo(ERS'�COMPENSATION INSURANCE,AS qEOUIRED BY SECTION
3700 OF THE LABOR CODE,FOR THE�PERFORMANCE�OF THE WOfil(FOR WHlp/THIS PERAIR IS,
ISSUm.MYw/�/ac�EAS' ENSATION Il/SURAtiCE CARRIER�AND POl.ICY NUMBER AAE: �CONSTRUCTION�
jcuaaiEa `N�/�/.�al�'i'�" � PLAN REVIEW
�Z POLICYNUMBER � 6�`(�-!�i"7Li( O� A/�— ELECTRIC
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0 (IFEssEcfaNNFIDwreECOhPIETIDOFnfaEatiitswRONEtu�OR�Oauasls/m)oaLEss� �PLUMBINO �
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Z I CERTIFY TIiAT W THE PERFORAIANCE OF THE.WOiLC FOR W/flq/T1119 PERMIT IS ISSUED,1 MECHANICAL�
C} SHALL NOT EMFLOY ANY VERSON W ANV NMINER SOAS TO BECOME SUBJECT TO THE - � � �
(/� WORKERS COMPENSATqN LAWS OF CA�IFORNitiµD NCREE THAT IF I SH011lp BECAAIE INSPECTION FEE
SUB.IECT TO THE WOPoCER5 COAI7ENSATqN PROViSqN3 SECTION 37a0 OF THE UBOR ' �
O `�i r/�Fom�nr courir wini nmsE aao � / ISSUANCE • �
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� WAiWIN(i:FALURETO SECURE WOR!(EAS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C
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� SU&IECTAN EMPIOYER 70 CRIMW�L PENALTIES i1ND CML FPlES UP TO ONE HUNDRED 7YfOUSAND ENERGY PERMIT
DOLLAR9(f100.000��IN�DDR10N TO THE COST OF COAIPENSATION,DAMAOES AS PRONDED FOR IN
J SECTION 370!OF 7HE LABOR COOE,IMEREST,AND ATfOHNEY'9 FEES. � � ' -
o� RETEN'fION FEE:
O� . QONSTRUCTION LENDING AGENCY � �PREALT FEE
� I HER�Y AFFIRM UNDER PENALTV OF PERIURY THAT THERE IS ACONSTRUCTION IEN�WO AOENCY
�Z� �fOR THE PERFORMANCE OF THE WOFK FOR NRi1CH 7HI5 PERMR IS ISSUED(SEC.3aP7,CIV.G). .
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LENDEftS NAME . . .. , .. ... .. _ . . . ���
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� LENDER'SADDRES3 �
w 'ICERTIFYTHATIHAVEREADTHISAPPLICATIONAtJDSTATETHATTiEABOVEWFORMATIONISCORRECL TOTAL FEES /��
� 1 AUREE TO COMPLV WITH ALL CRV AND CIXINTV ORDWANCES AND STATE UWS REUTMO TO BUILDIN6
.� CONSTRUCTION,AND HEREBY AIrtHOR1ZE REPRESENTATIVES OF 7HI5 COUN7V TO EMER UPON THE �
Z ABOVE-MENTIONEDPROPERTV.FORINSPECTIONPURPOSES. COMMENTS " �
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m PERMITTEE NAME(PR1Pfn /j .
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� 'SttiNA7URE OF PERMfTTEE DATE
� RECPT.NO. PAID BY VALIDATION
WHITE—Depertrnent Copy,YELLOW—Finarae Copy,PINK—Assessor Capy,GOLOENROD—File Copy,6REEI�ApplfcanYs Copy �
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INSPECTION RECOFtD . , ,
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SET BA�K � �FLOOR JOIST
FTGS/FORMS/STEEL �FHA REQMTS
ELECTRIC GRpUND �11NDER fIOOR DUCT
GROUND PLUMBlNG UNDER FLOOR CONDUlT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID HT.BOND BEAM
ROOF SHEATHING 8 FT.BOND BEAM
FRAMING/VENTILATION FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHIldG
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING �
SNOWEWTUB TE5T POOL ELECTRIC
EXT.LATH/5lDING POOL FENCING
WALL INSUlATION POOL FINAL
CEILING INSULATION OFF SITE IP/iPS.
DRYWALL NAILING DEDICATIONS
SEWER ' FINAL ENG.
SEPTICTANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIRTEST FINAL ZONING
FINAL CONST. FIRE DEPT.FINAL
FINAL HEATING HEALTH DEPT.FINAL
FINAL ELECTRIC DEV.FEES PAlD
FINAI PLUMBIN � ENERGY
FINAL PLANING
FINAL ENGIPlEERING • o e ,
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COMMENTS �a � C I� ����y�i�
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