HomeMy WebLinkAboutNo Permit Number (35) . � �� i
CITY OF DIAMOND BAR Pf'``
--� DEPARTMENT UF COMMUNITY&DEVELOPMENT SERVICES �
21660 E.Copley Drive Suite 190 ��
� (909)860-3195 Faz(909)861-3117 PRESS '
�'��^ BUILDING PERMIT APPLICATION FIRMLY i
o� JOBSITE � � APPLICATION � /� ��, ' NUMBER / O/ #/C
ADDRESS DATE � i
c� ISSUE TYPE • OCC
APN LOT TRA � DATE CONST: GROUP
p OWNER t• � �
� ADD S ZONING SETBACKS I
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r �v� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDER DECLARATION SFR/ADD/REM
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I HEREBY AFFlRIA UNDER PENALTV OF PERNRY THAT�AM EXEMPT FROM THE CONTRACTORS LI- Gflf89B/C8lpOR
W CENSEUWFORTHEFOLLOWINGREASON(SEC.7031.SBUSINESSANOPROFESSIONSCODE:ANVCITVOR (n
ZCOUHTYWHICHREWIRESAPERMRTOCONSTRUCT,ALTER,IMPROVE.DEMOLISH,ORREPAIRANYSTRUC- W Patio/Deck
��� TURE,PRIOIi TO ITS ISSUANCE,PLSO RE�UIRES THE APPLICANT FOH SUCH PERMIT TO FILE A SIGNEO w
STATEAIEM THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI-
� CENSE UW(CHAPTER i(COMMENCINQ WITH SECTION 7000)OF DIVISION 3 Of THE BUSINESS AND PRO- � PooVSpa
FESSqN50DDE)OflTHATHEOR5HEI5EXEMPTTHEREFROMANDTHEBA515FORTHEALLEGEDEXEMP- (�
TION.AHVVIOUTIONOFSECTION7031.5BVANVAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO Z Re-Roof
� A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLURS(5500).):
� ❑I,ASOWNEROFTHEPROPERN,ORMYEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, 0 Commercial � -
YALL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.704t,BU51- J
� NESS AND PROFESSIONS CODE:THE CONTRACTORS UCENSE UW DOES NOT APPLY 70 AN OWNER OF �
PROVEHf1'Mh10 BUILDS OR IMVROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
� THROUf3H HIS OR HER OWN EMPLOYEES,PFOVIDED THAT SUCH IMPROVEMENTS AFE NOT INTENDED OR m
0 OFFEREDFORSALEIF,HOWEVER7HEBUILDINOORIMPROVEMENTISSOIDWITHINONEYEAROFCOMPLE-
Z �'TION,THE OWNEH�UILDER WILL HAVE THE BURDEN OF PROVING iNAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF SALE).
- w� ❑I,AS OWNER OF THE PROPERfY,AM EXCLUSIVELY CAMRACTINO WfTH LICENSED CONTRACTORS
� TO CANSTRUCT THE PR0.IECT(SEC.7o1a,BUSINESS ANO PROFESSIONS CODE:THE CONTRAC70RS LI- V81U8fi0f1 ADJ.AREA
� CENSEUWDOESNOTAPPLYTOANOWNEROFAPROPERTVNRiOBUILD50RIMPROVESTHEREON.AN�
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� LICENSED CONTRACTORS DECLARATION W
OC 1 HEREBYAFFIRM UNDER PENALTY OF PERIURY THAT I AM LICENSED UNDEH PROVISIONS OF CHAPTER � .
Q„ Y(COMMENCINO WITH SEC 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z
�C W UCENSE IS IN FULL F AND EFFECT. /�/�+'�
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a� WORKERS'COMPENSATION DECLARATION a
NI HEREBV AFFIRM UNDER PENALTV OF PERIURY ONE OFTHE FOLLAWING DECUMTIONS: Z
� _I HAVE AND WIIL MAIN7AIN A CEPTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' 2
COMPENSATION,AS PROVIDED BV SECTION 370o OF 7HE LABOR CODE,fOP THE PEHFORMANCE U
Q OF THE WORK FOR NT11CH THIS PERMI7IS ISSUED. �
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w �HAVE MID WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION
Q � 37000F THE UBOR CODE,FOR 7HE PERFORM CE HE WORK FOR WHICH THIS PEFMIT IS
ISSUED.MY �COMPENSATION INSU C ARRIEy�jD POLICYNUMBERAflE: CONSTRUCTION
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Z I CERTIFV THAT IN 7HE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL �.f-�r�-!`�^a.
('J SHALLNOTEMPLOYANYPERSONINANYMANNERSOASTOBECAMESUBJEC770THE ��.;"!�t,
� WORKERS'COMPENSATIONLAWSOFCALIFORNIA,ANDAGFEETHATIFISHOULDBECOME INSPECTIONFEE �'� �� `...i.�
Y � SU&IECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 370o OF 7HE LABOR (� ` '�`
CADE,I SHALL FORTHWI7H COMPLV WITH SE PROVISIONS. J+� SUANC r n 4 /� �G���.1 0 -J�C.�C./
p DATE:,� APPIICANT.����� F'-i�.�� � ���°"1 A n�c.n���
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� ENERGY P/C �TTV IaT� � _J-r-��•' ' �
� WARNING:fAIIURE TO SECURE WORKERS'COMPENSATION CAVERAGE IS UNUWFUL,M!D SHALL BE ,y�a,, . - '�� - � .
� SU&IEC7ANEMPLOVEH70CRIMINALPENALTIES/�NDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT riTTTT T\TT�T�', Pt�':L..'+'��--n�- " �
OOLLARS(l100,000),IN ADDITION TO7HE COST OF COMPENSATION,DAMAGES AS PROVIDE�FOR IN y��"___ �
� SECTION 3708 OF 7HE UBOR CODE,INTEFiEST,AND ATTORNEY'S FEES. � RETENTION FEE:
� CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� I HEREBY AFFIRM UNDER PENALTI OF PERIURY THAT THERE IS ACONSTRUC710N LENDING AGENCY
FOR THE PERWRMAtJCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.). .
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� LENDER'S NAME
F- LENDER'SADDRE55
� ICERTIFVTHATIHAVEREADTHISAPPLICATIONANDSTATETHAT7HEABOVEINFORMATIONISCAiiRECT. TOTAL FEES
w I AGREE TO COMP�Y WITH PLL CITY AND COUN7Y ORDINANCES AND STATE LAWS REUTING TO BUILDING
� CONSTRUCTION,AND HEREBY AUTHORIZE HEPRESENTATIVES OF THIS COUNTY TO ENTER U70N THE
ZABOVE-MENTIONED PROPERN FOR INSPEC710N PURPOSES. ) COMMENTS -
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= RECPT.NO. �. PAID BY VALIDATION
~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD--File Copy,GREEN—Applicant's Copy
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SET BACK , FLOOR JOIST '_ •
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ELECTRIC GROUNQ (� � , UNDER FLOOR DUCT=" +
GROUND PLUMBING � UNDER FLOOR CUf�iJUIT "��. i� -- _. _
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SLAB GRADE , FIREPLACE FOUNDATION ' � ._ _� I
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TEMP POWER i FIREPLACE BOND BEAM _j
WATER SERVICE ? MID HT. BdND BEAM _ ` � ' _ 4
ROOF SHEATHING � ' � ' _ ' 8 F7. BOND BEAM- � • _ ___�
FRAMINGNENTILIATION FINAL BOND BEAM, ,.• �______
ROOF CaVFR PRE-GRADiNG � � .
FiOUGH NcATiNG BENCHING
ROUGH ELECTRIC • ROUGH GRADING
ROU��i PLUNIBING � FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL
�CEILING IIVSULATION OFF SITE IMPS.
DRYWAL.L NAILiNG DEDICATIONS
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� SE�C TANK LANDSCAPE/IRRIG.
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