HomeMy WebLinkAbout11-691� _
CITY OF DIAMOND BAR � ���
�---��`— DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
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(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS
"��'� BUILDING PERMIT APPLICATION � FIRMLY
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cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
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I HEREBY AFFIRM UNDER PENALTV OF PERIURV THAT I AM EXEMPT FPOM 7HE CONTRACTORS LI� G2f890/CBf�IOfI
W CENSE UW FOR THE FOLLOWING REASON(SEC.7031.5 BUSINESSAND PROFESSIONS CADE:ANV CI7V OR (n
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W TURE,PRIOR TO ITS ISSUANCE.AL50 qEQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNEO w Patio/Deck
S7ATEMENT THAT HE OR SHE IS LICENSEO PURSUANT TO THE PROVISIONS OF THE CON7RACTORS LI�
� CENSE LAW(CHAP7ER e(COMMENCING WI7H SECTION 7000)OF DIVISION 3 OF 7HE BUSINESS AN�PRO- � PooVSpa
, � FESSIONSCADE)ORTHATHEORSHEISEXEMPTTHEREFROAIANDTHEBASISFORTHEALLEGEDEXEMF� C7
V TION.ANYVIOLATIONOFSECTION7o31.58YANVAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Roof
A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLLARS(5500).J:
Z ❑I,ASOWNEROFTHEPROPER7Y,ORMYEMPLOVEESWI7HWAGESASTHEIRSOLECAMPENSATION, � Commercial
WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SAIE(SEC.70��,BUSI� J �
� NESS AND PROFESSIONS CADE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF �
PROPERTV WHO BUILDS OR IMPROVES THEFEON,AND NhiO DOES SUCH WORK HIMSELF OR HERSELF OR
Q 7HROUGH HIS OR HER OWN EMPLOYEES,PROVIDED THAT SUCH IMPROVEMEN75 ARE NOT INTENDED OR m
Q OFFEREDFORSALE.IF,HOWEVEFi,7HE8UIL�INGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE-
z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THA7 HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF SALE).
w ❑I,ASOWNEROF7HEPROPER7V,AMEXCLUSIVELVCONTRACTINGWI7HLICENSEDCONTRACTORS
[[ TO CONS7RUCT THE PR0.IECT(SEC.70/1,BUSINESS AND PROFESSIONS CADE:THE CANTRACTORS LI- V31U3fI0f1 ADJ.AREA
W CENSELAWDOESNOTAPPLYTOANOWNEROFAPROPERNWHOBUILDSOHIMPflOVESTHEREON,AND
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�� ❑�AM EXEMPT UNDER SEC. B.6 P.C.FOR THIS REASON Q
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� LICENSED CONTRACTORS DECLARATION w
� 1 HEREBY AFFIRM UNDER PENALTV OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
d B(COMMENCING WITH SECTION 7000)Of DIVISION 3 OF THE BUSWESS AND PROFESSIONS CODE,AND Z
X MY UCENSE IS IN FULL FORCE AND EFFECT. m
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� LICENSE CLASS IIC.NO. � .
~ DATE I CONTHACTOR d
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� WORKERS'COMPENSATION DECL RATION Q
� I HEREBV AFFIflM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: Z
� _IHAVEANDWILLMAINTAINACERTIFICATEOFCONSEN7705E1F�INSUREFORWORKERS' ¢
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Q CAMPENSATION,AS 7ROVIDED BV SECTION 3700 0F THE LABOR CODE,FOR THE PERFORMANCE U
Q !�THE WORN FOR WHICH THIS PERMIT IS ISSUED. �
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W INAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BV SECTION
Q 370o OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMI7IS
ISSUED.MV WORK 'COMPENSATI �INSUfiANCE CARRIER AND POLICV NUMBERARE: CONSTRUCTION
� CARRIER � PLAN REVIEW
Z POLICYNUMBER - � ELECTRIC
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� (IHISSECiXXJNE�NOTBE�lAPIEfEDOFT}�PER1.4�ISFORCNEMN�DFEDDOLLl�AS(f100)ORLESS} PLUMBING , ��
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Z I CER7IFV THAT IN THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUEO.I MECHANICAL
�}' SHAIL NOT EMPLOY ANV PERSON IN ANV MANNER 50 AS TO BECOME SUBJECT TO THE
(n WORNERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECAME INSPECTION FEE
= SUBJECTTOTHEWOFKERS'COMPENSATIONPROVISIONSOFSECTION37000FTHELABOR //
CADE,I S ALL FORTH ITH COMPLY WITH THOSE PROVISION$f ISSUANCE �7 I
O DATE: S�/ �,�PPLICANT. � SMIP
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J WARNING FAILURETO SECURE WORKERS'COMPENSATI COVERAGE IS UNUWFUL,AND SHALL BE ENERGY P/C
� SUBJECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
DOLLARS(5700,000).IN ADDI710N TO THE COST OF CAMPENSATION,DAMAGES AS PROVIDED FOR IN q
� SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATfORNEV'S FEES. RETENTION FEE: /����
a CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� 1 HEREBYAFFIRM UNDEfi PENALTV OF PERJURV THATTHERE IS ACONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.�. .
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� LENDER'S NAME
F- LENDER'SADORESS
� TOTAL FEES I✓��� �"'
� I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CARRECT.
w I AGREE TO COMPLV WITH ALL CI7Y AND CAUNTV ORDINANCES AND STATE LAWS REUTING TO BUILDING
� CANSTRUCTION,AND HEREBY AUTHORIZE REPRESENTA7IVES OFTHIS COUNTV 70 ENTER UPON THE
� ABOVE�M TIONED PROPERTV FOR INSPECTION PURPOSES.
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m PERMITTEE NAME(PRINT) '� ���� /// .
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� SIGNATUFEOFPERMITTE �- DA7E
= RECPT.NO. PAID BY VALIDATION
~ WHITE—Department Copy,YELLOW--Finance Copy,PINK—Assessor Copy,GO ENRO�File Copy,GREEN—Applicant's Copy
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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 FOUNDATI�N
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID H'T. 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 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.
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 1 DEV. FEES PAID
FINAL PLUMBING ENERGY
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COMMEfVTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
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