HomeMy WebLinkAbout14977CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
a 21660 E. Copley Drive Suite 190
(909) 860-3195 Fax (909) 851-3117
BUILDING PERMIT APPLICATION
JOBSITE
ADDRESS 11QL 161W4 LAICl
APN LOT TRACT
OWNER
ADDRESS 'r ,�
CITY ZIP TEL
APPLICANT TEL
CONTRACTOR T1IIR0 A O UbllE'Li4
ADDRESS (g, (o T - r -
n k 2771 /'
CITY 7( f� ZIP TEL�I!
ARCFVENG/
DESIGNER
ADDRESS
CITY ZIP TEL.
OWNER -BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CCMMC70RS Ll-
CENSE
4CENSE LAW FOR THE FOLLOWING REASON (SEG 7051.8 BUSINESS AND PROFESSK)NS COOS ANY CITY CR
CDUNTYWVgCH RECUT RESA PERMIT TO CONSTRUCT. ALTER IMPROVE, DEMOLISH, OR REPAIR ANY STRUC-
TURE.
TRUGTUBE. PRIOR TO ITS ISSUANCE ALSO RECUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
STATEMENT THAT HE OR SHE S LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI-
CENSE LAW tDHAPMR 8 tCOMMENCNG WITH BECTON 7000) OF DIVISION S OF THE BUSINESS AND PRO-
FESSIONSCODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THEALLEGED EXEMP-
TION. ANY VKXATON OF SECTION 7051.8 BY ANYAPPLIGANT FOR A PERMIT SUBJECTS THE APPLICANT TO
A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS 11500).):
D L AS OWNER OF THE PROPERTY. OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION.
WILL DO THE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 704, BU51-
NESS AND PROFESSONS CODE: THE CONTRACTORS LICENSE LAW DOES NOTAPPLY TO AN OWNER OF
PROPERTY VMO SUIDS OR IMPROVES THEREON, AND WHO ODES SUCH WORK HMSELF OR HERSELF CO
THROUGH HIS OR HER OWN EMPLOYEES. PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR
OFFERED FOR SALE IF, HOWEVERTHE SUALDNO ORIMPROVEMENT IS SOLD Wm9N ONE YEAROF OOMPLE-
TU N, THE OWNER-BUIDER WALL FAYE THE BURDEN OF PROVING THAT HE OR SHE DD NOT BUILD OR
IMPROVE FORTNE PURPOSEOF SAE"
O LAS OWNER OFTHE PROPERTY. AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS
TO CONSTRUCT THE PROJECT (SEG 704, BUSINESS AND PROFESSK)NS CODE: THE CONTRACTORS LI-
CENSE UAW DOES NCTAPPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND
VAO CONTRACTS FOR SUCH PROJECTS WITH LICENSED PURSUANT TO THE OONTRAC
TORS LICENSE LAW.).
O IAM EXEMPT LINDER SEC. B. M P.C. FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
1 HEREBYAFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER
8 (COMMENCING WITH SECTION 7000) OF DIVISION S OF THE BUSINESS AND PROFESSIONS CODE, AND
MY LICENSE 15 N FULL FORCE AND EFFECT. Jyl
LICENSE CLASS C^ _ ,l. UC. NO.
DATE Vis??�_ CONTRACTOR t�'
WORKERS' COMPENSATION DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELFNNSURE FOR WORKERS'
COMPENSATION, AS PROVIDED BY SECTION 5700 OF THE LABOR CODE, FOR THE PERFORMANCE
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.
I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REOURED BY SECTION
7700 OF THE LABOR CODE FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED. MY WORKEAS!''-COOMMPPENNSATT)ON INSURANCE CARRIER AND POLICY NUMBER ARE
WP
CARRIER ' A/o-ri e� I Cl_
POLICY NUMBER _ LI �- en _%O _
(DS SECDON NE EDICT BE COMFUTED CFTHE PERMITS RxIONE HUNDRED DOLLARS gtoo)ORLESS)
I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I
SHALL NOT EMPLOY ANY PERSON N ANY MANNER SO AS TO BECOME SUBJECT TO THE
WORKERS' COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF I SHOULD BECOME
SUBJECT TO THE WORKERS* COMPENSATION PROVISIONS OF SECTION 7700 OF THE LABOR
COD ISH FORWmH COMPLY WITH THOSE PRDISIONS.
DATE: '4 aTNAPPLICANT.. .. . .'G(
WARNING: AJLUIE TO SECURE WORKERS' COMPENSATION COERAGE 15 UNLAWFUL, AND SHALL BE
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (F 100.000), N ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 7708 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES
CONSTRUCTION LENDING AGENCY
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTR UCTKNN LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED (SEC. 5007, CIV. C.}
LENDERS NAME
LENDERS ADDRESS
1 CERTIFY THAT 1 HAVE READ THIS APPLICATION AND STATE THATTHE ABOVE INFORMATION IS CORRECT.
1 AGREE TO COMPLY WITH ALL CRY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
CONSTRUCTIOR AND NEREBYAUTIORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
ABOVE-MENTIONED PROPERTY FOR INSPECDON PURPOSES.
PERMITTEE N ✓
SKIkATURIEFOPPIEPMITTEE GATE
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DATEAPPLICATIO
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NUMB R r I,
ISSUE NA!
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TYPE OCC
DATE .J
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CONST, GROUP
ZONING SETBACKS
FRONT
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REAR
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SIDE/SIDE STREET
RW ❑
SIDE
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PROPOSED USE - O
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NO, DWEL
NO.
NO.
UNITS
STORIES BEDROOMS
DESCRIPTION SO. FT.
FACTOR PSF ADJ. AREAIVALUATION
SFR/ADDIREM
CAl
Garaga/Carport
WPatio/Deck
LL
PooVSpa
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Valuation 72dC"0
ADJ.AREA
QUANTITY DESCRIPTION
FEE
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CONSTRUCTION
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ELECTRIC
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PLUMBING
MECHANICAL
INSPECTION FEE
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ISSUANCE
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ENERGY P/C
ENERGY PERMIT
RETENTION FEE:
PRE -ALT FEE:
TOTAL FEES
COMMENTS
RECPT. NO.
PAID BY VALIDATION
WHITE—Department Copy. YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD—File Copy, GREEN--Applicanrs Copy
CITY OF DIAMOND. BAR
.... -'' ,'INSPECTION°RECORD
SET BACKFLOOR
JOIST]
FTGS/FORMS/STEEL
FHA REQMTS
ELECTRIC GROUND
... = +
UNDER FLOOR DUCT
GROUND PLUMBING
UNDER FLOORCOKIDUIT
SLAB GRADE- - _._ ..
_ i
FIREPLACE FOUNbATION
_• . - - - :.
TEMP POWER -
FIRE LACEBONb'BEAM
WATER SERVICE _ _
ROOFiSHEATHIOG' IV `- _
MI
FRANGNENTILIATIO�_
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-MID HT. BOND BEAM '
8 FT: -BOND BEAM.
FINAL BOND'BEA'M"
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ROOF COVER." J
PRE -GRADING
-
-ROUGH HEATING -
BENCHING
- ..
-ROUGH ELECTRIC
-
ROUGH GRADING
-ROUGH PLUMBING-,
-
FINISH GRADING
-SHOWERTrUB TEST -
POOL ELECTRIC
EXT. LATH/SIDING
POOL FENCING
WALL INSULATION
POOL FINAL .
CEILING INSULATION
OFF SITE IMPS.
DRYWALL NAILING
DEDICATIONS
SEWER. -.- --..
FINAL ENG.
; r
SEP.TICTANK.. _ ..__ ...
_.. ..__..
LANDSCAPE/IRRIG...
I .
-SEEP PIT/L.L.- _ _
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ON SITE IMPS.
GAS AIR TEST - -
FINAL ZONING
;
FINAL CONST.. - . . 3�7_od
.FINAL -HEATING -
✓
FIRE DEPT. FINAL' '
HEALTH DEPT. FINAL
FINAL ELECTRIC
DEV. FEES PAID
- -'
FINAL PLUMBING
ENERGY
-COMMENTS
SEPTIC TANK SIZE
SEEP.PIT/U SIZE
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