HomeMy WebLinkAbout10576CITY OF DIAMOND BAR OF
COMMUNITY DEVELOPMENT DEPARTMENT
216601- Copley Drive Suite 190
(909) 860-3195 Fax (909) 861.3117
B UILDING PERMIT APPLICA77ON
JOBSITE
ADDRESS—"j l j = I Qk} A �1Lt�S
APN LOT TRACT
OWNER — '
ADDRESS I
CITY ZI TEL. J
APPLICAK iti TEL.
CONTRACTOR
ADDRESS
CITY A iA TEL
ARCFI/ENG/
DESIGNER
ADDRESS
CITY ZIP TEL
OWNER -BUILDER DECLARATION
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT JAM EXEMPT FROM THE CONTRACTORS LL
CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE ANY CRY OR
COUNTY WHICH REQUIRESA PERMITTO CONSTRUCT.ALTER, IMPROVE, OEMOUSH,OR REPARANYSTRUC.
TURF PRIOR TO ITS ISSUANCE. ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LL
CENSE UW (CHAPTER 9 (COMMENCING WITH SECTION 70001 OF DIVISION 3 O THE BUSINESS AND PRP
FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP-
TION. ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOA A PERMIT SUBJECTS THE APPLICANT TO
A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (FSM).):
Q'U AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THETA SOLE COMPENSATION,
WILL DO THE WORK. AND THE STRUCTURE S NOT INTENDED OR OFFERED FOR SALE (SEC 7084, BUSI-
NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE UW DOES NOT APPLY TO AN OWNER Of
PROPERTY WHO BUILDS OR IMPROVESTHEREON, AND WHO DOES SUCH WORN HIMSELF OR HERSELFOR
THROUGH HIS OR HER OWN EMPLOYEES. PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR
OFFEREDFOR SALE IF, HOWEVER THE BUILDING WITHIN IMPROVEMENT IS SOLD WN ONE YEAR OFCOMPUE-
TION. THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID HOT BUILD OA
IMPROVE FOR THE PURPOSE OF SALE)
❑ L AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS
TO CONSTRUCT THE PROIEC7 (SEC. 7044. BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI-
CENSE LAW DOES NOT APPLY TO AN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON. ANO
WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTDR(S) LICENSED PURSUANT TO THE CONTRAP
TORS LICENSE LAW).
O IAM EXEMPT U�N.D(E7R SEC. B. i P.C. FOR THIS REASON
DATE—.30
7 � OWNERC�
LICENSED CONTRACTORS DECLARATION
I MEREBYAFFNN UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER
e (COMMENCING WITH SECTION ?DOD) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND
MY LICENSE IS N FULL FORCE AND EFFECT.
LICENSE CLASS LIC. NO.
DATE CONTRACTOR
WORKERS'COMPENSATION DECLARATION
1 HEREBYAFFIRA UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
_ I HAVE AND WALL MAINTAIN A CERTIFICATE OF CONSENT TO SE1F4NSURE FOR WORKERS'
COMPENSATION, AS PROVIDED BY SECTION 37DO OF THE LABOR CODE, FOR THE PERFORMANCE
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.
-1 HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE, AS REOUARED BY SECTION
37000E THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED. MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMDER ARE:
CARRIER
POLICYNUMBER
(THS SECTION NEED NOT BE 000XUTED OF THE PERMIT IS FOR ONE HUNDRED DOLLARS (3100) OR LES.%
I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I
SHALL NOT EMPLOYANY PERSON N ANY MANNER SO AS 70 BECOME SUBJECT TO THE
WORKERS, COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF 1 SHOULD BECOME
SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF BECTON 3700 OF THE LABOR
CODE.1 SHALL FORTHWITH COMPLY WITFI THOSE PROVISIONS.
DATE: APPLICANT.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL BE
SUELIECTAN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (SIM.000L N ADDITION TO ME COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN
SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
1 HEREBY AFFIRM UNDER PENALTY OF PERJUAY THAT THERE IS A CONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEG 3097, CIV. C).
LENDERS NAME
LENDER'SADORESS
I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS ACLATNG TO BUILDING
CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES.
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E I E E (PRINT]
3ICNATVAM PETWIrTEV DATE
PRESS
FIRMLY
APPLICATION —q PERMIT
DATE NUMB ER1� q/C
ISSUE TYPE OCC
DATE CONST. GROUP
ZONING SETBACKS ;
FRONT RW ❑
REAR O
SIDEISIDE STREET RW ❑
SIDE ❑
PROPOSED USE
NO. DWEL NO. NO.
UNITS STORIES BEDROOMS
DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION
SFR/ADD/REM
Garage/Carport
Patic/Deck
LwLI
LL
Pool/Spa
ZRe
-Roof
Commercial
In
Valuation ADJ.AREA
QUANTITY DESCRIPTION FEE
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CONSTRUCTION
PLAN REVIEW
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BUNG
MECHANICAL
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INSPECTION FEE 14f "mi
ISSUANCE E
SMIP
4.�1
ENERGYP/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—ADpllcant's COw
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CITY.OF DIAMOND BAR
INSPECTION RECORD
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SET BACK :
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FLOOR JOIST
FIGS/FORMS/STEEL
- "
FHA REQMTS
ELECTRIC GROUND
GROUND PLUMBING
�/
UNDERFLOOR DUCT !
UNDER FLOOR CONDUIT
SLAB GRADE
FIREPLACE FbutIDATION
TEMP POWER -
FIREPLACE BOND BEAM -
WATER SERVICE
MID HT. BOND BEAM
ROOF SHEATHING
8 F.T. BOND BEAM 1 .
FRAMINGNENTILIATION
-
'FINAL BOND BEAM j
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.:
FINAL HEATING --,!
-FINAL ELECTRIC d'//��
FINAL PLUMBING
FIRE DEPT., FINAL. -
HEALTH DEPT.'FINAL
DEV. FEES PAID
ENERGY
COMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE