HomeMy WebLinkAbout16934 ��` CITY OF DIAMOND BAR ������D
� DEPARTMENT OF COIvIIvIUNTTY&DEVELOPMENT SERVICES
21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 JUN 18100Z pRESS
��"-���� BUILDING PERMIT APPLICATION FIRMLY
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o ADDRES� CGYI'1 ZONING SETBACKS
z CITY ZIP TE 9 ( 7 FRONT RW ❑
o APPLICANT TEL. SIDE/SIDE STREET RW ❑
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� CITY ZIP O7 TEL.F�ODoZS�I(d 7�o PROPOSEDUSE -
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�z DESIGNER NO.DWEL. NO. NO.
� ADDRESS UNITS STORIES BEDROOMS
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cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
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I HEREBV AFFIRM UNDER PEN/�L7V OF PERIURY THAT I AM EXEMPT FROM THE CON7RACTORS LI- Gef89B/CBfPOR
W CENSELAWFORTHEFOLLOWINGREASON(SEC.7031.58USINESSANDPROFESSIONSCODE:ANVCI7VOR (n
U COUNT/NMICHREOUIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC- .
w TURE,PRIOR TO ITS ISSUANCE.ALSO REOUIRES THE APPLICANT FOR SUCH PE(iMIT TO FILE A SIGNED W Patio/Deck
STATEMENT THAT HE OR SHE IS LICENSED PURSUAN7 TO 7HE PROVISIONS OF THE CONTRAC70R5 LI-
� CENSE LAW(CHAPTER B(COMMENCING WITH SECTION 7000)OF�IVISION 3 OF THE BUSINESS AND PRO- � POOVSPB
O FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFOfi7HEALLEGEDEXEMP- (rJ
V TION.ANV VIOUTION OF SECTION 7031.5 BV ANV APPUCANT FOR A PERMIT SU&lECTS THE APPLICANT TO Z Re-Roof
A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(f5ao).�:
OI,ASOWNEROF7HEPROPERN,ORMYEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSA710N, �
Z WILL DO THE WOqK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7014,BUSI- J COmmBfCi81 -
� NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF �
PROPEHTY WHO 3UILDS OR IMPFiOVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
Q THROUGH HIS OR HER ONM EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS ANE NOT IN7ENDED OR m
w OFFEREDFORSALE.IF,HOWEVER,hIEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE�
� TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
Z IMPROVE FOR 7HE PURPOSE OF SALE).
_ ❑I,ASONRJEROFTHEPROPERTY,AMEXCLUSIVELYCANTHACTINGWI7HlICENSEDCANTRACTORS
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� TO CONSTRUCT THE PROJECT(SEC.70td,BUSINE55 AND PROFESSIONS CODE:THE CONT{iAC70R5 LI- V81U81i0f1 ADJ.AREA
W CENSELAWDOESNOTAPPLYTOANOWNEROFAPROPERTVWHOBUILDSORIMPROVES7HEHEON,AND
� WHOCONTRACTSFORSUCHPRQIECTSWITHAfANTHACTOR(S�LICENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION FEE i
Y 70RSLJCENSELAW.).
� ❑1 AM EXEMPT UNDER SEC. B.6 P.C.FOR THIS REASON Q
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DATE OWNER �
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� LICENSED CONTRACTORS DECLARATION W
� I HEREBV AFFIfiM UNDER PENALTY OF PERJURY 7HA71 AM LICENSED UNDER PROVISIONS OF CHAPTEF � �
d B(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z
`X AIV LICENSE IS M FULI FqpCE yJD FFECT. m
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� LICENSE C S � � IIC.NO. j
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U DATE CONTRACTOH � � � a
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o� WORKERS'COMPENSATION DECLARATION �
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� I HEREBV AFFIRM UNDER PENALTV OF PERJURV ONE OF THE FOLLOWING DECLARATIONS: Z
� _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CqNSEN7 70 SELF-INSURE FOR WORKERS' _
Q COMPENSATION,AS PROVIDED BY SEC710N 37o00F THE LABOR CADE,FOR THE PERFORMANCE w
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
�
w �I HAVE AND WILL MAMTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BY SECTION
Q 3700 OF THE LABOR CqDE.FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PEFiM1T IS
ISSUED.MY WORKE COMPEN TIO INSURAN E CARRIEH AND POLICV NUMBERARE: CONSTRUCTION
¢ �2�-�`i�v-ct�.
] CARRIER PLAN REVIEW
� POLICY NUMBER S E�ECTRIC
Z
¢ S 0
� (fHISSECTqNNE�NOTBEODMPLEfFDOFTFiEPERMffISFORONEHUrDREDDOLLAAS(f100)ORLESS� PLUMBING
Z I CERTIFV THAT IN THE PERFORMANCE OF 7HE WORK FOF WHICH THIS PERMIT IS ISSUED,I MECHANICAL
(.'} SHALL NOT EMPLOY ANV PERSON IN ANY MANNER 50 AS TO BECAME SUBJECT TO THE ��' ^ ' �
N WORKERS'COMPENSATION LAWS OF CALIFOFINIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE 1, �'--�J� � I V`
? SUBJECT TO THE WORKERS'CAMPENSATION VISIONS OF SECTION 9700 0F THE LABOR �L �� ' `�(�
COD�` ALL ORTHWITHCOMPLVWITHT�J PROVISIONS. ISSUANCE n �
p DATE: `� � O I APPLICANT. I`��/W� SMIP 1 ,r �` ��J /�r I I
� ENERGY P/C I
J WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE
� SUBJECTANEMPLOYERTOCRIMINALPENALTIESANOCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT I
DOLLARS(5100.000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDE�FOR IN IR
� SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTOHNEV'S FEES. RETENTION FEE: `�-+V' '�'�'����_�
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� CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS ACONSTRUCTION LENDING AGENCY
� FOR THE PERFOflMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.C.).
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� IENDER'S NAME
F_— LENDER'S ADD{iESS /+�
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� ICERTIFVTHATIHAVEflEADTHISAPPLICATIONANDSTATE7HATTHEABOVEINFORMATIONISCOFRECT. TOTAL FEES
� I AGREE TO COMPLY WITH ALL CITY AND COUNTV ORDINANCES AND STATE LAWS RELATING TO BUILDING
� CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
Z ABOV��MENTIO�PROPERTY FOR INSPECTION PURPOSES. COMMENTS
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� SIGNATUREOFPERMITTEE DATE
= RECPT.NO. PAID BY VALIDATION
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FTGS/FORMS/STEEL i FHA REQMTS � �
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ELECTRIC GROUND � UNDER FLOOR DUCT � �
-- -- ------ ----.__....�.--- -_. —.._.._�..-------_ � _._.____
GROUNQ PLUMBING � UNDER FLOOR CUt�IDUIT � ______
SLAB GRADE � _.__ ______ .._FIREPLACE FOUNDATI(3Ad___ ; _� �_ �
_ - -----......_.
TEMP POWER j ; FIREPLACE BOND BEAM '
WATER SERVICE � � MID HT. t3UNd BEAM
-- --- -._._ _—_._._____� —__._ —__.---__..._____________ __....____
ROOF SHEATHI(VG � 8 FT. BOND BEAM i
FRAMINGNENTILIATION �FlNA�BOiVD BEAM �
-- — .----- - ._. __._... ...---._._________- ____..._......----..
ROOF COVER PRE-GRADIfJG i �
FiOUGH HEATING B�NCHING i ,
ROUGH ELECTRIC ROUGH GRAdiNG
ROUGH PLUNIBING ' ; FIIUISH uRADtNG
-- ---_-- --- _-----
SHOWER�TUB TEST • ; POOL ELECTRIC _
-- ---- --..
EXT. LATH/SIDING j POOL F�NC{NG ;
WALL IiVSULATIOfV POOL FINAL
-- --_ — __..__.
CEILING IN�ULATION � OFF SITE IMPS. ;
DRYWALL N;41UNG DEDICATtONS J
SEWER --- ------ FINAL ENG.- --�------------ -----
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/L.L ON SITE IMPS. '- - - -� — --------.__�
GAS AIR TEST FWAL Z�NING
FIIVAL CONSL � FiRE DEPT. FINA!
FINAL HEATIMG �_ HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING � ENERGY �
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SEPTIC TAi�K SIZE
SEEP PIT/U SIZE -- —�— — -------- --
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