HomeMy WebLinkAbout17537 �-
CITY OF DIAMOND BAR
-----J�`` ---- DEPARTIv�NT OF COI�RvIUNITY&DEVELOPMENT SERVICES �
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21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 PRESS
�`'�»���' BUILDING PERMIT APPLICATION FIRMLY
o� JOBSITE� � ��� APPLICATION I � O�PERMIT I��'`11�L-�-f P/�
ADDRES DATE �`� NUMBER �, # � �
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� APPLICANT EL. REAR ❑
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cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREA/VALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
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p I HEREBV AFFIRM UNDER PENALTV OF PERIURV 7HA71 MA EXEMPT FROM THE CAN7RACTORS LI� Gfll2J0/CefPOff
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U COUNTVWHICHREOUIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC� W patio/Deck
w TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES 7HE APPIICAN7 FOR SUCH PERMIT TO FILE A SIGNED w
� STATEMENT THA7 HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CANTRAC70(i5 LI� �
CENSE LAW(CHAP7ER 8(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- POOUSPB
O FESSIONSCADE)ORTHATHEORSHEISEXEMPTTHEHEFROMANDTHEBASISFORTHEALLEGEDE%EMP- (�
V TION.ANVVIOLATIONOFSECTION7031.SBYANVAPPLICANTFORAPEfiMI7SU&1EC757HEAPPLICANT70 Z Re-Roaf
' � A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLURS(S5o0).):
Z ❑I,ASOWNEROFTHEPROPERTY,ORMVEMPLOYEESWITHWAGESAS7HEIRSOLECAMPENSA710N, � COrt1fflBfClel �
WILI DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7011,BU51- J
� NESS AND PROFESSIONS CODE:THE CON7RAC70R5 LICENSE LAW DOES NOT APPLV TO AN OWNER OF � �
PROPER7Y NRiO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
2 THROUGHHISOHHEROMMEMPLOVEES,PROVIDED7HATSUCHIMPROVEMENTSAFiENO71N7ENDEDOR m
� OFFEREDFORSPLE.IF,HOWEVER,TiEBUILDINGORIMPROVEMENTI550LDWI7HINONEVEAROFCOMPLE-
Z TION,THE OWNER-BUIL�ER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUIID OR
� IMPROVE FOR THE PURPoSE OF SALE).
W ❑I,ASOWNEROFTHEPROPERTV.AMEXCLUSIVELYCONTqACTINGWI7HLICENSEDCONTRACTORS
� TO CANSTRUCT THE PROJECT(SEC.70�6,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI� V2IU8(IOfI ADJ.AREA
W CENSE LAW DOES NOTAPPLY TOAN ONTJER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND
� WHOCONTRACTSFORSUCHPR0.1EC7SWITHACAN7RAC70R(S)LICENSEDPURSUANT707HECANTRAC- QUANTITY DESCRIPTION FEE
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� ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR 7HI5 REASON Q
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DATE OWNER �
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� LICENSED CONTRACTORS DECLARATION W
� 1 HEREBV AFFIRM UNDER PENALTY OF PERIURY THAT I AM LICENSED UNDER PFiOVI510N5 OF CHAPTER �
d B(COMMENCING WITM SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CO�,AND Z
X MY LICENSE IS IN FULL FORCE ND EFFECT.
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� LICENSE CLA � LIC.NO. j
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� WORKERS'COMPENSATION DECLARATION Q �
i � I HEFiEBV AFFIRM UNDER PENALTV OF PERIURV ONE OF THE FOLLOWING DECURATIONS: Z
Z _IHAVEANDWILLMAMTAINACERTIFICATEOFCONSEN770SELF-INSUREFORWOHKERS' 2
¢ CAMPENSATION,AS PFOVIDED BV SECTION a7oo OF THE LABOR CODE,FOR THE PERFORMANCE W
Q OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED. �
w IHAVEANDWILIMAINTAINWORKERS'CAMPENSATIONINSURANCE,ASREOUIREDBYSECTION
Q 370o OFTHE LABOFi CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS �
ISSUED.MY WORKERS'COMPENSATION INSURANCE�C,A/RRI'ER AND POLICV NUMBER ARE: CONSTRUCTION
j cqRRiEa� �r�� " �) PLAN REVIEW .
Z POLICY NUMBER � �GG� ELECTRIC I
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� (iHISSECiIONNE�NOTBECOfAPLEfEDOFhIEPERMffISWRONEFNI�DREDDOUARS(L100)ORLESS� PLUMBING
Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PEFMIT IS ISSUED,I MECHANICAL
(.'} SHALL NOT EMPLOV ANY PERSON IN ANV MANNEF SO AS TO BECAME SUBJECT TO THE
� WORKERS'COMPENSATIONLAWSOFCALIFORNIA,ANDAGREETHATIFISHOUIDBECAME INSPECTIONFEE �
� SUBJECT70 THE WORKERS'COMPENSATION PROVISIONS OF SECTION 370o OF THE LABOR
CADE.I SHALL FORTHWITH COMPLV WITH THOSE PROVISIONS. ISSUANCE `
p DATE: APPLICANT: SMIP .�l�
J WARNING:FAILURE TO SECURE WORKERS'CAMPENSATION COVEFAGE IS UNLAWFUL,FND SHALL BE ENERGY P/C
� SUBJECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
DOLLARS(5700.000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOH IN � �
� SECTION37o80FTHELABORCODE,INTERE57,ANDA7TORNEV'SFEES. RETENTIONFEE:
� CONSTAUCTION LENDING AGENCY PRE-ALT FEE:
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� I HEREBV AFFIRM UNDER PENALTV OF PERJURV THATTHERE IS A CONSTRUCTION LENDING AGENCV
FOR THE PERFORMANCE OFTHE WORK FOR WHICH 7HIS PERMIT IS ISSUED(SEC.9097,CIV.C.�.
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� LENDEF'S NAME
� LENDER'SADDRESS
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� I CERTIFY THAT I HAVE READ THIS APPUCATION�ND STATE THAT TFIE ABOVE W FORMATION IS CARRECT. D
w I AGREE TO COMPLY WITH ALL CITV D COUN ORDINANCES AND STATE UWS RELATING TO BUILDING �
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� CONSTRUCTION,AND HER V AU ORIZE RESENTA7IVES OF THIS COUN7V TO EN7ER UPON 7HE
Z ED PROP TV R INSPE ION PURPOSES. COMMENTS
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~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLD RO�File Copy,GREEN—Applicant's Copy
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GR�UND PLUMBING ; __ ___ __ __�_ .._ � UNQER FLOOR CU�IDUtT p �
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SLAB GRADE ;��`UL � FIREPLACE FOU{VDATiON ' �
TEMP POWER � __ FIREPLAGE B�N�J BEAM � --- ____ __...---
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WATER SERVICE i MID HT. BOND BEAM
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ROOF SHEATHING 8 FT. BOND BEAM _
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FRA�/IINGNENTILIATION I � FINA�BON� BEAM ____.i_____ �
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ROOF COVER i _ ! PRE-GRADING ___ � _. �__
ROUGH HEATING �BENCHING I
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ROUGH PLUMBING Flf�!!SH vRADING
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SHOWER/TUB TEST _ _�_�. POOL ELECTRIC _ __
EXT. LATH/SIDING � ; POOL FENGENG �
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WALL INSULATION i ; PO�L F�NAL ;
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CElLING IfV�ULATION � ' OFF SITE IMPS.
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DRYWALL hIAIUNG i ; DEDICA710NS _ _
SEWER FItvAL ENG.
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SEEP PIT/L.L. �- � � ON SITE IMPS. ; . , .
GAS AIR TEST FIi�AL ZONlNG
FIN�L CONST. /y � - — _ � , �lRE DEPT. fINAL__��� --- --�--�.
FINAL HEATING HEALTH DEPT. FiNAL
FINA�ELECTRIC i`j�1� DEV. FEES PAID
FINAL PL.UMBING ' � j ENERGY �
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CO�/IMENTS ^_
SEPTIC TAh1K SIZE
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