HomeMy WebLinkAbout17254 (25) �� CTI'Y OF DIAMOND BAR EX P I R E D
'------��` --- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21825 E.Copley Drive J U N 191��7.
(909)860-3195 Fax(909)861-3117 PRESS
����� 21715 BUILDING PERMIT APPLICATION FIRMLY
N JOBSITE APPLICATIO PERMIT P/C
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� ISSUE TYPE OCC
APN OT TRACT DATE CONST. GROUP
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o ADDR�SS O D ZONING SETBACKS
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o APPLICANT TEL. S DE/SIDE STREET RW ❑
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O ADDRE S O o _ j PROPOSED USE �D.w� ����
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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 7ERIURY THAT I AM E%EMPT FROM THE CONTRACTORS U- G8fd9B/C2fPOfI
W CENSELAWFORTHEFOLLOWINGREASON�SEC.7031.SBUSINESSANDPROFESSIONSCADE:ANVCITYOR (n
U COUNTVWHICHREOUIRESAPERMITTOCANSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANVSTRUC- W PatiolDeck
Z TUFiE.PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPUCANT FOR SUCH PERMIT TO FILE A SIGNE�
w STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CON7RAC70R5 LI� w
� CENSE LAW(CHAPTER B(COMMENCING WITH SECTION 7000)OF DIVISION 3 0F THE BUSINESS AND PRO- � POOVSPB
FESSIONSCADE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTNEBASISFORTHEALLEGEDE7(EMP� (�
� 710N.ANY VIOLATION OF SECTION 7031.5 BV ANV APPLICAN7 FOR A PERMI7 SUBJECTS THE APPLICAN7 70 Z Re-Roof
A qVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLlARS(5500)J:
Z ❑I,ASOWNEROFTHEPROPER7Y,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, O COrt1fi18fClel -
WILL DO THE WORK,AND THE STRUCTURE IS NOT INTEN�ED OH OFfERED FOR SALE(SEC.701a,BU51� J
N NESS AND PROFESSIONS CADE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF �
PFOPEflTY WHO BUILDS OR IMPROVES 7HEREON,AND WHO DOES Sl1CH WORK HIMSELF OR HERSELF OR
2 THROUGH HIS OR HER OWN EMPLOVEES,7ROVIDED 7HAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
QOFFEREDFORSILLE.IF,HOWEVER,hiEBUIIOMGORIMPROVEMENTI550LDWITHINONEVEAROFCOMPLE-
Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF SALE).
w ❑I,ASOWNEROFTHEPROPERTV.AMEXCLUSIVELVCONTRACTINGWITHLICENSEDCONTRAC70RS
� TO CANSTRUCT THE PRQIEC7(SEC.701d,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI� VelUetlOfl •� ADJ.AREA
W CENSE LAW DOES NOTAPPLV TOAN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND -
� WHOCANTRACTSFORSUCHPRQIECTSWITHACON7RAC70R(S)LICENSEDPURSUANT70THECONTMO QUANTITY DESCRIPTION � FEE
Y TORS LICENSE IAW.).
� ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q
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DATE OWNER V
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�Q LICENSED CONTRACTORS DECIARATION w
CC I HEREBY AFFIRM UNDER PENALTV OF PERJURV THA7 I AM LICENSED UNDER PROVISIONS OF CHAPTER �
� Y(COMMENCINQ WITH SECTION 7000)OF�IVISION 3 0F THE BUSINESS AND PROFESSIONS COOE.AN� Z
X MV LICENSE IS IN FULL PORCE AND EFFECT.
� LICENSE CLASS B c�i�,�3q Ff I c���.No. ���6Lb j
V DATE�f�r�I CONTRACTOR �CC d
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� WORKERS'COMPENSATION DECLARATION �
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� I HEREBVAFFIRM UNDER PENALTV OF PERIURV ONE OF7HE FOLLOWING DECLAMTIONS: Z
� _I HAVE AND WILL MAINTAIN A CERTIFICA7E OF CONSENT TO SELF-INSURE FOR WORKERS' _
Q . CAMPENSATION,AS PROVIDED BY SECTION 37000F THE UBOR CODE,FOR THE PERFORMANCE W
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
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� I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS RE�UIRED BV SECTION �,
QQ 3700 OF THE LABOR CODE,FOR THE PERFORMANCE F THE WORK FOR WHICH THIS PERMIT IS . //�rI �J
ISSUED.MV WORKERS'CC��MPE ATIO RANC�ARRIER AND POLICV NUMBER ARE: CONSTRUCTION �'„�
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� CARRIER S��I�Q �1� PLAN REVIEW
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� (iHISSECIIONNE�NOTBE�01.1ttETEDOFTHEPERMfrISFORONEHUI�DREDDOILPAS(f10D)ORLESS). PLUMBING __
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Z I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS P IT IS ISSUED,I MECHANICAL '4--�� ���\ I I^ � I� i�
C7 SHALLNOTEMPLOYANYPERSON 50 70BE &1 TTO7HE I d ' ' � � � �" �1 �
� WORKERS'COMPENSATION LAWS OF CALIFORNI AN AGREE AT I SH ULD BECOME INS?ECTION FEE �15�
= SU&IECTTOTHEWORKERS'CAMPENS IONPRO I51 NSOF ECT N370 OFTHE R I - n f1 .
CO ,I SH LL FORTHWITH COMPLV WIT THOS R ISIO . ISSUANCE / I i
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p DATE:IO DI APPLICANT: SMIP I �.
J WARNING:FAILURE TO SECURE WORKERS'CO ENSATION COVERAGE IS UNLAWFUL, SHALL BE ENERGY P/C �__.___
� SUBJECTAN EMPLOVERTO CRIMINAL PEN S AND CIVIL FINES 11P TOONE HUNDR D HOUSAND ENERGY PERMIT L`��-��'—`
DOLURS(f 700,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PR ED FOR W �
� SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. RETENTION FEE: I
� CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� I HEREBV AFFIFM UNDEFI PENALTY OF PERJURV THAT THERE IS ACONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.C.).
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� LENDER'S NAME
F_- LENDER'SADDRESS )
� I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CARRECT. TOTAL F E ES / j� ��
w I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS REUTING TO BUILDING
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATNES OF THIS COUNTV TO ENTER UPON THE
ZABOVE�MENTIONED PROPEFTV FOR INSPECTION PURPOSES. COMMENTS
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= RECPT.NO. PAID BY � � VALIDATION
~ WHITE epartment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—Applicant's Copy
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FTGS/FORMS/STEEL � FHA RE�MTS � •
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GR(�UND PLUMBING _ _ ___ j UN[�ER FLOC?R CU�IdUlT i , ` '; � ',
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SIAB GRADE FIREPLA'CE FOUNDATION ��' I �
TEMP POWER FIREPLACE BOND BEAM ___ ___
WATER SERVICE i -- MID HT. BOND BEAM ' � .
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RO�F SHEATHING jp/,�9 ts� �.--��---- 8 FT, BON'I�•�EAM.� . i ' -..---
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ROOF COVER PRE-GRADING �
ROUGH HEATWG BENCHING V �
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUiVIBING FINISH GRADlNG
SHOWER/TUB TEST ' POt�L ELEC i�iiC '
EXT. LATH/SIDING POOL FENCING �
WALL IIVSULATIOPI POOL FINAL i
CEIUNG IiVBULATION OFF SITE IMPS. '
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DRYWALL h1AlUNG DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPEfIRRIG. �
SEEP PIT/L.L. , dN SITE IMP�. i
GAS AIR TEST FiNAL ZONING
FINAL COfVST. FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINA� �
FIPJAL ELECTRIC DEV. FEES PAID
FINAL PLUMBItJG ENERGY �
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