HomeMy WebLinkAbout12-664 p�C�-CD
1��_ CITY OF DIAMOND BAR � ��/� � � R—
� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21810 Copley Drive,Diamond Bar,CA 91765
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS
,'°^'. BUILDING PERMIT APPLICATION � FVRMLY
o� JOBSITE Q�� APPLICATIO�j /�� PERMITJ � �p�Ii p/C
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cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AFiEANALUATION
Q OWNER-BUILDER DECLARATION SFR/ADD/REM
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I HEREBV.AFFlRM UNDER PEN/LLTY OF FERNRY THAT I AM EXEM7T FROA1 THE CONTRACTORS Ll- Gefe90JC9tPOi1.
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W NRE,PRIOR TO RS�ISSUANCE,ALSO REOUIRES THE APPLICAM FOR SUCH PERMIT TO FILE A SIGNED w
� STATEMENf THAT HE OR SHE IS LICENSED PURSUANT TO THE�PROVISIONS OF THE CONTRACTORS li- � �.. . .
� CENSE UW(CHAPTER B(COMMENCING WITH SECTION 7Doo)OF DtVI510N 3 OF THE BUSINESS AND PR0. PO01/SP8
. 0 FESSIONSCOD�ORTHATHEORSHEISEXEMPTTiEREFROMANOTHEBASISFORTHEALLEGEDE%EMP• C7 . . , _
V TION.ANYVIOLATIONOFSECTION7o31.5BYANVAPPIICANTFORAPERMITSU&IECTS7HEAVPLICANTTO Z Re-Rool
A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(fSOD).):
❑A AS OV/NER OFTHE�PROPEHTY,OR MY EMPLOVEES WITH 1VAGE5 AS THEIR SOLE COMPENSATION,
Z WILL DO THE 4YOR1C AND THE STAUCTURE IS NOT INTENDED OR OFFERED fOR SALE(SEC.7oaa,BU51- � COrttlflOfClal . -
� NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT AVPLY TO AN ONMER OF �
PROPEHTY NM1iO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
� THROUGHHISORHEROWNEMPLOYEES,CROVIDEDTHATSUq11MPROVEMENTSARENOTINTENDEDOR m -
Q OFFERmFORSALEIF,HOWEVERTMEBUILDINGORIMFROVEMENTI550LDWITHINONEYEAROFCAMPIE-
Z TION,THEOWNER�BUILDER WILL HAVE THE BURDEN OF PRONNG THAT HE OR SHE DID NOT BUILD OR - �
� IMPROVE FOR THE PURPOSE OF SALE).
w OI,ASOWNEROF7HEPROPERTY,AMEXCLUSNELYCONTRAC7INUWRHIICENSEDCONTRACTORS . ,
� TO CONS7RUCT THE PROJECT(SEC.7os1,BUSINESS AND PROFESSIONS CODE:iHE CONTMC70R5 LJ- V01U0fIOR ADJ.AREA.
W CENSE LAW DOES NOTAPPLY TOAN OWNER OF A VROPERTY WHO BUILDS OP IMPROVES 7HEREON,AND �
� WHOCANTRACTSFORSUCHPRQ1ECf5WITHACONfMCTOH(S)LICENSED7URSUAHTTOTHECONTRAG OUANTITY DESCRIPTION �FEE �
� TORS LICENSE LAW.).
❑I AM EXEMPT UNDER SEC. B.8 P.C.POR THIS REASON Q
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DATE OWNER ��
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� LICENSED CONTRACTORS DECLARATION w
� I HEREBY AFFIRM UNDER PENALTY OF PERIURY THAT IAM IICENSED UNDER PROVISIONS OF CHAPTER � ;
� 9(COMMENCINO�N77H SECTION 7000)OF DIVISION 30F THE BUSINESS AND PROiES510N5 CODE,AND Z
X" 4Y LICENSE IS IN FULL FORCE D EFFECT. m
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� WORKERS'COMPENSATION DECLARATION Q
� 1 HEREBV AFFIRM UNDER PENALTV OF VERJUHY ONE OF THE FOLLOWING DEClAM710N5: Z � � � � � �- �
� _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR NqRKERS' _
Q COMPENSATION,AS PROVIDED BY SECTION 37ooOF THE LABOR COOE,FOR THE PERfORMANCE �U
Q OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. � ' '
W �� 1 F1AYE AND WILL MAIMAIN WORKERS�COMPENSA710N INSUHANCE,AS REOUIRED BV SECTION ' �
Q 370a OF THE LABOR CODE,iOR THEPERFORMANCE�DF THE WOFK FOR WHltll iH15 PERMIT iS (,��� �
¢ ISSUED.MV WOR�BS'COMPENSATION INSURANCE CARqIER�AND POLICV NUMBER ARE: CONSTRUCTION� J..
> CARRIEH� PLANAEVIEW . , ��
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Z I CER7IFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS VERMIT IS ISSUED.I MECHANICAL
U' SHALL NOT EM7LOY ANV PERSON IN ANY MANNER SO AS TO BECAME SU&IECT TO 7HE
� WORKERS'CAMPENSATiONUW50FCAlIWRNIA,AtJDAGREETHATIFISHOUI BECAME INSPECTIONFEE�
= SU&IECTTOTHEWORI(ERS'COMPENSAT SOFSECTION070 HELABOR � � . �
CODE,I SHALL FOfiTHWITH COMPLY THOSE PROVI NS. ISSUANCE
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p DATE:��y.� '/` APPUCANi:
J WAiWINU:FAIWRETOSECUREWORKERS'CAMPENSATqNCAVERAGE15lINUWFU HALLBE ENERGYP/C
� SUBJECTANEMPLOYERTOCRIMINALPENALTIESANO�CIVIIFWESUPTOONEHUN HOUSAND ENERGYPERMIT
DOLURS(S100,000),�IN�DDITON TO THE COST OF CAMPENSATION,DMIAGES AS 7ROVIDED�FOR IN
¢ SE,C710N 77oe OF 7HE LABOR CODE,IN7EREST,ANDATTORNEI"S FEES. � RETENTION FEE:
a CONSTRUCTION LENDING AGENCY P E-ALT FEE:
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� I HEREBY AFFIRM UNDER PENALTV OF PERIURY THAT THERE IS A CANSTRUCTION IENDINO AGENCY
fOR THE PERFORMANCE OF THE WORK FOR WFIICH 7HI5 7ERMIT IS ISSUED(SEC.30L7,CIV.C.). ^�� ✓��
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�� LENDER'S NAME
F- LENDER'SADDRE55
� ICERTIFYTHATIHAVEREADTHISAPPLICATIONANDSTA7ETiAT7HEABOVEINFORMATIONISCORRECt TOTAL FEES � -
� I A6REE 70 COMPLY WITH ALL CT'AND COUN7Y ORDINAIJCES AND STATE LAWS REUTING TO BUILDING
� CONSTRUCTION.AND HEREBY AUTHORIZE REPRESENTATNES OF THIS COUNTV 70 ENrER UPON THE �
Z ABOV-MEMIONED PROPERTY FOR INSPECflO vuRvosEs. COMMENTS '
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= RECPT.NO. PAID BY VALIDATION
~ WHITE—De rtrnent Co YELLOW—Finance C
pa py, opy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy
CITV OF DlAMQPVD BAR
INSP�CTION RECQRD
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SET BACK �FLOOR JOIST
FTGS/FORMS/STEEL FHA REQMTS
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f_LECTRIC GROUND UNDER FLOOR OUCT
GROUND PLUMBING • 'UNDER FLOOR CONDUIT
SLAB GRADF �FIREPLACE FOUNOATION
TEMP PObVER �FIREPLACE BOND BEAM
WATER SERVICE 'MID HT.BOND BEAM '
ROdF SHEATHING I 8 FT.BOND BEAM
FRAMING/VENTILATION 'FINAL BOND BEAM
--- ----------------— - ----- ----- ---------- ---------------- --------------
ROOF COVER �PRE-GRADING
ROUGH HEATING 'BENCHING
ROUGH ELECTRIC �ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWER/TUBTEST 'POOL ELECTRIC
EXT.LATH/SIDING ;PQOL FENCING
WALL INSULATION 'POOL FINAL
CEILING INSULATIQN ;OFF SITE IMPS.
DRYWALL NAILING ';DEDICATIONS
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SEWER �FINAL ENG.
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SEPTICTANK LANDSCAPE/IRRIG.
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SEEP PIT!L.L. :.ON SfTE IMPS.
GAS AIRTEST :�FINAL ZONING
FINAL CONST. ;fIRE DEPT.FINAL
FINAL HEATING �HEALTH DEPT.FINAL
FINAL ELECTRIC �DEV.FEES PAID
FINAL PLUMBING ENERGY
FINAL PLANING
FINAL ENGINEERING • e �e '��_ ��"°���
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