HomeMy WebLinkAbout17603 �
CITY OF DIAMOND BAR ��
��----��``--- DEPARTMENT OF COMMUNTI'1'&DEVELOPNIENT SERVICES �
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21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 PRESS
��"-����+ BUILDING PERMIT APPLICATION FI RM LY
� JOBSITE / r APPLICATION PERMIT P/C
o ADDRESS � C� f� � DATE O NUMBER ����3 g
� ISSUE TYPE OCC
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o ADDRESS � ZONING SETBACKS
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CONTRACTOR
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� CITY ZIP TEL. PROPOSED USE
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iz DESIGNER NO.DWEL. NO. NO.
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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 AFFIFM UNDER PENALTV OF PERIURV THA7I AM E%EMPT FROM THE CONTRACTORS LI- GefBJe/C2fPOft
W CENSELAWFORTHEFOLLOWINGHEASON(SEC.70.71.SBUSINESSANDPROFESSIONSCODE:ANYCITYOR (n
U COUNT'NMICHREOUIqESAPERMIT70CAN5TRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANVSTRUC-
w TURE,7RIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICAN7 FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck ,
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF 7HE CANTRACTORS LI�
� CENSE LAW(CHAPTER B(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF 7HE BUSINESS AND PRO- u' POOVSPe
I O FESSIONSCODE)ORTHA7HEOFiSHEISEXEMP77HEREFROMANDTHEBA5ISFORTHEALIEGEDE%EMP- (� I
V TION.ANYVIOLATIONOFSECTION7031.5BVANYAPPLICANTFOHAPERMI7SUBJECTSTHEAPPLICANTTO Z Re-Root �.
A CIVII 7ENALTY OF NOT MORE THAN FIVE HUNDRED DOLURS(5500).):
Z ❑I,ASONRJEROFTHEPROPERTY,ORMVEMPLOYEESWITHWAGESAS7HEIRSOIECOMPENSATION, � COrt1ff18fCi21 � i
WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70�1,BUSI� J
N NESS AND PROFESSIONS CODE:THE CON7RAC70R5 LICENSE LAW DOES NOT APPLV TO AN OWNER OF � i
PROPEF7V Vh10 BUILDS OR IMPROVES 7HEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
� THROUGH HIS OR HER OWN EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS AfiE NOT INTENDED OR m
Q OfFEHE0WR5ALE.IF,HOWEVER,THEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE- ' '
Z TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD Ofl �
� ,IMPRO FOR THE PURPOSE OF SALE). �
I,AS OWNER OF THE PROPERTv,AM EXCLUSIVELY CONTRACTING W ITH LICENSED CON7RACTORS
� TO NSTRUCT THE PRQIECT(SEC.7004,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- V8IU8IlOf1 ADJ.AREA
W CENSEUWDOESNOTAPPLV70ANON?JEROFAPROPER7VWHOBUILDSORIMPROVESTHEREON,AND
� NMOCANTMCTSFORSUCHPRQIECTSWITHACANTRACTOR�S)LICENSEDPURSUANT707HECONTRAG QUANTITY DESCRIPTION FEE
Y TO{iS LICENSE IAW.).
� ❑I pAI EXEMPT UNDER SEC. B.6 P.C.FOR THIS REASON Q
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DATE �7 �_ I�I OWNER � U •
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� LICENSED CONTRAC RS DECLARATION w
� I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAP7ER �
d 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z
�X MY LICENSE IS IN FULL FORCE AND EFFECT. m
� LICENSE CLASS UC.NO. j
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V DATE CONTRACTOR a
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� WORKERS'COMPENSATION DECLARATION Q
NI HEHEBV AFFIRM UNDER PENALTY OF PERIURY ONE OF THE FOLLOWING DECLARATIONS: Z
� I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORKERS' _ -
� CAMPENSATION,ASPROVIDEDBVSECTION37000FTHELABORCODE,FOPTHEPERFORMANCE w
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
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w _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION
Q 3700 OF THE LABOR CODE,FOfl THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED.MY WORKERS'CAMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION
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j cnaRiER PLAN REVIEW
ZPOLICY NUMBER ELECT
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� (iHISSEC7qNNEmNOTBE00MRE�EDOFTHEPEMIf�ISFORONEFNI�DREDDOLLARS(L100)OqLESS). PLUMBING
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Z I CERTIFY THAT M THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL � �——'� /�'�� � � f � �
(,'} SHALL NOT EMPLOV ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE � � � � � - -.%
� WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOUID BECOME INSPECTION FEE ' /J
= SUBJECT TO THE WORKERS'CAMPENSATION PROVISIONS OF SECTION 3700 OF THE UBOR I �F r I O �1 n n� �S •
CADE,I SHALL FORTHWITH COMPLV WITH THOSE PROVISIONS. ISSUANCE
p DATE: APPLICANT. SMIP � �/`�,
J WARNING:FAILURETO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALLBE ENERGY P/C �-- '
� SU&IECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHl1NDREDTHOUSAND ENERGYPERMIT i—.--�'•
DOLLARS(flao,000),IN ADDITION TO THE COST OF COMPENSA710N,DAMAGES AS PROVIDED FOR IN
J SECTION 3)ae OF THE LABOF CODE,IN7ERE57,AND ATTORNEV'S FEES. RETENTION FEE: � �w
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� CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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Q 1 HEREBV AFFIRM UNDER PENAL7V OF PERJURV THAT THERE IS A CONS7HUCTION LENDING AGENCY
n- FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.7a87,CIV.C.�.
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� LENDER'S NAME
� IENDEfl'SADDRESS _
� I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFOFMATION IS CORRECT. TOTAL FE ES �� 5a
w I AGREE TO COMPLY WI7H ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELA7ING 70 BUILDING
� CANSTRUCTION,AND HEREBV AU7HORIZE REPRESENTATIVES OF 7HI5 COUNTY TO ENTER UPON THE
ZABOVE�MENTIONED PROPERN FOR INSPECTION PURPOSES. COMMENTS
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� IGN Ufj� F R I�jf7E DATE '
_ � �� RECPT.NO. PAID BY VALIDATION
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FTGS/FORMS/STEEL � FHA REQMTS - • _
ELECTRIC GROUND � UNDER FLOOR QUCT , �
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GROUND PLUMBING ; _ _ ___ _____� ! UNUER FLOOR CUt?!DUIT !
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SLAB GRADE I __�_ FIRERLAt,E;F(�U�lt�AT10N _' __ _
TEMP POWER , _+ FIREPLACE BOND BEAM __
WATER SERVICE__ _ � _.__ � MID HT. BOND BEAM
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ROOF SHEATHING � . ' ' 8 FT, B�ND B��1f+r! � � �
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FRAMINGNENTILIATION � j FINAL BOND BEAM �
RO�F COVER ' � PR� E-GRADING _ _ __
ROUGH HEATING � BENGHING
_ _ ___,_ �____. __-- ------__�
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING � ! FINISH GRADING
SHOWERlTUB TEST ' i POOL ELECTRIC
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EXT. LATH/SIDING ' ; POOL FENCING
WALL INSULATIOIV POOL F!(VAL
CEILIiVG IN�ULATIOIV - OFF SETE IMPS.
pRYWALL NAIUNG DEDlC,4TIONS
SEWER FINAL ENG.- ---- ----___ __�
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FINAL HEATIIVG j I HEALTH DEP.T. F!NAL .
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FINAL ELECTRIC j ; DEV. FEES PAID ...___.
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