HomeMy WebLinkAbout17661 (44) _�� _ CITY OF DIAMOND BAR �r �
� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �
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21825 E.Copley Drive
(909)860-3195 Faz(909)861-3117 PRES$
"''�.���± BUILDING PERMIT APPLICATION � FIRMLY
� JOBSITE � APPLICATION i � PERMIT I J.� P/C I
o ADDRESS DATE � NUMBER �I� / # �
� ISSUE /l� TYPE OCC
APN LOT TRACT DATE V
CONST. GROUP
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� ADDRESS � ZONING SETBACKS
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cn DESCRIPTION SQ.FT. FACTOR PSF ADJ-AREANALUATION
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I HEREBV AFFIfiM UNDER PENAL7V OF PERJURV THAT I AM EXEMPT FROM THE CONTRACTORS LI- Gef8y0/CefPOft
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U COUNTYWHICHREOUIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC-
w TURE,PRIOR TO ITS ISSUANCE.ALSO REOUIRES 7HE APPLICAN7 FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck
S7A7EMENT 7HAT HE OR SHE IS LICENSED PURSUANT TO THE PHOVISIONS OF 7HE CANTRACTORS LI-
� CENSE LAW(CHAPTER 9(CAMMENCING WI7H SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � POOVSpe
FESSIONSCADE)ORTHATHEORSHEISE%EMPTTHEREfROMANDTHEBASISFORTHEALLEGEDEXEMP- (�
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A CIVIL PENALTY OF NOT MORE THAN fIVE HUNDRED DOLURS(f500).�:
Z ❑I,ASOWNEROFTHEPROPERTV,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECAMPENSA710N, � CORIrt10fClel � I
WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SAIE(SEC.7o4I,BU51- J
N NESS AND PROFESSIONS CODE:7HE CANTRAC70F5 LICENSE LAW DOES NOT APPLV TO AN OWNEP OF �
PROPER7Y WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
C[ THROUGH HIS OR HER OWN EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
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Z TION,THE OWNEfi-BUILDER WILL HAVE THE BURDEN OF PHOVING THAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF SALE).
w ❑I,ASOWNEROFTHEPROPERIV,AME%CLUSIVELYCqN7RAC71NGWITHLICENSEDCONTRACTOFS
� TO CANS7RUCT THE PRQIECT(SEC.70l1,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- V81U81i0f1 ADJ.AREA
W CENSE LAW DOES NOT APPLV TO AN ONMER OF A PROPERTY WHO BUILDS OR IMPROVES 7HEREON,AND
� WHOCONTRACTSFORSUCHPRQIECTSWITHACANTRACTOR(5)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE
Y TORS LICENSE LAW.�.
� ❑I AM ExEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q
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� LICENSED CONTRACTORS DECLARATION w
� I HEREBY AFFIRM UNDER PENALTY OF PERIURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
d B(COMMENCING WITH SECTION 7000)OF DIVISION 3 0F 7HE BUSINESS AND PROFESSIONS CODE,AND Z
X MY LICENSE IS IN FULL FOHCE AND EFFECT. m
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� LICENSE`CLASS LIC.NO. 7 b j
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� WORKERS'COMPENSATION DECLARATION a
� I HEREBV AFFIRM UNDER PENALTY OF PERJURV ONE OF THE FOLLOWING DECLARATIONS: Z
Z _I HAVE AND WILL MAIN7AIN A CER7IFICA7E OF CONSENT TO SELF-INSURE FOR WORKERS' _
CAMPENSA710N,AS PROVIDED BY SECTION 370o OF THE UBOR CODE,FOR 7HE PERFORMANCE U
a OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
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w _I HAVE AND WILLMAINTAIN WORKERS'COMPENSATION INSUflANCE,AS REOUIHED BY SECTION i-���//q/ �\
Q 370o OF 7HE LABOFi CODE.FOR THE PERFORMANCE OF THE WORK fOR WHICH THIS PERMI7IS �v 1 � U
ISSUED.MY WORKERS' MP SA710N INSURA E CARRIER AND POLICV NUMBERARE: CONSTRUCTION
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� CARRIER �� �V// PLAN REVIEW
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� (iHI55ECilONNEmNOTBE00MPLEfEDOFTHEPERAVTISFORONEHUMREDDOl1MS(5100)ORLESS� PLUMBING
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Z I CERTIFY THAT MTHE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
CJ SHALL NOT EMPLOY ANY PERSON IN ANV MANNER SO AS TO BECOME SUBJECT TO THE
� WORKERS'COMPENSA710N IAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE
= SUBJECTTOTHEWORKERS'CAMPENSATIONPROVISIONSOFSECTION3700OFTHELABOR
CODE,I SHALL FORTHWITH COMPLV WITH THOSE PROVISIONS. ISSUANCE
� SMIP
p DATE: APPLICANT.
J WARNING FAILUHE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C
LL SUBJECTANEMPLOVERTOCRIMINALPENAL7IESANDCIVILFINESUP700NEHUNDREDTHOUSAND ENERGYPERMIT
DOLLARS(f7oo.oao�,IN ADDITION TO7HE COS70F COMPENSATION,DAMAGES AS PROVIDED FOR IN
� SECTION 37080FTHE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. ' RETENTION FEE:
d CONSTFiUCTION LENDING AGENCY PRE-ALT FEE:
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� I HEREBV AFFIRM UNDER PENAL7V OF PERJURV THAT THERE IS A CONSTRUC710N LENDING AGENCY
� FOR THE PERf-0RMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.C.).
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� LENDER'S NAME
F_ LENDER'SADDRESS � �
� TOTAL FEES I �,
� I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
w I AGREE TO COMPLY WITH ALL CITY AND CAUNTV ORDINANCES AND STATE LAWS RELATING TO BUILDING
� CONSTRUC710N,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE
� ABOVE�MENTIONED VROPERT FOF IN ECTION PURPOSES.
Z COMMENTS
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� SIGNATUREOFPERMITTEE DAT
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SLAB GRADE FiREPLACE FOUNDATiON ' � _
TEMP POWER � FIREPLACE BdND BEAM____ ______� ____
WATER SERVICE __��____ _� MiD HT. BOND BEAM _ _ ___ _
ROOF SHEATHING Z��(�/dl- � +8 Ff. B�ND BEAtJ� ----- ' ----
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ROOF COVER �3/Q,/sZ ��c�a.��' PRE-GRAD{NG
ROUGH HE,4TING QENCHItJG
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SHOWER/TUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING- ---�-------A-^-
WALL INSUlAT1C�(J POOL FINAL
CEILING INSULATION OFF SITE IMP'S. � � ��
DRYWALL NAILING DEDICATIONS
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SEWER FINAL ENG.
SEPTIC TANK � LANDSCAPE/IRRIG.
SEEP PIT/LL. , CN SITE IMPS.
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FINA�COiVST. �/G/o���f�c�¢,P�` ' FlRE DEPT. FINA� _
FINAL HEATIfVG I � HEALTH DEPT. FINAL
FINAL ELECTRIC ; � �EV. FEES PAID
FIh1AL PLUfVIBIP�G ENERGY I
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