HomeMy WebLinkAbout10-1027 I
_�,� CITY OF DIAMOND BAR �
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21825 Copley Drive,Diamond Bar,CA 91765 PRESS
'� (909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027
�`59���� BUILDING PERMIT APPLICATION FIRMLY
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� OWNER-BUILDER DECLARATION SFR/ADD/REM
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I HEREBY AFFIRM UNDER PENAL7Y OF PERJUNV THAT I AM E%EMPT FAOM iHE CANTiiACTORS LI- GalBgB/C9(pOR
W CENSE U�N FOR THE FOLLOWINO REASON(SEC.7031.6 BUSINESSAN�PROFESSIONS CODE:ANV CITV OR (n
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Z NRE,PRqR 70 ITS ISSUANCE,ALSO FEW IRES 7HE APPLICANT FOR SUp1 PERMIT TO FILE A SIONEO
W STATEMENT THAT HE OR SHE IS 110EN5ED PURSUANi TO THE PROVISIONS OF 7HE CONTRACTORS LI�
� CENSE U`N(CHAVTEA B(CAMMENCING WITH SECTION 7000)OF DIVIStON 3 OF TiE BUSINESS AND PRO- � P��USPB
� FESSIONSCODE)OR7HATHEORSHEISEXEMPTTHEREFFlOMANDTHEBASISFORTHEALLEGEDE%EMP- `�1
' � 71pN.ANVV10lATIONOFSECTION7031.60VANYAPMICANTFORAPERMITSU&lECTSTHEMPUCANTTO Z Fe-Roof '� [7V
� A CML VENALTV OF NOT MORE THAN FIVE HUNDRED DOl1ARS(f500�.):
� ❑I,ASOWNEROFTHEPROPERTV.ORMVEMPLOYEESWIiHWAdESASTHEIRSOLECOMPENSATION, � COrtIrtIBfC18I
Z VJlLI DO THE WORK.�ND TNE STftUCTURE IS NOT INTEN�ED OR OFFERED FOR SALE(SEC.7W�.BU51- J
� HESS AND FROFESSIONS CODE:TME CONTRACTORS IICENSE LAW DOES NOT APPLY TO fW OWNEF OF �
PROPERTYWFIOBUIIDSORIMPROVESTHEREON,ANDWHODOESSUCHWOFlKHIMSELFORHEFSELFOR m
� THROU(3H HIS OR FiER OWN EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR
W pFFEAEDFORSALEIF,HOWEVER.THEBUILDINOORIMPROVEMEMI550lDWITHINONEVEAROFCOMPLE-
� TqN,THE OWNER-&11LDER WILL HAVE TNE WRDEN OF PROVIN6 TFUT HE OR SHE DIO NOT OUILD OF
Z �AIpROVE FOR THE PURPOSE OF SALE).
' � ❑�,AS OWNER OF THE PROPERTY.AM E%CLUSNELV CANTFUCTINO WfTH LICENSED CONTRACTOR9
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Q TO CONSTRUCT THE PROJECT(SEC.7W1.BUSINESS ANO PROFESSIONS COOE:THE CONTMCTOR9 LI- ' VBIU8S�O71 � ADJ.AREA
W CENSE UW DDES NOTAPPLV TOAN OWNER OFA PROPERTV WHO BUILDS OR IMPROVES TNEREON,AND
Z WHOCONTRACTSFOASUCHPR0.IECTSWITHACANTRACTOR(S�LICENSEDPURSUANTTOTHECONTRAG pUANTITV DESCAIPTION FEE �
TORS LICENSE IAW.).
Q ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON U
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� DATE OVJNEA U '
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� �ICENSED CON7RAGTORS DECLARATION J
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I HEREBY AFFIRN UN�ER PENAL�'I OF PERIURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
d e(COMMENCINCi WfTN SECTION�000)OF DIVISION 3 OF 7HE BUSINE55 AND PROFESSKKJS CODE,AND Z ,
X 4V LICENSE IS IN FULL FORCE AND EFFECT. m
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� WOFKERS'COMPENSATION DECLARATION � �
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� 1 NEREBY AFFIRM UNDER PENALIY OF PE0.IURV ONE OF TNE FOLLOWING DECURATIONS:
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0 I HAVE AND WILL MAINTPJN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORKERS' S
� COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE,FOR TME PERFORMANCE �U
OF hIE WORK FOR WHICH THIS PERMIT IS ISSUED. �
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w �I HAVE AND WILL MAINTAIN WORKERS'COMPENSATKKJ INSURANCE.AS REOUIRED BV SECTION /�
Q 3700 OF THE IABOR CAOE,FOR THE PERFORMANGE OF THE WORK FOR WHICH THIS PERMIT IS LJ� ��
ISSUED.MV WORKE 5'CAMPENSATIO SURAN CARRIER AND POLICV NUMBER ARE: CONSTRU TION �� ��
� ��,� �� - PLAN REVIEW
CARRIEF7 4 �.���{
Z �,POLICV NUMBER � ��U ELECTRIC
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w MECHANICAL
Z 1 CERTIFV THAT IN THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED,I
�}' SMALLNOT EMPLOV ANV PERSON IN ANV MANNER SOAS TO BECOME SU&IECT TOTHE INSPECTION FEE
� WORKERS'COMPENSATION IAWS OF CALIFORNiq AND AGREE T/UT IF I SHOULD BECOME
S SU&IECTTOTHEWORKERS'COMVENSATIONPROVISIONSOFSECTION37000FTHELABOfl C �S`[�Q
CA�E.I$-HALL FORTHWITH CqMPIY WITH TNOSE PRONStONS. �
p DA7E: �✓ �L.��� APPLICANT: LU i3 � 4I f1� �P ' , �
w ENERGY P/C
--� WARNINO:FAILURE TO SECURE VJORKEfiS'COMPENSATKKJ CAVERAGE IS UNIAWFUL,AND SHALL BE '
J SU&IECT AN�MPLOVER TO CRIMINAI PENALTIES ANO CIVIL FINES UP TOONE HUN00.E0 THOUSAND
� DOLLAHS(Stao,o00).IN ADDITION TO THE COST OF CAMPENSATKJN,DAMAGES AS PROVIDED FOR IN ENERGY PERMIT
J SECTqN 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. ETENTIO . ���� '
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w CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� I HEREBV AFFIRM UNDER PENALTY OF PERIURV THAT THERE IS A CONSTRUCTION LENOINO AGENCV
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.�.
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� LENDER'S NAME
F- LENDER'SADORESS
¢ I CERTIFY THAT I HAVE READ THIS APPUCATION AND STATE 7HAT THE ABOVE MFORMATqN IS CORRECT. TOTAL FE ES ` '�����
w 1 AGREE TO CAMPLV WITH ALl CRV ANO COUNTY OROINANCES AN�STATE UWS FEUTING TO BUILDINO
� CONSTRUCTION,AND�HEPEBV AUTHORIZE REPRESENTATNES OF THIS COUNTV TO ENTEP UPON THE
� ABOVE�MENTIONED GR07ERTY FOH INSPECTION PURPOSES. .
Z . COMMENTS
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� SIO �EE DATE �
RECPT.NO. PAID BY � VALIDATION
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WHITE—Depanment Copy,YELLOW—Fl�ence Copy,PINK—Assessor Copy,QOLDENFOD--File Copy,GREEN—ApplkanYs Copy
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CITV OF DI�+iViOND BAR
INS�IECTlO� ��COFiD
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SET BACK FLOOR JOIST '
FTGS/FORMS/STEEL � FHA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOfJD BEAM
WATER SERVICE MID HT. BOND BEAM
ROOF SHEATHING 8 FT. BOND BEAM
FRAMINGNENTILATION FINAL BOND BEAM
ROOF COVER p PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWER�fUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSULATION PO�L FINAL
CEILING INSULATION OFF SITE fMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK � LANDSCAPElIRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY
C�'�n �':
COMMEiVTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
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