HomeMy WebLinkAbout16939 (32) I
CITY OF DIAMOND BAR p
--- --�� --- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES P�CXPBY'1��
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(909)860-3195Fa�c(909)861-3117 JUN 18 2002 PRESS
�"%��� BUILDING PERMIT APPLICATION FIRMLY
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APN LOT TRACT DATE � I CONST. GROUP
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o ADDRESS � ZONING SETBACKS
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CITY � ZIP �A • T ..�6•�(4-'S�Yq� PROPOSED USE
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cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
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I HEREBV AFFIRM UNDER PENALTV OF PERIURY THAT I AM EXEMPT FROM THE CANTRACTOHS LI- GefeJB/CefpOft
W CENSEUWFORTHEFOLLOWINGREASON(SEC.7031.5BUSINESSANDPROFESSIONSCODE:ANVCITVOR (n
U CAUN7YWHICHREQUIRESAPERMITTOCONSTRUC7,AL7ER,IMPROVE,DEMOLISH,ORREPAIRANYS7RUC-
w TURE.PRIOH TO ITS ISSUANCE,ALSO REOUIfiES THE APPLICAN7 FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CANTRACTORS LI- �
� CENSE lAW(CHAPTER B(COMMENCING WITH SECTION 700�)OF DIVISION 3 OF THE BUSINESS AND PRO- POOUSPB
FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFOR7HEALLEGEDEXEMP- (�
� TION.ANY VIOLATION OF SECTION 7031.5 BV ANV APPLICANT FOR A PERMIT SU&IECTS THE APPLICANT TO Z Re-Roaf
A CIVIL PENALTV OF NOT MORE THAN FIVE HUND{iE0 DOLlARS(S5ao).):
Z ❑I,ASONMEROFTHEPROPERTV,ORMYEMPLOVEESWITHWAGESASTHEIRSOIECOMPENSATION, � COfnmBfCial
WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OH OFFERED FOR SALE(SEC.7o4t,BU51- J
� NESS AND PROFESSIONS CODE:THE CANTRACTORS LICENSE LAW DOES NO7 APPLY 70 AN OWNER OF �
PROPERTY WHO BUILDS OR IMPROVES 7HEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
2 THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMEN75 ARE NO71N7ENDED OR m
Q OFFEREDFORS�LEIF,HOWEVER,7HEBUILDINGORIMPROVEMEN71550LDWITHINONEVEAROFCAMPLE-
Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NO7 BUILD OR
� IMPROVE FOR THE PURPOSE OF SALE).
w ❑I,ASONTJEROFTHEPROPERTV,AME%CLUSIVELVCON7RACTINGWITHLICENSEDCONTRAC70RS
� TO CANSTRUCT THE Pp0.1ECT(SEC.7o�d,BUSINESS AND PROFESSIONS CODE:7HE CONTRACTORS LI� V81Ue�lOf1 ADJ.AREA
W CENSEUWDOESNOTAPPLVTOANOWNEROFAPROPERTVWHOBUILDSORIMPROVESTHEREON,AND
� WHOCONTRACTSFORSUCHPRQIECTSWITHACONTRACTOR(5)UCENSEDPUHSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE
Y TORS LICENSE LAW.).
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� ❑I AM EXEMP7 UNDER SEC. B.8 P.C.FOR THIS REASON Q
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OATE OWNER v
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� LICENSED CONTRACTORS DECLARATION w
� I HEHEBY AFFIRM UNDER PENALTY OF PERIURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
� 4(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CADE,AND Z
X MV LICENSE IS IN FULL fORCE AND EFFECT. /�
� LICEN CLASS ���V LIC.NO. ` 1 I `�� j
V DAT��O 5/3I/Z V a+- CONTRACTOR �-
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[� WORKERS'COMPENSATION DECLARATION � �
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� I HER BV AFFIRM UNDER PENALTV OF PERIURV ONE OF THE FOLLOWING DECLARA710NS: Z �,�y(7 `O S SC �
0 �IHAVEANDWILLMAINTAINACER7IFICATEOFCONSENTTOSELF-INSUFiEFORWORKERS' _
Z CAMPENSATION,AS PROVIDED BV SEC710N 370o OF 7HE UBOR CODE,FOR 7HE PERFORMANCE U I
a OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. W '
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w _I HAVE AND WILL MAINTAIN WORKERS'CAMPENSATION INSURANCE,AS REQUIRED BY SECTION
Q 3700 OF THE IABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED.MV WORKERS'CAMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION
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� CARRIER PLAN REVIEW
Z POLICY NUMBER ELECTRIC �
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� (IHISSECTIONNE�NOTBE�A�FIEfFDOFiI-IEPEfitMISFORONEHIN�DREDDOLIARS(f100)ORLESS} PLUMBING
Z I CERTIFY THAT W THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL ` _ l �
(.'} SHALL NOT EMPLOY ANY PERSON IN ANV MANNER SO AS TO BECOME SUBJECT TO THE
� WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOM INS?ECTION FEE
= SU&lEC7 TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 0F 7HE LA
CAD ,I SH L FORTHWITH COMPLV W O PROV I ISSUANCE
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p DATE:�+ �� O pppLICANT: �
J WARNING:FAILURE TO SECURE WORKERS'COMPENSA710N COVERAGE IS UNUWFUL,AND SHALL BE ENEAGY P/C
� SUBJECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFINESUP700NEHUNDPEDTHOUSAND ENERGYPERMIT
DOLLARS(f7oa.000�,IN ADDITION TO THE COST OF CAMPENSATION,�AMAGES AS PROVIDED FOR IN
� SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTOflNEY'S FEES. FIETENTION FEE:
a CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� I HEREBV AFFIRM UNDER PENALTV OF PERIURY THAT TFIERE IS A CONSTRUCTION LENDING AGENCY
� 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'SADDRESS
� TOTAL FEES '
� I CER7IFV THAT I HAVE READ THIS APPLICATION AND STATE 7HAT 7HE ABOVE INFORMATION IS CORRECT.
w I AGREE TO COMPLV WITH ALL CITY AND COUNTY ORDINANCES AND STATE UWS RELATING TO BUILDING
� CANSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
� ABOVE-MENTIONED PROPER7V FOR INSPECTION PURPOSES.
Z COMMENTS
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� ��,�� ���� $/�3/�l
� SIGNA URE PERMIT7EE TE .
= RECPT.NO. PAID BY VALIDATION
~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy
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FTGSlFORMS/STEEL ; ! FHA REQMTS �
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ELECTRIC GROUND � � UNDER FLUOR DU�T . _
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GROUND PLUMBING ; UNQER FLOOR CUI�!DUIT �
--- ' ------..... .
SLAB GRADE FIR-P ACE FOUNDATION �J
TEMP POWER _ _i_ FIREPLACE BOND BEAM
-- ----_�_______ __________.-----
WATER SERVICE ' MID HT. BOND BEAM
ROOF SHEATH{NG 8 FT. BOND BEAM _ __ ______
FRAMINGNENTILIATION FINAL BOND BEAM _ __ _____
ROOF COVER PRE-GRA�ING
ROUGH HEATING BENCHING � �
ROUGH ELECTRIC I ROUGN GRADlNG __
ROUGH PLUMBING ; FINISH �RADING
-- __..__ ----.....---- ---___.�...__ _..
5HOWER/TUB TEST ; POOL ELECTRIC
EXT. LATH/SIDING � POOL FENCING
WALL I(VSULATION POOL FINAL �
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG �
SEPTIC TANK LANDSGAPE/lRRIG.
SEEP PIT/L.L. ON SITE IMPS. � A
GAS AIR TEST FINAL ZONING
FINA�CONST. FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBIMG ENERGY
C�GI�?OG�a -----
CO�/iiViENTS •
SEPTIC TANO( SIZE
SEEP PITIU SIZE -�
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