HomeMy WebLinkAbout10571CITY OF DIAMOND BAR
COMMUNITY DEVELOPMENT DEPARTMENT
21660 E. Copley Drive Suite 190
(909) 860-3195 Fax (909) 861-3117
BUILDING PERMIT APPLICATION
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APPLICANT /L F r,FS o n/ TEL. c-1 Vg - 9 -� FB
CONTRACTOR
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DESIGNER
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OWNER -BUILDER DECLARATION
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM EXEMPT FROM THE CONTRACTORS LF
CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.8 BUSINESSAND PROFESSIONS CODE: ANY CITY OR
COUNTY MICH REQUIRES A PERMIT TOCONSTRUCT,ALTEIL IMPROVE. DEMOLISH, OR REPAIRANY STRUC-
TUBE, PRIOR TO ITS ISSUANCE. ALSO REWIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS L4
CENSE LAW (CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PRO-
FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP-
TION. ANY VIOLATION OF SECTION 7071.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO
A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (5500).):
%"AS OWNER OF THE PRDPERTY.OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION,
WILL%"
DO THE WORK. AND THE STRUCTURE is NOT INTENDED OR OFFERED FOR SALE (SEC. 7041, BUST•
NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF
PROPERTY WHO BUILDS OR IMPROVES THEREON. AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR
OFFERED FORSALE F,IOWEVER THE BUILDING OR IMPROVEMENTIS SOLD W THINONE YEAR OFCOAPLE-
TON. THE OWNER -BUILDER WLL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BURR OR
IMPROVE FOR THE PURPOSE OF SALE}
O LAS OWNER OF THE PROPERTC AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS
TO CONSTRUCTTHE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS Ll.
CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON. AND
WHO CONTRACTS FOR SUCH PROJECTS WITIACONTRACTORI31 LICENSED PURSUANT TO THE CONTRAC-
TORS
O NTRAC-TORS LICENSE LAW.).
❑ I AM EXEMPT UNDER SE�C1. B. t P.C. FOR THIS REASON
DATE O c1 t- OWNER :;=
LICENSED CONTRACTORS DECLARATION '
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER
5 (COMMENCING WITH SECTION 7800) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND
MY LICENSE IS N FULL FORCE AND EFFECT.
LICENSE CUSS LIC. NO.
DATE CONTRACTOR
WORKERS' COMPENSATION DECLARATION
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF 714E FOLLOWING DECLARATIONS:
-1 HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF4NSURE FOR WORKERS'
COMPENSATION. AS PROVIDED BY SECTION 3700 OF THE LABOR CODE. FOR THE PERFORMANCE
OF THE WORK FORMMICH THIS PERMIT IS ISSUED.
-I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY SECTION
3700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
"ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE:
CARRIER
POLICY NUMBER
(f HS SECOON NEED NOT SE CON(IETED OF il[ PERMIT IS FOR CHE HUNDRED DOLIAAS (5100)OR LESS?
I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED. I
SHALL NOT EMPLOY ANY PERSON N ANY MANNER SO AS TO BECOME SUBJECT TO THE
WOM(ERS' COMPENSATION LAWS OF CALIFORNIA. AND AGREE THAT IF I SHOULD BECOME
SUBJECT TO THE WO W(ERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR
CODE, I SHALL FOFm4W TH COMPLY WITH THOSE PROVISIONS.
DATE: APPLICANT.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWRA, AND SHALL BE
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO CNE HUNDRED THOUSAND
DOLLARS (3100.000). IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN
SECTION 37080E THE LABOR CODE INTEREST, AND ATTORNEYS FEES. -
CONSTRUCTION LENDING AGENCY
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WWCH THIS PERMIT IS ISSUED (SEC. 3097, CIV C.I.
LENDERSNAME
LENOERSADORESS
I CERTIFY THAT 1 HAVE READ TNS APPLICATION AND STATE THAT THE ABOVE NrORMATON IS CORRECT.
AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
ABOVE-MENT PON ED PROPERTY FOR INSPECTION PURPOSES.
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PERMITTE NAME NWHT)
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SKIIQATUREOFPERMIrTEE DATE
PRESS
FIRMLY
APPLICATION . PERMIT l h P/C
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DATE NUMBER r N
ISSUETYPE OCC
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DATE CONST. GROUP
ZONING SETBACKS
FRONT RW ❑
REAR ❑
SIDEISIDE STREET RW ❑
SIDE ❑ '
PROPOSED USE
NO. DWEL. NO. NO.
UNITS STORIES BEDROOMS
DESCRIPTION SO. FT FACTOR PSF ADJ. AREAIVALUATION
SFR/ADD/REM
U)
Garape/Carpon
WPatiolDeck
LL
POOVSpa
zRe•Roof
U
Commercial
5
m
Valuation ADJ.AREA
OUANTITY DESCRIPTION FEE
J
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F
W
J
W
U
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Q
_U
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S
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W
3 7r 7
NSTR C O
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
CE �S- C2C.)
MI
ENERGY P/C
ENERGY-P,6R � -
PETE.--E:
PRE -ALT FEE:
X111 �% Q
TOTAL FEES
573-
.COMMENTS
RECPT. NO. 1 PAID BY AS 9y VALIDATI
WHITE—Department Copy, YELLOW—Finance Copy. PINK—Assessor Copy, GOLDENROD—FII9 Gopy, GREEN—ArVICanrs GOW
III
CITY OF DIAMOND BAR
114SPECTION RECORD'_•
P I �j p N��
fqoRl
SETBACK
FLOOR JOIST
FTGS/FORMS/STEEL
FHA R EOMTS
-7
ELECTRIC GROUND
UNDER FLOOR DUCT
GROUND PLUMBING
UNDER FLbOA-CONDUIT',.
SLAB GRADE-
7 .!1
-777-7=
FIREPLA'dEtbUNDATION
--A
-TEMP POWER -
FIREPLACE BOND BEAM
WATER SERVICE
ROOF SHEATHING
PAID HT. BOND BEAM
8 FT. BOND BEAM
FRAMING/VENTILIATION
nOOF-COVER
ROUGH HEATING -
'I �
FINAL BOND BEAM
PRE -GRADING
BENCHING
ROUGH ELECTRIC
ROUGH GRADING.,
ROUGH PLUMBING
FINISH GRADING
SHOWERITU13 TEST,
POOL ELECTRIC;
'EXT. LATH/SIDING---
POOL FENCING'
WALL INSULATION
POOL FINAL
CEILING INSULATION
OFF SITE IMPS.
DRYWALL NAILING
DEDICATIONS
SEWER
FINAL ENG..
.SEPTIC TANK .-
LANDSCAPE/IRRIG.
SEEP-PIT/LL
ON SITE IMPS.
GAS AIR TEST- 1
FfNAL-HEATING
.FINAL ZONING %
FIRE .DEPT FINAL''
-HEALTH DEPT. FINAL
'FINAL ELECTRIC
'DEV. FEES PAID
FINAL PLUMBING
_[ENERGY
COMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE