HomeMy WebLinkAbout17886 (25) J ,
CITY OF DIAMOND BAR ' /' '
-----� -- DEPARTMENT OF COMMUNTI'Y&DEVELOPMENT SERVICES � 1.�`/
21825 E.Copley Drive �
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(909)860-3195 Fax(909)861-3117 PRESS
"''%.�r�� BUILDING PERMIT APPLICATION FIRMLY
� JOBSITE � APPLICATION PERMIT ,;^/+G/ P/C I
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� ISSUE TYPE OCC
APN LOT�_ TRACT �66 9 DATE CONST. GROUP
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cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFF/ADD/REM
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p I HEREBY AFFIRM UNDER PENALTV OF PERJURY THAT 1 AM E%EMPT FROM 7HE CONTRACTORS LI- G8f09B/CflfpOR I
W CENSE lAW FORTHE FOLLOWING REASON(SEC.7031.5 BUSINESSAND PROFESSIONS CODE:ANV CI7V OR (n
U CAUNTYWHICHREOUIRESAPEFMI7TOCONS7RUCT,AL7ER,IMPROVE,DEMOLISH,ORREPAIRANYSTRIJC- W pyf10/DBCk
Z 7URE,PRIOR 70 ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PEFiMIT 70 FILE A SIGNED
� � STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PqOVI510N5 OF THE CONTRACTORS LI� �
CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� POOVSpB
� FESSIONSCODE)OR7HATHEOHSHEISE%EMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP- (� '
V TION.ANV VIOUTION OF SECTION 7031.5 BY ANV APPLICANT FOH A PERMIT SU&IECTS THE APPLICANT T0 Z Re-Roof �
A CIVIL PENALT/OF NOT MORE THAN FIVE HUNDRED DOLLARS(t500)J:
OI,ASON?JEROFTHEPROPERTV.ORMVEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, Q
Z WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7014,BUSI- J Commercial -
� NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NO7 APPLY TO AN OWNER OF �
PROPERTV NhiO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELf OR
Q THROUGH HIS OR HER OWN EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m �
Q OFFEREDFORSALE.IF,HOWEVEfi.THEBUILDINGOFIMPROVEMENTISSOLDWI7HINONEVEAROFCOMPLE-
� Z TION,THE OWNER-BUILDEFi WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUII�OR
� IMPROVE FOR THE PURPOSE OF SALE).
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[[ TO CANSTRUCT THE PR0.IECT(SEC.7os1,BUSINESS AND PROFESSIONS CADE:THE CONTRACTORS LI- VelUeilOfl ADJ.AREA
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� NM1iOCONTRACTSFORSUCHPR0.IECTSWITHACONTRACTOR(5)LICENSEDPURSUAN7TO7HECANTMC� QUANTITY ESCRIPTION FEE
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�Q LICENSED CONTRACTORS DECLARATION w ,ry o/�� rf�,
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I HEREBV AFFIHM UNOER PENALTY OF PEFJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � /j�..r /���L
� � 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z /J •C/ ��
`X MV LICENSE IS IN FULL FORCE AND EFFECT. m
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V DATE CONTRACTOR d
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, � WORKERS'COMPENSATION DECLARATION Q
� I HEREBV AFFIRM UNDER PENALTV OF PERJURV ONE OF THE FOLLOWING DECLARATIONS: Z �
Z _1 HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WOfiKERS' 2
CAMPENSATION,AS PROVIDED BV SECTION 370o OF 7HE LABOH CODE,FOR THE PERFORMANCE U
¢ OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
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w I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BY SECTION �, I
Q 3700 OF THE LABOR CODE,FOR THE PERFOfiMANCE OF THE WORK FOR WHICH THIS PEFiMIT IS � 1'�
ISSUED.MV WOHKERS'CAMPENSATION INSURANCE CARRIER AND POLICY NUMBERARE: CONSTRUCTION V
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� � POUCYNUMBER ELECTRIC � f ' l,
¢ (iHISSECiIONNEmNOTBEOJMPLEfEDOFTHEPERMfTISFORONEHUrDREDDOILPfiS�5100)ORLESS). PLUMBING I��—��\ J l J'��-..�/i �. v
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Z I CEFTIFV THAT M THE PERFORMANCE OF THE WOHK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL ( A 1'l l] 'I /� n I s,
(} SHALL NOT EMPLOY ANV PERSON IN ANV MANNER SOAS TO BECOME SUBJECT TO THE ���� ,(, V
� WORKERS'COMPENSATION LAWS OF CALIFOfiNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE I �
SU&1EC770 THE WOFKERS'COMPENSATION PROVISIONS OF SEC710N 3700 0F THE LABOR I
� CODE,I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. �SSUANCE �
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DATE: APPLICANT.
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J WAHNING FAILUfiE TO SECURE WORKERS'COMPENSATION CAVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C O
�y SUBJECTANEMPLOVERTOCRIMINALPENALT�ESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
DOLLARS(f100.000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVI�ED FOR IN
� SECTION37080FTHELABORCODE,WTEREST,ANDATTORNEV'SFEES. RETENTIONFEE: b�
a CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� I HEREBV AFFIqM UNDER PENALTV OF PERJURV THATTHERE IS ACONSTRUCTION LENDING 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'SADDRESS C
� I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTAL FE ES �����J
w I AGREE TO COMPLV WITH ALL CITV AND COUNTV ORDINANCES AND STATE LAWS RELATING TO BUILDING '
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� CqNSTRUCTION,AND HEREBV AUTHORIZE REPFESENTATIVES OF THIS COUNTV TO ENTER UPON THE f'\e...�
Z ABOVE-MENTIONED PROPER7V FOR INSPECTION PURPOSES. COMMENTS ��
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m PERMITTEE NAME l T)
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� SIGNATUREOF ERMIT7EE DA7E
_ � RECPT.NO. � PAID BY VALIDATION
~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—Applicant's Copy
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SET BACK � � � � FLOOR JOIS� - �
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FTGS/FORMS/STEEL �� D� : � FHA REQMTS , i
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ELECTRIC GROUND � ; ' URlDER FLO�JR Dt)CT �
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GRUUND PLUMBING �,;,� - 4��_--. .__.�_ UNDER FLOOR CU��QUIT , ! -
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SLAB GRADE �_;___
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TEMP POWER _j___.__ i ----- ----;.-I i=lREPLACE BOND BEAM ----E _______._
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WATER SERVICE ; __ _ �_j MID HT. F30ND BEAPdI
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ROOF SHEATHIfVG � _ � 8 FT. BONO BEAM f__ ___I
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FRA�INGNENTILIATION C�.fS � FINAL BOND BEAPvI __ _ i
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ROOF COVER ; ' PRE-GRADING �
ROUGH HEATING BENCHING ;
ROUGH ELECTRIC _ �p� __ _____� ROUGH GRADING __ i ____
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ROUGH PLUMBING b\` � � � FINISH GRADING
._ �-- — ----------
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SHOWER/TUB TEST (ot(�ld�. ; POOL ELECTRIC
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EX.T. LAT.H/SIDING
�— j PC7�L FFNCING .-__�__ _.
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WALL INSULATIOPV � G��- ' ' PO�L FiNAL I ._.---------
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CEILING IN�ULATiON ' Q � ; t��F SITE IMPS.
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DRYWALL NAILING i ' - � j DEDICATIUNS ( �
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SEWER � F(NAL ENG. ',.
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SEPTIC TANK � LANDSCAPE,IRRIG. j .
SEEP PIT/LL. � ON SITE IMPS. I
GAS AIR TEST �_ ; �I� NAI.ZOh11NG _ _
FINAL CONST. ���Z��' � �iRE OFPT. FINA�. —__—
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FINQ,L HEATING i ; NEA�TH DEPT. FINAL
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FINA�ELECTRlC -,���i _ i j DEV. FEES PAID
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FINAL_PLUMBING i i � �NERGY
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SEPTIC TAiVK SIZE
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