HomeMy WebLinkAbout12-557 (6) i .,
CITY OF DIAMOND BAR ✓ I
, "--�� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
' , 21825 Copley Drive,Diamond Bar,CA 91765
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 RES$
�'°�°. BUILDING PERMIT APPLICATION FIRMLY
o� JOBSITE r� 1 A � ` APPLICATI PERMIT I���� p/C
ADDRESS ��1 O �lA�\Y1 �,(�� 1 DATE ��' I Z- NUMBER/ �
� ISSUE��— TYPE i OCC
APN LOT TRACT DATE CONST.�y��;�'i'�— GROUP
p OWNER
p ADDRESS � ZONING SETBACKS
z CITY ZIP�$ TEL. � - FRONT qyy �
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a ADDRESS NO.DWEL. NO. NO.
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� DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
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� I HEREBY AFFIRM UNDER PENALTV OF PERJURV THAT I AM E%EMPT FROM TNE CONTRACTORS U- G818 B/C8
W CENSEUWFORTHEFOLLOWINOREASON�SEC.70.71.6BUSINESSANDPROFESSIONSCODE:AtJVC17YOR (� 9 ��
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w NRE,PHIOR TO ITS ISSUANCE,/�150 REOUIFES THE APPLICANT FOR SUCH PERMIT TO FILE A SI�NED w
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI�
� CENSE LAW(CHAPTER e(COMMENCINO WITH SECTKKJ 7000)OF DIVISION 3 OF THE BUSINESS AND PRO• � POOUSPB
FESSIONSCODE)OR7}UTHEORSHEISEXEMPTTHEREFROMANDTMEBASISFORTHEALLEGEDEXEMP- (�
TION.ANV VIOUTION OF SECTION 7031.6 BV PNY APPLICANT FOR A PERMIT SU&IECTS THE APPLICANT TO Z Re-Roof
A CIVIL PENALTV OF NOT MORE TMAN FIVE HUNDRED DOLLARS(f500)J:
� ❑I,ASON?JEROFTHEPROPERTV,ORMVEMPLOVEESWITHWAOESASTHEIRSO�ECOMPENSATION, � CpmmBfCl81
Z VALL DO THE WORK�N�THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70N,BU51� J
� NESS AND PqOFESSIONS CADE:THE CONTRACTORS UCENSE LAW DOES NOT APPLV TO AN OWNER OF j
PROPEfRV Vh10 BUILOS OR IMPROVES THEREON,AND YAiO DOES SUCH WOPK HIMSELF OR HERSELF OR
w TMROUGHHISORHEROWNEMPLOVEES,PROVIDEDTHATSUCHIMPROVEMENTSARENOTWTENDEDOR m
Q OFFEREDFOp5ALE1F,HOWEVERTMEBUILDINGOflIMPqOVEMENTIS50LDWfTMNONEVEAROFCOMPLE-
z TqN,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVWO THAT HE Oq SHE DID NOT BUIID OR
� IAIPROVE FOR 7HE PURPOSE OF SALE).
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❑1,AS ONRJER OF THE PROPERTY,AM E%CLUSIVELY CONTRACTING WfTH LICENSED CONTRACTORS
[[ TO CONSTRUCT TME PR0.IECT(SEC,701�,BUSINE55 AN�PROfE5510N5 CODE:THE CANTRACTORS LI� V8IU8SIOf1 ADJ.AREA
� CENSE LAW DOES NOTAPPLY TOAN ONRJER OF A PROPERTV WHO BUILDS OR IMPROVES 7HEREON,AND
WFIOCANTRACTSFORSUCHPRQIECTSWITHACONTRAC70R(S)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION
TORS LICENSE UW.). FEE
� ❑I AM E%EMPT UNDER SEC. B.8 P.C.FOR THIS REASON �
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� DATE OWNER ¢
�Q LICENSED CONTRACTORS DECLARATION w �
CC I HEHEBY AFFIRM UNDER PENALTV OF 7ERJURV TNAT I AM UCENSED UNDER PROVISIONS OF CHAPTER �
� B(COMMENCIN(3 WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z
��� W LICENSE IS IN FU�L FORCE EFFECT. m
� LICENSE C S �"'O LIC.NO. � ``D�� �
U DATE CONTRACTOR d
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� WORKERS'COMPENSATION DECLARA � r• - � ToY1
� I HEqEBY AFFIRM UNDER PENALTV OF PERIURY ONE OF THE FOLLOWING DECLAAATIONS: V
� Z
0 _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CqNSENT TO SELFINSURE FOR WORKERS' _
¢ COIdPENSATpN,AS PROVIDED BV SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMANCE U
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
�
I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIqED BV SECTION
Q 370o OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMR IS
� ISSUED.MV�;�PEry5q7��URANCE CARRIER AND POLICV NUMBERME: CONSTRUCTION
�j CARRIER /�CJ�•�� /1� PLAN REVIEW
POIICY NUMBER I�7 l-� \ �� �3`C li�
¢ •• ELECTRIC
� (i}USSECTqNNE�N0T8ECOARFfIDOFhEPE(AT�ISFOqONEFIU.pqEpp0.V�0.S(ilpp)pqLESS} PLUMBING
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Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERAl1T IS ISSUED.I MECHANICAL
G� SHAIL NOT EMPLOY ANY PERSON IN ANV MANNER SO AS TO BECAME SU&IECT TO THE �'�(-
(/� WORKERS'CAMPENSATION LAWS OF CALIFORNIq AN0 A4REE THAT IF I SHWLD BECOME INSPECTION FEE
SU&IECTTOTHEWORKERS'COMPENSATIONPROVISIONSOFSECTION37ooOFTHELA80R � , �
S COD I ALL FORTHWITH COMPLV THOSE PROVISIONS. ISSUANCE
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p DATE: APPLICANP. SMIP �
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'J WARNINO:FAILURE TO SECUPE WORKERS'CAMPENSA ON VERAGE IS UNUWFUL,AND SHAL�BE ENERGY P/C �
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� SU&IECTAN EMPLOVER TO CRIMINAL PENALTIES AND CI ES UP TOONE HUNDRED THOUSMID ENERGY PERMIT
DOlLARS(f100,000).IN ADDITION TO THE COST OF CAMPENSATION,DAMAGES AS PROVIDED FOR IN
w SECTION 37oe OF THE U80R CODE,INTEREST,AND ATTORNEV'S FEES. RETENTION FEE:
O CONSTRUCTION LENDING AGENCY PqE-ALT FEE:
� I HEREBV AFFIRM UNDER PENALTV OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AOENCV
FOR THE PERFORMANCE OF iHE WORN FOR WHICH THIS PERMIT IS ISSUED(SEC.3007,CIV.C.).
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� LENDER'S NAAIE
H LENDERSADORESS
w I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORAIATqN IS CORRECT. TOTAL FE ES � � �
� I AGREE TO COMPLV N7TH ALL GTV AND COUNTY ORDINANCES AND STATE L1W5 REUTINO TO BULLAINO
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO EMER UPON THE
Z ABOVE-MENTpNED PROPERTV FOR INSPECTION 7URPOSES. COMMENTS
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� SI RE OF P DATE
� RECPT.NO. PAID BY� VAUDATION
WHITE—Department Copy,YELLOW�inence Copy,PINK—Assesaor Copy,GOLDENROD—Flle Copy,OREEN—ApplicanPs Copy
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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 BOND BEAM
WATER SERVICE MID HT. BQND BEAM
ROOF SHEATHING ' ' 8 FT. BOND BEAM
FRAMINGNENTILATION FINAL BOND BEAM
ROOF COVER PRE-GRADING .
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
' ROUGH PLUMBING FINISH GRADING
SHOWERlTUB TEST POOL ELECTRIC
EXT.LATH/SIDING POOL FENCING
WAL��NSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
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
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COMMEfVTS '
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SEPTIC TANK SIZE
SEEP PIT/U SIZE
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