HomeMy WebLinkAbout13045CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
C 21660 E. Copley Drive Suite 190
(909) 860-319S Fax (909) 861-3117
BUILDING PERMIT APPLICATION
JOBSITE l/'
ADDRESS �[�7
APN LOT TRACT Q
OWNER
ADDRESS vA ot-ou 1214.
CITY o ZIP TEL.
APPLICANT TEL -
CONTRACTOR j4TLS �i
ADDRESS J- 'f Qy4grz
CITY ZIP TEL `>'
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DESIGNER
ADDRESS
CITY ZIP TEL.
OWNER -BUILDER DECLARATION
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS U.
CENSE UW FORTHE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE:ANY CRY OR
CAUIRYWHIUI REOUNESAPERMIT TO CONSTRUCT. ALTER IMPHOVE.DEMOLISL. OR REPAIR ANYSTRUC-
TVRE, PRIOR TO ITS ISSUANCE. ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS U -
CENSE LAW (CHAPTER 0 (COMMENCING WITH SECTION 7000) OF DIVISION ] OF THE BUSINESS AND PRO-
FESSIONS CODE) ORTHITHEORSHE ISEXEMPT THEREFROM AND THE BASIS FOR THEALLEGEDEXEMP-
TION . ANY VIOLATION OF SECTION TO]I.5 BY ANY APPLICANT FORAPERMIT SUBJECTS THE APPUCANT TO
ACRAL PENALTYOF NOT MORE THAN FIVE HUNDRED DOLLARS
(5500).1,
O L AS OWNEROFTHE PROPERTY. OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION,
WILL DO THE WORK. AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE ISEC. 7044.Bus I -
NESS ANO 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 NINTENDED EED OR
OFFERED FOR SALE I; BU
HOWEVERTHELmNoon SAPROVEMENTS SOLD WITHINCNE YEAR OF COMPLE-
TION. THE OWNERI'MLDER WALL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
IMPROVE FOR THE PURPOSE OF SALE}
O L AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS
TO CONSTRUCT THE PROJECT (SEC. 7044- BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS U.
CENSE LAW DOES NOTAPPLY TORN OVMER OFA PROPERTYWHO BUILDS OR IMPROVES THEREON. AND
WMOCONTRACTSFOH SUCH PROJECTS WITHA—FACTOR(S) LICENSED PURSUANT TO THE CONTRAC-
TORS LICENSE LAW.). ,
O 1 AM EXEMPT CINDER SEG B. A P.C. FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER
a (COMMENCNO WITH SECTION 7000) OF DMSION ] OF THE BUSINESS ARID PROFESSIONS CODE, AND
MY LICENSE 15 IN FULL FULFORCEE.AND EFFECT.
LICENSE CLASS �. GS 3 UC. NO. o
DATE/_ C(NRRAC:TOW^
W__ ORKKER�S' COMPENSATION DECLARATION 2
I HEREBYAFRRM UNDER PENALTY OF PER JURY ONE OF THE FOLLOWING DECLARATIONS:
I HAVE AND WILL MAINTAIN A CEITT RCATE OF CONSENT TO SELFINSURE FOR WORKERS'
COMPENSATION, AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,
X_ 1 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 PE RN IT IS
ISSUED. MY WORK ERT COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE:
CARRIEReC
POLIC'7 NUMBER ,��0All f
i
(DIS SECTION NEED NOT SEcrxoPLETiDOFTFE PERMITSFOR CNE FLINDRED 100108
I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS SSUED.I
SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE
WORKERS' COMPENSATION LAWS OF CALIFORNIA AND AGREE THAT IF 1 SHOULD BECOME
SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR
CODE. SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS.
DATE: 2 APPLICANT: M
WARNING, FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL BE
SUBJECTAN EMPLOYER 70 CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS IS 100,000), N ADDmON TO THE COSTOF COMPENSATION. DAMAGES AS PROVIDED FOR IN
SECTION 3705 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
CONSTRUCTION LENDING AGENCY
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS ACONSTRUCTIO N LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED ISEC. 7097. CIV C.I.
LENDERS NAME
LENDERS ADDRESS
I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
I AGREE TO COMPLY WITH ALL CRY AND COUNTY ORDINANCES AND STATE CAN'S RELATING TO BUILDING
CONSTRUCTION. AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES.
� PE TREE NAM -(PRINT)
I SIGIAT F ERMITT� DATE
PRESS
i FIRMLY
APPLICATION _ (] PERMIT P/C
DATE 1 NUMBE #00
ISSUE ;'1 .; TYPE "..•.- C ' .
DATE CONST. GROUP
ZONING SETBACKS
FRONT RW ❑
REAR ❑
SIDE/SIDE STREET RW ❑
SIDE ❑
PROPOSED USE
NO. DWEL. NO. NO. .
UNITS STORIES BEDROOMS
DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION
-SFR/ADD/REM
cf)
Garapa/Carport
WPatio/Deck
..
U-
PoGVSPa
ZRe
-Roof
Commercial -
m
Valuation ADJ.AREA
QUANTITY DESCRIPTION FEE
_J
Q
Q
' 0
W
-
LU
W
T.7
2
DO
J
D.
Q
U
2
Q
2
U
W
2
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CONSTRUCTION I J
PLAN REVIEW
ELECTRIC OL uv
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE F
SMIP
ENERGY PIC _FE$.
ENERGY PERMIT ej
RETENTION FEE- 1 D FAR •
UIITIT�\T;i•;
! 5 x;11
PRE -ALT FEE: D
TOTAL FEES Q 3 �? I4.
UU
COMMENTS
RECPT N0. PAID BY VALIDATION
WHITE—DeparVnent Copy, YELLOW --Finance Copy, PINK—Assessor Copy, GOLDEN —File Copy, GREEN—Appy Cs Copy
CITY OF DIAMOND BAR!
INSPECTION'RECORD
INSPtCTION DATE 'INSPECTOR
SETBACKI - ;
INSPECTION DATE INSPECT -OR
FLOOR JOIST
FTGS/FORMS/STEEL
FHA REOMTS.. -
ELECTRIC GROUND _-
UNDER FLOOR DUCT
GROUND PLUMBING
UNDER FLOOR CONDUIT ".
SLAB GRADE --
FIREPLACE FOUNDATION ' - ? -': : ! :�
TEMP POWER
FIREPLACE BOND BEAM
WATER SERVICE - - =
-MID HT. BOND BEAM''.. '
ROOF SHEATHING -
8 FT. BOND'BEAM... - !
FRAMINGNENTILIATION
FINAL BOND BEAM
ROOF COVER .
PRE -GRADING
ROUGH HEATING - -
BENCHING
ROUGH ELECTRIC - - -
ROUGH GRADING
ROUGH PLUMBING -
FINISH GRADING
SHOWER/TUB TEST
POOL ELECTRIC
EXT. LATHISIDING
POOL FENCING
WALL INSULATION
POOL FINAL
CEILING INSULATION
OFF SITE IMPS.
DRYWALL NAILING
DEDICATIONS
SEWER
FINAL ENG.
SEPTIC TANK _..... f T
..LANDSCAPE/IRRIG.
SEEP PIT/L.L.- -
-ON SITE IMPS.
_
GASAIR TEST - -
FINAL ZONING
FINAL CONST.: (.9 /�� _
FIRE DEPT. FINAL '
FINAL HEATING - t
HEALTH DEPT. FINAL
FINAL ELECTRIC
DEV. FEES PAID
FINAL PLUMBING
ENERGY
COMMENTS
i
SEPTIC TANK SIZE -.. •''
SEEP PIT/U SIZE