HomeMy WebLinkAbout14952CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
21660 E. Copley Drive Suite 190
(909) 860-3195 Fax (909) 861-3117
BUILDING PERMIT APPLICATION I
JOBSITE ADDRESS D Ka LL PR.
APN LO Y TRACT
OWNER A M� —T
ADDRESS 3• Y
CITY ZIP ( TEL.
APPLICANT TEL
CONTRACTOR 3 ti4
ADDRESS I .
CITY D ,t/ 2f ZIP TEL
ARCH/ENG/
DESIGNER
ADDRESS
CITY ZIP TEL
OWNER -BUILDER DECLARATION
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS I.I.
CENSE LAW FOR THE Fd10WN0 REASON (SEG 7031.5 BUSINESSAND PROFESSIONS CODE: ANY CITY OR
COUNTY WHICH REOUIRESA PERURTO CONSTRUCLALTER IMPROVE. DEMOUSKOR REPAIRANY STRUC-
TIME- PRIOR TO ITS ISSUANCE ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO RLE A SIGNED
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISICNS OF THE CONTRACTORS U•
CENSE LAW (CHAPTER 0 (COMMENCING WITH SECTION 7000) OF DIVISION 7 OF THE BUSINESS AND PRG-
FESSONS CODE) ORTHAT HE ORSHE IS EXEMPT THEREFROM ANDTHE BASIS FOR THEALLEGED EXEMP-
TION. ANY VIOLATON OF SECTION 7031.5 BY ANY APPLICk T FOR A PERMIT SUBJECTS THE APPLICANT TO .
A CfVL PENALTY OF NOT MOME THAN FIVE HUNDRED DOLLARS (SSW)): '
O L AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION,
WILL
DO THE WOPX, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEG 7044, BUSI-
NESSAND PROFESSMONS COOS THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF
PROKFI Y WHOBUILDS OR IMPROVES THEREON, AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
TWO" 14S OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT MENDED OR
OFFERED FOR SALE IF, HOWEVER THE BEADING OR IMPROVEMENT IS SOLD WITHIN ONE YFAR OF COMPLE.
TON. THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVNG THAT HE OR SHE DID NOT BUILD OR
IMPROVE FOR THE PURPOSE OF SALE).
O L AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING W TH LICENSED CONTRACTORS
TO CONSTRUCT THE PROJECT (SEC. 70x1. BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LI-
CENSE LAW DOES NOT APPLY TO AN OYMER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND
1NpCONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC-
TORS LICENSE LAW.)L
O 1 AM EXEMPT UNDER SEG B. L P.C. FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION '
I HEREBYAFFFM UNDER PENALTY OF PERAIHY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER
f (COMMENCNO WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS IND PROFESSIONS CODE, AND
ILLY UCENSE IS N FULL FORCE AND EFFECT.
LICENSE CLASS 9LIC. NO.
DATE CONTRACTOR��
FZR1=RVC011ENSATION DECLARATION S !!
I HEREBYAFFIRL UNDER PENALTY OF PERJURY ONE OF THE FOLLOW:NO DECLARATXNS:
I HAVE AND WILL MANTAN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS'
COMPENSATION, AS PROVIDED BY SECTION 3700 OF THE LABOR WOE, FOR THE PERFORMANCE
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.
I WIVE AND WILLMANTAN WOH1(ER5 COMPENSATION INSURANCE, AS REONRED BY SECTION
.___E THE LABOR COOS FOR THE PERFORMANCE OF THE WORK FOR_ -__-'
OR _-_ THIS PEPLIT IS
ISSUED. MY WORKEFLS'COMPENSATION NSUR . CARRIER AND POLICY NUMBER ARE
CARRIER-:�-r,4!:a
POLICY MIUBER
(THIS SECTION NE®M7T BE Cd fiETm OFTIE PERMT 6 PORCINE KAMM DDl1ARS (S100)CRLESS;"
I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I
SHALL NOT EMPLOY ANY PERSON N ANY MANNER SO AS TO BECOME SUBJECT TO THE
WORKERS' COMPENSATION LAWS OF CALIFORNIA. AND AGREE THAT IF I SHOULD BECOME
SUBJECT TO THE WORKESWCOMPENSATON PROVISIONS OF SECTION 3700 OF THE LABOR
C�OjDE.I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS.
DATE: �� i� APPLICANT _/
IF
WARNING: FARURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL BE
BJE
SUCT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (1 100.000). N ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR N
SECTION 3705 OF THE LABOR OODE, INTEREST, AND ATTORNEY'S FEES
CONSTRUCTION LENDING AGENCY
1 HEREBY AFFIRM LINDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED (SEG 3007, CIV. C.).
LENDER'S NAME
LENDER'S ADDRESS
1 CERTIFY THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
1 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
:�ROPEPITY FOR INSPECTION PURPOSES.
PERUITTEE HALE RUNT) /
O PERMRTEE DATE
PRESS
FIRMLY
APPLICATION a. C) PERMIT /C i't v O
/
DATE NUMBER V
ISSUE TYPE OCC
DATE - "CONST. GROUP
ZONING SETBACKS
FRONT RW p
REAR ❑
SIDEISIDE STREET RW p
SIDE 0 -
PROPOSED USEZ�K '
NO. DWEL NO. NO.
UNITS STORIES BEDROOMS
DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION
SFRIADDIREM
Garage/Carport
LU
Palic/Deck
LL
PooVSpa
t7
Z
Re -Roof
Commercial -
[[
Z °• i
m
Valuation b'S"y AD.L.ARE A
QUANTITY DESCRIPTION FEE
J
a
cc
F-
U
W
W
0
2
CO
J
0-
_U
Q2
U
W
CONSTRUCTION / •v v
PLAN REVIEW 7
ELECTRIC r el
PLUMBING
MECHANICAL
L
INSPECTION FEE
ISSUANCE —
SMIP If•1 I v L UU d
P
ENERGY P/C f"1 �. Tti? A 7 rn�TTti n 7�
ENERGY PERMIT �����T*
r . • .
. �.
RETENTION FEE:
TOTAL FEES
��
COMMENTS�ry
ALI
RECPT. NO. PAID BY VALIDATION
WHITE—Department Copy. YELLOW --Finance Copy, PINK --Assessor Copy, GOLDENROD --File Copy, GREEN—Applicant's Copy
CITY OF DIAMOND. BAR.
INSPECTION RECORD.,
SET BACK :- �' 1 \Il ��d
FTGS/FORMS/STEEL (J ' I ! ' ^.
FLOOR JOIST
FHA REQMTS
ELECTRIC GROUND -
UNDER FLOOR DUET;;
GROUND PLUMBING
UNDER FLOOR CONRUIT '-.
SLAB GRADE
_..__
FIREPLAbbOUNbATION c') 1,a .•= ' .'�. ��F :;,. I..
TEMP POWER
I FIREPL C�'BOND, EAM
WATER SERVICE
j --
MID H7.'BONDtalrAM ,
ROOF SHEATHING
��p `'
8 FT. O R BEAM',r•, �' ) •.•; �.
FRAMINGNENTILIATION
/ o
FINAL BOND BEAM
ROOF COVER .
' RRE•GRADING
ROUGH HEATING
- -
BENCHING
ROUGH ELECTRIC
ROUGH GRADING
ROUGH PLUMBING
- —
"FINISH GRADING
'SHOWERITUB TEST
POOL ELECTRIC .
EXT.-LATH/SIDING
POOL FENCING
WALL INSULATION
POOL FINAL .
CEILING INSULATION
OFF SITE IMPS.
DRYWALL NAILING
= }` r..:'; �7 I'+,
DEDICATIONS
SEWER.....
FINAL ENG.
SEPTIC TANK_ _ _' __ _
__
LANDS CAPE/IR RIG. .
-SEEP-PIT/L.L. -:
•` ...: - _
ON SITE IMPS.
GAS AIR TEST; -
=-
FINAL ZONING
FINAL -CONST., -
_ 3 .�
FIRE DEPT. FINAL
FINAL -HEATING
..
-HEALTH DEPT. FINAL
FINAL ELECTRIC -
-- - -
DEV. FEES PAID
FINAL PLUMBING
ENERGY
COMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
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