HomeMy WebLinkAbout15774 _1� CITY OF DIAMOND BAB � � \
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES '
21660 E.Copley Drive Suite 190
(909)860-3195 Fax(909)861-3117. PRE$$
���9�� BUILDING PERMTT APPLICATION � '� FIRMLY
Q JOBSITE O � n APPLICATION/ __��. PERMIT �G� P/ ��
a ADDRESS �d 2 [/��Q� DQ� DATE �� NUMBER �J #�,�
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APN LOT TRACT DATE CONST. GROUP
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N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
� OWNER-BUILDER DECLARATION SFR/ADD/REM
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p I HEHEBV AFFlRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTMCTORS LI- GefeJB/CefPOlf
W CENSEUWWRTHEFOLLOWINOREASON(SEC.7031.SBUSINESSMIDPROFESSIONSCODE:ANYCITYOR (n
C..) COUHTYWHIq1HEOUIRESAPERMRTOCONSTflUCT,ALTERIMPROVE,DEMOLISH,ORREPAIRANYSTRUC- W Patio/Deck
W TURE.VRIOR TO RS ISSUANCE,AL50 REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w
STATEMEHT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI�
� CENSE UW(CHAPTER D(COMMENCINO WITH SECTION 7000)OF DIVISION�OF THE BUSINESS AND PRO- LL' PooUSpa �
S FESSIONSCODE)ORTHATHEORSHEISE7(EMPTTHEREFROMANDTHEBASISFOR7HEALLEGEDEXEMP- (�
V TION.ANVVIOLATIONOFSECTION7o31.68VANVAPPUCANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Roof
� A CIVIL VEN�LTV OF NO7 MOfiE THAN FIVE HUNDRED DOLURS(i500).):
� ❑I,ASOWNEROF7HEPROPERTV,ORMYEMPLOVEESWITHWAGESAS7HEIRSOLECOMPENSA710N, � COR1rtIBfC181 �
WILL DO THE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.701�,BUSI� J
� NESS AND PROFESSIONS COOE:THE CONTMCTORS LICENSE LAW DOES NO7 APPLV 70 AN OWNER OF �
PROPERTY MIFp BUILDS OR IMFROVES THEHEON,AND NMO DOES SUCH WORK HIMSELF OR HERSELF OR
Q THROUGH MIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NO7IHTENDED OR m
QOFFEREDPDRSALEIF,HOWEVEF�TIEBUILDINGORIMPROVEMEHTISSOLDWITHINONEYEAROFCOMPLE-
Z TION,THE OWNER-BUIIDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF SALE).
W OI,ASOWNEROF7HEPROPEHTY,MIE%CLUSIVELVCANTMCTINOWITHLICENSEDCONTMCTOHS
[[ TO CONSTRUCT THE PRQIEC7(SEC.7oN,BUSINESS AND PROFESSIONS CODE:7HE CONTRACTORS ll� V21UatlOfl ADJ.AREA
W CENSE UW DOES NOTAPPLY TO AN ONMER OFA PROPERTV HM110 BUILDS OR IMPROVES THEREON,AND
� 1NIOCON7MCTSFORSUCHPH0.1ECfSWITHACONTRACTOR(5)LICENSEDPURSUMlTTOhIECONTRAG pUANTITY DESCRIPTION FEE �
Y TORS UCENSE LAW.).
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Q ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q C,.. +
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OATE OWNER V
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� LICENSED CONTRACTORS DECLARATION W I
OC 1 HEREBY AFFIRM UNDER PENALTY OF 7ER1UftY 7HAT I AM LICENSEO UNOEH PROVISIONS OF CHAPTER � � �'
d Y(COMMENCINO tNTH SECTION 7000)OF�IVISION�OF THE BUSINESS AND PROFESSIONS CO�E.AND Z
"� AI'/LICENSE IS IN FULL FOHCE ANO EFFECT. m P S � q
� LICENSE CLASS V G �1 IIC.NO. � j ���
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V DATE I r�� �ITD CONTRACTOR � d � �
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r� WORKERS'COMPENSATION DECLAFATION Q
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� I HEHEBY AFFIqM UNDER PENALTV OF VEiiIURY ONE OF THE FOLLOWING DECURATIONS:
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� _IHAVEMIDWILLMAINTAINACEfiTIFICA7EOFCONSENTTOSELF-INSUREFORWORKEFS' S
COMPENSATION,AS PROVIDED BV SECTION 3700 OF THE UBOF fADE,FOR THE PERFORMANCE U
Q OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
�
W �I HAVE M1D WILL MAINTAW WORKERS'COMPENSATION INSURANCE,AS RE�UIHED BV SECTION ^
O a700 OF THE LABOR CODE,FOR 7HE PERFORMANCE OF THE WORK FOR WHICH 7HI5 PERMIT IS � �� , 1O
ISSUED.MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION
� CARRIER PLAN REVIEW �
Z POLICV NUMBER ELECTRIC � •
Q
� (I}OSSECf10NNE�NDTBE00A�LEfmOFT1fPEAMf1SFURONEFUt�DREDDOLJ.A0.5(S�O�ORLESS). PLUMBING _. / �y-� •�
w MECHANICAL I i��!J`. I �
Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOH WHICH 7HI5 PERMIT IS ISSUED,I ,
�} SHAIL NOT EMPLOV ANV PERSON IN ANV MANNER 50 AS TO BECOME SUBJECT TO THE "'i'�'1�
� YKIRNERS'COMPENSATION LAWS OF CALIFORNIA.AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE
SU&IECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE UBOR �Q
s CODE,I SHALL FORTIWI7N CAMPLV WITH TF10SE PROVISIONS. ISSUANCE ����•
. � U SMIP ���� i 7fr'�!�
p DATE:.LI'��� APPLICANT. ,
J WARNINO:FAILURETO SECURE WORKERS'GOMPENSATION COVERAGE IS UNUWFUL, D SHALL BE ENERGY P/C �I�'g'�t:.'r.�.�'A�nJi�i,---
� SUBJECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND ENERGY PERMIT � ITT Tl7A7rv n L��
DOLUHS(i10o.o00),IN ADDITION TO THE COST OF CAMPENSATION,DAMAGES AS PROVIDED FOR IN - ,.��.�y ��`� �j
� SECTION37oeOFTHELABORCODE,IN7EREST,MIDATTORNEI"SFEES. RETENTIONFEE: ���~��•a �OO
d CONSTFiUCTION LENDING AGENCY PRE-ALT FEE: �
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� I HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT THERE IS A CONSTHUCTION LENOING AGENCY
FOR THE PERFORMANCE OF THE WOFK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.C.).
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� LENDER'S NAME � �
F= LENDER'SADDHESS .
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� I CERTIFY THAT I HAVE REM THIS APPLICATION AND STA7E THATiHE ABOVE INFOFMATION IS CORRECL TOTAL F E ES �✓ ���{' �
w I AGREE TO CAMPLV WITH/�LL CI7Y AND CAUNTV OPDINPNCES AND STATE UWS RELATING TO BUILOING � � � �
� CANSTRUCTION,AND HEREBV AUTHORRE REPRESENTATIVES OF THIS CWNTY TO ENTER UPON THE . '
ZABOVE-MENTIONED PROPEHTY FOR INSPECTION PUHPOSES. COMMENTS ��
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m PERMI77EE NAME(PRINT) �
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N SIONA7URE OF PERMIT7E DA7E � �
= RECPT.NO. PAID BY _ VALIDATION
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ELECTRIC GROUND !V � UNDER FLOOR DUCT-�— � . i�
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TEMP POWER FIREPLACE BOND BEAM , ���;' ;':�;�: ' •-'
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ROOF 5�-1�EATHI�tG=:.�'. r•-,:=,,' . '� 8 F7. BOND BEAM �.�.., _,�._ - �-:�.:;�:�:_� :� �:�•�.
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EXT. LATH/SIDING �.,., . POOL FENCING �,�31.��� _
WALL INSULATION ` � POOL FINAL
CEILING INSULATION OFF SITE IMPS. }�
DRYWAL.L NAILING DEDICATIONS � v I � �
SEWER FINAL ENG. � �
SEPTIC TANK � LANDSCAPE/IRRIG. j
SEEP PITlLL. '�����-:..'.'�= � ON SITE IMPS.
GAS AIR T ST ��'2,-Z�t� �' FINAi�ONING ___
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FiNAL ELECTRIC DEV. FEES PAID
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