HomeMy WebLinkAbout17311 (25) CTI'Y OF DIAMOND BAR ���Q� 1._;'i:`�i F���
-----1�! --- DEPARTMENT OF COIvIIvIUNITY&DEVELOP $� S
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21825 E.Copley Drive
- (909)860-3195 Fax(909)861-3117 J U N 17 2002
�'���� BUILDING PERMIT APPLICATION FIRMLY �
� � JOBSITE���O L�C/) ` L�� APPLICATION ' PERMIT l�3� P/C I
o ADDRES /�� DATE NUMBER � # �
� ISSUE TYPE OCC
^° APN LOT TRACT DATE CONST. GROUP
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o ADDRFryS� ZONING SETBACKS
Z CITY � ZIP�i765'TEL. C� ^S � FRONT RN/ ❑
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� ADDRESS NO.DWEL. NO. O C�V
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cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFRfADD/REM
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p I HEREBV AFFIRM UNDER PENALN OF PERIURY THA7 I AM EXEMPT FqOM THE CON7RACTORS LI� G2�0yB/C2fpOft
W CENSEUWFORTHEFOLLOWINGREASON(SEC.703t.5BU51NE5SANOPROFESSIONSCODE:ANYCIiYOR (n
U CAUNTYWHICHHEOUIRESAPEFiMI7TOCONS7RUC7,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC- �
W TURE,PRIOR 70 ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Pef10/DBCk
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF 7HE CONTRACTORS LI- �
� CENSE LAW(CHAPTER B(COMMENCING WI7H SEC710N 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� POOUSPe
� FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEAILEGEDE7CEMP- (�
V TION.ANV VIOLATION OF SECTION 7031.5 BY ANV APPLICANT FOR A PERMIT 5U&IEC75 7HE APPLICANT T0 Z Re-Root
A CIVIL PENALTI OF NOT MORE THAN FIVE HUNDRED DOLLARS(f5oo).):
Z ❑I,ASOWNEROFTHEPROPERTV,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECAMPENSATION, � COfTIrt18fC121 -
WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7014,BUSI- J
N NE55 AND PROFESSIONS CADE:THE CONTRACTORS LICENSE LAW UOES NOT APPLV TO AN OWNER OF �
PROPERTY WHO BUILDS OR IMPROVES 7HEREON,AND NMO DOES SUCH WORK HIMSELF OR HERSELF OR
Q THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THA7 SUCH IMPROVEMEN75 ARE NOT IN7ENDED OR m �.
w OFFEREDFORSALE.IF,HOWEVER,THEBUILDINGORIMPROVEMENTISSOIDWITHINONEYEAROFCOMPLE-
� TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DI�NOT BUILD OR
Z IMPROVE FOR THE PURPOSE OF SALE).
_ ❑I,ASOWNEROFTHEPROPEFiT1',AMEXCLUSIVELVCANTRAC7INGWITHIICENSEDCONTRACTORS
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� TO CANSTRUCT THE PRQIECT(SEC.7014,BUSINESS AND PROFESSIONS CADE:THE CONTRACTORS LI- V8IU8�lOf1 � ADJ.AREA
W CENSE UW DOES NO7APPLV TO AN ONMER OF A PROPERTY WHO BUYDS OR IMPROVES THEREON,AND
� WHOCANTRACTSFORSUCHPRQIECTSWITHACANTRAC70R(S)LICENSEDPURSUANTTOTHECANTRAC- QUANTITY DESCRIPTION FEE
Y TORS LICENSE LAW.).
¢ ❑I AM EXEMPT UNDER SEC. B.S P.C.FOR THIS REASON J
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� DATE OWNER � I
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�¢ LICENSED CONTRACTORS DECLARATION W
2 I HEREBY AFFIRM UNDER PENALTV OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAP7ER �
d 9(COMMENCING WITH SECTION 7000)OF DIVISION 30F THE BUSINESS AND PROFESSIONS CODE,AND Z
X MV LICENSE IS IN FULL fORCE AND EFFECT.
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� LICENSE CLASS �� � / LIC.NO. S �
V DATE���� � O � CONTRACTOR' a
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� WORKERS'COMPENSATION DECLARATION . Q
� I HEREBV AFFIRM UNDER PENALTY OF PERIURY ONE OF THE FOLLOWING�ECLARA710N5: Z
Z _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKEHS' _
¢ COMPENSATION,AS PROVIDED BV SEC710N 370o OF THE 1A80R CODE,FOR THE PERFORMANCE U
Q OF 7HE WORK FOR WHICH THIS PERMIT IS ISSUED. �
QQ _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BV SECTION � ^ ^ / r\
37oa OF 7HE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PEHMIT IS / w ) ��7/ )
ISSUED.MY WO NSATION INSU CE CARRIE �ND POLICY NUMBER AHE: CONSTRUCTION [/l/ C/'�/
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� (fHISSECTK)NNE�NOTBEOOMPLFfEDOFTHEPERMfTISFORONEHUI�DREDDOLIPAS(E100)ORLESS). PLUMBING
� W
Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
�} SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE
� WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE
� SU&IECT TO THE WORKERS'CAMPENSATION PROVISIONS OF SEC710N 3700 0F THE LABOR
CADE,I SHALL FORTHWITH COMPLV WITH THOSE PROVISIONS. ISSUANCE C
� SMIP �
p DATE: APPLICANT:
J WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C
� SU&IECT AN EMPLOYEF TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND ENERGY PERMIT
DOLLARS(floo.000�,IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
� SECTION 3708 OFTHE LABOR CODE,INTERES7,ANDATTORNEY'S FEES. RETENTION FEE:
� CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� 1 HEREBV AFFIRM UNDER PENAL7V OF PERJURV THAT THERE IS ACONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.C.).
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� LENDER'S NAME
H LENDER'SADDRESS
,� TOTAL FEES ��,, 3j�
� I CERTIFY TMAT I HAVE REAO THIS APPLICATION AN�STATE THAT THE ABOVE INFORMATION IS CORRECT.
� I AGREE TO COMPLV WITH ALL CITV AN�COUNTV ORDINANCES AND STATE LAWS RELATWG TO BUILDING
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUN7V TO ENTER UPON THE
Z A80VE�MENTIONED PROPERTV FOR INSPECTION PURPOSES.
Q COMMENTS
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¢ E E NAME(P T) `�O `O
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� TTEE DATE �
= RECPT.�O. PAID BY VALIDATION
~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENRO� ile Copy,GREEN—ApplicanYs Copy
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GROUND PLUMBING I UNDER �LOOR Ct����UIT ; �
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SLAB GRADE I FIREPLACE �OUNDATION ' � _
TEMP POWER ; FIREPLACE BONQ SEAM ___ _
WATER SERVICE ! . MID HT. BOND BEAM
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ROOF SHEATHING_ /( _�' b j �._______ � a �. �dN� BEAM �
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FRAMINGNENTILIATION i ___ I FINAL BOND BEAM __ i___ I _
ROOF COVER PRE-GRADING ; -�
ROUGH HEATING BENCHING _
ROUGH ELECTRIC I RQUGH GRADING
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ROUGH PIUMBWG ; i FIN15H uRADWG
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SHOWER�TUB TEST � POOL ELECTRIG
EXT. LATH/SIDIfVG POOL FENCING
WALL IAISULATIOfV POOL FINAL __ ___
CEILING IIVSULATION I � OFF SITE IMPS.
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pRYWALL NAILING i DEDICATIONS
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SEWER FINA�ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT(L.L. • O�J SITE IMPS.
GAS AIR TEST FINAL ZONING !
FINAL CONST. i FlRE DEPT. FINA� �--�-- __ ____.___---
FINAL HEATIfVG - HEA�.TH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FIfVAL PLUMBIMG ! � ENERGY
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