HomeMy WebLinkAbout18187 (25) �XPIRED
CITY OF DIAMOND BAR
-----���` ---- DEPARTMENT OF COMMLJNITY&DEVELOPMENT SERVICES
21825 E.Copley Drive 0 G T n 9 20p2
(909)860-3195 Faac(909)861-3117 PRESS
�`'-���� ' BUILDING PERMIT APPLICATION FIRMLY
, o� JOBSITE �'I/_� /�,,,I,J�ND� `TlQ APPLICATION , �� NE MBER ` � ���#/C
ADDRESS_�«� n��T� �� DATE
°r APN LOT TRACT ISSUE TYPE OCC
p OWNER �UL AI�L�It�G DATE CONST. GROUP
o ADDRESS � � ZONING SETBACKS
Z CITY �IAN�DA�� ZIP TEL. � F�'�H FRONT RW ❑
o APPLICANT TEL. S DE/SIDE STREET RW ❑
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Q CONTRACTOR SIDE ❑
� ADDRESS
� CITY ZIP TEL. PROPOSED USE
o ARCH/ENG/
�z DESIGNER NO.DWEL. NO. NO.
a ADDRESS
� CITY ZIP TEL. UNITS STORIES BEDROOMS
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v� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER•BUILDER DECLARATION SFR/ADD/REM
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I HEREBV AFFIFM UNDER PENALTV OF PERIURY THAT I AM E%EMPT FROM THE CONTRACTORS LI- G8f898/CBfpOfl
W CENSELAWFORTHEFOLLOWINGREASON(SEC.7o31.5BUSINESSANDPROFES510NSCODE:ANYCI7YOR (n �
U COUNTVWHICHRE�UIRESAPERMI7TOCONSTRUCT,AITER,IMPROVE,DEMOLISH,ORREPAIRANVSTFUC�
W TURE,PRIOR TO ITS ISSUANCE.ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRAC70RS LI�
� CENSE LAW(CHAPTER B(CAMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � POOUSPO
FESSIONSCADE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDExEMP� (�
� 710N.ANYVIOUTIONOFSECTION7031.SBYANVAPPLICAN7FORAPERMITSUBJECTSTHEAPPLICANTTO Z Re-Roaf
A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLURS(5500).):
Z ❑I,ASOWNEROFTHEPfiOPERTY,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, 0 COfi1R10fCIaI '
WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7041,BU51� J
� NESS AND PflOFE5510NS CODE:THE CONTRACTOflS UCENSE LAW DOES NOT APPLV TO AN OWNER OF �
PROPERN WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
� 7HROUGHHISORHEROWNEMPLOVEES,PROVIDE�7HA75UCHIMPROVEMEN75ARENOTIN7ENDEDOR m
QOFFEREDFORSALE.IF,HOWEVER,THEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCAMPLE�
Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PPOVING THA7 HE OR SHE DID NOT BUILD OR
� IM7ROVE FOR THE PURPOSE OF SALE).
w ❑I,ASOWNEROFTHEPROPER7Y,AME%ClUSNELYCONTFACTINGWITHLICENSEDCONTRACTORS
� TO CANS7RUCT THE PRWECT(SEC.70a�,BUSINE55 AND PROFESSIONS CODE:THE CONTRACTORS LI- VelueliOfl ADJ.AREA
W CENSELAWOOESNOTAPPLVTOANOWNEROFAPROPERTVWHOBUILDSORIMPROVESTHEREON,AND
� WHOCON7RACTSFORSUCHPROJEC7SWITHACON7RAC70R�5)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE
Y TORS LICENSE LAW.).
� ❑I AM EXEMPT UNDER SEC. B.6 P.C.FOR THIS REASON Q Y� �
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DA7E �Z OWNER �
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� LICENSED CONTRACTORS DECLARATION W
� I HEREBY AFFIRM UNDEFi PENA�TY OF PERJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
d e(COMMENCING WITH SECTION 7000)OF DIVISION 30F THE BUSINESS AND PROFESSIONS CODE,AND Z
�X MV LICENSE IS IN FULL FORCE AN�EFFECT. m
� LICENSE CLASS LIC.NO. � I
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V DATE CONTRACTOR d
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� WORKERS'COMPENSATION DECLARATION a
� I HEREBYAFFIRM UNDER PENALTY OF PEfL1URY ONE OFTHE FOLLOWING DECURATIONS: Z
Z _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' 2
CAMPENSATION,AS PROVIDED BY SEC710N 3700 OF 7HE LABOH CODE,FOR THE PERFORMANCE U
¢ OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
�
w I HAVE AND WILI MAIN7AIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SEC710N
Q 37000F THE LABOR CODE,FORTHE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS
ISSUED.MV WORKERS'COMPENSATION INSURANCE CAHRIER AND POUCV NUMBER ARE: CONSTRUCTION
J
� CARRIER PLAN REVIEW �\
Z POLICV NUMBER ELECTRIC \ J
Q
� (fHISSECTIONNEmNOTBECUMPLE�EDOFhiEPERMITISFORONEHUFDREDDOLLPAS(5100)ORLESS). PLUMBING
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Z 1 CERTIFY THAT M THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
(} SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECAME SUBJECT TO THE
N WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF 1 SHOULD BECOME INSPECTION FEE
= SU&IECTTO THE WORNERS'COMPENSATION PROVISIONS OF SECTION 37000F THE UBOR
CODE,I SHALL FORTHWITH COMPLV WITH THOSE PROVISIONS. ISSUANCE ♦
� SMIP
p DATE: APPLICANT:
J WARNING:FAILURE TO SECURE WORKEFS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALLBE ENEFGY P/C
� SUBJECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
DOLLAFS(=100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMACaES AS PROVIDED FOR IN
J SEC710N 37oe OF THE LABOfl CODE,IN7ERE57,AND ATTORNEY'S FEES. RETENTION FEE:
Q
� CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� I HEREBV AFFIflM UNDER PENALTV OF PERJURV THATTHERE IS A CONSTRUCTION LENDING AGENCY �
� FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.). �
Z
W
j LENDER'S NAME
�
H LENDER'SADDRESS
� ICERTIFYTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEINfORMATION15CORRECT. TOTAL FEES 5/ S
w 1 AGREE TO COMPLY WITH ALL CITY AND COUNTV ORDINANCES AND STATE LAWS RELATING TO BUILDING
� CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE
ZABOVE-MENTIONED PROPERTV FOR INSPECTION PURPOSES. COMMENTS
� P..�L �AQNdG�
m PE E NAME RINT
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Uj SIG A7UHEOFPERMITTEE DA7E
= RECPT.NO. PAID BY VALIDATION
~ WHITE—De artment Co YELLOW—Finance Co PINK—Assessor Co GOLDENROD—File Co GREEN—A licant's Co
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FTGS/FORMS/STEEL � ` FHA REQMTS �
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ELECTRIC GROUND ' ; UNDEF� FLC70R DU�T
-- ---- -. _-_- ---- ---__----- ; ---
GROUND PLUMBING ___ i UNDER FLOOR CUl�iQU1T ;
--- - ----- —..----- - --___._.............
SLAB GRADE FIREF�LACE �QUtJDATION ;
TEMP POWER j _� FIREPLACE BOND BEAM _ _ __
---
WATER SERVICE _ � ____ : MID HT. BOND BEA�
- -- ----------- --._
ROOF SHEATHIRIG � 8+ FT. BOND BEAM ______i ___
FRAMINGNENTILIATION ; FINAL SONQ BEAlV� i
--- —._�___ _..--- --. __ __ ..._.______. �__......
____...
ROOF COVER � PRE-GRA�ING ;
ROUGH HEATING BENCHING
ROUGH ELECTRIC � ROUGH GRADING � �
--- -- —
ROUGH PLUNIBING , ! � FINISH GRADING
__ _ _.__� _._.__.;.----- --...._._..-- ----- ..__.__.__ _......---- -----...... __...._..
SHOWER/TUB TEST I � POOL ELEC`('RIC
EXT. LATH/SIDIIVG I POOL FENCING
-- _. � _.—.___ _.._..- ------._�
WALL INSULATION ; POOL FINAL i
CEILIIVG IN�ULATION _ __ _ OFF SITE IMPS. _ _
DRYWALL NAILING j DEDiCATlOt�S
SEWER � FINAL ENG.
SEPTIC TANK LAPJDSCAPE/IRRIG. �
SEEP PITlL.L. ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL COfVST. �!RE DEPT. �WAL
FINAL HEATING _� HEALTH DEPT. FItJAL
-- ---.._ _........ —.---
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING I ENERGY
_— � -_- ---_...._---___._��_
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C�G�t Of� a o
CONiiViEf�TS _ _.
SEPTIC TA�lK SIZE � �
SEEP PIT/U SIZE �-- -
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