HomeMy WebLinkAbout17653 CTI'1'OF DIAMOND BAR
-- --��`-- DEPARTIv�NT OF COrRvIUNITY 8c DEVELOPMENT SERVICES �
21825 E.Copley Drive
_ (909)860-3195 Fa�c(909)861-3117 PRESS
�'��� BUILDING PERMIT APPLICATION FIRMLY
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o DATE � NUMBER #
� ISSUE O TYPE OCC
APN LOT TRACT DATE CONST. GROUP
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p ADDRESS Ur 22 G/►(G ZONING SETBACKS
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� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
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p I HEREBV AFFIRM UNDEF PENALT/OF PERJURV THAT I AM EXEMPT FROM THE CONTMCTORS LI- GBfa B/C8 OA
W CENSEUWFORTMEFOLLOWINOREASON(SEC.703t.58U51NE55ANDPROFESSIONSCODE:AN1'CITYOR (n 9 �
C-� COUNTVWHICHREOUIRESAPERMITTOCONSTRUCT,ALTER,IMPqOVE,DEMOLISH,ORREPAIRANVSTAUC- w
w TUFE,VRIOR TO ITS ISSUANCE.AL50 REWIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIONED w Patio/Deck
� STATEMENT THAT HE OR SHE IS LICENSEO PURSUANT TO THE PROVISIONS OF iHE CONTRACTORS lb
� CENSE LAW(CFIAPTER D(COMMENCINO WITH SECTION 70D0)OF DIVISION 3 OF THE BUSINESS AND PRO- � POOVSPe
Q FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTNEALLEOEDE%EMP- (�
V TION.ANVVqLATIONOFSECTION7031.60VANVAPPLICANTFORAPERMITSU&lECTSTHEAPPLICANTTO Z Re-Roof �
A CIVIL PENh1TY OF NOT MORE THAN FIVE MUNORED DOLLARS(f500�.):
� ❑I,ASONTJEROFTHEPROPERTY,ORMYEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, � CORIffIBfClel , i
Z WILL DO 7HE WORK�ND THE STRUCiURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.704�,BUSI- J
� NESS AND PROFESSIONS CADE:THE CANTRACTORS LICENSE lAW DOES NOT APPLV TO AN OWNER OF �
PROPERTV VAfO BUILAS OR IMPROVES THEREON,AND WHO DOES SUCH WORN HIMSELF OR HERSEIF OR
w TMROUGH HIS Oq HER ONRJ EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT IMENDED OR m
� OFFEREDFORS�LE.IF,FpWEVER7TiE8UILDINQORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE-
Z TION,THE OWNER-BUILDER WILL HAVE h1E BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF SALE).
w ❑I,ASOWNEROFTMEPROPERTV,AMEXCLUSIVELVCqMRACTINOWfTHLICENSEDCON7RACTORS
� TO CONSTRUCT THE PHOJECT(SEC.701�,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- VB�UetlOfl ADJ.AREA
W CENSELAWOOESNOTAPPLVTO/�NOWNEROFAPROPERTYWHOBUILDSORIMPROVESTHEREON,AND
� WHOCONTMCTSFORSUCHPRQIECTSWITHACONiRACTOR(5)LICENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION FEE
Y TOHS LICENSE UWJ.
� ❑I MI E%EMPT UNDER SEC. B.8 P.C.FOR THIS REASON �
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� LICENSED CONTRACTORS DECLARATION W
� I HEREBV AFFIRM UNDER PENALTY OF PEFLIURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER V.
� e(COMMENCINO WITH SECTION 7aoo)OF DNISION 3 OF TNE BUSINESS AND PROFESSIONS CADE.AND Z
��� MY UCENSE IS IN FULL FORCE AND EFFECT. m
� LICENSE CLASS �,�.No. 3�976.�% �
V DATE � CONTRACTOR� d
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� WORKERS'COMPENSATION DECLARATION Q
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N I HEREBVAFFIRM UNDER PENALTV OF PERIURY ONE oF7HE FOLLOWINO DECLARA7qN5: Z
0 _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORNERS' _
� COMPENSATION,AS PROVIOED BV SECTION 37a0 OF THE IABOR CODE,FOR 7HE PERFORMANCE U
OF THE WORK FOR WHICN THIS PERMIT IS ISSUED. w
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w I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS RE�UIRED BV SECTION �/q
Q 3700 OF 7HE LABOR CODE,FOR THE PERFORMANCE OF iHE WORK FOR WHICH THIS PERAl1T IS �.L j� �O
ISSUED.MV WOR)(ERS'CAMPENSATION IN�URANCE ARRIER/AN�D POLICV NUMBEFARE: CONSTRUCTION a
jCARRIER / �/L�// PLAN REVIEW
0Z POLICV NUMBER_f SH�� ��� ELECTRIC
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Z I CERTIFY THAT IN THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
C} SHALL NOT EMPLOV ANY PERSON IN ANV MANNER SO AS TO BECOME SU&IECT TO THE
(/j WORKERS'CAMPENSATION LAWS OF CAIIFORNI AND REE THA IF 1 OULD BECAME INSPECTION FEE
� SU&IECTTOTHEWORKERS'COMGENSATIONPyi IS SOFS O OOOFTHELABOR
� CODE I 5 FORTHWITH COMPLV WITH T 6 P� ISION ISSUANCE
�
`p DATE: � � OZ APPLICANT: SMIP
J WARNINO:FAILURE TO SECURE WORKEfiS'COMPENSATION RAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C
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� SUBJECTANEMPLOVERTOCRIMWALPENALTIESANDCMLFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
DOLURS(S1oo,o00),IN ADDITION TO THE COST OF COMGENSATION,DAMAGES AS PFOVIDED FOR IN
J SECTION 3�OB OF THE LABOR CODE,MTEREST,AND ATTORNEVS FEES.
w RETENTION FEE: � �
O CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBV AFFIqM UNDER PENALTV OF PERIURV THAT THERE IS A CqNSTRUCTION LENDING AGENCV
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.30D7,CIV.C.).
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� LENDER'S NAME
H LENDER'SADDRESS
w I CERTIFV THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATpN IS CARRECT. TOTA L FE ES � ?iu �
� I AQREE TO COMPLV N7TH ALL CfTY AND CqUNTY ORDINANCES AND STATE UWS RELATING TO BUfLDING
� CONSTRUCTION,AND HEREBV AUT}N)RIZE REPRESENTATIVES OF THIS CAUNTY TO ENTEq UPON THE
Z A80VE�MENTIONED PROPERTV FOR INSPECTqN PURPOSES. COMMENTS
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� SI6NAT OFPERMITTEE DATE
� RECPT.NO. PAID BY VALIDATION
WHITE-0epaAment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLAENROD—File Copy,GREEN—ApplicanYs Copy
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FTGS/FORMS/STEEL ^ FHA REC�MTS
ELECTRIC GROUND � UNDER FLO�R DUCT
GROUND PLUMBING UNDER FLOOR CUNDUIT
SLAB GRADE FIREPLACE �OUNDATION ^
TEP+/IP POWER FIREPLACE BOND BEAM
WATER SERVICE MID HT. 60ND BEAM
ROOF SHEATHIfVG �J�OZ .� 8 F?. BOND BEAM �_____�
FRAMINGNEfVTILIATtON FINA�.BOND BEAM
ROOF COVER __/��� �Y,�f�" PRE-GRADING
ROUGH HEA7ING BENCHING
ROUGH ELECTRIC ' ROUGH GRADING
ROUGH PLUN161NG FINISH GRADIPIG
SHOWERlTUB TEST ' POOL ELEGTRIC �
EXT. LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL
CEIL.ING IfVBULATION OFF SITE IMPS.
pRYWALL NAILING DFDiCATI�NS �
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/LL �^' ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. , F'RE DEPT. FINAL �
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING �NERGY
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