HomeMy WebLinkAbout17556 (42) _____ _
CTI'1'OF DIAMOND BAR � ��� �
^---��-- DEPARTMENT OF COMMUNITY&DEVELOP NT SERVICES I
21825 E.Copley Drive �
(909)860.3195 Fax(909)861-3117 PRESS
��-��� • BUILDING PERMIT APPLICATION FIRMLY
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� DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION
� OWNER-BUILDER DECLAAATION ' SFR/ADD/REM
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I HEREBY AFFlRM UNDER PENFLTV OF PERJURV THAT I AM E%EMPT FROM THE CONTRACTORS LI� G8fe9B/COfpOR
W CENSE UW FOR THE FOLLOWINO REASON(SEC.7031.5 BUSINESSAND 7ROFESSIONS CODE:ANV CITV OR (n
C� COUNTYWHICHREWIRESAPERMITTOCqNSTRUCT,A�TER,IMPROVE,DEAIOLISH,ORREPAIRANVSTRUC- w �
W NRE.PRIOR TO ITS ISSUANCE,�LSO RE-0UIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIONED w Patlo/Deck
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF 7HE CONTRACTORS LI� _
� CENSE LAW(CNAPTER e(CAMMENCINO WITH SECTION 7000)OF DIVISqN 3 OF THE BUSINESS AND PRO- LL Pool/Spa
0 FESSIONSCOD�ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEOEDEXEMP� (�
U TION.ANV VqLAT10N OF SECTION 7031.6 BYANY APPLICANT FOR A PERMIT SU&IECTS 7HE APPLICANT TO Z Re-Roof
A CML PENALTV OF NOT MORE THAN FNE HUNDRED DOLLARS(f500).�:
� ❑I,ASONTIEROFTHEPROPERTY,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECqMPENSATpN, 0 COrt1rtIBfClfll
Z WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFEFED FOR SALE(SEC.7o4d,BU51- J J
� NESS AIJD PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF �
PROPEHTV WFiO BUILDS OR IMPROVES 7HEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
� THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMEMS ARE NOT INTENDED OR m
� OFFEREDF9RSALEIF,HOWEVERII'7EBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE�
Z TION,THE OWNER�BUILDER WILL HAVE THE BUROEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF SALE).
W O I,AS ONTJER OF THE PROPERTV,AM E%C�USIVELV CANTRACTWO WfTH LICENSED CONTMCTOR$
� TO CANSTRUCT THE PRQIECT(SEC.70I4,BUSINESS AND PROFESSIONS CODE:7HE CONTRACTOqS LI� VelU9li0f1 ADJ.AREA
W CENSEUWDOESNOTAPPLVTOAtJOWNEROFAPROPERTVWHOBUILOSORIMPROVESTHEREON,AND
� � NM1/OCANTRACTSFORSUCHPHOJECTSWITHACONTRACTOR(S)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION
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0 ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q �O .
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DATE OWNER H
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� LICENSED CONTRACTORS DECLARATION w
� 1 MEREBV AFFIRAI UNOER PENALTV OF PERJURV THAT 1 AM LICENSED UNDEH VROVISKKJS OF CHAPTER �
� G(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CADE,AND Z �
��� MY LICENSE IS IN FUIL FO AND EFFECT. m
� LICENSE CLASS � LIC.NO. � 'S�-' � �
V DATE_ 1Z� S I � �DO�L�CONTRACTOR ,,, S ��A�7`C�I a
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� WORKERS'COMPENSATION DECLARATION ��j �
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� IHEFEBVAFFIRMUNDERPENALTVOFPERJURVONEOFTHEWLLOWINGDECIAAATIONS: Z
�Z _IHAVEPNDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWOqKERS' a
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COMPENSATION,AS PROVIDED BV SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMANCE U
OF h1E WORK FOR WHtCH THIS PERMIT IS ISSUED. W
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Qw _I HAVE AND WILL MAINTAIN WORKERS'CAMPENSATKKJ INSURANCE,AS REOUIRED BY SECTION
3700 OF THE U80R COOE.FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS �
ISSUED.MV WORKERS'CAMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION
jCARRIER � PLAN REVIEW
� POLICV NUMBER �J
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� (f}YSSEC�qNNEIDNOTBENAWLEfmOfhEpERf,1Tt$FpqpldEFIIA�DilEaDOLWtS(S7ao�OqLESS} PLUMBING �
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Z I CERTIFV THAT INTHE PERFORAIANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
U' SHALL NOi EMPLOY ANV PERSON IN ANV MlVJNER 50 AS TO BECAME SUBJECT TO THE I .„�J
N WORKERS'COMPENSATqN LAWS 0F CALIF IA,AND AGREE THAT IF I SHOUL INSPECTION FEE
SU&IECTTOTHEWORKERS'COMPENSAT PROVISIONSO SECTION3�00 T
� CODE,I SHALL FORTHWITH COMPLV WI seJ�yD ws ISSUANCE� N 1 !� �(1 .f ,y
O DATE: I'tO�OL . i �., � i ' V
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J WARNINO:FAtLUHE TO SECURE WORKERS' PENSATION COVERAGE IS UNLAWFUL,AND L BE
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� SU&IECTANEMPIOYERTOCRIMINALPENALIESANDCIVILFWESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT -__. �
DOLLARS(f 100,000),IN PDDITION TO THE COST OF COMPENSATqN,DAMAOES AS PROVIDED FOR IN
J SECTqN 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. �� � ' � (f+
w RETENTION FEE: '
O CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBV AFFIRM UNDER PENAL7Y OF PERIURV THAT THERE IS A CONSTRUCTION LENDING AOENCV �
FOR THE PEFFORMANCE OF THE WORN FOR WHICH THIS PERMR IS ISSUED(SEC.Joe7,CIV.CJ. -
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� LENDER'S NAME
H LENDER'SADDRE55
w� �� � � �32. •�0
I CERTIFV THAT I HAVE READ THIS APPUCATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTAL FE ES � �
� I AOREE TO COMPLV WITH ALL CITV AND CAUNTV ORDINANCES M1D STATE UWS REUTING TO BUILDING U
CANSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE ��
ZABOV MENTIONED PROPERTY FOR INSPECTION PURPOSES. �
� � COMMENTS
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QP MITTEE NAME(PRI
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� SIONATUHEO PERMfTTEE DATE �s�
RECPT.NO. 1 PAID BY�-I �G�b VALIDATION
WHI —Depariment Copy,YELLOW—Finance Copy,PINK—Assessor,Copy,GOLDENRO�File Copy,GREEN—ApplicanYs Copy
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SET BACK .. �, FLOOR JO!ST 1'�� .� . , -
FTGS/FORMS/STEEL � ! FHA REQMTS
ELECTR(C GROUND ` ' � , UNQER FLOOR DUCT • ,
� GROUND PLUMBING � UNDER FLOOR CU�ID,�JIT . �
SLABGRADE _` FIREPLACE`FOWNbA�ON - . "
TEMP POWER • �--FIREPUa'CE BOM11D BE,4M
WATER SERVICE � • � ! MID HT..B�ND BEA(VI ' � . "
ROOF SHEAT'Hlt�lG ' � ' ti � 8 FL BOND BEAM ` . . �
' �, FRAMINGNENTfLIAT(ON �2-/l?-JC.-� � INAL BOND BEAM - �
` -�RO.OF COVER � � -- PRE-GRADING � - � r; ,. . ' `---
ROUGH WEATING i3ENCHlMG � • ' � • � '
ROUGH Ei�ECTRiC ���f-oZ; RUUGH GRAdING ` � '
ROLlGN PLUMBING � FI�U{5H uRADWG
SMOWER/TUB TEST ! POOL ELECTRIC �
EXT. LATH/SIDING POOL FENCING
WALL INSULATIOiV � P�OL FINAL
CEILIi�lG tNSULA�fION OFF SITE IMPS. '
DRYWALL N,AiP�II�IG - i��/ (�L�Q = • DED{CATIONS _
SEWER � FI�IAL ENG. - �
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SEEP PIT/L.L. •� ` , . ON SITE IMPS. �
GAS AIR TEST FiNAL ZONING
FINAL CONST. � J F!RE J7EPT. FIPlAL --�-
FIN !_H�ATtNG � HEAL7H DEPT. FINAL
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• �iRAL ECECTRiC � � � _�� pEV.FEES PAID
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