HomeMy WebLinkAbout17377 � � X'�\Y' `�'G�
CITY OF DIAMOND BAR
-----��` --- DEPARTIvIENT OF COMMUNITY&DEVELOPMENT SERVICES
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21825 E.Copley Drive �
(909)860-3195 Fax(909)861-3117 PRESS
'`'-����+ BUILDING PERMIT APPLICATION FIRMLY
� JOBSITE � \lAFSTE CATION ' ' � '� NUMB R J�� #/C V`� ` /
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� ISSUE TYPE OCC
APN LOT TRACT DATE CONST. GROUP
p OWNER bi 21�D
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oCITY D- � ' ZIP `71)bs TEL. 2 '7 FRONT RW ❑
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� ADDRESS
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cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
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1 HEREBV AFFIRM UNDER PENALTY OF PERIURV THA7 I AM EXEMP7 FROM 7HE CONTRACTORS LI� G0f89B/CBfpOf1
W CENSELAWFORTHEFOLLOWINGREASON(SEC.7031.SBUSINESSANDPROFESSIONSCODE:ANVCITYOR (n
U COUN7YWHICHREOUIqESAPERMI7TOCONSTRUC7,AL7ER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC-
w TURE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICAN7 FOR SUCH PERMIT 70 FILE A SIGNED W Patio/Deck
� STATEMENT 7HAT HE OR SHE IS IICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS ll� � � �
� CENSE LAW(CHAPTER B(CAMMENCMG WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PiiO- POOVSPO
FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP� (�
� TION.ANVVIOLATIONOFSECTION7031.SBYANYAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO Z Re-Roof
A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLURS(f5o0�.):
Z OI,ASONMEROFTHEPROPERTV,ORMVEMPIOYEESWITHWAGESASTHEIRSOLECOMPENSATION, 0 COfilffl0fC18I �
WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70��,BU51� J
� NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF � .
PROPER7V WHO BUILDS OR IMPROVES THEREON,AND NMO DOES SUCH WORK HIMSELF OR HERSELF OR
� THROUGH HIS OR HER ONRJ EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
w OFFEREDWRSALEIF,HOWEVERTMEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCAMPLE�
0 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,AS ON7JER OF THE PROPER7Y,AM E%CLUSIVELV CONTRACTING WITH LICENSED CANTRACTORS
TO NSTRUCT THE PRQIECT(SEC.7041,BUSINE55 AND PROFESSIONS CADE:THE CONTMCTORS LI� V8I118(IOfI ADJ.AREA
W CENSELAWDOESNOTAPPLYTOANOWNEROFAPROPERTYWHOBUILDSORIMPROVESTHEREON,AND
� WHOCONTRACTSFOHSUCHPROJECTSWITHACANTRACTOH(5)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE
Y TORS LICENSE LAW.). 'l
� ❑I AM E7(EMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q � •I v
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DATE OWNER �
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� LICENSED CONTRACTORS DECLARATION w
� I HEREBY AFFIRM UNDER PENALTY OF PERIURY THAT I AM LICENSED UNDEH PROVISIONS OF CHAPTER � ,
� 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND � -' "
`X MY LICENSE IS IN FULI FORCE AND EFFECT. m � .
� UCENSE CLASS LIQ NO. j •
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V DATE CONTRACTOR a
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� WORKERS'COMPENSATION DECLARATION Q
� I HEREBY AFFIRM UNDER PENALTV OF 7ERIURV ONE OF THE FOLLOWING DECURATIONS: Z . -
� I HAVE AND WILL MAMTAIN A CERTIFICATE OF CANSENT TO SELf-INSURE FOR WOFKEHS' _
Z CAMPENSATION,AS PROVIDED BY SECTION 770o OF THE UBOR CODE,FOR THE PERFORMANCE 1U
Q OF THE WORK FOR WHICH THIS PEfiMIT IS ISSUED.
� �
w 1 HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION
Q 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS �
ISSUED.MV WORKERS'COMPENSATION INSURANCE CARRIER AND POUCY NUMBERARE: CONSTRUCTION
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� CARRIER PLAN REVIEW
Z POL,ICY NUMBER ELECTRIC V
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� (IFiISSECTqNNE�NO70EOCMPLEfEDOFTI-IEPERMfTISFORONEMN�OREDDOLfA0.S�S100)ORIESS? PLUMBING �
Z I CERTIFV THAT IN THE PERFORMANCE OF 7HE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
C.'} SHALL NOT EMPLOY ANY PERSON IN ANV MANNER SO AS TO BECOME SUBJECT TO THE
� WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE
= SU&IECTTO THE WOFIKERS'COMPENSATION PROVISIONS OF SECTION 37000F THE UBOR
CODE,I SHALL FORTHWITH COMPLV WITH THOSE PROVISIONS. ISSUANCE •
� SMIP
p DATE: APPIICANT: D=��
J WARNING:FAILURE 705ECURE WORKERS'CAMPENSA710N COVERAGE IS UNUWFUL,AND SHALL BE ENERGY P/C
� SU&IECTANEMPIOYERTOCRIMINALPENAL71E5ANDCIVIIFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
DOLLARS(f100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN �
� SECTION 3708 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES. RETENTION FEE: �
d CONSTRUCTION LENDING AGENCY PRE•ALT FEE:
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� I HEREBV AFFIRM UNOER PENALTV OF PERlURV THAT THERE IS A CONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF 7HE WORK FOR WHICH THIS PERMI715155UED�SEC.3097,CIV.C.).
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� LENDER'S NAME
F- LENDER'SADDRESS
� TOTAL FEES 2�3. � � g
� I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS COFRECT. �
w I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE UWS FELATING TO BUILDING
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� CONSTRUCTION,AND HEREBV AUTHOflIZE REPRESEN7A71VES OF 7HIS COUNTY TO ENTER UPON 7HE �y� /�
Z ABOVE�MENTIONED PROPERTV FOR INSPECTION PURPOSES. COMMENTS �R.� � � Yl � �
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m PEfiMITTEENAME(PRINT)
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= RECPT.NO. PAID BY VALIDATION
~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—Applicant's Copy
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FTGSlFORMS/STEE� )�-/�,-cYL' �� ; FHA RE�MTS _
ELECTRIC GROUND � j UNDEH FLOC?R DUCT� ,
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GROUND PLUMBING ' , � UIVDER FLt�Ot� C�i��DU1T___�
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SLAB GRADE —�— � FIREPLACE Ft'�UNDATION �
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TEMP POWER . � I J rIREPL�t�.,E �GND BEAM
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WATER SERVICE � MiD HT E3�t�i�SE�M
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ROOF SHEATHIPVG ' 8 FT. Bt�ND BEAM -- --- --'-� ____...--
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FRAMIPJGNENTILIATION I FINA�BOt�� BEAM '
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ROOF��OVER � PRE-GRA(�1NG
ROUGH HE,4TING BENCHIi�U
ROUGH ELECTRIC ; ROUGH GRADING
ROUGH PLUMBING ; � FINISH GRADING
— — --- ---- ------
SHOWER/TUB TEST I POOL ELECTRIC
--- — ---- ---- —- — ----- — -
EXT. LATH/SIDING � : POOL,FEN�lNG __.-- ���l� ��------
WALL INSULATIO�! ; POOL FINAL ;
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CEILING IN�Ulr4TION �- --------_--- i
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DRYWALL NAILIIVG ' DEt71CATit)NS
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SEWER FINAL�N�. i .
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SEPTIC TANK �ANDSCA�'E/It�-RIG.
SEEF' PI7/L.L. � ON SITE IMPS. �v� �
GAS AIR TEST FiNA�ZGtViNG � �
FIPUAL COPVST. � ' FlRE OEPT. FINA!
FINAL HEATIf�G HEALTH DEPT. FIhAL
FINAL ELECTRIC I . DEV. tEES PAID
FINAL PLUMBING � ENERGY
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CU�i�iEi�TS _ ___ .
SEPTIG T'AiVK SIZE �
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