HomeMy WebLinkAbout11952 (5) CITY OF DIAMOND BAR
COMMUNTTY DEVELOPMENT DEPARTMENT �� �
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(9D9)8b0-3195 Fax(909)861-31 l7
"��' BUILDING PERMIT APPLICATION FIRMLY
o DDRESS ��1 � ��'/�-T� APPLICATION • PERMIT /C
��/Q��- DATE �!�� � NUMBER � #
� APN LOT TRACT a�-J���o �SSUE TYPE OCC
DATE CONST. GROUP
p OWNER �I C [� C.t
� ADDRESS L�(J 1"�'11� C-� ZONING SETBACKS
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APPLICANT TEL. SIDE/SIDE STREET RW ❑
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� ADDRESS UNITS STORIES BEDROOMS
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� DESCRIPTION SQ.FT. FACTOF P5F ADJ.AREANALUATION
OOWNER-BI:iLDER DECLARATION SFR/ADD/REM
� I HEREBV AFFIRM UNDER 7ENALN OF PERJURY THA7 I AM EXEMPT FROM THE CANiRACTOflS LI- G8f298IC31p0�I
W CENSELAWFORTHEFOLLOWINOREASON(SEC.7031.5BUSINESSAN�PROFESSIONSCODE�,ANVCITVOR (n
U COUNTYWHICNREOUIRESAVERMITT6CONSTRUCT,AITEfi,IMPROVE.DEMOLISH,ORREPAIRANYSTRUC- w patio/Deck
Z TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPIICANT FOR SUCH PERMIT TO FILE A SIGNED
W STATEMENT THAT HE OR SHE IS LICENSED PUHSUANT TO 7NE PROVISIONS OF TME CONTRACTOHS LI-
� CENSE LAW(CHAPTER 9(CAMMENCMG WITFI SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � POOVSpe
� FESSIONSCA�E)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDE%EMP-
� TION.pNYVIOLATIONOFSECTION7031.5BVANYAPPLICANTFORAPERMITSUBJECTSTHEAPPLICRNTTO Z Re-Root
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Z WILL DO TNE WOHK,AN�THE STRUCTURE IS NOT MTENDED OH OFFEFED FOR SALE�SEC.7044,BUSI- J
� NESS AND PROFESSIONS CODE:THE COMRACTORS LICENSE LAW DDES NOT APPLY TO AN OWNER OF =
PROPERTY WHO BUILOS OR IMPROVES iHEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
� THROUGH HIS OR HEROWN EM7LOYEES,PROVI�E�THAT SUCH IMPROVEMENTS ARE NOT INTENDEDOR m
pOFFEREDFORSALE.IF.HOWEVER,THEBUILDINGOfi0.1PROVElAENTISSOLDWITHINONEYFAROFCOMPLE-
Z TION,THE OWNER�BUILDER WILL HAVE THE 6URDEN OF PROVING THAT HE OR SHE DID NOT BUIIA OR
� IMPROVEFORTHEPUPPOSEOFSALE).
❑I,AS OWNER OF TNE PROPERTV,�M EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS
� TO CONSTRUCT 7HE PRWECT(SEC.7046,BUSINESS AND PROFESSIONS CADE:THE CONTRACTORS U- V01118�i0� ADJ.AREA
W CENSE lAW DOES NOT MPLV TO AN ONMER OFA PROPERTV WHO BUILDS OR IMPROVES THEFEON,AND
� WHOCONTHACTSFORSUCHPROJECTSWITHACONTRACTOR(5)UCENSEDPUPSUANTTOTHECANTFAG QUANTITY D SCRIPTION FEE
Y 70RSLICENSEUW.).
� ❑I AM EXEMPT UNDER SEC. e.8 P.C,FOR THIS REASON �
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� LICENSED CONTRACTO DEC ATION W
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� I HEHEBY AFFIRM UNDER PE4AL7Y OF PERJURY THAT I AM LICENSED UNDER PPOVISIONS OF CHAP7ER �
� 9(COMMENCING WITH SECTION 7000)OF DIVISION 30F TME BUSINE55 AND PROFESSIONS CADE,AND Z
X MY LICENSE IS IN FULL FORCEAND EFFECL �
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U DATE GONTRACTOR �-
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� WORKERS'COMPENSATION DECLARATION Q
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� i HERE9V AFFIRAI UN�ER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
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� _IHAYEANDWILLMAMITAINACERTIFlCATEOFCONSENTTOSELFINSUREFORWORKERS' _
COMPENSATION,AS PROVIDED BY SECTION 37ao OF THE LABOR GODE,FOP TME FEFFORMANCE U
a OF THE WOFK FOR WHICH THIS PERMIT IS ISSUEO. �
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w _IHAVEANOWILLMAINTAINWORKERS'COMPENSATIONINSURANCE,ASREOUIREDBVSECTION .��( D
O 37oa OF THE LA90R CODE,FOR THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS '�� 1
ISSUE�.MY WORKERS'COMPENSATION WSURANCE CARflIER AND POLICY NUMBEfi AflE: CONSTRUCTION �
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j CARRIER PLAN REVIEW
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� (fHISSECTIDNNE�NOTBECOMPLEfEDOFTHEPERMfTISFORONEHUNDREDDOLlPFiS(5100)ORLESS�. PLUMBING
Z I CERTIfY THAT IN THE PERF�RMANCE OF THE WORK FOR WHICM THIS PERMI715155UED,I MECNANICAL
(} SHAIL NOT EMPLOYANY PERSON IN ANY MANNER SOAS 70 BECAME SUBJECT TO THE
� WORKERS'COMPENSATIONLAWSOFCALIFOPNIA,ANDAGREETHATIFISHWLDBECOME INSPECTIONFEE
SUBJECT TO THE WORKEFS'CAMPENSATION PFIOVISIONS OF SECTION 370o OF THE 1A00R
~ CADE,I SHALL FORTHWITH COMPLV WITNTNOSE PROVISIONS. �SSUANCE �� e�J���J
p DATE: APPLICANT: SMIP ^ 1 E"
� WARNING:FAILURE TO SECUfiE WORNERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL 6E ENERGY PJC
�—y SU&IECT AN EMPLOVER TO CRIMINQ VENALTIES ANO CIVIL FINES UP TO ONE HUNORED THOUSAN� ENERGY PERMIT
DOLl4R5�i10o.0oa).IN ADDITION TO THE COST OF COMPENSATI�N,�AMAGES AS PROVI�ED FOR IN
J SECTION37080FTHELABORCODE,INTEREST,ANDATTORNEV'SFEES. RETENTIONFEE: �
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� CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� I HEREBV AFFIRAI UNDER PENALTY OF PERJURY THATTHERE IS ACONSTRUCTION LENOING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.).
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� LENDER'S NAME .._._ - �
t= LENDER'S ADORE35 �l�
� ICERTIFVTHATIHAVEREADTHISAPPLICATIONANOSTATETHATTHEA80VEINFORMATIONISCORRECT. TOTAL FEES
w I AGREE TO COMPLV WITH ALL CITY AN�COUNTY OROINANCES AND STATE UWS RELATMG TO Bl11LDING
� CONSTRUCTION,ANOHEREBVAUTHORIZEREPHESENTATIVESOFTHISCOUNTVTOENTERUPONTHE
� ABOVE-MENTIONED PROPEFlTV FOR INSPECTION PURPOSES. COMMENTS
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m PERMITTEE NAME�PRINT�
� c 3� �'�% �� ..y $� °
� SIGNANREOFPE EE DA7E �
= RECPT.N0. PAID BY VALIDATION �
~ WHITE-0epartment Copy.YEILOW—Finance Copy,PINK—Assessor CaOY,GOLDENROD—File Copy,GREEN plfcant's Copy ' � � ��
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CITY OF DIAMOND BAR ` - `
INSPECT101V RECC�RD _ v. , ..
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SET BACK � , FLOOR J�IST � - - ,
F-CGS/FORMS/STEEL ' FHA REQMTS � � . ,. "
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ELECTRIC GFiOUND �� UND�R FLOOR DUCT �
GROUND PLUMBiNG " UNDER FLO�R GUNDUIT ' s '� ' °
SLAB GRADE __ . ' �;. ' 'c:: ; FIREPLACE F�UNDATION '
_—_.
TEMP POWER - FIREPLACE BOND BEAM '
WATER SERVIGE - , ,` ,' MID HT. BQND BEAM :: ,
ROOF SHEATHING ' ' - 8 F7. BOND BEAM - �
FRAMINGNENTiLIATION FINAL BOND BEAM ; ,,., , 9 �
ROOF COVER - PRE-GRADING �' ' '
__ ._ ._. .. ._ _ -
ROUGH liEATiNG � BEf��HING
ROUGH E�ECTRIC � RdUGH GRADING `
ROUGH P�UMBING �lNISH uRAC}ING�.," , .' , ,, , � .
SHUWER/TUB TEST i?OOL ELECTRIG � '
EXT. LA`fN/51DING POOL FENGING -
WALL INSULATtON ' , PbOL' FINAL '
:
CEILING INSULAT(ON � OF��ITE IMPS: �
DRYWALL NAILING DEbICATtONS " " �
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SEWER ' _ . ,.^ FIPdAL ENG,, � , � ,
SEPTIC TANK j :" = I ` ' ` . LANDSCAPEJIRRIG. " `
SEEP PlT/�.L. , _ _ _ I ..., "`'. '' ON SiTE IMPS. '., , ._
GAS AIR TEST � .... ___. i _. _ _ _ FlNAL' ZQNING „ ° " `
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FINA�C£?NST. � ; _ �IRE bEPT�FINAL�.'�.,
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FINAL HEA�ING _ i _ __._ _� WEALTH DEPT. FINAL ,: ,
FINAL E�EC7R1C� � _ _ . _ _ ; DEV. FEES PAID � . ,
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�1NAL PLUMBING -----, _ � ENEFiGY
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