HomeMy WebLinkAbout17056 (25) -----��----- CIT'Y OF DIAMOND BAR EXPIRED
� DEPAR'fIvIENT OF COMMUNTTY&DEVELOPMENT SERVICES 'I
21825 E.Copley Drive 1
"' (909)860-3195 Fax(909)861-3117 ��� 1 8 1Q�2 pRESS I
"'-.���' BUILDING PERMIT APPLICATION FIRMLY
o DDRIESS ,� � � APPLICATION � l.� a I NUMB R �l #/C
DATE
� D TEE �( NPE OCC
APN LOT TRACT CONST. GROUP
p OWNER _ � � �41 ��
p ADDRESS ir�L4S� FQ. �� ZONING SETBACKS
Z CITY ZIP TEL. . (o FRONT RW ❑
o APPLICANT TEL. S DE/SIDE STREET RW ❑
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Q ADDRESS PROPOSED USE T�' ,� ' IL"rvtl`
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iz DESIGNER NO.DWEL. NO. NO. �
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cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
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I HEREBV AFFIRM UNDER PENALTI OF PERJURV THA7 I AM EXEMPT FROM THE CON7RAC70RS LI- G8f890/CBfPOfI
W CENSEUWFORTHEFOLLOWINGREASON(SEC.7a31.5BU51NESSANDPROFESSIONSCADE:ANVCITVOR (n
U COUNTVWHICHREOUIRESAPERMITTOCANSTRUCT,AITER,IMPROVE,DEMOLISH,ORREPAIRANVSTRUC� W PeiiO/DBCk
Z TURE,PRIOH 70 ITS ISSUANCE,AL50 REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
w STATEMENT THAT HE OR SHE IS LICENSED PURSUAN7 TO THE PROVISIONS OF THE CONTRACTORS LI� w
� CENSE UW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF OIVISION 3 OF THE BUSINESS AND PPO- � POOVSpO
FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDExEMP� (�
� TION.ANV VIOLATION OF SECTION 7031.5 BV ANV APPLICANT FOR A PERMIT SU&IECTS THE APPLICANT T0 Z Re-Roat
A CIVIL PENALTV OF NOT MOFE THAN FIVE HUNDRED DOLLARS(SSao).�:
❑I,ASONRJEROFTHEPROPERTV,ORMYEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, 0
Z Commercial . -
WIIL DO THE WORK,AND THE STRUCTURE IS NOT IN7ENDED OR OFFERED FOR SALE(SEC.7011,BUSI- J
N NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV 70 AN OWNER OF �
PROPERTY NRiO BUILOS OR IMPROVES THEREON,AND WHO DOES SUCH WOFiK HIMSELFOR HERSELF OR
Q THROUGH HIS OR HER ONM EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NO7INTENDED OR m
QOFFEREDFORSALE.IF,HOWEVER,7HEBUIL�INGORIMPROVEMEN7ISSOLDWITHINONEYEAROFCOMPIE-
Z TION,7HE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPoSE OF SALE).
W ❑I,AS ONMER OF 7HE PROPEHTV.AM EXCLUSIVELV CON7RACTING WITH LICENSED CONTMCTORS
[[ TO CANSTRUCT THE PH0.IECT(SEC.7011,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI� VBIUflIl011 ADJ.AREA
W CENSELAWDOESNOTAPPLVTOANOWNEROFAPROFERTYWHOBUILDSORIMPROVESTHEREON,AND
� WHOCONTRACTSFORSUCHPROJECTSWITHACON7RACTOR(S)LICENSEDPURSUANTTO7HECON7RAC- QUANTITY DESCRIPTION FEE
Y TORS LICENSE LAW.).
� ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q
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DATE OWNER U
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� LICENSED CONTRACTORS DECLARATION W
2 t HEREBY AFFIRM UNDER PENAL7Y OF PERIURV THA71 AM LICENSED UNDER PROVISIONS OF CHAPTER �
d e(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z
`X MY LICENSE IS IN FULL FORCE AND EFFEC7. m
� LICENSE CLASS LIC.NO. j
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U DATE CONTRACTOR d
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� WORKERS'COMPENSATION DECLARATION Q '
� I HEREBV AFFIRM UNDER PENALTV OF PERJURV ONE OFTHE FOLLOWING DECLARATIONS: Z
Z _IHAVEANDWILIMAIN7AINACERTIFICATEOFCANSENTTOSELF-INSUREFORWORKERS' 2
¢ CAMPENSATION,AS PROVIDED BV SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMANCE w
OF THE WORK FOR WMICH THIS PERMI7IS ISSUED. � '
�
w _I HAVE AND WILL MAINTAIN WORKERS'CAMPENSATION INSURANCE,AS RE�UIRED BY SECTION
Q 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED.MY WORKEflS'COMPENSATION INSURANCE CARRIER AND POLICY NUAIBER ARE: CONSTRUCTION
Q
� CARRIER PLAN REVIEW
ZPOLICV NUMBER ELECTRIC o
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, 0 (IHISSECTIONNE�NOTBEQ'JMPLETEDOFiNEPERMfTISFORONEMII�DREDOq1A0.5(E100)ORLESS). PLUMBING _
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Z I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
� SHALL NOT EMPLOV ANV PERSON IN ANV MANNEH SO AS TO BECOME SUBJECT TO THE
(/� WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE
? SUBJECTTO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR � //1
CADE,I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. ISSUANCE C/
� SMIP
p DATE: APPLICANT:
J WARNING FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNUWFUL,AND SHALL BE ENERGY P/C
� SUBJECTANEMPLOYEFiTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
DOLLARS(1100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
� SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. (jETENTION FEE: �
d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: �
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� I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS A CONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED�SEC.3087,CIV.C.).
Z
W
= LENDER'S NAME
�
F— LENDER'SADDRESS
� I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTAL F E ES �/�� ��
w I AGREE TO COMPLV WITH ALL qTV AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
� CqNSTRUCTION,AND HEREBV AUTHORRE REPRESENTATNES OF THIS COUNTV TO ENTER UPON THE
� ABOVE-MENTIONED PROPEflTV FOR INSPECTION PURPOSES.
Z COMMENTS
� �5�7' �2 /A S 1 l�'C.Lt. hf�' C�
QPEHMI NAME(PRINT) � ��ioL/'rv'�� �LL
� SIGNAT�OF�ERMITTE���� ` DA E
_ �' r �, RECPT.N0. PAID BY VALIDATION
~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy
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SET BACK ' , ' � FLOCR JOIST I �
__ _...._..�—,_._ ._.� _.___ ....._ ____ _ _...._- -�----.-- :._____.
FTGS/FORMS/STEEL FHA REC�MTS ---�-
ELECTRIC GROUND ~� UNDER FLC}QR DUCT ;
---- --_-- --_..---- --. ..---- _...-- ------ ..____....---- ,
_ _..._�—
GROUND PLUMBING UNDER FLO,OR CUA.!DUIT ; ______
-- ----
SLAB GRADE � __ __� � FIREPLACE FOUNDATION___�__ _ �
TEMP POWER � FIREPLACE BONa E3EAM _ ' ___ � _ _
WATER SERVICE � {� MID HT. BOND BEAM _ ___ __
— ----
ROOF SNEATHING ' � 8 FT. BQND BEAM :
...._ � _.�-- -.__..--- — _____ _._...__�
_ _.___._._..._.....
FRAMINGNENTILIATION � FINAL BOND BEAM
ROOF COVER ____ _ �PRE-GRADING ______ __ �
ROUGH HE,4TING BENCHING
ROUGH ELECTRIC ROUGH GRAdING
- --- __ —__ _ -- --------
ROUGH PLUIVIBING ; ' FINISH GRA�ING
--!-- __.. _-- ------ ----...._.._.__.—
SHOWER/TUB TEST j POOL ELECTRIC
EXT. IATH/SIDING � � POOL FENCING
— -- -----_— __....__ _----..----
WALL INSULATION i POOL FINA�
CEILIiVG INSULATION ; OFF SITE IMPS.
_. �.__ -- ---._....__�_ _._. -- --_.------ ---
DRYWALL NAILING j DEDfCATIONS
SEWEFi FIiVAL ENG.
SEPTIC TANK LANDSCAPEIiRRIC.
SEEP PIT/L.L. � ON 81TE IMPS.
GAS AIR TEST , FINAL ZONING
FINAL CONST. --,i FIFiE DEPT. FINA�
FINAL HEATING �; HEALTH DEPT. FINAL
- ------ --.___ � _ �--.__...---
FINAL ELECTRIC � j � DEV. FEES PAID
FINAL PLUMBING , i ENERGY �—
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