HomeMy WebLinkAbout14963 (19)DIJI!IIINl1 HA t
CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
21660 E. Copley Drive Suite 190
(909)860-3195 Fax(909)861-3117
BUILDING PERMIT APPLICATION
ADDRESS
APN LOT TRACT
OWNER J:. ,L A- SJ' (,Qf,Z-#^Sb
ADDRESS
CITY ZIP 9 124 l TEL.04
APPLICANT TEL.
CONTRACTOR GCA/I COdI
ADDRESS -769 L A,Ar_fg,G Qom. YL91
CITYL44r ZIP 90ill( TEL. gY-j-60t
ARCH/ENG/
DESIGNER
ADDRESS
CITY ZIP TEL.
OWNER -BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI-
CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE: ANY CITY OR
COUNTY WHICH REQUIRESA PERMITTO CONSTRUCT, ALTER, IMPROVE, DEMOLISH, OR REPAIRANY STRUC.
TURE, PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI-
CENSE LAW (CHAPTER 0 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PRO-
FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP-
TION. ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO
A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS ($500).);
❑ I, AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION,
WILL 00 THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, BUSI.
NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF
PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
THROUGH HISOR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR
OFFERED FOR SALE IF, HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE-
TION, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
IMPROVE FOR THE PURPOSE OF SALE).
❑ I, AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS
TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI.
CENSE LAW DOES NOTAPPLY TOAN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND
WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S) LICENSED PURSUANTTO THE CCNTRAO
TORS LICENSE LAW.).
O 1 AM EXEMPT UNDER SEC. B. A P.C. FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
OHEREBY IRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER
NG WITH SECTION 7000) OF DIVISION 3OF THE BUSINESS AND PROFESSIONS CODE, AND
MIN FULL FORCE AND EFFECT. Z� LIC. NO. " lO�,-�,^
DATE �� 43lJ CONTRACTOF!j&-R /' i 0
WORKERS' COMPENSATION DECLARATION
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS'
COMPENSATION, AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.
'HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY SECTION
37000 THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUE MY WORK,E/RS' COMP NSATION INSURANCE CARRIERAND POLICY NUMBER ARE:
IE C
ICY NUMBER L--�
(THIS SECTION NEED NOT BE COMPLETED OFTHE PERMIT IS FOR ONE MARRED DOLIAGS ($100) OR LESS}
I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I
SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE
WORKERS' COMPENSATION LAWS OF CALIFORNIA AND AGREE THAT IF I SHOULD BECOME
SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR
ODELE. I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS.
DATE: T APPLICANT:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION R UNLAWFUL, AND SHALL BE
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND C P TO ONE HUNDRED THOUSAND
DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3708 OF THE LABOR CODE, INTEREST AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3007, CIV. C.).
LENDER'S NAME
LENDER'S ADDRESS
1 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
1 AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES.
i
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I
PERMITTEE NAME (PRINT)
I
I SIGNATURE OF PERMrTTEE DATE
PRESS
FIRMLY
APPLICATION PERMIT/q 3 P/C
DATE NUMBE #
ISSUE TYPE OCC
DATE 5-/ 6 y CONST. GROUP
ZONING SETBACKS
FRONT RW ❑
REAR ❑
SIDE/SIDE STREET RW ❑
SIDE ❑
PROPOSED USE G
NO. DWEL NO. NO.
UNITS STORIES BEDROOMS
DESCRIPTION SO. FT FACTOR PSF ADJ. AREANALUATION
SFR/ADD/REM
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Garage/Carport
WPatio/Dock
LL
Pool/Spa
U
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Re -Roof
0
Commercial
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Valuation ADJ.AREA
QUANTITY DESCRIPTION FEE
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CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
SMIP F' �►
ENERGY P/C
11 pvA
ENERGY PERMITTn
G ANJn C_
RETENTION FEE:
1
PRE -ALT FEE:
TOTAL FEES
COMMENTS
If q
RECPT NO. PAID BY VALIDATION
WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD --File Copy, GREEN—Applicant's L;M
CITY OF DIAMOND BAIL
INSPECTION RECORD
x
SET BACK
FLOOR JOIST
'
FTGS/FORMS/STEEL
FHA REOMTS
ELECTRIC GROUND
UNDER FLOOR DUCT
GROUND PLUMBING
I UNDER FLOOR CONDUIT
SLAB GRADE
FIREPLACE FOUNDATION
TEMP POWER
FIREPLACE BOND BEAM
WATER SERVICE
MID HT. BOND'BEAM
ROOF SHEATHING
8 IT BOND BEAM.
FRAMINGNENTILIATION
FINAL BOND BEAM
ROOF COVER
PRE -GRADING
ROUGH HEATING
BENCHING
ROUGH ELECTRIC
ROUGH GRADING
ROUGH PLUMBING
FINISH GRADING
SHOWER/TUB TEST
POOL ELECTRIC
EXT. LATH/SIDING
POOL FENCING
WALL INSULATION
POOL FINAL
CEILING INSULATION
OFF SITE IMPS.
DRYWALL NAILING
DEDICATIONS
SEWER
FINAL ENG.
SEPTIC TANK
LANDSCAPE/IRRIG.
SEEP PIT/L.L.
ON SITE IMPS.
GAS AIR TEST
FINAL ZONING
FINAL CONST.
FIRE DEPT FINAL
FINAL HEATING
HEALTH DEPT. FINAL
FINAL ELECTRIC
DEV. FEES PAID
FINAL PLUMBING
ENERGY
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COMMENTS
-
SEPTIC TANK SIZE
SEEP PITH SIZE
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