HomeMy WebLinkAbout14909 (19)CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES ®r
21660 E. Copley Drive Suite 190
(909) 860-3195 Fax (909) 861-3117
BUILDING PERMIT APPLICATION
JOBSITE
ADDRESS S
APN OT TRACT
OWNER r
ADDRESS s/911i
CITY ZIP J TEL.
APPLICANT TEL.
CONTRACTOR L°
ADDRESS
CITY /i7+ r ZIP SAEV_f_ T11.71 -�_
ARCFVENG/
DESIGNER
ADDRESS
CITY ZIP TEL.
OWNER-BUILDEn DECLARATION
1 HEREBY AFFIRM
UPERJURY NDER PENALTY Or PERRY THAT I AM EXEMPT FROM TIE CONTRACTORS LH
CENSE LAW FOR THE FOLLOWING REASON (SEC. 73315 BJS:4ESS AMD PROF ESSKONS COC[. ANY C:TYOR
COUNTY YN1CH RCOUIRCS A PEriM:T TO CONSTRUCT. ALTER M°ROVE. DCMOLIS{ On RE PAN AN'Y STRUC.
TURF.
PRIOR TO ITS
ISSUANCE. ALSO RECIARES THE APPLICANT FOR SUCH PCRM:T TO FILE A SIGNED
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROY.SK)NS OF THE CONTRACTONSS U.
CENSE UW (CO
ICHAPTER S MMNWITH TH SECTION 7000) OF DIVISION 7 Or THE BJS-NESS AND ORD.
IONS CODE
FESS) OR THAT HE Cn SIE IS EX[MRT THEREFROM AND THE BASIS FOR T•E ALLEGED EXEMP'
TION. ANY VIOLA' OF SCCTION 7771.5 BYANY APPLICANT FOR A PCnM'T SUrUCCTS THE APPLICANT TO
A CrAL PENALTY Or NOT MORC THAN FNE HUNOnED DOLLARS (F7001 }
O L AS OWNEn OF THE PROPERTY.On MY EMPLOYEES WI: H WAGES AS THEN SOLE COMPENSATION,
WILL DO THE WORK AND TIE STRUCTURE IS NOT IN -ENDED OR OFFERED FOR SALE ISEC. 7:41, BJSb
NESS AND PROrESS1ONS CODE. THE CONTRACTOns UCCNSE LAW DOCS NOT APPLY 70 AN OWNER Or
PROPERTY VA40 BUILDS OR IMPROVES THEREON. AND W40 DOCS SUCH WOrIK H'MSrLF OR FIC RSELF On
THROUGH HIS On FIER OWN EMPLOYEES. PROVIDED THAT SUCH PAPAOVCLI[NTS ARC NOT NTENnrD on
OFFERED FOR SALE Ir. HOWMR THE B'JLDNG OR UPROVELIMT ISSOLD WTH:N ONE. YEAR OF ODM :E.
TION, THE OWNER41UILDER WILL HAVE THE BJRCEN OF PnOVA0 THA7 HE OR SHE DO NOT BU:LD OR
IMPROVE FOR THE PURPOSE OF SALE),
O L A.OWFIER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTN :YATI LICENSED CDNTRACTOnS
TO CONSTRUCT OHC PnCUrCT (SEC. 7044. BUSINESS AND PROFESSIONS CODE THC CONTRACTORS u•
CENSE LAW DOES NOT APPLY TO A4 OWNER OF A PnOPCnTY WHO BUILDS OR IMPROVES THEREON. AND
WHO CONTRACTS FOR SUCH PROTECTS VRTHACONTRACTOn;S) LICENSED PUnS.M1 T TO THE CONTRAC.
TORS LICENSE LAW).
O I AM EXEMPT UNDER SEC B APC FCR THIS REASON
DATE OWNER
LICENSED CONTFIACTOAS DECLAnATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM LICENSED U ,ER PROVISONS OF D APTER
■ (COLMENCING W.TH SECTION 700C) OF DIVISION 7 OF THE BUSNE SS AND PROFESSIONS CODE. AND
MY LICENSE IS N FULL FORCE AND EFFFF+ECT.
LICENSECLASS
�(�(�/ LIC. NO. _
DATE ti:: e12C CONTRACTOR__
WORKERS' COMPENSATION DECLARATION
1 HrnCBYAFBVA UNDER PENALTY Or PERJURY ONE OF THE FOLLOW -NG CCCLARATONS.
_I HAVE A40 WLL MANTA:N A CEWIricATC OF CONSENT TO SELFJN'SURE FOR WORKEFi S'
CNSATgN. A, PFIIMD[D BY SEcT)oN 7700 or THE LADOn COOS. FOn TINE PERrOnMANCE
THE WCRtlU FOR WIHICH THIS PrnMIT IS ISSUED.
I HAVE AND WILL MA:NTAN WORKERS' COMPCNSA�KIN INSURANCE, AS REM:RED BY SECTILW
7700 OF THE LAnOF1 OODr.. OR lE P"E;pANCE Or THE WORK FOR W4'CrH THIS PERM'T IS
ISS:IED. MY WORICn^' PE. ATXHJ/I�^�'Y'�A4CC RR:[R AND POLICY MJMUER ARi
CARRIER • -
POLICY NUITO[R ,�
me SrcncN NETT. NOT AC COMIU7E0OrTC PES IS FOA DNE R NYEDDCIIARl aim on LESS)
I ccnTIFY THAT N THE PEnronLIANCC OF THE WORK Fon WITCH TH•S PEPMIT IS ISSUED. I
& AU NOT EMPLOY ANY PERSON N ANY MA.NNEn SO AS TO BECOME SUBJECT TO TIE
WORK COMPCNSAT ION LAWS OF CALIFORNIA AND AGREE THAT IF 1 Sm
SUB:CCT TO THE WORKERS' COMPENSATION PnONS10N5
OF
SEC'.I R
COOT. 1 SHALL FOnTHW1THCOMPLY IAIDH TIMEE PcP/R/�7OOV...SS)ISO/7NNr
DATE:y= APPLICANT.---R%Sl: A—WI,LSHA;—
WARNING FA.LUETOSECUJREWORKCRSCC4HPE Hh COVCRAGr ISL'IaA.A L BE.
SL,WECT.AN EMPLOYER TO CRUINAL PENALTIES AND CN'L FINES UP TO ONE NLIN.'OILF' iFwS_
DOLLARS (7100.0001. LN ADDITION TO THE COST Or COMPENSATION. DAMAGES AS PROV.7ED Folk IN
IO
SECTN 7705 OF THE LAROn COOL. IHTEPEST, AND ArTOrLNCYS FEES.
CONSTRUCTION LENDING AGENCY
1 HERE BY AFF:nM UNDER PENALTY Or PEFUUnY THAT THERE IS A CONSTRUCTION LENDINo AGENCY
FOR THC PE RFORMANCE OF THE WORK ron W 4CHH THIS PERMIT IS ISSJLD ISEC. 3 P7, CIV C.).
LENDERS NAME
LENDERS ADDPESS
1 CERTIFY THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE NronuxT10N is CORRECT.
I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BU:LDING
CONSTRUCTION. AND HEREBY AUTHORIZE RLPRF SFNTATIYES OF THIS COUNTY TO ENTER UPON THE
ABOVE MENTIONED PROPER INSPE '10N PURPOSES
P .I� (vn' I
&WUU F TTEE �DAIL r
PRESS
FIRMLY
APPLICATION PERMIT IJ P/C
v
DATE NUMBER i p
—
ISSUE��TYPE OCC
DATE CONST. GROUP
ZONING SETBACKS
FRONT RW ❑
REAR p
SIDE/SIDE STREET RW ❑
SIDE ❑
PROPOSED USES
NO. DWEL NO. NO.
UNITS STORIES BEDROOMS
DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION
SFFVADD,'nEM
Ga•agR'Carpert
WPa;IC/Dock
LL
POO:'Spa
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0
Co ercia!
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OUANTI DESCnIPT10N
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CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
MCC)IAN:CAL
INSPECTION FEE
ISSUANCE 'U
SMTP
ENERGY P,'C
ENERGY PERMIT
RETENTION FEC:
PRC -ALT FCC:
1
TOTAL FEES
COMMENTS
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nECPT _ PAID BY VALIDATION
E—AWMImert Copy, YELLOW—Finance Copy, PINK—Assessor Cory, GOLDENROD—Filo Copy, GRCCN—Applicant's Copy
CITY OF DIAMOND BAR.
INSPECTION RECORD
-�-�
SET BACK
-VATE
INSPECTOR
I
,,,.
FLOOR JOIST, �• - . •.
FTGS/FORIAS/STEEL
f
FHP, REOM TS
_
ELECTRIC GROUND
I
I
I UNDER FLOOR DUCT
_
GROUND PLUMBING
I
UNDER FLOOR CONDUIT'.,'.
':
I
SLAB GRADE
I
FIREPLXCE'FbUNDATION
TEI•.9P POWER
FIREPLACE BOND BEAM
WATER SERVICE
hill) HT. BOND BEAM
ROOF SHEATHING
�'`
: •` ' .
Fi FT. BOND 6EAP.9 . :,
I
FRAMINGIVENTILIATION
FINAL BOND BEAM
I
ROOF COVER
:
I PRE -GRADING
ROUGH HEATING
I BENCHING
ROUGH ELECTRIC
ROUGH GRADING
ROUGH PLU. BING
I FINISH GRADING
f
SHOINERITUB TEST
I
I POOL ELECTRIC
EXT. LATHJSIDING
I
I
I POOL FENCING
WALL INSULATION
I
I POOL FINAL
CEILING INSULATION
OFF SITE IMPS.
1
I
DRYWALL NAILING :' `\I
' �
� . • ., I
DEDICATIONS
I
I
SEWER ., \ _-. , ,
I ,• ' I
I FINAL ENG.
SEPTIC'TANK .
-.
I - -- I
LANDSCAPEARRIG.
SEEP P.IT/L.L..
I' ' - - •- ^; I
ON SITE IMPS.
GAS AIR TEST
I I
FINAL ZONING
FINAL CONST.
FIRE DEPT. FINAL
FINAL HEFTING
HEALTH DEPT. FINAL
FINAL ELECTRIC
FINAL PLUMBING
_
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I .
I - _ _I_I
`_ I
I DEV. FEES PAID
ENERGY
I
I
COMMENTS
SEPTIC TANK SIZE
SEEP PITlU SIZE
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