HomeMy WebLinkAbout18345 (29)f� CITY OF DIAMOND BAR
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DEPARTMENT OF COMMUNTfY & (DEVELOPMENT SERVICES
21825 E. Copley Drive
(909) 860-3195 Fax(909) 861-3117 PRESS
BUILDING PERMIT APPLICATION 1 FIRMLY
JOBSITE 3 Os ti k1:iLJP,
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APN LOT TRACT
OWNER - Al ) Lir J Al
ADDRESS
CITY IP . TEL. V o _02-13
APPLICANT �13TEL.
CONTRACTOR
ADDRESS
CITY ZIP TEL.
ARCH/ENG/
DESIGNER
ADDRESS
CITY ZIP TEL.
\1 _ OWNER -BUILDER DECLARATION
1 HEREBY AFFIRM UNDER PENALTY OF PERAJRY THAT I AM EXEMPT FROM THE CONTRACTORS LL
CENSE LAW FOR THE FOLLOWING REASON (SEC.7031.5 BUSINESSANO PROFESSIONS CODE:ANY CITY OR
COUNTY WHICH REOUIRESAPERMIT TO CONSTRUCT,ALTER MPROVE.DEMOUSH.OR REPAIR ANY STRUC-
TURE, PRIOR TO ITS ISSUANCE, ALSO REGUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS L4
CENSE LAW ICHAPTER Y (COMMENCINO WITH SECTION 7000) OF DIVISION a OF THE BUSINESS AND PRO-
FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THERE FROM AND THE BASIS FOR THE ALLEGED E%EMP•
TION. ANY VIOLATION OF SECTION 7031.5 BY ANYAPPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO
A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (SSW)):
O LAS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEA SOLE COMPENSATION,
WILL DO THE WORK AND THE STRUCTURE 15 NOT INTENDED OR OFFERED FOR SALE ISEC. 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 HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR
OFFERED FOR SALE F,HOWEVER, THE BUI D:NO OR IMPROVEMENT LS SOLD WITHIN ONE YEAR OF COUPLE -
TON. THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING :HAT HE OR SHE DID NOT BUILD OR
IMPROVE FOR THE PURPOSE OF SALE),
❑ L AS OWNER OF THE PROPERTY. AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS
TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS U.
CENSE LAW DOES NOTAPPLY TO AN OWNER OFA PROPERTY WHO aUODS OR IMPROVES THEREON, AND
WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S) LICENSED PURSUANT TOTHE CONTRAC-
TORS LICENSE LAW.),
❑ 1 AM EXEMPT UNDER SEC. B P.C. FORTHIS REASON
GATE OWNER
LICENSED CONTRACTORS DECLARATION
1 HERESY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER
P (OOMMENCNG WITH SECTION 7000) OF DIVISION SOF THE BUSINESS AND PP.OFESSONS CODE, AND
MY LICENSE IS N FULL FORCE AND EFFECT.
LICENSE CLASS LIC. NO.
DATE CONTRACTOR
WORKERS' COMPENSATION DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
�I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELFJNSURE FOR WORKERS'
COMPENSATION. AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.
_I HAVE AND WILL MAINTAIN WORKERSCOMPENSATION INSURANCE. AS RECUR ED BY SECTION
]700 OFTHE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE:
CARRIER
POLICY NUMBER
(IHSSECTION NEEDNOTBE CCMP ETEDCF7FE PER.rr 6 PORONEHUNE)REDDOLLARS(5100)ORLESS}
1 CERTIFYTNAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I
SHALL NOT EMPLOY ANY PERSON N 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
CODE, I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS.
DATE: APPLICANT:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL BE
SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (S10D,D00), N ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3705 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
1 HEREBYAFFIFN UNDER PENALTY OF PERAJRY THAT THERE IS A CONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THS PERMIT IS ISSUED (SEC. 311117, CIV C.),
LENDERS NAME
LENDERS ADDRESS
I CERTIFY THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THEASOVE INFORMATION IS CORRECT.
I AGREE 70 COMPLY WITH ALL CITY UNTYORDINANCES AND STATE LAWS RELATING TO BUILDING
CONSTRUCTION, AND HEREBY AVT RI REPRESENTATIVES DF THIS COUNTY TO ENTER UPON THE
7ENTIO1 PROPERTY F IN
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IRMITTEEN RIN7) _
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O SIGMA, EOF PERMITTEE GATE
APPLICATION22 PERMIT P/C
i'lDATE
NUMBER i
ISSUE 1t) . TYPE OCC
DATE U 1/ CONST. GROUP
ZONING SETBACKS
FRONT RV/_0_
REAR ❑
SIDE/SIDE STREET RW ❑
SIDE ❑
PROPOSED USE
NO. DWEL. NO. NO.
UNITS STORIES BEDROOMS
DESCRIPTION SO. FT. FACTOR PSF ADJ. AREA/VALUATION
SFR/ADD/REM
N
Garage/Carport
WPatio/Deck
LL
PoollSpa
Z
Re -Roof
Commercial
5
m
Valuation ADJ.AREA
QUANTITY `DESCRIPTION FEE
J
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U
r -
U
w
J
w
0
Z
CO
CL
U
Z
Q
2
U
W
5o
CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
SMIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE:
PRE -ALT FEE: '
TOTAL FEES
COMMENTS
RECPT. N0. PAID BY_LfrVALIDATION
WHITE—Depanment Copy, YELLOW—Finance Copy, PINK—ASsessor COPX UULUENKULF—rite copy. UHLLN—AppHCanrS wpy
CITY OF DIA140-NID BAR
INSPECTION! RECORD
SET BACK FLOORJOIST:
FTGS/FORMS/STEEL
F'HA RECIMT.S
_,__u.NDER FLOOR DUCT
ELECTRIC GROUND
GROUND PLUMBING
UINDER FLOOR CONDUIT
SLAB GRADE
FIREPLACE FOUNDATION
TEMPPOWER
FIREPLACE BOND BEAM
WATER SERVICE
ROOF SHEATHING 1 23 b
FRAMINGNENTil I—ON!
ROOF COVER
ROUGH HEATING
MID [IT. BOND BEAM
8 FT. BOND BEAM
FINAL BOND BEAM
PRE -GRADING
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
DRYWALL NAILING
OFF SITE IMPS.
DEDICATIONS
SEWER
FINAL ENG.
SEPTIC TANK
LANDSCAPEARRIG.
SEEP P1 T/L.L.
ON SITE IbAPS.
GAS AIR TEST
FINAL CONST. PT
FINAL HEATING
1
�_JHEALTH
FINAL ZONING
_j..FIRE DEPT FINAL
DEPT. FINAL
FiNAL ELECTRIC
DEV. FEES PAID
FINAL PLUMBING
ENERGY
COMMENTS
RkEl 'ONE
SEPTIC TANK SIZE
-SEEP PIT/U SIZE