HomeMy WebLinkAbout11-635 .
CITY OF DIAMOND BAR ` "
� ---�F�— DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �
, ' t 21825 Copley Drive,Diamond Bar,CA 91765 ' �i
(909)839-7020 Fax(909)861-3ll7 Building Inspection Hotline(909)839-7027 � PRESS
'°�'� BUILDING PERMIT APPLICATION FIRMLY
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ADDRESS� ��/d T /��L=ir-(�� C/Y DATE CATION NUMBER� #/C
ISSUE D TYPE
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� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDER DECLARATION SFR/ADD/REM
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p I HEREBV AFFIRAI UNDER PENALTV OF PERIURV THAT I AM EXEMPT FAOM THE CANTRACTORS LI� G8f8gB/CefPOA
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Z NRE,PRIOR TO ITS ISSUANCE,/�150 REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck
w STATEMENT THAT HE OR SHE IS 110EN5ED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI�
�S CENSE UW(CHAPTEH B(COMMENCWO WITH SECTION 7000)OF DIVISION 3OF THE BUSINESS AND PFO� LL' POOUSPB
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V TION.ANV VqUTION OF SECTION 7031.6 8V ANY APPLICANT FOR A PERMIT SUBJECTS 7HE APPLICANT T0 Z Re-Roof
A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(f50D)J:
� ❑I,ASOWNEROFTHEPROPERTV,ORMVEMPLOYEESWITHWAOESASTHEIRSOLECOMPENSATION, � COrt1rtI0fCi81
Z WILL DO THE WORK,M1D THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.701�,BUSI� J
N NESS AND 7ROFESSIONS CODE:THE CONTRAC70R5 LICENSE LAW DOES NO7 APPLV TO AN OWNER OF �
PROVERTY NM1iO BUILOS OR IMPROVES 7HEREON,AND NTIO DOES SUCH WORN HIMSELF OR HERSELF OR
Q 7HROUGH HIS OR HER ON?J EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
Q OFFEqEDFORSALEIF,HOWEVERTFIEBUIIDINGORIMPROVEMENTISgq_pW�7HINONEVEAROFCAM7LE-
Z TION,THE OWNEfl-BUIIDER WILL MAVE THE 9URDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF SALE).
�yJ ❑4���NNER OF THE PROPERTV,AM EXQUSIVELV CANTRACTING WfTH LICENSED CONTRACTORS
Q TO CONSTRUCT THE PRQIECT(SEC.70U,BUSINESS AND PROFESSIONS CADE:THE CONTRACTORS U- V8IU8�IOf1� ADJ.AREA
W CENSE LAW DOES NOTAPPLV TO AN ONMER OF A PROPERTV WHO BUILDS Ofl IMPROVES THEREON,AND
� W/bCONTRACT5FOR5UCHPR0.IECTSWITHACONTRACTOR(S)LICENSEDPURSUANTTOTHECONTRAC� QUANTITY DESCRIPTION
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� ❑I AM EXEMPT UNDER SEC. ' B.8 P.C.FOR THIS REASON Q .
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LL DATE ON?JER � I
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� LICENSED CONTRACTORS DECLARATION w
� I HEREBV AFFIHAI UNDER PENALTV OF PERIURV THAT I AM LICENSED UN�ER PROVISIONS OF CHAPTER �
� �(COMMENCINO WI7H SECTION 7000)OF DIVISION 3 OF THE BUSINESS ANO PROFESSIONS CADE,AND Z
�j� W LICENSE IS IN FULL FORCEAN�EFFECT. m
� ICENSE CLASS � LIC.NO. 'I V ���� �
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� WORKERS'COMPENSATION DECLARATION " Q
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N I HEREBY AFFIRM UNDER PENALTV OF PERIURV ONE OFTHE FOLIOWING DECLARATIONS: Z , � � � ' . -
� _I MAVE AND WILL MAINTAW A CERTIFICATE OF CqNSENT TO SELF�INSURE FOR WORKERS' ¢
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Q COMPENSATION,AS PROVIOED BY SECTION J�00 OF TNE LABOR CODE,FOR THE PERFORMANCE U
OF THE WORK FOR WHICH THIS PEFMIT IS ISSUED. W
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W _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTqN
Q 3700 OF THE LABOR CA�E.FOq THE PERFORMANCE OF THE WORK f-0R WHICH THIS PERMIT IS
ISSUED.MV WORKERS'COMPENS TION INSUR �CE CA RIER AND POLICY NUMBER ARE: CONSTRUCTION
j � CARRIER /�� PLAN REVIEW O ��' �
¢ POLICY NUMBER UOVI) I1 ��'O ELECTFiIC
0 (iHSSEC�IONNE�NO7BE07MPLE7EDOFTHEPEPMfT6FOqONEFiIN�DHED00U�AS(f100)ORLESS} PLUMBING �
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Z I CERTIFY THAT IN THE PERFORMANCE OF THE WOR1C FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
G} SHALL NOT EMPLOV ANV PERSON IN ANV MANNER 50 AS TO BECAME SU&IECT TO THE
(n WORKERS'COMPENSATIONIAWSOFCALIFORNIAANDAGHEETHATIFISHOULDBECOME INSPECTIONFEE
SU&IECTTOTHEWORKERS'COMPENSATIONPROVISIONSOFSECTION37ooOFTHELABOR � � �
O CODE,I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS, ISSUANCE
p DATE: APPLICANP. SMIP � SQ
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J WARNINO:FAILURE TO SECURE WORKERS'COMPENSATION CAVERAOE IS UNIAWFUL,AND SHALL BE ENERGY P/C
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� SUBJECTANEMPLOVEFTOCRIMINALPENALTIESANOCIVILFWESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
DOLW75({100,000),IN ADDITION TO THE COST OF COMPENSATqN,DAMAGES AS VROVIDED FOR IN n
W SECTION 3708 OF THE LABOR COOE.INTEREST,AND ATTORNEV'S FEES. RETENTION FEE: �.{,/ O
O CONSTRUCTION LENDING AGENCY PR ALT FEE:
� I HEREBV AFFIRM UNDER PENALTV OF PERJURY THAT THERE IS A CONSTRUCTION LENDINQ AGENCV ���f� � � O
FOR THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED(SEC.3077,CIV.C.�.
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� LENDER'S NAME
F— LENDER'SADDRESS
� I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT TiE ABOVE INFORMATION IS CARRECT. TOTAL FE ES (Jt V ��.Q�
� I AGREE TO COMPLV WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS REUTINO TO BUILDINO
� CONSTRUCTION,ANDHEREBYAUTHORIZEREPRESENTATIVESOFTHISCOUNTYTOEMERUPONTHE
Z ABOVE-MENTIONED 7ROPEF7Y FOR INSPECTION PURPOSES. COMMENTS
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� SIONATURE OF PE E DATE -
� RECPT.NO. PAID BY � VALIDATION �
WHITE—Department Copy,YELLOW—Finer�ce Copy,PINK—Asaessor Copy,GOLDENROD—File Copy,GREEN—
Applicanl's Copy
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SET BACK FLOOR JOIST
FTGS/FORMS/STEEL FHA REQMTS
ELECTRIC GROUND � UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE B�ND BEAM
WATER SERVICE MID H'T. BOND BEAM
ROOF SHEATHING 8 FT. BOND BEAM
FRAMINGNElJTILATION FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
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SHOWER/TUB TEST POOL ELEGTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSULATION POQL 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. J � FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAIQ
FINAL PLUMBING ENERGY
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