HomeMy WebLinkAbout17295 -----�� -- CITY OF DIAMOND BAR �X�IRED
DEPARTIvIENT OF COMMUNITY 8c DEVELOPMENT SERVICES
; r 21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 JUN 1� � �RESS
`'"-���'� BUILDING PERMIT APPLICATION FIR�VILY
o� JOBSITE /1�I�� �� DATE CATION I�U 2� ��, NU BER� /�� � #/�_
ADDRESS /
� ISSUE ���j I�I„I {�� ONST. GROUP
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o ADDRESS_/ � P � ZONING SETBACKS
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cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
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I HEREBY AFFIRM UNDER PENALT/OF PERJURV 7HA71 AM ExEMP7 FROM THE CANTRAC70R5 LI- G8f8QB/CBfpOfl
W CENSE LAW FOR THE FOLLOWING REASON(SEC.7031.5 BUSINESSAND PROFESSIONS CODE:ANV CI7V Oq (n
U COUNTVWHICHREOUIRESAPERMITTOCANSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANVSTRUG �
w TURE.PRIOR TO ITS ISSUANCE,AL50 REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF 7HE CONTRACTORS LI�
� CENSE LAW(CHAPTER B(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF 7HE BUSINE55 AND PRO- � POOVSpB
O FESSIONSCODE)ORTHA7HEORSHEISEXEMP77HEREFROMANDTHEBASISFORTHEALIEGEDEXEMP- (�
V 710N.ANV VIOUTION OF SECTION 7031.5 8V ANV APPLICANT FOR A PEFIMIT SUBJEC75 7HE APPLICANT T0 Z R2-R001
A CIVIL PENAL7Y OF NOT MOqE THAN FIVE HUNDRED DOLLARS(5500).):
Z ❑I,ASOWNEROFTHEPROPERTY,ORMVEMPLOV6ESWITHWAGESAS7HEIFlSOLECOMPENSATION, � COrt1rtIBfC181 �-
WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7o1a,BUSI� J
� NESS AND PROFESSIONS CODE:THE CON7RACTORS LICENSE lAW DOES NOT APPLY TO AN OWNER OF �
PROPER7V WHO BUILDS OR IMPROVES THEREON,AND YhiO DOES SUCH WORK HIMSELF OR HERSELF OR
Q THiiOUGHHI50RHEROWNEMPLOVEES,PROVIDEDTHATSUCHIMPROVEMENTSARENOTINTENDEDOR m
w OFFEREDFORSALE.IF,HOWEVER,THEBUILDINGORIMPROVEMENTISSOtDWITHINONEVEAROFCOMPLE-
0 TION,THE OWNE(i�BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
Z IMPROVE FOR THE PURPOSE OF SALE).
_ ❑I,ASOWNEROFTHEPROPERTY,AME%CLUSIVELVCONTRACTINGWITHLICENSEDCON7RAC70RS
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� TO CANSTFUCT THE PRQIECT(SEC.7014,BUSINE55 AND PROFESSIONS CODE:THE CONTRACTORS LI- V8I118(lOf1 ADJ.AREA
W CENSELAWDOESNOTAPPLYTOANOWNEROFAPROPERTVWHOBUILDSORIMPROVESTHEHEON,AND
F WHOCONTRACTSFORSUCHPRQIECTSWITHACONTHACTOR(S)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE
Y 70R5 LICENSE LAW.).
� ❑I AM E%EMPT UNDER SEC. B.d P.C.FOR THIS REASON J
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� DATE OWNER U
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� LICENSED CONTRACTORS DECLARATION W
� I HEREBV AFFIHM UNDER PENALTY OF PERJURY THA71 AM LICENSED UNDER PROVISIONS OF CHAPTER �
d D(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS COOE.AND Z
`X MY LICENSE IS IN FULL FORCE AND EFFECT. m
� LICENSE CLASS G—<O LIC.NO. j
V DATE ���p�D� CONTRACTOR d
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� WORKERS'COMPENSATION DECLARATION Q � q BOQ�D � /� _�
� 1 HEREBV AFFIRM UNDER PENALTV OF PERIURV ONE OF THE FOLLOWINC DECLARATIONS: Z / y� �y��
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Z _IHAVEANDWILLMAINTAINACERTIFICATEOFCqNSENTTOSELF-INSUREFORWORKERS' _ `��,��(y,� � -
¢ CAMPENSA710N,AS PROVIDED BY SEC710N 370o OF 7HE LABOR CODE,FOR THE PERFORMANCE U � �""� ��)•
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. w
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w _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BY SECTION
Q 370o OF 7HE LABOR CODE.FOF 7HE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS
ISSUED.MY WO7RK-ERS'CAMPENSATION INSURANC�E^CARRIER AND POLICY NUMBEfl AFE: CONSTRUCTION
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� CARRIER � ..i�7I. C4 PLAN REVIEW
Z POUCV NUMBER f(�C J/`� �� ELECTRIC
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� (fHLSSECiIONNE�NOTBE00MPLEfEDOFTHEPERMf(ISFORONEHUI�DREDDOlLARS(5100)ORLESS� PLUMBING
Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAI. +(/� �
C� SHALL NOT EMPLOV ANY PERSON IN ANY MANNER 50 AS TO BECOME SUBJECT TO THE
� WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE �
? SUBJECTTOTHEWORKERS'CAMPENSATIONPROVISIONSOFSECTION37000FTHEUBOR / '�
CODE,I SHALLFORTHWITHCOMPLV WITHTHOSE PROVISIONS. ISSUANCE C-T
� 7 SMIP
p DATE: O D APPLICANT: �_
J WARNING:FAILURE TO SECURE WORKERS'COMPENSA710N COVERAGE IS UNLAWFUL,AND SHALLBE ENERGY P/C
� SUBJECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDHEDTHOUSAND ENERGYPERMIT
DOLLARS(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PflOVI�ED FOR IN
� SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. RETENTION FEE:
pw.. CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� I HEREBV AFFIRM UNDER PENALTV OF PERJURV THATTHERE IS A CONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3oe7,CIV.C.).
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� LENDER'S NAME
H LENDER'SADDRESS `�
� TOTAL FEES �V c3'� �
� I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. �
w I AGFEE TO COMPLV WITH ALL pTY AND COUNTV ORDINANCES AND STATE LAWS RELATING TO BUILDING
� CONSTRUCTION,ANDHEREBVAUTHORI2EREPRESENTA71VE5OF7HISCOUNTVTOENTERUPONTHE
� ABOVE�MENTIONED PROPERTY FOR INSPEC710N PURPOSES.
Z COMMENTS
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m PERMITTEE NAME(PRI )
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� SIGNA O E MITTEE DA7E �
= RECPT.N0.�PAID BY( �� VALIDATION /
~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—Applicant's Copy
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FTGS/FORMS/STEEL ' • � I FHA REQMTS
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ELECTRIC GROUND ' � UNDER FLOOR DUCT �
_ --�- -- ------1--_ __------
GROUND PLUMBING � UNQER FLOOR CCJi�!dUIT�_
' ---_________
SLAB GRADE ( FIREPLACE FOUNDATION '" �
-- ---�---- --
TEMP POWER FIREPLACE.BOND BEAM � �
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WATER SERVICE MID HT. BOND BEAM � ; � ___
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ROOF SHEATHIh1G 8 Ff. BOf�D.BEAM . . . ___ ; _
FRRMINGNENTILIATION FINAL BOND BEAM
------ _._____.
ROOF COVER PRE-GRADING � �
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUIVIBING FINISH GRADING
SHOWERRUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING �
WALL INSULATION POOL FINAL
CEI�ING IN�ULATION OFF SITE IMPS.
---------�-
DRYWALL NAILIfVG DEdICATlO(VS
SEWER FIiVAL ENG. �
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/LL. ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CC}(VST. FIRE DEPT. FI�IAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC � DEV. FEES PAID
FIPJAL PLUMBIRIG ENERGY �
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