HomeMy WebLinkAbout12-473 _ _�i4,�_ CITY OF DIAMOND BAR �
, � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �.
21810 Copley Drive,Diamond Bar,CA 91765
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PRESS
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ADDRESS - DATE � �'/
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o ADDRESS � � '` .L�/�,Q ZONING SETBACKS
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� SIDE/SIDE STREET q�l p
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� DESCRIPTION SQ.FC FACTOR PSF ADJ.AFiEANALUATION
p� OWNER-BUIIDER DECLARATION � � SFR/ADD/REM
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W CENSEUWFORTHEFOLLOWINOREASON(SEC.7031.6BUSINESSANDPROFESSIONSCOOE:ANYCIT/OR � (n
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< NRE.PRIOR TO'RS ISSUANCE,ALSO REOUIRE9 THE APPLICANT FOR SUCH PERAIR TO FIIE A SIONED w
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PHOVISIONS OF THE CONTRACTORS L4 ...
� CENSE UW(CHAPTER Y(COMMENCW(3 WITH SECTION 7000)OF OMSION 7 OF THE BUSINESS AND PRO� � PooUSpa
, fES3qNSCOO�ORTHATHEORSHE�ISExEA1PTiHEREFROMANDTHEBA515FORTHEALLE6EDE%EAIP- C7
� TKIN.ANYVIOLATIONOFSECTION703t.6BYANYAPP�ICAN�FORAPERMITSU&IECTSTHEAPPLICANTTO Z qe-Roof � '
� A CIVIL PENN.TY OF NOT MORE THAN FNE HUNDRED DOIURS(f6oD)J: �
� ❑4ASOWNEROF7HEPROPERTY,ORMYEhIPLOVEESWITHYJADESASTHEIqSOLECOMPENSATICNJ, � 0 Commercfal � � �
Z WIIL DO THE WORI(AND THE 9TRUC7URE IS NOT IN7ENDED OR OFFERED FOR SALE(SEC,�7w�,BU51. _1 . '
� NE33 AND VROFESSIONS CODE:THE CONTRACTORS UCENSE LAW DOES NOT AVPLV TO AN OWNER OF ? -
PROPEHTY NTID BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WpqK HIMSELF OR HERSELF OR �
� TiROWH MIS Oq HER OWN EMVLOVEES,PROVIDED THAT SUCN pIPROVEMEMS ARE NOT INTENDED OR m ,
0 OFFERmFORSALEIF,HON�EVER7MEBUlIDP100RWPROVEMENTISSOLDWITIWOD)EVEANOFCOMPLE-
Z TION.TME ONTJER-&11LDER WILL HAVE TNE 9URDEN OF PROVINQ THAT HE OR SHE DID NOT BUIID OR
� MPROVE WR THE PURPOSE OF SALE� � � -
W ❑I,ASOWNEROFTHEPROPERTV,AMEXCLUSNEIYCANTMCTMOWfTNLICENSEACONTRACTOHS
� 70 CONSTRUCT THE PRQIECT(SEC.7oN,�BU5INESS AND PROFESSIONS CODE 7HE CONTMCTORS�U- V01U9t1011 ADJ.AREA�. � '
CENSEUWDOE9NOTAPVLVTOANOWNEROFA7qOPER7YNM1fOBUI�D30RIA1PROVE67NEREON,AND �
� NM17000NTRACTSFOiiSUCHPRQIEC75WITfACONiRACTOR(SjLICENSEDPUABUAMTO7HECONTfUG QUANTIN DESCRIPTION
� 70RSl10EN9ELAW.). �E .
� ❑1 AM EXEMPT UNDER SEC. B.8 P.C.FOR 7W5 REASON �
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FQ UCENSED CONTRACTORS DECLARATION W � � � � � � �
C= I HEREBY AFFlRM UNDER PENALTY OF GERNRV THAT IAM�LICENSED UNDER PROVISIONS OF CHAPTER � ' � �
� Y(COA/A1ENCwO WfTH SECTtON 7000)OF DMSION 7 OF THE BUSWESS AND PiiDFE5510N5 CODE,MA Z �
��� IAY LICENSE IS W FULL FORCE AND EFFEC7. • m
� UCGNSE CLASS � �IC.NO.. �� - �
V DATE . CONTRAC70R d . .. , ,
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� WORKERS'COMPENSATION DECLARATION Q � � � �
� 1 HEqEHV AFFIPLI UNDER PENALTV OF.PERJUHY ONE OF THE FOLLOW WG DECIARATqNS; V -
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� _I HAVE AND WILL MMNTNN A CERi1FICATE OF CON$ENT 70 SELF-INSURE FOR WORI(ERS' � � '
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Q OF THE WORK FOR WHKXi THIS PERMIT IS ISSUED. � , , .
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Q 37000F THE UBOR COpE,FOR 7HE PERFORMANCE OF THE WORK FOR WHICH tHiS PERMR IS
, � �SSUm.MV WOPo(ER5 CAMPENSATqN INSURANCE CARRIER AND POIICY NUMBER AAE: �CONSTRUCTION '
� CARRIER .�����y ��j� �f
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Z 1 CERTIFY THA7 W iHE PERFORAIANCE OF THE WORK FOR W Wp/THI3 PEfU1R IS ISSUED.I MECHANICAL
C7 SHALL NOT EMFLOY ANY PERSON W ANY MANNER 50 AS TO BECAME SU&IECT TO THE � �
(q N4RKER5 CAMPENSATIDN LAH5 OF CAIIFORNI�4N0 A6REE THAT IF I SHOULO BECOME INSPECTION FEE
SUBJECT TO7HE WOPoCERS'�COMPENSIUIDN VROVISIONS OF SEC7pN 370o OF THE LABOR �
S CODE,I SIULL fORTMVITH COA/PLY N7TN THOSE PROVISIONS. ISSUANCE
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p DATE APPLICANT: �SMIP
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J WAPNINO:FAILURETOSEWREWORKERSCOMPENSATIONCOVERA6EISUNLAWFUL,ANDSHALLBE �ERGYP/C �
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� SUBJECTAN EMPLOYER 70 CRIM WAL PENAL7IES AND CNIL FWES UP TOONE HUNDRED iHOUSAND ENERGY PERMIT
DOlLM3.(S10o.ODD),W ADDITION 70THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
J 6ECTION 370!OF TiE UBOR CODE,INTEqE3T,AND AiTORNEY$FEE3. � O
w � RETENTION FEE: �
O , CONSTRUCTION LENDING AGENCY � PRE-ALT FEE: '
� 1 HEREBV AFFIRM UNDER'PENALTY OF PERtt1RV THAT THERE IS ACONSTRUCTION LENpWp ApENCy �
�Z' FOR ME PEHFORMANCE OF THE WORN FOR NTi1CH T/�5 PERMR IS ISSUED(SEC.30W,CIV.GJ.
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�. LENDEl75 NAME - - '
F— LENDERSADDRE55 � � -
, �' I CERTIFY THAT 1 HAVE READ THf9 MPLICATION AfJD STATE THAT TiEABOVE INFOMIATIDN 19 CORRECT. TOTAL FE ES '
� IAUREE7000MPLYWITHALLCT'ANOCOLMTYOqpW�WCESANDSTATELAWSREU71N070BUILDINO //``iO
� CONSTRUCTION,AND HEREBY AUTFIORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UVON THE ' / �j
Z ABOVE-MEMIONED VROPER SPECTION CURPOSES. ! (
� �_–�^ f COMMENTS '
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m PERMI7TEE NAME(PRINT) � � '
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� WHITE-Depertment Copy;YELLONF--FIn Copy,PINK=Assessor Copy,GOLDENROD—Ffle Copy,GREEt�Appl{cant's Copy
CITY QF DIAi111QND BAR
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ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPIACE BOND BEAM
WATER SERVICE MID HT.BOND BEAM
ROOF SHEATHING 8 FT.BOND BEAM
FRAMING/VENTILATION FlfdAl B�ND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBIt�lG FINlSH GRADING
SH�WER/TUB 7EST POOL ELEC7RIC
EXT.LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAIIING DEDICATIONS
SEWER FINAL ENG.
SEPTICTANK LANDSCAPElIRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR 7EST FINAL ZONING
FINAL CONST. FIRE DEPT,FINAL
FINAL HEATING HEALTH DEPT.FINAL
FIN,4L ELECTRIC DEV.FEES PAID
FINAL PLUMBING ENERGY
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