HomeMy WebLinkAbout12-1021DIVIOND 11A i
CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY k DEVELOPMENT SERVICES
21810 Copley Drive, Diamond Bar, CA 91765
909) 839-7020 Fax (909) 861-3117 Building Inspection Hotline (909) 839-702
BUILDING PERMIT APPLICATION
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OWNER Z 7,Z4.irz1,v
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CITY ZIP /% TEL. -
APPLICANT TEL.
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ADDRESS
CITY ZIP TEL NeO 7 72
ARCH/ENG/
DESIGNER
ADDRESS
CITY ZIP TEL
OWNER -BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS U.
CENSE LAW FOR THE FOLLOWNG REASON (SEC. 7031.6 BUSINESS AND PROFESSIONS CODE: ANY CITY OR
COUNTY WINCH REWIRES A PERMIT70 CONSTRUCT, ALTER IMPROVE, DEMOLISH, OR REPAIRMUY STRUC-
TURE. PRIOR TO ITS ISSUANCE, ALSO REWIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI_
CENSE LAW (CHAPTER B (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PRO-
FESSIONSCODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP-
TION. ANY VIOLATION OF SECTION 7031.6 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO
A CNB. PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS
L AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION,
WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7011, BUsN
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 IF, HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OFCOMPLE
TION. THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
IMPROVE FOR THE PURPOSE OF SALE).
I, AS OWNER OF PROPERTY, AM EXCLUSIVELY CONTRACTING WITN LICENSED CONTRACTORS
70 CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS U.
CENSE LAW DOES NOT APPLY TO AN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREON, AND
WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTORS) LICENSED PURSUANT TO THE CONTRA6
TORS LICENSE LAW.).
0 I AM EXEMPT UNDER SEC. B. A P.C. FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER
Y (COMMENCING WITH SECTION 7000) OF DIVISION 3 O THE BUSINESS AND PROFESSIONS CODE, AND
MY LICENSE IS N FULL FORCE AND EFFECT. '
7LICENSECLASSG39LIC. NO.:/,. ,
DATE-s 3/ /T O/3 CONTRACTOR *
WORKERS' COMPENSATION DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATION&
I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE 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 WORCEWS COMPENSATION INSURANCE, AS REWIRED BY SECTION
37000E THE LABOR CODE, FOR THE PERFORMANCE OF, THE WORK FOR WHICH THIS PERMIT IS
ISSUED. My WORKEaS'
G
ENCE CARRIER AND POLICYCY NUMBER AR
CARRIER 5! V-'
POLICY NUMBER - Qd .
THIS SECTION NEED NOT BE OOMPLETEDOF THE PERMIT IS FOR ONE HUNDRED DOLLARS (1140D)OR LESS)
I CERTIFY.THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, 1
SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE,
WORKERS' COMPENSATION LAWS OF CALIFORNIA, AND AG!JEE THAT IF I SHOULD BECOME
SUBJECT TO THE WORKERS''COMPENSATION PRO ON$aFSECTKUN 37000E THE LABOR
CODE, I SHALL FORTHWITH COMPLY WITH THOS O ffbNs.
DATE: — - — APPLICANT:_
WARNINWFALURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL BE
SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (SIOD.O0WA IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3708 OF THE LABOR CODE INTEREST, AND ATTORNEYS FEES.
CONSTRUCTION LENDING AGENCY
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3087, CIV. C.).
LENDERS NAME
LENDERS ADDRESS.
I CERTIFY THAT IHAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
1 AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE. LAWS RELATING TO BUILDING
CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY 70 ENTER UPON THE
ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES.
PERMITT I(PRINT)
SK7NATURE OF PERMITTEE DATE
PRESS
FIRMI V
APPLICATIOIQ ) L PERMIT /CIZ,%V Z ( P7 / DATENUMBER #
ISSUE 3ZTYPE OCC
DTECONST. GROUP
ZONING SETBACKS
FRONT RW
REAR
SIDEISIDE STREET RW p
SIDE
PROPOSED USE
Si NV l{
NO. DWEL. NO. NO.
UNITS STORIES BEDROOMS
DESCRIPTION SO. FT. FACTOR PSF ADJ. AREA/VALUATION
SFR/ADD/REM
U)
Garago/Carport
LLLI
Patio/Deck
U-
a
Poovspa
Z Re -Roof
Commercial
M
Valuation ADJ.AREA.
QUANTITY DESCRIPTION FEE
U
ccI— UW
W
0Z
m
J
CL
JQU
QZ
2UW
DCONSTRUCTION ( ( /
PIAN. REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
SMIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE:
P}jE2 REE n
1_7
TOTAL FEES
COMMENTS
RECPT. NO. PAID BY VALIDATION §i_l
T CLLurv—rinance LAW. rnvR—Assessor Copy, GOLDENROD --File Copy, GREEN—Appl{cant'3 Copy
CITY OF DIAMOND BAR
INSPECTION RECORD
SET BACK
n
m
1 FLOORJOIST
FTGS/FORMS/STEEL I FHA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID HT. BOND BEAM
ROOF SHEATHING 18 FT. BOND BEAM
FRAMING/VENTILATION FINAL BOND BEAM
ROOF COVER PRE -GRADING
ROUGH HEATINGBENCI HING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWER/TUBTEST POOL ELECTRIC
EXT. LATH/SIDING I POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
NAILING DEDICATIONSDRYWALL
SEWER FINAL ENG.
SEPTICTANK LANDSCAPEARRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST & '/ FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC DEV, FEES PAID
FINAL PLUMBING ENERGY
FINAL PLANING
FINAL ENGINEERING
COMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
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