HomeMy WebLinkAbout18132 -----��----- CITY OF DIAMOND BAR EXC�I R�� i
DEPARTIv�NT OF COMMUNITY&DEVELOPMENT SERVICES
I 21825 E.Copiey Drive I
(909)860-3195 Fax(909)861-3117 0 C T 0 9 ZUOz PRESS
'`�»���� BUILDING PERMIT APPLICATION FIRMLY �
� JOBSITE p ,�/ APPLICATION PERMIT P/C
o ADDRESS�� 7 7 S • �O//'I/��- 7 �� DATE G-✓� ��� NUMBER--� #
°r APN LOT TRACT ISSUE / x TYPE OCC
DATE �P � � —U� CONST. GROUP
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� ADDRESS �6 7 S � 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 HEREBV AFFIRM UNDER PENALN OF PERJURV THAT I AM EXEMPT FROM THE CONTRACTORS LI- G8f896/C8(pOfl
W CENSEUWFORTHEFOLLOWINGREASON(SEC.7a31.5BUSINESSANDPROFESSIONSCODE:ANYCI7VOR (n
U COUNTVMRiICHREQUIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE.DEMOUSH,ORREPAIRANYSTRUG �
w TURE,PRIOR TO ITS ISSUANCE,AL50 REDUIRES THE APPLICANT FOP SUCH PERMIT TO FILE A SIGNED w Patio/Deck .
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI�
� CENSE LAW(CHAP7EH 9(CAMMENCING WITH SECTION 7000)OF DIVISION 3 OF 7HE BUSINESS AND PRO- � POOVSpB
� FESSIONSCODE)ORTHATHEOfiSHEISEXEMP77HEREFROMANDTHEBASISFORTHEALLEGEDEXEMP� (�
V TION.ANV VIOLATION OF SECTION 7031.5 BV ANY APPLICANT FOH A PERMIT SU&IECTS THE APPLICANT T0 Z Re-Roof
A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLLARS(f5oo).):
0 ❑I,ASOWNEROF7HEPROPERN,ORMYEMPLOVEESWI7HWAGESASTHEIRSOLECOMPENSA710N, Q COmmBfCidl -
Z WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7oI4,BUSI- J
� NESS AND PROFESSIONS CODE:THE CANTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER Of �
PROPERN NM1iO BUILOS OR IMPfiOVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
� THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
w OFFEREDFORSPLE.IF,HOWEVERTMEBUILDINGORIMPROVEMENTISSOLDWI7HINONEYEAROFCOMPLE-
� TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
Z IMPROVE FOR THE PURPOSE OF SALE).
�_ ❑I,ASOWNEROFTHEPROPERTV,AME%CLUSIVELYCONTRACTINGWITHLICENSEDCONTFACTORS
70 CANS7RUCT THE PRQIECT(SEC.70Ia,BUSINESS AND PROFESSIONS CADE:THE CON7RAC70RS LI- VelUetlOfl ADJ.AREA
W CENSELAWDOESNOTAPPLYTOANONTJEROFAPROPERTYWHOBUILDSORIMPROVESTHEREON,AND
� WHOCONTRACTSFORSUCHPRQIECTSWITHACONTRACTOR(S)LICENSEDPURSUANT70THECONTMC� �UANTITY DESCRIPTION FEE
Y TORS UCENSE LAW.).
�� ❑I AM EXEMPT UNDER SEC. B.6 P.C.FOR THIS REASON Q
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DATE OWNER �
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� LICENSED CONTRACTORS DECLARATION w
� I HEREBV AFFIRM UNDER PENALTV OF PERJURY TMAT 1 AM UCENSED UNDER PROVISIONS OF CHAPTER �
d 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS ANO PROFESSIONS CODE,AND Z
X MY LICENSE IS M FULL FORCE AND EFFECT.
� LICENSE CLASS `������ LIC.NO. ��SV'�`"�� j
V DATE �+�3'�e� CONTRACTO d
� WORKERS'COMPENSATION DECLARATION Q � �� � �
� I HEREBY AFFIFM UNOEH PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: Z Q� . / i/
LI �7
Z _IHAVEANDWILLMAMTAINACERTIFICATEOFCONSEN7705ELF-INSUREFORWORKERS' 2
Q CAMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMANCE IU
/OF THE WORK FOR WHICH THIS PERMI7IS ISSUED. �
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w _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BY SECTION
Q 3700 OF THE LABOR CODE,FOR THE PEFiFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED.MV WOHKE.A�,S�'.CA.�MP.E�NySAsTION IN/S��q NCE�C..A�R AND POLICV NUMBER ARE: CONSTRUCTION
� CARRIER V/�/ `� l��„�� PLAN REVIEW
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0 (iHISSECIqNNE�NOT8E00MPLEfEDOFTHEPERMfTLSFORONEMI�DREDDOLLPAS(f100)ORLESS} PLUMBING
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Z I CERTIFY THAT IN THE PERFORMANCE OF THE WORN FOR WHICH THIS P RMIT IS ISSUED.I MECHANICAL
(,'} SHALL NOT EMPIOY ANY PERSON IN ANY MANNER 50 AS TO BECOME JECT TO THE
� WORKERS'COMPENSATION LAWS OF CALIFORNIA,AN GRE AT I HOULD BECOME INSPECTION FEE
= SU&IECTTOTHEWORKERS'CAMPENSATIONPROV NS C O 7000FTHELABOR /� /�.�
CODE.ISHALLFORTHWITHCOMPLVWITHTHO OVI ISSUANCE L �C%V
� 6-3 o a APPLICA . SMIP
p DATE.
J WARNING:FAILURE TO SECURE WORKEHS'COMPENSA710N COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C
� SUBJECTAN EMPIOVER TO CflIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND ENERGY PERMIT
DOLLARS(floo,o00J,IN ADDI710N 70 THE COS70F COMPENSATION,DAMAGES AS PROVIDED FOR IN
� SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. RETENTION FEE:
� CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � •�
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� I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS A CONSTRUCTION LENDING AGENCY
�- FOR THE PERFOflMANCE OF THE WOf7K FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.CJ.
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� LENDER'S NAME '
� LENDER'S ADDRESS
� TOTAL FEES •�U
� I CERTIFV THAT I HAVE HEAD THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
w I AGREE TO COMPLV WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
� CONSTRUCTION,AND HEREBY AUTHORIZE FIEPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE
� ABOVE�MENTIONED PROPERTY F PEC710N PURPOSES. �
? COMMENTS
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= RECPT.NO. PAID BY VALIDATION
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GROUND PLUMB�NG ; UNQER FLOOR CUi�!DUIT i . • ' _ _
SLAB GRADE � FIREPLA�E�FOUNDATION___ ' __
TEMP POWER ! FIREPLACE BOND BEAM ' __
WATER SERVICE � MID HT. BOND BEAM _ _
ROOF 5HEATHING � 8 FT. BQND-BEAM i ___
FRAMING/VENTILIATION � FINA�BOND_BEAM ____ � ___
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