HomeMy WebLinkAbout18058 �� _ CITY OF DIAMOND BAR
-- � DEPARTIv1ENT OF CONIIvIUNTTY&DEVELOPIviENT SERVICES ���I��
21825 E.Copley Drive
" (909)860-3195 Fa�c(909)861-3117 �U�� 8 PRESS
��'%»��� BUILDING PERMIT APPLICATION FIRMLY
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p� OWNEFi-BUILDER DECLARATION SFR/ADD/REM
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I HEREBV AFFIFM UNDEFi PENALTY OF PERIURY 7HA7 I AM E%EMPT FROM THE CONTRAC70q5 LI� G8�8CjB/CBfPOft
W CENSEUWFORTHEFOLLOWINGREASON(SEC.7031.SBUSINESSANDPROFESSIONSCODE:ANYCITYOR (n
U COUNTYWHICHPEDUIRESAPERMITTOCONSTRUCT,ALTER,IMPFOVE,DEMOLISH,OFREPAIRANVSTRUC�
w TURE,PRIOR TO ITS ISSUANCE.ALSO REOUIRES THE APPLICANT FOR 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(CHAPTER B(CAMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- LL' POOUSPB
FESSIONSCODE)ORTHATHEORSHEISE%EMPTTHEREFROMANDTHEBASISFORTHEALLEGEDE%EMP� (�
� TION.ANVVIOUTIONOFSECTION7031.SBYANVAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Roof
A CIVII.PENALTY OF NOT MORE THAN FNE HUNDRED DOLLARS(f500).):
Z ❑I,ASONRJEROFTHEPROPERTY,ORMYEMPLOVEESWITHWAGESAS7HEIRSOLECOMPENSATION, 0 COrt1rtIBfC181 -
WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SAIE(SEC.70�1,BU51� J
N NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE lAW DOES NOT APPLV TO AN OWNER OF ?
PROPER7Y WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
. Q THROUGH HIS OR HER OWN EMPLOYEES,PROVIDED THAT SUCH IMPROVEMEN75 ARE NO7INTENDED OR m
� OFFEREDFORSALE.IF,HOWEVERTMEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE-
Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF SALE).
w ❑I,ASOWNEROFTHEPROPER7V,AME%CLUSIVELVCONTMCTINGWITHLICENSEDCANTMCTORS
[L TO CANSTRUCT THE PFQIECT(SEC.70M,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- V8IU8IIOf1 ADJ.AREA
W CENSELAWDOESNOTAPPLYTOANOWNEROFAPROPERTYWHOBUILDSORIMPROVESTHEREON,AND
� WHOCONTRACTSFORSUCHPROJECTSWITHACON7RACTOR(S)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE
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� ❑I M1 EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q
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DATE OWNEF � ,
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� LICENSED CONTRACTORS DECLARATION W
� I HEHEBV AFFIRM UNDER PENA�TV OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
d e(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PROFESSIONS CODE,AND Z
�X MY LICENSE IS IN FULL FORCE AND EFFEC7. m ,
� LICENSE CLASS LIC.NO. j
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V DATE CONTRACTOR a
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� WORKEFS'COMPENSATION DECLARATION Q
� I HEREBV AFFIRM UNDER PENALTV OF PERJURY ONE OF THE FOLLOWING OECLARATIONS: Z
Z _I HAVE AND WILL MAMTAIN A CERTIFICATE OF CANSENT TO SELF-INSURE FOR WORKERS' _
¢ CAMPENSATION,ASPROVIDEDBYSECTION37000FTHElA80RCODE,FORTHEPERFORMANCE `U
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
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W _I HAVE AND WILL MAINTAIN WORKERS'COMPENSA710N INSURANCE.AS REDUIRED BV SECTION �'o ,I� ///��� y�
. Q 370o OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMI7IS ,��,} / •'" { / )
ISSUED.MV WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION 1 L I lJ
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� CARRIER PLAN REVIEW � �
Z POLICY NUMBER ELECTRIC
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� (IFiISSEC�qNNE�NOTBE�CMPLEfEDOFTHEPEfUNTISFORONEMII�DREDD011A0.S(f100)ORLESS). PLUMBING
Z I CERTIFV THAT IN THE PERFORMANCE OF 7HE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
(.'S SHALL NOT EMPLOYANV PERSON IN ANY MANNER SOAS TO BECOME SUBJECTTO THE
� WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE
� SUBJECTTO THE WORNERS'COMPENSATION PROVISIONS OF SECTION 37000F THE IABOR �
� CADE,I SHALL FORTHWITH COMPLY WITH THOSE PFOVISIONS. ISSUANCE y�j'��
� SMIP I . �J�
p DATE: APPLICANT:
J WARNING FAILURE TO SECURE WOHKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C
� SUBJECT AN EMPLOYER TO CHIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND ENERGY PERMIT
DOLLARS(f100.000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOH IN `^
J SECTION 370B OF THE LABOR CADE,INTEflEST,AND ATTORNEV'S FEES. RETENTION FEE:
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� CONSTRUCTION LENDING AGENCY PRE-ALT FEE: �
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� I HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT THERE IS A CONSTRUCTION LENDING AGENCV
� FOR THE PERFOPMANCE OFTHE WORN FOR WHICH THIS PERMIT IS ISSUED(SEC.30B7,CIV.C.). .
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� LENDER'S NAME
F- LENDER'SADDRESS
� TOTAL FEES
� I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFOPMATION IS CORRECT. �� ���
w I AGREE TO COMPLV WITH ALL CITY AND CAUNTV ORDINANCES AND STATE LAWS RELATING TO BUILDING
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE o1 ,^�� /
ABOVE�MENTIO�PROPERT`F INSPECTIO PU �S. ��� COMMENTS L �
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I E NAME(PRINT) "���
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51 E F PERAi E DATE .
RECPT.NO. PAID BY VALIDATION
� WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy �^ (L �
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SET BACK � _�--� � FLOOR JOIST '
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FTGS/FORMS/STEEL • . ' FHA REaMTS
ELECTRIC GROUND ; � UNDER FLOOR DUCT �
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GROUND PLUMBING _,_ .___` UNDER FLOOR CUt��DUlT
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SLABGRADE , _-- --_ �FIREPLACE FC7�JP�DAl"10�!_ � �
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TEMP POWER � _ ;_ FIREPLACE BOIVD BEAM ' __ _ __ ____
W,4TER SERVICE T- i MID HT. BC7ND BEAM
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ROOF SHEATHING ���_G �� �8 Ff. BOND BEAM _ �
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FRAMINGNENTILIATION i ; FINAL BOND BEAM i
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ROOF COVER � . � PRE-GRAOING � �
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ROUGH HEATING BENCHING ;
ROUGH ELECTRIC ROUGH GRADlNG �
ROUGH PLUNIBING � FINISH GRADING
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SHOWER/TUB TEST i POOL ELECTRiC
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EXT. LATH/SIDING ' ; POOL FENCING
--- ___._....__- �
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WALL INSULATIOhJ ', P40L FINAL �
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CEILIMG IN�ULATION ; OFF SITE IMPS.
DRYINALL N,4ILING i DEDICATIONS ,
SEWER FINAL EIVG. �- .
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SEPTIC TANK , LANDSCAPE/IRRIG. ; �
SEEP PITiLL -�-f_ ON 51TE fi�9PS. ---- � -�__-_----T
GAS AIR TEST � �� FINAL ZONING
FIPVAL CONST. � � �!RE DEPT. FINA!
FINAL HEATING j HEALTH DEPT. FINAL
FINAL ELECTRIC ' DEV. FEES PAID
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FIPJAL PLUMBING I ; ENERGY I
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