HomeMy WebLinkAbout12831 (11)CITY OF DIAMOND BAR �� N
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
W 21660 E. Copley Drive Suite 190
(909)960-3195 Fax(909)861-3117 PRESS
'+ BUILDING PERMIT APPLICATION FIRMLY
JOBSITE
ADDRESS
APN LOT T T
OWNER
ADD S-
CI ZI LLILL.
APPLICANT
CONTRACTO
ADDRE
CITY Z TEL.
ARCH/E
DESIGNER
ADDRESS
CITY ZIP TEL.
OWNER -BUILDER DECLARATION
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LF
CENSE LAW FORTHE FOLLOWING REASON (SEC. 7031,6 BUSINESSAND PROFESSIONS CODE. ANY CITYOR
COUNTYMMICH REMAESA PERMRTO WNSTRUCT,ALTER, IMPROVE, DEMOLISH,OR REPAIRANY STRUC.
TURF. PRIOR TO ITS ISSUANCE. ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO RLE A SIGNED
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI-
CENSE LAW (CHAPTER 9 (COMMENCING WITH SECTION 70001 OF DIVISION 3 OF THE BUSINESS AND PRO-
FESSIONS CODE) 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 CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS ($SOD) J:
D I, AS OWNEROFTHE PROPEUX OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION,
WILL DO THE WORK, AND
THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, BUSI-
NESS AND PROFESSIONS NODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY 70 AN OWNER OF
PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO DOES SUCH WORKHa1SELF OR HERSELF OR
THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR
TO
OFFERED RSALE IF, TOW EVERTHE BUILDING OR IMPROVEMENT 6 SOLD WITHIN ONE YEAROF OOMPLE-
TION, THE OWNER•BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
IMPROVE FOR THE PURPOSE OF SALE).
D L AS OWNER OF THE PROPERTY, AM EXCLUSNELYCONTRACTING WITH LICENSED CONTRACTORS
TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI.
CENSE LAW DOES NOT APPLYTOAN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND
WMOCONTRACTSFOR SUCH PROJECTS WITHACONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC-
TORS LICENSE LAW). .
O I AM EXEMPT UNDER SEC. B. 6 P.C. FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM LICENSED UNDER PROVISIONS OF CHAPTER
0(COMMENCNG WITH SECTION 7000) OF DIVISION 3 O THE BUSINESS AND PROFESSIONS CODE, AND
MY LICENSE�ISINFULLCE AND EFFECT.LICENS LIC. NO. qq
DATE CONTRACTOR
WORKERS' COMPENSATION DECLARATION
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
I HAVE AND WALL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS'
COMPENSATION, AS PROVIDED BY BECKON 3700 OF THE LABOR CODE, FOR THE PERFORMANCE
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,
1 HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE, AS REQUIRED aY SECTION
5700 OF THE LIBOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15
ISSUED. MY WORKER ' y PENSATION INSURANC IE.R AND POLICY NUMBER ARE:
CARRIER ■ L^/ Pa -A •7
POLICY NUMBER
PHIS SECTMNEEDNOTBEOCMP ETEDOFTHEPETMT6RORONEHAOREDCDWARS(POD)ORUESS).
1 CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I
SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE
WORKERS' COMPENSATION LAWS OF CALIFORNIA, AND AGREE THAT IF I SHOULD BECOME
SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 37W OF THE LABOR
CODE. RTTMWITH COMPLY WITH THOSE PROVISIONS. %��
DATE: L-� APPLICANT A<zwj .1= fr'�'I(Sze,
WARNINO: FAILURE TO SECURE WORKERWOOMPENSATION COVERAGE IS UNLAWFUL. AND SHALL BE
SUBJECT AM EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (8100.000). N ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 5701 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
CONSTRUCTION LENDING AGENCY
I HEREBYAFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (BEC. 3097, CN. C.).
LENDERS NAME
LENDER'S ADDRESS
I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES.
P E N E RINUn
lNONATUR ERMIITEE DATE
APPLICATION 4 2 •- ��j PERMIT� P/C
GATE 1 l NUMBER #
ISSUE TYPE OCC
DATE CONST. GROUP
ZONING SETBACKS
FRONT RW ❑
REAR ❑
SIDE/SIDE STREET RW ❑
SIDE ❑
PROPOSED USE Z_
NO. DWEL. NO. NO.
UNITS STORIES BEDROOMS
DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION
SFR/ADD/REM
U)
GaragalCarport
WPatiolDeck
ILL
Poouspa
(3
Z
Re -Roof
OCommercial
m
Valuation ADJ.AREA
OUANTITY DESCRIPTION FEE
U
LFy-
L�l
L�
Z
DID
U
QZ
2
U
W
CONSTRUCTION
PLAN REVIEW
LECTRIC
UNG
MECHANICAL 'iii?tl
"I'SFEE
SSUANCE - —'
S -vEC9-1998
ENERGY P/C
ENERGY PERMIT [��'TjT'I' nF J]IAMI�`"�+ `•: �' ''
RETENTION FEE: 1RTM.T)TNC3r h, `_�r+,='•_
PRE -ALT FEE:
TOTAL FEES 6 %
COMMENTS
RECPT. NO. PAID BY VALIDATION _
WHITE—Department Copy, YELLOW—Financia Copy, PINK—Assessor Copy, GOLDENROD -File CGpy, GREEN--"Icant's Copy
CITY OF DIAMOND BAR
INSPECTION RECORD
ET BACK
FLOOR JOIST ;.•-
FTGS/FORMS/STEEL
7E
FHA REQMTS
ELECTRIC GROUND
LOOR DUCT
UNDER FLOOR-DUCT-
GROUND PLUMBING
GROUND
UNDER FJ-QOB CONDUIT-.
SLAB GRADE
FIREPLACE FOUNDATION - -• - }
TEMP POWER
FIREPLACE BOND BEAM
WATER SERVICE
MID HT. BOND BEAM - . -- - - - -
ROOF SHEATHING =
= -
8 FT. BOND BEAM -
FRAMING/VENTILIATION
FINAL BOND BEAM
ROOF COVER
PRE -GRADING
ROUGH HEATING
BENCHING
ROUGH ELECTRIC
-� • 1h�j
ROUGH GRADING
ROUGH PLUMBING
FINISH GRADING
SHOWER/TUB TEST
POOL ELECTRIC
EXT. LATH/SIDING
POOL FENCING
WALL INSULATION
POOL FINAL
CEILING INSULATION
{ OFF SITE IMPS.
DRYWALL NAILING
DEDICATIONS
SEWER
FINAL ENG.
SEPTIC TANK
LANDSCAPE/IRRIG.
SEEP PIT/L.L.
ON SITE IMPS. _
GAS AIR -TEST
-
I • FINAL ZONING
FINAL CONST. -
{ FIRE DEPT. FINAL j
FINAL HEATING
HEALTH DEPT. FINAL
FINALELECTRIC
•Z
DEV. FEES PAID
FINAL PLUMBING
ENERGY
i
COMMENTS
,
-
SEPTIC TANK SIZE
SEEP PIT/Ll SIZE
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