HomeMy WebLinkAbout15736CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES j
21660 E.Copley Drive Suite 190
909)860-3195 Fax(909)861-3117 PRESS
BUILDING PERMIT APPLICATION FIRMLY
vi JOBSITE 1 " APPUCATIONPERMIT PoADDRESSy .f DATE NUMBER
ISSUE TYPE OCC
APN LOT TRACT vZ- DATE CONST.GROUP
O OWNER A
ADDR SS 3 ZONING SETBACKS
CITY p ZIP TEL lio FRONT RW
APPLICANT TEL Ot REAR
SIDE/SIDE STREET RW
CONTRACTO SIDE
ADDR
PROPOSED USE I rG l LlZI In/S?Oaf_IgCITY
S
fZIP TEL.
Q (
TSS
ARCWENG1
DESIGNER NO.DWEL NO. NO.ADDRESS UNITS STORIES BEDROOMS5CITYZIPTEL
CO DESCRIPTION SO.FT. FACTOR PSF ADJ.AREAIVALUATION
L OWNER-BUILDER DECLARATION SFRTADDIREM
O
8I HEREBY AFFIRM UNDER PENALTY OF PERAIRY THAT I AM EXEMPT FROM THE CONTRACTORS LF GarageTCarportCENSEQLAWFORTHEFOLLOWINGREASONISEO7031.6 BUSNESSAND PROFESSIONS CODE ANY CIlYOR (n
COUNTYWHIC1I RECIRESAPERMITTO CONSTRUCT.ALTER IMPROVE.DEMOLISH.OR REPAIRANYS_ W Patio/DockTURF,PRIOR TD ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOP SUCH PERMIT TO FRE A SIQNED WSTATEMENTTHATHEORSHEISLICENSEDPURSUANTTOTHEPROVISIONSOFTHEC17HTRACTORSLH
CENSE LAIN 01APTERI ICOMMENCNO WITH SECTION 7000)OF DIVISXN S OF THE BUSINESS AND PRO. LL POGUSpa
FESSIONS CODE)OR THATHE OR SHE IS EXEMPT THEREFROM AND THE BASIS FDA 7HEALUEGED EXEMP-
TION.ANY VIOLATION OF SECTION MIA BY ANY APPLCANT FOR A PIERIA IT SUBJECTS THE APPLICANT TO Z Re-Root
1--- ACIVILPEN.LLTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(9500).k.
O L AS OWNEROF THE PROPERTY,OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION. Q Commercial.
WILL DD THE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7044.BUSI- J
NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF ?
PROPERTY YAO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
THROUGH WS OR HER OWN EMPLOYEES.PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
OFFERED FOR SALE F.HOWEVER.THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE-
TTUN.THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DO NOT BURR OR
IMPROVE FOR THE PURPOSE OF SALE}
LASOWNEROF THE PROPERTY,AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORSLLLLL
TO CONSTRUCT THE PROJECT(SEC.70".BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS U.Valuation ADJ.AREA
LF=L-1 CENSE LAW DOES NOTAPPLY TOAN OWNER OF A PROPERTY WHO BULDS OR IMPS THEREON,AND
WHDCONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC-QUANTITY DESCRIPTION FEETORSLICENSELAW}
IAM EXEMPT UNDER SEG B.S P.C.FOR THIS REASON U I"
7 L' L L C 3 Z
0 3.
DATE oWI+Ea U
4
UCENSED CONTRACTORS DECLARATION W
L I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER C7I(COMMENCINOWITIH SECTION 7000)OF DIVISION OF THE BUSINESS AND PROFESSIONS CODE.AM Z
IIILLL MY LICENSE 15 N FULL FORCE AND EFFECT.L m
LICENSE CLASS V ,MIC.NO. r j
DATE CONTRACTOR eX440 i
n
WORKERS'COMPENSATION DECLARATION
IRMIHEREBYAFFUNDER PENALTY OF PEILNNRYONEOFTHEFOLLOWINGDECLARATI & Z
I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENTTO SELF-INSURE FOR WORKERS'
COMPENSATION,AS PROVIDED BYSECTION 3700OFTHE LABOR COLE,FOR THE PERFORMANCE
LUOFTHEWORKFORWHICHTHISPERMITISISSUED.
0
Q _I HAVEAND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOIIRED BY SECTION
57000E THE LABOR COOL FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED.MY WOroS`ia5'COMPENSA NSURA15 CARRIER AND POLICY NUMB ER ARE: CONSTRUCTION
uRaea -A v PLAN REVIEW 3 T
POLICYNUMBERELECTRIC 2
Lpy
THIS SECTION NEED NOT BE COMPETED OFTH£PERMIT Is ICUCNEHUDRED • AW W PLUMBING
Z I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE
KOr WORKERSCOMPENSATN LAWS CF CALIFORNIA,ANDAOREE THAT IF IS1OUlO BECOME INSPECTION FEE
S SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 0100 OF THE LABOR
CODE,I SH FORTHWITH COMPLY WITH THOSEP SIONS. ISSUANCE I l
c "n LTf o 1 SMTP
C3 DATE: APPLICANT:
EZWARNING:FARURETO SECURE WORKERS'COMPENSATION COVERAGE IS UNIAWFLIL,AND SHALL BE ENERGY P/C
SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL F 14ES UP TO ONE HUNDRED THOUSAND ENERGY PERMITDOLLARS(S100.000),IN ADDITION TO THE COST OF CONPENSATIDN,DAMAGES AS PROVIDED FOR IN
J SECTION 5705 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. RETENTION FEE:
a CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
CC 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS ACONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THRs PERMIT IS ISSUED(SEC.SOP],CIV.G).
LENDERS NAME
LENDERS ADDRESS
T/L
I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION 15 CORRECT. TOTAL FEES I O M
1 AREE TO COMPLY WITH ALL CRY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
CONSTRUCT".AND HEREBY AUTNORIZE REPRESENTATIVES OF THIS COUNTY 70 ENTER UPON THE
ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. COMMENTS
m PERM (PRI
Q
CO DATE
F RECPT.NO. PAID BY VALIDATION
WHITE—Department Copy,YELLOW—FinaDoe Copy,PINK—Assessor Copy,GOLDENROD--File Capt',GREEN—Applicant's Copy
i ,;moi .'.ij ,.,yr... '''f,
1, *• , iy'.
CITY OF DIAMOND..BAR
INSPECTION RECORD Y. ..,
n
r
SET BACK-- 1 i irtIFLOORJOIST >
IFTGS/FORMS/STEEL- ' FHA REOMTS
ELECTRIC GROUND_._._ - _UNDER FLOOR DUCT 1
GROUND PLUMBING UNDER FLOOR CONDUIT I
ISLAB GRADE- - FIREPLACE FOUNDATION c. I
TEMP POWER - 3 FIREPLACE.BOND BEAM
WATER SERVICE-- MID HT.BOWD BEAM-
ROOF EAMROOFSHEATHING' 8 FT. BOND_BEAM_.__ 1
FRAMINGNENTILIATION FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING' - BENCHING
ROUGH ELECTRIC-_! ROUGHGRADING
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 LANDSCAPEARRIG.
SEEP PIT/LL ON SITE IMPS.
GAS AIF TEST_ _ FINAL ZONING
FINAL CONST. = ; t. FIRE DEPT. FINAL
FINAL-HEATING-. ' 1- i', ' HEALTH DEPT. FINAL
DEV. FEES PAID - FINAL ELECTRIC - - ---
FINAL-PLUMBING ENERGY
COMMENTS
SEPTIC TANK-SIZE
SEEP PIT/U SIZE- -