HomeMy WebLinkAbout10-1078 (5) ;\ . . .... . . . . . ' _
CITY OF DIAMOND BAR �
^----�� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21825 Copley Drive,Diamond Bar,CA 91765
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7027 PAESS
�'A"' BUILDING PERMIT APPLICATION FIRMLY
� JOBSITE
o ADDRESS ��� � � � _ DATE CATION NUMBE�,Q D g/C
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� ADDRESS � � ` � � PROPOSED USE � Op
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Q OWNER-BUILDER DECLARATION
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I p I HER�V AFFIiUI UNDER PENALTY OF PEfLIURV THAT I AA1 E%EMPT FROM THE CONTRACTORS U- Gflfe 0/C8
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W TURE.PRIOR TO ITS ISSUANCE,ALSO REOUIRES 7HE APPUCANT FOR SUCH PERMIT TO FILE A SIONED w
� STATEMENT THAT HE Ofl SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CANTRACTORS LI-
� CENSE UW(CHAPTER e(COMMENCINO WITH SECTION 7000)pF DIVISION 7 OF THE BUSINESS AND PRO� � POOVSPB .
, � FESSIONS CODE)ORTHAT HE OR SHE IS E%EMPT TNEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- (�
TION.ANV VIOLATqN OF SECT16N 7031.6 BV ANV APPLICMIT FOR A PERMIT SUBJECTS THE APPLICANT TO Z Re-Roof
A CIVIL PENALTY OF NOT MOHE THAN FIVE HUNDRED DOLLAHS(f600).):
� ❑I,ASON?JEROFTHEPROPERTY,ORMVEMPLOVEESWITHWAOESASTHEIRSOLECAMPENSATION, 0 COff1R16fC181
Z Wlll DO 7HE WOHI(AND 7HE STRUCTURE IS NO7 IN7ENDED OF OFFERED FOR SALE(SEC.7oN,BU51- J
N NESS AND VROFESSlONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF �
PROPERTV WIiO BUILOS OR IAIPROVES THERC-0N,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
Q 7HROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMEMS ARE NOT INTENDED Oq m
Q OFFEREDWRSALEIF,HOWEVERTMEW0.DINGORIMPROVEMENTISSOLDWITHINONEVEAROFCAMPIE.
Z TION,THE OWNEfi-BUILDER WILL HAVE THE BURDEN OF PROVWO THAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR TFIE PURPOSE oF SALE).
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❑I,AS ONMER OF THE PROPEHTV,AM EXCLUSIVELV CONTRACTINO WITH IICENSED COMRACTORS
[C TO CONSTRUCT TME VRQIECT(SEC.70,1,BUSINESS AND PROFESSIONS CODE:THE CONiRACTORS Ll- VBIUflIIOn ADJ.AREA
� CENSE UW DOES NOTAPPLY TO AN ON?JER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND
WMOCANTRACTSFORSUp1PRQ1ECTSWITHACONTRACTOR(S)LICENSEDPURSUANTTOTHECONTRAG OUANTITY DESCRIPTION FEE .
� TOHS IJCENSE LAW.).
� ❑I AM EXEM7T UNDER SEC. B.8 P.C.FOR THIS REASON Q � �L�.�
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�Q . LICENSED CONTRACTORS DECLAf7ATION � w � .
2 I HEREBY AFFIRM UNDER PENALTV OF PERIURY THAT I AM LICENSED UNDER PROVISIONS OF CHA7TER �
� G(COMMENGNG WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z �-f��.
��� MY UCENSE IS W GULL FORCE AND EFFECT. m
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� LICENSE CLASS LIG.NO. � �
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� WORKERS'COMPENSATION DECLARATION ¢
� I HEREBV AFFIRM UNDER PENALTV OF PERIURV ONE OF THE FOLLOWING DECLARATIONS: U
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� _IHAVEANOWILLMAINTAINACERTIFICATEOFCONSEMTOSELF-INSUREFORWORKERS' a
� CONVENSATION,AS PROVI�ED BV SECTION 3700 OF THE LABOH CODE.FOR THE PERFORMANCE U
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. W
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w I HAVE AND WILL MAINTAW WORNERS'COMPENSATION INSURANCE,AS REOUIREO BV SECTqN
Q 370o OF THE LA80R CODE,FOR 7NE PERFORMMJCE OF THE WORK FOR WHICH THIS PEFMIT IS
ISSUED.MV WORNERS'cp`u PENSATION INSU CE CARRIE AND POLICV NUMBER ARE: CONSTRUCTION
jCARRIER C�LAl�� ��i+�'��� ' PLANREVIEW
0 POLICY NUMBER
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� (�HISSECiKXJNEmNOTBEWAFLE7FDOFTiEPER1.RI5FORONEFAMOqEpppLl,/.R5(y7ao)ORLESS} PLU BI S �
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Z I CERTIFV THAT IN THE PERFORIAANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUEO,I MECHANICAL
C} SHALL NOT EMPLOV ANY PERSON IN ANV MANNER SO AS TO BECOME SU&IECT TO THE
(n WORKERS'COAIPENSATIONLAWSOFCALIFOFNI/�ANDAGREETHATIFISHOULDBECOME INSP NFEE
O SU&IECT TO THE K'ORKERS'CAMPENSATION PROVISIONS OF SECTION 37o00F THE LABOR ��
CODE.I SHALL FORTHWITH COMPLV WITH THOSE PROVISIONS. ISSU CE
p OATE: APPLICANT. SMIP
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J WARNINO:FAILURE TO SECURE MIORKERS'COMPENSATION COVERAGE IS UNLAWFUI.,AND SHAIL BE ENERGY P/C �
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�y SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THWSAND ENERGY PERMIT
DOLLARS(f100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
J SECTION 37oB OF THE LABOR CODE,MTEREST,AND ATTORNEY'S FEES. `�Q
w � TENTION FEE: Q
O CONSTRUCTION LENDING AGENCY FEE:
� I HEREBY AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS A CANSTHUCTION LENDINO AOENCV
FOR THE PERFORMANCE OF THE WORK FOF WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.CJ.
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� LENDERS NAME
F— LENDER'SADDRESS
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w I CERTIFY THAT I HAVE READ THIS APPUCATION AND STATE TNAT THE ABOVE INFORMATION IS CARqECT. TOTAL FE ES '� /�.�(/
� I AQREE TO COMPLV N7TH ALL CITV AND COUNTY ORDINANCES AND STATE UWS RELATINO TO BUILDINO !
� CONSTRUCTION,AND HEREBV AUTHOfiIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE '
Q/ VE�MEtlT10NED PROPERTV FOR INSPECTION PUqPOSES. COMMENTS '
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m MITTEE NAME(PRINn ---�•" � ' �
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N ICi 7UREOFPERMRTEE DA7E
� AECPT.NO. PAID B VALIDATION
E—Depertment Copy,YELLOW—Flnance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—Applicant's Copy
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SET BACK ' FLOOR JOIST
FTGS/FORMS/STEEL FHA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING UNDER.FLOOR CONDUIT
SLAB GRADE FIREPLP,CE FOUNDATION
TEMP POWER FIREPLACE BOIdD,BEAM
WATER SERVICE MID HT. BOND BEAM
ROOF SHEATHING 8 FT. BOND BEAM
FRAMINGNENTILATION FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
FiOUGH ELECTRIC g ►O ROUGH GRADING
ROUGH PLUMBING � ' o FINISH GRADING
SHOWERlTUB 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 �d FINAL ZONING
FINAL CONST. FIRE DEPT. FINAL
FINAL HEATING ' � - NEALTH DEPT. FINAL �
FINAL ELECTRIC ` DEV. FEES PAID
FINAL PLUMBING ENERGY
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SEEP PIT/U SIZE
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