HomeMy WebLinkAbout18138 �
CTI'Y OF DIAMOND BAR
------��`--- DEPARTMENT OF COMMUMTY&DEVELOPMENT SERVICES
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21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 PRESS
"'-���� BUILDING PERMIT APPLICATION FIRMLY
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� ISSUE f /f� TYPE OCC
APN LOT TRACT DATE ���� CONST. GROUP
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cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
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I HEREBY AFFIRM UNDER PENALT/OF PEFiJURY THAT I AM ExEMPT FROM THE CON7RAC70R5 LI� � Gefe9B/CefPOR
W CENSELAWFORTHEFOLLOWINGREASON(SEC.7037.SBUSINESSANDPROFESSIONSCODE:ANYCITVOR (n
U COUNTVWHICHREOUIRESAPERMITTOCANSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC-
W TURE,PRIOR TO ITS ISSUANCE,AL50 REQUIRES THE APPLICANT FOR SUCH PERMIT TO FIIE A SIGNED w Patio/Deck '
S7ATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI-
� CENSE LAW(CHAPTER e(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PRO� � PooUSpa
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A CIVIL 7ENALTV OF NOT MORE THAN FIVE HUNDREO DOILARS(f500).):
Z ❑I,ASOWNEROFTHEPROPERTY,ORMVEMPLOYEESWITH:WAGESASTHEIRSOIECAMPENSATION, 0 COmfilBfCl31 �
WILI DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFEHED FOR SALE(SEC.70dI,BU51- _!
� NESS AND PROFESSIONS CODE:THE CANTRACTORS LICENSE lAW DOES NO7 APPLV TO AN OWNER OF �
PROPERTV WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
2 THROUGH HIS OR HER OWN EMPLOYEES,PROVIDED THA7 SUCH IMPROVEMEN7S ARE NOT INTENDED OR m
� OFFEHEDFORSALE.IF,HOWEVER,THEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCAMPLE-
Z 710N,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVING TFIA7 HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF SALE).
w ❑I,ASOWNEROFTHEPROPERTV,AMEXCLUSIVELVCANTRACTINGWI7HLICENSEDCANTRACTORS
' � TO CONSTRUC7 THE PqOJEC7(SEC.7ot4,BUSINE55 AND PROFESSIONS CADE:THE CONTRAC70R5 LI- V81U8S10l1 ADJ.AREA
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� NMOCANTRACTSFORSUCHPR0.IECTSWITHACON7RAC70R(5)LICENSEDPURSUANTTOTHECONTRAG OUANTITY DESCRIPTION FEE
Y 70RS LICENSE LAW.).
� O I AM EXEMPT UNDER SEC. 8.8 P.C.FOR THIS REASON Q
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DATE OWNER U
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� LICENSED CONTRACTORS DECLARATION w
� I HEREBY AFFIRM UNDER PENALTY OF PERJURY THA71 AM LICENSED UNDER PROVISIONS OF CHAPTER �
d 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PROFESSIONS CODE,AND Z
X AIY LICENSE IS IN FULL FORCE AND EFFEC7.
� LICENSE CLASS G� LIC.NO. � w j
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U DATE Z• CONTRACTOR a
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� WORKERS'COMPENSATION DECLARATION Q
NI HEREBV AFFIRM UNDER PENALTV OF PERJURY ONE OFTHE FOLLOWING DECURATIONS: Z
� I HAVE AND WILL MAWTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' ¢
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CAMPENSATION,AS PROVIDED BY SEC710N 3700 OF 7HE IABOR CADE.FOR 7HE PEHf-0RMANCE W
Q OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
w �I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BY SECTION �/'� \
Q 770o OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ( J��► ( l
ISSUED.MY WORNERS'CAMPENSATION I ANCE RRIER AND POLICV NUMBERARE: CONSTRUCTION ��+ l� �v
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� CARRIER ��i'C��-+ � PLAN REVIEW 1 +
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� (IFIISSEC�qNNEmNOTOEOJMRETEDOFTHEPERMfTISFORONEHUPDREDDOLlAAS�5100)ORLESS). PLUMBING
Z I CERTIfV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,1 MECHANICAL
U' 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 INSPECTION FEE
= SU&IECT TO THE WORKERS'COMPENSATION P ISIONS OF S ION 370o OF THE LABOR '��
CADE.I SH LL FORTHWITH COMP OS ROVISION ISSUANCE //
p DATE:� APPLICANT: SMIP a\� O
J WARNING:FAILURE O SECURE WORKERS'CAMPENSATION VE cE is uNuwFu�,nNo s ENERGY P/C
� SU&IECTANEMPLOYERTOCNIMINALPENALTIESANDCIVIL P700NEHUNDRED7HOU ENERGYPERMIT
DOLLARS(f100.000�,IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
� SEC710N 3700 OF THE LABOR CADE.INTEREST,AND ATTORNEV'S FEES. RETENTION FEE: �
d CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS ACONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF7HE WORK FOR WHICH 7HI5 PERMI715ISSUED(SEC.7o97,CIV.C.).
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� LENDER'S NAME
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w TOTAL FEES �',� �� � .��J�Q,� �
� I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THA7 THE ABOVE INFORMA710N IS CORREC7.
� I AGREE TO COMPIV WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
� CONSTRUCTION,AND HEREBV AUTHORRE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE
Z ED PROPER7Y INSPECTION GURPOSES. COMMENTS '
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= RECPT.NO. PAID BY VALIDATION
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GROUND PLUMBING ' UNDER FLOOR CUI�IDUIT ' � ___ __
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SLABGRAQE � ___ FIRFPLAGE FOUNQATION_ _ �;_�_v � `
TEMP POWER _-- - ' ------- _�__.1� _FIREPLACE_BOND BEAM _ '..----_.__
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WATER SERVICE _, � I MID HT. B{�t�JD BEAM ____ .I
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ROOF SHEATHING ���/z.. '----- 8 FT. BdND BEAM �� ---------
FRAMINGNENTI�IATION FINAL BOIVD BEAM _ _
ROOF COVER ��`�z,� PRE-GRADING ;
ROUGH HEATING �G" BENCHING �
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ROUGH.ELECTRIC ROUGH GEiADING �
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ROUGH PLUMBING ; I FINISH �h�ADINC
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SHOWER/TUB TEST ' POO�ELECTRIC
EXT. LATH/SIDING POOL FENClNG �
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CEILING IN�ULATION OFF SITE IMPS. ;
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DRYWALL NAILING DEDIGATIC7NS I '
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SEWER FINAL ENG. '
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SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ' ON SITE IMPS
GAS AIR TEST FINAL ZONING
FINAL COfVST. FIRE DEPT. FINA�
FINAL HEATlNG HEALTH DEPT. FINA�
FIP�ALELECTRIC DEV. FEE�.PAID
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FINAL PLUMBING � ENERGY �—
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SEPTIC TAiVK SIZE
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