HomeMy WebLinkAbout14914 (20)CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
21660 E. Copley Drive Suite 190
(909)860-3195 Fax(909)861-3117 PRESS
BUILDING PERMIT APPLICATION f FIRMLY
JOBSITE 1
ADDRESS t i 5, ► AV
APN LOT TRACT
OWNER
ADDRESq_I �-
CITY Ilik ZIP TEL
APPLICANT TEL
CONTRAC R
ADDRESS
CITY ZIPc`jj2_%?__ TEL
ARCRENG/
DESIGNER
ADDRESS
CITY ZIP TEL
OWNER -BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LI.
CENSE LAW FOR THE FOLLOWING REASON fSEC. 7MI.5 BUSINCSS AND PROFESSIONS CODE: ANY CITY OR
COUNTYWHICH REOUHIES A PERMRT TO CONSTR LICT.ALTER IMPROVE. DEMWSNL OR __R_
STRUJ6
TORE. PRIOR TO FTS ISSUANCE. ALSO REWIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LH
CENSE LAW (CHAPTER V (COMMENCING WITH SECTION 7000) OF DIVISION S OF THE BUSINESS AND PRO-
FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP•
TON. ANY VIOLATION OF SECTION 7031.6 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO
A CML PENALTY OF NOT MORE THAN FIVE HU DR ED DOLLARS (SSM) 7
❑ L AS OWNER OF THE PROPERTY, OR MY EMPLOYEES'ATNWAGE SAS THEIR SOLE COMPENSATION.
WALL DO THE WORK. AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7014. BUS I.
NESS AND PROFESSIONS CCOC: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF
PROPERTY VAO BUILDS ON IMPROYESTHEREON. AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT MENDED OR
OFFEREDFOR SALE IF,HOWEVEFL THE BULDNG OR IMPROVEMENTIS SOLDWITHIN ONEYEA IOF COMPLE.
' T)ON. THE 0WNERN3UILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
IMPROVE FOR THE PURPOSE OF SALE).
ET L AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS
TO CONSTRUCT THE PROJECT (SEC. 70". BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LI.
CENSE LAW DOES NOT APPLY TORN OWNER OF A PROPERTY WHO eu LDS OR IMPROVES THEREON. AIA
V640CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAc.
TORS LICENSE LAW).
O IAM EXEMPT UNDER SEC. B. L P.C. FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER
9 (COMMENCING WrrH SECTION 7000) OF OMSION 3 OF THE BUSINESS AND PROFESSIONS CODE. AND
W LICENSE IS NUL
FL FORCE AND EFFECT.
LICENSE CLASS \_ ^ t LIC. NO. 20
`U
DATE CONTRACTOR
WORKERS' COMPENSATION DECLARA
I HEREBY AFFIRM UNDER PENALTYOF PERJURY ONE OFTHE FOLLO GDEC_A/tAT 44.
_I HAVE AND WALL MAINTAIN A CERTIFICATE OF CONSENT SELF -INSURE RWORKERS'
COMPENSATION, AS PROVIDED BY SECTION 3700 Or THE ASOn CODE, FOR THE PERFORM
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.
x I HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INS F J3E ED BYSECTION
/\
HAVE
THE LABOR COOS, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED. MY VAIAKERS'COMPENBATONIN6U CECARRICR AND POLICY NUMBER ARC.
CARRIER 2 M- ti, rj C,II
POLICY NU.IBCR
(THISsECDCN NEED NOT BE COMPLETED OF THE PERI.ET IS FOR ONE RM)PILM DOLLARilS1 I N4.
ICERTIFY THAT N THE PERFORMANCE OF THE WORK FORM HICH THIS PEnMIT IS
$HALL NOT EMPLOY ANY PERSON N ANY MANNER 50 AS TO BECOME SIIBJE TOTHE
WORKERS' COMPENSATION LAWS OF CALIFORNIA AND AGREE THAT IF IS BECOME
SUB.IECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 37 1 OF THE LABOR
CODE.1 SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS.
DATE: APPLICANT.
WARNING: FAILURE 70 SECURE WORKERS' COMPENSATION COVERAGE 15 UNLAWFUL. AND SHALLBE
SUBIECTAN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (SIM 0M). N ADDITION TO THE COST OF COMPENSATION. DAMAGE? AS PROVIDED FOR IN
SECTION 3708 OF THE LABOR CODE, INTEREST. AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 3097, CIV a).
LENDERS NAME
LENDERSADDRESS
1 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT
1 AO REE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
CONSTRUCTION. AND HEREBY AUTHDRRE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
I,MENTIONEDPROPERTYRDRIMP ON PURPOSES.
PC E NAME (PMHn
S44ArURE OF P MATTE DATE
APPLICATIO
PERMIT/tfl/P/C
DATE
NUMBER
A
ISSUE
TYPE
OCC
DATE
CONST.
GROUP
ZONING SETBA KS
FRONT
RW
❑
REAR
p
SIDEISIDE STREET
L-1
RW
p
SIDE
p
PROPOSED USE
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NO. DWEL. NO.
NO.
4
UNITS STORIES 1 BEDROOMS
DESCRIPTION SO. FT.
FACTOR PSF
ADJ. AREA/VALUATION
SFR/ADD/REM
(1)
Garage/Carport
WPatio/Deck
LL-
PDoVSpa
Z
Re -Roof
Commercial
-
5
DO
Valuation If
ADJ.AREA
QUANTITY 6ESCRIPTION
FEE
U
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H
U
W
LU
C3
2
f
S
U
W
,
176,
`
PTION
3
mix
n 5 7000
ISSUANCE
SMIP
11�� II77
_
ENERGY P/C
Y3p�TT1_
VV
ENERGY PERMIT BUILDINU
J
RETENTION FEE:
PRE -ALT FEE:
TOTAL FEES
3v
COMMENTS
RECPT. NO. PAID BY
VALIDATION
WHITE—Department Copy, YELLOW—Finance Copy, PINK—Assossor Copy. GOLDENROD—File Copy, GREEN—Applicant's Copy . v
CITY OF DIAMOND BAR.
INSPECTION RECORD
SET BACK
FLOOR JOIST,
FTGS/FORMS/STEEL
FHA REOMTS
ELECTRIC GROUND
UNDER FLOOR DUCT
GROUND PLUMBING
UNDER FLOOR CONDUIT
SLAB GRADE
FIREPLACE'FOUNDATION
- -
TEMP POWER
FIREPLACE BOND BEAM.
WATER SERVICE
-
MID HT. BOND BEAM
- -
ROOF SHEATHING '�✓
-IU
8 FT. BOND BEAM
FRAMING.NENTILIATION =10 . 0 ,
FINAL BOND BEAM
ROOF COVER
PRE -GRADING
ROUGH HEATING
BENCHING
ROUGH ELECTRIC
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
LANDSCAPEIIRRIG.
SEEP PIT/L.L.
ON SITE IMPS.
GAS AIR TEST
FINAL CONST.
FINAL HEATING
F -/�� _
f
_ FINAL ZONING
FIRE DEPT. FINAL
HEALTH DEPT, FINAL
FINAL ELECTRIC
DEV. FEES PAID
FINAL PLUMBING
ENERGY
COMMENTS
NEC
I _
SEPTIC TANK SIZE
SEEP PIT/U SIZE