HomeMy WebLinkAbout11-1574 CITY OF DIAMOND BAR � /
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(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909)839-7 2 PRESS
�'°�'� BUILDING PERMIT APPLICATION . . FIRMLY
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� APN LOT TRACT ISSUE TYPE Q, OCC
DATE CONST.�I.J GROUP
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o APPLICANT TEL. S DE/SIDE STREET RW ❑
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� CITY V ZIP TEL. o?S 7QS-y PROPOSED USE
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� DESIGNER NO.DWEL. NO. NO.
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N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDER DECLARATION SFR/ADD/REM
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� I HEFEBV AFFlRM UNDER PENALTY OF PERNRV THAT I AM EXEAIPT FiiOM THE CANTRACTORS U� G0l8 B/C9 R
W CENSE UW FORTHE FOLLOW WO REASON(SEC.7031.60USINESSAND PROFESSIONS CODE:M1V CITV OR (n 9 �
C1 COUNTVNM1iICHREWIRE3APERMITTOCONSTRUCT,ALTER,IMPROVE.DEAqLISH,ORREPAIRANV9TRUG W patio/Deck
�< TURE,PRqR TO ITS ISSUANCE.ALSO REW IRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIONED w
� STATEMENT 7NAT HE OR SHE IS LICENSED WRSUANT TO THE PROVISIONS OF THE CONTRACTORS LI�
� CENSE LAW(CHAPTER e(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� u' POOUSPB
� FESSpNS CODE)OR THAT HE OR SHE IS E%EMPT THEREFROM AND THE BA515 FOR THE ALLEOED EXEMP- �
TION.ANV VIOUTION OF SECTION 7031.6 BY ANV APPUCANT FOR A PERMIT SU&IECTS THE APPLICANT TO Z qe-Roof
A CML PENALT/OF NOT MORE THAN FIVE HUNDRED DOLLAAS(f500).):
� ❑I,ASON?JEROFTHEPROPERTV,ORMVEMPLOVEESWITHWAGESASTHEIRSOIECOMPENSATION, � COff1/fIBfC18I
Z WILL DO 7HE WORN,AND THE STRUCTURE IS NO7 IMEN�ED OR OFFERED FOR SALE(SEC.7oN,BUSI� J �
� NESS AND PqOFESSIONS CODE:THE CANTRACTORS LJCENSE LAW DOES NOT APPLV TO AN OWNEfi OF =
PROPERTV WIiO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
� THROUGH HIS OR HER OWN EMVLOVEES,PROVIOED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
� OFFEREDFORSALEIF,HOWEVERTMEBUILDINGOfiIMPROVEMENTI550LDWITHINONEVEAROFCOMPLE-
. Z TION,THE OWNEF7-BUIIDER WILL HAVE THE BURUEN OF PROVWO THAT HE OR SHE DID NOT BUILD OR
� NIPROVE FOR THE PURPQSE OF SALE).
w ❑I,AS ONMER OF THE PROPERTY,AM EXQUSIVELV COMRACTING WfTH LICENSED CONTRACTORS
� TO CONSTRUCT THE PR0.IECT(SEC.7011,BUSINESS AND PROFE5910NS CODE:THE CONTRACTOqS LI� V8IU8tlOf1 qp,�.qqEq
W CENSELAWDOESNOTAPPLVTOANOWNEROFAPROPERTVWHOBUILDSORIMPROVESTHEREON,AND
� Yh1000NTMCTSFORSUCHPROJECTSWITHACONTRACTOR(S)IICENSEDPURSUANTTOTMECONTRAP pUANTITY DESCRIPTION
� TORS LICENSE LAW.). FEE
O I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON J
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�'L' DATE OWNEF F-
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�¢ LICENSED CONTRACTORS DECLARATION w
CL 1 HEREBY AFFIRM UNDER PEN�LTV OF PERJUFV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � / � ���
� o(COMMENGNO WRH SECTION 7000)OF DIVISION J OF THE BUSINE55 AND PROFESSIONS CODE,AND Z
��� W UCENSE IS M FULL FORCE AND EFFECT. m � � ,C
� LICENSE SS ��✓ LIC.NO. ��� � �
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� WORKERS'COMPENSATION DECLARATION � � ,
� I HEFEBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECIARATIONS: V
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Z� _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' ¢ '
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C0IAPENSATION,AS PROVIDED BV SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMANCE W
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
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w I HAVE AND WILL MAIMAPI WORKERS'COMPENSATION INSURANCE,AS REQUIRED BV SECTION
Q370o OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED.MY WORKERS'COMPENSATION INSUHANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION
jCMqIER PLAN REVIEVJ
� POLICV NUMBER
� ELECTRIC
� (fFOSSECTqNN�NOTBECUREfmOFhEPERAY�ISFOqONE14.rDREDDOlL1fLS(t100)ORLESS). PLUMBING
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Z �CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOq WHIp1 THIS PERMIT IS ISSUED,1 MECHANICAL
CS SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SU&IECT TO THE
(n WORKERS'COMPENSATION UWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE
SU&IECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE UBOR
O COJ�DE.ISQH FORTHWITHCOMPLVWITHTHOSELPROV�I.,S,IO1NS.��p� ///��,/ ISSUANCE
p DATE: V O I APP�ICANT: F�S7 Y V Q`fl�� L[`r V/' SMIP
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J WMNINO:FAILURE TO SECUFE WORKEFS'CAMPENSATION CAVEiUGE IS UNLAWFUL,AND SHALL BE ENERGY P/C �
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� SU&IECTAN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND ENERGY PERMIT
DOLLARS(5100,000).IN ADDITION TO THE COS70F COMPENSATKKJ,DAMAdES AS PROVIDED FOR IN
J SECTION 3loe OF THE LABOF CODE,MTEREST,AND ATTORNEV'S FEES.
w RETENTION FEE:
O CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBV AFFIHM UNDER PENALTV OF PERJURY THAT THERE IS A CONSTRUCTION LENDINO AOENCV
FOR THE PERFORMANCE OF iHE WORN FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.).
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� LEN�ER'S NPA/E
� LENDERSADORESS
� I CERTIFV THAT I HAVE REA�THIS APPLICATION AND STATE 7HAT THE ABOVE WFORMATqN IS CORRECT. TOTAL FE ES
� 1 AGREE TO COMPLV WfTM ALL CITY AND COUNTY ORDINANCES AND STATE LAWS REUTINO TO BUILDING
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTEF U70N THE -
Z ABOVE-MENTpNED PROPERTY FOR INSPECTION PUqPOSES. COMMENTS '
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� 51 ATUF OFPERMITTE D TE -
� RECPT.NO. PAID BV VALIDATION
WHITE—DepaAm�t Copy,YELLOW—Finence Copy,PINK—Assessor Copy,60LDENROD—File ,GREE�
. Copy Applicant's Capy
CITY O� DIANiOND BAR '
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INSPECTION RECORD �
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SET BACKO* FLOOR JOIST
FTGS/FORMS/STEEL FHA REQMTS
ELECTRIC GROUND UNOER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID HT. BOND BEAM
ROOF SHEATHING 8 FT. BOND BEAM
FRAMINGNENTILATION 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 . r 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 FINAL ZONING
FINAL CONST. FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING r � ' ' ENERGY �
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COMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
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