HomeMy WebLinkAbout18307 (28)�- -
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-----1�-- CTI'Y OF DIAMOND BAR L
DEPARTIvIENT OF COMMUNTfY&DEVELOPMENT SERVICES `'1
21825 E.Copley Drive �
(909)860.3195 Fax(909)861-3117 PRESS
"'"', BUILDING PERNIIT APPLICATION . FI R M LY
o� JOBSITE _�J L/3� /1�! � DATEICATION � GJ �L NUMBER� #/C
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°-° APN LOT CT DATE ��� CONST. GROUP
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� ADDR�SS i • •
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cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDER DECLARATION SFR/ADD/REM
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I HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT I AM EXEMPT FROM THE CONTRACTOHS LI- G8f8Q6/CBfPOR
W CENSELAWFORTHEFOLLOWINGREASON(SEC.7031.SBUSINESSANDPROFESSIONSCADE:ANVCITVOR (n
U COUNTYWHICHREOUIRESAPERMRTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC- W Patio/Deck
Z NRE,PRIOR TO ITS ISSUANCE,ALSO RE�UIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
w STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CAN7RAC70RS LI- w
� CENSE LAW(CHAPTER D(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � POOVSpO
FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFOqTHEALLEGEDEXEMP- (� .
� TION.ANYVIOUTIONOFSECTION7031.5BYANVAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Roof �
ACIVIL VENALTV OF NOT MORE THAN FIVE HUNDRED DOLURS(l5a0).):
❑I,ASOWNEROFTHEPROPERT/,ORMYEMPLOYEESWITH,WAGESASTHEIRSO�ECOMPENSA710N, Q
Z Commercial —
WILL DO THE WORI(AND THE STRUCTURE IS NOT INTENDED OR OFFEiiEO FOR SALE(SEC.70l1,BUSI- J
� NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE UW DOES NOT APPLV TO AN OWNER OF j
7ROPEiffV WHO BUIIDS OR IMPROVES THEREON,PND WHO DOES SUCH WORK HIMSEI.F OR HERSELF OR
Q THibUGH HIS OR HER ONM EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
QOFFEREOFORSALEIF,HOWEVER,7HEBUILDINGORIMPHOVEMENTISSOIDWITMINONEYEAROFCOMPLE-
Z TION,THE OWNER-BUIIDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF SALE).
w ❑I,ASOWNEROF7HEPROPEHTV,AMEXCLUSNELYCANTMCTINGWITHLICENSEDCON7MC70RS
� 70 CONSTRUCT THE PRQIECT(SEC.7os1,BUSINE55 AND PROFESSIONS CODE:7HE CONTRACTORS LI- � VfllUflll011 ADJ.AREA
W CENSE LAW DOES NOTAPPLY TO AN ONMER OF A PROPERN WHO BUILDS OR IMPROVES THEREON,AND
� NM1IOCONTRAGTSFORSUCHPRQIECTSWITHACONTRACTOR(S)LICENSEDPURSUANTTOTHECONTRAC- �� I QUANTITY DESCRIPTION FEE �
TORS LICENSE UW.). ��
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� ' ❑I AM E%EMPT UNDER SEC. B.6 P.C.fOR THIS REASON iQ �
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� DATE OWNER
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F LICENSED CONTRACTORS DECLARATION �
� 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � .
� Y(COMMENCIHO WITH SECTION 7oao)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CADE,AND Z
XL' MV LICENSE IS IN FULL FORCE AND EFFECT. m
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� LICENSE C S v��`�' LIC.NO. V/ ��. j
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V DATE CONTMCTO � d
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� WORKERS'COMPENSATION DECLARATION Q
� I ER�BV AFFIRM UNDER PENALTV OF VERIURV ONE OFTHE FOLLOWING OECURATIONS: Z
� I HAVE AND WILL MAIN7AIN A CER71fICATE OF CANSENT TO SELF-INSURE FOR WORKERS' 2
� COMPENSA710N,AS PROVIDED BY SECTION 3700 OF THE UBOR CODE,FOR THE PEFiFORMANCE W
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
�
W I HAVE AND WILL MAIN7AIN WORKERS'CAMPENSATION INSURANCE,AS RE�UIRED BY SECTION
Q 97000F THE LABOR CADE,FOR THE PERFORMANCE OF THE WOHK f-0R WHICH THIS PERMIT IS
ISSUED.MY K 5' MPENSAj�ON INSU CARRIEH AND POLICV NUMBER ARE: CONSTRUCTION
Q �/
) CARRIER�A"�� / l/� . .� _ � PLAN REVIEW
ZPOLICV NUMBER � ELECTRIC
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� (IHISSELTpNNE�NOTBE00MPLETIDOFhIEPERIMISFORONEMIK7RED00UARS(S10U)ORLESS} PLUMBING
Z I CEHTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
(} SHALL NOT EMPLOY ANY PERSON IN ANV MANNER 50 AS 70 BECOME SUBJECT TO THE
� WORKERS'COMPENSATION UWS OF CALIFORNIA,AND AGREE 7HA71F I SHOULD BECOME INSPECTION FEE
� SUBJECTTOTHEWORKERS'COMPENSATIONPROVISIONSO SECTION37000FTHELABOR ���
� CODE SH FORTHWITH COMPLV WI OSE PROV / ISSUANCE
� ���j �j(' C.iV ' SMIP
p DATE:�aI7�j����� APPLICANT: /
J WARNING!FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNUWFUL,AND SHALL BE ENERGY P/C
LL SU&IECTPN EMPLOVER TO CRIMINAL PENAL7IES AND CIVIL FINES UP 700NE HUNORED THOUSAND ENERGY PERMIT
DOLLARS(f100,o00),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
� SECTION 3)oe OF THE LABOR CODE,INTEREST,AND ATfORNEY'S FEES. � RETENTION FEE: r
d CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� I HEREBV AFFIRM UNDER PENAL7V OF PER.IURY THAT 7HERE IS A CONSTRUCTION LENDING AGENCV
< FOR THE PERFORMANCE OF 7HE WORKFOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.C.). .
Z
W
� LENDER'S NAME
F— LENDER'S ADDRESS
� I CERTIFY THAT I HAVE READ 7HIS APPLICATION AND STATE THAT 7HE ABOVE INFORMATION IS CARRECT. TOTAL FE ES r
w I AGREE TO COMPLY WITH ALL CITY AND COUN7Y OR�INANCES AND STATE LAWS RELA7ING TO BUILDING
� CANSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE �
� ABOVE-MENTIONED PROPER7Y FOR INSPECTION PURPOSES.
Z COMMENTS
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� TUR OFPERMITTEE DATE �
— RECPT.NO. � PAID BY VALIDATION
WHITE—Depertment Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDEN O�File Copy,GR N—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 CUt�IDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEiVIP POWER FIREPLACE BOND BEAM
WATER SERVICE MID HT. BOND BEAM
ROOF SHEATHING 8 FT. BOND BEAM
FRAMINGNENTILIATION FINAL BOND BEAM
ROOF COVER PRE-GRADING �
ROUGH HEATING BENCHING '
, ROUGH ELECTRIC a a ROUGH GRADING
ROUGH PLUNIBING FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC
EXT.LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL
CEILING IPVSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINA�ENG.
SEPTIC TAN6C LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. FIRE DEPT. FINA�
FINAL HEATING HEALTH DEPT. FINAL
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FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY
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SEPTIC TANK SIZE
SEEP PIT/U SIZE
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