HomeMy WebLinkAbout18000 (25) l
CITY OF DIAMOND BAR �
----��` --- DEPARTMENT OF COIvIIv1UNTTY&DEVELOPMENT SERVICES
21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 PRESS
''���*"� BUILDING PERMIT APPLICATION FIRMLY
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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 PENAL7V OF PERIURY THA7 I AM EXEMPT FROM THE CONTRAC70Fi5 LI- GflIflJB/CefpOfl
W CENSELAWFORTHEFOLLOWINGREASON(SEC.7o31.5BUSINESSANDPFOFES510N5CODE:ANVCITYOR (n
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Z TURE,PRIOH TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
� STATEMENT THAT HE OR SHE IS LICENSED PUFSUANT TO THE PROVISIONS OF THE CONTRACTORS LI� �
� CENSE LAW(CHAPTER B(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PRO- POOUSPB
FESSIONSCODE)OfiTHATHEORSHEISEXEMPTTHEREFROMANDTHEBA515FORTHEALLEGEDEXEMP� (�
� TION.ANVVIOLATIONOFSECTION7031.SBYANYAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Roof
A CIVIL PENALTI OF NOT MORE 7HAN FIVE HUNDRED DOLLARS(f500).�:
Z ❑I,ASON?JEROFTHEPROPERTV.ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSA710N, � COmmBfCial -
WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR'SALE(SEC.7a41,BUSI� J
� NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE lAW DOES NO7 APPLV 70 AN OWNER OF �
PROPERTV WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORN HIMSELF OR HERSEIF OR
Q THfiOUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT WTENDED OR m
� OFFEREDFORSALE.IF,HOWEVER,7HEBUILDINGORIMPROVEMEN71550LDWITHINONEVEAROFCOMPLE-
Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF SALE).
w ❑I,ASOWNEROFTHEPROPERTV,AMEXCLUSIVELYCONTRACTINGWITHLICENSEDCAN7FAC70RS
� TO CANSTRUCT THE PROJECT(SEC.7041,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- V0IU0IlOf1 � ADJ.AREA
W CENSEIAWDOESNOTAPP�VTOANOWNEROFAPROPERTYWHOBUILD50RIMPROVESTHEREON,AND
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Y 70RS LICENSE LAW.).
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� ❑I AM EXEMPT UNDER SEC. B.6 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 PERIURY THAT I AM LICENSE�UNDER PflOVI510N5 OF CHAPTER � �
d e(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF 7HE BUSINE55 AND PROFESSIONS CODE,AND Z
X MY UCENSE IS IN FULL FORCE AND EFFECT.
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U DATE CONTHACTOR a
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� WOAKEAS'COMPENSATION DECLARATION -�
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� I HEREBY AFFIRM UNDER PENAL7V OF PERIURY ONE OF THE FOLLOWING DECLARATIONS: Z
0 I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORKERS' _ �
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CAMPENSATION,AS PROVIDED BV SECTION 37000F THE LABOR CODE.FOR THE PEflFORMANCE U
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. W
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� _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION G
Q 3700 0F THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS � } ��
ISSUED.MY WORKER'CA PENSATLJpw-�NSU�M/pCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION �./ ✓
¢ ��P_ 1 LIrIV _ PLAN REVIEW
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Z POLICVNUMBER �'�f�D ELECTRIC I
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� (IHISSECTIONNEmNOTBE00MREfEDOFTHEPERMITISWfiONEHUIDREDDOLLFAS�f100)ORLESS) PLUMBING I
Z I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
(,�} SHALL NOT EMPLOV ANY PERSON IN ANY MNNNER 50 AS TO BECOME SUBJECT TO THE
N WORKERS'COMPENSATIONIAWSOFCALIFORNIA,ANDAGf7EETHATIFI OME INSPECTIONFEE
= SU&lEC7 TO TH WORKERS'CAMPENSATION PqOVISlO OF SE 3700 Of THE LA ���
CODE,I HAL ORTHWITHCOMPIV WITH THOSE PRO �SSUANCE
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p DATE: �l APPLICA � SMIP I .
J WARNING:FAILURE TO SECURE WORNERS'COMPENSATION C RAGE IS UNLAWFUL,AND SHALL 9E ENERGY P/C i
� SUBJECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILF ESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
DOLLARS(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
J SECTION370BOFTHELABOFCODE,MTEREST,ANDATTORNEV'SFEES. ' RETENTIONFEE:
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a CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� 1 HEREBV AFFIqM UNDER PENALTY OF PERJURV THAT THERE IS ACONSTRUCTION LENDING AGENCY
� FOR THE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,qV.C.).
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� LENDER'S NAME
H LENDER'SADDRE55
� I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTAL F E ES / J �� �/
w I AGREE TO COMPLV WITH ALL qTY AND COUNTV ORDINANCES AND STATE LAWS RELATING TO BUILDING / ✓
� CONSTRUCTION,AND HEREBV AUTHORRE REPRESENTATNES OFTHIS COUNTV TO ENTER UPON THE L �
� ABOVE-MENTIONED PROPERTV FOR INSPECTION PURPOSES. ���
Z COMMENTS
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� SIGN , DATE
= RECPT.NO. PAID BY VALIDATION
~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy
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GRta1JND PLUMBING�----.-� _ ._ ' t)NDER FLOO�i G�t���7UlT � •
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SLAB GRADE � __ _ FIREPLACE FOUNQATION ____i__ '
TEMP POWER , __� FIREPLACE BOND BEAM __ _ _
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WATER SERVICE _ MID HT. B(�ND BEAM
ROOF SHEATHIRlG T/� �I � 8 FT. BONQ BEAM ____ � ___
FRAMINGNENTILIATI�N I FINAL BOND BEAM _______ � ___
ROOF COVER ��T�Z _ _g�//�_ PRE-GRADING_ _ _
ROUGH HEATING BENCHING
ROUGH ELECTRIC ��� ROUGH GRADING �
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ROUGH PLUMBING ; FINISH uRADINC�
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SHOWER/TUB TEST ' POOL ELECTRIC
EXT. LATH/SIDING �� POOL FENCiNG i
WALL INSULATION POOL FINAL
CEI�ING IN�ULATION OFF SITE IMPS.
DRY�/ALL NAILIP�G DEDICATIONS
SEWER FIfVAL ENG. �
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST —� FINAL ZONING
.�._. _ ---_ _____��._._._ ^._____.� _._._______
FINAL CONST. ' • �!RE DEPT. FINAC.
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,� FINAL HEATING ___ j � FaEALTH DEPT. FItyAL _ _
�'I� FINAL ELECTRIC _ � � DEV. FEES PAID _ _
FINAL PLUMBIMG FNERGY ;
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