HomeMy WebLinkAbout10867 .—��—
� CITY OF DIAMOND BAR � �
COMMUNITY DEVELOPMENT DEPARTMENT �
�,,.,: 21660 E.Copley Drive Suite 190 ����.5
(909)860-3195 Fax(909)861-3117 ,�—
�""' BUILDING PERMIT APPLICATION F9 R Afl LX
} JOBSITE /��� (' J, fi"� �� � APPLICATI N PERMIT P/C
o ADDRESS V Tr�^� DATE NUMBER� #
� ISSUE � � TYPE / OCC
� APN LOT TRACT DATE CONST. GROUP
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� ADDRESS ZONING SETBACKS
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� ADDRESS PROPOSED USE I C�C��J L �b0� S
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� DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION
� OWNER-BCILDER DECLARATION SFR/ADD/REM
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p I HEREBV AFFIRM UNDEfi PENALTY OF PERJURY THAT I AM E%EMPT FROM THE CONTRACTORS LI- � Garege/Carport
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U COUNTVWHICHREOUIRESAPERMIT�TOCONSTFiUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC- W Patio/Deck � �
w� TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES 7HE APPLICAN7 FOR SUCH PERMIT TO FILE A SIGNED w \
� STATEMENT THAY HE OR SHE IS LICENSED PURSUANT TO 7HE PROVISIONS OF THE CONTRACTORS LI- -
� CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PRO- u' POOVSPB
FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED E%EMP�
� TION.ANVVIOLATIONOFSECTION7031.SBYANVAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO Z Re-Roof
� A CIVIL PENALTV OF NOT MORE 7HAN FIVE HUNDRED DOLLARS(t500)J: I
f I,ASOWNEROFTHEPROPERN,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, Q
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z WILL THE WORK,AND THE STRUCTURE IS NOT IN7ENDED Ofi OFFEREO FOR SALE(SEC.7oa4,BU51- J
NESS AND PROFESSIONS CODE:THE CANTFACTORS LICENSE LAW DOES NOT APPLY 70 AN OWNER OF �
� PROPERTYWHOBUILDSORIMPROVESTHEREON,ANDWHODOESSUCHWORKHIMSELFORHERSELFOR � '
� THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTSARE NO7INTENDED OR m
w OFFEHEDFORSPLE.IF,HOWEVERTHEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE-
� TION,7HE OWNER-BUILOER WILL HAVE THE BURDEN OF PROVING THA7 HE OR SHE DID NOT BUILD OR
Z IMPROVE FOR THE PURPOSE OF SALE). �
� ❑I,AS OWNER OF THE PROPERTY,AM EXCLUSNELY CON7RAC71NG WITH LICENSED CONTRACTORS I
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� 70 CONSTRUCT THE PR0.IECT(SEC.7oa4,BUSINESS AND PROFESSIONS CADE:THE CONTRACTORS LI� VHIUel1011 O/V ADJ.AREA
W CENSE LAW DOES NOTAPPLY TO AN OWNER OF A PROPERTY WHO BUIlDS OR IMPROVES THEREON,AND — I
� WHOCONTRACTSFORSUCHPRQIECTSWITHACANTRACTOR(S)LICENSEDPURSUANTTOTHECANTRAC- QUANTITY DESCRIPTION FEE
Y TORSUCENSELAW.).
� �I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q.
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DATE � � OWNER U
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� LICENSED CONTRACTORS DECLARAT N w
� I HEREBYAFFIRM UNDER PENALTV OF PERIURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER �
d e(COMMENCING WITH SECTION 7000)OF DNISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND z I
`X MY LICENSE IS IN FULL FORCE AND EFFECT. m i
� LICENSE CLASS LIC.NO. j
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U DATE CONTRACTOR a
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� WORKERS'COMPENSATION DECLARATION Q
� I HEREBV AFFIRM UNDER PENALTV Of PERIURY ONE OF THE FOLLOWING DECIARATIONS: Z �'
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� I HAVE AND WILL MAMTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORKEflS' _
CAMPENSATION,AS PROVIDED BY SEC710N 370o OF THE LABOR CODE,POR THE PERWRMANCE U
¢ OF THE WOfiK FOR WHICH THIS PERMIT IS ISSUE�. �
�
w I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS FEOUIRED BY SECTION �
Q 370o OF 7HE LABOR CODE.FOR THE PERFORMANCE OF 7HE WORK FOR WHICH 7HI5 PERMIT IS / /. QD I
ISSUED.MV WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION !o �
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� CARRIER PLAN REVIEW
ZPOLICYNUMBER ELECTRIC
¢ (i}iISSE(.'iIONNEmNOTBEOJMPLEfEDOF7HEPERMfTISFORONEHUI�DRED00lWiS(5700)ORLESS). PLUMBING
0
Z I CEFiTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
C7 SHALL NOT EMPLOV ANV PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE
� WO(iKERS'COMPENSATIONLAWSOFCALIFOFNIA,ANDAGREETHATIFISHOULDBECOME . INSPECTIONFEE
= SUBJECTTOTHEWORKERS'CAMPENSATIONPROVISIONSOFSECTION37000FTHELABOR � ��
CAOE.I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. ISSUANCE
p DATE: APPLICANT: SMIP .S_�
J WARNING:FAILURE TO SECURE WORKERS'CAMPENSATION COVERAGE IS UNLAWFUL.AND SHALLBE ENERGY P/C
� SUBJECTANEMP�OVERTOCRIMINALPENAL7IESANDCIVILFINESUPTOONEHUND{iEDTHOUSAND ENERGYPERMIT
DOLLARS(f100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PHOVI�ED FOfi IN q J��/,�q
� SECTION37080fTHELABORCODE,WTEREST,ANDATTOFNEY'SFEES. RETENTIONFEE: Y9���_�_ ]i.�I�VI//
_a CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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�� I HEREBV AFFIHM UNDER PENALTV OF PERIURY THAT THERE IS A CONSTRUCTION LENDING AGENCY
FORTHE PERFOFiMANCE OF 7HE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3oW,CIV.C.�.
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? LEN�ER'S NAME
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I— LENDER'SADDRESS
� I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTAL FE ES �� � JrO
w I AGREE TO COMPLV WITH ALL CITV AND COUNTY ORDINANCES AND STATE IAWS RELATING TO BUILDING
� CONSTRUCTION,AND HEREBV AUTHORRE AEPRESENTATNES OF THIS COUNTY TO ENTER UPON THE
� ABOVE�MENTIONED PROPERTv FOR INSPECTION PURPOSES. /
Z � f� � / COMMENTS
� �/1.Pif� � `W Ll. 6�1/�
m PERMITTEE NA E(P IN
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� SIGNATURE O E E _ DATE (��
_ ' RECPT.NO._�N� PAID BY VALIDATION
~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—Fite Copy,GREEN—Applicant's Copy
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SET BACK ' � � .� FLOOR JOIST � � �
FTGS/FORMS/STEEL FHA REQMTS ,. • � � ., ..•, ;
ELECTRIC GROUND UNDER FLOOR DUCT '�. � ._,;.�. � '
GFiOUND PLUMBING UNDER FLOOR CUt�IDUIT ° ' ��� -
SLAB GRADE FIREPLACE FOUNDATION •
TEMP POWER FIREPLACE BOND BEkiIVI' ' "
'VVX�7�fi SERVlCE
"'' ' `'� �' � ' `` - MID HT. BOND BEAM
RO�F SHEATHfNG.•.� ti.` :o i�. ; _��. � ` 8 FT. BOND BEAM
FRAMINGNENTILIATION � FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRAQING
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.
SEPTICTANK "' " .'�-� LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST FINAL ZONING �• �
FINAL CONST. FIRE DEP.T. FINAL�1,;�,:�� •;• �i; � �- . �,
FINAL HEATING HEALTH DEPT. FINAL`�;� ' -
FINA�ELECTRIC DEV. FE.ES PAID • -•:- •-
FINAL PLUMBING ENERGY
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SEPTIC TANK SIZE �
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