HomeMy WebLinkAbout12197 �� CITY OF DIAMOND BAR �P[RL�
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21660 E.Copley Drive Suite 190
(909)860-3195 Fax(909)861-3117 J UN 13 1001 PRESS
������� BUII..DING PERMTr APPLICATION FIRMLY
� JOBSITE �j �^ APPLICATION � �'( PERMIT P/C
o ADDRESS�7��� C j TOI� ��� DATE � � NUMBER�� #
$ ISSUE TYPE OCC
APN LOT TRACT DATE P CONST. GROUP
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� ADDRESS
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� DESIGNER NO.DWEL. NO. NO.
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� DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION
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Q OWNER-BUILDER DECLARATION SFR/ADD/HEM
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p 1 HEREBY AFFlRM UNDEH PENAL7Y OF PERJURY THAT I AM EXEMPT FROM THE CANTRACTORS LI- G8l8JB/CBfPOR
W CENSEUWFORTHEFOLLOWINGREASON(SEC.7031.5BUSINESSANDPROFESSIONSCODE:ANVCI7VOR (n
U COUNTVWHIQIREOUIRESAPERMITTOCONSTHUCT,ALTEf�IMPROVE,DEMOLISH,ORREPAIRANYSTRUC- W al BCk
W TURE,PRIDR TO RS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w
� STATEMENT TNAT NE OR SHE IS LICENSED WRSUANf TO THE PROVISIONS OF 7NE CONTRACTORS LI-
� CENSE UW(CHAPTER 0(COMMENCINO WITH SECTION 7000)OF DIVISION]OF THE BUSINESS AND PR0. � PooUSpa
FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEQEO EXEMP-
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� A GVIL PENALTY OF NOT MORE THAN FNE HUNORED DOLlAHS(t500).):
� ❑I,ASOWNEROFTHEPROPERTY.ORMVEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, � CORIrtIBfClel � �
WILL DO THE WOPoC AND THE STRUCNRE IS NOT IHTENDED OR OFFERED FOR SALE(SEC.70//,BUSI- J
NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE UW DOES NOT APPLY TO AN OWNER OF
� PROPEHfYVM1iOBUILDSORIMPROVESTHEHEON,ANDWHODOE55UCHWORKHIMSELFORHERSELFOR �
� iHROUGH HIS OR HER ONM EMPLOYEES,PROVIDED THAT SUCH IMPROVEMEN75 ARE NOT INTENDED OR m �
W OFFEREDFORSALEIF,HOWEVER7FIEBUIIDINGORIMPROVEMENTISSOLDWRHINONEVEAROFCAAIPLE-
Z �TION,THE OWNER�BUILDER WILL HAVE THE BUNDEN OF PROVINO THAi HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF SALE).
❑1,AS OWNER OF THE PROPERTY,MA EXCLUSIVELY CON7MCTINO WfTH LICENSED CONfMCTORS
Q TO CONSTRUCT THE PRO,IECT(SEC.70H,BUSINESS AHD PROFESSIONS CODE:THE CONfRACTORS LI- V81U8fI0f1 ` O'—� ADJ.AREA '
W CENSEUWDOESNOTMPLYTOANOWNEROFAPROPERTYWHOBUILDSORIMPROVESiHEREON,AND
� NTiOCOHfRACTSFORSUCHPRQIECTSWI7HACONiRACTOR(S)LICENSEDPURSUAHfTOTHECONTRAG qUANTITY � DESCRIPTION FEE .
� NRS LICENSE UW.).
O ❑I AM IXEMPT UHDER SEC. B.8 P.C.FOR THIS REASON U
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� DATE OWNER
Z W 3 � b
F LICENSED CONTRACTORS DECLARATION w
. � 1 HEREBV AFFIfW UNDER PENALTY OF PERIURY 7HAT I AM LICENSEO UNDER PROVISIONS OF CHAPTER �
• � Y(COMMENCWO WITH SECTION 7000)OF DIVISION 7 0F THE BUSINESS AND PROFESSIONS CADE,AND Z
�� X MY 110ENSE IS IN FULL FORCE AND EFFECT.
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� WORKERS'COMPENSATION DECLARATION a
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N I HEREBV AFFlRM UNDER PENALTY OF PERIUtiY ONE OFTHE FOLLOWING DECLAMTIONS:
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� _IHAVEANDWILLMAINTAIHACERfIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' _
� COMPENSATpN,AS PROVIDED BY SECTION 97000F THE UBOR CODE,FOR THE PERFORMANCE W
OF THE WORK FOR Mrt11CH THIS PERMIT IS ISSUED. �
�
W _I HAVE AND WILL MAINTNN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BV SECTION
Q 37000FTHEUBORCODE,FORTHEPERFORMANCEOFTHEWOHKWRWHICH7HISPERMITIS z �� ?•0
ISSUED.MV WORKERS'COMPENSATION INSURANCE CARHIER AND POLICV NUMBEFi ARE: C STR
j �pqiEp PLAN REVIEW � ^ �
� POLICV NUMBER LECT
� (fFCSSEcioNNE�w78Ea0MtETmOcnfaEtA4fsFORONEFa1rDRmDalnRSR�m)oHtFSS) PLUMBING
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Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,1
(3 SHALL NOT EMPLOV ANV PERSON IN ANV MANNER SOAS TO BECAME SUBJECT TO THE
N WORKERS'COMPENSATION UWS OF CALIFORNI/�AND AGREE THAT IF I SHOULD BECOME �/y�� �j1� �`
S SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 9700 OF 7HE LABOR AN �h :J✓'--�+'V
CODE,I SHALL FOfiTHWITH COMPLV WITH 7HOSE PROVISIONS.
a iP i .53�
p DATE: � APPLICANP. �
w ERGY P/C
� WARNINO:FAILURE TO SECURE WORKERS'CAMPENSATION COVERAGE IS UNUWFUL,AND SHALL BE
SUBJECTANEMPLOVER70CRIMINALPENALTIESPNDCIVILFINESUP700NEHUNDREDTHOUSAND ENERGYPERMIT
DOILARS(ilao.o00).IN/�DDI710N TO THE COST OF COM7ENSA710N,DAAIAGES AS PROVIDED fOR IN
J SECTION 37oE OF TiE LABOR CODE,IN7EREST,AND ATfORNE1"5 FEES. RETENTION FEE:
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� CONSTRUCTION LENDING AGENCY PRE-ALT FEE: y�
� I HEREBV AFFIHM UN�ER PENALTY OF PERIURY THAT THERE IS A CANSTRUCTION LENDINO AGENCV L�
d FOR THE PERFORMANCE OF THE WORK FOR WHICH 7HI5 GERMIT IS ISSUED(SEC.3087,CIV,4�. � , �
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� LENDER'S NMIE
H LENDERSADDRESS
� I CER7IFY THAT I HAVE READ THIS APPLICATION AND STATE T1AT THE ABOVE INFORMATION IS CAFRECT. TOTAL FE ES /'�
W I AGREE TO COMPIV WITH ALl CT'M1D COUNTY ORDINANCES AND STATE UWS RELATING TO BUILDING � OQ. /
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� CONSTRUCTION,AND HEREBV AUTFIOR2E REPRESENTATNES OF 7HIS COUNT'70 ENTER UPON T1E . ✓ ,lJ
Z ABOVE-MENTIONED PROPERTV FOR INSPECTION PURPOSES. COMMENTS � ,
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� NANREOFPERAIRTEE � DATE �'
� RECPT.NO. PAID BY U VALIDATION
WHITE-0epeAment Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy
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SET BACK ' FLOOR JOtST " � " � . �
FTGS/FORMS/STEEL „ '�, �\ ,, FHA REQMTS
ELECTRIC GROUND - ' ' � UNDER FLOOR DUCT , '
GROUND PLUMBING UNDER FLOOR CU�IDUIT
SLAB GRADE FIREP'LACE FOUNDATION ` ''
TEMP POWER � � FIREPLACE BOND BEAM
WATER SERVICE � � MID HT. BOND BEAM
ROOF SHEATHING � �'� �• S Ff. BOND BEAM
FRAMINGNENTILIATION', FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING - BENCHING
ROUGH E�ECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWERITUB TEST � �-�.POOL ELECTRIC �
EXT. LATH/SIDING � � "POOL FENCING '
WAL�INSULATION POO�FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALI NAILING DEDICATIONS '
SEWER FINAL ENG.
SEPTIC TANK . , LANDSCAPE/IRRIG.
SEEP PIT/(..L. '�' '' ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAI.CONST. � FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC ' � DEV. FEES PAID
FINAL PLUMBING ENERGY
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