HomeMy WebLinkAbout17995 CITY OF DIAMOND BAR ��
`-----���` --- DEPARTMENT OF COIvIIv1iJNITY&DEVELOPMENT SERVICES
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� 21825 E.Copley Drive
(909)860-3195 F�(909)861-3117 PRESS
��'%����� BUILDING PERMIT APPLICATION FVRMLY
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ADDRESS_ DATE 5 � oa- NUMBER� #
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APN LOT TRACT DATE CONST. GROUP
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I HEREBY AFFIfiM UNDER PENALTV OF PERJURV THAT 1 AM EXEMPT FROM THE CONTRACTO{iS LI- G2fe JB/CBfpOR
�W CENSELAWFOR7HEFOLLOWINGREASON(SEC.7031.SBUSINESSANDPFOFESSIONSCADE:ANVGTVOFi (n
U CAUNTYWHICHNEOUIRESAPERMI7TOCONSTRUC7,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC-
w TURE,PRIOR TO ITS ISSUANCE.ALSO REoUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Pa110/DBCk
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CANTRACTORS LI� �
� CENSE LAW(CHAPTER B(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- POOUSPB .
FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP- C7
� TION.ANVVIOLATIONOFSECTION7031.SBVANVAPPLICANTFORAPERMITSU&lECTSTHEAPPLICANTTO Z Re-Roof
A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLURS(SSoo).):
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N NESS AND PROFESSIONS CODE:THE CANTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF �
PpOPERTV WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
� THROUGH HIS OR HER OWN EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
w OFFEREDFORSPIE.IF,HOWEVER,THEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE-
� TION,THE OWNEH-BUILDER WILL HAVE THE BUFDEN OF PROVING TNAT HE OR SHE DID NOT BUILD OF
Z IMPROVE FOR 7HE PURPOSE OF SALE).
�_ ❑I,ASOWNEROFTHEPROPEfiTY,AMEXCLUSIVELYCONTRACTINGWI7HLICENSEDCAN7RAC70RS
TO CANSTRUCT 7HE PR0.1EC7(SEC.70��,BUSINESS AND PROFESSIONS CADE:THE CONTRACTORS LI� VelUeilOfl ADJ.AREA
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� VAiOCANTRACTSFORSUCHPRQIECTSWITHACANTRACTOR(5)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE
Y 70RS LICENSE LAW.).
� O I AM ExEMP7 UNDER SEC. B.8 P.C.FOR THIS REASON Q
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DATE OWNER �
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� LICENSED CONTRACTORS DECLARATION w
� I HEREBV AFFIRM UNDER PENALTV OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
� 4(COMMENCINQ WITH SECTION 7000)OF DIVISION 30F THE BUSINESS AND PROFESSIONS CODE,AND Z _
X MY LICENSE IS IN FULI FOflCE AND EFFECT.
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� LICENSE CLrASS �
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� WORKERS'COMPENSATION DECLARATION Q
� I HEREBV AFFIRM UNDER PENALTV OF PERJURV ONE OF THE FOLLOWING DECURATIONS: Z
Z _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORKERS' _
¢ CAMPENSA710N,AS PROVIDED BY SECTION 370o OF THE UBOR CODE,FOR THE PERFORMANCE W
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
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w _I HAVEAND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS RE�UIRED BV SECTION
O 3700 OF THE LABOR CODE,FOR THE PEflFORMANCE OF THE WORK FOR WHICH THIS FERMIT IS
ISSUED.MY WORK�RS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION
j CARRIER �� F r PLAN REVIEW
Z POLICVNUMBER W C_ `L,�J,Q� �'l.L, I� ELECTRIC
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� (II-IISSECTIONNE�NOTBEOJMPLEfEDOFTHEPERANISFORONEHUhDREDDOILARS(5100�ORLESS} PLUMBING / 7/..
Z �CERTIFYTHAT IN THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL - -
(,'} SHA�LNOTEMPLOYANYPERSONINANYMANNERSOASTOBECAMESUBJECTTOTHE I (�_� , � -_�
� WORKERS'COMPENSATIONLAWSOFCAIIFOFNIA,ANDAGREETHATIF15HOUlDBECOME INSPECTIONFEE ��r /���,\
� SUBJECT TO THE WORKERS'COMPENSATION PHOVISIONS OF SECTION 3700 OF THE LABOR �� I,
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CADE.I SHALL FORTHWITH COMPLV WITH THOSE PROVISIONS. ISSUANCE . ill
p DATE:S��?jrOZ APPLICANT: V�L— K/rL��s�� . SMIP { IVI�fI � f� lll�i�
� ENERGY P/C I
J WARNING FAILURE TO SECURE WORNERS'COMPENSA710N COVERAGE IS UNLAWFUL.ANO SHALL BE
� SU&IECTANEMPLOVEFiTOCRIMINALPENALTIESANDCIVILFMESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT I'u?RT.
DOLLARS(f100.000).IN ADDI710N 70 THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
J SECTION 3708 OF THE LABOR CODE.INTEREST,ANDATTORNEV'S FEES. RETENTION FEE: J1�"""'--'— J /' �
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� CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS ACONSTRUCTION IENDING AGENCY
� FOR THE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.C.). �
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� LEN�ER'S NAME
� LENDER'SADDRE55
� ICERTIFVTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEWFORMATIONISCORRECT. TOTAL FEES (�( !'��
w I AGREE TO COMPLV WITH ALL CITV AND COUNTV ORDINANCES AND STATE LAWS RELATING TO BUILDING
� CONSTRUCTION,ANDHEREBVAUTHORIZEREPRESENTATIVESOFTHISCOUNTYTOENTERUPONTHE
� ABOVE-MENTIONED PROPERTV fOR INSPECTION PURPOSES.
Z COMMENTS
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� SIGN RMI DATE �+ '
= RECPT.NO. �_PAID BY L' VALIDATION
~ WHITE—De artment Co YELLOW—Finance Co PINK—Assessor Co GOLDENROD—File Co GREEN—A licant's Co
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ELECTRIC GR�UND �— � � � UNDEFt FLOQR DUCT
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GR�UND PLUMBING I UNDER FLOOR CUNDUIT ; ____
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SLAB GRADE __� ____ _ FIREPLACE FDU(VDATiON ______
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TEMP POWER _ � �_ FIREPLACE BOND BEAM � _� __
WATER SERVICE ' i MID HT, BONd BEAPvI �-
ROOF SHEATHIIVG ____--� ----� -_�8 FT. BOND EEAM -----4 -------__�___. _.__._...__._._.
FRAMIPJGNENTIUATION � FI�lAL BOND SEAM f
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ROOF COVER PRE-GRADING � � _
ROUGH HEATIfVG BENCHING !
ROUGH ELECTRIC V ROUGH GRADING �� � ^
ROUGH PLUNIBIIVG i ; FINISH GRADING
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SHOWER/TUB TEST i P�OL ELECTRIC
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EXT. LATH/SIDING ' , POOL FENCING
WALL INSUTATION POOL FINAL �
CEILfNG IPVBULATION ' OFF SiTE IMPS.
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DRYWALL NAILING DEDlCATIONS
SEWER FINAL EfJG. i
SEPTIC TANK LANDSCAPE;IRRIG. �
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SEEP PIT/LL � ON 51TE IMPS. i
GAS AIR TEST FINAL ZOfVING
FINAL CONST. _� F!RE �EPT. FlNA! ---- —
----- --- --------....__.
FINAL HEATING HEALTH DEPT. FINAL
FINA�ELECTRIC DEV. FEES PAID
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FIN�L PLUMBING � ENERGY
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CUiUiil�Ei�TS
SEPTIC TANK SIZE
SEEP PIT/U SIZE �.----- ------
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