HomeMy WebLinkAbout10685 - C1TY OF DIAMOND BAR
COMMUNTfY DEVELOPMENT DEPARTMENT
;,•G 21660 E.Copley Drive Suite 190 PRESS
(909)860-3195 Fax(909)861-3117
�'""'� BUILDING PERMIT APPLICATION FIRMLY
N JOBSITE /� ' '/ APPLICATION PERMIT ,(J�j�,�P/C
o ADDRESS ���� T T�����7Q �-/Y DATE NUMBER #
c� ISSUE ;7 TYPE OCC
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p OWNER /`�2, DATE CONST. GROUP
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p ADDRESS ��� ZONING SETBACKS
Z CITY.D�fI^'Jait/U /(i¢�f'ZIP TEL. 1Syb FRONT RW ❑
p APPLICANT TEL�f o REAR ❑
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cn DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BI;ILDER DECLARATION SFR/ADD/REM
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I HEREBV AFFIRM UNDEH PENALTV OF PERJURY THAT I AM E%EMPT FqOM 7HE CANTRACTORS LI- Gef89B/CflfpOR
W CENSELAWFORTHEFOLLOWINGREASON(SEC.7031.SBUSINESSANDPROFESSIONSCODE:ANYCITYOR (n
U COUNTYWHICHREOUIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYS7RUC- W Patio/Deck
w TURE.VRIOR TO ITS ISSUANCE.ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W �
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF TME CONiRACTORS LI�
� CENSE LAW(CHAPTER Y(COMAIENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- LL PooVSpa
FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDE%EMP� (�
� TION.ANV VIOLATION OF SECTION 7031.5 BV ANV APPLICANT FOH A PERMI7 SU&IECTS THE MPLICANT TO Z Re-Roof
�.� A CIVIL PENQTV OF NOT MORE THAN FNE HUNDRED DOLURS(i500�.):
� ❑I.ASOWNEROFTHEPROPEH7Y,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, � COrtIrtIBfCl81
Z WIIL DO THE WOfiK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.701�,BUSI- J
� NESS AND PROFESSIONS CODE:iHE CANTRACTORS LICENSE UW DOES NOT APPLV TO AN OWNER OF �
PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO OOES SUCH WORK HIMSELF OR HERSELF OR
� THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMEN75 ARE NOT INTENDED OR m
QOFFEREDFORS�LE.IF,HOWEVERTMEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE-
Z TION,THE OWNER-BUIIDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUIID OR
� IMPROVE FOfl THE PURPOSE OF SALE).
❑1,AS OWNER OF THE PROPER7Y,AM EXCLUSIVELV CONTRACTING WITH LICENSED CONTMCTORS
� 70 CONS7RUC7 THE PRQIECT(SEC.70�/,BUSINESS AND PROFESSIONS CADE:THE CONTFACTORS LI� V01U9f1011 p O �� ADJ.AHEA
W CENSE UW DOES NOTAPPLV TO AN OMMER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND
� NM1IOCANTMCTSFORSUCHPRQIECTSWITHACONTRACTOR(S)LICENSEDPURSUANTTOTHECONTMG QUANTITY DESCRIPTION . FEE
� TORS LICENSE LAW.�.
� ❑I AM EJ(EMPT UNDER SEC. 8.6 P.C,FOR THIS REASON Q
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DATE ONMER �
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¢ LICENSED CONTRACTORS DECLARATION W
OC I HEREBY AFFIRM UNDER PENAL7Y OF PERIURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
� B(COMMENCING WITH SECTION 7ooD)OF DIVISION 70F THE BUSINESS AND PROFESSIONS CADE,AND Z
LLI MY LICENSE iS IN FULL FORCE AND EFFECL m
� LICENSE CLASS � UC.NQ / I �� I j
V DATE � � CONTRACTOR c__M G��/iS� d
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� WORKERS'COMPENSATION DECLARATION a
� IHEREBYAFFIRMUNOERPENALTYOFPEiL1URYONEOFTHEPDLLAWW�DECURATIONS: Z
� _IHAVEANOWI�LhWNTNNACEATIFICATEOFCONSEHTTOSELf-INSUREFORWORKERS' _ .
COMPENSATION,ASPROVIDEDBYSECTION37000FTHElA80RCOU�FORTHEPFAFORMANCE �U
Q OFTHE WORK fOR WHICH THIS PERMIT IS ISSUED. � �
w �IHAVEANDWILIMAINTAINWORKERS'COMPENSATIONINSURANCE,ASREOUIREDBYSECTION (�
Q 77000FTHELABORCODE,PoRTHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMRIS ��, ��! �
ISSUED.MYWOHICERS'COMPENSATIONINSURANCECAARIERM1DPOl1CYNUMBEAARE CON� STRUCiT�
j CARRIER � PLAN IREV E1N
� POLICY NUMBER � � Q � � 7
Q � 6�- . �^� ELECTRIC
� (fHISSECTIONNE�NDTBECOMREfEDOFiIEPERMTISRJRONEFIIMDREDOd1AAS(510�)ORLESS} PLUMBING
2 I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
(r} SHALL NOT EMPLOY ANY PERSON IN ANV MMINER SOAS TO BECOME SU&IECT TO THE
N WORNERS'COMPENSATION UWS OF CALIFORNIA,M1D AGREE THAT IF I SHWLD BECOME INSPECTION FEE f� �1 �'r:��'1 .
? SUBJECT TO THE V10RNEF5'COMPENSATION PHOVISIONS OF SECTION 37000F THE LABOR I✓/_�Yl,I,,J ti7 Y� /L'� ' .�•
CADE,I SHALL FORTHWITH COMPLV WITH 7MOSE PROVISIONS. IS$UA l l f t�K�S-� � J/
p DATE:L��Cy��APPIICANT: ��7 �� � SMIP / • `�
J � ENERGY P/C �.
WARNINO:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNUWFUL,AND SHALL BE �
� SUBJECTANEMPLOVERTOCRIMINALPENAL7IESANDCIVILFINESUP700NEHUNDREDTHWSAND ENERGYPERMIT
( �' OOLURS(f100.oao).IN ADDITION TO THE CQST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
SECTqN]7oe OF TME LABOR CODE,INTEREST,AND ATTORNEV'S FEES. RETENTION FEE:
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a • CONSTRUCTION IENDING AGENCY PRE-ALT FEE:
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- � I HEREBV AFFIRM UNDER PENAL7V OF PERIURV THAT THERE IS A CONSTRUCTION LENDING AGENCY
FOR THE VERFORMANCE OF iHE WORK FOR WHIGI THIS PERMIT IS ISSUED(SEC.30Y7,CIV.C.).
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� LENDER'S NAME
F— LENDER'SADORESS
I CERTIFV THAT I HME READ THIS MPLICA71pJ ANO STATE THAT THE ABOVE INFORMATION IS CORRECT.
� I AGREE TO CAMPLY WITH ALL CITY AND COUNTV ORDINANCES AND STATE LAWS RELATING TO BUILDING TOTAL FE ES //- ' ��
� COHSTRUCTION,M1D HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
z ABOVE-MEHTIONED VROPERTY FOR INSPECTIOH PURPOSES. COMMENTS
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y IONAN F i EE ATE RECPT.NO �PAID BY �Z O(�/ VALIDATION
� WHITE—Department Copy,YELLOW�inance Copy,PINK—Assessor Copy,GOLDENROD--Ffle Copy,GREEN—AppllcanYs Copy
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ELECTRIC GROUND � Uf�DER FLOOR DUGT � ,��•'.-;. �
GROUND PLUMBING UNDER'FLOOA ef�l�IDUIT� -=.� �': ��"• '• � '�'`• �'� •
SL�4B GRADE FIREI�LAC� FO NdATION � � ' ` '
TEMP POUVER FIREPLACE BOND"B�AM' �- -� '• '• ._--'
�lIAYER SERVICE - MID HT.'Ba.�1D fl�Af�1. ' : .,:;� ,�. '�" ' : �.,;, �.;
ROOF SHEATHING -�/y7 � � 8 FT. BOND BEAM
FRAMING/VENTILIATIOfJ', FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGi-I HEATING BENCHING •
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUM.;�ING. �,,�ti ' � FINISH GRADING ' �
SHOVI/EF�T't`9B"��ST"� POOL ELECTRiC '
EXT:LATH/SIDIf�G,, ; u?;;:. � - POOL FENCING
NUALL INSULA`fiION ' � POOL FINAL • �
CEILING IfVSUL4TION OFF SITE IMPS.
DRYliUALL NAILING DEDICATIONS �
SE1AlER FINAL ENG.
SEPTIC Ti4NK - ' � � • •�;+� LAf�DSCAPE/IRRIG.
SEEP PIT/L.L. Ohl SiTE IMPS. _�
GAS AIR TEST - FINAL ZONING
Fl°dAL COf�ST. FIRE QEPT. FINAL
FIf�AL HEHTING FlEALTH DEPT. FINAL �
FINAL ELECTRIC DEV. FEES PAID ` .
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