HomeMy WebLinkAbout18317 (59) , , ^ _1�� CTI'Y OF DIAMOND BAR � - ,
DEPARTIvIENT OF COMr�tUNTi'Y 8c DEVELOPMENf SERVICES
21825 E.Copley Drive
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�"°'" BUII.DINGP APPLICATION . FI LY
� JOBSITE I �� APPLICATION �J l � PERMIT �r►` P/C
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� ISSUE �7/TYPE OCC
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� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION �
p� OWNER-BUILDER DECLARATION SFR/ADD/REM '
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p I MEREBV AFFIRM UNDER PENAL7V OF PEFiJURV THAT I AM EXEMPT FROM THE CONTRACTORS LF Gflrege/Cerport �
W CENSEUWFORTHEFOILOWW�REA.40N(SEC.7031.6BUSINESSANDPROFESSIONSCODE:ANVGYTVOR (n �
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� TURE,PRIOR TO I7S ISSUANCE,ALSO REW IRES THE MPLICANT FOR SUCH PERMIT TO FILE A SI�NED w I
� STATEMENT THAT HE OR SME IS LICENSED PURSUANT TO TME PROVISIONS OF 7HE CONTRACTOR9 LJ- � �
� CENSE UW(piAPTER o(COMMENCWO N7TH 9ECTION 7000)OF DIVISION 7 OF THE BUSINESS AND PRO- POOUSPB
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V 710N.ANVVqLAT10NOF3EC7qN703t.68VM7VAPPLICANTFORAPERMITSU&IECTS7HEMPLICANTTO Z RB-ROO}
A C1VIL PENALiV OF NOT MORE 7HAN FIVE HUNDRED DOLURS(iboo).): �
� ❑I,ASOWNEHOFTHEPROPERTY,ORMVEMPLOYEESWITHWAOESASiHEIRSOLECOMPENSATION, � CommBfCI81 �
Z WILL DO THE WOPo(,AND THE STRUCNRE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7011,BUSI� J �
� NESS ANO�ROFESSIONS CODE hIE CONiRAC70RS LICENSE LAW DOES NO7 APPLV TO MI OWNER OF �
PqOPERTY NT10 BUqDS OR IMVROVES THEREON,M1D WHO DOES SUCH M/ORK HIMSELF OR HERSELF Oq
Q THFiOUGHHISORHEHOWNEMPLOYEES,PROVIDmTHATSUCHWPROVEMENTSARENOTINTENDEDOR m
� OFFEREDWRSALEIF,MOWEVERTMEBUILDINOORIMPROVEIAENTISSOIDWfTI-0NONEVEAROFCOMPLE�
Z TqN,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVIN(i TFUi HE OR SHE DID NO7 BUIID OR ,
� W PfiOVE FOR 7HE PURPOSE OF SAL�. .
� ❑4ASOWNEROFTHEPHOPEHfY.M1E%CLUSIVELVCONTRACTWOWRHLICENSEDCONTRACTORS
TO CONSTRUCT THE PRQIECT(SEC.70N,BUSINE59 AND PROFESSIONS CODE THE CONiRACTOR3 LI- V8IU8�10l1 A0.1.AREA
CENSE UW DOES NOT MPLV TO AN OWNER OF A PROPERTV WFq BUILDS OR IAIPROVES 7HEREON,AND
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� ❑1 AM E%EMPT UNDER SEC. � B.8 P.C.FOR THIS REASON
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� LICENSED CONTRACTORS DECLARATION . �
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1 HEREBY AFFlRM UNDER PEN�LTV OF PERJURV THAT I AM LICENSED UNDER PpOVISION3 OF CHAPTER
� Y(COAWENCWO WITM SEC7IDN 7000)OF OMSION 3 OF THE BUSINESS AND PFiOFE5510NS CODE,AND •Y � Y �•
�x� W IICENSE IS W FULL FORCE AND EFFEC7. /f �-�. _
� LICENSE SS LIC.NO. � L. ' f�0..1 .Q 1_L �u
U DATE CONTRACTO L r`� 117 r
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� WORKERS'COMPENSATION DECLARATION � � �
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N I HEREBY AFFIRM UNDER PENAL7Y OF PERIURV ONE OF THE FOLLOWWO DECLARA7/ONS: Z
� _I HAVE AND WILL MAINTAIN A CEHTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' � �
� COAIPENSA7qN,AS PROVIDED BV SECTION 3700 OF THE LABOR CODE,FOR THE PERFORMANCE U
Q OF THE WORK FOH WHICH THIS PERMIT IS ISSUED. - � � ,^ ^ , ^A w -
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� �I HAVE AND WILL MAINTAIN WORKERS'COMPENSA710N INSURANCE,AS RC-0UIRED BV SECTION � ' Q !"r N �a �
Q 370o OF THE LABOR CODE,FOR THE PERFORMANCE OF 7HE WORN FOR WHIGi THIS PEHA/R IS Vr
�SSUED.MV ER COMPEN ��jIN�SyJqµ/�'�CAR�R,IE^RA^NDPOLIC NUMBERME: CONSTRUCTION
� �/�i i��L�_Wr�' 1./� �✓I S. PLAN REVIEW
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0 POLICY NUMBER �l'J 9 I ��'fC/l
Z ELECTRIC
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� (nbSSEcfqNNE�Mo'iBE00MPl.Er�oF7FEaEaAffSFOpaNEHl�O(i�oallAs(S7oqoqLESS), PLUMBING
Z I CERTIFV THA7 IN THE PERFORMMICE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL � �
LJ' SH/LLL NOT EMPLOV M1V PERSON IN ANV MANNER 50 AS TO BECOME SUBJECT TO THE
(n WORKER5 COMPENSATION LAWS OF CALIFOqNIh NND AOREE THAT IF I SNOUID BECOME INSPECTION FEE
SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE IABOR „
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p DATE: - APPLICANT: �SMIP '
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'� WAANINO:FA0..URE 70 SEQIRE WORKERS'COMGENSATION COVERAQE IS UNUWRIL,AND SHALL BE ENERGY P/C
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�y SU&IECT AN EMPIOVER TO CRW WAL PEWLL.TIES AND CML FINES UP TOONE HUNDRED TFqUSAND ENERGY PERMIT
DOLURS(i100.000).IN ADDITION TO THE COST OF CpAFENSATION,DAMAOES AS PROVIDED FOR IN
J SECTION 3708 OF THE UBOR CODE,MTEREST,AND ATTORNEY'S FEES. �
ct RETENTION FEE: �
OCONSTRUCTION LENDING AGENCY � PRE-ALT FEE:
� I HEREBV AFFIRM UNDER PEN�LTV OF PERJURV THAT THERE IS A CONSTRUCTION LENDWO AOENCY
FOR THE PERFORMANCE OF hiE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3007,pV.C.).
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� LENDER'S NMIE �
F— LENDERSADORESS
¢ I CERTIFY THAT I HAVE READ THI$MPLICATqN AND STATE THAT THE ABOVE PIFORMATION IS CORRECT. TOTAL FE ES � ��
� I A6REE TO COMPLY WfTM/�LL CfTV AND COUNTY ORDINANCES AND STATE LAWS REU7INO TO BUp.DINO � i�
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTA71VE5 OF 7HI5 COUHTY TO ENTER UPON THE '
Z /�BOVE�AIENTqNED GROPEHTV fOR INSPEC7qN PURPQSES. COMMENTS �
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� RECPT.NO. PAID BY VALJDATION
WHITE—Depertment Copy,YELLOW�inence Copy,PINK—Asseasar Copy,GOLDENRO de Capy,GREEN—Appllcan s Copy
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ELECTRIC GROUND "' UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR COMDUIT
SLAB GRADE FIREPLACE FOUNDATION '
TEMP POWER FfREPLACE BOND BEAM
WATER SERVICE MID HT. BOND BEAM � '
ROOF SHEATHING 8 FT. BOND BEAM ' � ' . �
FRAMINGNENTILIATlON FlNAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING ODf,��� ?�2�-� BENCHING
. ROUGH ELECTRIC oN� ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC
EXT, LATWSIOING POOL FENCING
WALL INSULATION POOL FINAL
CEILfNG INSULATION OFF SITE IMPS.
DRYWALL fVAILING DEDICATtONS
SEWER FlNAL ENG.
SEPTIC TAfVK LANDSCAPE/IRRIG.
SEEP PIT/L.L. �, � - ON SITE IMPS.
GAS AIR TEST ' � FINAL ZONING
FINAL CONST. ' � ' FIRE DEPT. FINAL
FINAL HEATING — .�b•' ;•� HEALTH DEPT. FINAL
FINAL ELECTRIC '" DEV. FEES PAID
FINAL PLUPVIBING ENERGY
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