HomeMy WebLinkAbout15102CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
21660 E. Copley Drive Suite 190 '
(909) 860-3195 Fax (909) 861-3117
BUILDING PERMIT APPLICATION
JOBSITE
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APN LOTS_ TR CT
OWNER i9y L ( '-I , -z—
ADDRESS Skrl -e
CITY ZIP TEL.
APPLICANT TEL
CONTRACTOR
ADDRESS�
CITY Ka rf"4ZIP TEL =
ARCWE G/
DESIGNER -
ADDRESS AJaPun
CITY r ZIP TEL ` y
OWNER -BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE ODNTRACTORS LI-
CENSE LAW FOR THE FOLLOWING REASON (SEC.7031.6 BUSINESS AND PROFESSIONS CODE ANY Cm OR
COUNTY WTBCH REGUIRESA PERI ITTO CONSTRUCT.ALTER IMPROVE, DEMOLISH, OR REPNRANY STRUC.
TURE. PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI-
CENSE LAW (CHAPTER I tCOIMMENCNO WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESSAND PRO-
FESSIONS CODE) OR THAT HE OR SME IS EXEMPTTHEREFRDM ANDTHE BASIS FOR THE ALLEGED EXEMP-
TION. ANY VICLATION OF SECTION 7071.6 BY ANY APPLICANT FORA PERMIT SUBJECTS THE APPLICANT TO
A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLWGS (115W)*
0 LAS OWNER OF THE PiOPERTY,OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION,
WILL
00 THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, 8US1-
NESSAND PROFESSI ONS COOS THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF
PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
THROUGH HS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE MOT INTENDED OR
COMPLOFFERED FOR STILE IF, HOWEVERTHE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONEYEAROF
E—TION. THE OWNER40LDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SNE DO NOT BUILD OR
IMPROVE FOR THE PURPOSE OF SALE}
O L AS OWNER OF THE PROPERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS
TO CONSTRUCT THE PROJECT (SEC. 7044. BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS U.
CENSE LAW DOES NOTAPPLY TO AN OWNER OF A PROPERTY WHO BOLOS OR NPRDVES THEREON, AND
WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTOR(S) LICENSED PURSUANT TO THE CONTIG
TORS LICENSE LAW),
01 AM EXEMPT TINDER SEC 8. L PC. FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
1 MEF"YAFFIRIJI UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER
•ENC'INO WITH SECTON TOW) OF DMSION ] OF THE BUSINESSAND PROFESSIONS CODE, AND
LICENSE 6 N FULL FORCE AND EFFECT,
LIC SECLAS LIC.NO. IgIII
" ^ _ COMPACTOR �-
WORKERS' COMPENSATION DECLARATION
. I HEREBYAFFIOM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
I NAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS'
COMPENSATION. AS PROVIDED BY SECTION 3700OF THE LABOR COOS, FOR THE PERFORMANCE
tl.IFTIIE WORK FORWMICH THIS PERMIT IS ISSUED.
VE AFD WILL MAILMAN WORKERS' COMPENSATION INSURANCE. AS REQUIRED BY SECTION
OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ED. MY WORKERS'COMMPETNSATION INSURANCE CARRIER AND POLICY NUMBER ARE:
RIEICYMJMBER ' gl
V
(THS SECTIONN®NOTSE CMF L17M OF TIE PEIM.ITISPOP ONE FLM,ER EDDCUL&I'S t$100) On LES.%
1 CERTIFYTHAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.1
SHALL NOT EMPLOY ANY PERSON N ANY MANNER SO AS TO BECOME SUBJECT TO THE
WORKERS'COMPENSATION LAWS OF CALIFORNIA. AND AGREE THAT IF I SHOULD BE E '-
SULIECTTOTHEWORKERS'COMPENSATIONP SIONSOF CTIDN ]7000$ H R
COODE. I SHALL FORTHWITH COMPLY W! Pt
IKON
GATE: 4= (,— PPI ICAM: 11-2
WARNING: FAILURE TO SECURE WORKERSCOMPENSATION COVERAGE IS UNLAWFUL. AND SHALL BE
SU SJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000), N ADDITIONTO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
CONSTRUCTION LENDING AGENCY
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC 7097, CIV. C.).
LENDERS NAME
LENDER'S ADDRESS
1 CERTIFY THAT 1 HAVE READ THIS APPLICATION AND STATE THAI ME ABOVE INFORMATION IS CORRECT.
1 AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
ABDVE#MENTONE PIOPERIFNSPECT,1 s'
!fv I
PERMIT E (PRINT) .� % ` CV
SIGN UI F•MTTEE .�. DATE
EXPIRED
JUN 18 M PRESS
FIRMLY
APPLICATIONf' „ / n PERMIT P/C
V D
DATE `7✓ NUMBER
ISSUE TYPE OCC
DATE �1 �^ a CONST. GROUP
ZONING SETBACKS
FRONT RW ❑
REAR ❑ -
SIDE! SIDE RW ❑
SIDE ❑
PROPOSED USE i r✓ �S 1
n 7 /
NO. DWEL. NO. / NO.
UNITS STORIES BEDROOMS
DESCRIPTION SO. FT. FACTOR PSF ADJ. ARE"ALUATION
SFR/ADD/REM
Garage/Carport
WPatio/Dock
LL
Pool/Spa
C7
Z
Re -Roof
0
Commercial -
m
ValUallon S ADJ.AREA
QUANTITY DESCRIPTION FEE
Q
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U
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0
2
QL
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U
4
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WLV
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CONSTRUCTION �
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE '
ISSUANCE P !J
SMIP
ENERGY P/C
ENERGY PERMIT
RETENTION FEE: [7
PPF—ALT F
TOTAL FEES
COMMENTS '
RECPT. NO. PAID BY VALIDATION
WHITE --Department Copy. YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD—File Copy, GREEN—Applicant's Copy
qt.
i = CITY OF DIAMOND .BAR
I.. INSPECTI0NiRECORD
- ,
�. �. ,FLOOR JOIST i i
7FTGSFO/STEEL,
l - FHA REQMTS ?
OUND--'•`::.-', . ____
UNDER FLOOR DUCT i
+GROUND PLUMBING
UNDER FLOOR CONDUIT
!SLAB GRADE -- - - '' - - - -
FIREPLACE FOUNDATION
ITEMP POWER -
FIREPLACE BOND BEAM
(WATER SERVICE - --
- MID HT. BOND BEAM
ROOFSHEATHItJ(,'.`ti�, `1-. ,:, ,�
'• 8FT:.BOND.BEAM
IFRAMING/VENTILIATION �' % '=�� �'''�
' `' • FINA00dO D BEAM-
iROOFCOVI'R ". _ - - r • PRE -GRADING
ROUGH HEATING ---
_ . _ .. __. BENCHING.
(ROUGH ELECTRIC
_ i - __ ROUGH GRADING
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.
'SEPTIC TANK
LANDSCAPE/IRRIG.
SEEP PIT/L.L.
- '''; ON SITE IMPS.
GAS AIR TEST
FINAL ZONING
FINAL CONST _ -_ ._ _. _
FIRE DEPT. FINAL - •
,FINAL HEATING
_ HEALTH DEPT. FINAL -
FINAL ELECTRIC ___._. _ ._ __ _.._-- _-
_ _ __ DEV. FEES PAID
FINAL PLUMBING
ENERGYT.
•COMMEN S -- -" - - -
-
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Z4 Z_6
1 ,
SEPTIC TANK SIZE
SEEP PIT/U SIZE
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