HomeMy WebLinkAbout18929 I
. I '
� CITY OF DIAMOND BAR � �
`�- ���` �-�-� DEPARTME?�1T OF COIvA�IUNI"IY&DEVELOPIvIENT SERVICES
1 - �
�. 21825 E.Copley Drive
_ (909)860-3195 Fax(909)861-3117 PRESS
� "`%���' BUILDING PERMIT APPLICATION FIRMLY
QJOBSITE y�4jZ p�� �/�l/_L/��l�L, �� DATE CATION ' NUMB R��� k/C
Q ADDRESS J /�L(Po1[ �•-fC
� ISSUE . TYPE OCC
APN LOT TRACT _ DATE CONST. GROUP
°C OWNER
O
" ADDRESS ZONING SETBACKS
OCITY ZIP TEL. FRONT RW ❑
APPLICANT TEL. REAR ❑
� SIDFJSIDE STREET RW ❑
z
a CONTRACTOR vf SIDE ❑
i
o CDDRESS��`��� ` ZIP ' TE J PROPOSED USE \ '
w ARCH/EN�
iz DESIGNER NO.DWEL. NO. NO.
a ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TFL. �
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUtLDER DECLARATION SFR/ADD/REM
O
� I HEREBV AFFIRM UNDER PENPLTV OF PE0.IURV THAT I AM EXEMP7 FHOM THE CONTRACTORS LI� � Garage/Carport
W CENSEUWFORTHEFOLLOWINGREASON(SEC.7031.5BUSINESSANDPFOFESSIONSCODE:ANVCITVOR
U COUNTVNTiICHREOUIRESAPERMITTOCONSTRUCT,ALTER,IMpROVE,DEMOLISH,ORREPAIRANV.TRUC� W P8i10/DBCk
Z TURE.PRIOR TO ITS ISSUANCE.ALSO REOUIFES THE APCLICANT FOR SUCH PERMIT TO FILE A SIGNED w �
� STATEMENT 7HAT HE OR SHE IS LICENSED PURSUAN7 TO THE PROVISIONS OF 7HE CONTRACTORS LI� � �,
� CENSE LAW(CHAPTER B(COMMENCING WITH SECTION 7000)OF DIVISION 3(1F THE BUSINE55 AND PRO- � PooVSpa
FESSIONSCADE)ORTHATHEORSHEISE%EMPTTHEREFROMAND7HEBASISFORTHEALIEGEDE%EMP� (�
� TION.ANVVIOUTIONOFSECTION7031.SBYANYAPPLICANiFORAPERMITSUBJEC�STHEAPPLICANTTO Z Re•Roof � ,
� A CIVIL GENALTV OF NOT MORE THAN FIVE HUNDRED DOLLARS(f5ao).�: ' ,
ZOI.ASOWNEROF7HEPROPERtt,ORMYEMGLOVEESWITHWAGESA5IHEIR50LECOMPENSATiON, � COmrtIBfCi81
WILL DO iHE WORK,AND THE STRUCTURE IS NOT INTEND[D OR OFFERED FOR SALE(SECJO��.BUSI� J '�
NESS AND PHOFESSIONS CODE:THE CONTRACTORS LICENSE LAW DO'c5 NO�APPIV TO qN OWNER OF
� PROPERT/NR10 BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OP �
CC THROUGH HIS OR HER OWN EMPLOYEES,PROVIDED THAT SUCH IMPROVEMEN75 ARE NOT INTENDED OR m
w OFFEHEDFORS�LEIF,HOWEVER,THEBUILDINGORIMPROVEMEN7ISSOLDWI7HINONEVEAROFCOMPLE-
� TION,THE OWNER-BUILDER WILL HAVE THE BUR�EN OF PROVING'HAT HE OR SHE DIO NO7 BUILD OR —
� IMPROVE FOR THE PURPoSE OF SALE). _ �� �"
w ❑I,AS OWNER OF THE PROPEFiTV,AM E%CLUSIVELV CONTRACTING WITH LICENSED CONTRAC70RS
� TO CONSTRUCT THE PROJEC7(SEC.7aa,BUSINESS AND PROFESSIONS CODE:7HE CONTRAC70R5 L6 VeWOtlOf1 ADJ.AREA
W CENSEUWDOESNOTAPPLVTOANOWNEROFAPROPEF7VWHOaUII.D50RIMPROVES7HEREON,AND
� WHOCONTRACTSFORSUCHPR0.IECTSWITHACONTRAC70R(5)I.ICENSEDPURSUANTTOTHECONTRAC� QUANTITY DESCRIPTION FEE
Y TORS LICENSE LAW.).
� ❑1 AM EXEMPT UNOER SFC. B.8 P.C.FOR THIS REASON � Q
� — U . I
� �
DATE OWNER U
Z W
� UCENSED CONTRACTORS DECLARATION w
� I HEREBYAFFIRM UNDER PENALTV OF PERJUPY THAT I AM LICENSED UNDER PROViSIONS OF CHAPTER �
� Y(CAMMENCING WITH SECTION 7000)OF DIVISION 7 OF THE BUSINESS AND PP.OFESSiONS CODE,AND Z , -�
�X AIV LICENSE IS IN PULI FORCE AND EFFEC7. m �
� • �i..� �
� IICENSE CLASS LIC.NO.� � � '
J
U DATE � � CONTRACTOR d
W
� WORKERS'COMPENSATION DEC ARATION Q
= U
N I HEREBV AFFIRM UNDER 7ENAL�OF PERIUFV ONE OF THE FOLLOWING DECLARATIONS:
(/) Q
� IMAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF�INSUREFORWORKERS' _
CAMPENSATION,AS PROVIDED BY SECTION 37000FTHE UBOR CODE,FOR THE PERFORMANCE U _.
¢ OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. � �
0
w _I HAVE AND WILL MAINTAIN WORKERS'CAMPENSATION INSURANCE,AS REOUIRED BV SECTION
Q 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PEHMIT IS
ISSUED.MY WORKERS'CAMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION �
� CARRIEfl �� PLAN REVIEW �
ZPOLICY NUMBER ELECTRIC � i
Q
p (iHISSECf10NNEmNOT0E00MREfEDOFTHEPERMfTISFORONEHUI�DREDDOl1A0.5(T100)OFiLE55). PLUMBING
w MECHANICAL
Z I CERTIFV TMAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMR IS ISSUED,I
�} SHALL NOT EMPLOV ANV PERSON IN ANY MANNER 50 AS TO BECOME SUBJE�T TO THE
� WORNERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOUID BECOME INS?ECTION FEE
'� SU&IECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 0F THE UBOR �
CADE,I SH FORTHWIFM COMPLV WITH THOS VISION ISSUANCE �
I
O DATE:__��.dPPLICANT: � r SMIP ' r'�.
wWARNING:FAILURE TO SECURE WORKERS'COMP SATION COVERAG� UNLAWFUL,AND SHALL BE ENERGY P/C '�
� SUBJECTAN EMPLOVERTO CRIMINAL PENALTIES ND CIVIL FINES UP TOONE HUNDRED THOUSAND ENERGY PERMIT �
OOLLARS(f7oo,o00),IN ADDITION 70 7HE COST F COMPENSATION,DAMAGES AS PROVIDED FOR IN
J SECTION370BOFTHELABORCODE.INTEREST,ANDATTORNEV'SFEES. RETENTIONFEE: �
Q
� CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� 1 HEREBVAFFIRM UNDER PENALTV OF PERIURV THATTHERE IS ACONSTRUCTION IENDING AGENCV
n- FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.7097,CIV.C.).
Z
W
� LENDEH'S NAME
F_ LENDER'SADDRESS ^
� I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE TFIAT THE ABOVE INFORMATION IS CORRECT. TOTAL FEES // �I�O
� I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO AUILDING � �� ' _
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPUN THE �
Z ABOVE-MENTIONED PROPERTY FOR INSPEC710N PURPOSES. CQ�y�/� N�
� Y - �
� /r
QPERMITTEE NAME(P{iINT) ' �I � 1
u� c7 I% �
� SIGNATUFiE OF PERM E � DATE
= RECPT.NO. _ PAID BY VALIDATION
~ ' WHITE—Department Copy.YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—ApplicanYs Copy
CC�'�'' �I� ��,������ �3�F�
� 8�3��°°�����"��DP� ��Gt)�� � � .
,�
.. _
o.
] D O L �^�.� p O - ,.� .D' ���' D` O o 'Y�
" � '���`..� � � .� �- _ .� . z�. a '�a
SET BRGK j � � . . � � ; , FLGOR J�IST ' � i� � �
_.__.__. ___._.....__ ._ __ _:. - ---------_..... _ �_. ___—_..... __._._�� _.---.-- --.____
FTGS/F�RMS/STEEL i . -- (---. . _
I-FNF� �3CQMl"S
------. - -- - - ___.___� --- _.. ____._. _---- � __--
—._ -,—
ELECTRIC GROUND � � UNDcf� F�OQR D11C1 __
--- , - ---- - � ---- - - -
_._
GR(�UND t'LUMBING � � UND�9 �LOOR C.U��DUIT i ___ _
- --- - - - - -- -- ----
SLAD GRADE __ ` ..._._� ...__.._.�___ i ..FIf�F�LPCE_r(3Uf�DATiON
.._ _— — -
, —____,..
TEMP POWER ----- __ ' --.....__ l �IREP�ACE f3CaP�ID BEAM
_--- ---... --- --- __.__._.._� �--- _..---.__
WATER SERVICE_ I i _.__.__._ ' I_P�IIQ HT. BOND E3EAM i
_. - - --+ --- ----=
_- -----
ROOF SHEATHING " � _+ t 8 FT. BQND BEAM �
- ---- - --+-- - -
FRAM{NGNENTIlIt1T'ION lot,^I� �f�i i ` FltvAl E30ND BFAM
- ---------- --- -- --- -- __ ------
__ . ___
ROOF CQVER __ �----• _ � PRE-t� RAJING `
— "—'__ ______. ..—��__—_"....._ .._'_ __ . .___._—����_
ROUGH HEATING , BENC;NING �
-- --..---- ---- ' - ---
ROUGH ELECTflIC � R�UGH GRADING �
— -- --y----- ---_._....__.�. -----.........- ----....----------�--
_'_�'_"'_'""'
RnUGH PLUMBING i I FINISrI uRADING I
�--------------— --._.��:__ _._.� , ---- -- _ _.�__._�.
�---._.._.�__ �.----... _.._._...
SHOWER(?UBTES'1" ; POOi ELEGTRIC '
--- - --- -�----•--- ---*1- - .._----- _--- — __, ----------
EXT. l�`,TH/SIDING j i POOL FENCING ;
----- -------..
--r-�-----_._._- ----
WALL INSULATION � POOL FiNAL '
- --- ----- - -- ----
---- --
CEILINu IN�ULATION � ' OFF S{TC IMPS �
- -------- -.}___ __ �._ � �.�_ -----_�_____ �_ ._ __
--_.�_�--
S�NI�R �� i C)EDiCATIC)NS `
DRYWALL NAILING '
--_..---- -- -----I-- ----- --- -- --- -------- --- ---�
I ' FINAL ENG_ �__
.__". __"_ _ _._.�.__.__y' . .
SEP'fIC TAfVK � �( LANDSCAPE/Ir�RIG. �
-- - ---- -- - -._ --- - - -
_
SEEP E'Ii7L.l_. I � ON Si E IMPS i �
•--•------ ----- ------.._._ ....____—__._..___.-1- --- ......_.. . .�.� _.._... ._-- --�------�----
. ..... ------
GAS AiR TFST � ; i�t 1�NINC � �
----- — — --- - ---- ------
----------
FIUAL CORST. I �] I FIRE dE�T. FINAL r
_ ���"���/-/-� -�--------<.t--------- ----
-------
FINAL HEATING � ; � HEALTH DE�"f. FWAI ' �
--- - ------! __-- - .___
- -- ---- -
F1NR�ELECT�iIC I � I DF_V. t-EES PAlD
�_.-._-�__..-------- —_ __� ..--------_.__.� :. , _ _ _� _ _._. _- ---_ _. _____
f=1i�Ai.PLUMBING � � I ENEt�GY �
�
_ -- ---- ----- ...._..-- ---___.._�._ ---------(
�-- ^-�- - - I --- --.
_ _. ----�--- ---- - � � O �� t - - -_..__. . __
� I
� t�U�.�i��i�NTS -- _—__ ----.-----___— ----- ----
i
— ___----- �
� -- ------------------
.�
SEPTE�TP.lJK SIZE �
SEEP PIT/U SIZE ----- ----- ------ -------- ----
, , :
� - _----
___---. _
� � - � r. -.— .
... �� , .. 1, a..
o :
: o
�`'r,,rn/ r. '
VV � �
., � .
, ,. � ,,.. ' __`_____'__._.........________�___..._._._ _._._'__'_—_'___.
:` �� c
S a . . 1
.� hx, .. � 4 �� , o
� `' �. ,. ��_'_..�.� ___"�__"_�_ __""_"'_ _'__'__ '._....�._.—, ��_
a4n' ,
��
A �:
,xq :.2C � ____— "
g o ,,