HomeMy WebLinkAbout13-01787_Redacted.pdf , f,- .'�"'�'`�+�_�_, C1TY OF DIAMOND BAR
� I ��I��I i ' I! DEPARTMENT OF COMMUNITY&D�VELOPMGNT SERVICES
rip��,�,� . 21810 Copley Drivc,Diamond 13ar,CA 9176� PRESS
� ' � , I
�+""�,. � (909)839-7020 Fax:(909)861-3117 Building Inspection Hotline(909)839-7027 FIRMLY
`'�"'%' BUILDING PERMI7'APPLICATION
� APPLICATION DATE:�D��� ' �� P/C# �
w JOBSITEADDRESS �a�� Cdtn o :CI.J
a ISSUE DATE: O I C� 1� PERMIT# G�w ' � �
z APN�I� ��'LOT TRACT
�-•
o OWNER O 'C� TYPE CONST. OCC GROUP:
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N ADDR SS � +� `n i
� CITY�7 Q� ZIP ��7 TEL. ZONING F ONTCKS RW ❑
a APPLICANT TEL. REAR ❑
�
� -` SIDE/SIDE STREET RW ❑
o CONTRACTOR �_l.a��'1��r� IO`��\C9�t°�� SIDE ❑
o� ADDRESS �
PROPOSED USE � O '(1-
� CITY ZIP TEL.
, o
a ARCH/ENG/DESIGNEF
� oADDRESS /
o �i DWEL.UNITS #STORIES #BEDROOMS
z CITY ZIP TEL.
m DESCRIPTION SQ.FL FACTOR PSF ADJ.AREANALUATION
Q OWNEfl-BUILUEfl DECLAAA710N
°C I hereby aflirm under penalty ot Derjury that I am exempt from the Contractor's State License Law for the reason(s) SFR/ADD/REM
0
p intlicated below by the checkmark(s�,I have placed nezt to the applicahle item�s)[Section 7031.5,Business and Garage/Carport
"� Protessions Code:Any city or caunty thal requires a permit to conslruct,alter,improve,demolish,or repair,any
0
iz structure,prior to its issuance,also requires the applicant for the permit to file a signed statement that he or she � Patio/Deck
a is licensed pursuant to ihe pravisions ol lhe Contractor's State License Law(Chapter9)Commencing with Section W
� 7000 af Division 3 of the Business antl Professions Code]or lhat he or she is exempt from licensure and the basis for � Pool/Spa
� the alleged exemption.Any violation oi Section 7031.5 by any applicant for a permit subjecis the apDlicant to a civil penalty C7 —
� of not more lhan five hunaretl dollars($500�. Q Re-Roof
o (,I,as owner o1 the property,or my employees with wages as their sole compensation,will do(_,)all 01 or(J porUons � Commercial
w of ihe work,and ihe shucture is notintended or ottered for sale(Section 7044,Business and Prufessions Code:The m
� ConVadors'State License Law does not apply to an owner of property who,through employees'or personal effort,builds
w or improves the properry,provided that ihe improvements are not intended or offered for sale.If however,the building or
� improvement is sold within one year of completion,the Owner-Builder will have the burden of proving that it was not Guilt '
por improved for the purpose of sale.�.
� I,as owner af the ro e
z (� p p Ay,am exclusivety conVactinq with licensed Contractors to conshuct the project(Section Valuation: Adj.Area:
7044,Business and Professions Code:The Contractors'State License Law does not apO�Y to an ovmer ol property who
� builds or improves thereon,and who contracts tor the projects with a licensetl Contractor pursuant to ihe Contractors'State QUANTITY DESCRIPTION FEE
Y License Law.).
p �}I.ym exempt from licensure under the ConVactor's State License law for lhe following reason(s): ¢
� ¢
LL By my signature below I acknowledge mat,except for my personal residence in which I must have resided for at least one w
o year prior to completion of the improvements covered by this permit,l cannot legally sell a sWcture that I have built as an w
a owner-builder if it has not been constructed in its entirety by licensed contractors.I understand that a copy of the applicable �
¢ law,Section 7044 of the Business and Professions Code is available upon request when this application is submitted or at
X the followi g Web site:http/vmw.leginto.ca.ov/calaw.htmi. �'
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� DATE: C7— ���SIGN:_��t9�✓��"` �
� LICENSED CONTRACTOR'S OECLARATION �
w I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9(commencing with Section 7000)
m of Division 3 ot the Business and Professions Code,and my license is in full force and effect. J
� ¢
N LICENSE CLASS: LIC.NO.: Q
o DATE: CONTRACTOR: _
a WORI(ER'S COMPENSATION DECLAHATION g
� I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: �4, s 3
oI have and will maintain a Certificate ot Consent to Self-Insure for Worker's Compensation,as provi0etl by CONSTRUCTION:
� Section 3700 of the Labor Code,for Ihe pertormance of the work for which this permit is issued. p�qN FEVIEW:
> I have and will maintain Worker's Compensalion Insurance,as required by Section 3700 of the Labor Code,for ELECTRIC:
� ihe peAormance ot lhe work for which ihis permit is issued.My Worker's Compensation Insurance Carrier and
a PoliqNumberare: PLUMBING:
� CARRIER MECHANICAL:
� POLICYNUMBER INSPECTION FEE:
� RHIS SECTION NEED NDT BE CAMPLEfED IF THE PERMR IS FOR ONE HUNDRED DOLLARS(3100)OR I.ESS).
� ISSUANCE: S♦
0 1 certify ihat in the De�ormance of ihe work(or which Ihis permit is issued,I shall not employ any person in any manner so as to O
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become subject to Ihe Worker's Compensation Laws of California.Md agree that if I should become subject ro the Worker's SM IP: •
J Compensalion provisions of Seclion 3700 of Ne tabor Code,I shall lorlhwifh cnmply wilh those provisioiu. ENERGY P/C:
LL onre: aaPLICnNT: ENERGY PERMIT:
� WARNING:Failure ro secure Workers Compensalion coverage is unlawlul,and shall subject an employer to criminal RETENTION FEE:
W penaltias and civil tines up to one hundred thousantl dollars(3100,000),in addition to the cost of the compensation,
n- damages as provided(or in section 3708 of Ne labor code,interest,and attomey's fees. PRE-ALT FEE: 1 ��
0
d CONSTRUCTION LENDING AGENCY BSAF: /
w I hereby affirm under penalry of perjury thal there is a Construction Lendin9 Agency(or Ihe pedormance of the work for
= which this permit is issued(Sec.3097,Civ.C.�.
� LENDER'S NAME:
� LENDER'SADORESS:.
a I certify ihat I have read this application and state that the above informalion is correct.I agree to comply with aIl city and TOTAL FEES
Z county ordinances antl siate laws relating to building construcfion,and liereby auihorize representatives of ihis county to COMMENTS:
p enter upon the above-mentioned property for inspectian purposes. �
J �� _
�
m
¢ PERMITTEE NAM (PMI
�
�
� SIGNATURE OF PERMITTEE DATE RECEIPT N�_ PAID BY: VALIDATION:
WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy
CI�'Y OF DiAMOND BAR " �
� tNSPECTIOfV .RECORD
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. m o , . A - • � � . • • -
SETBACK/LEITER � ,., ' %:`" ;x ;: , ': : :: TRACT AND LEDGER
FOOT.IN6S FORMS -- ;;_ - - SWITCH GEAR
r SLAB�'� '� COMMERCIAL HOOD �
UG.PLUMBING,...� - ,.�� T-BAR
UG.ELECTRICAL ! = - INTERCEPTER
UFER GROUND-�':'.. �' 1- -- HOT MOP/SHOWERPAN
_ .
SEWER LATERAL SEPTIC/CESSPOOL
MAIN WATER LINE ' HERS REPORT RECEIVED
SEWER CLEANOUT DEMOLITION
ROOF SHEATHING ROOF DRAINS
FLOOR SHEATHING ROUGH CONDUIT
SHEAfi WACLS,EXTERIOR:' , POOUSPA= =
SHEARWALLS INTERIDR' �� " . ROUGH PLUMBING ,''�, : _ _
FREiMINGNENTING ' ��'' RqUGH ELECTRICAL�,: . : � x:� -
ROUGH MECHANICAL �. -''i ROUGH MECHANICAL". � . ,; _ � � �s
-. GASTEST,,� -a � �:
ROUGH ELECTRICAL W(',)C('�) �;'�.� � - ,�:-:'y _ . " _ -
ROUGH PLUMBING � ''.' - .:,. ,, , . .: , ;;i ..' `::- ��:: . � REtE"GUNIFE. : « �`� _
INSULATION WALL ,POOL"P.RE<DECK BONDING <�: -Y =
INSULATION CEILING � P-=�P. ��, `����� '���' -
DRYWALL FENCE,/GATFJAtARM - , .;��
LATH(PRE) FINAL POOL- - _ - _
LATH EXTERIOR WAl.LS:
LATH INTERIOR WALL FOOTING/STEEL
GAS TEST WALL STEEL 1�T( )2N0( )LIFT
SCfiATCH COAT WALL BOND BEAM
ELECTRIC METER RELEASE WALL DRAIN/SEAL
GAS METER RELEASE WALL FINAL
SPECIAL INSPECTION R0.FRAMIN��PLANNINGAPPRQVAL ' ' "- ' `
FINAL'BUILDING. . "' ;�� - �,'�,� ;'B' � ROUGH FIREIIPPROVAL °
FINAL MECHANICAL: ;:: ` °.:` � ``�:. FINAL FIRE:DEPARTMENT ::, � '�: _
FINAL ELECTRICAL ' , . ,-' ,:. ; ;-" ,. . .: 'FINAL PLAPINING - -
FINAL PLUMBING ! FINAL ENGINEERING/PW '"- "'�� `' ' � ,�_ } � � , _
T.C.of OCCUFANCY `. ��- -� � �;.,,'= ���� �__� :_ ��'��� � �FINAL COMMUNITY,SERVICE$ _
CERT of OCCUPANCY_•;. _�;� FINAL HEALTH.DEPT.
- � � � � �� _�_ . .
�/���/ FINAL IN�USTRIAL,WASTE_:>' � � ` �
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COMMENTS: ��.��,��.., �,r. �.t�� Z� �t�t �
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�`.�.�-."4 . _ ;,. CITYOF;DIAMQNDBAK , . ,i' ,
; I � I I ' � ,`DEPARTMENT OF COMMUNITY&DEVELOPIVICNT SERVICES
�` � ; 21810 Copley Drivc,Diamond l3ar,cA 9i�hs . - RRESS
� (909)839-7020 Fax:(909)861-3117 Building lnspection Hotline(909)839-7027
` ��° ' ` FIRMLY
`'"B BUILDING PERMIT APPLICATION
i= _ .. . ,
� APPLICATION DATE: f O'� l P/C# ,
� 'JOB SITE ADDRESS � a. n ? /� ! {�
a ISSUE DATE: �'..,.7 FERMIT# I 3" V i � C>�
z. APN ` 'O . OT TI#ACT. -r
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'o OWNER�� s \�:(�t TYPE CONST OGC GROUP: .:
y ADDRESS. " .�'nl .a �� ., 1 .
CITY �'ZIP . TEL. ZONING ';SEfBACKS
, a . FBONT' . RW . p
� APPLICANT TEL: . REAR . . ❑
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N. : SIDE/SIDESTREET :. RW. ❑ .
: o CONTRACTOR �^�E..�J�+��rs'— V'S�..A .\�'�,�r. ' SIDE '
❑
o� �4DDRESS � `
o; CITY .,. Z{P: : , TEL. .: .' � .� �.;. ... r
PROPOSED USE '
. .� . � . . .. --.A
o ARCH/ENG/DESIGNER .. .
o ADDRESS � '
. N DWEL,UNITS #STORIES #BEDROOMS '
z .CITY ZIP ,'..,' . : TEL :, .'.. ` . .. , '
�. _ _ _
DESCRIPTION .;,. SQ.Ff: FACTOR PSF.� �. ADJ.AREANALUATION. '
. �� , . � .�. '�,-0HRIEH-BUfLDEA DECLAHATfON -. .. . .�. '.::� . .. .
¢� �' . ,. ,� . . . � : ... . : . , . , . . . : . � � �� SFR/ADD/REM � � � ' �
o' �tiereby anrrn under penalry ot perjury Ihat Y am eicempt from the,Conhac[a's State License law lor the reason(s}.
� p �indicated Oelow by the Checkma�k(s),I have placed�next to��the�applicable item(s):[Section 7031�5,�lness and . GaragPlCarport � .� - � � . . � ' - � � �
��Projessions Code:Any city ar.counry ihat iequires a�permlt to wnsUuct,altn,Improve,demollsh,or repair,`airy. � �
,, z structure,pdor to�fts Issuance,also.requires the epplicartt fm th0 peYmft.to file a signed afatemenl that he m she � � �Patio/Deck� � � � - , � . � � � , , � � .
a is Ilcensed pursuanf to the provislons o1 the Coohactor's Sqte lJcense Law(CAapter�COminencing with Sectlon. W
� N_ .-7000 of Oivisioo 3 01 the Buslness and Proles5ions Cade]or that he�a s�e,is exempt hom Iicensure and the basis Poi LL �Pool/Spa � - � . � � � � ' ��� . . �
- the'alleged exemption.Any violation o1.Section 7031.5 by any appficant fa a pertnit subjects Me applicardffi acivil percalty � . C7 �. � - � � . . . .
�, 01 not more than live huntlred doilars�(3500�.�',�.:;. : ..,..', �... ' ... .. � .. . . ZQ Re-Robt � . . � � .
. o� (�I,as owner of Ihe�property',or my employees with wages as iheir.sole compensation;wlll do(J all 01 or(]portions'. �� � Commercial .�� .� . � . . .� ' � ' .
. � �of tlie work,"and the shucture is.not Intended�a�alfered Mr sale�(Sectlon 7044,Buslness and RofessMre Code:The' m � _ - - , '
� :Contractors`State License Law does nbt a �^ �
ppry to an owner of property ivho,through employees'a personal ettort,builds
� or improves ihe property,provlded ihat the Improvemenfs ere notJritended o�ottered for saie.R however,the building or
lmprovement Is sold wlthln one year of compleUon,the Owner-Bullder will have the burdeo a1 proving mit R was not tiullt '
,
U or Improved fir the purpose of sale.). :' ,. , ` �'
' �(].I,as owner ol ihe�pmperty am exclusNely contracUng wlih Ilcensed.Contractors to construcl ffie proJect(SGction � �Valuation: �� Ad��Area �
� :7044,Business and ProtesstLns Codei The Corrtractars'�State License.Law dceS riot eppN.to an ovmer ol property jvho . � l� � �
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, ���� .buildsorlmpiovestherean,andwliocontractsiortheproJectswithallcem;ed.Contractoipursi��anttotl�eContracmrs'State ��,- .QUANTIIY� � � � � � , DESCRIPTION���� � � .� FEE���
� .Ucense.Law.): . . . . . ..:. , �.� .. . �
� �p (,J , � . ��licens�re�under the Contracttir's Stete License law for;the Mllowing,reason(s): � . '� . J��'� � - - �
I,am ezempt from
�. `� ..� ..� ,�.. .. � . . � � . __ . . .'.'. ., � ac . . . �� .. . , � � ,
LL' By my signature below I acknowledge that ezcept tor'my personal.Fesidence In which I must have resided}a at least one' - �� � � .. � - � � -
o', year prior to completlon of the Improvements covered by thls.permil,l cannot legalty setl a struiture ihat 1 have built as an W . . .. , . �
� ; .Q 'awner-builder il it has not been can3lructed In ils eMirely by Iice�rsed ca�hactors:I'understand lhala copjl of tl�e applicable. � � � ' �� -� �� �
� �taw,Sectlon 7044 ot the Business and�Professlons Code is available upon�request when.this applirzden Is submHled or a4 - � . � ' �-� � � . � � . �
X Ne following Web site:httphvww.leginfo.ca.govlcalaw.htmL .... '" � _ ". '.
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' o ,DATE: 'i � SIGN: ~ .... �.�_�,. > : �
~ '.LICENSED.CONTRACTDN'S DECLAMTION � '
I . w I hereby.aKrm�under penalty of perjury thal I am licensed under prwisiorrs of�Chapter.9(commehcing with Section 7(100) � � � � . - � . ��� . �
�m. ol Divlsion 3 of tfie Business and RMessions Code,and my license Is in tull7orie and�effect. � � � � J - � . _ . .
� I]CENSE CtA$S: : UC NO.: � ..
a .
:o� DATE:..� '.� ' ...��. C NTRACT R: � -. .- .� ' . . . -..` . . . .
��.. " ..'� � �:, -
0 0 x
Z W .
�I ,. ¢ .�- �..� ,' . .;� �." ;.�.. WORKER'S�COMPENSIUIONOEClAflA710N ,�. � ' g �" .. . � . . . . .
� I HEREBYAFFIHM UNDER PENAITY OF PERJURY ONE OF THE FOLLOWING DECLNiATIONS ��. �` � -�� � �� � � . . . �'� � �,
...o :, ' I have�and will malntain a CertAirate.ol Consent lo Self-tnsure.for Workers Compensauon,as prowdetl by�. � CONSTRUCTION-� � � 1,.���� 'j'� .
� �. � Seclion 3700 ot the'Labor Code.lor IAe peAormanie of ihe work to'r which this permR�is issued. ��� p�qN REVIEW: ' � ' � � �
I a
�' a�. I have and will maintain Worker's Compensatlon Insurance,as iequired by Section 37p(1 M ll�e Labor Code,lor� � � � � � . . . � � , � .. . � �
z the perlormance of ihe work tor whicfi fhis perinR fs issued.My Worker's Compensation huurance Camer and �L�CTRIC:
a Po�i�yNumberaie: : . : ' .- . PLUMBING:
_
. ;,
z' ,. CaneiER NE PNCN'CA�
� . POLICY NUMBER . `'
S E T ON. EE
� (fF11S SECTION NEED NOT BE COMPI.ETED IF.7}IE PQ1MR IS FOR ONE MlNDflED DOIlARS j510U�OR L 6Sj • � ��_•1
• �. . . '. ; ISSUANCE '. f�
� 0 1 ceniry.that in the pertamance of the work lor which Ihis permit Is issued,I shall not empby arry person in any manirer so as to` � � - � . ... . .
' � ,o �,became'sub�ed to�the Waker�Comperisatlon Law3�o1�Caldomia:MU�agree that II I shuultl tiecome suqec[in.tl�0 Waker's SM1P: ' � �'�n �.
w�' Compensatiai prwislu�s ot Section 3700 0l the laha Code,I sliall lathwilh compry wi11i those P�s.: .:. .'' .. . �EN ERGY'P/C:. :�' ��- � . -. .. � .. . � . - �.
� �' LL _DATE.� ". .� � ._.'..: �APPIICANT: � �..�.� .� :� - ,�'. . . . . . �. . . : . .. .
ENERGY PERMIT
`���-� 'WARNING FaiWre to secure Worker's Compensation coverAge:Is unlavRul,and shall sW�ecl��ah employer to aiminal �' ' � � ���'�� � � . � � - ' �
,: �- REfENTION FEE._
���w penaRles and chril tines�up to ane hund2d thousand dollars(5100,000);�In�addition to�.the�cost u(ihe�comperrsatlon, � � . n
o damages�asprovitled ta in secuon 3708 o1�Ne la6or cade�iiiteies4,and attomey's fees. . � � .PRE-ALT FEE:� . � ' � � �.:�� �'S,�}v` •�
a .. , CONSTRUCTION LENDING A6ENCY BSAF:
= I hereby affirm untler penalty of perJury thal there is a Construction Lending Ageriay tor Ihe perlomiance 6f the viorkYm,
.which ihis permit Is issuetl(Sec:3097,Civ C)�. .��' .� .; '� - ��� � � � � � - � � � .
. � ' � '�� � �.. , . .. � - . . . . " .. � . � .
. . . � ..., . � .. . ,.� . '� �' . . � -
� LENDER'S NAME: . '..
�
— -
' ..
-
'�.�� LENDER'S ADDRESS:��. ' ' �
� a .1 certity that I hav¢read Mls aDD�icatiodand state tliat the above fnfirmaUon Is cortect.I ag�ee to compry.wiUi�eA ciry.and-� � �TOTAL FEES � � � �� . . � �� , � . � � � �
�counry ordinances and sfate laws relafing fo 6tiilding constrticdon;end heteby;eulhodze represenktives cf tAis crounry to-
. z COMMENTSi
.� p �.enter upon ihe above-menlioned property for inspedion purposes, ;��� � • � � ' � - � � . � . . . , �
. � �---"""..-�.rn . � . . � . .
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'a � PERMIiTEE N/�ME7PRINn � . . � � � . .. �
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, � �� , �.'.I '. . , . �. ��, .,�.:�. . .� �..�. ,
= SIGNATUREAF PERM(fTEE �ATE • RECEIPT q PAID BY. ' 'VALIDATION:
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WHITE'—Department Copy,YELLOW :Finance Copy,PINK-Assessor Copy,GOLDENF70D File Copy;GREEN Applicent s Copy .
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