HomeMy WebLinkAbout15150�
��► � � CITY OF DIAMOND BAR �XP��ED
DEPARTMENT OF COMIvI[JNITY&DEVELOPMENT SERVICES
_ w 21660 E.Copley Drive Suite 190 MAY O 9 Z003
' (909)860-3195 Fex(909)861-3117 , . PRE$$
�4'^�' BUILDING PERMIT APPLICATION. FIRMLY
� JOBSITE p APPLICATION � PERMIT �I /j P/�� (q
o ADDRESS � e DATE NUMBER V # �
c� ISSUE � TYPE OCC
APN LOT TRACT DATE CONST. GROUP
°C OWNER � �
� ADDRESS n� ZONING S ACKS
Z CITY �� ZIP TEL. FRONT RW ❑
g APPLICANT TEL. REAR ❑
� , SIDE/SIDE STREET RW O
CONTRACTOR /.;1 I i �.��� SIDE ❑
g ADDRESS �'�°
CITY ZIP TEL. PROPOSED USE
� AR � M���� �
DESI ER��OarvQ T-ISC�L�- NO.DWEL. NO. r7 NO.
N ADDRESS UNITS STORIES / BEDROOMS
� CITY ZIP TEL.
�
v� DESCRIPTION SQ FACTOR PSF ADJ.AREA/VALUATION
Q OWNER-BUILDER DECLAFlATION SF DD EM
O
� I HEREBV AFFlRM UNDEH PENALTV OF PERAIRY 7HAT I AM FJ(EMPT FROM 7HE CON7RACTORS LF Gerage/Carport
CEHSEUWFOflTHEFOLLOWINOREASON(SEC.7031.6BUSPIESSANDPROFESSIONSOOOE:MIYCITYOR (n
COUNTVNMIp1RE0UIRESAPERMRTOCANSTRUCT,ALTER,WPROVE,DEMOIISH,ORREVAIRANV57AUG W PefIO/D6CK
TURE,PRqq TO RS ISSUANCE,AL50 REOUIRES 7HE APPLICAN7 FOR SUCH PERMIT TO FILE A SIQNED W
� STATEMENT THAT HE OR SHE IS LICENSE�PURSUANT 70 7HE PROVISIONS OF THE CONTRACTORS U- �
� CEN9E LAW(pUPTER Y(COMMENCWO WfTH SEC�ION 7000)OF DMSION 3 OF THE&151NESS AND PRO- PooUSpe
FESSIONSCOD�ORTHATHEORSHEISE%EMPTTHEREFROMAND7HEBASISFORhiEALLEOEDEXEMP- (�
TIOH.AHYVIOLATqNOFSECT10N7o31.6BYANVMPLICANTFORAPERMITSU&IECTSTHEAPPLIGNiTO Z Re-Roof
� AGVIL PEN/�LTV OF NOT MORE THMI FNE HUNDRED DOILARS(f5o0)J:
� ❑I,ASOWNEHOFTHEPROPERT/,ORMVEMPLOYEESWITHWAGiESASTMEIRSOLECOMPENSATqN, � COmm9fCi81 . �
WILL DO THE WORK AND THE STRUCTURE IS NOT IMENDED OR OFFERED FOR SIiLE(SEC.7a4,BUSI- J
� NFSS IND PROFESSIONS CODE:THE COHiMCTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF �
. PROPENT'/WFIOBUpDSORIYPROVESTHEREON,MIDWHODOESSUp/WOFKHIMSELFORHERSELFOR
Q 7NROUGH HIS OR HER ONT1 EMPLOYEE9,PROVIDm THAT SUCM IMPROVEMENTS ARE NOT INTENDED OR m
� ,OFFEREDFlORS�LEIF,HOWEVEq7HEBURDWOORIMPROVEM@lTISSOLDWfTHWONEVF�IROFCOMPIE-
Z 'TION,THE OWNER-BUILDER WILL MAVE TME BURUEN OF PROVWO iHAT HE OR SHE DID NOT BUILD OR
� WPROVE FOR THE PURPOSE OF SAL�. "1L1
W ❑4�.40WNEROFTHEPROPEHfY,AMD(CLUSNELYCONTMCTINOWITHLICENSEDCONTMCTORS
� TO CONSTRUCT THE Pqo,1EC7(SEC.7oa�,BUSINE55 AND PROFESSIONS COOE 7HE CONTMCLORS ll- VelUOti � ADJ.AREA
W CENgE UW DOES NOTAPPLV 70AN ONNER OFA VROPEF�'WFIO BUiDS OR IMPROVE9 T1ERC-0N,AND
� WIIOCONTMCTSf-0RSUCNVROJECTSWfTHACOMRACTOR�S)LICENSEDPURSUANTTOTHECONTRAG QUANTITY ESCRIPTI FEE �
� TORS UCENSE Uw.).
❑I AM E%EMPT UIDER SEC. B.a P.C.FOR THIS REASON � J '
3 ¢
DA7E OWNER U
Z W
� LICENSED CONTRACTORS DECLARATION �
` W
a 1 HF6�EBV AFFIRM UNDER PENALTY OF PERRIRV iHAT I MI LICENSED UNDER PROVISIONS OF CHAPTER �
� 7(�JMAIENCWO N7TH SECTION 7000)OF DMSION 9 OF THE BUSINESS NID PROFESSIONS COOE,AND Z
��� MY LtCENSE IS W FULL FORCE AND EFFECT. m
� LICENSE CUSS LIC.NO. j
U DATE, CONTHACTOR d
LL
� WORKERS'COMPENSATION DECLAFATION �
,� I HEREBY AFFIRM UNDER PENALTY OF PERIURV ONE OF 7HE FOLLOWINO DECLAMT10N5: Z
� _IHAVEANDWILLMAINTAINACERfIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' a � ' ,
S
COAIPEHSATION,AS PROVIDED BV SECTION J700 OF TNE LABOR CODE,FOR THE PERFORMANCE w
Q OF THE WORK FOR WHlq/THIS PERMIT IS ISSUED. � � � '
Q _1 HAVE AND WILL MNMAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION D X
37000F iHE LABOR CODE,FOR 7HE PERFORMANCE OF THE WORK FOR NT11CH 7HIS PERMIT IS ' 2
ISSUm.MY WORKERS'COMPENSATION INSURANCE CARNIER AND POLICV NUMBER AflE: CONSTRUCTION Jj� /
jawwEA � PLAN REVIEW � �
o aoucr Hu►�aea
ELECTRIC
� s[cna+rl�NoreEoo�.w�Er�oFn�PEaMiswaonEM�DR�Dotinas(fiao)oaLEss} PLUMBING
Z �CERTIFI'TUT W THE PERFOHMANCE OF 7HE WORK FOR WHICH THIS PERMR IS ISSUED.I MECHANICAL
C•J SHALL NOT EMPLOY ANV PERSON IN M7Y MANNER 50 AS TO BECOME SU&IECT TO7HE �U� '� }
(/� RKERS'CAMPENSATION UWS OF CALIFORNI/�AND AOREE THAT IF I SHOULD BECOME INSPECT�ON FEE ,I 1����I �I I/
S SUBJECT TO THE WORKERS'COMPENSATION PPOVISIONS OF SECiION 37000F THE LABO
COOE.ISHALLFORTHWITHCOMPLVWInyg�osEraovisroru . ISSUANCE
� `+t SMIP . � �:- �il(���
DATE: CI� APPLICANT: (/��J
WWARNINO:FAILUfiE TO SECURE WORKERS'COMPENSATION COVERAOE IS UNUWFUL,M!D SHI1.L BE ENERGY P/C / � ���� � � � ��f�� _
� Sl1BJECTANEMPLOVERTOCRIMWALPENAL7IESANDCIVILFINESUPTOONEHUNDREDT1i0USAND ENERGYPERMIT �'f°P'�7�?I�i�'�JTF}'�I�YSU'5���-�' � �
DOWViS(iloo.000).IN/�DDITION TO hiE COST OF COtdPEN5AT10N,DAMADES AS PROVIDEO FOF IN�� � �
¢ SECTpN 3708 OF THE LABOR CODE.MlTEREST,ANO ATTORNEY'S FEES. ' � RETENTION FEE: ^i',4+.^f ',i1,Y5AT� .C�s1�,!e/�d+J��1-S'�
d CONSTRUCTION LENDING AGENCY PR •ALT FEE• �; �a���
�O vQ ?
I HEREBV AFFlRM UNOER PENALTV OF PERIURV THAT THEHE IS A CONSTRUCTION LENDINO AQENCV � • � .
FOR TME PERFORMMICE OF THE WORK FOR WHlCH TMIS PERMIT IS ISSUED(SEC.3oY7,CIV.CJ. .
Z .
W
� LENDERS NAME ' . � ,
H LENDER'SADDRE55
w I CERTIFY TFIAT I HAVE REI1D THIS APP TION AND STATE TIiAT THE ABOVE INFOiU/AT10N IS CORRECT. TOTAL FE ES � � � '
� 1 AOREE TO N7TH ALL CITY D CAUNTY ORDINANCES AND STATE UWS RELATWO TO BUILDINO
� CONS 7 pFpY RIZE HEP ENTATNES OF THIS COUNTY TO EMER U70N THE ��/J /'�/� �� ,� . � ,
IONE VROPEHTV O C N P SES. OMMEN ��"'���1 ��
�
J
� �
Q �PE � r/^
�` �!� / �
� F PE rirE DATE RECPT.NO. PAID VALIDATION
� WHITE-0epaRment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD--File Copy,GREEN—Applicant's Copy
�
�a�i.,,4.., �1'TV OF C�IA��I�� ��If� � �
� a_ '���'��� . �-- � � ._ ,�,
.;.`j�'. '1u ", ,,�`,�, 6f�SIPECT0�9f� B�E�f��QD
� �
;
.ti � . , � . '� -�
� ,� s . 'o
' � �,��.� �1 � � o � � �'.r„�6 Q � . p i � o
� ('�(y�
K
5.. .n
, � �����{�'}
. �� �
. r..:.. ... .. .�.. . .�.� ^s , 4 0 . � �.. ., � „ '-. yj'� . . ���"4i . .... :.Y.b�^+�+w.i
u 4�../�
.. 4 � � ' �..��
SET BACK , FLOOR JOI,ST •. , , 1 . . ,
FTGS/FORMS/STEEL ' � FHA REClMTS • � � ' '
ELEC7RIC GROUND . • UNDER FLOOR QUCT •
GR�UND PWMBING UNDER FLOOR GUMDUIT � . ' � �
SLAB GRADE FIREPL-ACE FOUNDATION ` ' � � , •
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID HT. BOND BEAM
ROO,F SI�EATHING ' ' ` � 8 FC BOND BEAM
FRAMINGNENTfL1ATION FtNAL BOND BEAM -
ROOF COVER PRE—GRADlNG '
ROUGN NEATING ' BENCNING
ROUGH ELECTRIC • ROUGH GRADING - -
R(]UGH PLUMBING FINISH GRADING
SHOWERlTUB TEST POOL ELECTRIC
EXT. I.ATHlSIDING POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATION pFF SITE IMPS.
DRYWAL�NAILING DEDICATIONS
SEWER F(NAL ENG.
SEPTiC TANK • ' tAfVDSCAPE/IRRIG. ���
SEEP P177L.1.. ON SlTE INlPS. � �
GAS AIR TEST FlNAL ZC�NING �
FINAL CONST. FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID �
FINAL PLUMBING EfVERGY �
. J
� :O ,0 -----
CONIfViENTS �
� . — ,
. _
� , , _�_�_.
SEPTIC TAiVK SIZE �
SEEP PIT/tJ SIZE
s� � d� � �.
�'a�'"Y�'C'� j o:��`f k��k �
�� r����� k". �v,
��, w �6� � �
�� t x . '' i
�6
� i }�����
I 7C^�s . �� •
�� "�e}t P K� ___
� +t.- �sd�.:a��a". � . '
�-� � �
a . , . . . —�'—._
. .. .+�a��� �+:. � r� , . . . - .
�
"�'�� "�' ,�� „���y ��� " ' , ,. ` � • � — "
�. .