HomeMy WebLinkAbout14-3928 �,'•'� C1TY OF DIAMOND BAR
� I I i DEPARTMENT OF COMMUNITY&DEVELOYM�NT SERVICES �
• -; �p�,�`;�- ✓�� " 21810 Copley Drivc,Diamond 13ar,CA 91765 PRESS
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� (909)839-7020 Fax:(909)861-3ll7 Building Inspection Hotline(909)839-7027 FIRMLY
��4j��N, BUILDINGPERMITAPPLICATION
s JOB SITE ADDRESS APPLICATION DATE: ��� � �I � P/C#
a ISSUE DATE: 6— " �f/��PERMIT# � 1-� �,� �"rl
z APN LOT TRACT
o OWNER TYPE CONST. �1) OCC GROUP:
y ADDRESS � S SO /;/�2 V r�S �}' ZONING SETBACKS
� c�,v b:�ntio�d /�a� IP TEL. FRONT RW ❑
¢ APPLICANT TEL. REAR ❑
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� /'` / SIDE/SIDE STREET RW ❑
o CONTRACTOR _�� (Y�IO�f�I U1�I�l{�1'� SIDE ❑
c� ADDRESS � a ISS"I �} PROPOSEDUSE /{� �o' D I ✓0 2 i�
¢ CfTY �✓ ZIP 9�32�TEL. g0%`37O '"]0 ��
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o ARCH/ENG/DESIGNER
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o ADDRESS
o �I DWEL.UNITS tl STORIES k BEDROOMS
� CITY ZIP TEL.
OWNFR-BNLDER DECLANATION DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
¢ 1 hereby aifirm under penalty of perjury that I am ezempt hom Me ConUactor's State License Law for the reason(s) SFR/ADD/REM .
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p intlicate0 below by the checkmark(s),I have placed ne#to the aDW��ble item(s)[Section 70315,Business and Gara PJCarport
o Professions Code:My dty w county that requires a permit to construct,alter,improve,demolish,a repair,any 9
�z structure,prtor tn Its issuance,also requires ihe applicant for the permit to file a stgned stalement ihat he or she � Patio/Deck
a is licensed Dursuant to lhe proWslons of the Cantractor's Sfate llcense Law(Chapter�Commencing w{ih Secdon w
� 7�0 of Division 3 of the Business and Professia�s Code]or that he w she is ezempt hom Iicensure and the basis for LL P�VSpa
N the alleged e:emD�bn.My vialatian of Section 7031.5 by any appGcant for a permit subjects the appliqnt to a civil penalty
N Z Re-Roof —
� of not more than five huntlretl tlallars(5500). � � aa•
o U 1,as owner of the properry,w my employees wlth wages as iheir sote compensation,will do(_]all 01 or(_.)porlio� � Commercial
� of the work,and the struchire is not Intended or oflered for sale(Section 7044,Buslness and Pmfessions Code:The m
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� Contracmrs'State License Law dces not appry to an owner of property who,thmugh employees'or personal eftort,builds
u7l or imprwes the property,provided that ihe imprmements are not intended or oftered for sale.If however,the building or
� improvement is sold within one year of compledon,the Owner-Builder vnll have ihe buNen of proving ihat It was not built - �
por improvetl ta tlie purpose of sale.),
V �owneratthe m ty g P ) (
F ((�J!�a p perty,am ezGusNe conVactln with Ifcensed ConVactors to cansWct ihe ro ect Sec6on ValUation: Adj.Area:
o 7044,Business and Professions Code:The CoMractors'Stale License Law does rwt aPPN����ol properry who
Z builds w improves Ihereon,arM who contracts fa the projects with e Ilcensed Contracta pursuant to the ConVactors'Slate
cn QUANTITY DESCRIPTION FEE
Y Ucense Law.).
O U�am ezempl from Iice�ure under the ConVactor's State License law lor the lollowing reason(s): �
� �
LL B m�s nature below I acknowled e that,ezce t for m
Z Y ) �g g p y personal residence in which I must have resided fw at least o�e �
o year prlor to completion oi the Imprmements covered by mis permit,l canrwt legalty sell a structure that I have bu�l as an �,�,
¢ owner-bullder If It has rrot been constructed In its entirety by Iicensed contractors.I undersiand ttiat a wpy of the applicable
� law,Sectlon 7044 of ihe Business and ProfeSslax Code Is available upon request when ihis application is submitted or at
X the following Web stte:httpJwvnv.legin(o.p.gov/calaw.html. �
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w DATE: SIGN: �
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� LICENSED COMHACTOH'S�ECIARATION �
w 1 hereby affirm untler penatty of perjury that I am licensed under pravisions of Chapter 9(commencing wfth Section 7000)
m of Division 3 0l the Business and Protessions Code,and my license is in full force and eflect. J
N ��,��: �- 3 y ��.No.: �a�-.� 8'� �
0 onre:_��l2 G� coNrrucron: �f/h 2�T !!i//�r s/�/ _
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� WORNEN'S COMPENSATION OECLAflATION �
� I HFRFBY AFHRM UN�ER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: �/1 —�/�
oI have and will maUtain e Certiftpte ot Consent to Self-Insure iw worker's Canpensation,as provtded-by CONSTRUCTION: �Jv� /J
� Seclbn 3700 of Ihe La�or Code,for the pertmmance of the vrorte for which this permfl is issuetl. p�qN REVIEW: '
a I have aiM will maintain Worker's Compensation Insurance,as required by Section 3700 0l the labor Code,for
Z the pertormance of the work far which this permit is issued.My Worker's Compensatlo�Insurance Carrier antl ELECTRIC:
a PWicyNumherare: � � PLUMBING:
w �qqAiEq /.�-/yl.�ri C/a�✓ U�,�,t/G/f .T�/S MECHANICAL:
� PouCVNUMBER EUC �7 SfL��90� � INSPECTION FEE:
� (f}OS SEC�ION NFED NOT BE COMPI.ETED�F 7HE PERMR IS FOR ONE Ffi1NDRED DOLLARS�$10�OR LESSJ.
r= ISSUANCE: ��
o I certify�hat in tlie perfortnance oi ihe vrak Im whiGi ihis permH Is issueQ I shall rrot empby arry person in any manner so as to SM IP- _�,.r�
o become sib]ect to ihe Wmker's Compeasation laws ol Califomia Md a�ree Ihat If I shauld become subject tu me Worker's
� Compensa prwsbns of Sec�lon 3700 ot or Code sh II �rtnwim co�pry wilh ihose v�o'+�siax. ENERGY P/C:
LL DATE: l � qpPUCANL�?��ifw,t,.,X / ENERGY PERMff:
� wARNIN :Fai—�re Workers Co ensafion coverage is unlawlul,and shall suaect an employer to criminal RErENTION FEE: �
w penatties and dril fines up to one hundred thousand tlollars(3100,OOOJ,in addition to ihe cost of the compensation,
o damages as provided ta in sectian 3708 ot Ne labor code,interest,and attwney's tees. PRE-ALT FEE: -
a CONSTRUCTION LENUING AGENCY BSAF: �(��
w I here0y aflfrm under penalty of puJury that there is a Conslruction Lending Agency for t�e perfom�arxe ol ihe work lar �
= which this Dermit Fs fssuetl(Sec.3097,Civ.C.).
�
� LENDFA'S NAME
� LENDER'S ADORESS: �
aI certify that I have read thls application and slate tliat the above InlormaUon Is carrecL I agree N compry wiN all ciry antl TOTAL FEES
� county ordinances and state laws relatlng ro building conswction,and here�y aummize representatires of this wunty to COMMENTS:
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p enter upon the above-menGoned property lar inspection purposes.
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a PEF{MlTTEE INn
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� SIGNATURE OF P MRTEE 7E RECEIPT N�3�fA/3� PAID BY:� �.r��I VALIDATION:��_
WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—Fle Copy,GREEN—Applicant's Copy
CITY OF DIAMOtVD BAR
� INSPECTION RECORD
• e � • � ' • � � � '
SEfBACK/LETTER - ' - TfiACTAND LEDGER
FOOTINGS FORMS .,:�r , . - - ` -: - _ SWITCH GEAR
``` �� COMMERCIAL HOOD
SLAB� ��''- ` r `
UG.PLUMBING�- ��.-� ,.,; �'- `�` � � � T-BAR
UG.EIECTRICAL� ` } '� _ " '` INTERCEPTER
UFER GROUND`` : ,.,,,;� � �` ;�G. ' '' � `��'t' HOT MOP/SHOWERPAN
. ,:_ „ _ . , . � _ � _
SEWER LATERAL SEPTIC/CESSPOOL
MAIN WATER LINE HERS REPORT RECENED
SEWER CLEANOUT DEMOLITION
ROOF SHEATHING ROOF DRAINS
FLOOR SHEATHING ROUGH CONDUfi
SHEAR�WALLS EXTERIOR;- ; 3 ` POOUSPA., ;� _ � " ,
., . .� ; � �„ . .
:SHEAR':WALLS:INTERIOR.<'�a . :�• , . :, ,. �,� . . `... 'r., �" 'ROUGHePLUMBING. .'.-r=� _-. .::`,' '�;� i F ;a c : -
FRAMING,NENTING., �.,�" }j;" ''u _ ROUGH ELECTRICAL % � ty �-` ��` - x`�
:: . . ,. ,: _ ;; , � ��>*� AL' aA.. i� `�
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ROUGH MEGHANICAL � '�*` � `- ROUGH'MECHNNIC `. _ F _ ' r �: s � ' e r�
ROU6H;ELECT�iICAL',W(' ),C(, ) . > �;',,';;; GAS TEST`." a _ ' Y� j 7_ � r
ROUGH PLUM8ING �'� " f' - - PRE GUNITE` � �`� ��F ry�'
-----� —�� � - � - -: . � .�. _. _� . =�� _ '::' ' > �.
INSULATION WALL ;POOC P.,RE'DEGK BONDING � :i� '��'�s�,� f �; k`
INSULATION CEIUNG R=TRAP'=��`� ' ' �' `;� ' _�� �' .��' '`"
DRYWALL FENCE'l�GATE/AIARNI _ 1 � ' �" � ` �`
t r�;
FINAL'POOL- � - �
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LATH(PR� _ _ �>> _ �, _ 7 �=.
LATH EXTERIOR WALLS:
LATH INTERIQR WALL FOOTING/STEEL
GAS TEST WALL STEEL 1�( )2ND( )LIFT
SCRATCH COAT WALL BOND BEAM
ELECTRIC METER RELEASE WALL DRAIN/SEAL
GAS METER RELEASE WALL FINAL
SPECIAL INSPECTION ;RD�FRAMI,N.G PLANNINGAPRROVAL _ - `-� '^ � '
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FINAL�BUILDING. �=y "
� ` ''� T' 'ROU6H PIRE APPROVAL - F`' ``' '�` `� r "'
FINAL�MECHANICAL_..-' . . � , -::�„'� FINAL FIRE DEPARTMENT ' �; l�' ;�
�� ;` ` ' � ;�'r FINAL PLAtdNING , ` j �'" ; ,:�
FINAL'ELECTBIGAL„ � #; '''
FINAL PLUMBING„ � '�` `" �' FINAL ENGINEERINC/PW r:+ ` '
S A�` 4 1 k
T.C.of OCCUPANCY, � _ _ � µ�INAL COMMUNIN_$ERVICES , `_ �`�:ir �"' '= x }-:
CERT.�of OCCUPANCY � �"� ,- �^:;� FINAL HEALTH DEPT. " �
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k INAI INDUSTRIAL WASTE '�' ., }:' -
COMMENTS:
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