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HomeMy WebLinkAbout144 PALO CEDRO DR C1TY OF DIAMOND BAR �----��--- DEPARTMENT OF COIvIIvfUNITY&DEVELOPIv�NT SERVICES 21825 E.Copley Drive " pRESS �"" (909)860-3195 Fax(909)861-3117 FtRMLY "'.»�'' BUILDING PERMIT APPLICATION o DDRIESS / � / S' �p�'D Q, O APPLICATION PERMIT PiC DATE � � � D NUMBER # $ ISSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP °C OWNER f o ADD ESS 1 , lA Q ZONING SETBACKS o FRONT RW O oCITY lP I TE� _ R�R p o APPLICANT TE � 7 SIDE/SIDE STREET RW ❑ � CONTRACTOR �l'� SIDE � O ADDR SS _ PROPOSED USE � s S�'����� C�7y' ZIP 17 6� TE . w ARCH/ENG/ z DESIGNER NO.DWEL. NO. ) NO. a ADDRESS UNITS � STORIES / BEDROOMS N CITY ZIP TE�. u� DESCRIPTION SQ.FT. FACTOA PSF ADJ.AREANALUATION � OWNEF-BUILDER DECLARATION SFR/ADD/REM O I HEREB�AFFIRM UNDER PENALTI'OF PERM1IRV THAT I AM E%EMPT FROM THE CONTRACTORS LI� G0f8g6/CBfpOR W CENSEUWF-0RTHEFOILOWINOFiEASON($EC.7037.69USINESSANDPHOFESSIONSCODEM7YCITVOR (n U COUNTVNM1iICHREOUIRESAPERM�TTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUG W P8f10/DBCK wTURE,PRIOR TO ITS ISSUANCE.�LSO AC-0UIflES THE APPLICMlT FOR SUCH PERMIT TO FILE A SIGNED w � STATEMEM 111A7 HE ON SHE IS UCENSED PURSU/�N7 TO THE PROYISIONS OF THE CONTRAC70RS Lf- � CENSE LAW(CMAPTER Y(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � PaoUSpe ^ FESSqNSCODE)ORhUTHEORSHEISEXEMPTTHEREFROMANDTHEBA515FOR7HEALlEOEDE%EMP� /�.� V TION.ANVVIOLATIONOFSECTfON7o31.58VANVAPPUCANTFORAPERMITSU&lECTSTHEAPPLICANTTO Z RB-F00} VV � A CML PENALTY OF NOT MORE THAN FIVE HUNDHED DOLLAAS(f500).): _ , � p1,ASOWNEROFTNEPf30PERTY.OFMYEMPIOYEESWITHWAGESA5THE1FiSOLECOMPENSATlON, 0 Co711m8iC�81 � WILI DO THE WORI(AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SA�E(SEC.7041,BUSI- J � NESS AND PFOFESSIONS CODE:THE CANTRACTORS LICENSE lAW DOES NOT APPLV TO AN OWNER OF � PROPERTYNM1iOBU1LD50RIMPHOVESTHEPEON,ANDWMODOESSUCHWDRKHIMSELFORHERSELFOR m � ,7HROUC3H HIS OR NER OWN EM7LOVEES,PFOVIDED THAT SUpI IMPROVEMENTS ARE NOT IMENDED OR W OFFERmFOflSALE.IF,FqWEVERTMEBUILOINGORIMPROVEMENTI550LDWRMNONEVEAROFCOMPIE� 0 TION,THE OWNEH-BUILDER WILL NAVE 7HE BURDEN OF PROVINa THAT HE OH SHE DID NOT BUILD OR Z IMPROVE f-0R 7HE PURPOSE OF SALE�. _ �I,ASOWNEROFZTIEPROPERTY.M/E7(CLUSNEI�COMRACTINaWI7NUCENSEDCONTRACTORS � TO CANSTRUCT THE PROJECT(SEC.7oN,BUSINESS AND PROFESSIONS CODE:THE GONTMCTOPS LI- V01U8IIOf1 ADJ.AREA � CENSEUWDOESNOTAPPLVTOMIOWNEROFAPROPERTVWHOBUILDSORIMPqOVESTMEHEON.AND WFpCOliSRACTSFORSUC}iPRQ1ECTSWITHACONTRACTOR(S)LICENSEDPUFSUANTTOTHECONTMG QUANTITY DESCRIPTION FEE 70R5 LICENSE LAW.j. Y � e �F v � O ❑I AM F�CEMPT UNDER SEC. B.6 P.C.FOR hIIS REASON � � � A ` u' DATE �WNER ~ L / 'O.7 O � � LICENSED CONTRACTORS DECLARATION w � � 2 I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSEO UNDER PROVISIONS OF CHAPTER � „ p,. V(COMMENCINO N7TH SECTION 7a00)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CADE,AND Z MY�ICENSE IS IN FULL FOF7CE NJD EFFECT, m , F /+, � J N � � LICENSE OCRJS �' � � 1 J V � O CONTRACTOR d DATE w � WORKERS'COMPENSATION DECLAFIATION -� • = a � U � I HEFEBV AFFIRM UNDEfi PENALTV OF PEiiIURV ONE OF TNE FOLLOWINQ DECU�TIONS: Z O __I HAVE AND WILL MPJNTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR NbFKERS' 2 � ' Q COMPENSATqN,AS PROVIDED BV SECTION 3700 OF TME L/�BOR CODE,FOH THE PERFORMANCE w OF THE WORK FOR WMICH hIIS PERMIT IS 75SUED. � � W __I HAVE AND WILLMAINTAIN WORKERS'COMPENSATION INSURANCE.AS REOUIRED BY SECTION f �O Q 3700 OF THE UBOR COOE.FOF THE PERF-0RMANCE OF THE�'dORK FOR WHICH 7HI5 PERMIT IS ��j r' � ISSUED.MV WORKERS'CAMPENSATION INS�U CqE CARRIErq�\r+D POLICY NUMBER ARE: CONSTRUCTION ' � CARRIER ��^� ■ v h, ' J PLAN REVIEW Z vaicrr�n. ' R5~� U n�d ELECTRIC ¢ PLUMBWG � � (INiSSE(,'iIONNE�NOT9E�ET£DOFtFiEPEMYTISFORONEFI,X�URE0D7lLAFtSlit0010filESS1_ w I CERTIFV THAT M THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL Z (�J SHALL NOT EMPLOV ANV PERSON IN ANY ANNER SO AS TO BECAME SUBJECT TO TNE .. � WOqKERS'COMPENSATqNLAW50FCALl ORNI ANDAGREETHATIFISHOU BECOME INSPEC710NFEE � SU&IECT TO THE WORNERS'COMPENSATI N PR VISIONS ECTION 3700 THE ISSUANCE ���� � CODE.ISHALLFORTMWITHCAMPLVWITH OS RO�I51 •�+ O SMIP J O p� OATE: ` �� APPLICA . . J ENERGY P/C J WARNIN6:FAILURETO SECURE NI�RKERS'COMPENSATION COVERA�E IS UNUWFUL,M1D SMALL BE '� SU&IECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT OOLURS(f 100,000).IN ADDITION TO 7HE COST OF COMPENSATION,DAMAGES A$PFOVIDE�FOR IN � � J SECTION 3708 OF THE LABOR CODE.INTEREST,AND ATTORNEI"S FEES. RETENTION FEE: � w CONSTRUCTION IENDING AGENCY PRE-ALT FEE: d � I HEREBV AFFIqM UNDER PENALTV OF PE{L1URV THAT THERE IS A CANSTRUCTION 1EN01NG AGENCV d FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.30B7.CiV.C.). Z W � 4ENDER'S NAME 1-_ lENOER'SAOORE55 � O � f /T � dv � I CERTIFV THAT I HAVE REAO THIS APPLICATION AND STATE TIiAT hIE ABOVE INFORMATION IS CARRECT. TOTAL FE ES w I AOREE TO COMPLV WITH ALL CITV AN�CIXINTV ORDINMICES AND STATE UWS REUTING TO BUILDING � CONSTRUCTION,ANDHEREBYAUTFIORREFEPRESENTATNESOFTHISCWNTYTOENTERUPONTHE - /'� n Z AflOVE-MENTqNE07ROPERTYFORINSPECTIONPURPOSES. I /� >R� � COMMENTS o ���� , -�..� J � m PERM E N E(PRIIJn ' � ����'fl� ��� L � SI OF PEWAIITEE �ATE RECPT.NO. PAID BY Wr� VALIDATION � WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicent's Copy (�9�'� �f� �9���d(��1LC� �l�L� 06�1�i�[�C��'0�f� f��(��[i�� �o��oa � �a� � � o a � �. oa�p�oa � . oQ� . ��.� � � SEf BACK • FLOOR JOIST. , FTGS/FORMS/57EEL FHA REQMTS ELECTRIC GROUND UNDER FLO�R DUCT � GROUND PLUMBING UNDER FLOOR CU�IDUIT SLAB GRADE � FIREPLACE FOU�IDATION 7EMP POWER � � FIREPLACE BOND BEAM � WATER SERVICE MID HT. BOND BEAM ' ROOF SHEATH(NG . �-�� � 8 FT. BOfVD BEAM FRAM(1VGNENTILIATtON FItVAL BOIVD BEAM ROO�COVER �.- t?�"o�i �'"" - " -PRE-GRADlNG 4 � ' ROUGH HEATlNG BENCHING ROUGH ELECTRIC ROUGH GRADING ROUGH PLUNIBING FfNISH GRADING SHOWER/TUB TEST POOL ELECTRIC EX7. LATH/SIDING POOL FENCING WALL INSULATION POOL FINAL CEILII�lG IN�ULATION OFF SITE IMPS. DRYWALL NAIUNG DEDICAT(ONS SEWER FINAL EtVG. SEPTiC TAfVK LANDSCAPE/IRRIG. SEEP PfT/L.L. � ON SlTE IMPS. • GAS AIR TEST FlNAL ZONING FlNAL CONST. ,�5. o� FIRE DEPT. FINAL � FINAL HEATING HEALTH DEPT. FINAL � � FINAL ELECTRIC , DEV. �EES PAlD � FINAL PLUMBING ENERGY • � ;Y�o". "� � .�, COMi�f�iVTS � . , SEPTIC TANK S12E SEEP PIT/U SIZE � -- � " I � � � �