HomeMy WebLinkAbout16799 (32) 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
� � �
�