HomeMy WebLinkAbout11536 •` CTTY OF DIAMOND BAR
COMMUNITY DEVELOPMENT DEPARTMENT � ,� �
#-;,,,W 21660 E.Copley Drive Suite 190 � PRESS
(909)860-3195 Fax(909)861-3117
"�' BUILDING PERMIT APPLICATION FIRMLY
y JOBSITE l APPLICATION -2 � PERMIT P/C
o ADDRESS l 7 I�� aV Cr��..�Q�� L f l_,� DATE NUMBE� #
� ISSUE TYPE � OCC
APN LOT TRACT DATE CONST. GROUP
p OWNER G���,�-/R G(�/�J?
ADDRESS� ZONING SETBACKS
� CITY �� ZIP ! EL�� REART RW O
o APPLICANT TE�• SIDE/SIDE STREET RW ❑
� CONTRACTOR SIDE ❑
� ADDRESS
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� DESIGNER
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n. ADDRESS UNITS STORIES BEDROOMS
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� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
� OWNER-BI:ILDER DECLARATION SFR/ADD/REM
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W TURE,PFIOP TO ITS ISSUANCE,AL50 fiE�UIRES THE APPLICANT fOH SUCH PE(e�A1T TD FlLE A SIGNE� W
� STATEMENT THAT HE Ofl SHE IS IJCENSED PURSUMIT T0 7HE PROVISIONS OF THE CONTMCTORS LI-
� CENSEUW�CHAPTEt78(CAMMENCINGWITHSECTION7000)OF�IVISION30FTHEBUSINESSANDPflO- U' POOVSpB
FESSIONS CODEJ ORTHA7 ME OH SHE 19 EXEMP7 THEREFflOM AND THE BA515 FOR THE ALLEOED E%EMV-
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� q qVIL PENAL7Y OF NOT MOflE 7HAN FNE MUNORED DOLURS(S5ao).): ,
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z WILL 00 THE\YOHK ANO THE STRUCTURE IS NOT INTENDED Oti OFFERED FOR SALE(SEC.70/f,BU31- J
NESS M!D PROFESS�ONS CODE:THE CONTRACTORS LICENSE LAW OOES NOT APPLY TO AN OWNER OF
� PflOPERTYWHOBUILO50RIMPqOVESTHEREON,ANDNM1/O00E55UCHMbRKHI/A50.FORHER5EI.FOR �
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� TION,THE OWNER-BUILAEH WILL HAVE THE BUR�EN OF PflOVMG iHAT HE OR SHE DID NOT BUILD OR
Z IMPROVEFORTHEPURPOSEOFSAIEJ.
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W TO CONSTHUCT THE PHQIECT(SEC.70U,BUSWESS AND PROFES5IONS CODE:THE CONTRACTORS LI• V01UdI1011 ADJ.AREA
W CENSELAWDOE9NOTAPPLYTOANONRJEROFAPROPEflTVNTiOBU1lOSORIMPROVESTHEREON,PND
� WHOCANTRACTSPoRSUCHPROJECTSWI7HACOMRACTOR(5)LICENSEDPURSUANiT07HECOMAAC- QUANTITY DESCRIPTION FEE
� TOflSLICENSELAWJ.
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� ❑I AM EXEMPT UlDER SEG B.a P.Q FOR TH19 REA30N �
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u' DATE OWMER F
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� LICENSED CONTAACTORS DECLARATION W
2 1 HEPEBYAFFlRM UNDEN PENALTY OF 7ERIURY TNA�IM1 LICENSED UNDEfl PROVISIDNS OF CHAPTER �. J _' /� . �
d B(COMMENCIN6WITHSECTION7oao)OFDIVISION30FTNEBUSINE55J1NOPROFESSKKJSCODE,AND Z VL/ \./
X MV LICENSE IS IN FULL FOfiCE AND EFFECT.
� UCENSE CLASS G��c S G LIC.NO. �._3y/�"�� j
V DATE U�Z 7 `7� CONTRACTOR ��� d
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� WORKERS'COMPENSATION DECLARATION "� –r
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� IHEREBVAFFlRMUNDEHPENAITVOFPERJURVONEOFTHEFOLIOWINGDECURATIONS:
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� i MAVE AND WILL MAINTAIN A CERTIFlCATE OF COMSENT 70 SELF-iNSURE FOR WORNERS' _
� COMPENSATION,ASPflOVIDEDBYSECTION37o00FTHElA80RCWE,FORTHEVERfORAiANCE IU
OF THE WOPo(PoR VMICH THIS PEflM1T IS ISSUED. �
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W 1 HAVE AND WILL MAINTAIN WORKERS'COIAPENSATbN INSUPANCE,AS PEOUIRED BY SECTION
Q 37000F7HE UBOR CODE,FOH THE PERWRMANCE OF THE WORK WR W19CH iHiS PERMIT IS
ISSUED.MY WORKERS'COMPENSRTIOId INSURdNCE CARRtER AND POLICY NUM6ER ME: CONSTRUCTION
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Z ICERTIFYTHATMTHEPERFORMANCEOF7HEWORKWRWNICHTH�SPEHMITISISSUED,1 MECHAMCAL ~
U' SHALL NOT EMPLOY ANY PERSON IN M1Y M/wNEH SO A5 TO BECOME 5U&IECT 707HE �
� N'OflKERS'COMPENSATION LAWSOF CALIFORNIq ANO AGREE THAT IF I SHOULD BECOME INSPECT70N FEE ��r� I��/ a�1
j SU&IECTTOTHEWOiB(ERS'CAMPENSATIONPROYI510NSOFSECTION37000FTHEUBOR
CODE,I SHALL FOFifHWiTMCOMPLY WIh17F105E PROVISKKJS. ISSUANCE
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p DATE:��APPLICANE SMIP
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�y SU&IECTAN 6iAPLOYER TO CflIMMAL PENPLTIES ANO CML FINES UP TO alE MUN�RED THOUSMq ENERGY PERMIT
DOLURS(5700,000�,IN ADDITION TO TNE COST OF COlAPENSATION,DAMAGES AS PROVIDED WR IN
J SECTION37080F7HELABOflCOOE.WTEREST,ANDATfOHNEY5FEE5. RETENTIONFEE:
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a CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� �HEREBYAFFlFMUNOERPENALTYOFPEFlJUPYTHRTTHEREISAGONSTflIKTKKILENDINGAGENCY
Z fOR iHE PENFOi7MMICE OFTHE WORK FOR WHiCH THIS PERMI7IS ISS�EO�SEC.3097,CIV.C.).
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� IENDEWSNAME
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� ICERTIFYTHATIHAVENEADTHISAPPLICA710NANDSTATETHATTHEABOVEWFO(iMATIONISCORRECT. TOTAL FEES Z � �
� IAGREETOCdAVLVWITHALLCI7YANOCAUN7YORDINANCE5ANO5TATElAWSRELATINGTOBUILDING
� CONSTRUCTION,AND HEREBYAUh10RIZE REPflESENTATIVES aF iHis COUNTV TO ENTEfi UPoN THE
Z ABOVE#IENTIONED OROOERTV(-0R INSPECTKKJ PURPOSES COMMENTS
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m PERMI��E(PRINT) � G �� ^g n
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� SIGNATUREOFPERMITfEE DA7E (
= RECPT.NO. PAID BY VALIDATI
~ VYFIITE—Depertment Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—Applicant's Copy
C� y� � c„� oF a�A�a�a ��R
� � INSPEC"'r'It)N RECOF�D
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SET BACK ' FLaOA JOIST
FTGS/FC�RMS/STEEL FHA REQMTS
EtECTRIC GROUND UNDER F�OOR dUCT
GROUND P�UMBING UNDER•FLOOR CO�IDUIT
SLAH GRADE FIAEPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
WATER SERVtCE MID HT.BOND BEAM � -- "
ROOF SNEATHING 8 Ff. BQND BEAM
FRAMINGNEN7ILIATION FINAL BOND BEAM
F�OOF COVER PRE-GRADING
ROUGH HEATING BENCHING
AOUGH ELECTRIC ROUGH GRADING
ROUGH P�UMBING FINISH GRADING
SMOWER/TUB TEST POOI�ELECTRIC
EXT.lJ�TNlSIDING PO�L FENCING
WALL.INSULATION POOL FINAL
CEtLlNG INSULATION OFF SITE IMPS.
DRYtNALL NAILING DEdICATiONS
SEWER FINAL ENG.
SEPTIC TANK LANQSCAPE/IRRIG.
SEEP PIT/L.�. ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FIN,4L CONST. FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT.FINAL
F1NAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING � ' ENERGY
. � • _ . . ,
COMMENTS
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SEPTIC TANK SIZE
SEEP PIT/U SIZE
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