HomeMy WebLinkAbout11573 (5) - CITY OF DIAMOND BAR
COMMUNiTY DEVELOPMENT DEPARTMENT '
�:",^ 2166U E.Coplcy Drive Suite 190 PRES.�',�
� (909)860-3195 Fax(909)861-3117
'H"" BDILDING PERMIT APPLICATION FIRMLIf
� JOBSITE Z g$ �g� � APPLICATION PERMIT P/C
+� ADDRESS � 7/ �/�- '�� �Y DATE �Z`� � NUMBER � �� #�
ISSUE TYPE OCC
� APN �T s TRACT DATE CONST. GROUP
�j OWNER Z
p ADDRESS Z$� E �,/� 20NING SET ACKS
� C�TM��� Z�P . �� FRONT RW ❑
APPLICANT TEL. REAR O
o SIDE/SIDE STREET RW ❑
� '
CONTRACTOR Do�- �(r!� SIDE ❑
� ADDRESS, � � GIIW
� CIN ZIP���i TE � � PROPOSED USE ___ __ __ _
u�i ARCHlENG/
2 DESIGNER L- M MO.DWEL. NO. NO.
�a ADDRESS UNITS STORIES BEDROOMS
� CITY� ZIP� d TE`� —�"'���y
� DESCRIPTION 5Q.FT: FACTOR PSF ADJ.AREA/VALUATION
Q OWNER-BCILDER DECLAflATION - SFWAOD/REM -
O
Q I HERE9V AFFIRM UNDEP PENALN OF PERNRV THAT I AM E%EMP7 FROM THE WNTRAGTORS LI- GaragelCarport
W CENSELAWFOR7HEFOLLOWlNGREASON(SEG7a�15BU5ME55ANDPF�FES510NSCD�E:ANYpT'OR (n
C.� CWNTVWMICHREQUIRESAPERIAITTOGONSiRUCT,ALTER�M�P��.�EMOflSH,ORRFVAIRRNYSTRUC- W PaIl0/OBCk -
wTURE,PPIOR TO ITS ISSUANCE.AL50 REQLi!P�FS THE APPLICAhT FOR Sl1CH PERM17 T0 FlI,E A SIGNED �
� S�AiEMENT THAY HE OR SNE IS LICENSW PURSUANT TO 7HE PROVISIONS OF hiE('ANTPAC70R3 L6� .� paoVS a
f.EN5EL0.W{CHAPTEfl9(COMMENCINGNMTHSECTION7000)OFDIVISION30FTHEBl15ME55AN�PRO- P �
� FESSIONSCODE)ORTHATHEORSHEISE%EMPTTHEREfROMANDTHE8A5ISFDRTHEALLE6EDEXEMP. �
U TION.ANYVID�AiIONOiSECTIDN7o]1.5BVANYAGPLIChNTFOqAPERMITSl1&1ECTSTHEAPPLICANTTO Z
� ACIVILPENALTYOFNOiMORETHANFNEHUNOREODOLWRS(S50o).):
O C71.ASOWNEROFTHEPROPERN,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATpN, � CINfIR19(C18I
� WILI DO T�'�E WORK,AND THE STflUCTJflE IS NOT INTENDED ON OFGERED FOR SAL.E(SEC.�04/,BU51� J
NESS AND PpoFE5510M5 CODE:THE CONTFACTORS LICENSE UW DOES NOT APPLY i0 AN ONNlER OF ?
� FF#OPEflTVWHOBUII.l750RIMPROVESTHERC-0N,ANDWHOOOESSUCHWORNHIMSELFORHERSELFOR
[[ TM90UGMMISORHERONRJEMPLDVEES,PROYIDEDTHA75UCHIMPROVEMENTSAflENOTIHTEMDE00R �
w OFF[REV(-0RSALEIF,NOWEVERTME6UIIDINGOflIMPROVEMENTISSOIDWITHINONEYE4ROFCOMYLE-
� TIOY,THE OWNER-BUIL[1EF WiLL HAYE THE B�flOEN OF PROVINO THAT M[OR SHE DIO NOT BUILD ON
� IMP90VEFDATHE�URPOSEOFSA�E). ,
{,�} ❑I,ASOIMaEROFTMEPROPEHTY,AMEXCLUSIVELVCONiMCTINOWfTHIICENSEDWMMCTORS
� TO CONSTRUCT THE PflQ1ECT(SEC.�066,BUSINESS AND PROFESSIONS CODE:THE CONTRACTC�RS LL VflI118t10l1 A�J.AREA
ILI CENSEIAWDOE5NO7APPLYTOANOWNEROFAPR07EflNWt109UIL�SORIMPflOVESTHEREON,AN7
� WNOCANTFIACTSFOPSUCHPRQIECTSNMTHACON7RACTOR(S�UCENSEOPUqSVANTTOTiEGONTRAG pUANTITY OESCPIPTION FEE
TORS LIGENSE LAW).
� ❑1 RM EXEMPT UNDER SEC. 8.6 P.C.FOR THIS REASON �
� U
aC
� DATE OWNER �
� J
��[ LICENSED CONTRACTORS DECLARATION W
Ci IHEREBYAGFIRMUNDERPENAI.7YOFPERJUFlYTHnTI,WLicEN3EDUNDERPROVISION50FCNRP7ER �
d e{COMMENCINGWITHSECTION7DD'JiOFD!VISION30FTHEBVSINESSAN�PROFESSIONSCO�E.PN� Z
X MY UCENSE IS M FULL WRCEANO EFPECL m
F�J /� �
� l!CENSE C SS �� L1C.No. "�`�c��v � D
U �ATE N az CONTRACTOIi : 1! - 0�•• p�
',u , f� � S � .�
q3 WQRKERS'COMPENSATION PECL.AHA710N U O� �
�
� IiiEREBYAFFlRMl1N0ERPENAITYOFPERIURYONEOFTHEFOLLOWINGDECLAAATpNS:
� � Z
d
'� L] IMAVEAN�WLLLMAINT.4INACERTIf-ICATEOFCONSEMTOSELFINSUREFORWOPKEFS =
^CpMPENSATION.ASPROViDE�eYSECTION3�o00FTHEVBORCODE,i'ONTNEPERFOPAiANCE U
� OF 7HE WORK FOR WHICHTHIS 7ERMIT�S ISSl1F0. �
O
� __INAVEAN�WILLMAINTRINWORKEF$'COMPENSATIONiNSURANGE,ASREOUIpEDBYSECTION
� 31000F 7HE LABOR CODE,FOR THE PERFOFMANCE Oi THE W07N FOR WHICM TMIS PERMIT I$
ISSUEU.MY WORKERS'COM7ENSATION INSURANCE CARRIEF ANO POLICY NUMBER ARE CONSTHUCTION � •p�
j cnRRiER PIANREVIEW x�s�S C-fJ
� POI.ICYNUMBEfl ELECTFIC ��,
4 �^
� tn�55ECi�uE�naieE�.EreooFn��an�Tar�or�Kr�eooalar�s(s+mlor��sS4 PLUMBING --�� Z 4�`�J
W ICERTIFYTHATINTHEPEPfOPh/ANCEOFTHEWDRKFORWHICHTHISPERMITI5ISSUED,I MECHANICAL �'y� �O
7._
C'J SHAL�NOT EMPLOYANY PERSON IN ANV 1AANNEfi SO n5 T08ECOME S110JECT 70 THE ��� CI ,
tp WORKERS'COMVENSAiION LAWS OF CALIFORNIA/WD ACREE i I SFIOULO BECOME 1NSPECT�ON FEE b� y,
n
SU CTTO HEWORKEFS'GOMPENSATIONPqOV15 SOF �)OOOFTHEUBOR
j i��� iSSUANCE O a O.�
c �isr+ �coArHwirHcon+a�rwin� � is s.
o , sMiP 3•5��
p D0.7E-. Z APPLICANP
j ENER6Y P/C
J WARNINGFAIIURETOSECUqEWOflKERs'COMPENSATION flAGE�SUNLAWFUL,INOSNALLBE
� S119.lECTANEMPLOYEATOCRIMINALPENALTIE5l1NDGVIlF1 ESUPTOONEHUNOREOTHOUSANO ENERGYPERMIT
�OlUftS(5100,000�,IN MDITION TO THE COST OF WMPENSATION,OAMAGES AS PROVIDED FOR IN
� SECTION3TOBOFTHELABORCODE,MTEtiESL�NDATTORNEI^SFEES. {;�ENTIONFEE:
� CONSTRUCTION LENDING AGENCY PREALT FEE: •�
QC IMEPEBYAFFIRMUNOEaPENALNOFPEftJURY7HAiTHEREISRCON5Tpl1CTIONLEN�INGAGENCY
u- FOR THE FERFORMANCE Of THE WORK FOR WHIGVI THIS PERMR IS ISSUED(SEC.3097,CIY.C.�. —� � r
� �h✓1
� �F;
LFNDER'S NAME
H LENDER'SAODRESS �(Jy
� ICEFTIFYTHATIHAVEREADTHISAPPLICATIONAN�STATETHATTHEA80VEWFOHMATpNISCORRECT. TOTALFEES ?/��'�S1 '� � �
I AGBEE TO COMPIv WITH ALL CITY AND COUNTY Ofi01NANCES AND STA7E UWS PElA71NG i0 BUILDINO
� CONSTt#UGTION,ANOMEREBYAUTHORREREPPESENTAT!VESOFTHISCOUNTYTOENiEAUPONTNE
ABOYE-MENTIONEO PROVERTV FOH INSPECTION PURPOSES. (�'QrAMENTS
� ��- ,�"5
� P TT AME -T � ` (`/
f� � lJ
� - UX_OFPERMITT DAi
RECPt N0. PAID BY VAI.IDATION
� WHITE—DnpartmeniCo YELLOW—FinenoeCo PINK—AsaessorCo GOLOENROD—FileCo GFEEN—
PY. PY. PY. PY, APPlicant's CoPY
CITY OF DIAMUMVlCt BI'��t '
INSPECTiO►N RECdRD '
;
• • , l r � P � ` , i r ` • }
�
SET BACK . F�QOR JOlST '
FTGSIFLTRiv1S/STEEI - FHA REQMTS
ELECTRIC UNdER FLOC}R DUCT
GRQUND Pi.UN1B}NG UNDER FLOCIR CO�IDUIT
3
SLAB GRADE FIREPLACE FOtJNQATlON
TEMP POWER FIREPLACE BONd BEAM
WATER SERVICE Mid HT.BOND BEAM +
ROOF SNEA7HlNG S FT.BOND BEANS i
FRAM{NGNENTILIATIQN FINA�BOND BEAM
RflOF COVEA PRE-GRAdING
ROUGH HEATING BENCHING �
ROUGH ELECTRIC ROUGH�RADING
ROUGH P4UM81NG FINtSH GRADlNG j
SHOWERlTUB TEST POOL E�ECTRIG �
EXT.LAZHlSIDING � POOL FENClNG i
WALL 1NSULATION PI�OL FINAL �
CEIIiNG INSUlATION ' QFF SlTE lMPS. �
DRYWALL NAtLiNG DEDIGA710NS
SEWER • �tNAL ENG.
SEPTtC TANK • LANQSCAPEJIRRIG. �
SEEP PITIL.L. ON SI7E IIUIPS.
�S AIF�`fEST FINAi.ZONING
FtlVAL CQNST. \ , FIRE D�PT.FINAL
FINAL.NE'qTING HEAi.TH DEPT.FWAL
FtNRL ELECTRIC � �� DEV.FEES PAID j
FINA�PLUM6ING ENERGY j
�
.. - • • !
. , � _ _ _ _
COMMENTS
,
'; �. ;��,
a, . .
�„
.i . .
SEPTIC TANK St�
SEEP FtT/U SIZE %� �,��---TGs�'—y'�j'c�.�a�i� -�'�-
� .
.� 1� ,,�'/�,
�'' /cs
�l' _ f S il .i � $
�' � . �
� ����
__�_- �