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HomeMy WebLinkAbout11494 � i CTI'Y OF DIAMOND BAR � rt � COMMUNTI'Y DEVELOPMENT DEPARTMENT _:,. 21660 E.Copley Drive Suite I90 PRESS (909)860-3195 Fax(909)8613117 I � '""' BUILDINGPERMITAPPLICATION FIRMLY � ,10$$,IaF� ^ APf�ICATION Fy'ERMIT P/C Ac�EIRESS ��� �"�G� �i*�� DATE ` �' NtJM8EF1 # o ISSUE TYPE OCC °C—' APN LOT TRACT DATE CONST. GROUP °� QWNE�a 4-G� �u @.!L �' � ADDR � I`� � � � f. ZONING SETBACKS w CITY � ZIP t7�� TEL.��1 /�.I�_ FRONT RW ❑ � o APPLICANT `ZfR Q✓Y` TEL. 7'77 'J�� / SDE/SIDESTREET RW ❑ � CONTRACTOR SIDE ❑ o ADDRESS PROPOSEDUSE '1' �f :��E C• � CITY ZIP TEI. � , w RCH/ENG/ z DESIGNER NO.DWEL. . NO. ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANAIUATlON � � - OWNER-BCILDER DECLARATION SFR/ADD/FfEM O p I HEpEBY AFFIRM IJN�ER PENALTV OF PERJl1RY THAT I AM EXEMPT FROM 7HE CONTRAC70R5 LI- G8f8JB/C8(pOft W CENSELAWFORTHEFOLLOWINGPEASON(SEC.7031.6BUSINESSANDPROFESSIONSCODE:ANVCIT'OH (n U fAUNTYWHICMFEOUIRESAPERMITTOCAN5Tfll1CT,ALTER,IMPROVE.DEMOtJSH.ORREPAIRANYSTRUC• W patio/Deck wTL�PF,PRIOR i0 ITc�55UANCE,ALSO RE�UIRES THE APPLICAM FOR SUCH PERMIT TO FILE A StGNED W � STATEMENT THAY HE OR SHE IS LICENSFD PURSUANT TO THE PROVISIONS OF THE CANTRACTORS U- � CENSE lAW(CHAPTER 9(GOMMENCING WITH SECTION]000)OF DIVISION 3 OF THE BUSINESS AND PRO- � PooVSpa FESSIONS CADE)Ofl THAT HE OR SHE IS EXEMPT TNEREFFOM ANO THE BA515 FOR TME ALLEGED EXEMP• � TION.ANVVIOLATIDNOFSECTION7o31.58VANYAPPLICANTGORAPEPA/IT5U9JECT5THEAPPLICANTTO � Re-Roof � A qVll GENALTY OF NOT MOFE THAN FNE HUNDRE�DDLLARS(SSao).). � ❑I.ASOWNEROFTHEPROPERTY,ORMYEMP�OYEESWITHW/GESASiHEIR50LECOMPENSRTION, ❑ Commercial ` WILL DO THE WORN,AND TME STRUCTURE IS NOT INTENDED OR OFFEflED FOR SALE�SEG 70ee,BU51• J NE55 PN�PROFESSIONS CADE:THE CANTRACTOPS UCENSE UW DO[5 NOT APPLV TO AN OWNER OF � PROPEPTYWHOBUILDSOFi1MPROVESTHEFEON,ANDWHODOES5UG1�1WORNHIMSELFWiHEftSELFOR m (= THROUGHHtSORHEROWNE7.�PlOVFES,CROVIOE�THATSUCHIMPROVEAIENTSARENOTMTENDEDOR w OFFEREDFORSALE.IF,HOWEVERNEBUILDINGORIMPROVEMENTISSOIOWITHMONEVEAROFC011PLE- � TION,THE OWNEH-9UILDER WILL HRVE THE BVRDEN OF PROVMG THpT ME OR SHE OID NOT BUILD OR Z IA.IPROVE FOR THE PURPOSE OF SAIE). �5y� ❑I,ASOWNEROFTHCPROP.ERTV,AMEXCLUSIVELYCONTRACTINGWI7HUCENSEDCONTRACTOFIS [[ TO CON5TRUCT THE PFOJEGT(SEC.�o4a,EUSINESS AND PROFESSIONS CODE THE WMTFACTORS U- V81U8liOf1 ADJ.AREA - W CENSEIAWDOESNOTAPPLVTOANOWNEflOFAPflOPERTVWHOBl11LDSORIMPROYESTHEREON,AND � WNOCANTRACTSFORSUCHPRQIECTSWITHACONTRACTOR(S)LICENSE�PURSUANTTOTHECONTFA6 QUANTITY DESCRIPTION FEE TORS LICENSE LAW.). J s �j .,� },� � ❑I AM F�CEMPT UNDER SEC. 8.6 P.C.FOR THIS REASON e( /� �' ♦IL I� !T4-�.�}� I r � FM 4� ' ��'Co ' z DATE � U .. I P� ° P' 1i I� 1 W � UCENSED C�NTRACTORS DECLARATION W �' � C � I HEREBY AFFIRM UNDEF PENALTY OF PERJUflY THAT I AM LICENSEO UNDEti PROVISIONS OF GHMTER (L 0(COMMENGINGWITHSECTION7o00)OFDMSKKJ30FTHEBUSINESSANDPROFESSIONSCODE.AND ?G MY LICENSE IS IN FULL FORCE AND EFFECT. W � UCENSE CLASS LIC.NO. ~ DATE CONTRACTOR U � WORKERS'COMPENSATION OECLP.RATION Q � �7 I HfREBV AFF:RM UNDER PENALTY OF PERJURY ONEOFTHE FOLLOWING�ECLAMTIONS: � � I HAVE AND WILL MAMTPIN A GERTI�ICATE Of CONSEM 70 SE:F-INSURE FOR WORKERS' � CAMPENSATION.AS PROVIDED BY SECTION 77000F TME LABOR CODE,FORTHE PERGOFIMANCE ' OF THE WOFiK FOR WHICH THIS PERMIT IS ISSUE�. � W I NAVE AND WILL MAINTAIN WORNERS'COMPENSRTION INSt1RANCE,AS REWIRED BY SECTIDN ¢ 3�00 OF THE LABOR CO�E,FOR THE PERFORMANCE OF TME WORK WH WHICH THIS PERMIT IS � ISSUED.MVWORKERS'COM7E45ATIONINSUAANCECARRIERAN�POLICYNUMBERARE: CONSTRUCTION J � CARRIER PLAN REVIEW � POLICV NUMBER E� CTRI .r�/� q �issEcr�r+E�raTe�an��Eoocn�cEaur�srorzau��mocunASR�m)aa�ssl. PLUMBIN6� � � W MECHANI O Z I CERTIFV 7HAT M TME PERFORMANCE OF THE WORK FOfl WHICH THIS PEFMIT IS ISSUED,I �' SHALL NOT EMPLOY ANY PEHSON IN ANV MANNER 50 AS TO BECOME S1IAJECT TO THE � � WORKERS'GOMPENSATION LAWS OF CAltfOftN7A,AND AGREE THAT�F�SHOULD BECOME INSPECTION FEE � SU&IECTTOTHEWORKERS'COMPENSATIONPROVISIONSOFSECTION37UOOFTHELA80R � � CA�E.ISHALLFORTHWITHCAMPLYWITNTHOSEPROVISIONS. ISSUANCE � SMIP l` , � p DATE: APPLICANT. . W ENERGY P/C J WARNMGFAILURETOSEIXIREWORKERS'COMPENSATIONfAVERAGEISUNtAWFUL,PNOSHALLBE � SU&1ECT AN EMPLOYEfl TO CFIMINAL PENALTIES AND CIVII FINES UP TO ONE HUNDRE�THOU5AN0 ENERGY PERMIT DOlLAFS(f700,000).RJ ADDITION TO THE GOST Of COMPENSATpN,DAMADES AS PROVIDED FOq IN � � SECTION 37oe OFTNE IABOR CODE,MTEiiEST,AND ATTORNEV'S fEES. � � RETENTIOM FEE: � � CONSTRUCTION LENOING AGENCY PRE-ALT FEE: � O � I HERFAV AFFlFM UN�ER PENALTY OF PEfUURV TMAT THERE IS A CANSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERM�T IS ISSUE��SEC.3097,CIV.CJ. � Z w � LENDER'S NAME H IENDER'SADDPE55 � ICERTIFYTHATIHAVEflEADTHISAPPUGATIONANDSTATETHA7THEABOVEINFORMATIONISGORRECL TOTf1L FEES � , � W I AGPEE TO COAAPLV WITH ALL CIN AND COUNTV ORDINANCES AND STATE LP.WS flELATING TO BUILDING � CONSTHl1CT10N,ANDHEREOYAUTHORIZE(lEPRESENTAT!VESOFTHISCWNTYTOENTERUfONTHE zABOVE�MENTIONE07R�PEflTYFOFINSPEGTIONPURPO5E5. COMMENTS � �`}'�1 �e-en 1� �.1 � c�..r m e�e�N.a��.-�v,R,/r,n ^J�/�►,'�/ � t !/ �`O' - ¢ C�..vr��j[� '_� L � 3 ATUREOFPERMITik�E� " " � DATE — RECPL NO. PAID BY YAL �' WHITE—Department Copy.YELLOW—Finance Gopy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—Applicactt's��-opy � € cii-�r oF aran�ar�a B�►� ENSPECTION REC4RD • • � � � - � � � , . � . SET$ACK FLOOR JOIST � FTGSIFORM5/S7EE� FHA REQMTS ELECTRIC GROUND UNDER FLOOR DUCT GROUND PLUMBtNG UNDER FlOOR CO�IDUIT SiAB GRADE FIREPLACE FOUNDATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICE Mld'HT.BOND BEAM I ROOF SHEATHiNG g�' gQ�p g�q� FRAMINGNENTILIATfON FINAL BOND BEAM I ROOF COVER PRE-GRADtNG ' ROUGH HEATING BENCHING RQUGH ELECTRIC ROUGH GRAOIN� ROUGH PLUIVIBING FINISH GRADING SHOW�F�iTUB TEST POOL E�ECTFtIC EXI:LATH/SIDING POO�FENCING I WALL INSULATION POOL FINAL CEILINCa INSULATION OFF SITE IMPS. E DRYWALL NAiLING DEDICATIONS S�W�� FINAL ENG. SEPTtC TANK LANDSCAPE/IRRIG. SEEP PITIL.{.. ON SITE IMPS. CA5 Alfl TEST �INAL ZONING FINAL CONST. -ZS-� FIRE�EPT.FINAL E FiNAL HEATING _� � � �„fi HEAL.TH DEPT.FWAL ( FINAL ELECTRIC � � DEV.FEES PAtD � FINAL PLUM�ING ENERGY � � � � COMMENTS �_:1 � , :i,��s , r i: S�PTIC TANK SIZE SEEP PIT/U SIZE i N � e I