HomeMy WebLinkAbout18129 CTTY OF DIAMOND BAR �x�,` r�
--- ���— DEPARTMENT OF COMMUNTI'Y&DEVELOPIvfENT SERVICES
21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 PRESS
�'���� BUILDING PERMiT APPLICATION FIRMLY
¢ DDRIESS � � � 'APPLICATION � � NUMBER / I� #lC
o DATE �
� APN � TRACT ISSUE TYPE � OCC
DATE CONST. GROUP
p OWNER l
o ADDRESS ZONING SETBACKS
z CITY ZIP TEL: '� FRONT qyy p
g APPLICANT 2 ' TEL. REAR p
' SIDE/SIDE STREET qyy p
� CONTRACTOR A��NCEINSTALLER ' • SIDE ❑
ADDRESS
� CITY lakawmrl (T,�P907� TEL. PROPOSEDUSE
oARCH/ENG/
�z DESIGNER NO.DWEL. NO. NO.
n_ ADDRESS
cn UNITS STORIES BEDROOMS
� CITY ZIP TEL.
� DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
O
p I HEREBV AFFIRM UNDER PEWLLTV OF PERIURV THAT I AM EXEMPT FROM THE CANTRACTORS U� GdfOgB/CBfPOR
W CENSEUWFORTHEFOLLOWINGREASON(SEC.7IXi1.5BUSWESSANDPROFESSIONSCODE:ANVCITVOR (n
C..� COUNTYWHICHREOUIRESAPEflMITTOCANSTFiUCT,ALTER,IMPROVE.DEMOLISH,ORREPAIRANYSTRUC- w
w NRE,PRqR TO ITS ISSUANCE./�LSO RC-0UIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Palio/Deck
� STATEMENT THAT HE OR SHE IS LICENSED VURSUANT TO THE PROVISIONS OF THE CANTMCTORS LI�
� � CENSE LAW(p1APTER e(CAMMENCINO WITH SECTqN]000)OF DIVISION 3 OF THE BUSINE55 AND PRO� � Pool/Spa
Q FESSIONSCODE�ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP� (�
V TION.ANV VIOLATION OF SECTION 7031.5 BYANV APPLICANT FOR A PERMIT SU&lECTS THE APPLICANT TO Z Re-Roof
A CML PENALTV OF NOT MORE 7HAN FIVE HUNDRED DOLLARS(f500�.):
� OI,ASOWNEROFTHEPROPERTY,ORMVEMPLOVEESWITHWAOESASTHEIRSOLECOMPENSATION, � COrtIfi18fC18I
Z WIIL DO THE WORK,M1D THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70N,BUSI� J J
� NE55 AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF ?
PROPERTV WHO BUf�DS OR IMPROVES THEREON,AND WHO DOES SUCH WORN HIMSEIF OR HERSEIF OR
w THROUGM HIS OR HER ONRJ EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
Q OFFEREDf-0RSALEIF,FIOWEVER7HEBUIIDINOORIMPROVEMENTISSO�DWITHINONEYEqAOFCOMPLE-
Z TION.THE OWNERAUILDER WILL HAVE THE BURDEN OF PqOVING THAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF SALE).
�yJ OI,ASOWNEROFTHEPROPERTV,AME%CLUSIVELYCANTRACTINGWITHLICENSEDCONTRACTORS
� TO CANSTRUCT THE PRQIECT(SEC.7Ma,BUSINE55 AND PROFESSIONS CADE:THE CONTAACTORS ll- V81U8�10l1 ADJ.AREA
W CENSELAWOOESNOTAPPLVTOANON?JEROFAPROPERTYWHOBUILDSORIMPROVESTHEFEON,AND
� WFiOCONTRACTSFORSUCHPRQIECTSWI7HACOMMCTOR(5)LICENSEDPUHSU�WTTOTHECONTRAG QUANTITY DESCRIPTION FEE
Y TORS LICENSE UW.). .
� ❑I AA1 EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q
� U
� DATE OWNER ¢
Z U
� LICENSED CONTRACTORS DECLARATION . w , �
� I HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � '
� D(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF TI1E BUSINESS AND PROFESSIONS CODE,AND Z
LLI ����ENSE IS IN FULL RCE AND EFFECT. m
� LICENSE CLASS { LIC.NO. ��� � �
U DATE,�I / /"1'� _ CONTRACTOR � a
W v � — � � VCs """,,,,,,��� j�_j
� WORKERS'COMPENSATION DECLARATION�j�p�'TI!/' ¢
Y• -�I{.`� U
� I HEREBV AFFIRIA UNDER PENALTV OF PERJURV ONE OF THE FOLLOWING DECLARATqNS:
� Z
� _I HAVE MID WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' _
� COMPENSATpN,AS PROVIDED BV SECTION 3700 OF THE LABOR CODE,FOH THE PERFORMANCE U
OF TME WORK FOR WHICH 7HI5 PERMIT IS ISSUED. W
� �
W I HAVE AND WILL MAINTAIN WORKERS'CAMFENSATKKJ INSURANCE,AS qEOUIRED BV SECTKKJ r
Q 7700 OF THE LABOR CODE.FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS �'1
ISSUED.MV N S' E TqN ly$�CE CARRIEH AND POLICV NUMBER ARE: CONSTRUCTION U
J f
j CAARIER � PIAN REVIEW
Z POLICV NUMBER ELECTRIC
Q
� (iH55EC110NNE�NOTBE�OMPLEfmOFhEPEFlMfTISFORONEFiIN�FE�D011pA5(E100)OqLESS} PLUMBING
W
Z �CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
C} SMALL NOT EMPIOY ANV PERSON IN ANY MANNER 50 AS TO BECAME SU&IECT TO THE
(/� WORNERS'CAMPENSATION LAWS OF CALIFORNIq AND AQREE THAT IF I SHOULD BECOME INSPECTION FEE
SU&IECT TO THE WORKERS'COMPENSATION PqOVI510N5 OF SECTKKJ 3700 OF THE IABOR
O EIS FORTHWITHCOMPLVWI HO P90V1510J'� / ISSUANCE
`p DATE. Z� APPLICANT. � V- Yl.l'`�e! SMIP '
J WAANINO:FAILURE TO SECURE WOFiKERS'CAMPENSATKKJ COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C
LL SU&IECTANEMPLOVERTOCRIMINALPENALTIES/WDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
DOLLARS(floo,o00�,W ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
� SECTION3�OBOFTHEUBORCODE,MTEREST,ANDATTORNEV'SFEES. AETENTIONFEE:
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT THERE IS ACONSTRUCTION LENDINO AOENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICN 7HI5 PERMIT IS ISSUED(SEC.3097,CIV.C.).
Z
W
� LENDER'S NAME
� LENOER'SADDRE55
w 1 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATqN IS CARRECT. TOTAL FE ES
� I AGREE TO CAMPLV WITH ALL CITV AND CWNTV ORDINANCES AND STATE UWS RELATING TO BUILDING I ��
� CONSTRUCTION,ANDHEREBVAUTFIORIZEREPRESENTATNESOF7HISCWNTVTOENTERUPONTHE
Z ABOVE-MENTqNED PROPERTY FOR INSPECTION PURPOSES. COMMENTS
� c �-�
�
m PE TT NqM (P
a � � ��
�
� SIONATUREOFPERMI EE � D E
� RECPT.NO. PAID BY VALIDATION i
WHITE—Department Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy
��`fT� �f� �Q�f�l�f�9� [��V�3
��J�[�'f�C��"���9 1�[���I��D
° 0 ' � U o D�� � : �G�G3 �° � � DGJ`tt�- �� �
SET BACK � � FLOOR JOIST
FTGS/FORMS/STEEL FHA RECaMTS
ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING ilNDER FLOOR CU�IDUIT
SLAB GRAQE FIREPLACE FOUNDATION
TEA/IP POWER ' FlREPiJaCE 60ND BEAM
',NATER SERVICE � Mlp HT. BOND BEAM �
ROOF SHEATHING � �! &Fl-. BOND BEAM � �
FRAMINGNENT(UATION FlNAL BOND BEAM —T—
ROOF COVER --�---� PRE-GRADING
ROUGH HEATING EENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUNIBING FINISH GHADING
SHOWER/TUB TEST POOL ELEC7RIC
EXT. LATH/SIDING POOL FENCING
WALL INSULATI�N POOL FINAL f
CEILIRIG IfVSULATIOiV OFF SITE IMPS.
DRYWALL.iVAILING QEDICATIONS
SEWER FINAL ENG.
SEPTlC TANK LANDSCAPE/IRR�G.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FIPVAI_CONST. �IRE bEPT. FINAL
FINAL HEATIRIG HEALTH DEPT. FiNAL
FINA�ELECTRlC DEV. FEES PAID
FINAL PLUP/1BING ENERGY
����o
C4iViMEi�TS
SEPTIC TANK SIZE
SEEP PIT/U SIZE —
' �
� , (�
„ � y .