HomeMy WebLinkAbout18386 (11) CTTY OF DIAMOND BAR . � P���'
�---��` — DEPARTIvIENT OF COMMUNTI'Y&DEVELOPIv�NT SERVICES
21525 E.Copley Drive .
(909)860-3195 Fax(909)861-3117 RESS
"'%»�� BUILDING PERMIT APPLICATION FIRMLY
¢ DDRESS �SZ O ,i�'���4�C�iAT��. APPLICATIONYJ q PERMIT P/C
o DATE /�I / ���NUMBER #
� � ISSUE /�-� TYPE p C
APN � v� ACT DATE V L► CONST. GROUP
p OWNER
p ADDRESS ZONING SETBACKS
• z CITY ZIP TEL.
FRONT q�l ❑
o APPLICANT TEL. SIDE/SIDE STREET RW ❑
� CONTRACTOR D•�{'C O /,G� SIDE ❑
ADDRESS C,/ • D U E/L S
� cirv O/2A�/�� ZII���J'�EL. PROPOSE�� n/S Ti.t GG
w ARCWENG/ �/ �y
iz DESIGNER /"���-SE��I �/�� NO.DWEL. ' NO. NO. �
a ADDRESS
N CITY��'l�i✓6�E ZIP��YE . UNITS STORIES BEDROOMS j
� DESCRIPTION SQ.FL FACTOR PSF ADJ.AREANALUATION �
p� OWNER-BUILDER DECLARATION SFR/ADD/REM �'
O
p I HEREBV AFFIRM UNDER PENALTY OF PERIURV THAT I AM E%EMPT FROM iHE CONTRACTOflS LI- Gflf898/CBfPOft
W CENSE UW FOR 7HE FOLLOWINO REASON(SEC.70�1.5 BUSINESSAND PROFESSIONS CODE:ANV CITV OR (n
U �qJrJTVWF{ICHREOUIRESAPERMITTOCANSTRUCT,AITER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC- W Pg(10/D6CI(
w TURE.PRqR TO ITS ISSUANCE,AL50 REDUIRES THE AP7LICANT FOR S�1CH PERMIT TO FILE A SIGNED w
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CANTRACTORS LI� �
� CENSE LAW(C}1APTER 8(COMMENCINO Wlhl SECTKKJ 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� POOUSPO
� FESSIONSCODE)ORTHATHEORSHEISE%EMPTTHEREFROMANDTHEBASISFORTHEALLEOEDE%EMP- (�
TION.M/V VIOLATION OF SECTION 7031.6 BV ANV APPLICANT FOR A PERMIT SU&lECTS THE APPUCANT TO Z Re-Roof
A CIVIL PENALTV OF NOT MORE THM!FNE HUNDRED DOLLARS(f500).):
� ❑I,ASOWNEROFTHEPROPERTV,ORMVEMPLOVEESWITHWA6ESASTHEIRSOLECO/APENSATION, � COrt1rtI01Ci81
Z WILL DO THE WORK,AND THE STRUCNRE IS NOT INTENDED OH OFFERED FOR SALE(SEC.70N,BU51� J
� NE55 M1D PROFESSIONS CODE:THE CONTRACTORS LICENSE UW DOES NOT APPLV TO AN OWNEP OF �
PROPERTY WHO BUIlDS OR IMPROVES 7HEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
wTHROU6H HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMEMSARE NOT INTENDED OR m
0 OFFEREDf-0RS�LEIF,HOWEVERTNEBUILDINOORIMPHOVEMENTISSOLOWITHINONEVEAROFCAMPLE-
Z TION.TME OWNER�BUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF SALE).
w ❑I,ASOWNEROFTHEPROPERTV,AMEXCLUSIVELVCONTRACTINOWITHLICENSEDCANTRACTORS
� TO CONSTRUCT THE PROJECT(SEC,70N,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS ll� V81U8t1Of1 ADJ.AREA
W CENSE LAW DOES NOTAPPLV TOMI OWNER OF A PROPERTV WHO BUILDS OR IMPROVES THEREON,AND
� NRIOCONTRACTSFORSUCH7R0.1ECTSWITHACANTRACTOR(S)LICENSEDPURSUMITTOTHECONTRAC- QUANTITY DESCRIPTION FEE
Y TORS LICENSE LAW.�.
� ❑I AM EXEMPT UNDER SEC. B.6 P.C.FOR THIS REASON Q
?� U
� DA7E OWNER H
Z U
� LICENSED CONTRACTORS DECLARATION W
� I HEREBY AFFIRM UNDEH PENALTV OF PERIURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
� D(COMMENCWO WITH SECTqN 7000)OF DIVISION�OF 7HE BUSINESS AND PROFESSIONS CADE.AND Z
MV UCENSE IS IN FULL F��D.EFFECT. � �/ m
� , ��� �
� LICENSE C �/ �� LIC.NO. �
U DATE � / •O� CONTRACTOR a
W
� WORKERS'COMPENSATION DECLARATION Q
� U
� I HERFBY AFFIRM UNDER PENALTV OF PERIURV ONE OF THE FOLLOW WQ DECLARATIONS: Z ,
� _1 HAVE AND WILL MAINTPJN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WOR)(ERS' _
� COAIPENSATqN,AS PROVIDED BV SECTION 37000FTHE LABOR CADE.FOR THE PERFORMANCE U
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. w
� �
Qw I HAVEAND WIL�MAINTAIN WORKERS'COMPENSATION INSURANCE,AS RE�UIRED BV SECTION
37o00F THE LABOR CADE,FOR THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS f ��. �
ISSUED.MV WORKERS'COMPENSATION INSU C CARRIER AN �Q1CV NUMBER ARE: CONSTRUCTION
� CAflRIER � `J Q I L�_�"' � . PLAN REVIEW �.
ZPOLICV NUMBER ELECTRIC �
Q
0 ((FLLSSECiIONNE�NOTBE�OMPLEfEDOFTHEPEiUNTSFORONEViU1�DNED�OU>175(St00)ORLESS} PLUMBING
W
Z I CERTIFV THAT W THE PERFORAIANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
C'3 SHALL NOT EMPLOV ANV PERSON IN ANY MANNER SO AS TO BECOME SU&IECT TO7HE
(/� WORKERS'COMPENSATION LAWS OF CALIFORNIA AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE
= SUBJECTTOTHEWORKERS'COM7ENSATIONPROVISIONSOFSECTION37o00FTHELABOR
E.I SH/�LL FORTHWITH COMPLY OSE PROVISIONS � ISSUANCE
p DATE� •O APPLIC� SMIP ��T�
J WARNING FAILURE TO SECURE WORKERS'COMPENSATKKJ COVERAGE IS 11NLAWFUL,AND SHALLBE ENERGY P/C
J
� SU6IECTANEMPLOVERTOCRIMINALPENALTIESANDqVILFINESUPTOONEHUNDREDT}KKISAND ENERGYPERMIT
DOLLARS(f 100.000).IN ADDITION TO THE COST OF COMPENSATKKJ,DAMAOES AS PROVIDED FOR IN
� SECTqN3708OFTHEUBORCODE,INTEREST,MlOATTORNEI"5FEE5. RETENTIONFEE:
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBV AFFIRM UNDEF PENALTV OF PERIURV THAT THERE IS A CONSTRUCTION LENOINO AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.30D7,CIV.CJ.
Z
W
� LENDER'S NAME
F— LENDER'SADDRESS
w I CEFTIFV THAT I HAVE READ THIS APPLICATqN pND STATE THAT THE ABOVE INFORMATqN IS CORRECT. TOTAL FE ES , J�
� I AGREE TO COMPLY WITM ALL CITY AND COUNTV ORDINA7JCE5 AND STATE UWS RELATING TO BUILDING
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATNES OF HIS WUNTV TO ENTER UPON THE
Z ABOVE�MENTIONED PROVEflTV FOR INSPECTbN PURPOSES. COMMENTS
� — ��, �,n ,� � �
�
m PERMITTEENPA/E(PRINT)
¢ ��,_.�..�j . �9_ o
E OF PERMITTEE DA7E �
= RECPT.NO. PAID BY VALIDATION
~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLD N D—File Copy,GREEN—ApplicanYs Copy
tCQ`Tf�f �l� ���o'���� ��1�
��- ���f����0��1 V�f��C�L��
0
` 1�� DD GJ� �� ►O��G°�� ` � �C tt � ° o ,`� OG�C�f� �:�
SET BACK � � FLOOR JOIST �
FTGS/FORMS/STEEL FHA REC�MTS �
ELECTRIC GROUND � UNQER FLOOR DUCT
GROUND PLUMBING � UNDER FLOOR CUt�IdUiT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER ` FIREPLACE BOND BEAM
WATER SERVICE MID HT. 80ND BEAPdi •
'ROOF SHEATHING � I 8 FT. BOND BEAM ' ` `
FRAP/IINGNENTILIATI�N FiNAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEA711UG BENCHlNG..
ROUGH ELECTRlC ROUGH GRADING
ROUGH PLUNIBING FINISH GRADING
SNOWER/TUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSUl�lTION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FI(VAL EtVG.
SEPTIC TANK LANDSCAPE/IRRiG.
SEEP PiT/L.L. ' • ON SITE IMPS. �
GAS AIR TEST FINAL ZONING '
FlNAL CONST. �1RE DEPT. FINA!
FlNAL HEATING HEAL7H DEPT. FINAL .
FlIJAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING � ENERGY
`�G�iI O� a c , ,
CONiMERITS
SEP71C TANK SIZE
SEEP PITlU SIZE —
� _,.
� ' _ F � (�s'
�