HomeMy WebLinkAbout18769 ' � �.,� CIT'Y OF DIAMOND BAR Cj
� DEPARTIv1E'�1T OF COMMi.JNI7'Y&DEVELOPIv�NT SERVICES ����'r o�/
21825 E.Copley Drive
(909)860-3195 Fax(909)861-3ll7 PRESS
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0 ISSUED.MV WORKEflS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBER AAE�. CONSTRUCTION
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Giart�und Bar, CA 91?65 ��
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PERMIT # _ ___--__._ t,,
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FOR INSPECTIGN. HA1lE APPRaVED PI..ANS t3N ]�B AT TIME C3F �NSPECTION. INSPECTION R�QUES�
SNALL BE MADE 24 Ht�URS TN ADVAN�E. Ft'JR INSPECTIGIN REQUEST, F'LEASE CALL 909.8C0.3195.
_ INSPEC'RON y�.� DATE INSPECTOR INSPECTIC>N DATE INSPECTOR----
�etback v _.._ .—.- �. Drywa�l Nailing �,'/,�' c";s f r���---___
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ExcavationJFarms/Fteinforcing ' ` Gas Line Air Test �
----—-- --� -- _.—_�_..__..._
Ground Plumbing T-Bar Ceiling _ _ � _�_
Electrical Ground Smoke Detector(s) � ���_._____
Water Service Fina! Mechanica! � �__ ..___.
Under Slab Ducts Final Electrical ----___..__.__�
Under Slab Conduit Final Plumbing _.. _-----__.__..�_..
Fire lace Four�dation Final Plannin �
_—___._ -- . ._
Joists�Girders__ _ Final Fire D�gt.
Slab Grad� Finai Health Dept. _ _ _
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DC} Nt'�T Ct3NCEAL UNTIL ABOVE ARE SIGNECt Final Canstruction °
--- __ ___ __-- -- - __ . �
Mid-Height Bond 8eam Certificate af C3cc. '
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8 Foat Bond Beam
---.--____ ,_ . __.._�____ ..____ _---..__
�in�! Boncl �3eam y SWIMMING POOL INSPE�'iIUN RECCfftD
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ttoof Sheathinc� �� _s-�-��" � Location ��_ ----��. ______
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Shear IVailing ;���p����(�; '��!-f �%�`� Steel, fiorms &bondin �__- �- _____
--- _____. _�.� - __
Dtl NCDT CONCEAL UN1ZL ABOVE ARE SIGNED Light Conduit
_____.__^__—.�
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F�aming &lie��iildtion -�%t.'�=�)� f rj�
_....______.__�____�_ __— �_� _ __-- -----.
Ft.c�of Covering ,,, DO NQT GUNITE OR POUR UNTIL ABOVE
Ro�c�hiMechanical .W._.__—.. ` � ' =�i +,.--�'� IS SIGNED __
Rou�h Eiectrica3 � �`>,�.'� t` Conduit Under Deck _ ..� __.__
_ftc�ugh�P�umbing Gas T > ` ' GasLine Under Deck �__�__.�
Shower Pan Test WaterLine Under Deck � _
_--_. _�..-- ____ . _ _
Stucc� �1eshJSiding � l�� C� =�` .� P-Trap
D13 NOT CONCEAL UNTIL ABt3VE ARE S GNED DO NI�T POUR DECK UN'TIL ABOVE SIGNED
VVal1 Tnsulation� �� r � Electric Wires _ _
t`.eiliny Insulatiar� Fence & G�tes __� _
C.,ewer poor Alarms
-- -- __ ��_ _`..�__ ------ —___. �
aeptic Tank Rough Wiring
�,eeK�age Pit or Leach Line Fin�l �4ectric _ _ _.
__---�� .� _..____._ __._____ .._._. _ ___.__�___ __ _�
Gas Line Test i
__._ �__._..___ .___._ _ - .�.__ .___._�._e �__ ._ P . __. ._.__
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Fir►al Approval
------_. __------- -- _.�..—.. _ �_______--I _ _. _..__
CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117
BUILDING PERMIT APPLICATION
PRESS
FIRMLY
JOBSITE pI t
ADDRESS T 76�
2
APN LOT TRACT
OWNER?C+-' < �'-^'
42�Z>
ADDRESS Z 7-C�3 t�/Zt'C_<
CITY ZIP'/'TEL. �%L
APPLICANT r TEL.
CONTRACTOR
ADDRESS
CITY ZIP TEL.
NG/EKu &
DESIGN � GIN C
DESIGNER u7 iIJ
ADDRESS
CITY ZIP TEL.
OWNER-BUILDER DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI.
CE14SE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESS AND PROFESSIONS CODE:ANY CITY OR
COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT,ALTER. IMPROVE. DEMOLISH,OR REPAIR ANY STRUC-
TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI-
CENSE LAW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO-
FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP-
TION.ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS TNF APPLICANT TO
A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(5500)).
^ I,AS OWN ER OF THE PROPERTY,OR MY EMPLOYEES WITH WAGES AS I HEAR SOLE COMPENSATION,
WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC. 7044,BUSI-
NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF
PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR
OFFERED FOR SALE. IF,HOWEVER,THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE-
TION.THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OH
IMPROVE FOR THE PURPOSE OF SALE).
L7 I,AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS
TO CONSTRUCTTHE PROJECT(SEC. 7044. BUSINESS AND PROFESSIONS CODE.THE CONTRACTORS LI-
CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO STUDS OR IMPROVES THEREON.AND
WHO CONTRACTS FOR SUCH PROJECTS WITH ACONTRACTORISI LICENSED PURSUANT TO THE CONTRAC-
TORS LICENSE LAW).
0 IA M EX MPT UNDER SEC. P.C. FOR THIS REASO
NER IQ-_AL
LICENSED CONT ACTORS DECLARATIO
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER
9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND
MY LICENSE IS IN FULL FORCE AND EFFECT
LICENSE CLASS LIC N0.
DATE CONTRACTOR
WORKERS'COMPENSATION DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELFINSURE FOR WORKERS'
COMPENSATION.AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.
I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUIRED BY SECTION
3700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED. MY WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE
CARRIER
POLICY NUMBER
(THIS SECTION NEED NOT BE COMPLETED OF THE PERMIT IS FOR ONE HUNDRED DOLLARS(5100)OR LESS)
I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I
SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE
WORKERS'COMPENSATION LAWS OF CALIFORNIA.AND AGREE THAT IF I SHOULD BECOME
SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR
CODE,I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS.
DATE APPLICANT.
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS($100,000),IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN
SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES
CONSTRUCTlON LENDING AGENCY
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS ACONSTRUC)IION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED SEC. 3097,CIV C.)
LENDER'S NAME
LENDER'S ADDRESS
I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT
1 AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE WS RELATING TO BUILDING
CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
ABOVE-TIONED PROPERTY FOR INSPECTION PURPOSES.
PE TTEE A E(PR
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GNAT 0 e ITI'EE DATE
APPLICATION
L PERMIT P/C
T
NUMBER( # L I
UE TYPE OCC
CONST.GROUP
ZONING SETBACKS
FRONT RW
REAR
SIDE/SIDE STREET RW u
SIDE
PROPOSED USE 1 117i,
N0. DWEL. N0. N0.
UNITS STORIES BEDROOMS
DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREA/VALUATION
SF D REM
CO Garage/Carport
W Patio/Deck
I- PooVSpa
Z Re-Roof
Commercial
M
Valuation ADJ.AREA
QUANTITY DESCRIPTION FEE
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INS?ECTlON FEE
ISSUANCE sf
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SMIP
ENERGY P/C
ENERGY PERMIT A�Oj
RETENTION FEE:
PRE-ALT FEE:
TOTAL FEES 6 5. 7 tp
CQMMENTS
P
1
-71
RECPT. 0. PAID BY VALIDATION
ITE-Department Copy,YELI.OW-Finance Copy, PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy
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11
Building&Safety Division
21825 E.Copley Dr.
Diamond Bar,CA 91765
t".,j> vl +: s
PERMIT# DATE ISSUED: 1� 2,
Y4
JOB ADDRESS: DESCRIPTION:
POST IN A SAFE,CONSPICUOUS PLACE AT FRONT OF JOB. PROVIDE PERMITTJUM8ER WHEN CALLING
FOR INSPECTION. HAVE APPROVED PLANS ON JOB AT TIME OF INSPECTION.INSPECTION REQUEST
SHALL BE MADE 24 HOURS IN ADVANCE. FOR INSPECTION REQUEST,PLEASE CALL 909.860.3195.
INSPECTION DATE INSPECTOR INSPECTION DATE INSPECTOR
Setback�--'--- , Drywall Nailing
Excavation/Forms/Reinforcing Gas Line Air Test
Ground Plumbing T-Bar Ceiling
Electrical Ground Smoke Detector(s)
Water Service Final Mechanical -
Under Slab Ducts Final Electrical
Under Slab Conduit
Final Plumbing
Fireplace Foundation
Final Planning
Joists Girders
Final Fire Dept.
Slab Grade Final Health Dept.
DO NOT CONCEAL UNTI L ABOVE ARE SIGNED Final Construction
Mid-Height Bond Beam Certificate of Occ.
8 Foot Bond Beam
Final Bonet Beam SWIMMING POOL INSPECTION RECORD
Roof Sheathing Location
Shear Nailing Steel,forms&bondin
NOT CONCEAL UNTI L ABOVE ARE SIGNED Light Conduit
F"i-aming&Ventilation -<2 0 ,r:jl
Roof Covering DO NOT GUNITE OR POUR U NTIL ABOVE
Rough Mechanical--- ,, IS SIGNED
Rough Electrical Conduit Under Deck
Rough Plumbing Gas T > GasLine Under Deck
Shower Pan Test WaterLine Under Deck
Stucco Mesh/Siding P-Trap
DO NOT CONCEAL UNTI L ABOVE ARE S GNED DO NOT POUR DECK UNTIL ABOVE SIGNED
Wall Insulation -�° Electric Wires
Ceiling Insulation Fence&Gates
sewer poor Alarms
Septic Tank Rough Wiring
Seepage Pit or Leach Line Final Electric
Gas Line Test
Final Approval