HomeMy WebLinkAbout10-1074 _.�`_ CITY OF DIAMOND BAR �
� DEPARTMENT OF COMMUNITY&DEVELOPMEI�� E I
;,,� , 21825 Copley Drive,Diamond Bar,CA 91765 (� � 7°����n
(909)839-7020 Fax(909)861-3117 Building Inspection Hotline(909) '/U�7 PRESS
""�'� BUILDING PERMIT APPLICATION FIIRMLY
APPL�CATION PERMIT h f p/C
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� ISSUE / TYPE OCC
APN LOT, TRACT DATE J O�- �1��I� CONST.� GROUP
p OWNER KEV�� FfO�-L{ i
a ADDRESS �6'72 C/tonLcf,O �.f2 t�.Gc 1�2. ZONING SETBACKS i
z CITY Dl��g,�.�ryrJ.� �AR,r ZIP ,ly �'fS' TEL.�[�1"-���"�l/L� FRONT qyy p I
� APPLICANT TEL. REAR �
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� CITY RAr.�C Llc� ZIP�I�'30 TEL. $�S� PROPOSED USE /.�,F TS/L �P�!„Yr/ G/-f( -p /7
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� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
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p I HEREBV AFFIHM UNDER PENAL7V OF PERJURV 7HA7 I AM EXEMPT FPOM THE CONTRACTORS LI- G8f3g0/CeryOR
W CENSE LAW FOR THE FOLLOWING REASON(SEC.7031.5 BUSINESS AND PROFESSIONS CADE:ANV CITV OR (n
U COUMVWHICHRE�UIRESAPERMITTOCONSTRUCT,AITER,IMPROVE,DEMOLISH,ORREFAIRANYSTRUC- W Patio/Deck
w TURE,PRIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANT fOR SUCH PERMI7 TO FILE A SIGNED W
� STATEMENT 7HA7 HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CON7RAC70RS LI� �
� CENSE LAW(CHAP7ER 8(COMMENCING WI7H SEC710N 7000)OF DIVISION 3 OF 7HE BUSINESS AND PRO- POOIISPB
, Q FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFOR7HEALLEGEDEXEMP� �
V TION.ANYVIOLATIONOFSECTION7o31.58YANVAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Roof
A CIVIL PENALTV OF NO7 MORE THAN FIVE HUNORED DOLLARS(SSoo).):
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Z MALL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.704�,BU51- � J
N NESS AND PROFESSIONS CODE:7HE CONTRACTORS LICENSE LAW DOES NOT APPLY 70 AN OWNER OF �
PqOPERTY NMO BUILDS OR IMPROVES THEREON,AND NhiO OOES SUCH WORK HIMSELF OR HERSELF OR
wTHROUGH HIS OR HER OWN EMPLOVEES,PROVIDED 7HAT SUCH IMPROVEMENTS ARE NOT IN7ENDED OR m
Q OFFEREDFORSALE.IF,HOWEVER,THEBUILDINGORIMPROVEMENTISSOlDWI7HINONEVEAROFCOMPLE�
Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THA7 HE OR SHE DID NO7 BUILD OR
� IMPROVE FORTHE PUHPOSE OF SALE).
W ❑I,ASONMEROFTHEPROPERTV,AMEXCLUSIVELVCONTRACTINGWI7HLICENSEDCOMRAC70RS
[[ TO CANSTRUCT THE PROJEC7(SEC.7041,BUSINESS ANO PROFESSIONS CADE:THE CONTRACTOPS LI� V21Ufl�lOf1 ADJ.AREA
W CENSE lAW DOES NOT APPLV TOAN OWNER OFA PROPERTV WHO BUILDS OR IMPROVES 7HEREON,AND
� WHOCONTRACTSFORSUCHPROJECTSWITHACANTRAC70R(5)LICENSEDPURSUAN7TOTHECONTRAC- OUANTITY DESCRIPTION FEE
Y TORS LICENSE LAW.).
� ❑I AM EJ(EMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q � C
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DATE OWNEF F � � , �
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� LICENSED CONTFACTORS DECLARATION w � � �
- � I HER6BV AFFIRM UNDER PENALTV OF PERJURY THAT I AM LICENSED UNDEH PROVISIONS OF CHAPTER �
� 8(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z �W (, �
��� AIV LICENSE IS IN FULL FORCE AND EFFECT. m
� LICENSE CLASS /� I �IC.NO. (� ��`'( D..�� �
V DATE jO`�fl�' oZ n I C7 CONTRACTOR .t� �l1�SS�I� d
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� WORKERS'COMPENSATION DECLARATION a
NI HEREBY AfFIRM UNDER PENALTV OF PERJURV ONE OF THE FOLLOWING DECLARA710N5: Z
� I HAVE ANO WILI MAIN7AIN A CERTIFICATE OF CON5EN7 70 SELF-INSURE FOR WOHKERS' ¢
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�PENSATION,AS PROVIDED BY SECTION 3700 OF TNE LABOR CODE,FOR THE PERFORMANCE U
Q THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
� I HAVE AND WILL MAINTAIN WORNERS'COMPENSATION INSURANCE,AS RE�UIRED BV SECTION
Q 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED.MV WORKERS'CAMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION
Q r
� CARRIER /� TV � PLAN REVIEW
ZPOLICVNUMBER ��Q S —1 l O C RIC �e ��
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� (�Fi1SSECTqNNEmNOTBEOJMi�EfEDOFTHEPERMf�ISFORONEHUI�DREDDOLLAF15�5100)ORLESS) PLUMBING
Z I CER7IFV THAT M THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
C} SHALL NOT EMPLOY ANY PERSON IN ANV MANNER 50 AS TO BECOME SUBJECT TO THE
y WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE
� SUBJECT TO THE WORI(ERS'COMPENSATION PpOVI510NS OF SECTION 37000F THE LABOR
� CADE,I SHALL FORTHWITH COMPLV WITH THOSE PROVISIONS. P. E _ �
� SMIP
p DATE; APPLICANT.
J WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALLBE ENERGY P/C
� SUBJEC7 AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP 70 ONE HUNDRED THOUSAND ENERGY PERMIT
DOLLARS(S10o,000J,IN ADDITION 70 7HE COS7 OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
J SECTION 3708 OF THE LABOR CODE,INTEREST,AND A7TORNEV'S FEES.
p� RETENTION FEE: �
� CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
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� I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION IENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.).
Z
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� LENDER'S NAME
F— LENDER'SADDRESS
� TOTAL FEES �-3�
� I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
W I AGREE TO COMPLV WITH ALL CITY AND COUNTV ORDINANCES AND S7ATE LAWS REUTING TO BUILDING
� CONSTRUCTION,ANDHEREBYAUTHORIZEREPRESENTATNESOFTHISCOUNTVTOENTEFiUPONTHE �
� ABOVE�MENTIONED PROPERTY FOR INSPECTION 7URPOSES.
Z COMMENTS
� � 2v 1
m PEFMI77EE NAME(PRINT) �
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� SIGNATUREO PE{iMl EE DA7E
= RECPT.NO. . PAID B � VALIDATION
~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assassor Copy,GOLDEN O�File Copy,GREEN—Applicant's Copy
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SET BACK FLOOR JOIST
FTGS/FORMS/STEEL FHA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR CONDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID H'T. BOND BEAM �
ROOF SHEATHING � 8 FT. BOND BEAM
FRAMINGNENTILATION FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADiNG
SHOWER/TUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
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FINAL ELECTRIC � DEV. FEES PAID
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FINAL PLUMBING ENERGY
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COMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE '
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