HomeMy WebLinkAbout17838 CITY OF DIAMOND BAR �x�f'r'��
-----��` — DEPARTMENT OF COARv1UNTI'1'&DEVELOPMENT SERVICES
21825 E.Copley Drive
- (909)860-3195 Faac(909)861-3117 PRESS
''%���� BUILDINGP�RMITAPPLICATION FIRMLY
oN JOBSITE � APPLICATION ,(�� PERMIT ( �� P/�
ADDRESS V DATE "" � NUMBER #
� ISSUE TYPE OCC
APN LOT TRACT DATE � CONST. GROUP
p OWNER
o ADDR S ZONING SETBACKS
z CITY � ZIP TEL. �(,Li�'� • FRONT qyy ❑
� APPLICANT TEL. REAR ❑
z SIDE/SIDE STREET RW ❑
� CONTRACTOR � ` SIDE ❑
ADDRESS �
o CITY F�t'�l���YY1. ZIP TEL.�«`j��7' PROPOSED USE
o ARCH/ENG/
�z DESIGNER NO.DWEL. NO. NO.
a ADDRESS
� CITY ZIP TEL. UNITS STORIES BEDROOMS
�
N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUIIDER DECLARATION SFR/ADD/REM
O
� I HEREBV AFFlRAI UNDER PENALTV OF PERJURY THAT I MI E%EMPT FROM THE CONTRACTORS LI- G8f89B/C8lPOft
W CENSE UW FOR THE FOLLOWINO REASON(SEC.7031.5 BUSINESSANO PROFESSIONS CODE PNY CITV OR (n
U COUNTYNRiIqIREOUIRESAPERMITTOCONSTRUCT,ALTER.IMPROVE,DEMOLISH,ORHEPAIRANVSTRUC- W paCw/Deck
Z NRE,PRIOR TO RS ISSUANCE,AL50 REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIONED W
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO 7HE PROVISIONS OF THE CONTRACTORS LI� �
� CENSE UW(CHAVTER Y(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF iHE BUSINESS AN�PRO- PooUSpa
� FESSIONSCODE)ORTHATHEORSHEISE%EMPTTHEFEFROMAN�THEBASISFORTHEALLEGEDEXEMP� (�
TqN.ANV VIOLATION OF SECTION 7031.6 BV ANV APFLICANT FOR A PERMIT SU&lECTS THE APPLICANT TO Z Re-Roof
A CML PENAL7Y OF NOT MORE hiPN FNE HUNDRED DOLLARS(f5o0)J:
� �I,ASON7JEROFTHEPROPERTY,ORMVEMPIOYEESWITHWA0ESA5THEIRSOLECOMPENSATION, � COR1ff1B�Ci8I
Z WILL DO THE WORK,AND iHE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7oN,BUSI- J
� NESS AND PROFESSIONS COOE:THE CONTRACTORS LICENSE UW DOES NOT APPLV TO AN OWNER OF �
PROPERTV WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSEIF OR HERSELF OR
wTHROUGN HIS OR HER ONM EMPLOVEES,PROVIDED TiAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
Q OFFEREDFORS�LEIF,FIOWEVERTMEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE-
. Z TION,THE OWNER�BUILDER WILL HAVE THE BUROEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR
� IA/PROVE FOR THE VURPOSE OF SALE).
�y,� ❑I,AS OWNER OF THE PROPERiY,AM EXCLUSNELY CAN7RACTINO WITH LICENSED CONTRAC70RS
� TO CONSTRUCT T1E PR0.IECT(SEC.7W1,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS Ll- V8IU0SIOf1 ADJ.AREA
W CENSEUWDOESNOTAPPLYTOANONTJEROFAPROPERTVWHOBUILDSORIMPROVESTHEREON,AND
� WHOCONTRACTSFORSUCHPRq1ECTSWITHACONTRACTOR(5)UCENSEDPURSUANTTOTHECONTRAG QUANTITY DESCFIPTION FEE
Y TOfi5L10ENSELAW.).
� ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q
?� U
� DATE OWNER ¢
�Q LICENSED CONTRACTORS DECLARATION w
CC I HEREBV AFFIRM UNDER PENALTY OF PERIURY THAT 1 AM LICENSED UNDER PROVISqNS OF CHAPTEfi � .
� D(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PROFESSKKJS CODE,AND Z
X`I MY LICENSE IS IN FULL FORCE M1D EFFECT. m
L�I
� LICENSE CLA �LIC.NO. �
V DATE O� CONTRACTOR d
W �
� WORKERS'COMPENSATION DECLARATION Q
N U
� I HER�Y AFFIRM UNOER PENALTV OF PERJURV ONE OF THE f-0LLOWING DECLAMTIONS: Z
�Z _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WOR1(ERS' ¢
Q
COMPENSATION,AS PROVIOED BV SECTION 370o OF TME IABOR CODE,FOR THE PERFORMMICE w
OF THE WORN f-0R WHICH THIS PERMIT IS ISSUED. �
� \
w HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS RC-0UIRED BY SECTION
Q 37000Fh1EL}BORCODE,FORTHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMRIS
ISSUED.MV WORKE S' OMPEN TION INSURiy/CE CAARIEF AN POLICv NUMBERARE: CONSTRUCTION
jCARRIER tTlJ Y� �_ PLAN REVIEW
0 POLICV NUMBER �� ��
Z . ELECTRIC
Q
� (1WSSECTqNNE�NDTBEODMPLEfmOfT{VE{A1Tt$FpqpNE{{U.pqEpppupRS(s100)ORLESS� PLUMBING
W
Z I CERTIFV THAT INTHE PERFORA/ANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
('} SHALL NOT EMPLOY ANV PERSON IN ANV MANNER SO AS TO BECOME SU&IECT TO THE
(n WORNERS'COMPENSATqNLAW50FCALIFORNIANdDAGREETHATIFIS OBECAME INSPECTIONFEE
SU&IECT TO THE MIORKERS'CAMPENSATION PROVISIONS OF SECTqN 3700 THE IABOR w
S COOE,I F THWITH COMPLV WIT/THO E P ISIONS. ISSUANCE !�/ .
O �q _
p DATE: V PPLICANP. SMIP
W
� WARNING:FAILUFE TO SECURE WORKERS'COMPENSATKKJ CAVEFAGE IS UNLAWF L,AND SHALL BE ENERGY P/C
� SU&IECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDhqUSAND ENERGYPERMIT
DOLLARS(f 100.000),W ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
� SECTION 3708 OF TME LABOR CODE,INTEREST,AND ATTORNE'f5 FEES. RETENTION FEE:
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS A CONSTRUCTION IENDINO AGENCV
FOfl THE PERf-0RMANCE OF hIE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.J.
Z
W
� LENDER'S NAME
I-- LENDERSADDRESS T
w I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT hIE ABOVE INFORMATION IS CARRECT. TOTAL FE ES � � V
� I AGHEE TO COMPLV WITH ALL CITY AND CWNTV ORDINlWCES AND STATE LAWS REUTINO TO BUILDING
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATNES OF THIS COUNTV TO EMER UPON THE
Z ABOVE-ME IONE PROPERTV FOR INSPECTION PURPOS .
� COMMENTS
J
�
m PEFMI EE NM1 RINn
Q
� �
� SIO P TTEE `` DA E�
= RECPT.NO. PAID BY VALIDATION
• ~ WHITE—Depertment Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENR D—File Co GREEN—
py, ApplicanYs Copy
��1�Y �(F �6�1f�icCDf�9� �Q[�
s�����C3'9C�f�9 �(�t���B�D
� ° ���°�• 11`�`�� � ° � n � � �`� �� o o �-�" �-, �;� �[�L�Uo��°sa�..
SET BACK FLOOR JOIST
FTGS/FORMSlS7EEL FHA RE�M75
ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR CUMDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID HT. BOND BEAM
ROOF SHEATHING S Ff. BOND BEAM
FRAiVIINGNENTILIATION FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHlNG
ROUGH ELECTRIC ROUGN GRADING
ROUGH PLUIVIBlNG FINISH �RADING
SHOWER/TUB TEST POOL ELECTRIG
EXT. LATH/SIDWG POOL FENCING
WALL INSULATION POOL FINAL
CEI�ING INSULATIOfV OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINA�ENG. �
SEPTfC TANK LANDSCAPE/IRRIG.
SEEP PfT/L.L. ON SITE IMPS. '
GAS AIR TEST FINAL ZONING
FINAL CONST. FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
F1NAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING EIVERGY
���o
COfi�NiENTS
SEPTIC TAiVK SIZE
SEEP PIT/U SIZE
�
� [�
� �