HomeMy WebLinkAbout10-1067 ----1�--
C1TY OF DIAMOND BAR ���� ��U ��
�- - � DEPARTMENT OF COMMUNTI'Y&��I�
,� , .
21825 E.Copley Drive UC�45 n(��(�f}Q(�{'� F� ESS
.,,,,y�,.w (909)860-3195 Fax(909)861-3117 U u i� �� i�ui.�
BUILDING PERNIIT APPLICATION RMLY
N JOBSITE G� � �� I APPLICATION c/ PERMIT/0 r0/ � P/C I
o ADDRESS / DATE �d`/�7�D. NUMBEo( 7 IQ #
� issue TYPE occ
APN-��LOT TRA DATE �O�� ��D CONST.� GROUP
p OWNER /'! �,r ) //!�f i .
o ADDRESS K �'� 7 ZONING SETBACKS
Z CITY I�TEL. G�� 7 FRONT RW ❑
o APPUCANT l 7, O /^. TE �� SIDE/SIDE STREET RW ❑
z
� CONTRACTO G- SIDE ❑
o ADDRE d �� PROPOSED USE '��A�il QX%t �''t5 /C���^' £ �u
cirv ziP TEL.�lio�G"35�� �—� /� ��•
w ARCH/ENG/ �
z DESIGNER NO.DWEL. NO. NO.
a ADDRESS UNITS STORIES � BEDROOMS
� CITY ZIP TEL.
�
�n DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION _SFR/ADD/REM
O
I HEREBV AFFIRM UNDER PENAL7Y OF PERIURV THA7 I AM E%EMPT FROM THE CON7RAC70RS LI- G8f9JB/C9�OR
W CENSEUWFORTHEFOLLOWINOREASON(SEC.7o31.58USINESSANDVROFESSIONSCADE:ANYCI7VOR (n
U COUNTYWHICHREOUIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC- W patio/Deck
Z TURE,PRIOR TO ITS ISSUANCE,ALSO RE�UIRES THE APPLICAHT FOR SUCH PERMIT TO FILE A SIGNED
w STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CON7RACTORS LI• W
� CENSE UW(CHAPTER Y(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � POOVSpB
FESSIONSCODE)OR7}iATHEORSHEISEXEMPTTHEREFROMANDTHEBA515FOHTHEALLEGEDEXEMP- (� ,
� TION.ANVVIOUTIONOFSECTION7091.5BVANYAPPLICANTFORAPERMITSU&lECTSTHEAPPLICANTTO Z Re-Root �
A CIVIL PENALTV OF NO7 MORE THAN FIVE HUNORED DOLLARS(i500).�:
Z ❑I,ASOVMEROFTHEPROPERTY,ORMVEMPLOYEESWITHWAGES THEIRSOLECAMPENSATION, 0 Commercial . - �
MAIL DO THE WORK,AND THE STRUCTURE IS NOT IN7ENDED OR OF ED FOR SALE(SEC.701�,BUSI� J
� NESS AND PROFESSIONS CODE:THE CON7RACTORS LICENSE OES NOT APPLY TO AN OWNER OF �
PROPEHfYNRiOBU�LDSORIMPROVESTHEFEON,ANDWHO SUCHWORKHIMSELFORHERSELFOR m
� THROUGH HIS OR HER OWN EMPLOYEES,PROVIDED THAT H IMPROVEMENTS ARE NOT INTENDED OR
QOFFEREDFORSALEIFHOWEVER7NEBUILDINGORIMP MENTISSIXDWITHINONEYEAROFCOMPLE-
Z TION,THE OWNER�BUILDER WILL MAVE THE BURDE F PROVING THAT HE OR SHE�ID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF SALE).
w ❑I,ASOWNEROFTHEPROPEHTY,AMEX SIVELVCONTRACTINGWITHLICENSEDCONTMCTOHS
� TO CONSTRUCT THE PR0.IECT(SEC.704/, INESS AND PROFESSIONS CODE:THE CONTRACTORS LI- V81U8f1Of1 ADJ.AREA '
� CENSE LAW DOES NO7APPLY TO AIJ O OFA 7ROPERTY WHO BUILDS OR IMPROVES THEREON,AND
WHOCONTRACTSFORSUCHPR0.IECT ITHACONTRACTOR(S)LICENSEDPURSUANTTOTHECANTRAG QUANTITY DESCRIPTION FEE �
Y TORS IJCENSE UW.). ..
¢ ❑I MI EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON U 6(J �
�
li.. �
DATE OWNER U
Z w
� LICENSED CONTRACTORS DECLARATION W
� I HEREBY AFFIRM UNDER PENALTV OF PERIURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � ,
� e(COMMENCINO WITH SECTION 7000)OF DIVISION 30F THE BUSINESS AND PROFESSIONS CODE,AND Z
X`� MV LICENSE IS ItJ FULL FORCE AND EFFECT. r� m
� UCENSE CLASS LIC.NO. 1 �%�""'V �
H /� -�,` �
V DATE!U di4—�/A CONTRACTOR d
W
� WORKERS'COMPENSATION DECLARATION Q O u
= U
� I HEREBY AFFIRM UNDEH PENAL7Y OF PERIURY ONE OF THE FOLLOWING DECUMTIONS: Z �
� _IHAVEANDWILLMAINTAINACEF7�IFICATEOFCONSENTTOSELF-INSUREFORWORKERS' _ , .
COMPENSATION,AS PROVIDED BY SECTION 37000F THE LABOR CADE,FOH THE PERFOPMAtJCE U
Q OF 7HE WORK FOR WHICH THIS PERMIT IS ISSUED. �
0
w �I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION
Q 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED.MY WORKERS'COA�PENSATION INS ANCE C RRIER AND POIICY NUMBER ARE: CONSTRUCTION
¢ �
� CARRIER L! � !C PLAN REVIEW�
ZPOLICV NUMBER ��� 6� �1. RIC
¢ (iHSSECf10NNE�NOTBE00AGLEfmOFhEPERAfflSFaRONEMRDREDDOUAiLS�S10U)ORLESSA PLUMB
� '
W � �
Z I CEHTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I HANIC
�(!j SHALL NOT EMPLOY ANV PEHSON IN ANY MANNER BECAME SUBJECT TO THE .
� WOHKERS'COMPENSATION LAWS OF CALIFOR AND AG EE THAT IF I SHOULD BE E INSPECTION FEE
SUBJECTTO THE WORKERS'COMPENSATIO OVISION OF SECTION 37000F R
� CODE,�SHALL FORTHWI7H COMPLY WITH OSE PRO IONS. NCE
� DATE(O •�� �SMIP
p APPLICANT:
J WARNING:FAILURE TO SECUflE WORKERS'COMP NSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C
� SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP 700NE HUNDRE�THOUSAND ENERGY PERMIT
DOLURS(floo,000).IN/�DDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOH IN
� SECTION 3708 OF THE LABOR CODE;INTEREST,ANO ATTORNEY'S FEES. ' TI FEE: �
d CONSTRUCTION LENDING AGENCY pRE-ALT FEE:
O
� I HEREBV AFFIHM UNDER PENALTY OF PERIURV THAT THERE IS A RUCTION LENDING AGENCV
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PER ISSUED(SEC.30W,CIV.C.�. �
Z
W
� LENDER'S NAME
F- LENDER'S ADDRESS
� /`
�' ICERTIFY7HATIHAVEREADTHISAPPLICA710NANDSTATETHATTHEABOVEINFORMATpNISCORRECT. TOTAL FEES I � � �
W I AGHEE TO CAMPLV WITH ALL CITY AND COUNTV ORDINANCES AND STATE UWS RELA71N0 TO BUILDING
� CONS7RUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON 7HE �.
ZABOVE�MENTIONED ROPERTV FOR INSPEC710N PURPOSES. COMMENTS �
�
.__1
�
m PERMITTEE AME(P
Q
� �
N SIGNATURE OF PERMI ATE �
= RECPT.NO. PAID BY VALIDATION
~ WHITE—Department Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLD OD—File Copy,GREEN—ApplicanPs Copy
1 ,
� ,. . .. � . . .. . ' .w'v, < ��. ., . .2rt:: . .'f' S� . :3r:. .i�.re „ ..µ.; .. �, . ., >.r. .Y';�� .:! ���. . ., . .. / .. , .: . .., .... Y5e _
U w�� r�..� �"/�k,;.�W iJ �1�0��11 �� �Q�IIH��OCI� �P�UI(-'G •.l .�� , ��....; ;a
� � �������� �L�����
�� f �,
��� �Q� � � � �� �Q Il� �� � �
SET BACK ` � FLOOR JOIST
FTGS/FORMS/STEEL e FHA REQMTS
ELECTRIC GROUND UNDER FLOOR DUCT . '
GROUND PLUMBING UNDER FLOOR CU�IDUIT � • -
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BONQ BEAM
WATER SERVICE MID HT. BOND BEAM
ROOF SHEATHING 8 FT. BOND BEAM •
FRAMINGNENTILIATION FINAL BUND BEAM
ROOF COVER ` PRE-GRADING
ROUGH HEATING BENCHING
, ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUNIBING FINISH GRADING
SHOWERlTUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL
CEILIfVG 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
FINA�CONST. Z FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBIfVG ENERGY
C�Gfi�OI� o � o � ,
COiViiViENTS �ca
SEPTIC TANK SIZE
SEEP PIT/U SIZE
�
� '�
�