HomeMy WebLinkAbout14992 (32)UI,1)1111U Ii,IR
CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY& DEVELOPMENT SERVICES
21660 E. Copley Drive Suite 190
(909) 860-3195 Fax (9D9) 851-3117
TION '
BUILDING PERMIT APPLICA
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-DATE NUMBER M
DDRESS
DATE CONST. GROUP
ZONING SETBACKS
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APN __LOT TRAC
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SIDEISIDE STREET RW ❑
OWNER A S
PROPOSED USE
ADDRESS
UNITS STORIES BEDROOMS
CITY ZI TE913
DESCRIPTION SO -'FT FACTOR PSF ` - ADJ. AREA/VALUATION
APPLI ANT ki E TE
SFR/ADD/REM
CONTRACTOR III
Garage/Carport
ADDRESS 7!q le
Palio/Dock
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DESIGNER •
Commercial
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OWNER -BUILDER DECLARATION
QUAA.NTITY DIfSCRIPTION F
1 HEREBY AFFRM UNDER PENALTY OF PERJURY THAT IAM EXEMPT FROM THE CONTRACTORS LI-
HCENSE
CENSELAW FOR THE FOLLOWING REASON (SEC. 7031.6 BUSINESS AND PROFESSIONS CODE ANY CITYOR
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COUMY WHICH REOUIIESAPERMTTO CONSTRUCT, ALTER MPROYE, DEMOUSK OR REPWRANY STRUC•
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TORE, PRIOR TO ITS ISSUANCE, ALSO REWIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS U•
S
CENSE LAW (GUIPTER B (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PR0-
FESSIONS CODE) OR THATHE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP-
TION. ANY VIOLATION OF SECTION 7031.6 BYANYAPPLICANT FOR A PERMIT SUBJECTS THEAPPLICANT TO
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A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (SWI E
CLAS OWNER OF THE PROPERTY.OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION.
WILLDO THE WORK, AND THE STRUCTURE IS NOT MENDED OR OFFERED FOR SALE (SEC. 7044. SUSI.
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NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF
PROPERTY WHO BUILDS OR IMPROVES THEREOH.AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
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THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE: NOT INTENDED OR
_
OFFERED FOR SNE IF, HOWEVER THE BUILDING ORIMPROVEMENT IS SOLD WRTNN ONE YEAR OF COMPILE -
TION. THE OWNER.BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DO NOT BUILD OR
IMPROVE FOR THE PURPOSE OF MEL
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C L AS OWNER OF THE PROP ERTY, AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS
TO CONSTRUCT THE PROJECT (SEC 704A. BUSINESS AND PROFESSIONS CODE THE CONTRACTORS U-
11
CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON. AND
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WHO CONTRACTS FORSUCH PFIOJECTS WTTHA CONNTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC-
ELECTRIC -
T .. LICENSE LAW.).
PLUMBING
C IATA EXEMPT UNDER SEC. B. s P.C. FOR THIS REASON
MECHANICAL N Y R -
DATE OWNER
INSPECTION FEE
ISSUANCE 6 V n '
7, 2D09
LICENSED CONTRACTORS DECLARATION
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IHERESYAFFRM UNDER PENALTY OF PERJURYTIAT IAM LICENSED UNDER PROVISIONS OF CHAPTER .
ENERGY P/C lel'
8 COONAF.NOIO WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE. AND
ENERGY PERMIT UJILDING AN
MY LICENSE IS N FULL FORCEMO EFFECT.
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WORKERS' COMPENSATION DECLARATION ,�..: •_" ": _
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I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
RECPT. NO. PAID BY VALIDATION
A CERTIFICATE OF CONS ENT TO SELF -INSURE FOR WORKENS
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_IHAVEANDWALLMMNTAN
COMPENSATION, AS PROVIDED BY SECTION 3700 0 F THE LABOR COO E. FOR THE PERFORMANCE
OF THE WORK FOR WNICH THIS PERMIT 11 ISSUED. -
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HAVE AND WILL MASNPAN WORKERS' COMPENSATION INSURANCE, AS REQUIRED BY SECTION -
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3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WOW( FOR WHICH THIS PERMIT IS
ISSUED. MY�WOO7R•KKEESR_T CCOORjP�.lH(R�ANTIOIN'�IN.SURANCE CARRIER AND POLICY NUMBER ARE: ' . '-
CARRIER JF�1TL'�� • ✓[�'
POUCYMIMSER E `�
(TITSW=MNEMN0TBEpOL IUMOFTHEPEMr ISFORONEIA3t(YDOOIJAns R+oo)OILESSj
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I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I
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SHALL NOT EMPLOY ANY PERSON N ANY MANNER SO AS TO BECOME SUBJECT TO THE
U`3
WORKERS' COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME
SUBJECT TO THE WORKERS' COMPENSATION PRO FSECTION 37000E THE LABOR
ISHAL/L/j�GORT!ry HCOMPLr WITH S.
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C
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DATE: .
i�_�J+APPLIG
SHALL BE
COVERAGE ZONE
YINAL
PEYCOEPE
SUSXCTWAMINGANEURETOSEWRE
HUNFUL DRED THOUSAND
PENALTIES SA AND CMLFNES.UP TODAM ONE MNDPEDTHOUSAND
(3100. 000), N AOOITON TO THE COST Of COMPENSATION. DAMAGES AS PROVIDED FOR K
DOLLARSLJECTANEMPLOYERTOTIONTO
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SECTION37os OF THE LABOR CODE INTEREST, ANDATTORNEY'S FEES.
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CONSTRUCTION LENDING AGENCY
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NEPESYAFFRM UNDER PENALTY OF PERJURY THATTHERE IS ACONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMITIS ISSUED (SEG 3007. CIV G).
LENDERS NAME
Ir
LENDERS ADDRESS
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I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
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(AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
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CONSTRUCTION. AND HEREBY AUTHORIZE REPRESENTATNES OF THIS COUNTY TO ENTER UPON THE
ABOVE.MENTIONED PROPERTY FOR INSPECTIONP}1RPOSES.
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PRESS
WHITE—DWSrtmenl Copy, YELLOW—Finance COpy, PINK—Assessor Copy, GOLDENROD—File Copy, GREEN-,"icant's Copy ✓ %.10
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APPLICATION'10,PERMIT �P/C—/�
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-DATE NUMBER M
ISSUE TYPE OCC ..
DATE CONST. GROUP
ZONING SETBACKS
FRONT �, - "1 RW p
REAR ❑
SIDEISIDE STREET RW ❑
SIDE ❑
PROPOSED USE
NO. DWEL NO. NO. `
UNITS STORIES BEDROOMS
DESCRIPTION SO -'FT FACTOR PSF ` - ADJ. AREA/VALUATION
SFR/ADD/REM
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Garage/Carport
W
Palio/Dock
L-
PDOI/Spa
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Commercial
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Valuation ADJ.AREA
QUAA.NTITY DIfSCRIPTION F
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CONSTRUCTION
PLAN REVIEW
ELECTRIC -
PLUMBING
MECHANICAL N Y R -
INSPECTION FEE
ISSUANCE 6 V n '
7, 2D09
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ENERGY P/C lel'
ENERGY PERMIT UJILDING AN
RETENTION FEE: Q'
PR
TOTAL FEES �� • , S /„
cc Q 44 A1�
anni
RECPT. NO. PAID BY VALIDATION
WHITE—DWSrtmenl Copy, YELLOW—Finance COpy, PINK—Assessor Copy, GOLDENROD—File Copy, GREEN-,"icant's Copy ✓ %.10
CITY OF DIAMOND BAR-
-" INSPECTION'RECORD' -
N, DATIE 'MMOTOR
INSPECTION DATE INSP
SETBACK-
FLOOR JOIST '1} _ "r'. r i''• II
FTGS/FORMS/STEEL% 'p -
FHA REOMTS - - -
ELECTRIC GROUND- - - ` = I
' " " UNDER FLOOR DUCT:
.
GROUND PLUMBING I- fNOt�
UNDER FLOOR CONDUIT:
SLAB GRADE - -
FIREPLACE -FOUNDATION
TEMP POWER - -
FIREPLACE BOND BEAM
WATER SERVICE - - _ _-__ :-- - _
-_ -MID HT. BOND BEAM-
EAM
ROOF SHEATHI G -
ROOF
•
8 FT!BOND BEAM ", - i ., ,,• _
FRAMINGA=ry��1� 7/L/6
FINAL BOND BEAM , : r .
ROOF COVER l
PRE -GRADING -, r . .
ROUGH HEATING -
BENCHING
A j!
ROUGH ELECT RI a - -� � - `
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.
-GASAIRTEST:
FINAL ZONING
FINAL CONST.. - -- t "` ,
FIRE DEPT. FINAL -
FINAL HEATING
HEALTH DEPT. FINAL
-FINAL ELECTRIC - - -
i DEV. FEES PAID
FINAL'PLUMBING
ENERGY:
RyeEF5 il I ol I I<.;
ZVI
COMMENTS -
0-7
-
1
SEPTIC -TANK SIZE
SEEP PITIU SIZE