HomeMy WebLinkAbout14053� � CITY OF DIAMOND BAR . EXPIRED DEPARTMENT OF COMMUNTTY&DEVELOPMENT SERVICES _ � 21660 E.Copley Drive Suitc 190 Q�T 1 6 2QQ� PRESS (909)860-3195 Fax(909)861-3117 ��'^�' BUII.DING PERMIT APPLICATION FIRMLY oN JOBSITE //9� D�fl"�IGDI`Q � �IV,D DATEICATION "/'7� � NU B R � " U�J #lC ADDRESS / � �SSUE TYPE OCC APN LOT TRACT DATE CONST. GROUP �j OWNER � `�'- �` ADDR�7S�S 7 O i �/ �fL U ZONING SETBACKS z CITY .�CJ�S ,f}�tl4IES ZIP� TEL. - / FRONT RW ❑ g APPLICANT � TEL. SIDE/SIDE STREET RW ❑ � CONTRACT n1 SIDE ❑ g ADDRESS PROPOSED USE e r � � � CITY �= .• 'J�-�� ZIP�,J�2 TEL� � DU ARCH/ENG/ z DESIGNER S� � � �"� r � k' ADDRESS ,.� NO.DWEL. NO. NO. NCITY � ZIP TEL.�N� UNITS STORIES BEDROOMS N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADD/REM � I HEREBV AFFlq4 UNDER VEIULTV OF 7ERIURV THAT I AA1 E%EMPT FROM THE CONTRACTORS LI� GflfBAB/COfPOR CENSEUWFORTHEFOILOWINOREA.90N(SEC.7031.6BUSINESSMIDPROFESSIONSCODEANYCIiYOR (n COUHTYWMdIREOUIRESAPER4RTOCONSTRUCT,AITER�PFiOVE.DEMOUSH,ORREPAIRANVSTRUC- W PefIO/DOCk NRE,PRpR TO ITS ISSU/�NCE,AL50 REW IRES TME APPLlCANT FOR SUCH PERMIT TO FILE A SIONED w STA7EMENT THAT HE OR SHE 19 LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI� � CENSE UW(p1ADTER Y(COMMENCPIO W17H SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � POOUSPB FESSIONS CODE)OR THAT HE OR SHE 19 E%EMPT THEREFROM AND THE Bti515 FOR hiE ALLEOED EXEMP� V TqN.AHVVIOLATqNOFSECT10N7091.6BYANVMPLICANTFORAPERMITSU&lECT3THEAPPLICANTTO Z Re-Roof � A CML PENALT/OF NOT AqRE THAN FIVE HUNDRED DOLURS(i:AO).�: � � ❑4��NEROFTHEPROPER7Y,ORMVEMPLOVEESWIhiWAOESAS7HEIqSOLECOMPENSATION, 0 Commerclal . � - - WILL DO THE WORK,ANO THE STRUCTURE IS NO7 INTENDED OR OFFERED FOR S/�LE(SEC.7a1,BUS1- J � NE9S MO PiqFESGKINS CODE:THE CONTRACTORS LICENSE UW DOES NOT APPLV TO AN OWNER OF j . PROPEAf1'NRq BU0.D5 OR IMPROVES TIEREON,AND WHO DOES SUCFI WORK HIIASELF OR HERSELF OR � 7HROUGH HI$OR HER OMM EAIPLOVEES,PROVIDm TFUT SUCH IMVROVEMENTS ARE NOT IMENDED OR m OFFERm FOR SALE IF,FIOWEVER TME BUIlDINO OR IMPHOVEMENT IS SOI,D WITMN ONE YEAR OF COMPLE �'TqN,THE ONTIER�UILDER WILL 11AVE hIE BURDEN OF PROVINO THA7 HE OR SHE DID NO7 BUILD OR � WPROVEFORhfEPURPO5EOF5ALE} I � ❑I,hSOMMEROF 7HE PROPEHTV,MI EXCIUSIVELV CANTRACTINO WRH LICENSED COHTRACTOR3 TO CON9TRUCT TNE PRO.IECT(SEC.70M,BU91NE53 AND PROFESSIONS CODE:THE CONTRACTOfiS LI� V8IU91�0l1 - AQJ.AREJi CENSE UW DOES NOT APPLV TO AN OWNER OF A PROPERTY NM1iO BUtlAS OR MPROVES THEREON.AND • � N1pCONTMCTSFORSUqiPRQIECT5YIITHACONifUCTOR(5)LICENSEDPURSUMlTTOTHECONTMG pUANTITY �.DESCRIPTION � -'h .'`� FEE � � loas uc�se uw.>. O I AM E%EMPT UNDER SEC. 8.8 P.C.FOR THIS REASON � 3 U � Q OA7E OWNER � � • � LICENSED CONTRACTORS DECLAAATION w J � W 1 MEREBV AFFuw UNDER PENALTY OF PERIURV iT1A7 I AM LICENSED UNDER PROVISIONS OF CHAPTER /� � �(COMMENCUJ(i WITM SECTION 7000)OF OIVISION J OF TME BUSINESS M1D PROFESSIONS CODE,AND Z 11`�r V � MY LICENSE IS Rl FULL FOHCE AND EFFECT. / m 0 UCENSECUSS �`�4' LIC.NO. UG.� � �V DATE�� CONTRACTOR �=� � a 13J � �A�� WORKERS'COMPENSATION DECLAHATION Q � I HEREB UNDER PENALTV OF PERJURV ONE OFTHE FOLLOWINO DECURATIONS: Z � _IHAVEANDWILLMAINTAINACEATIFlCATEOFCONSENTTOSELF�INSUREFORWOPKERS' a S Q COMVElISATION,AS PROVIDED BY SECTION 37ao OF THE U�BOR CODE,FOR TME PERFORMANCE �U O OF THE WORN f-0R WHICH TT11S PERMfT 19155UED. � � _I HAVE ANO WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REWIRED BV SECTION � ' Q ]70o OF THE LABOR COOE.FOR TME VERFOPMANCE OF hiE WORK FOR WHICH THIS PERMIT IS � ISSUEO.A1Y WORKERS'COAIPENSATION INSURANCE CARRIER M1D POLICV NUMBER ARE: CONSTRUCTION > -cnnaiER � PIAN REVIEW _�._.� � pI �UQ�I Z voucrw�eER - � ELECTRIC �I i vr Llf'�(y1(}j�fD Bf� / 0 sEc.'int�r�IDrq7aem�rIDaFn�aeaursfnaor�Hu��ooau�aslfioo)oa� PLUMBING �Li�r,-- � ,) 3 � l7 Z I CE IFYTNAT W THE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMI7151SSUED,1 MECHANICAL —��i�,���`+��` (.'J NOT EMPLOV ANY PERSON W ANV MANNER 50 AS TO BECOlAE SU&IECT TO THE � RS'COMPENSATpN UWS OF CALIFORNIA,AND AOREE THAT IF I SFqULD COME INSPECTION FEE TTOTHEWORKERS'C,OMFENSATqN7ROV1 qNSOFSECTION 7000F E�LABOR Oi s warnwirr�cor,�a�r N/nni/rH/qsE/p� wsa,r.+1s. //� ISSUANCE OZ' p 0 . ��I � APFLICAMT. �//!�`�/•�f�!"/ �. / Y.'�� �SMIP w � ENEAGY P/C � �, , I WARHINO:FAILURE TO SEWRE WOfUCERS'COMPENSATION COVERA6E IS UNLAWFUL,AND SHALL BE � SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THWSAN� ENERGY PERMIT DOLLARS(f700,000�,IN ADDfT10N TO iHE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN � SECTION 370!OF THE LABOR CODE,INTEREST,AND ATTORNEI"S FEES. ' RETENTION FEE: d CONSTRUCTION LENDING AGENCY PRE•ALT FEE: O � I HEREBV AFFIRM UNDER PENPLTV OF PERIURV THAT TMEPE IS A CONSTRUCTION LENDIND A6ENCY FOR TME PERFORMANCE OF 7HE WORK FOR NM1ilCH THIS PERMIT IS ISSUED(SEC.30V7,CIV.C.). , Z W � LENDER'S NAME - � LENDERSADDRE55 • ¢ ICERTIFYTHATIHAVEREADTHISAPPLICATIONANDSTATETHATTHEABOVEWFORMATIONISCORRECT. TOTAL FEES � w 1 A�REE 70 CAMPLY N7TH ALL CfTY AND CIXINTY ORDINANCES IND STATE LAWS REL�TINO TO BULDINO � � CONSTFUCT ,ANO HEREBV AUTFK)RIZE REPRESENTATNES OF THIS COUNTV TO ENTER UPON THE - � ABOVE�ME ION PROVERTY FOR INSPECTqN PURPOSES. COMMENTS - � � �- - ��1, � m PERMITTE (PRINn I 'y� � � � ' ���/����`'� l��� / ' .-, .�.. � �� CI N SNiHANREO P.ER/AITTEE / �/� � DATE ' � � � � •- RECPT.NO. oein wy VALIDATION WHITE--Department Copy,YELLOW�inence Copy,PINK—Assessor Copy,GOLDENROD--File Copy,GREEN--ApplicanYs Copy � �,�.�- � ••, CITIf �(F �9��li��l� �10,1(� ;'._. . ,':i�:... II�4SP�C����1 ff�I���ff��D �'ri(;�, .` : i,.1�� p � � �.: � � � ' 0 � � "t � :ti��� � � ^�:l� �'. .�(.�.�G �� ; � -� '�., ,r.. U l� ��.� SET BACK . FLOOR JOIST — , , FTGS/FORMS/STEEL � FHA REQMTS � ELECTRIC GROUND UNDER FLOOR QUCT GROUND PLUMBING � UNDER FLOOR CU�{DUIT ' ' � SLAB GRADE � � . FIREPLACE FOUNQATION TEMP POWER FIREPLACE BOND BEAM WATER SERVICE� - MID HT. BOND.BEAM . � ' ' ROOF SHEATHiNG � ' 8�Fi: BOND BEAM ' ' �'RAMINGNENTILIATION ' • • FINAL BOND BEAM . ROOF CC}VFR PRE-GRADING - ROUGH HEATING � BENCHING. � . ROUGH E�ECTRIC ' � ROUGH GRADING • ROUGH PLUMBWG FINISH GRADING SHUWER/TUB TEST POOL ELECTRIC • EXT. LATH/SIDING -� POOL FENCING WALL INSULATIOPI - POOL FINAL CEiLING IPISULATION � OFF SITE IMPS. DFiYWAL�NAlLING DEDICATIONS . SEWER FINAL ENG. - SEPTIC TANK LANDSCAPE/IRRIG. - 5EEP P!T/LL. ON SITE IMPS. �:�.5 AIR TEST =�� ,q? FINAL ZONlNG — F!hi,�,�,t�ONST. FIRE DEPT. FINAL FitJ%,L NEATING . HEALTH DEPT. FlNAL i�`.x��_ ELECTRIC DEV. FEES PAID ���__.__ . � :.'�s.;_PLUMBING � ENERGY � _ _ _._. � �- -... L� o o �� ' . # ', , '` • _ , . ___ ` �C�t�IMENTS .. - ` � �. . . � SEPTIC TANK SIZE SEEP Pi�T/U SIZE � Y ' ,N ^�.y� �,q . - ' . ;�Y F ��:��. �':� o UV ioY ".A�. ��:�. ��� .4�.:.' ^� a'� � �� ° . :"llU. . - ,� �1. .� � - . � .�� �,�, ��t �. � �� � _ �' <s i . 1