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HomeMy WebLinkAbout16644 CITY OF DIAMOND BAR � -----��`— DEPARTMENT OF COIvIIvtUNITY&DEVELOPIvtENT SERVICES v 21825 E.Copley Drive PRESS � (909)860-3195 Fax(909)861-3117 "":c;�''� BUILDING PERMIT APPLICATION FIRMLY Q DDRESS ��� �����/—�- DATE'CATION � � � �J NUMBER lV`� #1C � Q ISSUE n'PE � APN LOT TRACT DATE CONST. GROUP � OWNER � � ZONING SETBACKS o ADDRESS FRONT RW ❑ w CITY ZIPC�1�6ri TEI. 3- '� z REAR ❑ � APPLICANT TEL. S SIDE/SIDE STREET RW ❑ � CONTRACTOR SIDE � � ADDRESS /� PROPOSED USE q � C�Ty ZIP _L.�T TEL g/lJ CLCL_ ---------- w ARCH/ENG/ z DESIGNER NO.DWEL. NO. NO. a ADDRESS UNITS STORIES BEDROOMS NC�Ty ZIP TEL. N DESCRIPTION S�.Ff. FACTOR PSF ADJ.AREANALUATION � OWNER-BUILDER DECLARATION SFR/ADD/REM O I HEFEBV AFFIRM UNDER PENALTV OF PERIURV TFIAT I AM E%EMPT FROM THE CONTMCTORS LI� G8f8gB/CB�OII W CENSEUWFORTHEFOLLOWINaREASON(SEC.7031.5BUSINESSANDPROFESSIONSCODE:ANVCITYOR (,() U CWNTVWHICHREOUIRESAPERMITTOCANSTRUCT,ALTERIMPROVE,DEIAOUSN.ORREPAIRANVSTRUC� IW P8f10/DBCI( wNRE.PRIOF TO ITS ISSUANCE.ALSO FEQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED � STATEMEM THAT HE OR SHE IS 110ENSED WRSUANT TO THE PROVISIONS OF THE CONTfiACTOPS LI� � p�USpa � CENSE LAW(CNAPTER D(COMMENCWO WITH SECTION 7000)OF DIVISION 3 OF 7HE BUSINESS AND PRO� � ^ FESSIONSCODE)ORTFIATHEORSHE�SEXEMP7THEREFROMMIDTHEBASISFORTHEALLEGEDE%EMP- V TION.AM'VIOLATION OF SECTION 70J1.6 BV ANY APPLICANT FOR A PERMIT SU&lECTS THE APPLICANT T0 Z Re-Rool � A CIVIL PENAL7Y OF NOT MORE TNAN FIVE HUNDRED DOLUHS(fb00�J: l � O�.�ONRJEPOFTHEPROPERTV.ORMVEMPLOVEESWITHWAGESASTHEIRSOIECOMPENSATION. 0 Commerciaf Z WILL DO hiE WORI(.AND iHE STRUCTUFE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7W1,BU51� J N NE55 AND PHOFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV 70 AN OWNER OF � PROPERTYVhiOBUhDSORIMPROVESTHEfiEON,ANDWMODOE55UCHWOFKHUASELFORNEHSELFOR m � THROUGH HIS OR HER OWN EMPLOYEES,PROVIDED hIAT SUCM IMPROVEMENTS ARE NOT INTENDED OR QOFFEREDFORSALEIF,HOWEVERTMEBUILOINGORIMPROVEMENTISSOIDWITHINONE�EAROFCOMPLE- Z TION,7HE OWNER�BUIIDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUIID OR � IMPROVEFORTHEPURPOSEOFSALE). w ❑I.ASOWNEROFTHEPROPER7Y.AME%CWSIVELYCANTRACTWGWf�FiUCENSEOCONTRACTORS TO CONSTRUCT THE PR0.IECT(SEC.)oM,BUSINESS AND PROFESS�ONS CODE:THE CONTW CTORS LI� V81U8�iOf1 ADJ.AREA W� CENSELAWOOESNOTAPPLVTOANOWNEflOFAPROPERTVWF109UILD50RIMPROVESTMEREON.AND Z WIIOCONTMCTSFORSUCHPROJECTSWfTHACON�MCTOR�S)LICENSEDPURSUAN"fTOTMECONTRAG QUANTITY DESCRIP710N FEE Y 70RS LICENSE UW.). J O �E7(EMPT UNDER SEC. B.8 P.C.FOR 7HI5 REASON U � � � DATE I OWNER � tl V Z W � ICENSED CONTRACTORS DECLARATION -� � W I HEREBV AFFlRM UNDER PENALT'OF PERIUFV THAT I AM UCENSED UNDER PROVISIONS OF CHAPTER Vr d e(COMMENpNO WfTH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE.AND Z X MV UCENSE l5 W FULL FORCE AND EFFECT. /,� m � UCENSE CIASS ��T UC.NO. `J ,�O�• � V pq7E I CONTRACTOR d . W � WORKERS'COMPENSATION DECLARATION J Q N U N I HEREBV AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWINO DECLAMTIONS: Z Q � _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-lNSURE FOR N"ORNERS' 2 Q COMVENSATpN,AS PROVIDED BY SECTION 3700 OF TME LA80R CODE,FOR THE PEHFORMANCE w OF THE WORK FOR WHICH THIS PEFMIT IS ISSUED. � � W I HAVEAND WILL MAINTAIN WORKERS'C0/.1PENSATION INSURANCE.AS REWIRED BY SECTION Q 37000FTHEUBORCADE,FORTHEPERWRMANCEOFTHEWOHI(FORWHICHhIISPERMiT15 ` ISSUED.MV WORKERS'CAMPENSATION INSURANCE CARRIER AN�POLICV NUMBER ARE: CONSTRUCTION � CARRIER PLAN REVIEW Z POLICY NUMBER ELECTRIC ¢ PLUMBING � (iFLLSSEC[/�NNEHINO7BEOJl.PIE�IDOFT1EPEfMCtSGORONEF0.1DDFiED00LL0ASRtW)ORIESS) w MECHANICAL Z I CERTIFV THAT W THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I (} SHqLL NOT EMPIOV ANV PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE � �' �•-. t � WOHI(ERS'CAMPENSATION LAWS OF CAUFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE F SUBJECT TO THE N�ORKERS'COMPENSATION PROVIS�ONS OF SECTION 7�00 OF THE LABOR � � CODE.I SHALL FORTHWI7H COMPLV WITH TFIOSE PROVISIONS. ISSUANCE � O SMIP p DATE: AP%.ICANT: � J ENERGY P/C J WARNIN(i:FA1LURETOSECUREWORKERS'CAMPENSATIONCOVERACEISUNLAWFUL.lWDSHALLBE �—y SU6IECTANEMPLOVERTOCRIMWN.PENALTIESANDCIVILFWESUPTOONEHUNDREDTFKKISAND ENERGYPERMIT _____, pOLLARS(f t 00,000).IN I.�DITION TO THE COST OF COMPENSATION.DAMAOES AS PROVIDED FOR IN --_._. J SECTION 37oB OF TNE LABOF('ADE,INTEREST,M!D ATTORNEYS FEES. RETENTION FEE: � a CONSTRUCTION IENDING AGENCY PRE-ALT FEE: � I HEREBV AFFIfUI UNDER PENALTY OF PERJURY THAT THERE�5 A CONSTRUCTION LENOINa AGENCV n- FOR TNE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS�SSUED(SEC.3a97,qV.C.). ' Z W � LENDERS NAME F- LENDERSADORE55 Q ICERTIFVTHATIHAVEREADTH�SAPPLICATIONAN�STATETHATTHEABOVEINFORMATIONISCORNECT. �TOTAL FEES � � w I AGREE TO COMPL�WITH ALL CITV AND COUNTY ORDINANCES AND STATE UWS REUTINO TO BUILDINO ((��,, � CANSTRUCTION,AND HEREBV AUTHOFIZE NEPRESENTATNES OF TMIS COUNTY TO ENTER UPON THE ��, 1�/�1 �� � ABOVE-MENTIONEDPROPERTYfORINSPECTIONPURPOSES. ,_ � COMMENTS /V r r � � SeNy �� �� � QPERMITfEENAME I � -�� ' v N � N 516N�TURE� oATE RECPT.NO. •PAID BY VALIDATION h WHITE—Department Copy,VEILOW—Finence Copy.PINK—Assessor Copy,GOIAENROD—File Copy,GREEN—ApplicanYs Copy (C�lt"�-f �f� fI�U�6���� [��� Qb�l�f�f���'9�Gl�1 f�C����L�D �° �� :ti � DQ`u� D��C� f D��� . a �� , �� � l� SET BACK FLOOR JOIST FTGS/FORMS/S7EEL FHA RECIMTS ' ELECTRIC GROUND ' UNDER FL�OR DUCT GROUND PWMBING UNDER FLOOR CUf�IDUIT SLAB GRADE ' FIREPL�CE FOUNDATION TEMP POWER FIREI'LACE BONQ BEAM WATER SERVICE � MID HT. BOND BEAM ROOF SHEATHING 8 FT. B�NO BEAM FRAMINGNENT(LIAT'I�N FINAL BOND BEAM ROOF COVER PRE-GRADING ROUGH HEATING BENCHlNG ROUGH ELECTRIC AOUGH GRADING ROUGH PLUfVIBING FINISH GRADING SHOWERrI'UB TEST POOL ELECTRIC EX7. LATH/SIDING POOL FENCING WALL INSULATION POOL FINAL CEILING IN�ULATION OFF SITE IMPS. i DRYWALL NAILIfdG DEDlCATIONS i SEWER FINA�ENG. SEPTIC TANK LANDSCAPE/IRRIG. SEEP PIT/L.L. ON SITE IMPS. GAS AIR TEST FINAL ZONING FINAL CONST. FIRE DEPT. FINAL FINAL I-lEATING HEALTH DEPT. FINA� FINAL ELECTRIC DEV. FEES PAID FINAL PLUP/iBING ENERGY C�l��OG o � o� m. � •.LL CONIMEIVTS SEPTIC TANK SIZE SEEP PIT/U SIZE � , l�i � —_ �