HomeMy WebLinkAbout10575 (5)CITY OF DIAMOND BAR'.
COMMUNITY DEVELOPMENT DEPARTMENT
;.. ' 21660 E. Copley Drive Suite 190
(909) MO -3195 Fax (909) 861.3117
BUILDING PERMIT APPLICATION
JOBSITE 7
.ADDRESS 1J�o
D aM0nc ?_1&r 1DxVA-
APN LOT TRACT
OWNER i r6 DA
ADDRESS OYI V
CITY r ZIP TEL 714
.
APPLICANT TEL.&Z&- - 110
CONTRACTOR
ADDRESS 1I3c.N )Yl \YT1c7S G
CITY ,;aYi nxmroSZIP q%1_1 TELdbab 4962-0)
ARCH/ENG/
DESIGNER
ADDRESS
CITY ZIP TEL.
OWNER -BUILDER DECLARATION
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS U -
CENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSNESSAND PROFESSIONS CODE: ANY CITYOR
COUNTY WHICH REWRESA PERMIT TO CONSTRUCT,ALTEFL IMPROVE. OEMOUSKOR REPMRANYSTRUC.
TURF- PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
STATEMENT THAT HE OR SHE M LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS L4
CENSE LAW (CHAPTER S (COMMENCING WITH SECTION 7000) OF DrV%ON 0 OF THE BUSINESS AND PRO•
FESSIONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP-
TION. ANY VIOLATION OF SECTION 7001.5 BYANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO
A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (SSW).):
O L AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION,
WILL DO 714E WOIL AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044. IUSI.
NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF
PROPERTY WHO BUILDS 0 IMPROVES THERECN,ANO WHO DOES SUCH WORK HIMSELF OR HERSELF OR
THROUGH HIS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTSARE NOT MENDED OR
OFFERED FORSALE IF, IOWEVERLTHE BUILDING OR IMPROVEMENT IS SOLD N7THINONE YEAR OF COMPLE•
TION. THE OWNERDURDEn WALL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
IMPROVE FOR THE PURPOSE OF SALE]
O L AS OWNER OF THE PROPERTY. AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS
TO CONSTRUCT THE PROJECT (SEC. 7044, BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS U.
CENSE LAW DOES NOTAPPLY TO AN OWNER OF A PROPERTY WHO BURRS OR IMPROVES THEREON, AND
WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAC-
TORS LICENSE LAW.).
O 1 AM EXEMPT UNDER SEG B. a P.G FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERAURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER
I (COMMENCING WITH SECTION 70m) OF DIVISION S OF THE BUSINESS AND PROFESSIONS CODE. AND
MY LICENSE IS N FULL FORCE AND EFFECT,
LICENSE CUSS LIC. NO. 111"Inn
l
oATE CONTRACTORC� T-ne
WORKERS' COMPENSATION DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
�I HAVE MIO 1MLL MAINTAIN A CERTIFICATE OF CONSENT TO SELr4NSURE FOR WORKERS'
COMPENSATION AS PROVIDED BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE
OF THE WORK FOR WHICH TNS PERMIT IS ISSUED.
1 HAVE AND WALL MAINTAIN WORKERS• COMPENSATION RISURANC£, AS REOUIRFD BY SECTION
7700 OF THE LABOR CODE, FOR THE PERFOIMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED. MY WORKE COMPE ATKON INSURANCE CARRIER AND POLICY NUMBER ARE:
CARRIER of M EaMe�
POLICY NDNBER WC 9 2 - C/o
(nay SECTION NEEDNOT BE COMPLETED OFTNE PERMIT IS FORON/EKINDRDOOLLARS ($100) OR LESS]
I CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I
SHAM NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE
WDRKERS' COMPENSATION LAWS OF CALIFORNIA AND AGREE THAT IF 1 SHOULD BECAME
SUBJECT TO ME WORMERS• COMPENSATION PROVISION5 OF SECTION 7700 OF THE LABOR
CODE. I SHALL FORTHWITH COMPLY NSTH THOSE PROVISIONS.
DATE: APPLICANT:
WARNING: FAILURE TO SECURE WORKERS• COMPENSATION COVERAGE IS UNLAWFUL. AND SKULL BE
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (III W.000), N ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR N
SECTION 87080E THE LABOR CODE. INTEREST. AND ATTORNEY'S FE ES.
CONSTRUCTION LENDING AGENCY
1 HEREBY AFFIRM LANDERPENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED (SEG 3017. CIV C.I.
LENDERS NAME
LENOER'SADDRESS
I CERTIFY THAT I HAVE READ THE APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS,000NTY TO ENTER UPON THE
ABOVE�ED PROPERTYFOR INSPECT RP01ES.
PERIIITTE Nn
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a1GNA E ♦ ` - OATS
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LY
CATIO
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DAPS ti)� NUMBEPERMIT
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ISSUE i TYP�EE OCC
DATE '3� CO{6. GROUP
ZONING SETBACKS
REAR Of T n ^R ❑❑
SIDE/SIDE STREET RW ❑
SIDE ❑
PROPOSED USE IF V )
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NO. DWEL. No. NO.
UNITS STORIES BEDROOMS
DESCRIPTION SO. FT. FACTOR PSF ADJ. AREAIVALUATION
SFR/ADDREM
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Valuatbn N� ADJ.AREA
QUANTITY DESCRIPTICN FEE
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PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
MSU
SNIP -
ENERGY P/C
ENERGY PERMIT
RETENTION FEE:
PRE -ALT FEE:
TOTAL FEES �j lfN 3
L✓ �
COMMENTS
Q Q K Y g VALIDATION
RECPL NO. PAID BY
• WHITE—Mpanment Copy, YELLOW—Finarm Copy, PINK—ASseewr Copy, GOLDENROD—FLM Copy, OREEN--RPPOcanFs Copy
CITYOF DIAf IONUBAR F rV)
INSPECTION RECORD'
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SET BACK:=-,-- -
_..._
; ---- ,FLOOR -JOIST------ •,-a----- -------
------ - ..._.. __1.�
FTGS/FORMS/STt"'t'-
/�= J.
-- -... - --.- -I -FHA REQMTS ------
ELECTRIC GROUND
:. + UNDER FLOORrDUCT„'. % , , „• :
I ��
GROUND PLUMBING':.`••'�rt��
--
-- -` UNDER FLOOR -CONDUIT -
SLAB GRADE - �
---- - - -
�.,.,.. _,.�...,_.:.. PLACE.FOUNDATION_.:- _--�"------'----
:,:. _ . I FIRE
-------------
`•TEMPPOWER = ____-=__.
.__ _:.:-:_......____
. " _._ _'--: -FIREPLACE BOND BEAM
WATER SERVICE
MID HT•'BOND BEAM}
ROOF SHEATHING ` '
�!� �7
8 FT. BOND BEAM
FRAMING/VENTILIATION
._
FINAL. BOND BEAM
ROOF COVER ----,--
PRE -GRADING -
ROUGH HEATING -1 ----'
i`
ROUGH ELECTRIC - -
-- ---
------;- ` - ROUGH GRADING .
ROUGH PLUMBING"j----
- T---
- - - FINISH GRADING
SHOLVERlTUBTEST,
-POOL ELECTRIC
EXT LATH/SIDING --' -
-- -- -
--, , -:, - --'- - - -POOL FENCING.;.. °
WALL INSULATION i
POOL: FINAL ^
CEILING INSULATION
OFF SITE I. IPS.
DRYWALL NAILING
DEDICATIONS
=:' ' ; :.•
SEWER..---------
-------
--' - --'- --, - -FINAL ENG.. .........
i -
SEPTIC TANK
..._ _.LANDSCAPE/IRRIG.; .; :,' •
::..". _ .;%::'.., ::• ± ;,;
_ . ONSITE IMPS.
;..:
GASAIRTEST,--.__
FINAL ZONING
FINAL -'CONST:-;- ------ -
-- ----
---------;----- FIRE 6EPT. FINAL ...
FINAL HEATING- - ---
- -
- -HEALTH DEPT: FINAL ".
FINAL ELECTRIC --
--- - - -
- - --._._ ..- --- _DEV, FEES PAID-
AIDFINAL
FINALPLUMBING -- -
-- ---- -
- --'- -- ENEFIGY
-COMMENTS_.-
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___-__- --__ ..--.____- .. � U.^�..__ � '• ' ' J __—_ ,.....�Y Y.'. Fig.._ I � .. _. .. -
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SEPTIC TANK SIZE... - -'
- ----------------
SEEP PIT/U SIZE..
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