HomeMy WebLinkAbout18298 (11) . �x�'�� ,
CTI'Y OF DIAMOND BAR
----��� -- DEPARTIvIENT OF COrRvIUMTY 8r.DEVELOPMENT SERVICES
� 21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 PRESS
��`9��� BUILDING PERMIT APPLICATION � FIRMLY
} JOBSITE ,^ �/ , APPLICATION �J (}�„� PERMIT p/C
o ADDRESS ���I , b�l��I O�I 1✓ Y�,A'�, L�� � DATE ^ NUMBER # ��
� APN LOT TRACT D TEE ��v U O ST. GROUP
p OWNER �' ��� U 12 �'�L 1 � � I f�
o ADDRESS ���, tw I,�L S��R L�U • ��FJ�'l�, ZONING SETBACKS
Z CITY Lo S H'f�(�.,K/ 9tCZIP G,� • TEL. FRONT p�/y ❑
� APPLICANT T�� TEL. REAR p
� SIDE/SIDE STREET RW O
a� CONTRACTOR SIDE ❑
ADDRESS . �
� CITYSo LL 1"Gbnr(� ZIP_� TEL.� PROPOSEDUSE
oARCWENG/ _
z DESIGNER
w NO.DWEL. NO. NO.
a ADDRESS I
� CITY ZIP TEL. UNITS STORIES BEDROOMS
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION I
cn
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
O
p I HEREBV AFFIRM UNDER PENAITV OF PERIURV THAT I AM EXEMPT FqOM THE CONTRACTORS LI� G8f999/C9fPOft
W CENSEUWFORTHEFOLLOWINGREASON(SEC.7071.6BUSINESSANDPROFESSIONSCODE:ANYCITYOR (n
C-� COUNTYWHICHREOUIRESAGERMITTOCONSTRUCT,/�LTER,IMPROVE,DEMOLISH,ORREPAIRANVSTFiUC�
W TURE,PRIOR TO ITS ISSUANCE,/�LSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIaNED w Patio/Deck
� STATEMENT 7HAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRAC70RS LI� �
� CENSE LAW(C}iAPTEF D(COMMENCINQ WITH SECTION 7o00)OF DIVISION a OF THE BUSINESS AND PPO� POOUSPO
� FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEDEDEXEMP- (!�
TION.MIVVIOLATIONOFSECTION7o31.5BVMIVAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Roof
A CML PENN.7V OF NOT MORE THAN FNE HUNORED DOLLARS(f5o0).�:
Q ❑I,ASOWNEROFTHEPROPERTY,ORMYEMPLOVEESWITHWAQESASTHEIRSOLECOMPENSATION, � COrtIrtIBfCl91
Z WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFEFED FOR SALE(SEC.7014,BU51� J l
� NESS AND PROFESSIONS CODE:THE CONTRACTORS UCENSE UW DOES NOT APPLV TO M!OWNER OF �
PROPERTY WFq BUILDS OR IMPROVES THEREON,AND NMO DOES SUCH WORK HIMSELF OR HERSELF OH
w THROUGH HIS Oq HER OYM EMPLOVEES,PROVIDED THAT SUCN IMPROVEMENTS ARE NOT INTEN�EOOR m
� OFFEREDFORSALEIF,HOWEVERNEBUILDINOORIMPROVEMENTISSOLDWfTHINONEVEAROFCAMPIE-
Z TqN,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF SAL�.
w OI,ASOWNEROF7HEPROPERTV,AMEXCLUSNELVCANTRACTINGWfTHLICENSEDCANTRACTORS �
� TO CONSTRUCT THE PR0.IECT(SEC.70N,BUSINESS AND PROFESSfONS CODE:THE CONTRACTORS LI� V0IU8fI0f1 ADJ.AREA
W CENSE UW DOES NOTAPPLV TOM!OVMER OF A PROPERTV WIiO BUILD50R IAIPROVES THEREON,AND
� WHOCONTiUCT5FOR5Uq1PR0.1ECTSWITHACONTRACTOR(5)LICENSEDPURSUM7TTOTHECAMRAG QUANTITY DESCRIPTION FEE
Y TORS LICENSE LAW.).
� ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q
?� U
� DA7E OWNER H
Z U
� ' LICENSED CONTRACTORS DECLARATION W
� I HEREBY AFFIRM UNDER PENALTV OF PER1UfiV THAT I AA/LICENSED UNDER PROVISIONS OF CHAPTER �
� Y(COMMENCIN(i WITH SECTION 7000)OF DIVISION 7 0F THE BUSINESS AND PROFESSIONS CADE,AND Z
��� MV LICENSE IS IN FULL FORCE AND EFFECL � m
0 LICENSE CLASS LIC.NO. ����_ �
V DATE ��A L CONTRACTOR d
W
� �_'- WORKERS'COMPENSATION DECLARATION Q
� U
� I HEREBY AFFIRM UNDER PENALTY OF GERIURV ONE OF THE FOLLOWINO DECURATIONS: Z
OZ 1 HAVE MID WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORNERS' ¢
Q =
COMPENSATION,AS PROVIDED BV SECTION 37ao OF THE UBOR CODE,FOR THE PERFORMANCE U
OF THE WORN FOR WHICH THIS PERMIT IS ISSUED. W
� �
Qw _I HAVE M1D WILL MNINTAIN WORKERS'CAMPENSATION INSURANCE,AS REOUIRED BY SECTION
3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS �
ISSUED.MV WORKERS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBERARE: CONSTRUCTION
J
j CARRIER �y`r���A.�� ' PLAN REVIEW •
�Z POLICYNUMBER �� 67�� O Z ELECTRIC O.SD
Q
� (iHI55ECilONNE�NOTBE00A1PLE7mOFhEPER4TrI5FpRONEFiIN�OHEDDOLI}AS(tta0)ORLESS} PLUMBING
W
Z �CERTIFVTHATMTHEPERFORMlWCEOFTHEWORKFORWHICHTHISPERMITISISSUED.I MECHANICAL
C7 SHALL NOT EMPLOV ANV PERSON IN ANV MANNER SO AS TO BECOME SU&IECT TO TFIE
(n WORKERS'COMPENSATION LAWS OF CALIFORN10.NJD AGREE THAT IF I SFqULD BECOME INSPECTION FEE
? SU&IECTTOTHEWORKEFS'COMPENSATIONPROVISIONSOFSECTION37000FTHELABOR
CODE,I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. ISSUANCE �
p DATE:�,-'��6?c APPLICANT:T►_�) �/�.I S � SMIP ,��
'J WARNINO:FAILURE TO SECURE WORKERS'COMPENSATION CAVERAGE IS UNLAWFUL,AND SHALLBE ENERGY P/C
J
� SU&IECTM!EMPLOVEF TO CRIMINAL PENALTIES AND CML FINES UP TOONE HUNDRED THOUSAND ENEFGY PERMIT
DOLLAAS(f10o,000),IN ADDITION TO THE COST OF CAMPENSATION,DAMAGES AS PROVIDED FOR IN
J SECTqN 3708 OF THE LABOR CADE.INTEREST,AND ATTORNEV'S FEES.
w RETENTION FEE: - l�O
O CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBV AFFIRM UNDER PENALTV OF PE{LIURV THAT THERE IS A CONSTRUCTION LENDWG AGENCY
FOR THE PERFORMANCE OF THE WORN FOF WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.).
Z
W
� LENDER'S NAME
� LENDER'SAD�RESS
�
TOTAL FEES /� '—'
� I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORPECL , ` ,
w I AGREE TO COMVLV WfTH ALl CITY AND COUNTY ORDINANCES AND STATE UWS RELATING TO BUILDING v ' � � n r 'l��,l
� / «IG�V V��-`
� CANSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS CWNTYTO ENTEfi UPON THE ��
Z ABOVE-MENTIONED PROPERTV FOR INSPECTION PURPOSES. MENTS `�� � Jv �'
� K�'(� C 4-1-o w .S.N'A��2 - ._
m PERMI7TEE NAME INT) �
¢ P�g��'�'.2- 6-�-rri �
�
� SIONATUI� DAT
� RECPT.NO. PqID BY � VALIDATION
WHITE—Department Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENR ile Copy,GREEN—Applicant's Copy
�Op �
���f'�Y �� �al��ii�D�� 1�Q(F�
D���f�(��04�G� f�[�(��[t�i� ,
' �� �' '� �� � U o G'� � _ ��� n � DGJ4C�� � � OG�C� o ' :��� �
SET BACK FLOOR�JC�lST , . . �
FTGS/FORMS/STEEL FHA REQMTS
ELECTRIC GROUND � UNDER FLOOR DUCT ` ^ �
GROUND PLUPdIBING � UNDER FLOOR CU�IDUIT �
SLAB GRADE FIREPLACE F(OUNDATION '
TEMP POWER FIREPLACE BOND BEAM �
W,4TER SERVICE MID HT. BUND BEAM
ROOF SHEATHING 8 FT. BOND BEAM
FRAMING/VENTILiAT10N " � '� � FINAL BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATtNG SENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUNIBING FINISH GRAb{NG
5HOWERIfUB TEST POO�ELECTRIC
EXT. IATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL �
CEILING INSULATION �FF SITE IMPS.
DRYWALL.NAILilUG DEDICATIONS
SEWER FINAL ENG. �
SEPTIC TANK LANDSCAPEIIRRIG.
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST FlNAL ZONING
FINAL CO�lST. , �lRE DEPT. F1NAL
FINAL HEATING HEA�TH DEPT. FINAI
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY
.���o � --
C������5
SEPTIC TANK SIZE �
SEEP PIT/U SIZE
�
� .
� [�, -
� . �