HomeMy WebLinkAbout10561�F.
CITY OF DIAMOND BAR,
COMMUNITY DEVELOPMENT DEPA E I
21660 E. Copley Drive Suite 190.
(909) 860.3195 Fax (909) 861.3117
BUILDING PERMIT APPLICATION
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ADDR�' 'S
ESS A IMP AJ i i ✓lp
APN LOT TRACT -
OWNER O 8�;TOU 1 A V
ADDRESS SSI/ N. D 119 A\ Q dU P 15 A P fl, k L
CITY Oh" ZIP`J/_7�C TE0!e_f 3%G-2?Fzv
APPLICANT F A L!& TEL
CONTRACTOR
ADDRESS
CITY ZIP TEL
ARCRIENG/
DESIGNER
ADDRESS
CITY ZIP TEL
OWNER -BUILDER DECLARATION
1 HEREBY AFFIRM UNDER PENALTY OF PEP -JURY THAT [AM EXEMPT FROM THE CONTRACTORS Ll -
CENSE UW FOR THE FOLLOWING REASON (SEC. 7031.5 BUSINESSAND PROFESSIONS CODE ANY CITYOR
COUNTYWHICHREOUIRESA PERMIT TO CONSTRUI IMPROVE. DEMOLISH.OR REPAIR ANY STRUC•
TUBE. 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 LI-
CENSE LAW (CHAPTERS
(COMMCNCINO WITH SECTION 7600) Or DIVISION S OF THE BUSINESS AND PRO-
FESSKONSCODE) OR THAT HE OR SHE 13 EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP-
TION. ANY VIOLATION OF SECTION 7031.6 BYANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO
A CML PENALTY OF NOT MORE THMI FIVE HUNDRED DOLLARS (6500).1:
O L AS OWNEROF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION,
WILL DO 714E WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 70". BUSI-
NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF
PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
THROUGH HIS OR HER OWN EMPLOYEES. PROVIDED THAT SUCH IMPROVEMENTS ARE NOT MENDED OR
OFFERED FOR SALE IF, HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OFCOMPLE-
TION, THE OWNER -BUILDER WILL 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. 70u• BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS U•
CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON, AND
WHO CONTRACTS FOR SUCH PROJECTS WITHA CONTRACTOR(S) LICENSED PURSUANT TOTHE OONTRAC-
TORS LICENSE LAW.).
O IAM EXEMPT UNDER SEC. B. . 3m THIS, REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION '
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER
I (COMMENCING WITHSECTION 7006) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND
MY LICENSE IS IN FULL FORCE AND EFFECT.
LICENSE CUSS LIC. NO.
DATE CONTRACTOR
WORKERS' COMPENSATION DECLARATION
I HEREBY AFFIRM ULCER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELFaNSURE FOR WORKERS'
COMPENSATION,AS PROVIDED BY SEC71ON 3700 OF THE LABOR CODE, FOR THE PERFORMANCE
OF THE WORK FOR WHICH THIS PERMIT 95 ISSUED.
�I RAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE. AS REOUIRED BY SECTION
3700 OF THE LABOR COOS, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE:
_...CARRIER
POLICY NUMBER
PHIS SECTION NEED NOTSE COMPLETED OF THE PERMIT. B FOR ONE HUNDA DOOl1AAS(61000RLESS),
I CERTIFY TRAT INTHE PERFORMANCE OF THE WORK FOR WHI31 THIS PERMIT IS ISSUE0.1
SHALLNOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE
WORKERS' COUPENSATION LAWS OF CALIFORNIA. AND AGREE THAT IF I SHOULD BECOME
SUBJECT TO THE WOWERV COMPENSA71ON PROVISIONS OF SECTION 3700 OF THE LABOR
CODE, I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS.
DATE; APPLICANT:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL BE
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO CNE HUNDRED THOUSAND
DOLLARS 16100,0001. IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 37DI OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
CONSTRUCTION LENDING AGENCY
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERM,T 13 ISSUED (SEC. 3067, CW. C.).
LENDER'S NAME
LENDERS ADDRESS
1 CERTIFY THAT HAVE READ THIS 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 COUNTY TO ENTER UPON THE
ABOVEyEHTgyEDPROPERiY�QR�j� PURPOSES.
PE((My_Lv_iT�—�6l:.NAYT7'—�v hHT��((yy��''
rIGNATUREJOF PERMITTEE DATE '
WHITE—Department Copy, YELLOW—Fnance Copy, PINK—Assessor Copy, GOLDENROD—File Copy, GREEN—Applicant's Copy V
PRESS
/ FIRMLY
CATIAPPLI/ �1 PERMIT PSC
A
_
DATE NUMBER >t
ISSUE TYPE OCC
DATE C GROUP
ZONING SETBACKS
FRONT Fi1W� ❑
REAR _- (�� ❑
SIDE/SIDE STREET RW ❑
SIDE ❑
.ROPOSED USE S LfYn Nr�Nrr S'�G�YG�1:-C ��
TIRZ! CJ0ff1V /CF
NO. DWEL NO. NO.
UNITS STORIES BEDROOMS '
DESCRIPTION SO. FT. FACTOR PSF ADJ. AREA/VALUATION
SFRIADD(REM
Garapa/Carport
Uo
Palio/Deck
LL-
POOVSpa
Z
Re -pool
0
Commercial
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VafuallcrL�2 VQ 0! ' ADJ.AREA
QUANTITY DESCRIPTICN FEE
J
Q
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LJ
W
J
W
t7
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m
CL
CL
Q
U
Z
Q
S
U
W
CONSTRUCTION
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
SMTP
ENERGY P/C
t:
ENERGY PERMIT
RETENTION FEE:
PRE-ALTFEE: +
Ij
-
TOTAL FEE `" IW " • - -!
COMMENTS
RECPT. NO. ✓B2� PAID BY 14f y' VALIDATION
T` O IAMOND BAR'.`
I E ION RECORD
,- .
•_.• , �/.t,' � ��'1/.. ��. �� 1. .'ll.'��?-!. ,.: � ..
SETBACK ._.. __..... ... FLOORJOIST------
FTGS/FORMS/STEE : a
FHA REO"dTS ---. .
"
-
ELECTRIC GROUND -
UNDER FLOOR DUCT
GROUND PLUMBIN¢, i; : n ' -;:
"
UNDER FCOOR CONDUIT - '
SLAB GRADE -- `' - - ':: ':: '
FIREPLACE FOUNDATION-_--
TEMP POWER:-: ...:-._:_...... ___ - :..-__ .........._ ---
FIREPLACE BOND BEAM
.-- --. .__ ..._:.. , :.,,.. • . , .
N1I1) HT. BOND BEAM
,
ROOF SHEATHING '- _
8 FT. BOND BEAM
FRAMING/VENTILIATION
`FINAL BOND BEAM
ROOF COVER._... .__... -- '- .. -
-- - --
PRE -GRADING.
ROUGH HEATING -...._ .__ - ! ._..
:.::
BENCHING
-ROUGH ELECTRIC - - - - - - -" --;
=
ROUGH GRADING
ROUGH PLUMBING - -' - .... ........:...:..:
FINISH GRADING
SHOWER/TUB TEST
-
POOL ELECTRIC
,
-EXT. LATH/SIDING -. -_.. .. - ---
POOL FENCING
i
WALL INSULATION
POOL FINAL
CEILING INSULATION
OFF SITE IMPS..'. ' .:. ;:
�•
DRYWALL NAILING !
DEDICATIONS
.SEWER _ I
_
FINAL ENG.
.SEPTIC -TANK--. _-._. .._ _. _ .... '_ _..
-
LANDSCAPE/IRRIG.
SEEP_PIT/LL---' - - ... .... -- - -
- -
-ONSITE IMPS.
GAS AIR TEST ----. _. _..---'----.... ------._..__:.._...__....
.FINAL ZONING
FINAL -CONST:. _.._..- ---------
--
_:.
FIRE DEPT. FINAL 'j-
.. �. ;..�..�,.
FINAL -HEATING - - ---- ... _. _.. - - ------
HEALTH DEPT. FINAL _---
I�.
FINAL ELECTRIC- - -- --- _....
DEV. FEES PAID
FINAL PLUMBING'-- - -
ENERGY •
!
COMMENTS
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SEPTIC TANK SIZE-
-
SEEP PIT/U SIZE - i1i._. -.._ ...-
_. �46- _
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