HomeMy WebLinkAbout14-4300 �-�'u'�='�:,�_� C1TY OF DIAMOND BAR
I I I I i ' I DEPARTA9ENT OF COMMUNITY&DEVELOPMCNT SERVICES �
���Ili��i;��- 21810 Coplcy Drivc,Dia�nond Bar,CA 91765 PRESS
�� , (909)839-7020 Fax:(909)861-3117 Buildin Ins ection Hotline 909 839-7027
<,�,q,.,,.,..;. � p c ) FIRMLY
��'�"'l- BUILDING PERMIT APPLICATION
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� 3 `Q APPLICATION DATE: ' � a 1 P/CH
w JOB SITE ADD SS /�
z APN CT ISSUE DATE: ��' �' �D�� PERMITtI �� 1 V�_
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o OWNER � TYPE CONST. OCC GROUP:
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� ADD ESS
N CITY ' IP TEL. v ZONING F ONTCKS RW ❑
o APPLIC TEL. qEqR
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cn ! SIDE/SIDE STREET RW ❑
o CONTRACT R 1 SIDE
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� ADDR S h PROPOSED USE
¢ CITY �� ZIP TEL.� `
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o ARCH/EfVG/DESIGNER
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o ADDRESS
ti DWEL.UNITS li STORIES k BEDROOMS
z CITY ZIP TEL.
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION I
OWNER-BUILDEA DECLMATION
o I hereby attirtn under penalty of perjury that I am exempt irom the Contractar's State License Law fw ihe reason(s� SFR/ADD/REM
p indicated below by the checkmark�s�,I have placed next to the aDW�ble item(s)[Section 70315,Buslness anA Garage/Carport
o Professlons,Code:Any city or caunty that requlres a permft to cansWci,alter,improve,demolish,a repair,any
w strucNre,prfor to its issuance,also requires the applMant fa Me permit to file a stgned statement ihat he or she N Patio/Deck
a is licensed pursuant to the provisions of the CaMraclor's State lJcense Law(Chapter 9)Cammencing wlth Section W
N 7000 of Division 3�of the Business and Professions Cade]or tbat he or she is exempt hom Iicensure and the basls lor � PooVSpa
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� Ne alleged ezemption.My violation of Section 7031.5 by any appllcant tor a pertnit subjecis the applicant to a civil perqly C7
V' ot not rtrore than five huMred dMlars(5500). 2 Re-Roof
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o (J I,as owner af the property,or my employees wIN wages as their sole compansatlon,will tlo O all.ot or(.]porlions � Commercial
� of the work,antl iha structure Is not intentletl a oftered for sale(Section 7044,Business end Piofessions Code:The �
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Z Contractnrs'Stata License Law dces rwt appry ro an nvmer ot property vfio,through employees'or personal effart,huilds
w w improves ihe property,providetl ih2t ihe Improvements are not irrtended or offered for sale.II however,ihe building or
� improvement is sold wlthin one year of completion,the Owner-Bultder will have tha burden of proving ihat it wa5 no[built
ow improved for,me purpose of sale.).
� I,as owner af the m
r (, P perty,am excluslvety crontracting wlth lice�ued Contractors to construct the proJect(Section
0 7044,Business arM Professions Cotle:The COMractors'Skte License Law does rwt appty to an owner ol properry who Vatuation: Adj.Area:
z builds a improves mereon,and who cmtracts tor tha projecls with e Ilcensetl Cantractor pursuant to the Contrxrors'Sbte QUANTITY DESCRIPTION FEE
�
Y License Law.).
o U I am exempt hom lice�ure under Ne Contractor's State llcense law for the following reason(s): �
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`i m si nature below I acknowled e that,exce t lor m
BY Y 9 9 p y personal residence In whkh I musi have resieed for at least one c.~.�
o year prior to completion of the improvemenfs covered by this permit,l canrrot legalty sell a shucWre mat 1 have built as an �
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� owner-buiider If It has not been constructed in ifs entirery by licensed contractors.I undershaml ihat a copy of the applicable
� law,Section 7044 of the Business and Professions Code ls available upon request when this application is submittetl or at �
� Ne idlowirg Web si[e:httpAwnv.leginfo.ca.gov/calaw.hhnL � �
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�ATE: SIGN: �
� 110ENSED CONTfiACTOR'S DECLARATIOH � r
w I hereby affirm under penalty of per�ury that I arn licensed under prwisiwis of Chapter 9(commencing with Secfion 7000) � �
� o!Division 3 0l Me Business antl Professions Code,and my ticense ts in f��ce and e�� J .
� f] �
"' uc�se cvss
�n uc.No.:� r1e
o DATElA`1'�' CONTRACTOR: �
� � WORKEA'S COMPENSATION DECIARATION �
� I HEREBY AFFlRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECUIRATIONS:
o I have and will maintain a Certifiqte ot Consent to Setl-Insure far Worker's Compensation,as provided by CONSTRUCTION:
Sectlon 37�01 the LaOa Code,for the perimmance of the work for which this permit is issued. p�,qN REVIEW-
� I have and will maintain Worker's Compensatfon Insu2nce,as required by Section 3700 of the labor Code,for
Z the peAamance ot tne vmrk tor which this permit is issued.My Wwker's Compensafion hiswance Carrier antl ELECTRIC:
¢ PolicyNum PLUMBING: % f IP
� ct�nni� " N
'�'-' MECHANICAL•
� POLJCY NUMBER
� INSPECTION FEE:
� (T}flS SECfION N NO IF 1}g IS E HUNDRED DOLL.4RS($t Of�OR LESS�.
0 1 certily that in the pertwmance of the vrork Im which Ihls pemiit's issued,I slnu mt empby arry persen e�arry manner so as to ISSUAN CE: f�
o hecome subJect to Ure Waker`s Compersation Larrs p1 Calilpmia.And agree Ihat if I slroul �n e subject tn the Wmker's SM IP:
� �nsa � of Section 3700 of the Labor Code,I st�ll lath ' a i as�jmis' ENERGY P/C:
J APPUCANT:_ �'%
`L ENERGY PERMIT:
� WARNING:FaiNre ro seare Warker's Campensation coverage•i5 ul,and s ject an employer to criminal RETENTION FEE:_ �• rJn
� penatties and pvil fines up to one hundred thousand dollars($100,000),in adtlition to the cosl of the comperrsaUai,
o damages as prmided for in section 3708 ot me labor code,interest,antl attomey's lees. PRE-ALT FEE:
d CONSTRUCTION LENDING AGFNCY BSAF:
w I hereby affirm under penally of perjury that there is a Construction Lertding Agen�y for the peAorn�ance ol the work fm
= which thls permit is issued(Sec.3097,Civ.C.).
�
� LENDEA'S NAME D
� LENDER'S ADDRESS: - I � 6 �
a I certify that I have read thls apPlicatlon and state mat ihe above intormatlon is cortect.I agree to compty wim all ciry antl TOTAL FEES
�' crounry adinances and state iaws relating tn building constructlon,and hereby authorize representatives ot mis county to COMMENTS:
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9 enter upon the above- ntianed prope or inspectbn purposes.
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a PEAMfTTEE NAME Nn
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_� SIGNANRE OF PERMITTEE pATE RECEIPT p��� pqlD BY: �4 9 � VALIDATION:�
WHfTE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy.GOLDENROD—Rle Copy,GREEN—ApplicanYs Copy
CITY OF DIAIVIOND BAR
IMSPECTION RECORD
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SETBAGKl,LETfER,- _ ` :'=� TRACTANDLEDGER
f00TIN6S FORMS t ��.:�� _ ;;. >:: SWITCH GEAR
SLAB `: '�� �," , c ,�`-�s* ��; �;;>.'Fs COMMERCIALHOOD
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UG.PLUMBING ;, � ` - r.:;� - "' T-BAR
UG:ELECTRIGAL . ' �€_� � ' " - `� INTERCEPTER
'"= s � - ��'v�- ,`A ,�;� {:�,�'' HOT MOP/SHOWERPAN
'UFER�GROUND;�=: ` r , zr. r.. _ , � .y .. - _
SEWER LATERAL SEPTIC/CESSPOOL
MAIPI WATER LINE HERS REPORT RECEIVED
SEWER CLEANOUT DEMOLITION
ROOF SHEATHING ROOF DRAINS
FLOOR SHEATHING ROUGH CONDUIT
' ' ' �� r} " PUOUSPA�.s � ` 'y4 �J;: ;-° a� r # 4:;
SHEARyWALLS EXTERIOR:` ? - °
SHEAR'WALLS:INTERIOR. ; ' � r � ROUGH RLUMBING � ; '. t°` ` % ``�
FRAMING,NENTING '� - - � �' � �'' s RqUGHELECTRICAL,;;� � �, � = �'� �*�� �` � ;
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��� �` � ' �`< ' r:'�.,:` ROUGH,MECHRNICAL`E. }� �." '` n''` ;2 ,'i�" ' �r- ,`�t" ' �"_
ROUGH tNECHANiCAL �� �� � � � k 1 � � ' .,
ROUGH ELECTRICAL W( )C(: ) ' = " �.�',�- � ' -= GAS TEST,`,� � ` � '� E. '� -
ROUGH,PLUMBING - � U�::�.�I' , ,�'• ��� h'' PRE.GUNITE 1 ;` �` -
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INSULATION WALL POOL'PRE DECK.BONDING i'' _ ' k ; ` ''° "
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INSULATION CEIUNG P'�P �_ '� � ` '
DRYWALL FENCE/GP,TE/ALARM �� � r� '' �`
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LATH(PRE� ' FINAL POOL � �� - �-�=
LATH EXTERIOR WALLS:
LATH INTERIOR WALI FOOTINGlSTEEL
GAS TEST WALL STEEL 1 sr! 1'LND� �UF�'
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SCRATCH COAT WALL BOND BEAM
ELECTRIC METER RELEASE WALL ORAIN/SEAL
GAS METER RELEASE WALL FINAL
SPECIAL INSPECTION �RO:FfWMIN6 PLANNINGAPPR01%AL �-' 'r��` �'� �' t' '`
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FINAL'.BUILDING - '� '' - ' �' `� "- '' =t' ROUGHFIREAPPROVAL ;� �u� `{� ' �{1
, ��`� ., FINAL�FIRE DEPARTMENT�a"`� `= �": {
FINAL.MECHQNICAL_ - `"
FINAL•`ELECTRICAL � t ; FINAL PUWNING �, ;` ' `' � r' ' - i '
, �r �,{��>t F�INAL ENGINEERINC/,PW ���� � a � � �� � �� ' '' `� ;
FINAL-�,P,LUMBING � � `, �>� , Il ��} � �
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T.C.of OCCUPANCY ' - �;1� "- 'EINAL COMMUNIt1f_SERUtCES _ _ � -�t +:` �
CERT of�OCCUPANCY;;;'.., .z , �;. ..4'• r;'� .," , .,°-� ��:^,�., .. : >. FINALHEr4LTF1.DEP7 ,�,j_ f � } �
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FINIILINDUSTRIAL.WASTE°;:' " ' ' �" ��
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COMMENTS:
� FA6c�E �EN
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