HomeMy WebLinkAbout18238 A
CITY OF DIAMOND BAR �X p- � I
--�� --� DEPARTME?VT OF COMMUNI"I'Y&�DEVELOPIvtENT SERVICES ` �
I
21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 PRESS
�"�9M� BUI DING PERMIT APPLICATION FIRMLY
aN JOBSITE �? � U �!�[ 1 � �Qn APPLICATION PERMIT n P/C
ADDRESS �/ �� J� DATE NUMBE -�� #
� APN LOT—�--��" RACT ISSUE _ / TYPE ._..�./ OCC
p OWNER �/�. /�-i���I`� DATE �1� CONST. ,�I GROUP
o ADDRESS _ ZONING SETBA KS
Z CITY ZIP TEL. ,�. FRONT qyy ❑
g APPLICANT TEL. REAR p
zd. SIDE/SIDE STREET RW p
� CONTRACTOR t� G/ SIDE
ADDRESS �
� CITY � C ZIP EL. T.� .' PROPOSED USE �
oARCH/ENG/
z DESIGNER '
w NO.DWEL. NO. NO.
a ADDRESS
� CITY ZIP TEL. UNITS STORIES BEDROOMS
cr�
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
� OWNER-BUILDER DECLARATION SFR/ADD/REM CJCJ
O
� I HEREBV AFFlRM UNDER PENALTV OF PERIURV THAT I AM EXEMPT FROM THE CONTRACTORS LI� G8l8gB/CafP011
W CENSEUWFORTHEFOILOWINOREASON(SEC.70.A1.SBUSMESSANDPROFESSIONS�ADE:ANVCITYOR (n
U Cp�JpJJ`/W�{�CHREWIRESAPERMITTOCqN57AUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRM1YuTRUC� w
w TURE,PRIOR TO ITS ISSUANCE,AL50 RC-0UIRES THE APPLICANT FOR SUCH PERMIT TO FILE A S16NED w Patio/Deck
� STATEMENT THAT ME OR SME IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI� � �
� CENSE LAW(CHAPTER G(COAIMENCINQ WITH SECTION 7000)OF DIVISION 7(1F THE BUSINESS AND PRO� POOUSPO
� FESSIONSCODE)ORTHATHEORSHEISEXEMPTTH�REFROMANDTHEBASISFORTHEALLEGEDEXEMP- (�
U TION.ANVVIOLATIONOFSECTION7031.SBYANVAPPLICAN�FORAPERMITSUBJEC'�STHEAPPLICANTTO Z Re-Roof ,
AqVIL FENALTV OF NOT AqRE TNAN FIVE HUNDRED DOLLARS(f500�.):
0 ❑I,ASOWNEFOFTHEPROPERTV,OHNVEMP�OVEESWITHWAGESASIHEIRSOLECOMPENSATiON, � CORIrt10fC181
Z WILL DO THE WORI(,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOH SALE(SEC.7W�,BU51� J
� NESS AND PROFESSIONS CODE:THE CANTRACTORS LICENSE UW DOES NO'APPLY TO fW OWNER OF �
PqOPERTV WHO BURDS OR IMPROVES THEREON,AND NMO DOES SUCN WORN HIMSELF OR HERSELG OR
� THRWOH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
Q OFFEREDFORSALEIF,HOWEVER7HEBUILDINOORIMPROVEMENTISSOIDWITHINONEVEAROFCOMPLE-
Z TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVING'MA7 HE OR SHE DID NOT BUILD OR
� W PROVE FOR THE PUFPOSE OF SALE).
w ❑I.AS ONRJER OFTHE PROPERTV,AM E%CLUSIVELY CONTMCTING WITH LICENSED CONTRACTORS
[C TO CONSTRUCT THE PRQIECT(SEC.)ON,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI� V9111811Of1 ADJ.AREA '
W CENSEUWDOESNOTAPPLVTOANOWNEROFAPR07ERTYWHOdUII.D50RIMPROVESTHEREON,AND
� WHOCONTRACTSFORSUC/1PRPIECTSWITNACONTRACTOR(SJLICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION
Y roas ucENSE uw.>. FEE
� ❑1 M1 EXEMPT UNDER SEC. B.6 P.C.FOR TMIS REASON Q (�
�2 U
� DATE OWNER F-
Z � r, s /-r t
� LICENSED CONTRACTORS DECLARATION w .
� I MEREBY AFFIRM UNDER PENALT,`/OF PERIURV THAT 1 AM UCENSED UNDER PROV�SIONS OF CHAPTER
� Y(COMA/ENCWO WITH SECTION 7000)OF DIVISION 70F THE BUSINE55 AND PP.OfESSIONS CODE,AND Z � �f'�<<'� + �
XL' MY UCENSE IS IN FULL FORCE AND EFFECT. m
LLI ///
� LICENSE CLASS �� LIC.Np.�� � � ` /
wDATE �% �i S' '" � CONTRACTOR �%�- ^� d ��
� WORKERS'COMPENSATION DECLARATION Q ,
� U
� I HEREBY AFFIRM UNDER PENALTV OF PERIURV ONE OF THE FOLLOWIN(i DECLARATIONS: Z
�Z _I HAVE AND WILL MAINTAIN A CEiiTIFICATE OF CONSENT TO uEIF�INSURE FOR WORNERS' a
Q
PENSATION,AS PROVIDED BV SECTION 37000F THE IAHOR COOE,FOR THE PERFORMANCE U
OF THE WORK FOR WMlpi TMIS PERMIT IS ISSUED. W
� �
w 1 H�VE AND WILL MAINTAW WORKEiiS'COMPENSATION I qqNCE,AS REOUIRED BY SECTpN
Q 37000F THE LABOR CODE,FOR THE PERFORMANCE E WORN FOR WHICH THIS PERMIT IS J ''
ISSVED.MV WQRI(�RS' PENSATION 1 SURANCE A RIER(JjD POLICV NUMBER ARE: CONSTRUCTION �^'
� CARRIER /�', ���'n � � �` PLAN REVIEW �
Z POLICV NUMBER ELECTRIC
Q
� (iH4SSECTIONNE�NOTBE00AWLEfEDOFTHEPERuffI5FOi7pNEF41�OREDWILMS�ft00)OqLE55} PLUMBING
W
Z �CERTIFV THAT IN THE PERFORMANCE OF THE WOqK FOR WHICH THIS PERMIT IS ISSUED,1 MECHANICAL
C.�J SHALL NOT EMPLOV ANY PEHSON IN ANV MANNER 50 AS TO BECAME SU&IECT TO THE
� WORKERS'COMPENSATqN LAWS OF CALIFORNIq AND AGREE THAT IF 1 SHOULD BECOME INS?ECTION FEE
'= SU&IECTTOTHEWORKERS'COMPENSATIONPROVIS OFSECTION37000FiHElA80R '
CODE,I SHALL FORTHWITH COMPLY -�"' ISSUANCE
p DA7E: � °_� APPLICANT: SMIP ,� l�
W
J WARNING:FARURE TO SECURE WORKERS'COMPENSATION CAVERAGE IS UNLAWFUL,qN0 SHALL BE ENERGY P/C
J
� SUBJECTANEMPLOYERTOCRIMWALPENALTIESANDCMLFINESUP100NEHUNDREDTHWSAN� ENERGYPERMIT
DOLLARS(f100,000),IN ADDITION TO THE COST OF COMPENSATqN,DAMAGES AS PROVIOE�FOR IN
J SECTION 3708 OF TNE LABOR COOE,INTEREST,AND ATTORNEV'S FEES.
aC RETENTION FEE:
w
O CONSTRUCTION LENDING AGENCY PRE-ALT FEE: ' �
� I HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT THEFE IS A CONSTRUCTION IENDING AGENCY
� FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.).
Z
W
� LENDER'S NAME
F-- LENDER'SADDRE55 �
�
w 1 CERTIFV THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATKKJ IS CARRECT. TOTAL F E
� 1 AGREE TO COMPLV WITH ALL pTY AND COUNTV ORDINANCES AND STATE UWS RELATING TO BUILDING -
� CANSTRUCTION,AND HEREBV AUTHORIZE REPFESENTATIVES OF THIS COUNTV TO ENTER UPON THE '
Z ABOVE-MEMION INSPECTIO SES. COMMENTS
� � �"c� 'f� L,� Y��'7
m PERMITTEE NAME(PRINT) l
� ��� �� ����
� SIGNATUREO� RMI DATE
= RECPT.NO. PAID BV � VALIDATION
~ WHITE—Department Copy,YELf.OW—Finance Copy,PINK—Assessor Copy,GOLDENROo--File Copy,GREEN—Applicant's Copy
�GT"�' �� �l�iP�C��� ��R
BiVS�E�'�'B�Ji� ���CD�3�➢
- �l�ls�U l� a ' E 0 � .,�:t� ° 0 � � p ..� ,��o :�.
SET BACK � � FLOOR J(?15T .
-- -. - ______ ___.
FTGS/FORMS/S7-EEL FNA REQMTS T
---
. --- ------:�__--__--- ____�_ .___ __^,.___._.�
ELECTRIC GROUND � IJNDER FLOOR DUCT
-- ---- ------ ----- ___�. ___ _.
GROUND PLUMSING UNDER FLOOR CURIDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE ' j MID HT. BOND BEAM
ROOF SHEATHING � (,'� i�v�-- I 8 F7. BOND BEAM �
FRAMINCNENTILI�ATION �' � �INAL BONO BEAM
ROOF COVER PRE-GRADING
FiOUGH NEATING BENCHING
ROUGH ELECTRIC RC�UGH GRADING
ROUGH PLUMBItVG FINISH ^vRADING
SHOWERITUB TEST POQL ELECTRIC
EXT. LATH/SlDING P�OL FENCING
WALL INSULATION � POOL FINAL
CEILING INSULATION _ I C�FF SITE IMPS.
DRYWALL NAiL(N� t DEDIC�TIQNS '
- ---- ----- a-- ��---- -----
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT/L.L. ' ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. FIRE DEPT. FINAL
FIfVAL HEATINC, ! HEALTH DEP7. FINAL
FiNA�ELECTRIC I � DEV. FEES PAID '
f-INAL PLUMBING � � � 1 LNERGY ��
- -- _---
- -- --- -- ,O d 7=�
CONiiViENTS
SEPTIC TANK SIZE � �
SEEP PIT/U SIZE � -
a �
- :� :
p ,
� " � .[�
.._.__.�_____.._ -_
� `.�, .
� ---_- ---- --
� � '� -