HomeMy WebLinkAbout15042 (17)CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
�c 21660 E. Copley Drive Suite 190
(909) 860.3195 Fax (909) 861-3117
M1A. BUILDING PERMIT APPLICATION
JOBSITE ],T&
ADDRESS ^1 �+' $g Yi" l7A"�" �� 1�(L iJ`` '�
150
APN LOT TRAC
OWNER1I LLL
ADDRESS .3 r liQ.1C� 4AtA SSE Rom
CITY �a-33G ZIP Zi01 TEL.
APPLICANT TEL.
CONTRACTOR 0,13 -4 �'x•
ADDRESS
CITYPkA4'.?r+PL ZIP :146 TEL.7Lq!E49
ARCWENG!
DESIGNER
ADDRESS
CITY ZIP TEL
OWNER -BUILDER DECLARATION
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS L4
CENSE UW FOR THE FOUDW74G REASON (SEC. 7031.58LISINESSAND PROFESSIONS COLE-AJIYCITYOR
COUNTY WHICH REOUMESAPERMI TTO CONSTRUCT,ALTER IMPROVE. DEMOUSH.OR REPAIR ANY STRUC.
TORE. PRIOR TO RS 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 U -
CENSE UW (CHAPTER 0 (COMMENCING WITH SECTION 7000) OF DIVISION 3 O THE BUSINESS AND PRO-
FESSONS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP.
TION. ANY VIOLATIDN OF SECTION 7071.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO
A CIVIL PENALTY OF HOT MORE THAN FIVE ANY DOLLARS ($500)1:
0 L AS OWNER OF THE PROPERT/, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION.
K AN
WILL DO THE WORD THE STRUCTLNE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7041 BUSI-
NESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE UW DOES NOT APPLY TO AN OWNER OF
PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
THROUGH HOS OR HER OWN EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR
OFFERED FOR SALE IF. HCWEVERTHE SUILDNG OR IMPROVEMENT IS SOLD WITHIN ONE YEAROF COMRE-
TON, THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE 010 NOT BUILD OR
IMPROVE FORTHE PURPOSE OF SALE}
O L AS OWNEFI OF THE PROPERTY. AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS
TO CONSTRIA:T TETE PROJECT (SEC. 70". BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS U.
CENSE LAW DOES NOTAPPLY70AN OWNER OFA PROPERTY WHO SUFDSORIMPROVES THEREON. AND
WHO CONTRACTS FOR SLICK PROJECTS WITHA COFITRACTOR(S) LICENSED PURSUANT TOTHE CON7RAC-
TORS LICENSE LAI).
01 AM EXEMPT UNDER SEC. B. L PC. FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT IAM LICENSED UNDER PROVISIONS OF CHAPTER
0 (CCMMENCNO WITH SECTION 7000) OF DIVISION ] OF THE BUSINESS AND PROFESSIONS CODE. AND
W LICENSE IS N FULL FORCE AND EFFECT. R ��Fy
LICENSE C S `� LIC. N0. -s `" z(- `�
DATE coNrRACTorTC6 YM�aa/�/ Nr6K411-
WORKERS• COMPENSATION DECLARATION
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATION&
I HAVE AND WILL MANTAN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS'
COMPENSATI N. AS PROVIDED BY 5ECTION 77M OF THE LABOR CODE, FOR THE PERFORMANCE
OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED.
I
IHAVE AND WALL MAINTAIN WOW(ERS'COMPENSATONINSURANCE. AS REWIRED BY BECTON
37M OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED. MY WORKERS COUPE NS -MIN IN`U ECARR:ERA No POLICY NUMBER ARE:
CARRIER
I POLICY Nl1MBER�
(THIS wcnoN WED NOT BECOMPLEIEDOF THE PERMIT MFOACNE HUNDRED DOLIARS(S100)0RLES51
1 CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED, I
1 S+ULL NOT EMPLOY ANY PERSON 'MANNER SO AS TO BEF SUB.FCf T07HE
j WORKERS'COMPENSATKN
LAWS
a IFORNIA, AND A.K.7 4 FISNOULD BECOME
SUBJECT TO THE WORMERS' ENS PROV`SKNS OF SE T J ]704 OF THE LABOR
CODE. S FORTNAATN COMPL WITH SEPROVISONS-
r
DATE: APPL n .—
i
WARNING: N EMPLOYE
SECURE CRIMINAL
PE WORMERS* COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL BE
SUBJECT AN EMPLOYER TO CW4:NAL PENALTIES AND CML FIVES UP 70 ONE HUNDRED THOUSAND
CIOLLAR5111 M.owl. IN ADDITI N TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN
J
SECTION 3700 OF THE LABOR CODE. INTEREST, AND ATTORNEY'S FEES.
J CONSTRUCTION LENDING AGENCY
)_
1HEREBYAFFIRMuINDERMMCE PENALTY OF PERJURY THAT IS PE ISACONSTRUCTION UED(SEC LEND NO AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SGC ]007, CN. C).
1
- LENDEfYS NAME
LENOEITSADDRESS
I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
1 AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
CONSTRUCTION, AW HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE
ABOVE MENTIONED PROPERTY FON INSPECTION PURPOSES,
Il�iilp►TM L�i77�
O E EE NAME (PRINT)
SIGNAIUREOF RMITTEE DATE
C
PRESS
FIRMLY
APPLICATION ( PERMIT / 1(.� 1 PIC
DATE NUMBER— 'tel X
ISSUE TYPE OCC
DATE CONST. GROUP
ZONING SETBACKS
FRONT RW ❑
REAR ❑
SIDE/SIDE STREET RW ❑
SIDE ❑
PROPOSED USE
NO. DWEL O. NO.
UNITS STORIES BEDROOMS
DESCRIPTION SO. FT. FACTOR PSF ADJ. AREANALUATION
SFRIADDIREM
U)
Garage/Carport
W
Patio/Deck
LL
PooVSpa
Z
Re -Roof
Commercial -
M
Valuation ADJ.AREA
QUANTITY DESCRIPTION FEE
J
U
cc
0-
U
W
J
w
0
Z_
m
U\3.qN
L'LJ 1 Le1 s
Z
4
x
U
W
i
CONSTRUCTION
PLAN REVIEW
ELECTRIC
L C^'^�•-j`
PLUMBING
/nI
MECHANICAL n(�
INSPECTION FEE
ISSUANCE AA ti
CITY tt
CITY UL' Ll!`..•"::J-\:J '✓:' f\ c
SMTP
F3LIIJ I v':_T %� 1) ✓J,�1'..._ i Y
ENERGY P/C •�I
ENERGY PERMIT
RETENTION FEE:
PRE -ALT FEE:
TOTAL FEES /
COMMENTS
T
40,
RECPT. NO.
PAID BY VALIDATION
WHITE—Department Copy, YELLOW—Finance COPY. PINK—ASSOSSOT COPY, UOLUtNHOL)—FIN) L:opy. LiNttN—Appucanr5 kOPY
CITY OF DIAMOND BAR
114SPECTION RECORD
aKCc .�!.�
SET BACK W
`�� ti:• e�ie
I►`.RIJ►� i__1r.=.. 10�-yaE�".r�
FLOOR JOIST I - i
FTGS/FORMSlSTEEL
FHA REOMTS
1
ELECTRIC GROUND
UNDER FLOOR DUCT•..
I
GROUND PLUMBING
UNDER FLbbR"COPJDUIT
SLAB GRADE
FIREPLACE FOUNDATION
TEMP POWER
FIREPLACE BOND BEAM
WATER SERVICE
MID HT BOND•BEAM '
' • '
ROOF SHEATHING
8 FT. BOND BEAM
FRAMING/VENTILIATION
FINAL BOND BEAM
COVER
PRE -GRADING
.ROOF
ROUGH HEATING
ROUGH ELECTRIC
(��r5�
BENCHING
ROUGH GRADING
ROUGH PLUMBING
FINISH GRADING
SHOWER/TUB TEST
POOL ELECTRIC
EXT LATH!SIDING
POOL FENCING
WALL INSULATION
POOL FINAL
-CEILING INSULATION
OFF SITE IMPS.
DRYWALL NAILING
DEDICATIONS
SEWER
FINAL ENG.
_
SEPTIC TANK
LANDSCAPE/IRRIG.
SEEP PIT/L.L.
ON SITE IMPS.
GAS AIR TEST
FINAL ZONING
FINAL CONST.
FINAL HEATING
FINAL ELECTRIC
'LZ
FIRE DEPT. FINAL
HEALTH DEPT. FINAL
DEV. FEES PAID
I
FI"JAL PLUMBING
ENERGY
COMMENTS
—
1
SEPTIC TANK SIZE
SEEP PIT/U SIZE _
V.
I
i
- —� ----