HomeMy WebLinkAbout18056 (25) CITY OF DIAMOND BAR ` �;
�---��-- DEPARTMENT OF COMMIJNITY&DEVELOPMENT SERVICES .' �
21825 E.Copley Drive
"� (909)860-3195 Fax(909)861-3117 �-��" PRESS
��'%���' BUILDING PERMIT APPLICATION -` FIRMLY
� JOBSITE �/Z` � �Lj��/��� ��,/ APPLICATION O _ /1�PERMIT a�`L P/C �`
o ADDRESS �a �S DATE �� O�NUMBER UJ t� #
� ISSUE C� /y TYPE pCC
APN LOT TRACT DATE / ULi CONST. GROUP
p OWNER Y���fis�/.q3-/.�� L
p ADDRESS �/'Z-(of U�/1N/JIFC.- ZONING SETBACKS
FRONT Ryy ❑
' z CITY ��`At�euNo 3s�✓ ZIP TEL. ��z-O� � ❑
o APPLICANT fr.Mn� h,wil G�r[l. TEL. S DE/SIDE STREET RW ❑
� CONTRACTOR __���7R✓ ��NC�� eoNs�,�c i�.�N SIDE p
ADDRESS iU(oSc7 �• ►✓.4S"1/�i�Gro,� �c.✓�
� CITY INb:fi��i��k, ZIP d o TEL. �41-o�3oi PROPOSED USE i �
w ARCH/ENG/
z DESIGNER C�Av E�.�t.'' ��l C j ' �
a ADDRESS NO.DWEL. NO. NO.
� CITY ZIP TEL. UNITS STORIES BEDR OMS
�
� • DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREA/VALUATION
p� OWNER-BUILDER DECLAAATION SFR/ADD/NEM
O
p I HEREBV AFFlRAI UNDER PENALTV OF PERJURV THAT I M1 EXEMPT FROM THE COMRACTOFS LI- G8f8Q0/CBfPOft
W CENSEIAWFORTHEFOLLOWINOPEA50N(SEC.7031.6BUSINESSANDPROFESSIONSCODE:ANYCITVOR (n -�
C-� COUNTYWHICHREOUIqESAPERMRTOCONSTRUCT,ALTER,IMPHOVE,DEMOLISH,ORREPAIRANYSTRUG w �
w NRE.PRIOR TO ITS ISSUANCE,ALSO REW IRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w P8110/DBCk
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO 7HE PROVISIONS OF THE CONTRACTOqS LI- �
� CENSE UW(CHAPTER B(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND Pq0- POOUSPe
� FESSIONSCODE)OR7HATHEORSHEISE%EMPTTHEREFROMANDTHEBASISFORTHEALLEOEDEXEMP� (�
U TION.ANY VqLAT10N OF SECTION 7031.5 BV ANV APPLICANT FOR A PERMIT SU&IECTS THE APPLICANT TO Z RaRoof
A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLlAHS(SSoo).):
� ❑I,ASOWNEROFTHEPFOPERTV,ORMVEMPLOYEESWIiHWA0E5A5THEIRSOLECOMPEN5AT10N, � CORIRIBfC181 -�
Z WILL DO 7HE WORK,AND THE S7RUCTUqE IS NO7 INTENDED OF OFFERED FOR SALE(SEC.7011,BUSI� J
� NESS AND PROFESSIONS CADE:7HE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF �
PROPERTY WFIO BUILDS OR IMPROVES THEREON,AND NRiO DOES SUCH WORK HIMSELF OR HERSELF OR
Q THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m �
t��� W OFFEREDFORSALEIF,HOWEVER,THEBUILDINOORIMPROVEMENTISSOLDWITHINONEVEAROFCAMPLE�
� TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE Ofi SHE DID NOT BUILD OR
Z IMVROVE FOR THE PURPOSE OF SALE).
_ ❑I,AS OVMER OF THE PROPERTV,AM E%CLUSIVELV CANTRACTING WITH LICENSED CONTMCTORS
W
� TO CANSTRUCT THE PRQIECT(SEC.7wa,BUSINESS AND PROFESSIONS CODE:TNE CONTRACTORS ll- VBIUelI0f1 ADJ.AREA
� W CENSE LAW DOES NOTAPPLV TOAN OWNER OFAPROPERTV WHO BUILDS OR IMPROVES THERC-0N,AND
� � NMOCQNTRACTSFORSUCHPROJECTSWITHACONTRACTOR(S�LICENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION ,
Y roqsucENseuw.�. FEE
� ❑I AM E%EMPT UNDER SEC. B.8 P.C.FOR THIS REASOY Q �� /G�J f y/���,f (� 2 Q D
� V ♦ � s Lb
LL DATE OWNEq �F ' ��v
. Z - _ .U.. _ _ '
. _ .�
� LICENSEDCONTRACTORSDECLARATION w ` M��
� � .So
I HEREBV AFFIRM UNDER PENALTY O;PERJUFY THAT I AA1 LICENSED UNDER PROVISIONS OF CHAPTER �r 1 ���('�'TU� �S�W(�✓L
a, o(COMMENCINO WIiH SECTION 7000 OF DIVISqN 7 OF THE BUSINESS AND PROFESSIONS COOE,AND Z
X MV LICENSE IS IN FULL FORCE AND EFFECT. m ,
� �� ZT�7I� � I �O' Ll_\
� LICENSE CLA S LIC.NO. � 1 S�� IC L'�✓ ,d ��
V DATE Z CONTFlACTOR [�l.rf'J/�7/�iVJ/ a
w �� c S � l� t ✓i '
� WORKERS'COMPENSATION DECLARATION a �� � ,�S
N .. U
� I HEREBV AFFIRM UNDER PENALTV OF PERIURV ONE OF THE FOLIOWING DECLARATIONS: Z �
� _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORKERS' _
Z COMPENSATION,AS PROVIDED BY SECTION 3700 OF TME L/�BOR CODE,FOR THE PERFORMANCE U
¢ OF E WORK FOR WHICM THIS PERMIT IS ISSUED. w
W �
VE AND WILL MAINTAIN WORKERS'CAMPENSATION INSURANCE,AS REOUIRED BY SECTION ///...���
Q 3700 OF THE LABOR CODE.FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS I i �,'.0 (�
ISSUED.MV WOR!(ERS'CAMPENSATION INS/UHANCE C RIER AND POLICV NUMBER AFiE: CONSTRUCTION L � J V �
j CARRIER _S��7h [.,/ �/`�� PLAN REVIEW
Z POLICV NUMBER /�[r.J�9 r(STf"GTI� ELECTRIC ,S O
¢ �
� (iH4SSEtTqNNE�NOTBE07R�LEfIDOFT1-EPEWMISFOqpNEFiU�pqEppq1q0.5(S1ao)ORLFSS� PLUMBING ,�D
W �
Z 1 CERTIFY THAT IN THE PERFOfUAANCE OF THE WOH1C FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
U' SHAIL NOT EMPLOV ANV PERSON IN ANY MANNER 50 AS TO BECOME SU&IECT TO THE �
(/� WORKERS'COMPENSATIONLAWSOFCALIFORNIA,ANDAGREETHATIFISHWLDBECAME INSPECTIONFEE �
SU&IECTTO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 37o00F THE LABOR
O COD,I SHALL FORTHWITHCOMPLV WITNTHOSE PROVIS ISSUANCE /D •.D
p DATE:�� APPLICANT: �� SMIP �
w �� ENERGY P/C
J WARNINO:FAILURE TO SECURE WORNERS'COMPENSATION CAVERAGE IS UNLA L,AND SHN1 BE
J
LL SU&IECTAN EMPLOVERTO CRIMWAL PENALTIES AND CML FINES UP TOONE HUNDRED THOUSAND ENERGY PERMIT
DOLURS(5100.000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED F-0R IN
J SECTION 3708 OF THE LABOR CODE.INTEREST,AND ATTORNEV'S FEES.
w RETENTION FEE: '
O CONSTRUCTION LENDING AGENCY PRE-ALT FEE: ! � �
%
� I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS A CONSTRUCTION LENDINO AGENCV
FOR THE PERFORMANCE OF iNE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3oe�,CIV.C.).
Z
W
� LENDER'S NAME .
F— LENDER'SADORESS
w 1 CEflTIFY THAT I HAVE READ iHIS MPLICATION AND STATE TIiAT THE ABOVE INFORIAATION IS CORRECT. TOTAL FE ES a�J��!� �y O� �
� I AGREE TO CAMPLV WITH PLL ClTY AND COUNTY ORDINANCES AN�STATE LAWS RELATING TO BUILDING o O � �
� CANSTRUCTION,AND HEREBV AUTHOAIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE �/�O
Z ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. COMMENTS �
� �,�-�� c.P� c .
m PERMITTEENAME(PRINT) J
� � a
N SIQNATU PERM EE DATE .
� ' � RECPT.NO. � PAID BY VALIDATION � �
WHITE—D artment Copy.YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—ApplicanYs Copy
�9�"� �I� �B�QGI��I� (��f�
���t������� f������
0�� � D�� � � � o� � " �� ' �G�trl o Y��� �� DGJS� � � ' ��p �
SET BACK � .; � FLOOR JOIST `
FTG�/FORMS/STEEL /,, �Z � FHA REC�MTS
1��___�
ELECTRIC GROUND � UNDER FLOOR DUCT
GRC7UND PWMBING �-L�'���`' _ UNDER �LOOR•CU�4DUIT
SLAB GRADE f� D'Z '" ' FIRFPLr�GE�C�UNDATION
TEMP POWER FIREPLACE BOND BEAM
WATER SERVlCE _ MID NT: BOND B�AM•
RUaF SHEATHIiVG � L °'� ' j�• ' 8 FT. BOND BEAM
FRAMING/VENTiLiATlO(J � � .FIlVAL BOND�BE/riM
ROdF COVER �� PRE-GRADING
ROUGH NEATING �D BEPJCHliVG
ROUGH ELECTRlC O, _ �. .. ROUGH GRADI.N�
AOUGH PLUMBING ' �' �Y � FINISH GRADING _
SHOWER/TUB TEST POOL ELECTRIC
EXT. LATH/SIDING � ��3 pZ �,�07 , POOL FENCING
WAL�INSULATION �'/ g� � . . - . —�v __" - _
J ��� POOL FINAL
CEILING If�lSULATION 9��,x_ � OFF SITE IMPS. _ `
DRYWALI.NAILING �Q.l��y0j/ �,_�� DEDICATIONS
J� -y-*-- -A---
SEWER (�.�/� �J/� //� FINAL ENG. - ...:�
/-P-L_�/ . ./�JJ,. .�;i ::._.
SEPTIC TAIVK � LANDSCAPE/IRRIG.
SEEP PIT/LL � . - ON SITE IMPS. �� � �
GAS AIR TEST FINAL ZONING,
FINAI.CCNST. I�3. . ,'�JRE DEPT,,FIIVA!'
FI�lAL HEATING 'V HEALTH dEPT. FINAL �
FINAL E�ECTRIC ��� . � DEV. FEES PAID
FINAL PLUMBIMG . ENERGY
- —�. � • ---- - — -- ---
, , [���� . � ��
, � . , � . , ;: . ... . .
�r'1i��E�1TS� P�tw��.- c�Z�[�oug . �tL�Cf�S�-�-i�e<-D�E -,_Fr�sl3c� ua+�u�S�S . 5�¢�..
Et��ue��b�C� w16t� ._ .�_�-5:o�;; . .
�=�-o-2—N�pda�tc-T—L=�R_t��CWc,4� ut�c�.l� �--
� , . �> �
� , .. ,:. , .
, .. . � , 1, .
.. .. . ' . i � �
SEPTIC TANK SIZE -. - . _ .. ; .
SEEP PIT/U SIZE — —
� �� .y� � — . .
�� °� ���� ;' [
, � , - . ,
. , , • ,
� � � � , .� � � ,
�