HomeMy WebLinkAbout16630 (22) CITY OF DIAMOND BAR ��P�RED
�----��'-- DEPARTMENT OF COMMUNITY 8c DEVELOPMENT SERVICES
zia2s E.copiey�rve JUN 18 2001
(909)860.3195 F�(909)861-3117 PRESS
����� BUILDING PERMIT APPLICATION FIRMLY
� JOBSITE 1 ,[?� APPLICATION ,., 1 1`f�� PERMIT I l _l O p/C
o ADDRESS � �� v � �"�m6� �• DATE < < V NUMBER U v #
� APN LOT TRACT �SSUE TYPE OCC
p OWNER `7-'�� DATE CONST. GROUP
o ADDRESS_�yGZ,/9U a'�`►9�+^�Bd' ' ZONING SETBACKS
� CITY +Gta+.�» �i ar ZIP TEL./6i'/s'�/9 id?Y FRONT RW ❑
APPLICANT ei P..�� TEL. %9C�'7�'1�!9'7 REAR �
� CONTRACTOR C l �� SIDE/SIDE STREET qyy p
;r ea G ` �Y SIOE �
� ADDRES 3� S'- OK ci
� ��n' " �'�` ZIP ¢'3�9TEL. S3�"J '7' PROPOSED USE
oARCH/ENG/
z DESIGNER
a ADDRESS NO.DWEL. NO. NO.
� C�TY ZIP TEL. UNITS STORIES BEDROOMS
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION .
O SFR/ADD/REM
Q I HEREHV AFFIRM UNDER PENAL7V OF PERIURV THAT I AM E%EMPT FqOM TryE CONTRACTORS LI- G8f8 0/C8
W CENSEUWFORTHEFOL�OWINGREASON(SEC.7o31.58U51NESSANDPROFESSIONSCODE:ANYCITYOR (n 9 �rt
ZCIXINTVWHICHRE-0UIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE.DEAIULISH,OHREPAIRANVSTRUC- w
NRE,PRIOR TO ITS ISSUANCE.ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIONED w P8�I0/DBCI(
�w STATEMENT 7HAT HE OR SHE IS LICENSED W RSUANT TO THE PROVISIONS OF 7HE CONTRACTORS U-
CENSE LAW(CMMTER 8(COMMENCIN�WITH SECTION 7000)OF DIVISION 7 OF THE BUSINESS AND PRO- � POOVSPB
� FESSpNS CODE)OR 7HAT HE OR SHE IS E%EMPT THEREFROM AND THE BASIS FOR THE ALLEOED EXEMP� (�
TION.ANYVqLATIONOFSECTION7031.5BVANYAGPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Roof
� A CML PENALT/OF NOT MORE THAN FIVE HUNDRED DOILARS(1600).): �
� OI,ASOHTJEROFhIEPROPERTV,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, 0 COf11ffIBfCI81
Z N�LL DO TME WORK�ND THE STRUCTURE IS NOT IN7ENDED OP OFFERED FOR SALE(SEC.7aM,BUSI� _J '
� NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF �
PROPERTV WFq BUILDS OR IMPROVES TMEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF Oq
w THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED TFUT SUCH IMPROVEMEN7S AAE NOT INTENDED OH m
Q OFFEAEDFORSALEIF,HOWEVER711EBUILDINGORIMPROVEMENTISSOLDWI7HINONEVEAROFCOMPLE�
Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PURP0.SE OF SALE).
�y,� ❑I,ASOWNEROF7HEPROPERTV,AME%CLUSIVELYCqNTRACTIN6WITHUCENSEDCOMRACTORS
[t TO CANSTRUCT h1E PR0.IECT(SEC.7ou,BUSINESS AND PFOFESSIONS CODE:THE CONTRACTORS Ll- VBIUeSIOf1 ADJ.AREA
� CENSE LAW DOES NOTAPPLV TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND
WMOCONTRACTSFORSUCHPR0.IECTSWITHACONTRACTOR(S)LICENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION
Y TORS UCENSE UW.). FEE
Q ,O I AM E%EMPT UNDER SEC. B.6 P.C.FOR THIS REASON Q - .
� U •
� DATE OWNER �
� LICENSED CONTRACTORS DECLARATION w
. � I HEREBY AFFIRM UNDER PENALTV OF PERIURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
� e(COMMENCIMO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS/WD PROFESSIONS CADE,AND Z
�� MY LICENSE IS M FULL FORCE AJND EFFEC7. m
� LICENSE C S �/'��' LIC.NO. ��D Z�� Z — �
V DATE � �� �� CONTfL4CTOR�Y Gc.'�S'JL a
w
� WORKERS'COMPENSATION DECLARATION Q
� U
� 1 HEREBV AFFIRM UNDER PENALTV OF PERIURV ONE OF THE FOLLOWING DECURATqNS: Z
0 _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WOqKERS' �
� COMPENSATION,AS 7ROVIDED BV SECTION 3�OOOF THE LABOR CODE,FOR THE PERFORMMICE U
Q OF hIE WORK FOR NRiICH THIS PERMIT IS ISSUED. �
Qw _I HAVE AND WILL AIAINTAIN WORKERS'COMPENSATKKJ INSURMlCE,AS RE�UIRED BV SECTION
3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS �
ISSUED.MV WORKEFS'COMPENSATION INSURlWCE CARRIER AND POLICV NUMBERARE: CONSTRUCTION
� CMqIER PLAN REVIEW
� PoLICV NUMBER
Z ELECTRIC •� O
¢
� (Il-0SSECTONNE�NOTBENA4LEfEDOFTHEPEPo.Yi1$FOppryEFiU�OqEppplqRS(s100)OqLESS} PLUMBING
W
Z I CERTIFV THAT IN THE PERFORMANCE OF THE NfORN FOR WHICH THIS PERMIT IS ISSUED,1 MECHANICAL
(,'} SHALL NOT EMPLOV ANV PERSON IN ANY MANNER 50 AS TO BECAME SU&lEC TO THE
(/� WORKERS'COMPENSATKKJLAWSOFCALIFORNIA�NDAGRE HATIF DBECOME INSPECTIONFEE
S SUBJECT TO THE WORKERS'CAMPENSATION PROV N EC OF THE UBOR
coo,i w.wRrNvnTH cana�v vnrH o ISSUANCE �O�
O DATE:� �/ APPLICANT: � . SMIP `��W"�^:'�1
wWARNING:FAILURE WORKERS'COMPENSATKKJ COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C ' ' �� ��
�y SU&IECTANEMPLOVERTOCRIMINALPENALTIESMIDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
DOLLARS(f100.000).IN ADDI110N TO THE COST OF COMPENSATqN,DAMAOES AS PROVIDED f-0R IN
J SECTION 3708 OF THE LABOR CADE.INTEREST,AND ATTORNEI"S FEES.
p� RETENTION FEE:
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: I
�� I HEREBV AFFIRM UNDER PENALTV OF PERIURY THAT THERE IS ACANSTRUCTION LENDING AOENCY
� FORTHE PERF-0RMANCE OFTHE WOH7(FOR WHICH THIS PERMIT IS ISSUED(SEC.3oe7,CIV.C.). ���
Z
W
� LENDER'S NAME
1— LENDER'SADDRESS
w I CERTIFV THAT 1 HAVE READ THIS MPLICATION AND STATE TNAT THE ABOVE INFORMATION IS COHRECT. TOTAL FE ES , ��
� I AGREE TO COMPLY WITH ALL CITV AND COUNTY ORDINANCES AND STATE UWS REIATINO TO BUILDING
� CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATNES OF THIS CW NTV TO ENTER UPON THE
Z ABOVE-MENTIONED PROPER FOR INSPECT PUR sEs. � COMMENTS
� �v� I� 1
�
m PE I (P
� � d�
� 510 A E OF RMfTTE DA � ,
� RECPT.NO. PAID BY VALIDATION
WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy.GOLDENROD—File Copy,GREEN—Applicant's Copy
' - . . ' . . .. � � . � . , _..1���'v�V'.... ...�.J' . iJ'Y-v. :�4..—�.�-. . . .. . . .M1 .��`�... - . . ... . . . ,. . .
�1J��II �4 �Ilb'l1YVIl�Y V� ILLIr"1!U U
uU V�������U V ������
° � U o ��U�-� '� � p ,�3 �,��(�.�11 Q G� . � ' l� � o �
SET BACK � ?- FLOOR JOfST.�; A ,
FTGS/FORMS/STEE� � FHA REQMTS
EL,ECTRfC GROUND UNDER FLOOR DUCT'
GROUND PLUMBING � UNDER FLOOR.CUMDUiT
SLAB GRADE FIAE�'1,..4CE:FOUNDATION
. __.—T—T___._. ._�._. _.
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE M1D HT. BOND BEAM
R�OF SHEATHI�IG 8 FT. BOND•BEAM
FRAMINGNENTILIATION FlNAL E30ND BEAM
R�OF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC �� ROUGH GRADING ___
ROUGH PLUNIBING FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSULATION POO�FINAL
CEILING INBULATICIN OFF SITE IMPS.
DRYWALL NAIUf�G DEDICATIONS
SEWER FINAL ENG.
SEPTIC TAfVK LANDSCAPE/IRRIG.
SEEP PIT/L.l.. ON SITE IMf'S.
GAS AIR TEST FINAL ZONING
FINAL CONST. FIRE D�P7. FINAL
FlNAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMSING ENERGY
��� , �
COii�li�EiVTS
SEPTIC TAh1K SIZE
SEEP PIT/U SIZE
�
,� �
o ��
^ . •
. �l✓ o , , IJ!- 1