HomeMy WebLinkAbout17659 (44) CTTY OF DIAMOND BAR
^---��`-- DEPARTIvIENT OF COMMUNTI'Y&DEVELOPMENT SERVICES
21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 PRESS
��%A��r BUILDING PERMTT APPLICATION FIRMLY
¢ ADDRESS�����f� � APPLICATION ' `CJ f}� PERMIT � P/C �
p DATE � NUMBER #
� ISSUE �� �q�J TYPE OCC
APN LOT '' TRACT DATE VA'�� CONST. GROUP
p OWNER
o ADDRE$S ZONING SETBACKS
Z CI ZIP TEL.
FRONT qyy �
g APPLICANT TEL. REAR ❑
zd SIDEJSIDE STREET RW ❑
� CONTRACTO SIDE p
ADDRESS �
� CITY ZIP TEL. P P D SE8
w ARCH/ENG/ y�
�z DESIGNER NO.DWEL. ` NO. NO.
a ADDRESS
� CITY ZIP TEL. UNITS STORIES BEDROOMS
�
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
O
� I HEREBV AFFIRM UNDER PENALTV OF PERIURV THAT I AM E%EMPT FROM THE CANTRACTORS LI� Gef9(J6/CBfPOR
W CENSELAWFORTHEFOLIOWINOREASON(SEC.7031.SBUSINESSANDPROFESSIONSCODE:ANVCITYOR (n
U COUNTVYAiICHHEOUIRESAPERMITTOCANS7AUCT,ALTER,IMPROVE,DEMOUSH,ORREPPJHANY57AUC- w
w NRE,PRqR TO ITS ISSUANCE,/�LSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIQNED w Patio/Deck
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CANTRACTORS LI�
� CENSE LAW(CHAPTER e(COMMENCINO WITH SECTqN 7000)OF DIVISION 3 OF THE BUSINE55 AND PRO- � POOI/SP9
^ FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANDiHEBA515FORTHEALLEQEDE%EMP- (�
V TION.ANVVbUT10NOFSECTION7031.58YANVAPPUCANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Roof
A CML PENALTV OF NOT A/ORE THAN FIVE HUNDRED DOLLARS(5500).):
� ❑I,ASOWNEROFTHEPROPER7Y,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, �
. Z WILl00 THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70I4,BUSI- J COffIrtlBfCldl �
� NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO N!OWNER OF �
PROPERTY WFq BUILDS Oii IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
w THROUGH HIS OR HER OMM EMPLOVEES,PROVIDED THAT SUCN IMPROVEMENTS ARE NOT INTENDED OR m
0 OFFEREOFOR9PLEIF,HOWEVERTI'IEBUILDINOORIMPROVEMEN7ISSOLDWITHINONEYEAROFCOMPLE-
Z TION,h1E OWNER�BUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUIID OR
� IMPqOVE FOR THE PURPOSE OF SALE).
w ❑I.AS OVMER OF 7HE PROPERTY,AM E%CLUSIVELV CANTMCTING WfTH UCENSED CONTRACTORS
� TO CONSTRUCT THE PROJECT(SEC.7oI4,BUSINE55 AND PROFESSIONS CODE:iHE CONTRACTORS LI- VeIUeflOfl ADJ.AREA �
= CENSEUWDOESNOTAPPLVTOANONRJEROFAPROPERTVWFIOBUILDSORIMPROVESTHEREON,AND
� WF�OCONTRACTSFORSUCHPq0.1ECT5WITHACANTRACTOR(S)LICENSEDPURSUANTTOTHECONTRAG QUANTITY DESCfiIPTION , �'
Y TORS 110ENSE UW.). FEE � .
� ❑I AM EXEMPT UNDER SEC. ' B.8 P.C.FOR THIS REASON Q
� U
. � DATE OWNER ' �
Z U
� LICENSED CONTRACTORS DECLAFATION w
� I HEREBY AFFIHIA UNDER PENALTY OF PERIURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
d B(COMMENCINO WITH SECTION 7000)OF�IVISION 3 OF THE BUSINESS AND PROFESSIONS CODE.AND Z
X MY LICENSE IS IN FULL FORCE AND EFFECT. / m
lLl �
� LICENSE CLASS LIC.NO. rV �
U DATE CONTRACTOR a
W
� WORKERS'COMPENSATION DECLARATION Q
N I HEHEBV AFFIRM UNDER PENALTY OF PERIURV ONE OF THE FOLLOW WG DECLARATIONS: V
� Z
� I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE F-0H WORKERS' a
Z =
Q COMPENSATION,AS PROVIDED BV SECTION 37oa OF THE UBOR CODE,FOR THE PERFORMANCE U
OFh7E WORK FOR WHICH TNIS PER/AIT IS ISSUED. W
� �
QW _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REIXIIRED BV SECTION /�� a '
37o00F THE LABOR CqDE,FORTHE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS � � �e J . �./�O
ISSUED.MV WORKERS'CA�jMP/E�NS�ATION INSURANCE�C/A�R'R�IER AND POLICY NUMBER ARE: CONSTRUCTION l/ 1
jCARRIER �J.L/j� �i�D/lV/ PLAN REVIEW
Z POLICVNUMBER�(�Q��(�'�1/ ELECTRIC
Q
0 (iHI55ECiXJN1�F�ND78EWMREfIDOFTFEPERIMISFOqONEM1I�DREDDp.LARS(flao)OqLESS� PLUMBING -
W
Z I CEflTIFY THAT IN 7HE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUEO,I MECHANICAL
C7 SHALL NOT EMPLOV ANV PERSON IN ANV MANNER SO AS TO 9ECOME SU&IECT TO THE
(/� WOR)(ERS'COMPENSATqNLAW50FCALIFORNIA,ANOAGREETHATIFISHWLDBECOME INSPECTIONFEE
SU&IECT TO THE WORKERS'CAMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR r
�j CODE,I SHALL FORTHWITH COMPLV WITH THOSE PROVISKKJS. ISSUANCE
�
p DATE: APPLICANT: SMIP
W
J WARNING FAfLURE TO SECURE WORKERS'COMPENSATION CAVERAOE IS UNLAWFUL,AND SHALLBE ENERGY P/C �
J
� SU&IECTANEMPLOVERTOCRIMINALPENALTIESANDCMLFINESUPTOONEHUNDREDTHWSAND ENERGYPERMIT
DOLLARS(S1o0,000),IN ADDITION TO 7HE COST OF fAMPENSATION,DAMAOES AS PROVIDED FOR IN
J SECTION 3708 OF 7HE LABOR CODE,INTEREST,AND ATTORNEYS FEES.
oC RETENtION FEE:
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBV AFFIRM UNDER PENALTV OF PEFiJURV TNATh1ERE IS ACONSTFUCTION LENDINO AGENCV
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.�.
Z
W
� LENDER'S NAME
F— LENDER'SADDRESS
w I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE iliAT THE ABOVE INFORMATION IS CORRECT. TOTAL FE ES I �
� I AGREE TO COMPLV WITH ALL CITV AND COUNTY OROINpNCES AND STATE LAWS RELATING TO BUILDING
� CONSTRUCTION,AND HEREBV AU7HORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE
Z ABOVE�MEMIONED PROPERT F INSPECTKKJ PURPOSES. COMMENTS �
�
J
�
m PERMITTEE NAME(P
¢ y- - �
� .�
� SIONATUFEOFPERMITTEE D TE
� RECPT.NO. PAID BY . VALIDATION
WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanYs Copy ,
(�9�P'� ��' �'D��f�ic�f�9�,1��[f�
o����c��or�� ������
0�� Dl�� ��n3 � OG�+ ° � DGQ� 0 ° �� tr Q �
SET BACK � FLOOR JOIST __. '.
r4 ` F!-fA REC�MTS
FTGS/FORMSISTEEL -� ; . �
ELEC7RIC GROUND � UNDER FLOOR DUCT ,
GROUND PLUMBiNG UNDER FLOOR CU�IDUIT .
SLAB GRADE FIREPLACE FOl1NQATION
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE � ^ MID HT. BOND,BEAM
ROOF SHEATHING 2�/�L'.� , , , 8 FT. BOND BEAM
FRAMfNGNENTIUATION � � ' :. �� �FiNAL BOND BERM
ROOF COVER �� ��� PRE-GRADING � �
ROUGH HEA7ING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH P�UNIBING FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSULATION POQL FINAL '
CEILING INSULATION OFF SITE IMPS. � �
DRYWALL iVAILIfdG DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK � LANDSCAPE/IRR1G.
SEEP PIT/L..L. '' � ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONSL FIRE DEPT. FINA�
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FIPVAL PLUMBING ENERGY
�
_ ��l � Q ',
CONiMEi�TS
SEPTIC T�4fVK SIZE
SEEP PIT/U SIZE
� °
A�I [�
� . . ,;' _ •, -