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HomeMy WebLinkAbout18221 (28) _��� _ CITY OF DIAMOND BAR DEPARTIv�NT OF COMMUNTI'1'&DEVELOPIv1ENT SERVICES 21825 E.Copley Drive '� (909)860-3195 Fax(909)861-3117 PRESS �'-���w BUILDING PERMIT APPLICATION � 2 I FIRMLY Q JOBSITE //� ,�L ��;�,.,5 DATE t-2- 0?/ ¢ ADDRESS �'I�-v Gl _J� D2 APPLICATION� / NUMBER � ri/C �Z� � AP ��7 B�I LOT TRACT '��020'� ISSUE TYPE _��,,_i� OCC p OWNER�LO � � DATE CONST. � -ry_ GROUP �_ o ADDRESS ZONING SETBACKS Z CITY J�� ZIP TEL. FRONT RW ❑ g APPLICANT i..3h P_�ebCK� TEL.���� REAR ❑ zd SIDE/SIDE STREET RW ❑ � CONTRACTOR SIDE p ADDRESS � CITY ZIP TEL. PROPOSED USE I� o w ARCH/ENG/ z DESIGNER GJ/i C- G} w NO.DWEL. ) NO. NO. a ADDRESS d L..i . cn UNITS / STORIES �_ BEDROOMS � CITY!'it/�.C./LLa ZIP Z TELq '/ N DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION O OWNER-BUILDER DECLARATION SFR/ADD/REM Q p I HEREBV AFFIRM UNDER PENALTV OF PERNRV THAT I AA1 E%EMPT FROM THE CONTRACTORS LI� G8fe9B/Ca1POfS W CENSELAWFORTHEFOLLOWINOREASON(SEC.7o31.5BUSINESSANDPROFESSIONSCqDE:ANVCITYOR (n U �p�Jry7'yW{{�HREWIRESAPERAIITTOCONSTRUCT,ALTER.IM7ROVE,DEMOLI$H2OFREPAIRANVSTAUC- w w NRE,PRIOR TO ITS ISSUANCE./�LSO REOUIRES THE APPUCANT FOR SUCH PERMIT TO FILE A SIGNED w Patlo/Deck � STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI� � CENSE LAW(piMTER e(COMMENCINO WITH SECTION 7000)OF DIVISION 3 0F THE BUSINESS AND PRO� � POOVSPB � FESSIONSCODE)ORh1ATHEORSHEISEXEMPTTHEREFROMANDTHEBA515FOHTHEALLE4EDE%EMP- (� V TION.ANYVqLATIONOFSECTION7031.6BYANYAPPLICANTFORAPEPMITSU&IECTSTHEAPPLICPNTTO Z Re-Root A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(f500)J: � OI,ASOWNEROFTHEPROPERTV,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECAMPENSATION, � COrtIrtI0fCi81 Z WILL DO THE WORK�ND THE STRUCTURE IS NOT INTENDED OR OFFEREO FOR SALE(SEC.7014,BUSI� J � N NESS AN�PROFESSIONS CODE:THE CONTfiACTORS LICENSE UW DOES NOT APPLV TO AN OWNER OF � PROPERlY W/10 BUILDS OR IMPROVES THEflEON,M1D NM110 DOES SUCH WORK HIMSELF OR HERSELF OR � THROUGH MIS OR HER ONM EMPLOVEES,PROVIDED 7HAT SUCH IMPROVEMENTS ARE NOT INTEN�ED OR m � OFFEREDFORS/�LEIF,HOWEVERTMEBUILDIN60RIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE� Z TION,THE OWNER-BUILDER WILL MAVE THE BURDEN OF PROVING 7HAT HE Ofl SHE DID NOT BUILD OR � IMPROVE FOR 7HE PURPOSE OF SALE). w ❑I,ASOWNEROF7HEPROPERTV,AMEXCLUSIVELYCANTqACTINGWfTNUCENSEDCONTRACTORS [= TO CONSTRUCT THE PRQIECT(SEC.70u,BUSINE55 AND PROFESSIONS CADE:THE CONTRACTORS LI- VeI1Je�lOf1 —�qDJ.AREA W CENSELAWDOESNOTMPLVTOANOWNEROFAPROPERTYWHOBUILDSORIMPROVESTNEREON,AND � WFIOCONTRACTSFORSUCHPRO,IECTSWITHACONTMCTOR(S)UCENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE Y TOqSLICENSEUWJ. Q ❑I AM EXEMPT UNDER SEC. B.8 P.C.F-0 THIS REASON Q ?� � U � � Z U /� LICENS CONTRACTORS DECLARATION w � I HEHEBV AFFIRM UNDER PENALTV OF PERIURY THAT I AM LICENSEO UNDER PROVISIONS OF CHAPTER V. � e(COMMENCIN(7 WITH SECTqN 7000)OF DNISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z ��� MV LICENSE IS IN FULL FORCE AND EFFECT. � � LICENSE CLASS LIC.NO. � V DATE CONTRACTOR a W � WORKERS'COMPENSATION DECLARATION Q � U � I HEFEBV AFFIRM UNDER PENALTY OF PERJURV ONE OF THE FOLLOWING DECLARATIONS: Z � 1 HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOq WORKERS' _ � COMPENSATION,AS PROVIDED BV SECTION 370o OF THE LABOR CODE,FOR THE PERFORMMlCE U � OF TME WOR1C FOR WHICN THIS PERMIT IS ISSUED. w � � Qw _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION 37000FTHE LABOR CODE,FOR THE PERFORMpNCE OFTHE WORN FOR WHICHiH15 PERMIT IS ISSUED.MV MIOHICERS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBERARE: CONSTRUCTION jCARRIER PLAN REVIEW 0 POLICV NUMBER Z ELECTRIC Q 0 (iH55ECiXJNNE�ND7BE00MR.ETmOFhEPEPoMISFOqONEHXI{iEDOq1ARS(f700)ORIESS} PLUMBING � W Z I CERTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSIIED,I MECHANICAL � �}' SHAIL NOT EMPLOY ANV PEFSON IN ANV MANNEF 50 AS TO BECAME SU&IECT TO THE (n WORKERS'CAMPENSATION LAWS OF CALIFORNIA,AND AOREE THAT IF I SHOULD BECOME INSPECTION FEE = SU&IECT TO THE WORI(ERS'COMPENSATKKJ PROVISKKJS OF SECTION 3700 0F THE LABOR CODE,I SHALL FOHTHWITH COMPLV WITH THOSE PROVISIONS. ISSUANCE � O / p DATE: APPLICANT. w NERGY P/� J WARNING FAILURE TO SECURE WOAKERS'CAMPENSATION CAVERAOE IS UNLAWFUL,AND SHALL BE � SU&IECTAN EMPLOVEF TO CRIMINAL PENALTIES AND CIVIL FINES 11P TOONE HUNDRED THOUSAND ENERGY PERMIT DOLURS(5100,000).IN ADDITION TO THE COST OF COMPENSATqN,DAMAGES AS PqOVIDED FOR IN � J SECTION 37oB OF THE LA80H CODE,INTEREST,AND ATTORNEV'S FEES. OC RETENTION FEE: OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: � I HEREBV AFFIRM UNDEH PENN.TV OF PERIURY THAT THERE IS A CANSTRUCTION LENDING AOENCY FOR THE PERFOHA/ANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.70G7,CIV.G�. Z W � LENDER'S NAME H LENDER'SADORESS w I CERTIFY THAT I HAVE READ THIS APPLICATIONAIJD STATE 7HATTHE ABOVE INFOfiMATION IS CARRECT. TOTAL FEES 5�S � OS � �7'\ � � I AGREE TO CAMPLV WITH ALL CITY AND COUNTV ORDINANCES AND STATE UWS RELATING TO BUILOINQ � V� � CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATNES OF 7HI5 COUNTY TO ENTER UPON THE /� /� A Z ABOVE-M NED PROPEHTV FOR���yssee���TION PURPOSES. /� C%(J�C 2 � l � � /J COMMENTS � = x L �j o 1�/r/iT� . m �MITTEE ¢ ��..�.. � 2� � � N SfONATUREOF ERMI DA � RECPT.NO. PAID BY VALIDATION � WHITE—DepaAment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—App icanYs Copy - (�Q�'�Y �1� �Old�l�Gl9�D �Qf� �F��t�(���'Bct�G�i`�3I����� [�� o �t` r� Q�f��=��G . �`�r��l DD GJ� �� � 5ET BACK � �.,. FLQOR.JOIST ! ' FTGS/FORMS/STEEL ���" FHA FtE(]MTS , ���� v " . EL�CTRIC GROUND � ~�{1NDE R'FLOOR DUCT, - • GROUND PLUMBING _ y ' UNDER"'FLOOFi�CUM1IDUIT , ' SLAB GRADE _ �A ,i��,. � :__ FIRE�'LACE.FOUNDATION ' TEMP POWER FIREPLAC� BOND BEAM � WATER SERVICE � MIU HT. BOND BEAM ROOF SHEATHING �,�2�,�L� � ' ` $ FT.BQND BEAM FRAMIP�lG/VENT(LIATION ,�-��°��^� � ��• FiNAL BOND BEAM ` fi00F COVER � _ PI�E-GRADING ROUGH HE,4TING ` D� � ,,..,: �Etv�N1MG.' � ' ROUGH ELECTRlC �-� �'��' ROUGH GRA�ING ROUGH PLUNIBING � FINISH uRADING SNOWERITUB TEST �� � POQ� ELEGTf�IL EXT. LATH/SIDING �U�Q-�� �i�. �` POOL FEh�GlNG WALL IIVSULATION , POOL FlfdAt�' CElLI1�lG INSULATION OFF SITE fMPS. DRYWALL NAIUNG D�DICATI�t�1S SEWER - FINAL ENG. SEPTiC TANK LANDSGAF'E/iRRIC,. SEEP PIT/L.L. � ON SITE lMPS. GAS AIR 7EST ' FINAL ZONiNG FINAL CONST. FIRE DEPT. FINAL � FINAL HEATING � HEAL7H DEPT. FINAL FINAL ELECTRIC � DEV. FEES PAID FINAL PLUP/1BIMG ENERGY �CT. S� �1��� � _ — �� � COMiliIEfVTS _po��� r� �1 �c oE- [3�ii:s�h� �� ��.�-N�,�`2-.- c�r. �G-��Q� �-�� ��<� � .. .� r. , , . , SEPTIC TAiVK SIZE �� , SEEP PIT/U SIZE � - � _.� . �' � � . . , _ • . � i � . ,, T