HomeMy WebLinkAbout18263 (28) i
CTTY OF DIAMOND BAR �'�
- ��` ---� DEPARTMENT OF CONIIvIt1NI'fY&�DEVELOPMENT SERVICES �"' �
I
21825 E.Copley Drive
(909)860-3195 Fau(909)861-3117 PRESS
��'%9�� � BUILDING PERMIT APPLICATION FI MLY
� JOBSITE /� n APPLICATION PERMIT � /C
o ADDRESS Z��S� C.J�O�-Os� S•'�Z.���S 1�-Q DATE �� NUMBER #
� APN LOj TRACT ISSUE ✓7 7ypE pCC
DATE � ��-CONST. GROUP
p OWNER � (�_ 1 � �-
p ADDRESS ZONING SETBACKS
z CITY ' ZIP 7EL. FRONT qyy p �
� APPLICANT TEL. REAR p
¢ SIDE/SIDE STREET RW ❑
� CONTRACTOR ^4 �.u.K. ..�1 So�C.2..,� SIDE p
� � ADDRE S � 'f�JC� �J �
� CITY �GO u�-.30 ZIP� 1� TEL g���o�/2-OZA� PROPOSED USE
oARCH/ENG/ �
�z DESIGNER NO.DWEL. NO. NO.
� ADDRESS
I cn UNITS STORIES BEDROOMS
� CITY ZIP TEL.
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREA/VALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
O
p 1 HEREBV AFFIqAI UNDER PENALTV OF PERIURV THAT I AM EXEMPT FROM THE CANTR�CTOqS LI- GefO 0/C8 ff
W CENSELAWFOR7HEFOLLOWINOREASON(SEC.�OJI.6BUSMESSANDFROFESSIONSCODE:ANVCITYOF (n 9 �
U �JMyWryICHHEOUIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE.DEMOLISH,OPREPAIRANVSTRUC- W Patio/Deck
Z 7URE,PRIOR TO ITS ISSUANCE,AL50 REOUIHES THE APPLICANT FOR SUCN PERMIT TO FILE A SIGNED w '
� STATEMENT THAT ME OR SHE IS LICENSED PURSUAIlT TO THE PROVISIONS OF THE CONTRACTORS�I- . �
� CENSE UW(CHAPTER Y(COMMENCING WITH SECTION�000)OF DIVISION 3(1F THE BUSINESS AND PRO- POOVSPB
� FESSIDNSCODE)ORTHATHEORSHEISE%EMPTTHEREFROMANDTHEBASISFORTHEALlEOEDE%EMV� (�
U TION.ANY VIOLATqN OF SECTION 7031.5 BY ANY APPLICAN�FOR I.PERMIT SU&lEC f5'fHE APPI.ICANT TO Z Re-Root �
A CIVIL 7ENALT/OF NOT A/ORE THAN FNE HUNDRED Dq.URS(f500).):
0 OI,ASONRJEROFTHEPROPERTY,OPMVEMPLOVEESWITHWAGESASIHEIRSOLECOMPENSATiON, O COrt1ffIBfC18I
Z WILL DO THE WORK,AND THE STRUCNRE IS NOT IN7ENDED OR OFFERED FOR SALE(SEC.70��,BU51- J
� NESS AND PFOFESSIONS CODE:TNE CONTRACTORS LICENSE LAW DOES NO'A7PLV TO AN OWNER OF �
PROPERTV NT/O BURDS OR IMPROVES TMEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
Q THROUOM HIS OR NER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
�., OFFEREDFORSALEIF,HOWEVER7HEBUILDINOORIMPROVEMENTISSOLDWITHINONEVEAROFCAMPLE-
Z TION,THE OWNER�BUILDEH WILL HAVE THE BURDEN OF PROVING'HAT HE OR SHE DID NOT BUILA OR
� IMPROVE FOR THE PURPOSE OF SALE�.
w ❑I.ASONRJEROFTMEPROPERiV,AMEXCIUSIVELYCANTPACTINGWITHLICENSEDCONTRACTORS
[t TO CANSTRUCT 7HE PRQIECT(SEC.70N,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS U� ValUBfiOf1 � ADJ.AREA �
W CENSE UW DOES NOTAPPLY TOAN ON7JER OFA PROPERTV WHO dUII.DS 0R IMPROVES TMEREON,AND
� WHOCONTMCTSFORSUCHPR0.IECTSWITHACONTRACTOR(S�1.IGENSEDPURSUMITTOTHECONTRAG QUANTITV DESCRIPTION FEE
Y 70R5 LICENSE LAW.).
� ❑I AM E%EMPT UNDER SEC. 8.d P.C.FOR THIS REASON Q
� U
� DA7E OWNER H �
Z U
� LICENSED CONTRACTORS DECLARATION w
� I HEREBY AFFIRM UNDER PENALTV OF PERJURV THAT I AM LICENSED UNOER PROV�SIONS OF C/IAPTER �J
� e(COMMENCINQ WITH SECTION 7000)OF DIVISION 30F THE BUSINES$ANO PP.OFESSlONS CODE,AND Z �+ � � i
��� MV LICENSE IS IN FULL FORCE AND EFFECT. m � 'J
� LICENSE C SS ��� ���.No. •Sr3���/3� ��� � v
U DATE �I CONTRACTOR �1�'f:F�Y-R�+�2 � d � �C� ��1�4t 1r� ' � `�
w � W `Y��G'r���� _
� WORKERS'COMPENSATION DECLARATION a
� U
� I HEREBV AFFIRM UNDER PENALTV OF PERJURY ONE OF THE FOLLOWINC DECLARATIONS: Z �
�Z I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WOHI(ERS' a
Q =
COMPENSATION,ASPROVIDEDBYSECTION3]OOOFTMELABOHCODE,FOqTHEPERFORMANCE U
Q OF THE WORK FOR WNICH THIS PERAl1T IS ISSUED. �
w _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURMlCE,AS REOUIRED BV SECTION
Q 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUE�.MY WORKERS'COMPENSATION INSURANCE CARRIER M!D POLICV NUMBER AAE: CONSTRUCTION '
J
j CARRIER PLAN REVIEW �
Z POLICV NUMBER ELECTRIC
Q w
� (I}YSSEC�IONNE�NOTBEO0A43EfEDOFhEPERMRISFOfiQVEHlM7REDpOL1/�RS�Stpp)OqLE55� PLUMBING x-
{yi •v
Z I CERTIFV THAT IN TNE PERFORMAtJCE OF THE WORK FOR WHICH THIS PEHMIT IS ISSUED,1 MECHANICAL
C,'} SHAIL NOT EMPLOY ANY PERSON IN ANV MANNER SO AS TO BECOME SU&IEf,T TO THE
� WORKERS'CAMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULO BECAME INS?ECTION FEE
� SU&IECTTO THE WORKERS'COMPENSATION PROVI JONS OG SEC 3l0o OF THE LABOR . . _�
� CO E,I SH FOR7HWITH COMPLV WITH TH ROVISIONS. ISSUANCE ' L
� -7
p DA7E, Z d�G_qpp�IC SMIP
W
J WARNIN6:FAILURE TO SECURE WORKERS' PENSATIO COVERAGE IS UNUWFUL,AND SHALL BE ENERGY P/C �
J
�y SU&IECTAN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND ENERGY PERMIT
DOLLARS(St00,000),IN ADDITION TO THE COST OF COMPENSATION,�AMAGES AS PROVIDED FOR IN
w SECTION37o80FTHELABOFCADE.INTEREST,ANDATTORNEV'SFEES. RETENTIONFEE: /
O CONSTRUCTION LENDING AGENCY PRE-ALT FEE: '
� I HEREBV AFFIRA/UNDER PENALTV OF PERIVRV THATTHERE IS ACONSTRUCTION LENDINC AOENCV
� FOR THE PERFORMANCE OF TNE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.700],CIV.C.�.
Z
W
� LENDEii'S NMIE
� LENDER'S ADDRESS
� TOTAL FEES � l ,$�
� I CERTIFY THAT I NAVE READ THIS APPLICATION AND STATE THAT THE ABOVE W FORMATION IS CORRECT.
w I AOREE TO CAMPLV WITH ALL CITV AND CWNTV ORDINANCESAND STATE UWS RELATING TO BUILDING
d
� CONSTRUCTION,AND HEREBV AUTHORRE REPRESENiATIVES OF TNIS COUNTV TO ENTER UPON THE
Z ABOVE�MENTIONED 7ROPERTV FOR INSPECTION PURPOSES. COMMENTS
� J i�-� ��
�
m PERMITTE � (P NT)
Q
� �
T P EE E
� � RECPT.NO. PAID BY VALIDATION
, WHITE—Department Copy,VELI.OW—Finence Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy
�0`�`�t' �� IC�B�aI�V�$�RC� �6�6�
6i��P��`gJ�6'� ��CC�f�D
�� �ti�; � �- �`<�3- �- � '� a '" -. . . � . _. .
. ;� �° O a. .,f .s�.,�, a ' ,& �M 0 " ' a 4�r',,.� o � � +.r
,_-
d =
# � .'g� v� ' } '�- p � F � 0
s i�
SET BACK � � � �, � FLOOR JrJlST�. � _ � � � �� . , �
-_._ � �----�-- � __
FTGS/FORMS/STEEL � � FHA REQMTS
� ______.---------
ELECTRIC GROUND ' UNDEFi FLOOR DUC�I'
GRUUND PWMBING �, v UNDER FLOOR CU�IDUI7 �
SLAB GRADE , FiREPLACE FOUNDA?ION
TEMP POWER ^FIREPLACE B�ND BEAM
WATER SERVICE � MID HT, E30ND BEAM
ROOF SHEATHING 8 FT. BOFJD BEAM J
FQnnn�.�^^��T�__��N � �-p�, ---� �FIIVAL BOND BEAM �
a _ ,_
ROOF COVER PRE-GRADING
ROUGH HEATING BENCHING
ROl1GH ELECTRIC � HC�UGH GRADlNG
ROUGH PLUMBING j FINlSH uRADlNG ^
SHOWER/TUB TEST POOL ELECTRIC
EXT. LATH/51D1NG I POOL FENCING
WALL INSULATION POQL FINAL
CEILING IN�ULATION OFF SITE 1MPS.
DRYWALL NAILING DEDiCATIONS
SEWER FINA�ENG.
SEPTIC TANK LANOSCAPElIRRIG.
SEEP PITlL.L. � � ON SITE IMPS.
GAS AIR TEST FI�JAL ZCJNING
FINAL CONST. .y(e,b'� . �� �v _FIRE DEPT. FINAL
FINAL FIEATING i��-d� ��, I�HEAI.�H DEP"f. F1NAL
�iNAL E�ECTRIC .-��G I DEV. FEES PAID
FlNAL PLUMBING �_��j� � _ ,I ENERGY
- r �� �a � 's,:�
, � � . ;
ca�3--�r�- - - -
�a�_�1��_ �� A_ _ . _ __ _ -.. .- --- . -- -� -
C:UIUIMENTS
•, . . ---- — —
,
.;
. �. .� ,
SEPTIC TANK SIZE
SEEP PITIU SIZE ---J`�—
a y : :.� --- . --
_ �.
"` � • , � ,�� __
� . o� .. �,.�u„ � .
�
� . ... . .. , �, ' �_ + �