HomeMy WebLinkAbout18189 (25) CITY OF DIAMOND BAR ����'v
---�� — DEPARTMENT OF COIvIIviUNTI'1'&DEVELOPMENT SERVICES
21825 E.Copley Drive �
„ (909)860.3195 Fax(909)861-3117 PRESS
�"���� BUILDING PERMI'P APPLICATION „ FIRMLY
o DDRIES9��W v �OGlF^���1�) ? DATE CATION ,,.,� �(��U BER � � q/C
� ISSUE TYPE OCC
APN LOT TRACT DATE CONST. �I GROUP
p OWNER L� � C . i
p ADDR SS D ZONING SETBACKS �
z CITY� ZIP TE FRONT qyy �
o APPLICA T TEL. y g REAR �
zd SIDE/SIDE STREET RW ❑
� CONTRACTOR SIDE p
ADDRESS
o CITY ZIP TEL. PROPOSED USE �n v G_ �_ �
w ARCWENG/ /
z DESIGNER �7 -— �� �✓ o r
a ADDRE S / p NO.DWEL. . NO.
� CITY � ^/R" ZIP � TE UNITS STORIES BEDROOMS
v�
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM �
O
p I HEREBV AFFIRM UNDER PENALTV OF PEFiJURV THAT I AM EXEMPT FROM THE CONTRACTORS LI- Gflf9QB/CefPOR
W CENSELAWFORTHEFOLLOWINOHEASON(SEC.7031.SBUSINESSMIDPROFESSIONSCADE:ANVCITVOR (n
U CpUNTyWI{�CHREWIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOUSH,ORREPAIRlWYSTRUC- w
w NRE.PRIOR TO ITS ISSUANCE,AL50 REW IRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIoNED w Patio/Deck
� STATEMENT THAT HE OR SHE IS UCENSED WRSUANT TO THE PROVISIONS OF THE CONTRACTORS U- �
� CENSE LAW(pUPTER 9(COMMENCINO WITH SECTION 70D0)OF DIVISION 3 OF THE BUSINESS AND PRO- POOUSPO
� fESS10NSCODE)OR7HATHEORSHEISEXEMPTTHEREFROMANDhIE9A515FORTHEALLEOEDE%EMP- (7
V TION.ANY VqUT10N OF SECTION 7031.6 BV ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT T0 Z Re-Roof
A CML PENALTV OF NOT MORE THAN FNE HUNDRED DOLLARS(S5o0).):
� ❑I,ASOYMEROFTHEPROPERTV,ORMVEMPLOVEESWITHWAOESASTHEIRSOLECOMPENSATION, � COrtlfnBfC18I
Z WILL 00 THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70/�,BUSI- J
� NE55 AND PROFESSIONS CADE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO/W OWNER OF �
PROPERTV N?i0 BUILDS OR IMVqOVES THEREON,AND WHO DOES SUCH VJORK HIMSELF OR HERSELF OR
wTHROU6HHISORHEROWNEMPLOVEES,PROVIDEDTNATSUCHIMPROVEMENTSARENOTINTENDEDOR m
� OFFEREDFORSALEIF,HOWEVER,hIEBUILDINGORIMPROVEMENTIS50LDW1THINONEVEAROFCOMPLE-
Z TtON,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE Ofl SME DID NOT BUILD OR
� IMPROVE FORTHE PURPOSE OF SALE).
w ❑I,AS OWNER OF THE PROPEHTY,AM EXG.USNELV CONTRACTINO WRH LICENSED CONTRACTORS
� ' TO CANSTRUCT THE PR0.IECT(SEC.7oN,BUSINE55 AND PROFESSIONS CODE:THE CONTRACTORS LI- V8IU9�1Of1 ADJ.AREA
W CENSEUWDOESNOTAPPLVTOANOVYtJEROFAPROPERTVWFiOBUILD50RIMPROVESTHEREON,AND
� WFIOCONTRACTSFOflSUCHPR0.1ECT5WITHACONTRACTOR(5)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION
Y TORSLICENSELAW.). FEE
� ❑1 AM E%EMPT UNDER SEC, B.8 P.C.FOR THIS REASON Q
� U
LL DATE OWNER H
Z U
� LICENSED CONTRACTORS DECLARATION W
� I HEREBY AFFIRM UNDER PENALTV OF PERIUFV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � '
� 0(COMMENCING WITH SECTION 7000)OF DIVISION 3 0F THE BUSINESS AND PROFESSIONS CODE.AND Z
�� MY LICENSE IS W FULL FORCE AND EFFECT. m
. � LICENSE CLASS LIC.NO. �
U DATE CONTRACTOR d
W
� WOPKERS'COMPENSATION DECLAAATION Q
� U
� I HEREBV AFFIRM UNDER PENALN OF PE0.IURV ONE OF THE FOLLOWINIi DECIARATKKJS: Z
0Z _IHAVEANDWILLMAINTAINACERTIFICATEOFCANSENTTOSELF-INSUREFORWORNERS' a
Q
COMPENSATqN,AS PROVIDED BV SECTION 3700 OF THE LABOR COOE,FOR THE PERFORMANCE U
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. W
� �
Qw _IHAVEANDWILLMAINTAWWORKERS'COMPENSATIONINSUMNCE.ASREOUIREDBVSECTION
370o OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED.MV WORKERS'COMPENSATION INSURANCE CAARIER AND POLICY NUMBER ME: CONSTRUCTION
> cARRiER PLAN REVIEW
Z POLICV NUMBEF ELECTRIC `��
Q
� (fl-OSSEC1101dNE�NDTBE07A�LEfFDOFTI-�PEpAqTISFOqpNEM1rDREDDOl1hR5(t10o)ORLESS} PLUMBING
W
Z I CERTIFV THAT W THE PERFORMANCE OF THE WORK FOR WHICH T PERA/lT IS ISSUED,I MECHANICAL
C7 SHALL NOT EMPLOV ANY PERSON IN ANY MANNER SO AS TO BEC U&IECT TO THE
(/7 WORKERS'COMPENSATION LAWS OF CALIFORNI0.N�D AGREE TMA I I SHOULD BECOME INSPECTION FEE
SU&IECTTOTHEWOR)(ERS'COMPENSATIONPROVISqN50FSEC 37000FTHE qFi J �• .
S COOE,I SHALL FORTHWITH COMPLV WITH FIOSE PROVISIONS. / ISSUANCE
�
p DATE: qP SMIP
W
J WARNINQ:FAILURE TO SECURE WORKERS'COMP NSATION CAVE E IS LA L,AND SHALL BE ENERGY P/C
J
�y SUBJECTANEMPLOVERTOCRIMINALPENALTIES DCMLFINESUPTOONEHU REDTHOUSAND ENERGYPERMIT
DOlLARS(5100,000).IN ADDI710N TO THE COST OF MPENSATION,DAMAGES AS PflOVI�ED FOR IN
J SECTION 37oe OF 7HE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. �
OC RETENTION FEE:
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBV AFFIfiM UNDER PENALTV OF PERIURV THAT THERE IS A CONSTRUCTION IENDING AOENCV
FOR THE PEHFORMPNCE OF THE WORK FOR WHICH TNIS PERMIT IS ISSUED(SEC.3087,CIV.C.).
Z
W
� LENDER'S NN./E
� LENDERSADORE55
� I CERTIFY THAT I HAVE READ THIS APPLICATqN ANO STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTAL FE ES
w I AGREE TO COMPLV WITH ALL CfTY AND CWNTY ORDINlWCES AND STATE LAWS RELATING TO BUILDING I ����
� CONSTRUCTION,AND HEREBV AUTFIORIZE REPRESENTATNES OF iH15 COUNTV TO ENTER UPON THE V
� ABOVE�MEMqNED PROPERTV FO SPECTION PURPOSES. '
Z COMMENTS
� S� ��
J
�
¢ PERML EE NAME(PRIrIT)
� SIGNA RE OF PERMI DATE
_ � RECPT.NO. PAID BY VALIDATION
~ HITE—Depariment Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENROD—File Co GREEN—
py, ApplicanYs Copy
� �i'4 V�1 O�/.'���. ���tlII9�1V tl V�+:�l/-Y�
�[����f�,��lT8��9 f�[��(����
,,, _ ..
_,,..,�: ,
0 � �� DD LQ� O[�� ° p . ��� DD Q4C� D[� o 0
SET BACK _ ` - �_.�` � FLOOR JOIST ` __
FTGS/FORMS(STEEL �Ha REC�MTS
ELEC7RIC GROUND � UNDER FLOOR,pUCT � � ,
GRDUND PWMBING � UNDER FLOOR..CU�IDUIT
SLAB GRADE FIREPLR `�bUNDATION
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID HT. BOND BEAM
ROOF SHEATHING , 8 FT B�ND BEAM
FRAMIfVGNENTILIATION FINAL BOND B�AM
ROOF COVER _ � ' PRE-GRADING'
ROUGH HEATING BEt�CHIW(fi•�` '�,�1
ROUCH ELECTRIC � � R�UGH GRAbING
ROUGH PLUMBING ������ � FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL li�lSULATION POOL FINAI.
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILWG DEDIGATION5
SEWER ' F1tvAL ENG. �
SEPTIC TANK • LANDSCAPE/IRRIG.
SEEP PIT/L.l.. � �.` ON Si�TE IMPS.
GAS AIR TEST FINAL ZONING
FINAL COi4ST. ��� �� FIRE DEPT.`FIP1A�
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC �� ` , � DEV. FEES PAID
`O'-�c3- --
FIPVAL PLUMBWG ��� � EN�RGY
_ � �>
--- -� _ �� Q_����::;.� - ��� - - -
CO�/iNiEfVTS �-�Z -oz �� �c: ��s � � -���
SEPTIC TI�NK SIZE �
SEEP PIT/U SIZE
�
, A� [�
� � ��'=� �– � � — --
� , ", �1�;' ,
�� �
: , •- �