HomeMy WebLinkAbout16826 (25) C1TY OF DIAMOND BAR
--��`-- DEPARTMENT OF CONIIvIiJNTTY 8c DEVELOPMENT SERVICES
I 21825E.CopleyDrive EXPIR�G� PRESS
'"� (909)860-3195 Fax(909)861-3117
�`':.9M'~ BUILDING PERMIT APPLICATION 1 a �(jQ3 FIRMIY
� JOBSITE APPLICATION � t0� O` PERMIT J,�' ��P/C
a ADDRESS DATE � NUMBER lV #
� APN LOT TRACT DATEE / l 1 v' ONST. GROUP
°� owr�F�'—IA / �
� ZONING SETBACKS
o ADDRESS FRON7 RW ❑
Z C�Ty Z�p TEL. REAR �
g APPLICANT TEL. SIDElSIDE STREET RW �
Q SIDE ❑
� CONTRACT . �
� ADDRESS PROPOSED USE
� C�Ty ZIP��� TEL
w ARCH/ENG/
z DESIGNER NO.DWEL. NO. NO. �
a ADDRESS UNITS STORIES BEDROOMS �
� C�7y ZIP TEL. �
� t
DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
� OWNER•BUILDER DECLARATION SFR/ADD/REM \
O
p I HEREBV AFF1iUA UNDEF PENALTV OF PE0.NRV THAT 1 AM EXEMPT FROM THE CONT{UCTORS LI- G910gB/C8fP0A
W CENSEUWFORTMEFOILOWINOREASON(SEC.7031.56USINESSANDPROFESSIONSCADE:ANVCITVOH (n
U COUNTVWHICHREOUIRESAPEfiMITTOCON57AUCT,ALTER,IMPROVE.DEMOLISH,ORREPAIRPNYSTRUC� W P8I10/DBCk
WYURE.PRpR TO ITS ISSUANCE.K50 REQUIRES THE A7PLICN7T FOR SUCH PERMIT TO FlLE A SIONED w
� STATEMENT 1HAT HE OR SHE IS LICENSED PURSl1ANT TO THE PPOVISIONS OF THE CONTMCTORS LI� � p��Spa
� CENSE LAW(CNAPTER B(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF 7NE BUSINESS AND PRO- �
^ FESSIONSCO�E)ORTHATHEORSHEISEXEMP7THEREFROMANDTHEBASISFORTHEALIEGEDEXEMP�
V TION.ANY VIOIATION OF SECTION 7031.5 BV ANY APPLICANT FOR A PERMIT SU&IECTS 7HE APPLICANT TO Z Re-Roof
� A CIVIL PEN/�LTV OF NOT MORE 7HAN FIVE HUNDRED DOLLARS(f5o0).�: l
� ❑I,ASOMMEROFTNEPROPERTY,ORMYEMPLOVEESNATHWA�ESASTHEIRSOIECOMPENSATION. � Commercial
Z WILL DO THE WORI(AN�THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7041,BU51� J
� NESS M1D PROFESSIONS CODE:THE CONTqACTORS LICENSE LAW DOES NOT A7PLV TO AN OWNER OF �
VROPERTVYM03UILDSORIMPROVESTHEAEON,ANDWHODOESSUCHWORKHIMSELFORHERSELFOR m
� THROUGH HIS OR HER OWN EMPLOVEES.7ROVIDED THAT SUCH IMPROVEMEMS AAE NOT MTENDED OR
0 OFFEREDFOFSALEIF,HOWEVERTMEBUILDINaOFIMPROVEMENTISSOLDWITHINONE�EAROFCOMPLE�
Z TION,TME OWNER�BUILDER WILL HAVE TME BURDEN OF PROVINO 7HAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF SALE).
w ❑I,ASOWNEROFTHEPROPERTY.AMEXCLUSIYELYCOH�RACTINOWfIHUCENSEDCONTRACTORS
Q TO CONSTRUCT THE PRQIECT(SEC.7014,BUSINESS AND PROFESSIONS CODE:TNE CONTW1CTOq5 LI� V81U811011 ADJ.AREA
� CENSELAWDOESNOTAPPLVTOANOWNEROFAPROPERTVVA106UILDSORIMPROVESTHEREON.AND
WViOCONTRACTSFOPSUC1iPRQ1ECTSWITHACONTMCTOR(S)LICENSEDPUFSUANTTOMECON7iUG QUANTITY DESCRIPTION FEE
Y TORS UCENSE UW.). J
O ❑I AA1 EXEMPT UNDER SEC. 8.8 V.C.FOR THIS REASON �
� 2
LL DATE OWNER V
O J
� LICENSED CONTRACTORS DECLARATION w
� I HEREBY AFFIRM UNDER PENALTV OF PERJURV THAT 1 AM LICENSED UNDER PROVISIONS OF CHAPTER �r ��
p� D(COMMENCINO WITH SECqqqT���ION 7000)OF DI�ISION�OF hIE BUSINE55 AND PROFESSIONS CODE.AND Z
X MY LICENSE IS IN FULL FO E AN EFFECT. m
LIJ /! ' �
� LICENSE CLA U LIC.N0. I J
V DATE � � CONTRACTOR . I a
W
� WOiiKERS'COMPENSATION DECLARATION � �
� a
� U
� I HEREBV�FFIRM UNDER PENALTV OF PERIURV ONE OF7HE WLLOWING DECURATqNS: Z
Q
� __I HAVE AND W�LL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' 2
Q COMPENSATION,AS PROVIDED BV SECTION 3100 OF THE LA60R CODE,FOH THE PEHFORMMICE W
F THE WOflK FOH WHICH TNIS PEiYM�T IS ISSUED. �
W
I HAVE ANO WILL MAINTAIN WORKEHS'COMPENSATKKJ INSUHANCE.AS REWIRED BY SECTION
O 3700 OF THE IABOR CODE.FOR THE PERFORMANCE OF THE N�ORN FOR WHICH THIS PERMIT IS
ISSUED.MV WOR.��K.y�S/'��o P 5 1 N INSURA�N/y�CARRIEF7 AND POLIGV NUMBER ARE: CONSTRUCTION
j CARRIER / !� �' v� - �- PLAN REVIEW
z POl{CV NUMBER ELECTRIC
Q
� (i}BSSECT/JNNE�NO7BEOOMR.Ef�OFTF�EPEPo.�TSF��'EFMOREDOOl1IfiSlS70010qLES5} PLUMBING ' o
W MECHANICAL
Z I CERTIFY THAT IN THE PERFOHMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED,I
'CJ SHALL NOT EMPLOY ANY PERSON IN ANV MANNER 50 AS TO OECA�E SUHJECT TO iHE INSPECTION FEE
N WORKERS'COMPENSATION LAWS OF CALIFORNIA.AtJD AGREE THAT IF I SFKKILD BECAME
� SUBJECT70THEWORKERS'COM7ENSATION OVISIONS FSECTION37000/A`;fyE R ISSUANCE
� CODE. SHALLF RTHWITHCOMPLVWITM SEPROVISI 5. ��
� ,f�.�i r•�j v� SMIP
p DATE:_���APPUCANT: �
W ENERGY P/C
J WARNIN6:FAILURE TO SEWRE WORKERS'CAMPENSATION COVERAOE IS UNLAWFUL.AND SHALL 9E
� SUBJECTMI EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND ENERGY PERMIT
DOLLARS(f1o0.000�.IN ADDIiION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
� SECTION 37oB OF THE UBOfl COOE,INTEREST,i1ND ATTORNEY'S FEES. RETENTION FEE:
W
� CONSTRUCTION LENDING AGENCY PRE-AlT FEE:
� I HEREBV AFfIRM UNDEF PENALTV OF PERJURV 7HAT TNERE IS A CANSTRUCTION LENOING AOENCV
�- fOR THE PERFORMANCE OF THE WORK FOR WHICH TNIS PERMIT IS ISSUED(SEC.�09�,CIV.C.). ' '
Z
W
� LENDEfYS NAME
F- LENDEflSAD�RESS
� I CERTIFV THAT I HAVE READ TH�S APPLICATION AND STATE TIiAT THE ABOVE INFORMATION IS CORRECT. TOTA L FE ES ��� 5 O
w I AGFEE TO GOMPLY WITH ALL pTV AND COUNTY ORDINANCES AN�STATE LAWS REUTING TO BUIIDING
� CONSTRUCTION,AND HEREBV AUTHORIZE FEPRESENTATNES OF THIS CWNTI'TO ENTER UPON THE
� ABOVE� ENTIONED 7ROPERTV FOR INSPECTION PURPOSES.
Z � �� // COMMENTS
�
J
�
m PERM E(7R1 I!� D
Q
�
� si ANREOFPERMITTEE DATE RECPT.NO. �� PAIDBY VALIDATION
S
F"' WHITE—Department Copy,YELLOW—Finance Copy.PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy
�91f� t�(� D?���il�(L� t�/�f�
��l�f�f��`�"0�(� (��(�C�ff��
�� oa��a � �a� � a ���a o��- , o ° �� s
SET BACK � � FLOOR JOIS.T
FTGS/F�RMS/STEEL ~ FHA RE�Pv1TS
ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBiNG UNDER FLOOR CUNDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
WA7ER SERVICE MID HT. BOND BEAM
ROOF SHEATHING 8 FT. BOND BEAM
FRAMINGNENTILIATION FINAL S�ND BEAN9
ROOF COVER PRE-GRADING
AOUGH HE/1TlNG BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUNIBING FINISH uRADING
SHOWER/TUB TEST POOL ELECTRIC
EXT. L4TH/SIDfNG ` pOOL FENCING
WALL INSULATION POOL FINAL �
CEILIfVC INSULATIOt�I OFF SITE IMPS. Y
DRYWAL�NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TAfVK LANDSCAPE/IRRIG. �
SEEP PIT/L.L. ON SITE IMPS.
GAS AIR TEST FINAL ZONING �
FINAL CONS7. �IRE DEPT. FIfVAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELEGTRIC ' DEV. FEES PAIQ �
FIfVAL PLUMBIi�1G � I� ENERGY
��-�U � '�o `� . .
CONIfViENTS - - - - , - - ----
SEPTIC TAhlK SIZE
SEEP PIT/U SIZE
�
� � � —
o ,
�