HomeMy WebLinkAbout14-3985 � ,:�yna':,,
�,.�. CITY OF DIAMOND BAR
I�ITI'. I I I ' I� DEPARTMENT OF COMMUNITY&DEVELOPMEN'i'SERVICES
� ,'r{�p�„�, = ' 21810 Copley Drive,Diamond 13ar,CA 91765 PRE�S ;
"�� 909 839-7020 Fax:(909 A61-3117 Buildin Ins �4tion Hotline(909)839-7027 FIRMLY
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�"���°`. BUILDING YERMIT APPLICATION
� APPLICATION DATE: � ��I P/C#
¢ JOB S17E ADDRESS ��/�, �/ /�
w ISSUE DATE: �� � '"� �/ PERMIT# �L�'��9�.!__
z APN LOT TRACT
o OWNER � /� TYPE CONST. OCC GROUP:
� ADDR SS ZONING SEfBACKS
� CITY �21P TEL. FRONT RW �
¢ APPUCANT TEL. REAR �
o � � SIDE/SIDE STREEf RW Q
} CONTRACTOR/ SIDE �
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c� ADDRESS PROPOSED USE
� CITY , ZIP TEL. �-/
� ARCH/ENG/DESIGNER � %/t����
oADDRESS �+ �1 _ �1 DWEL UNITS.�(�_ �1 STORIES� #BEDROOMS
a CITY ZIP��,2fi9/TEL. DESCRIPTION SO.FT. FACTOR PSF ADJ.AREANALUATION
� � DWNER-HUILDER DECLAHATION
°C 1 hereby afllrm under penatty of Derjury that I am e�:empt Irom the Ca»tracta's State Ucense Law tor ttie reason(s) SFR/ADD/REM
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p intlicated betow try Ne checkmark(s�,I have placed ne#to the aDD�icable item(s)(Section 70318,Buslness and Garage/Carport
w Aofesslons Cada:My city a county lhat requires a permft to construcR alter,improve,demolish,or repair,any
-� a structure,prior to fts issuance,also reqWres the appllcaM tor Ihe permii to file a signed sWtement thal�e or she tq Patio/Deck
Nis licensed Dursuant to the provislons af ihe Contrecta's Sfate Llcense Law(Chapter 9)Commencing with Settlan W
� 7000 of Uivislon 3 at the Buslness anA Prolessions CodeJ or that he a she is exempt hom licensure and the basis for � P�USpa
N the alleged exemD���_Any vialafion ol Section 7037.5 by any apDlicant 1or a permit subjects the apD��t to a civil penalry Z Re-Roof
� o�rwt more than frve huntlretl dollars(5500).
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o U I,as owner of the property,or my emplo�ees wilh wages az Iheir sole compensation,will do U all oi a(,portions � ommerc a
� 01 tl�e work,am1 Me 5tructure is not intended or oNered for sale(Sec�ion 7044,Business and Professions Code:The m
� Contractors'State License Law does not appty to an avmer of property who,ihrough employees'ar personal eflort,bullds
w w improves the property,D�vlOetl that the fmprmemen[s are not intended or oflered ta sale.It however,the building or
� improvament is sold within one year of comple6on,the Owner-BUIIUer will have the burden of proving that It was not bultt
pw Improved fw the purposo of sale.).
� I,as owner af the ro e ry conVacW wtth Iicensed Contractors to construct the pro ec1 Section
U p p rty,am exclusive g j � Valuation: Adj.Area:
0 7pq4,Business and Professions Code:The Contractms'Stale License Law tices not appty to an ovmer ot properly who
z buildsorimprovesthereon,andwhocontracfslatheprojeclswilhallcensedCantraclorpursuanttolheContractnrs'State qUANTIIY DESCfliPTION FEE
�
Y License Law.).
O U�am�empt from licensure uiWer the ConVactors State License iaw Iw Ihe foltowing reason�s): �
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`� By my signature below I aclmowledge ihal,ezcept for my personal residence In whicb I must have resided Im at least one w
Z year prlor to completlon of the improvements covered 6y U�is permit,l cannot legalty sell a structure that I have built as an w
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� owner-builder il it has not been constructed in ILs entirery by Ilcensed conVactas.I understand ihat a copy olihe appliphie
� law.Secdon 7044 of the Busir�ess and Professions Code is avallable upon request when this applipllon is submitletl ar at
� tl�e tollavnng Web site:�ttplv�xv.leginlo.ca.gov/qlaw.htrnL z
DATE: SIGN: �
� LILENSED COMRACTOH'S DECLARATION �
� �
� I hereby affirm uiuler perelty ot perjury Ihal I am licensed untler pmvisions W Chapter 9 tcomme�in9 with Seciwn 7000)
w
� of Dlvision 3 01 the Business antl Protessions Code,and my Ilcense is in fuli force and eftect. �
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� LICENSE CLASS: LIC.NO.: z
o DATE: CANTRACiOR: �
� WOHI(ER'SCOMPENSATIONOECIARATION . g
� I HEAEBY AFFlRM UNDER PENALTY OF PEAJURY ONE OF THE FOLLOWING DEQ.ARATIONS: �
w ��,9�
¢ I have and win maintaln a Certifinte ol Consent to Seu-Insure tor Waker's Compensation,as providetl by CONSTRUCTION:
� ecGon 3700 ot the Labor Code,for Ihe perfmmance ol the work far whiGi this permit is issued. p�qN REVIEW:
�
> I have aM will maintain Walcer's Compensatfon Insurance,as rcquiretl by Sediwi 3700 oi the Laba Code,for E�ECTRIC:
o the perfarmance of tha work fa which ihis permit is issued.My Worker's Compensatian Insurance fartier and
¢ Polic/Numberare: �j�� r_� J PLUMBING:
� CARPIER tJ�/G� /��i� ��� - MECHANICAL:
Z PoL1CY NUMBER �. �� ,� INSPECTION FEE:
N (fHIS SECfIDN NEED NOT BE COMPLEIEU IF1HE PfAMIT IS FOR ONE FN�RED DOLLARS(S100j OR LESS). ISSUANCE: ���
� I certify that in the pertwmarcz ot tice work la which ' permtt is' .I shMl ml employ am/person in arry manner so as to �,..y 7
obeowne subJect�o WorkerS Compeisa�. La ot Calif Md agree that if I shoWd becane subject fi Ne Waker.s SM IP:
� Gampen � sw�solSectbn3740ot Cate, �I ' wilhttrosev�siais. ENERGYP/C:
J DATE: APPLICNJT:
� ENERGY PERMIT:
� wARNING: tl re to secure Worker's Com tlon coverage is unlawful,and shall subject an emproyer to criminal REfENTION FEE: '3"'�a
w penallles and civil(�nes up to one hunAred thousand dollars($100,000),in adtlitim to the cost of the wmpensation,
� damages as prwided lor in section 3708 ot the Wbor codo,interest.and attomey's tees. PRE-ALT FEE:
� CUNSTHUCTION LENDING AGEPICY BSAF: `�
w I hereby affirm under penalty o1 perjury that there is a Construction Le�ing Agency for thB peAamance ol the work fm
� whicb Ihis permit fs issued�Sec.3097,Civ.C.).
� LENDER'S W+ME: ��.
� LENDER'SADDRESS: �
a I certity Ihat I have read thls apD�icatlon and state that the above iniwmation is cortecl.I agree[o comply with all city and TOTAI FEES
� county ortlinances and siate laws relating ro building construcbon,antl hereby authorize represenfatives of this counry to COMMENTS:
Z enter upon Ne atwve-mentiono perry for in/�pec�wn purposes.
� S�4�-.5
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a PER F�(PRINT) � /y
� / REGEIPT#d+��7� PAID BY:Y �✓I�V VALIDATION:��
= SIGNAT RE PERM �AT
�
�
� WHITE—Depariment Copy,YELLOW—Finance Copy,PINK—ftssessor Copy.GOLDENROD—Fle Copy,GREEN—Applicant'S Copy
CITY OF DIAMOND BAR , t--. ,
INSPECTION RECORD ' ` '
. e � . o - • e � � '
SETBACK/LETTER — - TRACTAND LEDGER
FOOTINGS FORMS � - SWITCH GEAR
S�B.t ' ` `-: � . '- ' COMMERCIAL HOOD
UG..PLUMBING. -_ __ _ - T-BAR
UG.ECECTRICAL �:' = �_ „-'--� �•,: INTERCEPTER
UFER GROUND ,��? HOT MOP/SHOWERPAN
SEWER LATERAL SEPTIC/CESSPOOL
MAIN WATER LINE HERS REPORT RECENED
SEWER CLEANOUT DEMOLITION
ROOF SHEATHING ROOF DRAINS
FLOOR SHEATHING ROUGH CONOUIT
SHEAR WALLS:EXTERIOR '! t , � ` POOL`/SPA; y - �" �
�SNEARWALCS.INTERIOR`_ �� � �� ROUGH PLUMBING •i �' "�
�R�1MlNGNENTING ��} _ � � h '� `+ ROUGH ELECTRICAL� ' � � � � ''�r� `" '� ��
ROUGH.�INECHANICAL.� = �, ,��,;,r s ! fiOU.GH�MECHANICAL'�`� � � • � w , � �� � ��';�� '�', `�-
.�, � ra ; r , 't S_= 2 '.�. - ti �'�� � T[ _ 1 i. �"
ROUGH ELECTRICAL W(::)C( ) ';, f � 'f GAS TEST.�, .�+ r r � :
�� . ._�;, : � � � � ,�,
�RDUGH PLUMBING _ -� PRE GUNITE � . ,`:� -` �' r� , � '� �F`' �`� "3'
�:. , , ;. ��� , . ,. �. ,...,, .. � �-
_ .. �
INSULATION WALL POOL PREDECK BONDING r -
INSUlATION CEILING ��"�P �' � �
t �:,
�FENCE/GATE/ALARM - �� Y y ` ���
DRYWALL _ _
LATH(PR� ,FINAL POOL �,`..' . -_ - �=�,,.
LATH EXTERIOR � WALLS:
LATH INTERIOR WALL FOOTING/STEEL
GAS TEST WALL STEEL 1�T( )2ND( )LIFT
SCRATCH COAT WALL BOND BEAM
ELECTRIC METER RELEASE WALL DRAIN/SEAL
GA5 METER RELEASE WALL FINAL
SPECIAL INSPECTION R�•� ' -
__.- �, ,;� �t r `�fi
FRAMING PLANNINGAPPROVAL r
FINAL.BUILDING � ROUGH:FIREAPPROUAL � - -
FtNAL MECHANICAL ''- : FINAL FIRE DEPARTMENT. ' � h��r ,
r .� � , _. � J.�� �. �
FINAL ELECTRICAL ' � ; , �� FINAL PLANNIN�;: :: > ' r - �t �
FINAL PLUMBING ,`.'_:' ' ,. ' ;`, :� " ; FINAL'ENGINEERING/PW• , 3�. ,ii " +� .^r�' ' � " '°�
TC:�of OCCUPANCY� � ` u r �`� FINAL COMMUNIIY SERV(CES, ` � ' ��
CERT.of OCCUPANCY:- ;;.F _ a,'-�� ,' - FINAL"HFIILTH UEPT s ' � ' r ' ��'%
FINAL�IND,USTRIALWQSTE'�� � ' ar' ° �'� ':� _ �°��� �
COMMENTS: ' � � �4'�-�A.�'r
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