HomeMy WebLinkAbout14-3987 '�i4i� C1TY OF DIAMOND BAR
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I_ I I ' DEPARTMENT OF COMMUNITY&DEVEI:OPM�NT SERVICES
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pl�;,�'��-" " 2181U Copley Drive,Diamond 13ar,CA 91765 pRESS
, (909)839-7020 Fax: (909)861-3117 Building Inspection Hotline(909)839-7027 FIRMLY
\``'�"'� BUILDING PERMIT APPLICATION
~ �- 9-�v �y
� ���A�� L APPLICATION DATE: P/Ck
w JOB SITE ADDRESS 1�y !'
z APN LOT TRACT �SSUE DATE: �^ g'- "U'��PERMIT# �H'�gd �
0 �^
w OWNER � /' � L(� TYPE CONST. OCC GROUP:
� ADDRESS Q - � /
� CITY��Cj'f�'n,J��/,YLfLIP��[�'TEL. ZONING FRONT KS RW ❑
a APPLICANT TEL. REAR ❑
�
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Y CONTRACTOR � / �f- f1 r �,�� � SIDE/SIDE STREET RW ❑
o SIDE ❑
� ADDRESS � PROPOSED USE f
Q CITY �� I ZIP EL. '
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o ARCH/ENG/DESIGNER Sf f��
o ADDRESS �i/iGh� Eir�n r�� q DWEL.UNITS tl STORIES_�� #BEDROOMS
a CITY �! O ZIP�f�'L/vq/TEL.��D'�l/l/'���
� OWNER-BUILDER DECLAHATION
DESCRIPTI ON S Q.F f. F A C T OR PSF ADJ.AREANALUATION
o I hereby attirm under penally af perjury ihat I am exempt from Ne Coniractor's State License Law for me reason(s) SFR/P,DD/REM �
p Intlicated below by the checkmark(s�,I have Dlaced next to the applicable item(s)[Section 7031.5,Buslness and
o Professfons Cade:My city or county that reqWres a permit to cor�struct,alter,improve,demolish,or repai�,any GarageJCarpwt
w struch�re,pNor to its issuanc0.also requlies the appliwnt for the permit to flle a signed statement that he m she N Patio/Deck
� Is licensed pursuant to the Drovisfans of the Co�actor's Sfate Uce�e Law(Chapter 9)Commencing wIN Sectfon W
N 7000 of Uivision 3 of ihe Business and Prolessla�s Code)or ihat he or she is exempt hom Iicensure and the basis fm � P�USpa
N the allegetl exemption.My vidafion of Sectian 7031.5 by any applicant fw a Dermit subjects the apDlicant to a civil penalty Z Re-Roof
of rrot more than live huntlred dollars($500).
o (,I,as owner of the property,w my employees with wages as thelr sole compe�uatlan,will do(J all ol or U portlons � Commercial
� ot the work,and the structure is not Intended w ottered far sale(Section 7044,Business and Protessions Code:The �
� Contracinrs'State License Law dces not a to an owner al ra e who,throu h em lo m
� DPN P D�h' g p yees'or personal ettort,buil0.s
or improves the property,provlde0 that the Imprmemants are not intended or oflored for sale.II however,the building or
� Improvement Is sold within one year of comple0on,the Owner-Builtler will have the burden of proving that it wa5 not built
U w improved tor the purpose oF sale.).
r, U�.es owner o1 the pmpe�iy,arn exdusivety conVacting with Iicensed Contractors to ca�sWct the project(Section
0 7044,Business and Professlons Code:The Contractors'State License Law dces not appry tn an owner of property who Valuation: / Adj.Area:
Nbuilds a improves Ihereon,and who conUacts tor the projecls with a licensed Cantractm pursuant to the Contractnrs'State QUANTIIY DESCRIPTION FEE
Y license Law.).
o U�am exempt hom Ilcer�sure untler the ConVactnr's Stete License Ww for ihe following reason(s): �
� �� By my slgnaWre below I aGarowletlge ihat,excep[for my porsonal residence In which I must have resided for at least one
o year prior N completion of Ue improvements covereA by this permit,l canrrot legally sell a structure that I have built as an �
w
r. owner-builderllithasrwtbeenconsWctedlnitsentirerybylicensedcontractors.lunderstandthatacopyoltheapplicable
� law,Section 7044 of the Business and Professims Code is availa6le upon request when this appliptlon a submitted w at �
a the idlowing Web stte:httpl�wnv.leginfo.ca.gov/plaw.himl. �
x Z
w DATE: SIGN: - m
O �
r LJCENSED COMRACTOH'S DECLAHATION � �
a
w I hereby aKrm under penalty of perjury that I am licensed under provisians of Chapter 9(commencing with Secfion 7000)
m of Division 3 of the Bustness and Professions Code,a�my Acense is in full farce and etfecL
� ��
� LICENSE CLASS: LIC.NO.: z
o DATE: COMRACTOR: ' . �
� WORNER'S COMPENSATIDN UECLARATION �
� I HFAEBY AFFlRM UNDER PENALTY OF PERJUflY ONE OF THE fOLLOWING DECLARATIONS: �
oI have and will malnhain a Certiflpte of Consent to SeH-Nsure fw Worker's Compensation,as provided by CONSTRUCTION: ��. ,
� � Secibn 3700 of the Labrn Code,for Ihe pertormance af ihe work for which this permit is issued. p�qN REVIEW:
� I have aM will malntain Worker's Compensation Insurance,as required by Settion 370�of the Labor Code,fOr ELECTRIC:
Z the perfwma�e of the wwk for which this permit Is issued.My Worker's Compensafion Insurance Carrier antl
a PolicyNumberar�eQ /�/� /� PLUMBING:
� CARRIEA G1"�G7/L /���
"' / ��L����� � MECHANICAL
� POIJCYNUMBFA � INSPECTION FEE:
� (T}tlS SECfION N�NOT BE COMPLEfED IF TFff PQIMIT I$FINi ONE MINDRED DOLLMS�'S7p�OR LESS�. � ����
q �cerlifY+ha�in the oe+�amarice m me wak rar vim;cn ih ISSUANCE: `
permit ed,I shall mt empby arry person in any maru�er so as to SM IP: ',
o beoome s�bjecl to the Waker9 Con�pensation Law Calif ia. itl agree ihat if I shouM hecom¢subject tn the Worker's
� Cmnpensati of Section 3700 W r de, s�I ui mpry witn ttwse provisiors. ENERGY P/C:
J DATE: APPUCANT: . .
`� ENERGY PERMIT:
� WARNING:Fail e to secure Worker's Camp�r�sa8on coverage is uMavAul,and shall subJecl an empbyer to criminal � M
w penatties and civil fines up to wie hundred thousand dollars($100,000),in additlon to the cost of the com REfENTION FEE: V��
pensation,
o damages as provitled tor In section 3708 ot me labor cade,interest,and attomey's fees. PRE-ALT FEE:
d CONSiRUCTION LENDING AGENCY • g$qF; � D�
� I hereby aifum untler penalty of perJury that there is a ConsUuction Lending Agency tw Ihe peAormance of the work for
= which this permit is Issuetl(Sec.3097,Cfv.C.). �
� LENDFA'S NAME
� LENDER'SADDRESS: � y� 0�
a I certify that 1 have read ihis application and state that ihe above in(wmafion is correcL I aqree to compty with all ciry and TOTAL FEES
� county ordinances and sfate haws relating m building construction,antl hereby auNorize representatives of this caunry ro COMMENTS:
oZ enter u he above-mention ra la i
perty �ction puryoses. ,
� �j � y
m
Q PERM 6�PRINn
� �
� SIGNATURE F PERMITf E DATE RECEIPT#�Q I�� PAID BY:f�I!/'I y VALIDATION:_/�/ �
0
� WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy.GOLDENROD—Fle Copy,GREEN—ApplicanYs Copy
��
CITY OF DIAMOND �AR
INSPECTION RECORD
• � � � • - s � � • '
SETBACK%LETTER ': T . . � - TRACT AND LEDGER
� SWfTCH,GEAR
FOOTINGS.FORMS. �'��`� � }�:,t '�' k� �� .t 1- -
SLAB: ,�, r '`3 .��?;'�1 � � � ., i�} .� , 4 r ._:'' '�> �r COMMERCIAL HOOD
U6.'PLUMBING��`s � � -'` �''��`; - `' T-BAR
� ` " �= INTERCEPTER
UG:ELECTRICAL,. '
UFER GROUND ' ` ' � HOT MOP/SHOWERPAN
SEWER LATEFAL SEPTIC/CESSPOOL
MAIN WATER IJNE HERS REPORT RECEIVED
SEWER CLEANOUT DEMOLITION
ROOF SHEATHING ROOF DRAINS
FLOOR SHEATHING ROUGH CONDUIT ;
- ,- �;; POOUSPA_ - ,. > ,
SHEAR WALLS�EXfEHIOR_ � " `-` "
:,s ; � ;, _
SHEAR WALLS�INTERIOR� �f : � ROUGH P,LUMBING ;. _ �
> .. . �
FRAMINGNENTING u `} ��, . `' fiOUGH EEECTRICAI:�; . r:` - _
ROUGH�MECHANICAL _ ', �"a ?� �_`- ``� �+` ;ROUGH�MECHANICAL � � >:r -= f � '
ROUGH°ELECTRICAL W(`)C(._) �'` . ' `' a't '- - ;GASTEST: _ - " ' F� `, �
ROUGH PLUMBING � �- `. �{ _ Y` _ ' ` ��� . `° - PRE GUNITE ';'. .
- � � -.�a_ �t�: T� , �
. _,
INSULATION WALL POOL PRE,DECK BONDING �','- :��� .,�' '; ; `'`.
INSULATION CEILING P`�P ��� � � �' ��
..�
DRYWALL FENCE7 GATFJ ALARM r� ' '_`
LATH(PRE) ✓ � � �FINALPOOL' _ ,ty�:�% � `�� .. ` - �-
LATH EXTERIOR •ZZ—�� ��' WALLS:
LATH INTERIOR � WALL FOOTING/STEEL
GAS TEST WALL STEEL 1�T( )2ND( )LIFT
SCRATCH COAT WALL BOND BFAM
ELECTRIC METER RELEASE WALL DRAIN/SEAL
GAS METER RELEASE WALL FINAL ,
SPECIAL INSPECTION .RO:FRAMING Pf.ANMNGAPPROVAL `` ` s � , � r$ ,' � `
FINAL:BUILDING - � ROUGH`FIREAPPROVAL `1 `
FINAL MECHANICAL �. .; : FINAG FIRE DEPARTMEf+IT : ' � { - ; `
FINAL ELECTRICAL , � ; ;FINAL PLANNING _ ' � - S
FINAL PLUMBING r �` �" FINAL ENGINEERING/PW ���� ` �''
T.C._of OCCUPANCY �. �. � -- ��i ; `, '�INAL COMMUNITY SERVICES �. �� �
� { r FINAL HEALTH DEPT ' '�i� � ' � �
CE�T of OCCUPANCI'r,`; , ; ,1':° ..�.,:��, ,�aa, � ���� � , �: z
fINAI`:INDUSTRIAL WASTE�:. �'� r' " `_ ' � � -
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COMMENTS: