HomeMy WebLinkAbout18123 (25) __� CITY OF DIAMOND BAR �
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES I
� 21660 E.Copley Drive Suite 190
(909)860.3195 Fax(909)861-3117 PRE�
�^�^� BUII.DING PERMTI'APPLICATION FIRMLY
QJOBSITE QoD ��� ���l� Q��L� d�A•r+� G 3 DATE CATION�� �Z�NUMBER_ !�5�23 #�� I
Q ADDRESS o ��vr�� n v irr �
$ ISSUE 7 TYPE OCC ,
APN LOT TRACT DATE �v CONST. GROUP
p OWNER
" ADDR S . ZONING SEfBACKS
w CITY IP TEL FRONT RW ❑
� APPLICANT G �, REAR ❑ I
� SIDE/SIDE STREET RW ❑
CONTAACT O SIDE ❑
Q ADDFESS � PROPOSED USE
� CITY ZIP
� ARCWENG/
� DESIGNER NO.DWEL. NO. NO.
ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL.
�
cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
O
� I HER�V AFFOiN UNDER PENALTY OF FE0.IURY THAT�I MI EXEMPT FROM THE CONTMCTORS LI- G8f99B/CBfPOR .
CENSEUWFORTHEfOLLOWINOREtiSON(SEC.7o31.6BUSWE5SMIDPROFESSION500DEM1YGTVOR (n
COUNTYWHIqiREWIHESAPERMRTOCONSTRUCT.ALTER�MPROVE.DEMOLISH.ORREPAIFANYSTRUG W P9I10/DBCI(
TURE PRIOR TO ITS ISSUANCE,AL50 REWIRES TiE MVLICANT FOR SUCH GERAUT TO FlLE A SIONED W
BTATEMEN7 7NAT HE OR SHE IS LICENSED PURSUANT 70 hiE PROVISIONS OF T1E CONTRACTORS LI-
� CENSE UW(CHAPTER Y(COMMENCINO MATH SECTION 7000)OF DMSION 3 OF THE BUSMESS AND PRO� � POOUSpO �
FESSIONS CODE)OR THAT HE OR SHE IS E%EMPT 7HEREFROM AND 7HE BASIS FOR THE ALLEQED EXEMP-
TION.ANY VIOU1710N OF SECTION 7031.6 BV AHY APPLIGNT FOR A PERMIT SUBJECTS THE APPLICANT TO Z Re-Roof
� ACML PENALTY OF NOT MO(iE T1AN FNE HUNDRED DOLLARS(f600).):
� �4�.S�WNEROFTHEPROPEHTV,ORMVEMPLOVEESWITHWAOE9ASTHEIHSOLECOMPENSATqN, � COffIR1BfC18I . �
WRL DO THE WOPo(AHD TME STRUC7URE IS NOT IMENDED OR OFFERED FOR SALE(SEC.7MI,BUSF J
N NESS M0 PROFESSIONS CODE:THE CONTRACTOiiS LICENSE UW DOES NOT APPLV TO AN OWNER OF �
VROPERTY WF10 BULpS OR IAIPROVES TIEREON,AND WHO DOES SUCH WORN HIMSELF Oq HERSELF OR
Q TMAOUdH IIIS OR HER OMM EMPLOVEES,VROVIOm 7HA7 SUCH IM7ROVEAIEMS ARE NOT RfTENDED OR m ,
QOFFEA�FORSALEIF,FqWEVER7I�EBULDINOORIMPiqVEA/BfiISSOLDN7THP10NEVEAROFCOMPLE
Z �'TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVWO TFIAT HE OR SHE�ID NOT BUILD OR
� IMPROVE FOR THE PURP0.4E OF SALE). .
(IJ ❑LASOM?IEROF7HEPROPEHTV,MIEXCLUSNELVCONTMCTINOWfTHLICEN9EDCONTMC70RS
Q TO CONSTRUCT THE PRO.IECT(SEC.70M.BUSINESS M1D PROFESSIONS CODE:7HE CON7FiAC70RS lJ- VeIl18UOf1 . ADJ.AREA
W CE16E UW DOES NOTMRY TOMI ONMER OF A PROPERTY WFIO BUIlD3OR IMPROVES TIEREON,AND
� �w�ocorarw�crsFoasua+vAaecrswin+�ca+rrucTo�s���smvuaswwrron�Ec«rrw�c pUANTITY DESCRIPTION F�E .
� TOR9 LICENSE UW.).
❑1 AM E%EMPT UlIDER SEC. B.L P.C.FOR THIS REASON �
3 �
� �
DATE ONRJER �
0 W
F UCENSED CONTRACTORS DECLARATION W �
� I NEREBY AFFIAAI UNDER PENALTY OF PEiUUM 7YUT I AM LICENSED UNDER PROVISIONS OF CHAPTER O
� Y(COLQIENCWO WITH SECTION 7000)Of DIVISION 3 OF THE BUSINESS PND PROFESSIONS CODE.AND Z C O I
�j� W LICENSE IS Bi FIAL FORCE AND EFFECT. �O � � m
�
� L�C S � LIC.NO. � . -
V DATE ' -0 CONTMCTOR a
W
� WORKERS'COMPENSATION DECLARATION ¢
� I HEREBYAFFIRM UNDER PENALTY OF PERIURV ONE OF THE FOLLOWINO�ECLAFiAT10N5: Z
� _I HAVE AND WILL MAINTNN A CERTIFICATE OF OONSENT TO SELF-INSUHE FOR N'ORKERS' �
COMPQ/SATIOH,A9 PROVIDm BV SECTION J'1000F THE IABOR CODE,FOfl THE PEHFORMMICE W
Q � OF THE WOfiK FOR WHICN THIS PERMIT IS ISSUED. �
Q _1 HAVE AND WILL MAIMAIN WORKERS'COMPENSATION MSURANCE,A9 REOUIRED BY SECTION
37000F THE LABOf1 COOE,FOR hiE PERFORMANCE OF THE WORK WR WMIq1 THIS PERMIT IS
^ ISSUm.MV WOPKERS'COMPENSATION I RANCE CARRIER AND POLICY NUAIBER ARE: CONSTRUCTION
Q
> CARRIER �� PLAN REVIEW
� POLICY NUTABEH 1�G I�
Z —�� ELECTRIC � � ,
Q
� (itas6Ecrqr+r�rq7eeaora�r�aFnfa�rr,�isFoaonEt��oalntisK��)��ss} PLUMBING
Z I CERTIFV THAT W THE PERFORNANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
(,7 SHALL NOT EMPLOV M1V PERSON W ANY MANNER SO AS 70 BECOME SUBJECT 70 7HE
� WORNERS'COMPENSATION LAWS OF CALIFORNI/�AND AGREE THAT IF I SMOUTA BECOME INSPECTION FEE
SlB1ECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTqN 3700 OF THE UBOR
rj WDE.I SHML FORT�MM�7H COMPLV VlITH THOSE PRO ar�s. � ISSUANCE Z,Ss[dfC7
p DATE:��VAPPLICANT: �d V'r �SMIP
� WARNINO:FAILURE TO SEWRE WORKERS'COMPENSATpN COVERA4E IS UNLAWFUL,AND SHALL BE ENERGY P/C
LL SUBJECTMIEMPLOYEHTOCRMPJALPENALTIESANDCM�FINESUP700NEHUNDREDTHOUSAND ENERGYPEFlMIT
OOLLARS(f100.000),IN IDDITION TO hiE COST OF COMPENSATqN,DAMAGE9 AS PROVIDED FOR IN
¢ SECTION 97oE OF THE LABOR CODE.PlTEREST,AND ATTORNEVS FEES. � RETENTION FEE:
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBY AFFlfiM UNDER PENALTV OF PERNRY THAT THERE IS A CONSTRUCTION LENDWO AOENCY �
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.30Y1,GV.C.). -
Z
W
� LENDERS NAME � �
C LENDERSADORESS
¢ I CERTIFY THAT 1 HAVE READ TNIS MPl1CATION AND STATE hiAT TNE ABOVE INFORMATION IS CORRECT. TOTAL FE ES ' � D
w I��REE TO COMPLV N7TM ALL CfTV AND COUNTY ORDWANCES AND STATE UWS REUTING TO BU0.DIN0
� CONSTRUCTION,AND HEREBY AUTTIORIZE REPRESENTA7IVES OF?HIS COUNTV 70 ENTER UPON 7HE �I{'p_�� C " .
ZqBOVE�MEMqNED 7ROPERTY FOH INSPECTION PURPOSES. COMMENTS �� •'`J,v G Gr' O�
0 � r-
_ �Y�
O] pE
a �' 27 42�
�
� s�a AE OF PEru�IrrEE DA7E RECPT.NO. �PAID BY VAl1DAT10N
� WHITE—Depertment Copy,YELLOW—Fmenoe Copy,PINK—Assessor Copy,GOLDENROD--File Copy,GREEN—Applicant's Copy
`1
CITY OF DIAIVIC)B�i) �e4R
IiUSPECTIC�b�4 RE�CB�f�
r , .,
o , = , � „ _. > � ��
• .�:kd u 1 .. p � � � � { � ^ x:1,
. � n� .�
,,- ,,`
......_.,... �e . . � Y.�` R e� �.. '� - � .. � ��a�'� i ��1�,� � Q
. .
� ..
SET BACK � .� _ . , .. . �;.� , . � . : .� .. _
�� FLOOR JOISTI ...,. , . ,. ..,, _. . ,. ,
FTGS/FORMS/STEEL • FHA REQMTS � � � � � '
ELECTRIC GROUND UNDER FLOOR DUCT
GROUND PLUMBING UNDER FL'OOF�GO�IDl11T-�••• .; ' '
SLAB GR�4DE FIREP�AGE_FO�.JPJD�ATION ' � �� _ , •i •. +
TEMP POWER FIREPLA�E BOND BEAM ���' �t' � - ' � • .
WATER SERVICE MID HT. BOND BEAM ~ . , ' 3 , .
.RO�F SHEATHING 8 FT: BQ�ID�BEAM , . • ' • '
FRAMINGNEfVTILIATION FINAL BOfVD BEAM ` ' �
ROOF COVF_R PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC
E)CT. LATH/SIDING � POOL FENCING � � •
WALL INSULATION � POOL FINAL �
CEIUNG INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDiCATfONS
SEWER FINAL ENG.
SEPTIC TANK UaNDSCAPE/IRRlG.
SEEP PIT/L.L. ON SlTE IMPS.
GAS AIR T�ST FINAL ZONING
FINAL C�NST. FIRE DEPT. FINAL
FiNAL HEATING HEALTH DEPT. FINAL
FiNAL ELECTRIC DEV. FEES PAID
�lN.�L PLUMBING , , ,�.:.,. ,, � ENERGY
. - . -�� ,._ . -....
'�
� � �i'".t/MI�Jo. � .. � ..
. . ._.. _ . . _..�_..__ , - . • •�� . .:r . .
COMMENTS
�'- -
; , _ , , , , � �,
SEPTIC TAlVK SIZE
SEEP PIT/U SIZE
�� Y (�.:�
: � •
C C � �i.' 9�� .
�� �
9 Q.
1 ��
^ .r
b'.
� f ay
^� � n�'
� "b"`
�k °�x � 5 ��` 4 � . . " :� � �� • '
,' f .. °� . . . .. .
��,y,t;, A -� F-,�
�� ,��'` ."- 7''�'�°p� �.s"� , t . "I .�:�`. 1 � .' I 1 . .
%� '°Q`+. +��^�,s.` '� 5 1 . ---�i . .
fk �1 r7 i-o :i ^�` ' ' . t.
x d� r.�� �.� �K� ,t;: . . , . ` . ' --.. . � . , ,