HomeMy WebLinkAbout17976 I CITY OF DIAMOND BAR --r�
----J��— DEPARTMENT OF CONIIvIUNITY&.DEVELOPIv�NT SERVICES
21825 E.Copley Drive PRESS
(909)860-3195 Fax(909)861-3117 I
"%�'`µ BUILDING PERMIT APPLICATION FIRMLY �
� JOBSITE � u ' 4. �� APPLICATION PERMIT P/C
oADDRESS � � � � DATE 5/9/02 NUMBER 1976 #
� ISSUE TYPE OCC
APN LOT TRACT DATE CONST. GROUP
°C OWNER
� ZONING SETBACKS
o ADDRESS FRONT RW ❑
Z C�Ty ZIP TEL. REAR � � �
g APPLICANT SIDE/SIDE STREET RW �
� CONTRACTOR 3823 Industry Ave. sioE �
� ADDRESS L @W00 • PROPOSED USE
o �in ziP 562 986-b��1
w ARCH/ENG/ C36#594282
z DESIGNER NO.DWEL. NO. NO.
a ADDRESS UNITS STORIES BEDROOMS
NCITY ZIP TEL.
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
� OWNER-BUILDER DECLARATION SFFUADD/REM
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Q I HEREBV AFFlRM UNDER PENALTV OF PERM1IRV THAT I MI E%EMPT FROM THE CONTRACTORS LI� Gef9(JB/C9fpOR
W CENSEIAWFORTNEFOIIOWIN6REA50N(SEC.�031.SBUSINESSANOPROFESS�ONSCODE:PNYCITYOH (�
U COUNTYWHICHREWIRESAPEFUIITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC- W Pado/Deck
WTUqE.PRIOR TO ITS ISSUANCE,ALSO REOUIRES TNE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVVSIONS OF THE CONTRACTOFS LI�
� CENSE LAW(C}1APTER B(COMMENCINO WITH SECTION 7000)OF DIVISION 3 0F THE BUSINESS AND PRO� � PooUSpe
^ FESSIONSCODE)ORTHATHEORSHEISE%EMPTTHEREFROMANDTHEBASISFORTHEALLEOEDE%EMP- (,�}
� TION.ANV VIOLATION OF SECTION 70.31.5 BV ANY APPUCANT FOR A PERMIT SU&lECTS THE APPLICANT T0 Z Re-Roof
r A CNIL 7ENALTV OF NOT A/ORE THAN FNE HUNDRED DOLURS(S600)J:
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Z WILI DO THE WORK.AND 7HE STRUCTURE IS NOT MTENDED OR OFFERE�FOR SALE(SEC.70a1,BUSI� J
N NESS AND PROFESSION5 CODE:THE CANTRACTORS LICENSE LAW DOES NOT AGPLY TO AN OWNER OF �
PFOPERTV WHO BUILDS OR IMPFOVES THEREON.MdD WHO DOES SUCH WOFK HIMSELF OA HERSELF OR m
� 7HROUGH HIS OA HER OMM EMPLOYEES,PF70VI�ED THAT SUCN IMVROVEMENTS ARE NOT INTENDED OR
W OFFEREDFORSPLEIF,HOWEVER'�HEBUIIDINGOHIMPROVEMENTISSOIDWITHINONEYEAAOFCAMPLE-
� TqN,7HE OWNER�BUILDER WILL HAVE TME BURDEN OF PROVINO THAT HE OR SHE DID NOT BUIID OR
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= O1�.5�W'NEROFMEPROPEfiTV,M1EXCLUSIVEIYCONTRACTIN�WRHUCENSEDCONTRACTORS
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W CENSELAWDOESNOTAPPLVTOANONRJEROFAPROPERTYNTfOBUILD50RIMPROVESTHEREON,AND �
Z NRiOLONTRACTSFORSUCNPRO.IECTSWITHACONiMCTOR(S)LICENSEDPURSUANTTOTHECOMTiiAC� QUANTITY DESCRIPTION FEE
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� LICENSED CONTRACTORS DECLARATION J
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CL IHEREBYAFFIRMUNDERPENALT�(p� yE���p(�'i PqQ VISIONSOFCHAPTER �r
d V(COMMENC�NO W�TN SECTION A�1)6�OI�IILBSIf�PfIIfL6651DNS CODE,.WD Z
X MY LICENSE lS IN FULL FORCE AND EFFECT.�23�nd�SSt/1/AVQ. �
p UCENSECLASS Lake��(��J.4�.fbp,pC�A�C�, 90712 �
f' DATE 7.`ONTR}fC70H51 1 �
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� WORKERS'COMPENSATION OECLARATION J
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� I HEREBY AFFIRM UNDER PEN/�ITY OF 7ERIURY ONE OF THE FOLLOWING DECUMTIONS: Z
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� I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELFINSURE FOR WOHI(ERS' 2
� CAMPENSATION,AS PROVIDED BY SECTION 37000F THE LPBOR('ADE,FOR THE 7ERFORMANCE w
OF THE WOHK FOR MMICH THtS PERM17 IS ISSUED. �
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w I HAVE AND WILL MAIMAIN WORKER5 CAMPENSATION INSU�WJCE,AS HEOUIRED BY SECTION
Q 3700 OF 7HE R COOE,F R THE PERF MANCE OF THE WORK FOR WHICH 7HI5 PERMR IS
ISSUED.M R' T I UfiANCE CARRIER AND POLICV NUMBERAAE: CONSTRUCTION
� CAqRIER PLAN REVIEW
ZPOIICY NUMBER ELECTRIC
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p (IFiSSECf10NNE�NOTBENRWLEf�OFTHEPEPMf5FbRONE1M�EDD7LLARSlS�oo�ORLE551 PLUMBING ��
w MECHANICAL
Z 1 CEATIFV THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I
(,�} SHALL NOT EMPLOY ANY PERSON IN ANY MANNER 50 AS TO BECAME SU&IECT TO hIE INSPECTION FEE
� WORKERS'COMPENSATION LAWS OF CALIFORNIq AND AGREE THAT IF I SFKKILD BECOME
S SUBJECTTOTHEWORKERS'CAMPENSATIONPROVISIONSOFSECTION370uOFTHELABOR �SSUANCE /��
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0 DATE: APPLICAN7: �,
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J WARNING:FAILURE TO SECURE WORKERS'CAMPENSATION COVERAGE IS UNIAWFUL,AND SHALL BE .
LL SUBJECTANEMPIOVERTOCRIMINALPENALTIESANDCMLFINESUPTOONEHUNDREDTHWSAN� ENERGYPERMIT
DOLLARS(f 700.000).IN ADDITION TO THE COST OF fAMPENSATION,OAMAGES AS PROVIDED FOR IN +(--�
J SECTpN 3'IOB OF THE LABOR CODE,INTEFEST,M1D ATfORNEY'S FEES. RETENTION FEE: �J
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a CONSTRUCTION LENDING AGENCY PRE-AlT FEE:
� I HEREBV AFFIqM UNDER PENALTV OF PERJURV TMAT THERE IS A CANSTRUCTION LENDING AGENCV
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� �ENDER'S NAME
F- LEN�ER'SADORESS �//��
� I CERTIFV THAT I HAVE READ TH�S APPLICATION AND STATE THAT 7HE ABOVE INFORMATqN IS CORRECT. TOTAL FE ES I ��r� 7 /
w I AQREE TO COMPIV WITH ALL CITY AND CAUN7Y ORDINANCES AND STATE LAWS RELATING TO BUILDING ,�� { L/��
� CONSTRUCTION,ANDHEREBVAUTHORI2EREPRESENTATIVESOFTHISCOUNTVTOENTERUPONTHE
ZABOVE�M€NTIONE�PROPERTY FOR INSPECT��URPOSES. COMMENTS
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GROUND PLUMBING UNDER FLOOR CU�IDUIT
SLAB GRADE FIREPLACE FOUNDATIORI
TEMP POWER FIREPLACE BONf� BE,etM"`'. ':; ':;;_' ••
WATER SERVICE MID HT. BOND BEAM;� •.�- .,°. �
ROOF SHEATHIPVG 8 FT. BOND BEAM " ' r: •" ••
FRAMINGNENTILIATIOM FINAL BOND BEAM ' �� .
ROO�COVER PRE-GRADING
ROUGH HEATING BENGHING
ROUGH ELECTRIC �� ROUGH GRADING
ROUGH PLUMBING �/2/ �'tr � _ FINISH uRADWG _
SHOWER/TUB TES7 � � POQL ELECTRIC
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WALL INSULATION POOL FINAL J
CEILING INSULATiON OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/fRRIG.
SEEP PIT/L.L. ON 51TE lMPS.
GAS AIR TEST F1NAL ZONING
FINAL CONST. , �IRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC � DEV. FEES PAID
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