HomeMy WebLinkAbout17553 �` CITY OF DIAMOND BAR
� DEPARTMENT OF COMMiJNITY&DEVELOPMENT SERVICES � �
� 21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 PRESS
�`%r�` BUILDING PERMIT APPLICATION FIRMLY
y JOBSITE APPLICATIO PERMR �j P/C
o ADDRESS 2 • `P ` DATE d � ' — NUMBER //�'�� p
� ISSUE TYPE OCC
-- APN LO TRACT DATE CONST. GROUP
p OWNE� �
p ADDRESS r' ZONING SETBACKS
z CITY V� 'ZIP � TEL. L . FRONT RW ❑
o APPLICANT � � • TEL REAR •❑
� SIDE/SIDESTREET RW ❑
c� CONTRACTOR' SIDE ❑
� AD�RESS �
� CITY ZIP TEL PROPOSED USE
o ARCH/ENG/ ' ,
z� DESIGNER NO.DWEL NO. NO.
= CIDTMDRESS Z�P TEL UNITS STORIES BEDROOMS
�
v� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AFEANALUATION
p� OWNER•BUILDER DECLARATION SFRlADDlREM
O
1 HEREBY AFFWM UNDER PEWLLTY OF PERIURY T/UT 1 AM E%EMPT FROM THE CONTRACiORS lM GaragalCarport
W CENSEUWFOHTHEFqlOWIN6REA50N(SEC.70.11.6BUSINESSANDPROFESSIONSCODE:ANYCITYOR (n
C.> COUNTYWHICHREOURESA7ERMITTOCONSTRUCT,ALTERIAIPROVE,DEUOUSH.ORREGAIRANYSTRUC• W pylio/DeCk
� iURE,GNIOR TO RS 65UANCE.ALSO REOl11FES THE APP�ICANi FOR St1CH DERIAIT TO FlLE A SIGNED W
STATE4ENT THAT HE OR SHE IS LICENSEO DURSUAN7 TO T11E GROVi510NS OF THE CONTRACTOR9 Lb
� GENSE UW(CHAPTER Y(COAIMENCINa VATH SECTION 7000)OF DIVISION 7 OF THE BUSiNE55 AND PRO- � PooVSpa
FESSIONSCODE)OHTIUTHEOflSH[ISEXEMPTiHEREFROMANDTNEBA515FORTHEALlE6EDE%EMP• (�
� TION.IINYVIOLATIONOFSEGTION70]7.6BYANYAPPLICANTfORAPERMiTSU&IEGTSiHEAPPLIWNTTO Z Re-Roof
A CML VENALiY OF NOi MORE THMJ FNE NUNDRED OOIURS(iSool.Y
ZOI.ASOR'NEROFTHEPR07ERiY,ORMYEMPLOYEESWITHWAGE5A5THEIRSOLECOMPENSATIDN, O COTrt10fCW� -
WILl00 THE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEG 70u.BU51• J
N NE55 ANO DiiOFESSIONS COOE:THE CONTMCTORS LICENSE LAW DOES NOTAPPLY TO AN OMMER OF ?
VROVEitTY NAIO BUILDS OR IIAPROVES THEREON.AND NMO OOES SUCH WORK HIMSEIF OR HERSELF OR
Q TNqOUGHHI50RHEROVMEMDLOVEES,ORONOEDTNATSUCNIAIPROVEIAENTSARENOTINTENDE00R m
W OFFERWFOAS�LLEIF,HOWEVER7YtE8U0.DINCORMPFiOVEIAEMIS50LDWIiMNONEYEAqOfCOMPLE-
� TqN,THE OWNER-BURDER WILL FUVE THE BURDEN OF FROYwG TMAT HE OR SHE OIO NOT BUILD OR
Z MVROVEFORTMEPURPOSEDFS�LE�
_ ❑�ASONTlEROFTHEPROPEHTY,AME%CLU5IVELYCONTMCTPlOWfTHLICENSEOCON7MCTORS
W
(L TO CONSTRUCT TME 7RQIECT(SEG 70u,BUSINESS AND PROFESSIONS CODE:THE CONTMC70RS LI- Vdl�ati0�1 ADJ.AREA
� CENSEUWOOESNOTAPPLYTOIUIOYMEROFAPROPERTYWHOBUILDSOHIMPROYESTMEREON.AND
WHOCOMMCTSFORSUCHGF6IECTSWITHACONTMCTOH(S)LIGENSEDGURSUANTTOTHELONfMG QUANTITY DESCFaIPTION FEE
� TORSIJCENSEUWG �..
� O 1 M1 E%EMPT UNDER SEG B.8 D.C.FORTHIS NEASON Q
� V '
V' DATE ONMER �
O W
� LICENSED CONTRACTORS DECLARATION W >
INEREBVAFFIRMUNOERPENALTVOFPERJURYTrUTIMIIICENSEDUNDERPROViSKKJSOFGHAP7ER Ur
p., O�COMMENqN6WITH5ECT10N70oo70FDIVISION70FTHEBU51NE551W�PROFE55iON5CODE,AND Z
u� MY LICENSE IS W FULL FORCE AND EFFEC7. m
� UCENSE CUSS � IIC.NO. � 1
F J
V DATE COMW.CTOR a
w
� 'WORKERS'COMPENSATIONDECLAAATION a
� IHEREBYAFFIRMUNOERGENALTYOFVEiLIURYONEOFTHEFOIIOWiNGDECURATIONS: Z
Q
� _IHAVEANDWILL4AIN7AiNACERTIFIGITEOFCONSENTTOSELF�NSUREFORWOIiNERS' _
COMPENSATqN,115FROV10EDBY5EC710N37000FTNELABORCO�E,FORTHECERFORAUNCE W
OF iHE W'ORK iOR WHlpi THIS PERMI715 ISSUEO. �
O
W _IHAVEANDN1LLIAAINTAMWORKERS'COA�PENSATIONWSURANCE,ASREOUIREDBVSECiION
O 77000FTHEUBORCODE.FOATHEPERFORMANCEOFTHEWOFUCFORWHICHT1115PERMITIS
ISSUED.MYMlORKERS'COMPENSA710NINSURIWCECMRIERMlDGOLICYNUMBERME: CONSTRUCTION
Q
� CARRIER PLAN REVIEW
� POLICYNUM9ER ELECTRIC
� (nus[cnor+rKmraoreEoa.atFimoFn�a�ro.rtswaa+e��R+aqa+�ssl PLUMBING
w �5�Z 1 CERTIFYTIUT IN THE VERFOHMANCE OF THE N'ORK FORwHICH THIS PERMiT IS ISSUED,I MECHANICAI I
C7 SHALLNOTEAIPLOYANYVERSONPlANYMANNERSOASTOBECAMESUBIECT70THE ._ —
Vj WORKERS'CdA7EN5ATIONUW50FCALIFORNIAANOAGREETHATIFI5110ULDBECOME INSPECT�ONFEE ""�`� �"�� ' ' �— -
S SUBJECTTO7HEWORNERS'COMPENSATIONDROVISIONSOFSECTION770oOFTHEI�BOR �!�. �� `� 1 �' � l,�� (v�
cooE,i sruu For+n�n+cw�a�r vnn�nas¢vaohs�s. ISSUANCE � w
� ' SMIP
p DATE: APRICANT. ,
� ' ENERGY P/C
WARNIlM:FAILURE TO SECURE WORKERS'COAIPENSATION fAVERAGE IS L1MAwM,AND SHALL BE
J SUBJECTANEMPLOVERTOCRIMWALPENl1LTIESANDCMLiWESUGTOONEHUNDREDTV10U5AND
LL OOlUR9�f100.000),NADDITONTOTHECOSTOFCOMPENSATION,D�AGESASPROVIDEDFOflIN ENERGYPERMIT I
¢ SECiqN070eOFiHEUBOPOODE,MlTERESL/WDATTORNEYSFEES. F�ETENTIONFEE: -i--��• i
a '� CONSTRUCTION LENDING AGENCY PRE•ALT FEE:
O
Q IHEREBVAFFIRMUNDERPENALNOFPERIUMTHATTNEREISACONSTRUCTIONLENDWQACENCY
� FOR iHE CERFORAIANCE OFTHE WORN FOR WHldl THIS PERMtT IS ISSUED(SEC.1o97,CIV.G�.
Z
W
�Z LENOERS NAME
}
F_ LENOER'SAODRESS �'
w ICEHTIFYTHATIHAVEREADTHISAPVIICATIONANDSTATElNATTMEABOVEINFOHMATIONISCORRELT. TOTAL FEES ��SD
� IAGREEiOCOMiLYWITH1ILLCT'ANDCOUNTYOROWNICESANDSiATEUWSFEUTWCTOBULDINC ��l
CONSTRUCTION.AND HEREBY AUTHORIZE REVFESEMATNES OF TNIS CWNN TO EMER UPON iHE
Z ABOVE-MEIlTIONEDPROPEHTYFORINSPECfiONFURP0.SE5. COMMENTS
_ ��� ��� � .
m vEa�+irrEe uuee irwrm .
v�i � � �J ��Z
� SIGNATURE OF PE TTEE DATE
� RECP7.NO. PA1D BY � VAUDATION
. WHITE—Depanment Copy,YELLOW—Finance Copy,PINK—Assessa Copy,GOLD NROD—File Copy.GREEN—ApplicanYs Copy
� ... ..... . .. .. . � - , .. , ,, .. , ,i r �. ..{ �'t;r�:k�!1 n.. _.�,- '.��-.�. � ., ,... . . . �,� r ' � � . ...�... •" ,. .,- -� �,.
C�Tt' C�r 6.�I�1PJiG�P�1D F�f�,R
II�'S��C�ICxf� FsE�:�F�D
I��E-'iF�:3.c�Cl�,i��l �"l���C= .__I►��=i�'.1=?c��cau,�._...._.ji���=1:�:.c:"ftcj►'G ;n�,��� �►rF-'i:�l::e'�t'fl1�� '�
------- __ __ - " -- - � ._..._.._.._ ..... . ... . _�_ � _..___ -------- - -. . .--- __ .._....._-�-- -•-I ---___.._.-_.�.��.__--
SET BACK I ; i � I FLO�R JOIST � I L__ __
FTGS/FORP�IS/STEEL I I I I FNA REQMTS �
ELECTRIC GROUND �_ � � ; UND�A FLOOR DUCT � �
GROUND PLUMBIfJG i UNDER FLOOR CU�!DUIT
SLAB GRADE I FIRFPLACE FOUNDATION I
TEMP POWER I I I FIREPLACE BOND BEAh1
WATER SERVICE � _� P�11D HT. BO�lD BEAP.4 __ _
ROOF SHEATHING' i 8 FL BOND BEAP.1 i
FRAMINGNENTILIATION I I FINAL 60ND BEAM i
ROOF COVER I ~ PRE-GRADING � i
ROUGH HEATING BENCHING
ROUGH ELECTRIC I � RUUGH GRADING
ROUGH PLUMBIPJG � FI��ISH uRADING
SHO�^JERlfUB TEST � _1 POOL ELECTRIC
EXT.LATH/SIDING � ; POOL FENCING �
WALL INSULATION POOL FINAL I
CEILING INSULATION I OFF 51TE I�APS.
DRYWALL NAIUNG �_ _ DEDICATIONS _
SE4VER I/8�z _� FINAL ENG.
SEPTIC TANK � LANpSCAPE/IRRIG.
SEEP PIT/L.L. ON SITE It�1PS.
GAS AIR TEST FINAL ZONING
FINAL CONST. FlRE DEPT. FIrJAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY
-.,.-�^-•,-•,-�.,---
_. _ -- - - rp:.rr.:.i� �:4: -
CUMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
I`� �
�,�Ei� -
._. -- ---- .:'�..__. . .._._....,i