HomeMy WebLinkAbout13023CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY & DEVELOPMENT SERVICES
21660 F. Copley Drive Suite 190
(909) 860-3195 Fax (909) 861-3117
BUILDING PERMIT APPLICATION
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ADDRESS
ADDRESS / ✓
APNOTR ACT
OWNER _L m
ADO ESS ( D 3 c'1 ki I C-t.l 6W
CITY ZIPI1- Si TEL in -q1/' '/SLI
APPLICANTLC"Ttfin.1/ nh ;/A/(TE L'7Qq- . 2-(.yL7
CONTRACTOR lCf-C-e 12i)oFI/JG- C
ADDSS 9 • r�—!� n 51 O i
CITY1I ION li 1117 , ZIPF /7 r -S- TEL. - 27 n
ARCH/ENG/
DESIGNER
ADDRESS
CITY ZIP TEL
OWNER -BUILDER DECLARATION
I HEREBY AFFRIM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS U•
CENSE UW FOR THE FOLLOWING REASON (SEC 7031.5 BUSNESSAND PROFESSIONS CODE ANYCIY OR
COUNTY W14CH REQUIRES A PERMIT TO CONSTRUCTALTER, IMPROVE. DEMOLISH. OR REPAIRANY STRUG
TURF. PRIOR TO ITS 6SUANCE. ALSO REWIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LL
CENSE UW (CHAPTER 6 (COMMENCING WITH SECTION 7000) OF DMSION S OF THE BUSINESS AND PRO.
FE5510NS CODE) OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP-
TION.
XEMP.
O
TN. ANY VIOLATION OF SECTKN 7051.6 BYANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO
A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS It500Lt
O LAS 01 OFTHE PROPERTY.OR MYEMPLOYEES WITH WAGESAS THEIR SOLE COMPENSATION.
WILL DO THE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044. BUSI-
NESS AND
PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF
PROPERTY IMO BULDS OR IMPROVES THEREON, AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
THROUGH HIS OR HER -EMPLOYEES, PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR
OFFERED FOR SALE F. HOWEVER THE BNA -DING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPILE
TION. THE OWNERBUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DO NOT BURR OR
IMPROVE FOR THE PURPOSE OF SALE).
(7 L AS OWNER OF THE PROPERTY. AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS
TO CONSTRUCT THE PROJECT (5 EG 704 BUSINESS AND PROFESSIONS CODE THE CONTRACTORS U
CENSE LAW DOES NOT APPLY TO AN OWNER OFA PROPERTY WHO BUILDS OR IMPROVES THEREOF, AND
THIO CONTRACTS FOR SUCH PROJECT'S WITHACONTRACTOR(S) LICENSED PURSUANT TO THE CONTRAr-
TORS LICENSE LAW.).
O IAM EXEMPT UNDER SEC. B. t P.C. FOR THIS REASON
DATE OWNER
LICENSED CONTRACTORS DECLARATION
1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM LICENSED UNDER PROVISIONS OF CHAPTER
S (COMMENCING WITH SECTION 70001 OF DIVISION a OF THE BUSINESS AND PROFESSIONS COLE. A D
MY LICENSE R N FULL FORCE AND EFFECT /'- —7U,
UCENSECLASS `^ 3G LIC. NO. `? 1 ID 1 / I �
DATE '- It — 9 `1 CONTRACTOR,(. 1{.:/� .(A
WORKERS' COMPENSATION DECLARATION
I HEREBYAFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS:
I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENTTO SELFHNSURE FOR WORKERS'
COMPENSATION. AS PROVIDED BY SECTION 57M OF THE LABOR WOE, FOR THE PERFORMANCE
OF THE WORK FOR WHICH THIS PERMIT O ISSUED.
I FUME AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE, AS REWIRED BY SECTION
.700 OF THE LABOR CODE. FDA THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUM MYWORRKKERRw COMPENSATION INSURANCESAji ,M!D POLICYNUMBERARE:
CARRIER �.7 T�75T�1=•��J�' P`Ff1AJ\
POLICYNUMBER iC TS 7 •-1 14 1-wu Iz:—
"%Cr1ON FEEDNOTBECM41ETEDOFTHE PEFWIS FCRONE L1lf•DREDOCLIAJLS (SIMOI LESS}
1 CERTIFY THAT N THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I
SKULL NOT EMPLOY ANY PERSON IN ANY MANNER WAS TO BECOME SUBJECT TO THE
WORKERS' COMPENSATION LAWS OF CALIFORNIA AND AGREE THAT IF I SHOULD BECOME
SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF SECTION 5100 OF THE LABOR
CODE. I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS.
DATE: APPLICANT.
WARNING: FALURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL BE
SUBJECTAN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND
DOUARS (t 100.0001• IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN
SECTION 5709 OF THE LABOR CODE. INTEREST. AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I HEREBY AFRRM UNDER PENALTY OF PERJURW THAT THERE IS A CONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC. 0097. GW. C.).
LENDERS NAME
LENDERS ADDRESS
I CERTIFY THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING
CONST OH, AND HEREBY AUTHPRZE REPRESENT AT SOF T14 S COUNTY TO ENTER UPON THE
ABOVE"M NTONED PROPERTY FO SPECTON PORP .,E
e
PERMITT4; E (PMNT)
l rl0 2-11-9G
I SIGNATURE OF PERMITTEE DATE
PRESS
FIRMLY
APPLICATIPERMIT
ON%� 04j 151
DATE ! 11 i—� NUMBER
ISSUE TYPE OCC
DATE CONST. GROUP
ZONING SETBACKS
FRONT RW ❑
REAR ❑
SIDE/SIDE STREET RW ❑
SIDE ❑
PROPOSED USE F Sr{M414 !-
2.710= Her
24 L - a
NO. DWEL NO. NO.
UNITS STORIES BEDROOMS
DESCRIPTION SO. FT. FACTOR PSF ADJ. AREANALUATION
SFR/ADD/REM k57 ijj 03,
17)
Garape/Carpon
LLJWPatio/Dock
LL
POOVSPB
Z
Re -Roof
Commercial -
5
m
Valuation ADJ.AREA
QUANTITY DESCRIPTION FEE
J
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U
W
J
W
Z
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a
U
2
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CONSTRUCTION ` I `�
PLAN REVIEW
ELECTRIC
PLUMBING
MECHANICAL
INSPECTION FEE
ISSUANCE
4
SMIP 3
" ENERGY P/C 1AO
ENERGY PERMIT
RETENTION FEE:1C3
PRE -ALT FEE:
TOTAL FEES
COMMENTS
RECPT. NO. PAID BY VALfDAT10N
WHITE—Department COPY, YELLOW—Finance Copy, PINK—Assessor Copy, GOLDENROD—File Copy, GREEN --Applicant's Copy
CITY OF DIAMOND BAR
INSPECTION RECORD
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SET BACK !
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FLOORJO1ST� _ _ �t, ; -•
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-' -
FTGS/FORh1S1STEEL
`
FHA REQMTS. Y
ELECTRIC GROUND _
_
UNDER FLOOR DUCT
GROUND PLUMBING
UNDER FLOOR GONDUIT- '-
SLAB GRADE -
FIREPL+AGE•FOUNDATION r
;. .' • • :.i'
TEMP POWER
FIREPI-JACEBOND'BEAM
WATER SERVICE
ROOF SHEATHING
r—
MID HT. BOND 8EAh1
B FT. BOND BEAM
FRAFr!INUr��E1VTILIATION
' `' '' 1.1
FINAL BOND BEAM
-
.ROOF COVER
PRE -GRADING
ROUGH HEATING
BENCHING
ROUGH ELECTRIC .
ROUGH GRADING
--
ROUGH PLUMBING `-r'-,
FINISH GRADING
'SHOWER/TUB TEST , ,
POOL ELECTRIC
EXT. LATWSIDING °
' '
POOL FENCING
_:
WALL INSULATION -
'• f--; r
POOL FINAL
CEILING INSULATION
OFF SITE IMPS.
DRYWALL NAILING -
DEDICATIONS
SEWER
FINAL ENG.
SEPTIC TANK
LANDSCAPE/IRRIG.
SEEP PIT/L.L.
- ' i"
ON SITE IMPS.
.GAS AfR TEST
FINAL CONST. -. . ,o�
FINAL HEATING ._ _..
-
!
FINAL ZONING
-IRE DEPT. FINAL
HEALTH DEPT. FINAL
FINAL ELECTRIC -- I
DEV. FEES PAID
- -
I=U•.AL PLUM ",SING
ENERGY
COMMENTS
SEPTIC TANK SIZE
SEEP PIT/U SIZE
-