HomeMy WebLinkAbout17355 - - -- -- 'i V�lJ�--
' ` CITY OF DIAMOND BAR �
� ----��--� DEPARTMENT OF COMMLJNITY&DEVELOPMENT SERVICES v
21825 E.Copley Drive PRESS
"' (909)860.3195 Fax(909)861-3117
`:.�'w BUILDING PERMIT APPLICATION FIRMLY
� JOBSITE 2�' `�ndian Creek �76v APPLICATION PERMIT �13�� P/C ��_293 I
oADDRESS DATE 7�3�O� NUMBER �i
� ISSUE TYPE OCC
APN LOT 7H TRACT 23483 DATE CONST. GROUP
p OWNER Mona
"" ADDRESS ZONING SETBACKS
FRON7 RW ❑
Z CITY Z!P TEL���&�'��� REAR �
o APPUCANT TEL. SIDE/SIDE STREET RW O
� CONTRACTO� F' eVe OPmen ' SIDE � �
p C N E Wa n U Zlp •�TEL. PROPOSED USE - ��
w ARCH/ENG/
z DESIGNER NO.DWEL. NO. •
� ADDRESS UNITS STORIES BEDROOMS
NCITY ZIP TEL.
� DESCRIPTtON S�.Ff. FACTOR PSF ADJ.AR ALUATION
' � OWNER-BUILDER DECLAfiATION SFR/ADD/REM —
O � �
� 0 I HEREBV AFFIRM UNDER PENAL7Y OF PERIURV THAT I AM EXEMPT FROM THE CONTfUCTORS LI- GBfe JB/C9IPOrt l
W CENSEUWFORTNEFOIIOWINGREASON(SEC.�031.68USINESSANOPROFESSIONSCODE'.MIYCITVOR (n
U CWNTVNTiICHREWIRESAPEFlMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH.ORREPAIRANVSYRUC� W patio/Deck
WNRE,PRqR TO ITS ISSUANCE.ALSO REWIqES iHE APPLICANT FOR SUCH PERMIT TO FIIE A SIGNED w
� STATEMENT THAT NE OR SHE IS LICENSED PUASUANT TO THE PROVISIONS OF THE CONTRACTOAS LI�
CENSE LAW(��TER e(COMMENCIN�WITH SECTION 7000)OF DIVISION 9 OF THE BUSINE55 AND PRO- � POOVSPB
� FE5510N5 OODE)OR THAT HE OR SHE�S E%EMPT THEREFROM AND THE BASIS FOR THE ALLEOED E%EM7�
TqN.ANV VIOLATION OF SECTION 7071.6 BV ANV APPLICPNT FOR A PERMIT SU&IECTS THE APPLICANT TO Z Re-Roof
� A CNIL PENAL7Y OF NOT MORE 7HAN FIVE HUNDRED DOLUAS(5500).):
O ❑I,ASOWNEAOFTHEPROPERTV.ORMYEMPIOYEESWITHWA0ESA5THE10.SOLECOMPENSATION, � COTrtIBfC18I
Z WILL D�7HE WORN,M1D 7HE S7RUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7a�,BUSI- J
� NE55 M1D PROFESSIONS CADE:7HE CONTRACTORS LICENSE LAW DOES NOT AVPLV TO AN OWNER OF � �
PROPERTYWHOBUILDSORIMPROVESTHEAEON,AtiDWriODOE55UCHWORKH7M5ELFORHERSELFOfl m �
Q THROUOM HIS OR HER OWN EMPLOVEES,PROVIDED 7HAT SUCH IMPROVEMENTS ARE NOT INTENDED OR ,
QOFFEREDFORSRLEIF,HOWEVERTMEBUILOINOOFIMPFOVEMENTISSOIDWfTMINONEVEAROFCOMPLE�
Z TKKJ,THE OWNER�BUILDEH V/ILL HAVE THE BURDEN OF PROVING TFIAT NE OR SHE DID NOT BUIID OR
� IMPROVE FOR THE PURPOSE OF SALE).
w p1,ASOWNEHOFTHEPROPERTY,AMEXCLU51vELYCANTRACTINOWITHLICEN5E000NTRACTORS
� TO CONSTRUCT THE PROJECT(SEC.7oN,BUSINESS AND PROFESSIONS CODE:THE CANTW CTORS LI� V8IU8lIOf1 ADJ.AREA
W CENSE UW DOES NOTAPPLV TO AN ON?JER OF A PROPERTV WFIO BUILDS OR IMPROVES 7HEREON,AND
Z WIipCONTRACTSFORSUCMPR0.IECTSWITHACONTMCTOR(S)LICENSEDPURSUANTTOT7ECONTMC- QU/\(.J7j7\' DESCRIPTION FEE
TOiiS LICENSE LAWJ.
� J
O ❑I AM IXEMPT UNDER SEC. B.a P.C.FOR 7HI5 REASON �
� Q
LL DATE OWNER U
O w
� LICENSED CONTRACTORS DECIARATION �y �
� I HEREBV AFFlRM UNOER PENALT'I OF PERIURY THAT I AM UCENSED UNDER PROVISIONS OF CHAPTER �
� B(COMMENGINGWITHSECTION7oo0)OFDIVISION30FTHEBUSINESSANDPROFESSIONSCODE,AND Z
X MV UCENSE IS IN FULL FORCE�ND EFFECT. ., m
L1J c�
� LICENSECLASS B �,�.No. 649012� �
� � o«�T�,oTOR imon u:n a
DATE
W
� WORKERS'COMPENSA710N DECLAAATION �
Q
N U
� I HEREBV AFFIRM UNDER PEN�LTV OF PERJURV ONE OFTHE FOLLOWING DECLARATIONS: Z
Q
Q __I HAVE MJD WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WOFiKERS' S
� COMPENSATION,AS PROVIDED BV SECTION 370o OF THE LABOR CO�E,FOR TNE VERFORMANCE W
OF THE W00.K FOR WHICH TNIS PEFiMIT IS ISSUEO. �
0
W _I HAVE AND WILI MAINTAIN WORKERS'CAA/PENSATqN INSURANCE,AS RE�UIRED BV SECTION a`
Q 37000FiHELABORCODE,FORTHEPERFORMANCEOFTHEWORNFORWHICHTHISPERMITIS �'J �
� ISSUED.MV WOFKERS'COMPENSATION INSURMlCE CARRIER AN�POLICV NUMBEFARE: CONSTRUCTION � .�1
j CMRIER Golden Ea le Insurance PL4NREVIEW 2 c�"1 Ti
� POLICYNUMBER ELECTRIC IJ�Q��v
¢ �Q
��uSSEcrpnr��r+o7eeod.w�ErEnoFTt+eaEw.*r�s�oaa+E�n�rnaE�oounasR��l��ss} PLUMBING ��".
fED `
Z 1 CEPTIFV THAT IN THE PERFORMANCE OF THE WORK FOR WH�CH THIS PERMIT IS ISSUED,I MECHANICAL �`��� �
(�} SHALL NOT EM7LOV ANV PERSON IN M1Y MANNER 50 AS TO BECAME SUOJECT TO THE INSPECTION FEE -
� WORKERS'COMPENSATION LAWS OF CALIFORN10.AND AOREE THAT IF I SHOULD BECOME .
SU&IECT TO THE N�ORKERS'COMPENSATION PFOVIS�ONS OF SECTION 9700 Of THE UBOR ,s ��
� CODE,I SHALL FORTHWITH COMPLV WI7N THOSE PRO`�SIONS. ISSUANCE
O � SMIP
� DATE; APPLICANT: . , O �
� ENERGY P/C ��
WARNINO:FAILURE TO SECURE WORKERS'CAMPENSATION COVERAGE IS�NL4WFUL,AND SHALL BE �
LL SU&IECTANEMPLOVERTOCRIMINALPENALTIESAIJDCNILFINESUPTOONEMUNDREDTHOUSAND ENERGYPERMIT .
DOLLARS(5100.000).IN ADDITION TO THE COST OF COMPENSATION,DAMP.OES AS PROVIDED FOR IN ..�
� SEC�ION 3�080F TNE LABOR COOE.INTEREST,AND�TTORNEY'S FEES. RETENTION FEE: �
w CONSTRUCTION LENDING AGENCV PRE-ALT FEE:
d
P
CC I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS A CANSTRUCTION LENOINO AGENCV
� FOR THE PERWRAfANCE OF THE WORK FOR WHICH iH75 VERMIT IS�SSUEO(SEC.3087,CIV.C.). '
Z
W .
� LENDER'S NAME
F- LEN�ER'SADDRESS r ///
� I CERTIFY THAT I HAVE READ THIS APPUCATION AND STATE THAT hIE ABOVE INFORMATION IS CORFECT. TOTAL F E CS '\U� 1 , ,
w I AOREE TO COMPLV N77H ALL CITY AND CWN7V ORDINANCES AND STATE LAWS REL�T�NG TO BUILDING � �
� CONSTRUCTION,M1D HEREBY AUTTIORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE
� ABOVE�MENTIONEO PROPERTY FOR INSPECTION PURVOSES.
Z COMMENTS
�
J
�
m PERMITTEE NAME(PRI�
¢ � . L,.D
�
� SI RE FPEN.��TrEE DATE
RECPT.�O. PA1D BY VALIDATION
� WHiTE—Department Copy,YELLOW—Finence Copy,PINK—Assessor Copy.GOLDENRO�File Copy.GREEN—Applicant's Copy
� i����l �� [�16�a���f�[�' IB,�Ir�$ ' ' ' '
�h�l�V��C� +?OG��9 IF�[�C��G�?[�
0('�n�� D� :� �G'�,: r:��.�'?� �,.�;����u OL� DGJ`t� � � � o � "
5ET BACK �,� � �LnnR JOIST , �
--- �-- -– --_ _— __ _�_ -- ----_.
F7GS/FORMSISTEEL � � __ FHA REQMTS
FLECTRIC CROUND UNDER FLOOR DUCT
GF10UfVD PLUMBWG UY�lDEt� FLOOR CUMDUIT
SLAB GRADE FIREPLACE FOUNDAi"lOtV
TEMP P�WER � FfREPLACE BOND BEAM
WATEH SERVICE _��� ���._ M!� FfT. BOND BEAM_ ��
ROOF SHEATHING �� .� 8 FT. E30ND BEAM
FRAMfPiG/VEfVTILiATION FINAL BOND BERM
RGOF CaVER Q/ r RE-GRADING
ROL)GH HEATIh1G �'r �ENCNlNG
ROUGH ELECTRIC r � ROUGH GRADING
RUUGH PLUMBING� � � � � F(f�ISN GRADING
SHOWER�TUB TEST � T POOL ELECTRIC -- �--- � ---
EXT. LATH/SIQWG Il���^� �� POOL FENClNG
WAL�INSULATION �� � POOL FINAL
CEILIiV� INBULATION �i� � OFF SITE IMPS.
DRYWALL NA{LING �' ��J-Q�-- ���}" DE�!CATIONS
SEWEF{ _ �'`�y�_ ��^��js� FI�IAL ENG. _� `_ -
SERTtC?AtJK LANDSCAPE/IRRiG.
SEEP PIT/LL. . ' C'1N SlTE IMPS.
GAS A!R TEST F!lVAL ZONI�JG �
Ir=1�"�i4•' �
FIlVAl.CQt�lST. �lRE dEPT. FINA�
sl���.
FINAL NEAI�ING H�,n,�.TH DEPT. FINAL '
FINAL ELEi,TRIG , �.�_" __ D�V_FEFS PAID __,�_ �
FiNAL PLUP�tBII�G � . ENcRGY , ------
. .�� --�-��dz --- — -----�--- --
.�Td (v(�j_.�_j_q•zC�c;�9���___ - c. � --�,,o��-o _ ^ Q�- ` ;�`„�---=_-- _
!� —
9 � 1i�30'c'�
� �O�Ni�(�ITS _����.._S��- c��ti .� _�'! �
._��_/.���" G��d r _ ___!�✓-�� _ --------- ---
SEPTIC TAfVK SiZE "" .
SEEP P17/iS SILE �' -- --
� � � � � �� ��� �
. ,� a
:,� � , � �
�,x . .
,� � � � '. � ,__� o
� .