HomeMy WebLinkAbout17681 (25) CITY OF DIAMOND BAR
�---��`--- DEPARTNIENT OF CONA�IUNTI'Y&DEVELOPMENT SERVICES ��(PORED
;; r 21825 E.Copley Drive
'"� (909)860-3195 F�(909)861-3117 PRESS
'�'�»»���w BLTILDING PERMIT APPLICATION J U N 18 2002 FI RM LY
¢ DDRIESS ����J � � v v/L ziG L� APPLICATION O�PERMIT j�11 ([' P/C
p DATE NUMBER� ��0 0 #
� ISSUE F1'� TYPE OCC
APN-� LOT TRACT DATE ����CONST. GROUP
p OWNER �//�L��/�,� � I.f�-
o ADDRES --� ZONING SETBACKS
z CITY ' • /1. ZIP TEL ? � �� / FRONT RW ❑
� APPLICANT TEL. REAR ❑
�� SIDE/SIDE STREET RW ❑
CONTRACTOR � / � SIDE ❑
� ADDRESS /. o�/� �
� CITY ZIP/- TE . (� PROPOSEDUSE ►► I
oARCWENG/
�z DESIGNER NO.DWEL. NO. NO.
a ADDRESS
� CITY ZIP TEL. UNITS STORIES BEDROOMS
�
v� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
O
p I HEREBV AFFIRM UNDER PENALTV OF PERIURY THAT I AM E%EMP7 FROM 7HE CANTRACTORS ll- GflfeyO/CefpOff
W CENSELAWFORTHEFOLLOWINGREASON(SEC.703t.5BUSINESSANDPROFES510N5CODE:ANVCITVOR (n
U CAUNTVWHICHREOUIRESAPERMITTOCANSTqUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANY57RUC� W Patio/Deck
Z TURE,PRIOR TO ITS ISSUANCE,ALSO RE�UIRES THE APPLICAN7 FOR SUCH PERMIT TO FILE A SIGNED
�w STATEMEN7 THA7 HE OR SHE IS LICENSED PURSUANT TO THE PFiOVI510NS OF 7HE CONTRACTORS LI- w
CENSE UW(CHAP7ER B(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� u' POOVSPB
FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEFEFROMANDTHEBASISFORTHEALLEGEDEXEMP- (�
� TION.ANVVIOLATIONOFSECTION7031.58VANVAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Roof �
A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLURS(SSao�.):
� ❑I,ASOWNEROFTHEPROPERTV,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, � COffIfflOfClel -
Z WILL DO THE WORK,AND THE S7RUC7UfiE IS NOT IN7ENDED OR OFFERED FOR SALE(SEC.70a4,BU51- J
N NESS AND PHOFESSIONS CADE:THE CANTRACTORS LICENSE UW DOES NO7 APPLV 70 AN OWNER OF �
PROPERTV WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
� THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMEN7S ARE NO71N7ENDED OR m
w OFFEREDFORSALE.IF,HOWEVER,hiEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCAMPLE-
0 TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING 7HAT HE OR SHE DID NOT BUILD OR
Z IMPROVE FOR 7HE PURPOSE OF SALE).
�_ ❑I,ASOWNEfiOFTHEPROPERTV,AME%CLUSIVELVCON7RACTINGWI7HLICENSEDCONTRACTORS
TO CANS7RUCT THE PROJECT(SEC.70/4,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI� V21U2�1Of1 ADJ.AREA
W CENSELAWDOESNOTAPPLYTOANONTJEROFAPROPERTYWHOBUILDSORIMPROVESTHEREON,AND
� N?1000NTRAC75FORSUCHPROJECTSWITHACON7RAC70R(S�LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE
Y 70RS LICENSE LAW.).
�¢ ❑I AM EXEMPT UNDER SEC. B.6 P.C.FOR THIS REASON Q
U
� ¢
DATE OWNER U
Z W
� LICENSED CONTRACTORS DECLARATION W
� I HEREBY AFFIRM UNDER PENAITV OF PERJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
� e(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF 7HE BUSINESSAND PROFESSIONS CODE,AND Z
X MV LICENSE IS IN FULL FOFiCE AND EFFECT. , /�
� LICENSE CIASS � LIC.NO. � r I j
U DATE y��� CONTRACTOR �✓.D� a
W
� WORKERS'COMPENSATION DECLARATION Q
� I HEREBV AFFIRM UNDER PENALTV OF PERJURY ONE OF THE FOLLOWING DECIAfiATIONS: Z
Z _IHAVEANDWILLMAINTAINACERTIFICA7EOFCONSENT705ELF-INSUREFORWORNERS' _
Q CAMPENSATION,AS PROVIDED BY SECTION 3700 OF 7HE LABOR CODE,FOR 7HE PERFORMANCE W
OF THE WORN FOR WHICH THIS PE{iM1T IS ISSUED. �
�
w _I HAVE AND WILL MAMTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION
Q37000F THE LABOR CODE RTHE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED.MY WORKEAS' ENSATION INSURANCE CARRIER nAND POLICY NUMBER ARE: CONSTRUCTION
a � I f�l�� `U�'J+ PLAN REVIEW
� CARRIER /� L /�n
Z POUCYNUMBER �i�/��I /�.L +J� ELECTRIC
Q
� (fHISSEI.'f10NNE�NOTBEWMPLEfEDOFiHEPERIMISFORONEHUNDREDOp1PFi5(i1D0)ORLESS). PLUMBING • 1
Z I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSl1ED,I MECHANICAL
(.7 SHALL NOT EAIPLOV ANV PERSON IN ANY MANNER SO AS TO B OME SUBJ T TO T E
N WORKERS'COMPENSATION LAWS OF CALIFORNIA, D AGR THAT IF I O LD B ME INSPECTION FEE
SU&IECTTOTHEWORKEFS'COMPENSATIONPR SIONS SECTIO 00 FT UBOR
� CADE.I ALLFORTHWITHCOMPLVWITHTH ROVI R ISSUANCE �
� SMIP
p DATE: APPLICANT:
J WARNING:FAILURE O SECURE WORKERS'CA NSATIO COVEHAGE IS UNLA 11L,AND SHAlLBE ENERGY P/C
� SUBJECTANEMPLOYEfiTOCRIMINALPENALTIESANDCIVILFINE5UP700NE NDREDTHOUSAND ENERGYPERMIT
DOLLARS(f100.000),IN ADDITION 70 7HE COST OF COMPENSATION,DAMAGES AS PROVIDED FOH IN
� SECTION3708OFTHELABORCODE,MTEREST,ANDATfORNEV'SFEES. RETENTIONFEE: �
d CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
O
� 1 HEREBV AFFIRM UNDER PENALTY OF PERIURV THATTHERE IS ACONSTRUCTION IENDING AGENCV
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUE�(SEC.9087,CIV.C.�.
Z
W
� LENDER'S NAME
F- LENDER'SADDFESS
� TOTAL FEES LP7�5d
� I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
w I AGREE TO COMPLV WITH AlL CITY AND COUNTV ORDINANCES AND STATE LAWS RELATING TO BUILDING
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE
� ABOVE-M TIONED PROPEf7TV FOR INSPE PURPOSES.
Z {� COMMENTS
o L r' ' i
�
m PER TTEE NAME V T)
cn �' t .Erl � �
N SIGNATUfiE F MI DATE
= RECPT.NO. � PAID BY VALIDATION
~ WHITE—Department Co YELLOW—Finance Co PINK—Assessor Co GOLDENRO�File Co GREEN—A licant's Co
PY, PY, PY, PY, PP PY
� . . . . . . �. �., � . . � n .. '�4 � . . . 4. . . � . _.r . .... '�J� . . , •. ✓��4�r.�.F,.hiy �' . ..�. � .. ... .. . .. .1.. .. ..
�� L 11 `�3-'� ��411�9Y�SV� ILL4"1l�
a��G°>�C�����I I�I���L�i[�
` 0 � �C�IOf�. DCQ`� (�`rI�G°-�C�� OG�C� � ' tt`� 0� o '
FTGS/FORMS/STEEL ���- ------ FLOOR,lOfSl" �
-I- ---------- �
�---- i - - -- -- - ---- _._.._._.
_____ FHA FiEQft�ITS �
SET BACK
' -----
- --- ---- ._ _ ._ .�_.__ _{_ __ ___�
ELEC7RIC GROUNC� 1 i UNDER FLOOft DUCT ; _��
---- ---- - --- ---- - - -�-----
GRC?UND PLUMBING � � UNDER FLOOR CU�!DUIT �
- -- ---- ----- --- --�-------......_._
SLAB GRADE FIREPLACE FOUNDATION __ __
TEMP POWER FIREPLACE BOND BEAM � __ __
W,4TER SERVICE MID HT. BOND BEAM ___
ROOF SHEATHING 8 Ff. 80�1�J BEAM _____ _.__
FRANiIPJGNENTILiATION FINAL BOND BEAM �
- ------- ---- __� _--- ----._... --...-----
�...._....._._..---
ROOF COVER � PRE-GRA�ING --_�.__.____ I ____.---
HOUGH HEATING � .�_ ---- BENCH4t�G --- _- � -_ - ------
ROUGH ELECTRIC RQUGN GRADING `
--- -- --------- . .- -.._..--- ------
ROUGH PLUfVIBING � FINISH GRADING _ _
SHOWERlTUB TEST POOL EL.ECTRIC
EXT. LATH/SIDING , POOL FENCING
WALL IiVSULATION POOL FINAL I
CEILIiVG IIV�ULATiON OFF SITE IMPS.
- - ---- ----____..---.._
DRYWALL NAILIfVG DEDICATIONS
--- - --- -_____......._..---
SEWER FI�lAL E[�#�.:�. i
---- -_��_......_. '---------.-----
SEPTIC TANK LAP�DSCAPE/IFiRIG.
SEEP PIT/LL. ON SITE EMPS.
GAS AIR TEST FINAL ZONING
FINAL COIVST. �!RE DEPT. FIiVA!.
FINAL HEATtNG HEALTH DEPT. FihlAL
FINAL ELECTRIC DEV. FEES PAID
FIf�AL PLUMBIMG ENERGY
--- ------ -------------+- ---_.___.
i
�, __ i ... _._.._
C��� ��:��- � � � i
COMfViEi�TS
SEPTIC TANK SIZE
SEEP PIT/U SIZE - � �- - --�-
� � _. --___ -- -____--
,� �
� , . , ---