HomeMy WebLinkAbout17706 (46) .�.�+ \
I CITY OF DIAMOND BAR i I
' -----��-..----
DEPARTMENT OF COMMUNTI'Y&DEVELOPMENT SERVICES . �"" �
21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 PRESS
"''�.����" BUILDING PERMiT APPLICATION FIRMLY
o DDRIESS1����' Xloi�.� Gr�s f /��, APPLICATION �� � o�PUMBER I � �O� #/C
DATE O�1
°-° APN LOT TRACT ISSUE TYPE OCC
p OWNER _ �/�J ���K DATE CONST. GROUP
o ADDRESS ZONING SETBACKS
Z CITY ZIP TEL. y{�.,Z FRONT RW ❑
o APPLICANT TEL. S DE/SIDE STREET RW O
z
m CONTRACTOR o SIDE ❑
a ADDRESS ��_�In�dst�-Ave.
� CITY ' TEL. PROPOSED USE
o ARCH/ENG/
iz DESIGNER NO.DWEL. NO. NO.
a ADDRESS
� CITY ZIP TEL. UNITS STORIES BEDROOMS
�
cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
O
p I HEREBY AFFIRM UNDER PENAL7V OF PERIURV THAT I AM EXEMPT FROM THE CANTRACTORS LI� G8f898/C2fpOfl
W CENSELAWFOR7HEFOLLOWINGREASON(SEC.7031.5BUSINESSANDPROFESSIONSCADE:ANYCITVOR (n
U CAUNTVWHICHREOUIRESAPERMITTOCANSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC-
w TURE,PRIOR TO ITS ISSUANCE.AL50 REQUIRES 7HE APPLICAN7 FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck
� STATEMENT 7HA7 HE OR SHE IS LICENSED PURSUANT TO THE PHOVISIONS OF 7HE CONTMCTORS LI- � -
� CENSE UW(CHAPTER B(CAMMENCING WI7H SEC710N 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� POOVSpB
0 FESSIONSCADE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDE%EMP- (�
V TION.ANY VIOLA710N OF SECTION 7031.5 BV ANV APPLICANT FON A PERMI7 SUBJECTS THE APPLICAN770 Z R8-R001
A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLLARS(S5o0).):
Z ❑I,ASOWNEROFTHEPqOPERTV,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, � COfflffl0fC18I -
WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7014,BUSI- J
� NESS AND PROFESSIONS CODE:7HE CON7FiAC70RS LICENSE LAW DOES NOT APPLY TO AN OWNER OF �
PROFERTV WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
� THRIXIGH HIS OR HER ONRJ EMPLOVEES,PFOVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
Q OFFEREDFORSALEIF,HOWEVER,THEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCAMPLE-
Z TION,THE OWNER-BUIIDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF SALE).
w ❑I,ASOWNEROFTHEPROPERTY,AMEXCLUSIVELYCON7RAC71NGWITHLICENSEDCANTRACTORS
� TO CANSTRUCT THE PR0.IECT(SEC.70��,BUSINESS AND PROFESSIONS CODE:THE CONTHACTORS LI- VeIU2�lOn ' ADJ.AREA
W CENSEUWOOESNOTAPPLVTOANOWNEROFAPROPERTVWHOBUILDSORIMPROVESTHEREON,AND
� WHOCANTRACTSFOPSUCHPROJEC75WITHACON7RAC70R(S�LICENSEDPURSUANTTOTHECON7MC� QUANTITY DESCRIPTION FEE
Y TORS LICENSE UW.�.
� ❑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 PENALTV OF PERJURY THA71 AM LICENSED UNDER PROVISIONS OF CHAP7ER %L /}� �J✓ S/^�
d D(COMMENCMGWITHSECTION�000)OFDIVISION30FTHEBUSINESSANDPROFESSIONSCODE,AND Z I � // ' {J � ✓ �� ✓ V
X MY LICENSE IS IN FULI FOFCE AND EFFECT. I_ --
j/�� .FI(�,'�" J�'/J�� �
� LICENSE CLASS, ��"/ r LIC.NO. �/ / .J�� �
~ DATE CONTRACTOR • I• �. J
U a I
w
� WORKERS'COMPENSATION DECLARATION Q �
� 1 HEREBV AFFIRM UNDER PENALTV OF PERJURV ONE OFTHE FOILOWING�ECLAFATIONS; Z
� I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORKERS' _
Q COMPENSATION,AS PROVIDED BV SECTION 3700 OF THE LABOR CODE,fOF THE PERFORMANCE W
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
� I
w _I HAVE AND WILLMAINTAIN WORKERS'COMPENSATION INSURANCE,AS RE�UIRED BV SECTION
Q 37000FTHE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ,
ISSUED.MV WORKERS'CAMPENSATION INSURA�CE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION
Q CARRIER Jr�n-r��yv.�.o / .� PLAN REVIEW
ZPOLICY NUMBER '✓r V� 'l.� �I U� ELECTRIC
¢ r.
� (iHISSECIIONNE�NOTBEQ7MREfEDOFTiEFERMfTISFORONEHUI�DREDDOILARS(E100)ORLESS). PLUMBING
Z I CEFiTIFV 7HAT IN THE PERFORMANCE OF THE WORK FOR WHICH 7HI5 PERMIT IS ISSUED,I MECHANICAL
(.'} SHALL NOT EMPLOV ANV PERSON IN ANY MANNER 50 AS TO BECOME SUBJECT TO THE
� WORKERS'COMPENSA710N LAWS OF CALIFOFiNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE
= SUBJECTTOTHEWORKERS'CAMPENSATIONPROVI NSOFSECTION37000FTHElABOR
CODE,ISHALLFORTHWITHCOMPLVWITHTHOSEP O SIONS. ISSUANCE
� SMIP
p DATE: APPLICANT: � .
J WARNING:FAILURETO SECURE WORKERS'COMPENSATION COVERAGE IS UNIAWFUL,AND SHALLBE ENEAGY P/C
� SU&IECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT �
DOLLARS(St00,o00),IN ADDI710N TO THE COST OF CAMPENSATION,DAMAGES AS PROVIDED FOR IN
J SECTION37080FTHELABORCODE,INTEREST,ANDATfORNEV'SFEES. RETENTIONFEE:
�
� CONSTRUCTION LENDING AGENCY PRE=ALT FEE:
O
Q 1 HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS A CONSTRUCTION IENDING AGENCY
� FOR THE PEflFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.C.�.
Z
W
? IENDER'S NAME
�
� LENDER'SADORE55
� TOTAL FEES ��: )�
� I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE MFORMATION IS CORRECT.
w I AGREE TO COMPLY WITH ALL CITV AND COUNTV ORDINANCES AND STATE UWS RELATING TO BUILDING
� CANSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE
� ABOVE�M�NTIONED PROPERN FOR INSPECTION PUR70SE5. COMMENTS
Z
� ��r�a rG� ����
�
Q PERMITTEE N_A�./E(PRr J��r� �� ),
� i:��' /
N SIGNATUHEOFPERMITTEE DA7E `
= RECPT.NO. PAID BY VALIDATION
~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENRO File Copy,GREEN—Applicant's Copy
� (���f"� �1� II����ilt��il� 1�3G�f�
�(r���'�C��`8�i� ��C�C�G�i�
0�[� U o DGQS� 0� t a G3 0 � �C�DOGJ DQ� 0 ° � � �
SET BACK I
:. ' FLO�R JQIST '
_..._ ___ -- ' -- ----------......_---
----
FTGS/FORMS/STEEL ; � FHR REQMTS '
--._--�--- --:.._.._-. --- _�..-------- -�--- ------
ELECTRIC GROUND � I UNDER FLUOR DUCT � �
— �— __� __.r.— _.._ —_ _..-----.___--- -------�—
GROUND PLUMBING i �JNDER FLOOR CUNDUIT , �
---- -------- — __ .---- -- --- ;— --r---- -..--.. ..
SLAB GRADE i - -- --__....� �IFiEPLACE FOUNDATION_ _ _
_� _ ___
TEMP POWER � � _I_ FIREP�ACE BOND BEAM----:_.�,------
---.----
WATER SERVICE ' MID HT. BOND BEAM �
--- - ---}- -- ---- --------- -----
ROOF SHEATHIiVG � 8 FT. BOND BEAM ____ � _
- — —..
FRAMING/VENTILIATIOtJ _ � FINAL 80ND BEAM
----- --......-----..
ROOF COVER ' � PRE-GRADING �
ROUGH HEATIh1G BENCHIRIG I
ROUGH ELECTFiIC ROUGH GRADING
ROUGH PLUIVIBING : FINISH uRADING
-- —+- -__ ----...__----- ------.....__.._._____----------
SHOWER/TUB TEST i POOL ELECTRIC
- - �---_-- ------ --..__...-------
EXT. LATH/SIDING ; ; POOL FENCING
-- — . _..._...._._.___�__ ----__.�__..._.._
WALL INSULATION ; PO
� OL FiNAL I �
-- —.--- ---- - ___.______
CEILING INBULATION j ; QFF SITE IMPS. �
--.-- � - - - -
DRYWALL NAILIIVG ' DEDICATIONS �i �
SEVdER FI�lAL ENG.
SEPTIC TAIVK LANDSCAPE/IRRIG. j
SEEP PIT/L.L. ON SITE IMPS. '
GAS AIR TEST f FINAL ZONING �
FINAL COfVST. � � FIRE DEPT. FIIVA�
FINAL FfEATING � HEALTH DEPT. FINAL _
---
FINAL ELECTRIC � f DEV. FEES PAID
_......__----_ ._____ ___-,-
F�NAL PLUMBING ,��Z�� �. � �NERGY
___----- � ----- -- �---�-----.._---t-- - -...._.. �
--- ,
_.._._.
�����s o j
C������5
SEPTIC TAi�K SIZE �
SEEP PIT/U SIZE -- ---
� --- ---
,� �
� '�