HomeMy WebLinkAbout13366 ��_ CITY OF DIAMOND BAR �
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES I
� 21660 E.Copley Drive Suite 190 �
(909)860-3195 Fax(909)861-3117 PRESS
� ���. BUILDING PERMTT APPLICATION FIRMLY
} JOBSITE �'r` / /� IIAr� � A1 � APPLICATION �,I/[�LJQ� NUMB R 13�� #�� �g
o ADORESS � ��r•� YR�� �•1� DATE 7 L��
ISSUE TYPE OCC
� APh LOT TRA T DATE ^�� CONST. GROUP
p OWNER
"' ADDRESS LN ZONING SETBACKS
W CITY � . ZIP�,� TEL. FRONT RW ❑
�j APPLICANT �) �M � iV O LAN TEL. REAR ❑
SIDE/SIDE STREET RW ❑
� CONTRACTOR SIDE ❑
Q ADDRESS PROPOSED USE �I (AilIYDO'IAtS.
o CITY ZIP TEL. .Y�L + � S
wo ARCH/ENG/
� DESIGNER O • � C ' NO.DWEL. NO. NO.
CDDRESS ZIP� TEL . 1 UNITS � STORIES �L BEDROOMS
� DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDER DECLARATION SFR/ADD/REM
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p I HEREBY AFFlRM UNDER PENPLTV OF PERNRY THAT 1 AM EXEMPT FROM THE CONTMCTORS LI- Gdf89B/C0�011
W CENSELAWFORTHEFOLLOWINOREASON(SEC.7031.68USINESSANDPROFESSIONSCODE:ANYCITYOH (n
U COUHTVWHICHREOUIRESAPERMRTOCONSTRUCT,ALTER,IMPROVE,DEMOLJSH,ORREPAIRANVSTRUC• W Patio/Deck
W TURE,PRIOR N 1T9 ISSUANCE.AL50 RC-0UIRES THE APPLICANT FOH SUCH PERMIT TO FILE A SIGNED W
� STATEIAENT THAT HE OR SME IS LICENSED PURSUANT TO 7HE PROVISIONS OF THE COHTRACTORS LI�
� CENSE UW(CNAPTER Y(COMMENCINO WI7H SECTION 7000)OF DIVISION 9 OF THE BUSINE55 AND PR0. u- PooVSpa
FESSIONS COO�OR TTUT HE OR SHE IS EXEMPT hIEREFROM AND THE BASIS FOR THE ALIEGED EXEMP-
TqN.ANYVIOLATIONOFSECTION7031.6BYANYAPPLICANTFORAPERMITSU&lECTSTHEAPPLIC/VJ7T0 Z Ro-Root
. � ACML VENALTY OF NOT MORE THAN FNE HUNDRED DOLURS(i500).):
� ❑I,ASON?IEROFTHEPROPERTY,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, � COrtIR1BfClfll � �
MIILL DO THE WORK AND THE STRUCTURE IS NOT INTEN�E�OR OFFERED FOR SALE(SEC.70a�,BUSI- J
NESS AHD PROFESSIONS CODE:THE COHTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF
� PROPEHfYYh10BUILDSORIYPROVESTHEREON,ANDVAiODOESSUCHWORKHIMSELFORHERSELFOR m
� TMiqUGH HIS OH HER OWN EMVLOVEES,PHOVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR
Q ,OFFEREDFORSALEIF,FqWEVERTMEBUILDINOORIYPROVEMFMISSOLDWITHINONEYEpHOFCOMPLE-
Z `TqN,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUIID OR
� W PROVE FOR TH:RIRPOSE OF SALE).
❑I,AS ONTIEROF hiE PROPEHTI',AM EXCIUSIVELY CONTMCTINO WITH LICENSED CONTRACTORS
Q TO CONSTRUCT THE PRQIECT(SEC.7w4,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- VaIl18IlOf1 ADJ.AREA
W CENSELAWDOESNOTAPPLYTOANOWNEROFAPPOPERTVWHOBUILDSORIMPROVE57HEREON,AND
� NTIOCOMRACTSWRSUCHPRQIECTSWITHACONTRACTOR(S)LICENSEDPURSUANfTOTHECONTRAG QUANTITY DESCRIPTION � FEE . ,
� 700.5 LICENSE UWJ. .
O ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON U
�i ¢
� OATE ONMER F'
W
F LICENSED CONTRACTORS DECLARATION W
� 1 MEREBY AFFIRAI UNDER PENALTY OF PERIURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �r �y^1'�.�«-✓
� G(COMMENCWO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PROFESSIONS CODE,AND Z
��� MY LICENSE IS IN FULI FORCE AND EFFECT.
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� UCENSECLASS LIC.NO. � Qd!Ad � � 1a�9 - �
DATE CONTRACTOR a � �
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� WORKERS'COMPENSATION OECLARATION Q �- b x Va' 1.�1�:'-"'• --
V r,r.�. ...r n t..rr�. c A"i.TTY
� I HEREBY AFiIRM UNDER PENALTV OF PE0.IURY ONE OF THE FOLLOWING DECLAMTIONS: Z �V AL'LLLV^ �Y'v� �-�--� � �
Q
0 I HAVE AND WILL 1MINTNN A CEHTIFlCATE OF CONSEN770 SELF-INSURE FOR WORKERS' 2
� COMPENSATION,AS PROVIUED BY SECTON 970o OF THE U1BOR CODE,FOR THE PERFORMANCE �U
OF 7HE WORK FOR WHlqi THIS PERMIT IS ISSUED. � �
�
_I HAVE AHD WILL MAINTNN WORKERS'COAIPENSATION INSURANCE,AS REQUIRED BY SECTION
Q 97000F THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS �
ISSUED.MY WORKERS'CONPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION
jCMRIER PLAN REVIEW � � 'i
� POLICY NUMBER ELECTRIC '
0 (fFUSSECTqNNE�NOTBE00AflFTIDOF7}fPERAffSFORONEFiIR�DREDDOl1ARS�I100)ORLESS} PLUMBING
Z I CERTIFY THAT IN THE PEHFORMANCE Of THE WORK FOH WHICH THIS PERMI715155UED,I MECHANICAL
(f} SHQL NOT EMPLOY ANY PERSON IN ANY AIANNER 50 AS TO BECAME SUBJECT TO THE .
� WORKERS'COMPENSATIONUWSOFCALIFORNIA,ANDAGREETHA7IFISHOULDBECAME INSPECTIONFEE
S SUBJECTTO THE WORNEHS'COMPENSATION PROVISIONS OF SECTION 37000F 7HE LABOR ISSUANCE ' ^ "
CODE,I SHILLL FOHTHWI7H COMPIV Wlhl TMOSE PROVISIONS. /�
p DATE: APPLICANT. .SMIP �� (./
� ENERGY P/C
J WMNINO:FAILURE TO SECURE WORKERS'CAMPENSATION CAVERAGE IS UNLAWFUI,AND SHALL BE
LL SU&IECTANEMPLOVEHTOCRIMINALPENALTIESANDCIVILFINESUP700NEHUNDREDTHOUSAND ENERGYPERMIT '
DOLURS(ita0.000),IN ADDI710N TOTHE COSTOF COMPENSA710N,DAMAGES AS PROVIDED FOR IN
� SECTION J70E OF THE LABOR CODE,INTEREST,AND A7TORNEY'S FEES. RETENTION FEE: �� O
a CONSTRUCTION LENDING AGENCY pRE��T FEE: `
O !/I . /�n� �
� I HEREBY AFFIRM UNDER PENALTV OF PERIURV THAT THERE IS A CONSTRUCTION LENDING AGENCV � 1�X�C.C.
FOR THE PERFORMANCE OF hIE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.30P7,CIV.C.).
Z
W
� LENOER'S NAME n
H IENDER'SADDRESS
� I CERTIFY THAT I HAVE READ THIS MPUCATION AND STATE TUTTiE ABOVE INFOfUTATpN IS CORRECT. TOTAL FEES
w I A�REE TO COMPLV WfTH ALL CITY AND COUHTY ORDINANCES AND STATE tAWS REUTING TO BUILDING
� CONSTRUCTION,AND HEREBY AUTFIORIZE REPRESENTATIVES OF THIS COUNTV 70 ENTER UPON THE �
ZABOVE-MENTIONED PROPE TY FOR INSPECTION rosEs. t COMMENTS �
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� �V
m PERMITTEE NAME(P ��
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N SIONATUREOF RM DATE
� RECPT.NO. PAID BY • � VALIDATION
WHITE—Department Copy,YELLOW�inance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—ApplicanPs Capy
C9T�( O� DIAiUlOND BAR
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SET BACK. � � . � ,'_' FLOOR JOIST ;��,...' -���;� :�� � ,
FTGS/FORMS/STEEL ��•, � , � ,'� FHA REQMTS
ELECTRIC GROUND ' � UNDER FLOOR DUGT,� _.; ;:� , . r .,.,�r;-;� ��s '
GROUND PLUMBING UNDER FLOOR CUMDUI��� .� :-','�1 �� '' ' � '�`
SLAB GRADE FIRER4P�GE FOUN� TION •���`- •� ' '��j ' ��
TEMP POWER � FIREPLACE ONQ-� AM " + '
WATER SERVICE MID HT. BOND BEAM -
,.. , ;��: . ,�..._ ,_ ._; �;....� . �
ROOF'SHE�THiMG�'.';,'': r ' - 8 FT. BOND BEAM ;
FRAMING%VEPITILIATION �� � � FINAL BOND BEP,M,. . • ; �
ROOFCOVER •'+'� PRE-GRAD�.N6i - _,'_'� �.1, °,�•"�r.�`:'�,+; `� �
+•.
ROUGH HEATING BENC' '�1G '• .`;:'�'-� ;.•�',�•, -�—�,r-�•�,°•-�: ;�-':
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING FINISH GRADING
SHOWER/TUB TEST � � � POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WAL�INSULATION � POOL FINAL
� CEILING INSULATION OFF SITE IMPS. ��
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG. �
SEPTIC TANK . � LANDSCAPE/IRRIG.
SEEP PIT/L.L. — �� � �� ON SITE IMPS.
GAS AIR TEST - FINAL ZONING
FINAL CONST. � FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINAC ELECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY �
� � . 61 �"Q` ��
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COMMENTS
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SEPTIC TANK SIZE
SEEP PIT/U SIZE
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