HomeMy WebLinkAbout13360 �
�� CITY OF DIAMOND BAR
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES I
21660 E.Copley Drive Suitc 190
� W (909)860-3195 Fax(909)861-3117 PRESS I
������. BUII.DING PERMIT APPLICATION FORMLY
o DDRESS �Zd 1A� fTl� � � APPLICATION Q_//.�_�� NU B R_�_�Z��/��/�
DATE �
ISSUE ��.�,1.,�� � TYPE OCC
� APh LOT TRACT
�` - DATE "J CONST. GROUP
p OWNER �v fa�'-`73Pr`7 N•O� �•
p ADORESS n�0 Z� IiA �I.N� ZONING SEBACKS
�W CITY D ig. ZIP�� TEL.� REART RW ❑
APPLICANT J. Mti . N61A4A1 TELe SIDE/SIDESTREET RW O
� CONTRACTOR SIDE ❑
Q ADDRESS PROPOSED USE��-1�.. �.�.bFr7 ,I�C.A��N�T7.W IMDOWS
o CITY ZIP TEL. (�, �DYRy�_ � �1 J . � ~
w ARCH/ENG/ ` '
z DESIGNER ��� �NOC.A.N � (MC • NO.DWEL. � NO. �,L NO.
a ADDRESS � UNITS STORIES BEDROOMS
N CITY ZIP�'� TEI�•
y , DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDER DIECLAFiATION SFR/ADD/REM
O
p I HEREBY AFFlRM UNDER PEN�LTV OF PERIURY THAT I AM EXEMPT FROM 7HE CONTRACTORS LI- G8f0JB/CBfPOR
W CEHSEUWFORTNEFOLLOWINGREA.ON(SEC.70.71.58USINESSANDPROFESSIONSCODE:MlYC17YOR (n
U COUlT'WHIdiREOUIRESAPERMRTOCONSTAUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC- W P8110/DBCk
ZNRE,PRIOR TO ITS ISSUANCE,ALSO RE�U�RES THE APPLICAHT FOR SUCH PERMIT TO FILE A SIGNED � W�
� STATEMENT THAT HE OR SHE IS llCENSED PUitSUAHT TO hIE PROVISIONS OF THE CONTMCTORS LI-
� CENSE UW(CNAPTER Y(COMMENCINO WITM SECTION 7000)OF DIVISqN 3 OF 7HE BUSINESS AND PR0. � PooVSpa
FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT 7HEREFROM AND THE BASIS FOR THE ALLEOED E%EMP•
TqN.ANY V10LAT10N OF SECTION 7091.6 BV ANV APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT T0 Z Re-Roof
F A CML PENKTI'OF NOT MORE THAN FNE HUNDRED DOLURS(5500).1:
� ❑I,ASOWNEROFTHEPROPERTV,ORMYEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSA710N, � COrt1RIBfCl81 � "
WILL DO THE YNDRI(AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7oa1,BUSI- J
NESS AND PROFESSIONS CODE:THE CONTMCTORS LICENSE UW DOES NOT APPLV TO AN OWNER OF
� PROPERTYNRqBU0.D50RIMPROVESTMERC-0N,ANDNMODOESSUCHWOHNHIMSELFORHERSELFOR �
Q iHROUGH HIS OR HER ONM EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS AHE NOT INTENDED OR m �
W OFFEREDPDRSIILEIF,FpWEVE0.7ME8UILDINGORIMPfiOVEMINTISSOLDWITHINONEVEAROFCOMPLE-
Z �TION,THE OWNERAUILDER WILL HAVE THE BURDEN OF PROVINO h1AT HE OR SHE DID NOT BUILD OH
� OAPROVE FOfl THS PURPOSE OF SALE).
w OI,tiSOWNEROFTIEPROPEHfV,AMEXCIUSIVELYCONTRACTINOWRHIICENSEDCONfRACTORS
Q TO CONSTitUCT THE PRQIECT(SEC.7oN.BUSINESS ANO PROFESSIONS CODE:THE CONTRACTOPS LI- V81U8l1Of1 ADJ.AREA
W CENSEUWDOESNOTAPPLYTOANOWNEROFAPROPERTVNRiOBURDSORIMPROVESTHEREON,AND
� WFqCONTRACTSFORSUCHPRO.IECTSWITHACONTMCTOR(S)LICENSEDPURSUANTTOTHECONTMP pUANTITY DESCRIPTION FEE �
� TORSLICENSELAWJ.
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O ❑I AM El(EMPT UNDER SEC. B.6 P.C.FOR THIS REASON Q
3 � •
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� DATE ONMEF V .
� LICENSED CONTRACTORS DECLARATION � - —"
� W '�
I HEREBY AFFIRY UNDER PEN/�LTY OF PERIURV 7NAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
p: Y(COMIAENCIHO VYITH SECTION 7000)OF OMSION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z ^
X IdY LICENSE IS IN FULL FORCE MID EFFECT. m ^^
0 LICENSE CLASS LIC.NO. � 1� tJ � I���
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WDATE CONTRACTOR a T�T+V^ 7� A A`y
�P.A :I \l� R:7!'S�.�.r.l�1J�!"11\
� WORKERS'COMPENSATION DECLARATION � ����P���t_�-I����ir'�1 �
� I HEREBV AFFIRM UNDER PENALTV OF PEfUURY ONE OF THE FOLLOWING DECUMTIONS:� - �
� Z
� I HAVE AND WILL AUINTAIN A CERTIFIGTE OF CONSENT TO SEIF-INSURE FOR WORKERS' 2
� COMPENSATION,AS PROVIOED BY SECTON s7oo OF 7HE LABOR CODE,FOR THE PERPDqMANCE � W
OF 7HE WORK FOR WHIG1 THIS PERMIT IS ISSUED. � .
0
w _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS RE�UIRED BY SECTION � � ��
Q 370o OF THE LABOR CODE.FOR THE PEflFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED.MV WORKERS'CONPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION
j �qqiEp PLAN REVIEW S
� POLICV NUMBER ELECTRIC
0 �niss[crqran�r�orgEap,s�repaFnfpEqr.irswqoriEr�uro�opaLws�sim)oa�ss� PLUMBING
w MECHANICAL
Z I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I
(,r} SHALL NOT EMPl.OY ANV PERSON IN ANY MANNER 50 AS TO BECAME SUBJECT TO THE
N WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGfiEE THAT IF 1 SHOULD BECOME INSPECTION FEE
S SUBJECT TO THE WORKERS'COMPENSA710N PROVISIONS OF SECTION 37000F 7HE LABOR
COOE,I SHALL FORTHWITH COMPLV WIT1 THOSE PROVISIONS. ISSUANCE /"�
� SMIP L�
p OATE: � APRICANT: .
� ENERGY P/C
WARN�NO:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE
�y SU&IECT AN EMPLOVER TO CFIMINAL PENALiIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND ENERGY PERMIT
OOLLARS(i100.000).IN A�DI710N T07HE COSTOF COMPENSATION,DAMAGES AS PROVIDED FOR IN
J SECTION 37oe OF THE UBOR CODE,MTERES7,AND ATfORNEY'S FEES. RETENTION FEE: A- �•
Q
a CONSTRUCTION LENDING AGENCY p��T/FEE: �
Q I HEREBY AFFIRM UNDER PENALTV OF PERIURV THA77HERE IS A CONS7RUCTION LENDINO AGENCY ( �Vp. � ��
d FOR THE PEHFORMANCE OF hiE WORN FOR WHICH 7HIS PERMIT IS ISSUED(SEC.30i7,CIV.C.). ��"
Z
W '
� LENDER'S NAME t
F— LENDER'SADDRESS
w ICER7IFYTHATIHAVEREADTHISAPPLICATIONANDS7ATETHATTHEABOVEINFORMA7qNI5CORRECT. TOTAL FEES
� 1 AGREE TO CAMPLY N7TH ALL CT'AND COUNTY ORDINANCES AND S7A7E UWS REUTINO 70 BUILDING
CONSTRUCiION,AND HEREBV AUTHORIZE REPHESEHTATIVES OF THIS COUN7Y TO ENTER UPON THE
ZABOVE-MEHTIONEO P�PEHTY FOR IHSPECTION PURPOSES. � COMMENTS -
� /
m PERAIfTTEE NAME(PR �
� 3
N SIONATURE PE DATE '
� RECPT.NO. PAID BY O' VALIDATION
WHITE—Department Copy,YELLOW�inence Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—Applicant's Copy
�
Ci�Y OF DiABUIOND BAR
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FTGS/FORMS/STEEL ' � `. ,' , . �;, ,�; 'FHA REQMTS
ELECTRIC GROUND ' � UNDER FLOOR DUCT,; . , .j ,.:_,.� �,; , :.', _r; ,
GROUND PLUMBING UNDER FLOOR CC�MDUIT� ; :��'. ��'w .) =+..•`.`'r i'.
SLAB GRADE ' FIREPLAC� F,�, NDQT,ION i'"'�'•�`� � .;.� ��
TEMP POWER FIREf'LA`CE g0(VQ'B�AM � �-' � �
WATER SERVICE � MID HT. BOND BEi4M
ROO��SHEAT.HIN� �`•�'• :� ,. , ',-j ;�,;; "_� f . .� 8 FT. BOND BEAM � i
FRAMINGNENTILIATION� � ' FINAL BOND BEAM-,� , ,.;+ ,. �� ,,_�,��;. ,.,,;. }
ROOFCOVER ''� PRE-GRADI,�JC! �•�� =� ��--�;�'� r��'' � �: — � �
ROUGH HEATING BENC ,IW�' ���''�' �" • - '� 'i�'-,��`'�-�'�-
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUNIBING FINISH GRADING
SHOWER/TUB TEST, POOL ELECTRlC -
EXT. LATH/SIDING POOL FENCING ' �
WALL INSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK — LANDSCAPE/IRRIG.
SEEP PIT/l..L. - � � ' - �. ' QN SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAI.CONST. �,�.� �.�,� FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUMBING ENERGY
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