HomeMy WebLinkAbout17133 ^-----��--- CTTY OF DIAMOND BAR
� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES �C������ �
21825 E.Copley Drive
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�"���� BUILDING PERMIT APPLICATION JUN 19 2002 ��RMLY
� JOBSITE �/��� �'A���� CI1�. APPLICATIO�y/� PERMIT � P/C �
o ADDRESS 4 Ywl ��/ DATE �� NUMBER}?/�J #
� ISSUE TYPE OCC
, APN LOT ACT DATE CONST. GROUP
°C OWNER
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o ADDRESS ZONING SETBACKS
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o APPLICANT TEL. O S DE/SIDE STREET RW ❑
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a CONTRACTO I SIDE ❑
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� CITY I ZIP I(OO TEL PROPOSED USE
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iz DESIGNER NO.DWEL. NO. NO.
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cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
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I HEREBV AFFIRM UNDER PENALTV OF PERJURV 7HAT I AM EXEMPT FROM THE CON7RACTORS LI- Gef890/CefPOR
�W CENSELAWFORTHEFOLLOWINGHEASON(SEC.7031.SBUSINESSANDPROFESSIONSCODE:ANVCITYOR (n
U CAUNNWHICHREOUIiiESAPERMITTOCAN57iiUC7,AL7ER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC- W P8I10/DOCk
w TURE,PRIOR TO ITS ISSUANCE.AL50 REOUIRES THE APPLICANT FOR SUCH PEFiMIT TO FILE A SIGNEO W
STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI�
� CENSE UW(CHAPTER e(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� � POOUSPB
0 FESSIONSCADE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDE%EMP� (�
V TION.ANVVIOLATIONOFSECTION7031.SBYANVAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO Z Re-Roof
A qVIL VENALTV OF NOT MORE THAN FIVE HUNDRED DOLLARS(5500).):
Z ❑I,ASOWNEROFTHEPROPERTV,ORMVEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, Q Commercial –
WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70a,BUSI� J
� NESS AND GROFESSIONS CADE:THE CANTRACTOflS LICENSE LAW DOES NOT APPLV TO AN OWNER OF
PROPERTYWHOBUILDSORIMPROVES7HEREON,ANDWHODOESSUCHWORKHIMSELFORHERSELFOR � �
� THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THA7 SUCH IMPROVEMEN7S ARE NOT INTENDED OR m
� OFFEREDWRSALE.IF,HOWEVERTMEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCAMPLE-
Z TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF SALE).
w ❑I,ASOWNEROFTHEPROPERTV,AMEXCLUSIVELYCONTRACTINGWITHIICENSEDCONTRACTORS
� TO CONSTRUC7 THE PRQIECT(SEC.70��,BUSINESS AND PROFESSIONS CODE:THE CONTRAC70RS LI- V81U0iiOn ADJ.AREA
W CENSE UW DOES NOTAPPLV TO AN ONMER OF A PROPERTV WHO BUILDS OR IMFfiOVES THEREON,AND �
� WHOCANTfiACTSFORSUCHPROJECTSWITHACANTRACTOR(S)LICENSEDPURSUANTTOTHECANTRAC- QUANTITY DESCRIPTION FEE
Y TORS LICENSE UW.).
�� ❑I AM EXEMPT UNDER SEC, B.8 P.C.FOR THIS REASON Q
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DATE OWNER �
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� LICENSED CONTRACTORS DECLARATION w
� I HEREBY AFFIRM UNDER PENALTV OF PERJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � / /`
a e(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF 7HE BUSINE55 AND PROFESSIONS CODE,AND Z � 1
X MV UCENSE IS IN FULL FORCE AND EFFECT. yA
� LICENSEC S :/ IG LIC.NO. � �0,�� j � ' `Y,O�
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w DATE CONTRACTOR a r r•
� WORKERS'COMPENSATION DECLA ION ¢
� I HEREBV AFFIRM UNDER PENALTV OF PEPJURV ONE OF THE FOLLOWINCa DEC ATIONS: Z
Z _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' _
Q CAMPENSATION,AS PROVIDED BV SECTION 370o OF THE LABOR CODE,FOR THE PERFORMANCE �U
Q � OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
w I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BY SECTION "'
Q 3700 0F THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS u/' �0
ISSUED.MY W�pRKgRS'CAMPgNSATI WSURANCE ARR�IER�D�POLICV NUMBERARE: CONSTRUCTION 7
J N LL-t1 ohA( �I re ��' UU
j cnaaiEa, PLAN REVIEW
� POLICV NUMBER ELECTRIC
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� (iHISSECIIONNE�NOTBE00MRtTFDOFTI-�PERMfTISFOfiONEHUPDREDDOILARS(5100)ORIESS� PLUMBING
Z I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR W ICH HI PERMIT IS ISSUED,I MECHANICAL
�}' SHALL NOT EMPLOY ANY PERSON IN ANY MANNER 50 AS TO M UBJECT TO THE �1
� WORNERS'COMPENSATION IAWS OF CALIFOFNIA,AND A H F I SHOl1LD BECOME INSPECTION FEE T'T':� r\ 'ST T�. 7
= SU&IECT TO THE WORKERS'COMPENSA710N PROVISIO ON 770o Of THE UBOR I�['�'�/.�—�\ J � I �J
CODE,I SHALL FORTHWITH COMPLY WITH THOSE P ISSUANCE
� SMIP I
p DATE: APPLICANT.
� ENERGY P/C I �
J WARNING:FAILURE TO SECURE WORKERS'COMPENSATIO�CAV S UNUWFUL,AND SHALL BE
� SUBJECTANEMPLOVERTOCRIMINALP[NALTIESANDCIVIL TOONEHUNDREDTHOUSAND I I
DOLLARS(5100,000),INADDITIONTOTHECOSTOFCOMPENSATION,DAMAGESASPflOVIDEDFORIN ENERGYPERMIT �p�(� _
� SECTION37080FTHELABORCODE.INTEREST,ANDATTORNEV'SFEES. RETENTIONFEE: IJL�R__ /.
� CONSTRUCTION LENDING AGENCY PRE•ALT FEE: �— ^
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� I HEREBV AFFIFM UNDER PENALTY OF PERJURV THAT THERE IS A CONSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3oD7,�Cl\C.).
Z
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S LENDER'S NAME
�
F- LENDER'SADDRESS
! � I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CARRECT. TOTAL FE ES �• �
w I AGFEE TO COMPLV WITH ALL CRY AND COUNTV ORDINANCES AND STATE LAWS REIATING TO B�ILDING
� CONS7RUCTION,AND HEREBV AUTHORIZE REPRESENTA71VE5 OF THIS COUNTY TO ENTER UPON HE
� ABOVE�MENTIONED PROPERTY F INSPECTION PURPO S.
Z COMMENTS
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m PERMITTEE NAME(PRINT) /� O� �
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� SIGNATUREOFPERMITTEE �TE
_ . RECPT.NO. PAID BY "' � VALIDATION
~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—Applicant's Copy
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FTGS/FORMS/STEEL � � FHA REQMTS �
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ELECTRiC GROUND � � j UNDER FLO(�R DUCT i
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GROUND PLUMBING ; UNDER FLOOR GUMDUIT � �
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SLAB GRADE FIFiEP�AGE FO1.1�1�ATiON_ ' ' ' '
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TEMP P�WER _ __ FIREP�ACE BOND BEAt��_____..______.�
_..__._
WATER SERVICE _____ __ _ MID HT. BOND BEAM
_- -=---
-_. __.
ROOF SHEATHING ! 8 �. BOND BEAM ' ___ �
FRAMINGNEtJTiLIATION i FINAL BOPJD BEAM
ROOF COVER � PRE-GRADING
ROUGH HEATING BENCHING
ROUGH ELECTRIC R�UGH GRADING
-- __......__. ____.___ _�_______ -._._.__-----.
ROUGH P�UNIBING FINISH GRADING
� ____ ___. . __..__--- --.._ .__...---.�- _____._...__..
SHOWER�fUB TEST POOL ELECTRIC I
- - --- ----- -..._ -...t-
EXT. LATH/SIDING ' i POOL FENCING �
WALL INSULATION ; POOL FIf�AL
CEILlNG IN�ULATI�N � �FF SITE IMPS.
DRYWALL NAI�ING � DEDICATIONS
SEWER FINAL ENG. _ - ---------- ------ -
SEPTIC TANK LANDSCAPEfIRRIG. � �
SEEP PIT/L.L. ON SiTE iMPS.
GAS AIR TEST FIP�AL ZONING
FINAL COIVST. FlRE DEPT. FINA�
FINAL HEATIIVG HEALTH DEPT. FINAL
- -- _____..�.
FINAL ELECTRIC DEV. FEES PAID
FINAL PLUfWBING ENERGY -___..._�_____ �.��.---.------
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C��� o c.a_ a. �. � i: _._.
CO�(iii�ENTS
SEPTIC TAi�K SIZE
SEEP PIT/U SIZE " -
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