HomeMy WebLinkAbout13363� - , - -
_!� CITY OF DIAMOND BAR �
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21660 E.Copley Drive Suite 190
I , � (909)860-3195 Fax(909)861-3117 PRESS
������'� BUILDING PERMIT APPLICATION FIRMLY
o DDRESS '�`�� W���A[ G� DATECATIONG�I�- / d NUMB R I�J�3 #�� ���U
O
c� ISSUE TYPE OCC
APN LOT RACT DATE CONST. GROUP
p OWNER � �D.�[ .
� ADDRESS O i'Y� �} CI ZONING SETBACKS
�w CITY ZIP�� TEL.� REART RW ❑
APPLICANT . 1'V1� -NO L�tNI TEQ SIDE/SIDE STREET RW ❑
� CONTRACTOR SIDE ❑
� ADDRESS PROPOSED USE F��� i ��`DbtU�7�7. (N INr,�'��S-�
CITY ZIP TEL.
� ' �- -
w ARCH/ENG/ �G - - - ' -
z DESIGNER � NO.DWEL. NO. NO.
a ADDRESS UNITS � STORIES �L' BEDROOMS
� CIN ZIP TEL:
y DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDER DECLARATION SFR/ADD/REM
O
0 1 HEREBV AFFlRM UNDER PENALTY OF PERRIRV 7HAT�AM EXEMP7 FROM 7HE CONTRACTORS LI- G9f899/Cd1p01I � �
W CENSEUWFORTHEFOLLOWINOREASON(SEC.7031.6BUSINESSANDPROFESSIONSCODE:ANVCI7VOR (n
U COUHfYWHICHREOUIflESAPERMRTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC- W Patio/Deck
w NRE,PflIOR TO ITS ISSUANCE,ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A StONED W
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTMCTORS ll-
� CENSE UW(CHAPTER Y(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � PooVSpa
FESSqNS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BA515 FOR THE ALLEGED E%EMP-
TION.ANYVIOLATIONOFSECTION1W7.5BYANYAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO Z Re•Roof
� A CML PENKT'OF NOT MORE THAN FNE HUNDRED DOLURS(i5o0).):
� ❑I,hSOWNEROFTHEPROPERTY,ORMYEMPLOYEESWITHWAGE5A5THEIRSOLECAMPENSATION, � Commercial -
MIILL DO THE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.701/,BUSI� J
N NESS AHD PROFESSIONS CODE:TME CONTRAC70RS IICENSE LAW DOES NOT APPLV TO AN OWNER OF �
VROPEHfY NM1fO BUILDS OR IMPROVES THEREON,AND WHO OOES SUCH WOHK HIMSELF OR HERSELF OH
Q T1Rq1OHHISORHEROWNEMPLOVEES,PROVIDED7HATSUCHIMPROVEIAENTSARENOTINTENDEDOR m
QOFFERmFORSALEIF,FpWEVER711EBUILDINGORIMGROVEMEMIS50LDWfTHINONEVEAROFCOMPIE-
Z �`TqN,THE OMMERAUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOHTHE PURPOSE OF SALE).
w ❑I,ASONMEROFTHEPROPERTV,AME%CIUSIVELYCONTRACTINOWITHLICENSEDCOHTRACTORS
� TO CONSTAUCT iHE VRQIECT(SEC.7oM,BUSINESS AND PROFESSIOHS CODE:THE CON7RACTORS LI� VelUOflOf1 ADJ.AREA
W CENSEUWDOESNOTAPPIYTOANOWNEROFAPROPERTYNR10BU1LOSORIMPROVESTHEfiEON,AND
� NM1qCONTRACTSFORSUq1PROJECTSWITHACONTMCTOR�S)LICENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION FEE �
� 70RS 110ENSE UWJ.
❑I AA1 EICEMPT UNDER SEC. B.6 P.C.fOR THIS REASON Q
3 c>
� ¢
DATE OWNER �
W
F LICENSED CONTRACTORS DECLARATION W "`" �
� I HEREBYAFFIRM UHDER PENALTY OF PER1UFiV THAT I AM LICENSEO UNDER PROVISIONS OF CHAPTER ,
� Y(COMMENCINO WfTH SECTION 7000)OF DIVISION 70F THE BUSINESS AND PROFESSIONS CADE,AND Z - - �+
�� W LICENSE IS IN NLL FORCE AND EFFECT. I
°° ����Z � c� I.7.��
� LICENSE CLASS LIC.NO. j
� rTTmv nC Y�T 9.T�h.�1'�11 t� t�
V DATE CONTRACTOR a �vn n a � A�r;� ,
W S:^F'iTY 'P1XhTS"v �_...�: �'i.�..i'�d ]
� WORKERS'COMPENSATION DECLARATION Q """"""—
= U
� I HEFEBY AFFIRIA UNDER PENALTY OF PERIUM ONE OF THE FOLLOWING DECLAMTIONS:
� Z
� _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSEN7 TO SEIF-INSURE FOR WORKERS' 2
COMPENSATION,AS PROVIDED BV SECTON 3700 OF THE LABOR CODE,FOR THE PERFORMANCE U
Q OF h1E WORK FOR WHICH THIS PERMI7IS ISSUED. �
0
W _I HAVE AND WILL MAIMAIN WORI(ERS'COMPENSATION INSURANCE,AS RE�UIRED BY SECTION �
Q 370o OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED.MV WORKERS'COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION
j �qp�Ep ' PLAN REVIEW Q
� POLICV NUMBER ELECTRIC
� (nuSSEctpr+NE�raieEoolR'LEfIDOFhEPERMfSFOHONEFiIR�DREooa1las(S�ao)oa�Ess1 PLUMBING
Z I CERTIFV THA71N 7HE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
(,�} SHALL NOT EMPLOY ANY PERSON IN ANY MANNER 50 AS TO BECAME SU&IEC7 TO THE
� WORKERS'COMPENSATION UWS OF CALIf-0RNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE
S SUBJECTTOTHEWORKERS'COMPENSATIONPROVISIONSOFSECTION37000FTHELABOR
cooE,i sH�Forrntwin+coMv�r win+niosE aaoviswrrs. ISSUANCE /-�
� SMIP �i �V
p OATE: APPLICANT. .
W ENERGY P/C
J WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVF.HAGE IS UNLAWFUL,AND SHALL BE
� SUBJECTAN EMPLOYER TO CRIMINM.PENALTIES AND CIVIL fINES UP 700NE HUNORED THOUSAND ENERGY PERMIT
DOLLARS(i1o0.000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN C
� SEC7qN 3708 OF THE LABOR COOE,INTEREST,AND ATTOFNEY'S FEES. � RETENTION FE6 ��.n `�.._
d CONSTRUCTIONLENDINGAGENCY pHC-�p�`��E; •,/�
O f/ LL
� I HEREBV AFFIHM UNDER PENALTV OF PERIURV THAT 7HERE IS A CANSTRUC710N LENDING AGENCY i � l
FOR 7HE PERFORMANCE OF THE WORK FOR NRiICH THIS PERMIT IS ISSUED�SEC.70�7.CIV.C.).
Z
W
� LENDER'SNAME
F— LENDER'SADDRESS
� ICERiIFYT1ATIMAVEREADTHISAPPLiCATIONANDSTATETUTTiEABOVEINFORMATIONISCORREC7. TOTAL FEES
w I AGREE TO COMPLV N7TH ALL CITY AND COUNTV ORDINANCES AND STATE UWS RELATING TO BUILDING '
� CONSTRUCTION,ANDHEREBYAU7TiORIZEREPRESENTATIVESOFTHISCOUNTYTOENTERUPONTHE
ZABOVE•MEMpNED�PERTV FOR INSPECT PURPOSE� COMMENTS ' �
�
� �
m PERMIT7EE NAME(PRI �
a Jt �
�
� SIONANRE OF PE I DAT
� RECPT.NO. PAID BV �• VALJDATION
WHITE—Department Copy,YELLOW—Finence Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—ApplicanYs Copy
. . . .. . .. - , . .. . . , . ..c::., . :r , .. . ,{• , . . . ,
CITY O� Di�►MOND BAFi
II�9SP�CTB09V RECO@�D .
{y � .. � .� . � � o �
''. 2^�`(��,;�� , ',�l.'�"�5'k' ��Mf '. ' ��� . � � �
SET BACK � _ FLOOR J._OI:�STi '�`� , � ,,. :,�;,•;',;;;� c.�. � !'`-;:�,
FTGS/FORMS/STEEL �. FHA REQMTS
EIECTRIC GROUND . ' UNDER FLOOR DUCT ;�� , �, �•;, , ,-.; , ..� :
GROUND PLUMBING UNDER FLOOR CU�IDUIT-:.' � � �+'�%�'.�:�t,; ```�!-�.•,`
SLAB GRADE FIREP,L CE FO,U .DATION ='� `" �� . . : � 4s � �
TEMP POWER • FIREPLA'CE B�OND B�AM � � '� �'�
WATER SERVICE MID HT. BOND BEAM
.' ; .` ' . `• 8 FT. BOND BEAM
ROOF SI-��AT�11l��,' � .,--
FRAMINGNENTILIATION , � �� � ' FINAL BOND BEAM, ; •
ROOF COVER .'y• ',� PRE-GRi�DING -���� < .•:. •r, ,y.1..��� .: ,r-
ROUGH HEATING BENCI-!1N ' '� ' Y:'� -: ;�'.;�.:`4�y"s ?!.?;'.
ROUGH ELECTRIC � ROUGH GRADING
ROUGH PLUPVIBING FINISH GRADING
SHOWER/TUB TEST POOL EIECTRIC
EXT. LATH/SIDING POOL FENCING � �
WALL INSULATION POOL FINAL .
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG. •
SEPTICTANK ._ �. . �_, LANDSCAPE/IRRIG.
SEEP PIT/l..L. � '��� ON SITE IMPS. '
GAS AIR TEST FINAL ZONING
FINAL CONST. ,,� � � FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID �
FINAL PLUMBING ENERGY
o p ;'p o:;r� h�' .
Ca�/iiViEiVTS �
- -_ .� -��.
__ . ; .. __
SEF1'IC T,4NK SIZE
SEEP PIT/U SIZE
� ".�--------�� :r,;
�' ""�
a >x`4� ;a �
��� r, '� ; ',L� . � � .
i � .` , '
�i � ' ' ` . ;w. .��� � � —
o F -. �s ,
� 4 y °' � a.: ,�t, _ A , � ' ,
�%� ,��;��;.r *`�.� c z e . Z � .� '-1 --�• �� . . _ .�� . - .
` �
�,� . ' �,� ,� . � , . .