HomeMy WebLinkAbout13386 _!f� CITY OF DIAMOND BAR F
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
� 21660 E.Copley Drive Suite 190
(909)860-3195 Fax(909)861-3117 PRESS
��`'A�' BUILDING PERMIT APPLICATION FIRMLY
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� ISSUE �-2 /� TYPE OCC
APN LOT�� TRACT DATE j��J-'9`7 CONST. GROUP
p OWNE� BI'rt7/t7 F^�•D.A . �
� ADDRESS � Y�I G ZONING SETBACKS
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APPLICANT �� .IV1 11e[�n1 TEL81A//�TL� SIDE/SIDESTREET RW ❑ I
� CONTRACTOR • SIDE ❑
p� ADDRESS PROPOSED USE ��- I�T`� �I Li I'�
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� DESIGNER NO.DWEL. NO. NO.
CDDRESS Z�� TE UNITS �" STORIES 2' BEDROOMS
y DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDER DECLARATION SFR/ADD/REM
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Q I HEREBV AFFlRM UNDER PENALTY OF PERIURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- GflfBQB/C81pOff�
W CENSELAWFORTXEFOILOWINOREA50N(SEC.7031.5BUSINESSANDPROFESSIONSCOOE:ANYCITYOq (n
U COUHTI'NMIGIREOUIRESAPEHMRTOCONSTRUCT,ALTER.IMPROVE,DEMOLISH,ORREPAIRANVSTRUG W Pdt10/DBCk
W TURE,PRIOR TO IT9 ISSUANCE,ALSO REDUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W
� STATEMEHT THAT HE OR SHE IS LICENSEU PURSUANT TO THE PROVISIONS OF THE CANTMCTORS LI�
. � CENSE UW(CiIAPTER Y(COMMENCINO WITH SECTqN 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � PooVSpa
FESSqN3 COOE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND TME BASIS FOR THE ALLEGED EXEMP-
TION.ANYVIOLATIONOFSECTION70.91.6BYANVAPPLICANTFORAPERMITSU&lECTSTHEAPPLICANTTO Z Re-Root
� ACML PENALTV OF NOT MORE THAN FIVE HUNDRED DOLURS(f5o0)J:
� ❑I,ASOWNEROFTHEPROPER7Y,ORMYEMVLOYEESWITHWAGESASTHEIRSOLECAMPENSATION, � COrtIrt1BfCIHI � �
WILL DO THE WORK,AND THE STRUCTURE IS NOT INTEN�ED OR OFFERED FOR SALE(SEC.70a1,BUSI- J
NESS AND PROFESSIONS CODE:THE COHTRACTORS LICENSE LAW DOES NOT AP7LV TO AN OWNER OF
N PROPEHTYMRfO8UM50RIMPROVESTHEREON,ANDWHODOESSUCHWORKHIMSELFORHERSELfOR �
Q THROUGH HIS OR HER OMM EMPLOYEES,VROVIDED THAT SUpi IMPROVEMENTS ARE NOT INTENDED OR m
0 OFFERmFORSALEIF,HOWEVERIF�EBUItDIN00RIMPROVEAIEMISSOLDWITHINONEYEAROFCOMPLE-
Z �`TION,THE OWNER-0UILDER WILL HAVE THE BURDEN OF PROVINO hIAT HE OR SHE DID NO7 BUILD OR
� IMPROVE FOR THE PURPOSE OF SALEJ.
W ❑I,AS OVMER OF THE PROPERf1',AM EXCLUSIVELY CONTRACTING N7TH LICENSED CONTRACTORS
� TO CONSTRUCf THE PRQIECT(SEC.7oH,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- VflIUBSlOf1 ADJ.AREA
CENSE lAW OOES NOTAPPLY TOAN OWNER OFA PROPERTV WHO BUILDS OR IMPROVES 7HEREON,AND
� YAIOCOMMCTSFORSUCHPRQIECTSWITHACONTRACTOR(S)LICENSEDPURSUAHTTOTHECOHTRAG �UANTITY DESCRIPTION � FEE �
� lORS UCENSE UW.�.
� ❑I AM IXEM7T UNDER SEC. B.8 P.C.FOR THIS REASON �
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DATE OMMER V .
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F LICENSED CONTRACTORS DECLARATION �j I
� I HEREBY AFFIRM UNDER PENALTY OF PERIURV THAT I AM LICENSED UNDER PHOVISIONS OF CHAPTER . �
� Y(COAIAIENCINO WITH SECTION 7000)OF DNISION 3 OF THE BUSINESS AND PROFESSIONS CADE,AND Z ���� •�.� '
�� AIY UCENSE IS IN FULL FOfiCE AND EFFECT. m u i i+1=+=y
� LICENSE CLASS LIC.NO. � j �I
V DATE CONTRACTOR a (y]n r " � ���
W � 14� V
� WORKERS'COMPENSATION DECLARATION Q
� U �'T V/lC i nu�;a"s.,r�e'ti i1 \D
N 1 HEREBY AFFIRM UNDER PENQTV OF PE0.1Uq'/ONE OF THE f-0LLOWING DECURATIONS: � v ��y����v� � ��
v� a �T �rnrr�. �:r.r�n <;�n�:r-:�rv
� _I HAVE AND WILL MAINTAIH A CERTIFICATE OF CONSENTTO SELF-INSURE FOR WORKERS' 2 `� V
COMPENSATION,AS PROVIDED BV SECTION J7o00F THE LABOH CADE,FOR THE PERFORMANCE U
Q OF THE WORK FOR WHICH 7HIS PERMIT IS�SSUED. �
�
W _I HAVE AHD WILL MAINTAIN WORKERS'COMPENSA710N INSURANCE,AS REOUIqED BV SEC710N
Q 3700 OF THE UBOR CODE,FOR THE PERFORMANCE OF THE WORI(FOR WHICH THIS PERMIT IS '�
ISSUED.MY WORKERS'COMPEHSATION INSURANCE CARRIER AND POLICY NUMBER ARE: ONSTRUCTIO �7 n
� CARRIER PLAN REVIEW "4 D 4
� POLICY NUMBER ELECTRIC I
0 (fFiISSECTqNNE�NOTBE00MPlETmOFTfPEFA4f15FORONEHIFDRmDOLL/�iLS(itOD)ORLESS� PLUMBING I
Z I CERTIFV TMAT IN hiE PERFORMANCE OF THE WORK FOR WMICH THIS PERMIT IS ISSUED,I MECHANICAL li
O SHALL NOT EMPLOY ANY PERSON IN ANY MMlNER SO AS TO BECAME SU&IECT TO THE � I
WORKERS'COMPENSA710N UWS OF CALIFOHNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE
SUBJECT 70 7HE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE LABOR
s CODE,I SHALL FORTIWITM COMPLV WI7H 7T105E PROVISIONS. SUANC I
� SMIP /.
p DATE: � APPLICANT. .
� ENERGY P/C
J WARNINO:FAILURE TO SECURE WORNERS'COMPENSATION COVERAGE IS UNUWFUL,AND SHALL BE
� SUBJECT AN EMPLOYER TO CRIMINAL PEN/�LTIES AtJD CIVIL FINES UP TO ONE HUNDRED THOUSAND ENERGY PERMIT
DOLURS(i1 oo.0ao).IN ADDI710N 70 THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN �
� SECTION 3708 OF 7HE UBOR CODE,IN7EREST.AND ATTORNEI^S FEES. RETENTION FEE:
d CONSTRUCTION LENDING AGENCY P ALT FEE: �
� I HEREBV AFFIHM UNDER PENALTY OF PERIURV 7HAT THERE IS A CONSTRUCTION LENDING AGENCY � �i/ �
FOR THE PERFORMANCE OF THE WORK WR WHICH THIS PERMIT IS ISSUED(SEC.30P7,CIV.CJ. �.� �
Z
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� LENDER'SNAME
H LENDERSADORESS -
w I CERTIFV THAT I HAVE READ THIS APPLICATION AND STATE THATTHE ABOVE INFORMATION IS CORRECT. TOTAL FEES
d I AGREE TO CAMPLV WI7H ALL CRV M1D COUN7Y ORDINANCES AND STATE UWS RELATINO70 BUILDING -
CONSTRUCTION,AND HEREBY AUTHORIZE REPHESENTATIVES OF 7HIS COUN7V TO ENTER UPON THE .
ZABOVE-MEN7pN�BTqOPE FORINSP TIONPURPOSES. COMMENTS �
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m PERMITTEE N (P � 2 /�
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y SIONA7URE PE DATE /�
� ✓ RECPT.NO. �S 7 C7 PAID BY VALIDATION
WHITE-0epertment Copy,YELLOW–�Inance Copy,PINK—Assessor Copy,GOLDENROD--File Copy,GREEN—ApplicanYs Copy
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CYT'V OF DIAIVIOnID �AR
B�lS�'ECTIOfV F�ECO�iD �
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.SET BACK • . FLOOR JOIS�`E .1. ',.j; :�5 �•.�.ti ..��� • ; !., ��.
FTGS/FORMS/STEEL � :�, �_ __�-,, FHA REQMTS
ELECTRIC GROUND ' ' � UNDER FLOOR DUCT :� • ,„� : : .� , , ;ti �
GROUND PLUMBING UNDER FLOOR CU�iDUITi:�'� �'�s•.fti- r�C' ��.;;" �
SLAB GRADE FIREP C FQ.U.NDATION ; �'�� •i '�''`'" ` '��'�l' `'"�`_
TEMPPOWER - ' FIRE L�C�'�O�D$EAM ' J�- `'' '� 6� "�
WATER SERVICE - MID HT. BOND BEAM
� - ' `{ } 8 FT. BOND BEAM
ROOF�SH AT. trlG� " ' :,
FRAMINGNENTILIATION � FINAL BOND BEAM, , ; ;
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ROOFCOVER .;., PRE-GRAQlN�, I � �t,:ti_::s;<��t:':w:.:,:., •.�;;,•, '
ROUGH HEATING ' BENCHi {._L_�,:�. .,��; `,"�L�=!' :':-';n�Y�Z=;�� '.
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUNIBING FINISH GRADING
SHOWERrT'UB TEST POOL ELECTRIC '
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. ' \ � ON SITE IMPS.
GAS AIR TEST - FINAL ZONING
FIN,4L CONST. p U ,¢�� FIRE QERT. FINAL �
FIN,4L HEATING HEALTH DEPT. FINAL
FINAL ELEGTRIC ' DEV. FEES PAID
FINAL PLUMBING ENERGY
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COMMENTS
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SEPtIC TANK SIZE
SEEP PIT/U SIZE
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