HomeMy WebLinkAbout13379 ��� CITY OF DIAMOND BAR '�
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
I 21660 E.Copley Drive Suite 190
� (909)86U-3195 Fax(909)861-3117 �RESS
������^�� BUILDING PERMIT APPLICATION FIRMLY
�� JOBSITE /J�j�(� �A ' A� A �1�,D/�1 � DATE CATION� /LJ_�� NUMBER I3 3 11 #/C / " "�
ADDRESS v�l"LU �'C�/'��'C �I F�li1iC/ � 7
c� ISSUE e� 7 [r TYPE OCC
APN LOT TRACT DATE �-1 " �7 � `� CONST. GROUP
°C OWNER •
O
" ADDRESS ZONING SETBACKS
w CITY Z P TEL. FRONT RW ❑
� APPLICANT . �NO TEL��_ SIDE/SIDE STREET RW ❑
� CONTRACTOR SIDE ❑
Q ADDRESS PROPOSED USE � (/�IIN�✓S
� CITY ZIP TEL.
w ARCH/ENG! �
z DESIGNER . � G' NO.DWEL. NO. NO.
a ADDRESS UNITS � STORIES 2� BEDROOMS
� CITY � ZIP TE .Z
� DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDER DECLARATION SFR/ADD/REM
O
p I HEREBV AFFlRAI UNDER PEN�L7V OF PERNRV THAT I AM EXEMPT FROM THE CON7RACTORS LI- GflffigB/C81p01I
W CENSEUWFORTNEfOILOWINOREASON(SEC.7031.68USINESSAN�PROFESSIONSCODE:ANYCI7YOR (n
U COUHfYWHICHREOUIRESAPERMRTOCONSTRUCT,ALTER,IMPROVE,OEMOLISH,ORREPAIRANVSTRUC� W Patio/Deck
Z TURE,PRIOR TO ITS ISSUANCE,AL50 REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
�� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE COMRACTORS LI� w
� CENSE UW(CHAPTER i(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � PooVSpa
FESSIOHS COOE)OH THAT HE OR SHE IS EXEMPT THEREFROM AND THE BA515 FOR THE ALLEOED EXEMP-
TION.ANVVpUT10NOFSECTION7091.68YANYAPPLICANTFORA7ERMITSUBIECTSTHEMPLICANTTO Z Re-Roof
� ACML PENALT'OF NOT MORE THAN FNE HUNDRED DOLURS(i500).):
� ❑I,ASOWNEROFTHEPROPERTV,ORMYEMPLOYEESWITHWAGESASTHEIRSOIECOMPENSATION, � COf11rt1BfCl81 �
WILL DO THE WORK AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70Il,BUSI- J
NESS AND 7ROFESSIONS CODE:7HE CONTMCTORS LICENSE UW DOES NOT APPLV TO AN OWNER OF
� PiqPERTV MM1IO BUILDS OR IMPROVES THEREON,AND MRiO DOES SUCH WORN HIMSELFOR HERSELF OR �
� Q 7HAOU(iH MIS OR HER ONM EMPLOYEES,PROVIDED hIAT SUGi IMPROVEMENiS ARE NOT INTENOED OR m
QOFFERFDPDRSALEIF,HOWEVERTFIEBNLDINGOHIMPROVEMEMISSOLDWITNINONEVEAROFCOMPLE•
Z �'TqN,THE ONMER-0UILDER WILL MAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
= IAIPROVE FOR THE PURPOSE OF SALE).
❑1,AS OWNER OF THE PROPEHTV,AM EXCLUSIVELY CONTMCTING WRH LICENSED CONTRACTORS
¢ TO CONSTAUCf THE PRQIECT(SEC.70H,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- Ve1U8110f1 ADJ.AREA
W CENSE UW DOES NOTAPPLY TOAN OWNER OFA PR07ERTY WF10 BUILDS OR IMPROVES THEHEON,AND
� NRiOCONTMCTSFORSUCHPROJECTSWI7HACONTRACTOR(5)UCENSEDPURSUANTTOTHECONTRAG qUANTITY DESCRIPTION � � FEE .
� 10R5 LICENSE IAW.).
Q ❑I AM EJ(EMPT UNDER SEC. B.6 P.C.FOR THIS REASON Q
3 � � i�� r,,��
� OATE OWNER F '"""
U
w
F LICENSED CONTRACTORS DECLARATION W
� I HEflEBY AFFIRM UNDER PENALTV OF PERIURY hIAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � N:Q f i i j �f1�
d Y(COMYENCIHO M/ITM SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z 1 S V ;J
MY LICENSE IS IN FULL FORCE AND EFFEC7.
i�5 � CI1'Y�nF t e ti,:���.�„ x�n�
� UCENSE CUSS LIC.NO. J �UII.D�rr� .q.TJYI�.fa FFtTV
V DATE CONTRACTOR a
W
� WORKERS'COMPENSATION DECLARATION Q
= U
� I HEREBYAFFIRM UNDER PENALiY OF PEiL1UM ONE OF THE FOLLAWING DECURATIONS: '
y Z
� I HAVE AND WILL MAINTAIN ACERTIFlGTE OF CONSEM 70 SELF-INSURE FOR WORKERS' 2
� OOIAPENSATION,AS PROVIDED BV SEC710N 77000F TNE LABOR CODE.FOR 7HE PERFO{iMANCE W
OF THE WORK FOR NMICH THIS PERMIT IS ISSUED. �
O
w _I HAVE AND WILL MAINTAIH WORKERS'COMPENSATION INSUMNCE,AS REOUIRED BY SECTION �
Q 3700 OF THE UBOR COOE,FOR THE PERFOHMANCE OF THE WORK FOR WHICH THIS PERMIT IS �i Q
ISSUED.MY WORKERS'COMPENSATION INSURANCE CARRIER M1D POLICV NUMBER ARE: CONSTRUCTION
jc�RqiER PLAN REVIEW �
� POLICYNUMBER ELECTRIC
� (I}455ECfpNNE�NDTBEOOAPLEfEDOF1IEPEFAII'ISfORONEV0.R�DFEDDOUMS(St00)ORLESS} PLUMBING
W MECHANICAL
Z I CERTIFV THA71N THE PERFORMANCE OF THE M10RK FOR WHICH THIS PERMIT IS ISSUED,I
(� SHALL NOT EMPLOV ANV PEHSON IN ANV MPNNER SOAS TO BECAME SU&IECT TO THE
y WORNERS'COMPENSATION UWS OF CALIFORNIq AN�AGHEE THAT IF I SHOULD BECAME INSPECTION FEE
S SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 37000F THE IABOP !�
CODE,I SHAIl FOHTHWITH COMPLY WI7H THOSE PROVISIONS. ISSUANCE J�L��
p DATE: APPLICANT: SMIP I i�Q
� ENERGY P/C
J WARNINO:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNUWFUL,AND SHALL BE
, � SUBJECT AN EMPLOVER TO CRIMINAL PEN/�L71ES AND CIVIL FINES UP 70 ONE HUNDRED THOUSAND � ENERGY PERMIT
DOLURS(i100.000),IN ADDI710N TO THE COS70F COMPENSATION,DM/AGES AS PROVIDED FOR IN
� SECTION 3708 OF THE IABOR CODE,IN7ERE5T,AND ATTORNEI^5 FEES. RETENTION FEE: ��D
OCONSTRUCTION LENDING AGENCY PH ALT FEE: �
� I HEREBV AFFIRM UNDER PENALTV OF PERIURV THATTHERE IS A CANSTRUCTION IENDING AGENCY ������.I
FOR TNE PERFORMANCE OF THE WOqK WR WHICH THIS VERMIT IS ISSUED(SEC.3oY7,CIV.C.).
Z
W
� LENDER'S NAME �/ � ���
F- LENDERSADDRESS
Q ICEHTIFVTHA7IHAVEREADTH�SAPPLICATIONANDSTATE7HAT7HEABOVEINFORMATIONISCORRECT. TOTAL FEES
W I AGREE TO COMPLV N7TH ALL CRY M1D CWNTY ORDINANCES AND STATE LAWS RELA7ING TO BUILDING
� G+ONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THI COUNTY TO ENTER UPON THE �
� ABOVE-MENT��OPERTY FOR INSPE auaaoses. COMMENTS �- �
Z
� v ' v
m PEFiMITTEE H (PRINn �
Q
N
� SIONANNE OF P DAT ^
� � RECPT.NO. PAID BY � VALIDATI
WHITE—Depertment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—Applicant's Copy
- - - .— , .�.. ,,:.. , . :�� , ,r� , .
. ,.. . .� . y..,., . . ., . i :,.. , .
CI�'1( OF DIAi1�O1VD ��►R �
6E�SPECTIOn1 RECO�iD
o �a :� � � �����, . �� o . � � , . � .
,�. ��
SET BACK ' • i � . . ' =��� FLOOR JQI T' `. ,` '� . ��, � ;: ''
�1.�, 6..,1 +R r :a t�.'
FTGS/FORMS/STEEL . FHA REQMTS
ELECTRIC GROUND ' � UNDER FLOOR DUCT =•, ; ;. R , � ,� ,
GROUND PLUMBING UNDER FLOOR CU�ID'IJiT..'�E'1:. s�.,:'�."'.�;,=.1:'� �r• `y`:.`
SLAB GRADE ' FIREPLACE FOUNDA�"ION ��' i'''' `:s`''�`:;';''.'
i::a:�.._ . r'--.r i: ,
TEMP POWER FIREf��ACE B�I�D� AM ��� �
WATER SERVICE MID HT. BOND BEAM
RObF SH'�ATwING� �`�; '� ` - •;� � � � `.' ; ..-' 8 FT. BOND BEAM
FRAMINGNENTILIATION � FINAL BONi�BEAM.,.. .. ,..., ,.
'� PRE-GRAOING � � :-i��� ,.�� .-, -'•� .�.. •< ,. ,`';,.
ROOF C�VER . t .�'__
ROUGH HEATING BENC,1 � �`�J'���r�;;.� .'zF. .;4.°,`{t,��.:<r.,
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUIVIBING FINISH GRADING
SHOWER/TUB TEST POOL ELECTR[C
EXT. LATH/SIDING PnOL FENCING
WALL INSULATION PO�L FINAL -
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK _ , LANDSCAPE/IRRIG.
SEEP PIT/L.L. 1= ' ` ��' l ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. � FIRE D'EPT FINAL
FINAL HEATIfJG HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID �
FIiVAL PLUMBING ENERGY
..� Q ��� +��R
COiViiViENTS
SERTIC TANK SIZE .
SEEP PIT/U SIZE
� .
�- .;�, _�� � _
�� :*
.� ��` ��� � �
- �:� � �� � ._
,, . .
t `.,; � \ ` . 1
� ' .. .. . ' • ' � . ._
�� �
i, ����\� . .;� ' .
"a�,��k."� a _ . i ' � � � " � . . :+��, .
I