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HomeMy WebLinkAbout16256 (9) �� CITY OF DIAMOND BAR ������� DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES .� 21660 E.Copley Drive Suite 190 k! � PRESS ������� BUII.DING PERMIT APPLICATION `���d '� 3 Z6OO F�RMLY o D RIESS ib73 M6LViC- ��L n.Ol. DATECATION � � _ NUMBER /��v #/C $ issue rrPE occ APN LOT TRACT DATE � d CONST. GROUP °C OWNER O � ADDRESS ZONING SETBACKS Z CITY ZIP TEL. REART RW ❑ g APPLICANT �F(.1�C1 �DSP t= TEL SIDE/SIDE STREET RW ❑ � CONTRACTOR r'�-C15 S�Ci �A'1_'1-� �-����5 SIDE ❑ ADDRESS � Q a S PROPOSED USE T�►� ��42�HZ1 /1 G/-('(� � � cirr L�1- ziP � TEL.�IU .- ` � r o ARCWENG/ • z� DESIGNER NO.DWEL. NO. NO. a ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. . � DESCRIPTION S0.Ff. FACTOR PSF ADJ.AREANALUATION Q OWNER-BUILDER DECLARATION SFR/ADD/REM O p 1 HEREBY AFFlRAI UNDER PENAL7Y OF PERNRY THAT 1 MI E%EMPT FROM THE CONTRACTORS LI- � Garage/Carport W CENSELAWFORTHEFOLLOWINGREASON(SEC.7o31.5BUSINESSANDPROFES510N5CODE:ANVCITYOR U COUNTYNMICHRC-0UIRESAPERMRTOCONSTRUCT,ALTER,IMPFOVE,DEMOLISH,ORREPAIRANYSTRUC- W P81�0/D9Ck Z TURE,PRIOR TO ITS ISSUANCE,KSO REW IRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNEO � STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- w S CENSE UW(CHAPTER Y(COMMENCINO WITM SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- u" POOVSpB 4 FESSIOHSCODE)ORiHATHEORSHEISEXEMPTTHEREFROMANDTHEBA5ISFOHTHEALLEGEDEXEMP- �� TION.ANV VIOLATION OF SECTION 7031.5 BV ANY APPLICANT FOR A PERMIT SU&IECTS THE APPLICANT TO Z Re-Roof � ACML PENALTV OF NOT AqRE THAN FIVE HUNDRED DOLURS(i5a0).�: � ❑I,ASONMEROFTHEPROPERTY,ORMYEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSATION, � Commercial - NALL DO THE WORIC AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.701/,BUSI- J NESS AND VROFESSIONS COOE:THE CONTRACTORS LICENSE LAW DOES NO7 APPLV 70 AN OWNER OF � PRDPERTYMh10BUILD50RIMPROVESTHEREON,ANDNMODOESSUCHWORKHIMSELFORHERSELFOR � Q T1ROUf3H HIS OR HER ONrtJ EMPLOYEES,7ROVIDED 7HAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m Q ,OFFEREDFORSALEIF,HOWEVER7NEBUILDINOORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE- Z 'Tlpl,THE OWNER-BUILDER WILL HAVE THE BUfiDEN OF PROVIN�THAT HE OR SHE DID NOT BUIID OR � IMPROVE FOR THE PURPOSE OF SALE). ❑I,AS OVMER OF THE PROPEHiY,AM E%CLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS Q TO CONSTRUCT h1E PR0.IECT(SEC.7oN,BUSINE55 AND PROFESSIONS CODE:THE CANTMCTORS LI- V81U8IIOf1 ADJ.AREA W CEHSEUWDOESNOTMPLYTOANOWNEROFAPROPERTYWIiOBUILDSORIMPROVESTHEHEON,AND � WIIOCOHTRACTSFORSUq1PROJECTSWITIACONTMCTOR�S)IICENSEDPURSUANTTOTHECONTMG QUANTITY DESCRIPTION FEE iORS UCENSE LAW.). O ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q � V � Y O 3 � � � DAiE OMMEH � Z U W � LICENSED CONTRACTORS DECLARATION W � I HEREBY AFFIRAI UNDER PENALTV OF PE0.IURV hIAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � p. Y(COMMENCINO WITH SECTION 7000)OF OIVISION 3 OF THE BUSINESS AND PROFESSIONS CADE,AND Z YC W LICENSE IS IN FULL WHCEAND EFFECT. m LU � LICENSE CLASS LIC.NO. j � J V DATE CONTRACTOR a W � WORKERS'COMPENSATION DECLARATION Q = U � IHEREBYAFFIRIAUNDERPENALTYOFVERJURVONEOFTHEWLLOWINGDECURATIONS: �j Z � 1 HAVE AND WILL MAIN7AIN A CERTIFICATE OF CANSENT TO SELF-INSURE FOR WORKERS' _ � COMPENSA710N,AS PROVIDED BY SECTION 37ao OF THE LABOR CODE,FOR THE PERFORMANCE `U � OF THE WORK FOR NMICH THIS 7ERMI715 ISSUEO. � 0 w _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BY SECTION Q 3700 OF THE LABOR CODE,FOR THE PERFORMMICE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.MY WORKERS'GOMPENSATION INSURANCE CARHIER AND PoLICY NUMBER ARE: CONSTRUCTION jc�RqiEq PLAN REVIEW �i � POLICV NUMBER ELECTRIC �Z� TO S�•%�I y Q (tY45SECfqNNE�NDTBE001�LETmOF71EPERMTISFORONEHIN�DRED00LlIAS(f100)ORLESS} PLUMBING Z I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH 7HIS PEHMIT IS ISSUED,I MECHANICAL (�J SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS ECAME T TO THE � WORNERS'COMPENSATION UWS OF CALIFORNI D RE THAT I I SH LD BECOME INSPECTION FEE SUBJECTTOTHEWORNERS'COMPENSATIONP V 10 SO SEC71 37o OFTHEUBOR �j COD ,I SH FORTHWIiH COMPLV WITH THOS P OV 10 . ISSUANCE p DATE: � �` �` APPLICANT: �SMIP w ENERGY P/C J WARNINO:FAILURE TO SECURE M/ORKERS'CAMPENSATION CAVER UN FUL,AND SHALL BE � LL SU&IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CNIL FINES UP TOONE HUNDRED 7HOUSAND ENERGY PERMIT DOlURS(iloo.o00).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN J SECTpN370EOF7HElABORCODE,IN7EREST,PNDATTORNEV'SFEES. � RETENTIONFEE: Q d CONSTRUCT.10lJ LENDING AGENCY • PRE•ALT FEE: ' � I HEREBY AFFIRM UNDER PENAL7V OF PERJURV THAT THERE IS A CONS7RUCTION LENDING AGENCV FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3aB7,CIV.C.). Z W � LENDER'S NAME � IENDER'SADDRESS i � I CER7IFY THAT I HAVE READ 7HIS APPLICA710N AND STATE THA77HE ABOVE INFORMATION IS CORRECT. TOTAL FE ES l v �j J w I AGREE 70 COM7LV WITH ALL CIT'ANO COUNTY ORDINANCES AND S7ATE LAWS REUTINO 70 BUILDING ^ � CONSTRUCTION,AND HEREBV AU7HORIZE REPRESEN7ATIVES OF 7HIS COUN7V TO ENTER UPON 7HE � � / / � ABOVE�MENTIONEDPROPERTVFORINSPECTIONPUHPOSES. � � ' — Z COMMENTS (tJ �• 1 � � �� �� QPERMITiEENAAAE(PRINn � n cn / / 7 q �1 � SIGNATURE OF PERMITTE DA7 � RECPT.NO. PAID BY VALIDATION E—Department Copy,YELLOW�inence Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—ApplicanPs Copy C9�1°lf �I� ���6�il�l�l� ��IR ' -�'-'` 8�1Sf�[�(��°0��1 f�C���G�� , , . ` OG�J�G��t�O[� :�o ..: 'f , k O � p O �- ��y � 1 ��i D� � 5,��. N4x`J+ e°� `?'"�aa .� . .,. , . ,.- . ,� . . � , .. . . .� SET BACK � � � ' FLOOR JOIST �, , _ - _.,_ ; _-- FTGS/FORMSlSTEEL � FHA REQMTS ' � ELECTRIC GROUND 'UNDER FLOOR DUCT � GROUND PLUMBING UNDER FLOOR CUt�;t�UIT ---._........._._..._. SLAB GRADE FIREPLACE FOUNDATION - ----__. _.....__—_.. TEMP POWER FIREPLACE BOND BEAM ' ' ' ' ' � WATER SERVICE MID HT. BOND BEAM � . , ROOF SHEATHING • • 8 Ff. BOND BEAM ' FRAMING/VENTILIATION FINAL BOND BEAM ROOF COVFR PRE-GRADING � ROUGH HEATlNG BENCHING ROUGH E�ECTRIC ROUGH GRADING ` � ROUGH PLUIVIBING FINISH GRADING SHOWER/TUB TEST POOL ELECTRIC EXT. LATH/SIDING POOL FENCING WALL NVSUTATION POOL FINAL CEILING I[USULATION � OFF SITE IMPS. � � � DRYWALL NAILING DEDICATIONS SEWER FINAL ENG. SEPTIC TANK LANDSCAPE/IRRIG. SEEP PfTlL.L. ON SITE IMPS. GAS AIR TEST FINAL ZONING FINA�.�QNST. � F1RE bEPT. FINAL ^ E�IN�'i�HEATlNG HEALTH DEPT. FINAL � - "•lN��ELECTRIC DEV. FEES PAID ?~i- �!�L PLUMBING ENERGY ........... . b ——._ _—o:" I � (i�YK(f�YN(N ':. `.. ' .A�1.,`�yl:.1V : �,-.. . _ -- �......_._ . . . � , i CUMiViE1�TS SEPTIC TA�lK SIZE SEEP PITJU SIZE -- � l�U � _ . , y'� _--___.__