HomeMy WebLinkAbout15413 �' �U /�
� �� CITY OF DIAMOND BAR (�J
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES `-��
21660 E.Copley Drive Suite 190
(909)860-3195 Fax(909)861-3117 PRESS
������ � BUILDING'PERMITAPPLICATION FIRMLY
o� JOBSITE DATE CATION � , � �V NUMB R�'� I/#/C
ADDRESS I �� � c�a:.
� ISSUE TYPE OCC
-- APN LOT_ TRACT DATE CONST. GROUP
°C OWNER � ESS -��
O
�` ADDRESS C ZONING SETBACKS
� CITY� ' �' ZIP '�f�pt�TEL. � - r 'fS�/ REART RW p
APPLICANT + TEL. SIDE/SIDE STREET RW ❑
� CONTRACTOR SIDE ❑
Q ADDRESS ,
� CITY ZIP TEL. PROPOSED USE
o ARCH/ENG/ �
� DESIGNER NO.DWEL. . . NO.
a ADDRESS UNITS STORIES BEDROOMS
� CITY ZIP TEL.
�
cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDER DECLARATION SFR/ADD/REM
O
I HEREBV AFFlRM UNDER PENAL7V OF PERNRV THAT I AM EXEMPT FROM THE CONTRACTORS LI� G8f89B/CBfpOli
W CEHSEUWFORTHEFOILOWINOREASON(SEC.70.71.58USINESSANOPROFESSIONSCODE:ANYCINOR (n ,
U COUHT`/WHIq1RE0UIRESAPERMRTOCONSTAUCT,ALTER,IMVROVE.DEMOLISH,ORREPAIRANYS7AUC- W Patio/Deck
Z TUHE,PRIOH TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED
w STATEMEM THAT ME OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- w
� CENSE UW(CHAPTER Y(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � POOVSp2
FESSpNSCODE)ORTHATHEORSHEISEXEMPT7HEREFROMANDTHEBASISFORTHEALLEGEDEXEMP- (�
TION.AHYVIW.ATIONOFSECTION7W7.68YANYAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Roof
� A CIVIL FENALTV OF NOT MORE TNAN FIVE HUNDRED DOLURS(t5a0).):
� ❑I,ASOWNEROfTHEPROPER7V,ORMVEMPLOVEESWITHWAGESASTHEIRSOLECOMPEN5A710N, � COfilrtl8fdfll � '
YALL DO THE WORK,AND THE STRUCTURE i5 NOT INTENDED OR OFFERED FOR SALE(SEC.7011,BUSI� J
� NESS AND PqOFESSIONS CODE:TNE CONTRACTORS LICENSE UW DOES NOT APPLV TO AN OWNER OF �
PROPEHfY WFIO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
Q TMROU(3H HIS OR HER ONM EMPLOYEES,PROVIDED hIAT SUCH IMPROVEMENTS AHE NOT INTENDED OR m
QOFFEREDPDRSALEIF,HOWEVERTMEBUILDINOOHIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE-
Z �'TION,THE OWNER�BUILDER WILL HAVE THE BURDEN OF PROVINO THAT HE OR SHE DID NOT BUILD Ofl
� IMPROVE FOH THE PURPOSE OF SALE).
w ❑I,AS OYMER OF THE PROPEHTV,AM EXCLUSIVELY CONTRACTINO WITH LICENSED CONTMCTOHS
� TO CONSTRUCT THE PRQIECT(SEC.70u,BUSINE55 AND PROFESSIONS CODE:THE CANTRAC70R5 LI- VelUBflOf1 ADJ.AREA
L11 CEN9E UW DOES NOTAPPLV TO AN OHMER OF A PROPERTY WHO BUILDS OR IMPROVES 7HEREON,AND
F WFqCOHTRACT5FOR5UCHPR0.1ECT5WITHACONTMCTOR(5)LICENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION FEE �
� TORS LICENSE UW.).
J
Q ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q
3 �
� � g c� °C
DATE / OWNER 5 �'��'� 1 V
Z W
� UCENSED CONTRACTORS DECLARATION W . ,
� I HEREBY AFF�RM UNDER PENALTY OF PERIURV THAT I AM LICENSED UNDER 7ROVISIONS OF CHAPTER �
d Y(COMMENCWO WITH SECTION 7000)OF DIVI510N 9 0F THE BUSINESS AND PROFES510N5 CADE,AND Z �
X. MY IICEHSE IS IN FULL FORCE AND EFFECL m �
LLJ
0 LICENSE CUSS LIC.NO. - j
� J
V DATE CONTRACTOR a
W
� WORKERS'COMPENSATION DECLARATION �
Q
N 1 HEHEBV AFFIRM UNDER PENKTY OF PERIURY ONE OF THE FOLLOWING DECUMTIONS: �
CA a
� _I HAVE AND WILL AWNTAIH A CEt7�IFICATE OF CONSENT 70 SELF-INSURE FOR WORKERS' 2
CONPENSATION,AS PROVIDED BV SECTION 3l0o OF THE LABOR CODE,FOR THE PEHFORMMICE U
Q OF 7HE WORN FOR WHIW THIS PERMIT IS ISSUED. �
0
W _1 HAVE AND WILL MAIHTAIN WORKERS'COMPENSATION INSURANCE.AS REQUIRED BY SECTION
Q 3700 OF THE LABOR CODE,FOR THE PERFORMANCE OF TNE WORK f-0R WHICH 7HI5 PEHMIT IS
ISSUED.MV WOHKERS'COMPENSATION INSUiUNCE CARRIER AND POLICV NUMBER ME: CONSTRUCTION
jc�aateA PLAN REVIEW
Z POLICV NUMBER ELECTRIC
Q
0 (fFA55ECilONNE�N�78E00A�LEfIDOF71�PERMT6FaRONEHU1�DFiEDDOI.LIAS(StOo)OFLF55) PLUMBING
Z 1 CERTIFV THAT IN THE PERFORMANCE OF THE NlORN FOR WHICH 7HI5 PEHMIT IS ISSUED,I MECHANICAL
(�} SHALL NOT EMP�OY AHY PERSON IN ANY MANNER SOAS TO BECAME SUBJEC7 TO THE
� WORKERS'COMPENSATION LAWS OF C/�LIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE
SU&IECT TO THE WORKERS'COMPENSA710N PROVISIONS OF SECTION 370o OF THE LABOR �
s CODE,ISHALLFOHTHWITHCOMP�YWITITHOSEPROVISIONS. ISSUANCE _
� SMIP
p DATE: APPLICANT: - .,,,,� .
J WMNINO:FAIWRE TO SECURE WORKERS'CAMPENSATION CAVERAGE IS UNLAWFUL,AND SHALL 8E ENERGY P/C
� SU&IECTAN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED 7HOUSAND ENERGY PERMIT
DOLLARS(f100,000).IN ADDITION TO THE COST Of COMPENSATION,DAMAGES AS PROVIDED FOR IN
� SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. ' RETENTION FEE:
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: C�n�'�����$��
� I HEREBV AFFIRM UNDER PENALTY OF PERIURV THQ THERE IS ACANS7RUCTION LENDING AGENCY I�T TTY 41�T/'� A ��(�p �TR) �
fOR THE FERWRMMICE OF 7HE WORK FOR WHICH 7HI5 PERMIT IS ISSUED(SEC.3oY1,CIV.C.). `��II�TD.Jl1-C��—•
Z
W
� LENDER'S NAME �
F— LENDER'S ADDRESS
� I CER7IFY THAT I HAVE READ THIS APPLICA710N AND STATE THA7 THE ABOVE INFORMATION IS CAHRECi TOTAL FE ES � 1.�. v �
w I AGNEE TO CAMPLV WITH ALL CITV AND COUN7Y ORDINANCES AND STATE UWS REUTING TO BUILDING
� CONSTRUCTION,AND HEREBV AU7F10RIZE REPRESEN7A71VE5 OF THIS COUN7Y 70 ENTER UPON 7HE �/� � �
Z ABOVE�MENTIONED PROPERTV POR INS7ECTION PURPOSES. COMMENTS � I v '""
� � S�- !��-ti �5 5 i G�c-
m PERMITTEE INn ; '
� �,��r �l/►�e o ,
= SIONATUREOF PERMITfEE DAT -
RECPT.NO. � PAID BY VALIDATION
~ WHITE-0epertment Copy,YELLOW--Finence Copy,PINK—Assessor Copy,GOIDENROD—Fite Copy,GREEN—Applicant's Copy
�
.. , . ., T. . . �t•ya;e: .d....�R��..1j�.�a'v. . }'. ,��c+jr•>'yJ� �.��4�ei:.. „' .�iMa�, 4�,.i�.'�.. 'u' , t �T'�e�a. . .,"",:tr.�CN���.Zy ' ��:� �. � ..� ' .
� {�� ..r�ii'. . , , �
� � irI tl 6 O�F LL1'�L�'6BVO��I� �P�9� ,.- •
�
.� 4GCIa7����8�11�1 U't�`1.����
. . . . ,. , � ,' ,x
� 9 �+a.`�,x''r p � ���+���� d � n "'� � Q �*�,.° � � 1 � .�..o .°
� � r � �.•
• , .
�r � �� . • i.� , ,'.� ,,. . , �;
, .� .,, ,. _ � � P „�, .• . � ,�.,, o.
��. ,���'. .... �.: +r� __. . . � - ,
SET BACK � I FLOOR JOIST 1
FTGS/FORMS/STEEL FHA REQMTS ' �
ELECTRIC GROUND � UNQER FLOOR QUCT - j
GROUND PLUM8ING UNDER FLOOR CUMDUIT . '� �. � • � __
S�AB GRADE FIREPLACE'�F(3UNDATION � � • __
TEMP POWER FIREPLACE BOND BEAM
iNATER SERVICE MID HT. BOND BEAM i
ROOF SHEATHING 8 FT. BOND BEAM � _
�FRAMINGNENTILIATION FINAL B�ND BEAM
ROOF COVER PRE-GRADING
ROUGH HEA7ING BENCHING
ROUGH ELECTRIC - ROUGH GRADING
ROUGH PLUfv1BING FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC
EXT. LATH/51DING POOL FENCING
WALL INSULATION POOL FINAL �
CEILING INSULATION OFF SITE IMPS. ,
DRYWALL NAILING DEDICATIONS
SEWER FINA�ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
SEEP PIT(L.L. ON SITE IMPS.
GAS Ait�TEST ' FINAL Z�NING
FINA�CONST. FIRE DEPT. FINAL
Fi�tAL HEATIfvG � HEALTH DEPT. WNAL V_ i
Ff�lRL ELECTRiC� DEV. FEES PAID _, _
___.�
i=1flf�L PLUM ING ENERGY I
_� � --�.._�-
�___I'�� �1�/ _'' � � - � -- �
' -�-� ;� � ��� �-����� ` �__----- � -----�--�-
C(J�11(�IENTS _ _
--
��2�' oa � Z.(�� ��J"k s�.�'(ko�_---8��. _ _ __.._________._____..__
�^ _ —_� -- -----__
� "��� ��� — -------.__.
�:,�. . -
SEPTIC TA�lK SI�E,'��' � �` ''+�? °
. �,�_=�:,,
SEER PIT/U SI��f_� ;,,�,� .� ---`- -----
�r; � � .� , ;'��:
., .
�,i'� 4r � -'� ,�. — — ----
�v rw:��t � _?-�F� C,��r l' t s 1t�1� . , i
:�YYy, J�: .
{!' a `i �
��� � � v � i � ° -, .
r
r
� S�' 1 `..
� : t r . ,.. ., . __'
� � J, �
��1
G y 'O
�i i' 4 _ o-,- . .
tU k� � ';':'���
N!t P
'1' 1 _._
k, r � �
�cF Y` �.�V . . 1
/
