HomeMy WebLinkAbout17920 i CTI'Y OF DIAMOND BAR
- --��`` --- DEPARTMENT OF COMMUNITY&DEVELOPIvIENT SERVICES
� 21825 E.Copley Drive .
(909)860-3195 Fax(909)861-3117 n � ,f� -��PRESS
��'%����+ BUILDING PERMIT APPLICATION �' C��iL��liTit-� Ar F� MLY
JOBSITE 2
¢ ADDRESS �D�7 7 /1'1-�s!'�Q/�1t/Q-Y �G . APPUCATION �J, �JFRMIT P/C
o DATE o� NUMBER I��#
� ISSUE PE OCC
APN LOT 1'RACT DATE CONST. GROUP
p OWNER /ET7"" .�'/���d�'J
" ADDRESS 'g � D ZONING SETBACKS
Z CITY.d/�'rh � ZIP ! �-S—TEL. _S� ' FRONT RW ❑
o APPLICANT TEL. S DE/SIDE STREET RW ❑
z
¢ CONTRACTOR �C. SIDE ❑
� ADDRESS "+dr ST o
� CITY Lf�i ZIP�TEL. PROPOSED USE
o ARCH/ENG/
iz DESIGNER NO.DWEL. NO. NO.
� ADDRESS
� CITY ZIP TEL. UNITS STORIES BEDROOMS
cr�
cn DESCRIPTION SQ.Ff. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
O
p I HEREBV AFFIRM UNDER PENALN OF PERJURY THAT I AM E%EMPT FROM THE CONTRACTORS LI- Gflf3JB/CefPOff
W CENSELAWFORTHEFOLLOWINGREASON(SEC.7031.SBUSINESSANDPROFESSIONSCODE:ANYCITVOR (n
U CAUNTVWHICHREOUIRESAPERMITTOCANSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC�
w TURE.PRIOR 70 I7S ISSUANCE,ALSO REOUIRES THE APPLICANT FOH SUCH PEHMIT 70 FILE A SIGNED� W Patio/Deck
STATEMENT THAT HE OR SHE IS LJCENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI�
� CENSE UW(CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � POOVSpa
FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT7HEREFROM AND THE BASIS FOH 7HE ALLEGED EXEMP- (�
� TION.ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SU&IECTS THE APPLICANT TO Z Re-Roof
A CIVIL PENALTV OF NOT MORE 7HAN FIVE HUNDRED DOLLARS(f5oo).): �
Z ❑I,ASOWNEROFTHEPROPERTY,ORMYEMPLOVEESWITHWAGESAS7HEIRSOLECOMPENSA710N, � COfflrtlBfCi81 =
WILL DO 7HE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70�a,BUSI� J
� NESS AN�PROFESSIONS CODE:THE CONTRACTORS UCENSE UW DOES NOT APPLV TO AN OWNER OF �
PROPER7Y MM1iO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
Q THROUGHHISORHEROWNEMPLOVEES,PFOVIDEOTHATSUCHIMPROVEMENTSARENOTINTENDEDOR m
Q OFFEREDFORSALE.IF,HOWEVER,THEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE-
Z TION,THE OWNER-6UILDER WILL HAVE THE BURDEN OF PROVING THA7 HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF SALE).
w ❑I.ASOWNEROFTHEPROPERTV,AMEXCLUSIVELYCONTRACTINGWITHLICENSEDCANTRAC70RS
� TO CONSTRUCT THE PRQIECT(SEC.70�4,BUSINE55 AND PROFESSIONS CADE:THE CONTRACTOflS LI- V8IU8�1Of1 ADJ.AREA
W CENSELAWDOESNOTAPPLVTOANOWNEROFAPROPERTYWHOBUILDSORIMPROVESTHEREON,AND
� WHOCANTRACTSFORSUCHPRQIECTSWITHACONTHACTOR(5)UCENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE
Y 70RS LICENSE LAW.).
� ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q
� U
tL �
DATE OWNER �
Z w
� LICENSED CONTRACTORS DECLARATION W
� I HEREBY AFFIRM UNDEti PENALTV OF PERIURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � /ii�� " ,B
� Y(COMMENCING WITH SECTION)000)QQQGGF,,,DIVISION 3 OF THE BUSINESS AND PROFESSIONS CADE,AND Z ����
`X MV LICENSE IS IN FULL FORCE A �CT. �� m '
� L�CENSE CLASS � LIC.NO. ,�OS� j
V DATE � CONTRACTOR a
W
� RKERS'COMPENSATION DECLARATION Q
NIHEREBVAFFIRMUNDERPENALTVOFPERJURVONEOFTHEFOLLOWINGDECLARATIONS: Z
Z _IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWORKERS' _
¢ CAMPENSATION.AS PROVIOED BY SECTION 9700 OF THE LABOR fADE,FOR TME PERFORMANCE W
O K FOR WHICH THIS PERMIT IS ISSUED. �
�
w _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BY SECTION
Q 3700 0F THE LABOR CADE.FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS
ISSUED.MV WORKERS'CAMPENSATION INSURANCE CARRIE AND P Y�UMBEflA/AF���, CONSTRUCTION
j CARFiIER �/`� "' ��C/'E�/`S � pLAN REVIEW
Z POLICY NUMBER ELECTRIC
Q �`
� (IFiISSECTIONNE�NOTBEOJMPLEfEDOF7HEPERMfTISFORON RED (E� )ORLESS) PLUMBING � �V
Z I CERTIFY THAT IN THE P RFOHMANCE OF THE WOR OF W IS ISSUED,I MECHANICAL
(} SHALLNOTEMPLOVAN PERSONINANVMANNE OMES JE T�THE
� WORKERS'C PENS IONLAWSOFCALIFOR ND O BECOME INSPECTIONFEE
SUBJECTTO HE WO ERS'COMPENSATION VI51 TI 3 E LABOR
� CODE, L F COMPLV WITH TH E PRO ISSUANCE '
� SMIP �
p DATE: D PPLICANT:
� J WARNING:FAIL RE TO CURE WORKERS'COMPENSATION COVERAGE IS UNUWFUL,AND SHALL BE ENERGY P/C
� SUBJECTANEMPLOVE TOCFIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
DOLLARS(3700.000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN � '
J SECTION 37oB OF THE LABOR CADE,IN7EHEST,AND ATTORNEV'S FEES. RETENTION FEE:
2
d CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
O
� I HEREBYAFFIRM UNDER PENALTY OF PERJURY 7HAT7HERE IS ACONSTRUCTION LENDING AGENCV
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3oB7,CIV.C.). .
Z
w
? LENDER'S NAME
�
F- LENDER'SADDRESS
� TOTAL FEES
� I CEFTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
w I AGREE TO COMPIY WITH ALL qTY AND COUNTV ORDINANCES AND STATE L4W5 RELATING TO BUILDING
d
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF THIS COUN7V 70 EN7ER UPON THE
Z ABOVE-MENTIONED PROPERTV FOFi INSPECTIO osEs. COMMENTS
� �
�
m PEPMI77EE NAME(PRI
Q �
(/J
�J SIGNATUREOFPERMI7TE DATE .
= RECPT.N0. PAID BY VALIDATION
~ WHITE—De artment Co YELLOW—Finance Co PINK—Assessor Co GOLDENRO�File Co GREEN—A IicanYs Co
P PY. PY. PY, PY. PP PY
� . ' ' • . . - .. , v ., v. 4.��hbu� �ir:Ma�� •a. ._. ,. . . � ' ' � "C�.::.'nv .,-'".,•.-.vl:,�ysy.�v.. . ...., � . ... . .. r • . , . . .
`l.n0 8 U �� �U/n1iIX9�YIICI� !O7lfillf-'Q
�I��p���0�I� ������
Oa�'° �� DQ � � � , �Gtr o G'� b �4L� 0[��� Q ��a`:
SET BACK � i � FLOOR JOIST j
_..-- ------_ ..._. _.--- ---_... -------- ___.__..._ � __-- -- ..._._
FTGS/FORMS/STEEL � FHA REQMTS
ELECTRIC GROUND I � , UNQER FLOQR DUCT
_. ---- --__— ---__. _�____._ ..___.�___.—__ ___._ __..------
__.---
GROUND PLUMBING ; UN�ER FLOOR CUh�bUIT ;
— — ---- ------
SLAB GRADE _i�____ _+� FIRERLACE FOUNDATION __ ; ��
TEMP POWER � i FIREPLACE BOND SE,4M�_____�� __
WATER SERVICE � _ ; MID HT. BOND BEAM _ _ ____
- --—
ROOF SHEATHING __„_�_ � � 8 FT. BQNI�BEAM �
- - --�---. --- _.__..-----._.__��__� __......_...__...
FRAiVIINGiVENTILiATION� ' FINAL BOND BEAM __ I ____
ROOF COVER PRE-GRADING (
ROUGH HEATING 1 BERlCHING '
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBING � � FIMSH GRADING
---- - - ------- ---______..
SHOWER/TUB TEST � ; � POOL ELECTRIC
EXT. �ATH/SIDING '� POOL FENCING
— --- ----......-- ------- ___�---_.-----
WALL INSULATION i POOL FINAL i
CEILING INBULATIOfV ' OFF SITE IMPS.
� �. ....-------{.� __ .__._._._..._.._.------
DRYWALL NAILING i ` DEDICATIUNS �
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPEIIRRIU.
___ _._ _..--
SEEP PITIL.L. ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. �� ; F!RE DEPT. FINAL. �-"___ .._._.
FINAL HEATING __�_ i HEALTH DEPT. FINA�
— - ---�- —..---.__ _____ ___.
FINAL ELECTRIC � ' DEV. FEES PAID
FINAL PLUMBING i � ENERGY
- - -._. — -------� • _..
, ;
�
C��l Of� o c o . i _....---
COMii�ENTS .
SEPTIC TA�lK SIZE
SEEP PIT/U SIZE — —���
�
°� ` � � ------------
� -----