HomeMy WebLinkAbout17381 (26) _��` CITY OF DIAMOND BAR
DEPARTMENT OF CO�R�UMTY&DEVELOPIvIENT SERVICES EXPIF���
21825 E.Copley Drive
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��'%����+w BUILDING PERMIT APPLICATION FIRMLY
} JOBSITE APPLICATIO PERMIT / P/C
o ADDRESS 23620 Monument Canyon DATE �� NUMBER/ ,7 3�/ #
' o ISSUE TYPE OCC
^° APN LOT TRACT DATE CONST. GROUP
� o OWNER Cimarron Oaks I HOA
o ADDRESS h75 W_ F�orh�11 R�V 10�+ ZONING SETBACKS
Z ciTv Claremont ziP 91711 TEL. ' FRONT aw ❑
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ADDRESS ��TC2 �t.
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cn DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER•BUILDER DECLARATION SFR/ADD/REM
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p I HEREBV AFFIRM UNDER PENALTY OF PERIURV 7HA7 I AM ExEMPT FROM THE CON7RACTORS LI- Ciyf2 JB/C8fP011
W CENSE UW FOR THE FOLLOWING REASON(SEC.7031.5 BUSINESSAND PROFESSIONS CODE:ANV CITV OR (n
U COUNTYWHICHHEOUIqESAPERMITTOCANSTRUCT,ALTER,IMPROVE.DEMOLISH,ORREPAIRANYSTRUC- W Patio/Deck
w TURE,PRIOR TO ITS ISSUANCE,ALSO HEQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w
STATEMEN7 THAT HE OR SHE IS LICENSED PURSUANT TO 7HE PROVISIONS OF THE CAN7RACTORS LI�
� CENSE LAW(CHAPTER B(CAMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- u" POOVSpB I
� FESSIONSCODE)ORTHA7HEOHSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDEXEMP� (�
V TION.ANY VIOLATION OF SECTION 7031.5 BY ANV APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO Z Re-Roaf �
A CIVIL PENAL7Y OF NOT MOFE THAN FIVE HUNDRED DOLLARS(SSOD).):
Z ❑I,ASOWNEROFTHEPROPERTY,ORMYEMPLOVEESWI7HWAGESASTHEIRSOLECOMPENSA710N, 0 COfilrtlBfCl81 �
WILL DO THE WORN,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70��,BUSI� J
� NESS AND GROFESSIONS CADE:7HE CAN7qAC70RS LICENSE LAW DOES NO7 APPLV 70 AN OWNER OF � �
PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR �
� THROUGH HIS OR HER OWN EMPLOYEES,PROVIDED 7HA7 SUCH IMPROVEMENTS ARE NOT INTENDED OR m '
� OFFEREDFOFiSALE.IF,HOWEVER7NE8UILDINGORIMPROVEMENTISSOLDWI7HINONEYEAROFCAMPLE- ,
Z 710N,7HE OWNER-BUI�DER WILL HAVE THE BURDEN OF PfiOVING 7HA7 HE OR SHE DID NOT BUILD OR
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w ❑I,ASOWNEROFTHEPROPEF7TV,AMEXCIUSIVELYCONTRACTINGWITHLICENSEDCANTMCTORS C
� TO CONS7RUCT THE PRQIECT(SEC.7o�I,BUSINESS AND PROFESSIONS CADE:THE CONTRACTORS L4 V21U2110f1 )OOO ADJ.AREA
W CENSEUWDOESNOTAPPLYTOANOWNEROFAPROPERTVWHOBUILDSORIMPROVESTHEREON,AND
� WHOCANTRACTSFORSUCHPROJECTSWITHACONTRACTOR(S)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE
Y TORS LICENSE LAW.).
�� ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q
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� LICENSED CONTRACTORS DECLARATION w
� I HEREBV AFFIRM UNDER PENALTV OF PERIURY 7HA71 AM LICENSED UNDER PROVISIONS OF CHAPTER �
d Y(COMMENCING WITH SECTION 7000)OF DIVISION 7 OF THE BUSINESS AND PROFESSIONS CADE,AND Z
X MY LICENSE IS IN FULL FOFiCE AND EFFECT. '
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� LICENSE CLASS�-�9 NT�. ��o.No.413067 j
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~ DATE " CONTRAC70R � ^ri d
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� WORKERS'COMPENSATION DECLARATION Q
� I HEREBV AFFIRM UNDER PENAL7Y OF PERIURV ONE OF 7HE FOLIOWING DECURA710N5: Z
� IHAVEANDWILLMAMTAINACERTIFICATEOFCONSENTTOSELF-INSUREFORWOFNERS' ¢
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¢ COMPENSATION,AS PROVIDED BV SECTION 3700 OF THE LABOH CADE,FOR THE PERFORMANCE w
Q OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
� ��I HAVE AND WILL MAINTAIN WORKERS'COMPENSA710N INSURANCE,AS REOUIRED BV SECTION n�
Q 37000F THE LABOR CODE.FORTHE PEFiFOFMANCE OF THE WORK FOR WHICH THIS PERMIT IS 1� f/•'
ISSUED.MV WORNERS'COMPENSATION INSURANCE CARRIEH AND POLICV NUMBER ARE: CONSTRUCTION i
� CARRIER A.M.S. PLAN REVIEW
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� (1HISSECTqNNE�NOTBEC�OMREfEDOF7FiEPEWMISFORONEHUI�DREDDOlLF13S(51a0)ORLESS} PLUMBING
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Z I CERTIFYTHAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I MECHANICAL
�} SHALL NOT EMPLOV ANV PERSON IN ANY MANNER 50 AS TO BECAME SU&IECT TO THE
� WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULO BECOME INSPECTION FEE !'�� - ----- _
SU&IECTTOTHEWORNERS'COMPENSATIONPROVISIONSOFSECTION37000FTHELABOR .- �
� CODE.I SHALL FORTHWITH COMPLV WITH THOSE FROVISIONS. ISSUANCE � �
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p DATE: APPLICANT: ' {
J WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNUWFUL,AND SHALL BE ENERGY P/C I I � Q ��-'•I�
J �� SUBJECTANEMPLOYERTOCRIMINALPENALTIESANDCIVILFINESUP700NEHUNDREDTHOUSAND ENERGYPERMIT �
DOLLARS(fl0o.o00),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN '
� SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. '-� r d
RETENTION FEE:
a CONSTRUCTION LENDING AGENCY PRE-ALT FEE: �
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� 1 HEREBY AFFIRM UNDEH PENALTV OF PERJURY THAT THERE IS A CANSTRUCTION LENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3087,CIV.C.).
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� LENDER'S NAME
� LENDER'SADDHESS
� I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CARRECT. TOTAL FE ES //3� �O
w I AGREE TO COMPLV WITH ALL qTV AND COUNTV ORDINANCES AND STATE LAWS RELATING TO BUILDING
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� CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE
z ABOVE-MENTIONED PROPERTV FOH INSPECTION PURPOSES. COMMENTS
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N SIGNATUREOFPERMI E , DATE �
= RECPT.NO. PAID BY VALIDATION
~ WHITE—De artment Co YELLOW—Finance Co PINK—Assessor Co GOLDENROo--File Co GREEN—A licant's Co
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FTGS/FORMS/STEEL � FHA REQMTS �
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ELECTRIC GROUND ; ! UNQER FLOt�R DtJCT
--- --- -------_ ___ ..___. __._. _.- _. ------ -� .__
GR�JUND PLUMBING � _.__ ; UNDER FLOC7R�C`�1�t�UIT
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SLAB GRADE ; ___ FIREPLACE F04Jiv�?ATION I
---. .._ _.._..-- -----t---
TEMP POWER � _ __ FIREPLACE_QONd SEAM ___
WATER SERVICE MID HT. BOND BE,AM ___ ____
ROOF SFiEATHIiVG �/-Z�=cl . _ 8 Ff. BO�1D BEAM __ � _
FRAMINGNENTILIATION � FINAL BOPJD BEAM � _
ROOF COVER � PRE-GRADING _
ROUGH HEATING BENCHING __ _
ROUGH ELECTRIC RQUGH GRADING
--- _.___�._ _..._-��_......_-
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ROUGH PWNIBING -�- � FINISH GRADING
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--_.._..._.._.
SHOWEH/TUB TEST ; POOL ELECTRIC
--...- ---__ _.--_�__----------
EXT. IATH/SIDING ' POOL FENCING i
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WALL If�SULATIOtJ ; POOL FINAL
CEILING IN�ULATI�N �FF SITE IMPS.
DRYWALL i�IAILI(VG i DEDICATIONS
SEWER FINAL ENG.
SEPTIC TAi�K LANOSCAPE/IRRIG.
SEEP PIT/L.L. � ON SITE IMPS.
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GAS AIR TEST FINAL ZUNING ^ _ _ _
FINAL CONST. � � � FIRE DEPT. FINf�.�
FINP,L HEATING _� HEALTH DEPT. FiNAL _
FiNAL ELECTRIC i DEV. FEES PAID�
FINAL PLUMBIAIG � ENERGY � - �
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