HomeMy WebLinkAbout17461 (42) CITY OF DIAMOND BAR
--� -��` -- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 PRE$S
��'-���� BUILDING PERMIT APPLICATION FIRMLY
¢ DDR'ESS 23670 Monument Canyon APPLICATION PERMIT P/C
o DATE �Z U NUMBER175'�� #
� ISSUE TYPE OCC
APN LOT TRACT DATE CONST. GROUP
p OWNER .i Illgrroll � G T HOA
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cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER•BUILDER DECLARATION SFR/ADD/REM
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I HEREBV AFFIHM UNDER PENALTV OF PERIURV THAT I AM EXEMPT FROM THE CONTRAC70R5 LI� Gefe9B/C3fPOff
W CENSEUWFORTHEFOLLOWINGREASON�SEC.7o31.5BU51NESSANDPROFESSIONSCODE:ANVCITVOR (n
U COUN7VWHICHREOUIRESAPERMITTOCANSTRUCT,ALTER.IMPROVE,DEMOLISH,ORFiEPAIRANYS7RUC-
w TURE,PRIOR 70 I75 ISSUANCE,AL50 REOUIRES THE APPLICANT FOR SUCH PERMI7 TO FILE A SIGNED w Patio/Deck .
STATEMENT THAT HE OR SHE IS LICENSED PURSUAN7 TO THE PROVISIONS OF THE CON7RACTORS LI-
� CENSE UW(CHAPTER e(CAMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO� � POOVSPB
� FESSIONSCADE)Oq7HATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLEGEDExEMP- C7
V TION.ANV VIOLATION OF SECTION 7031.5 BY ANV APPLICAN7 FOR A PERMIT SU&IECTS THE APPLICANT TO Z Re-Roof
� A CIVIL PENAL7V OF NOT MORE THAN FIVE HUNDRED DOLLARS(S5ao).):
� ❑I,ASONTJEROFTHEPROPERTV,ORMVEMPLOYEESWITH:WAGESASTHEIRSOIECAMPENSATION, � COrt1rtlBfClel -
Z WILL DO THE WORK,AND THE STRUC7URE IS NOT IN7ENDED OR OFFERED FOR SALE(SEC.7odl,BUSI- J
� NESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NO7 APPLY TO AN OWNER OF �
PROPERTV WHO BUILDS OR IMPROVES 7HEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
� THROUGH HIS OR HER OWN EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
Q OFFEREDFORS�LE.IF,HOWEVERTMEBUILDINGORIMPROVEMENTISSOIDWITHINONEVEAROFCAMPLE�
Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR
i � IMPROVE FOR THE PURPOSE OF SALE).
w ❑�,ASONMEROFTHEPROPERTV,AME%CLUSIVELYCON7RAC71NGWITHLICENSEDCONTRAC70R5
� TO CANSTRUCT THE PROJEC7(SEC.70�a,BUSINESS AND PROFESSIONS CODE:THE CONTRAC70RS LI- VelUetlOfl ADJ.AREA
W CENSELAWDOESNOTAPPLVTOANOWNEROFAPROPERTVWHOBUILDSORIMPROVESTHEREON,AND
I � WHOCANTRACTSFORSUCHPROJECTSWITMACON7RAC70R(S)LICENSEDPURSUANTTOTHECON7RAC- QUANTITY DESCRIPTION FEE
Y 70R5 UCENSE LAW.).
� ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q
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DATE OWNER U
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� LICENSED CONTRACTORS DECLARATION W I
� 1 HEREBY AFFIRM UNDER PENALTY OF PERJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
d 9(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PROFESSIONS CODE,AND Z
X MV LICENSE IS IN FULL FOFiCE AND EFFECT. m
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� LICENSE CLASS�—` _�I� LIC.NO. (F�`��� j
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V DATE 7—_�1—1 J_7 CONTRACTOR Rn3*!l I R(ln-F i.n� a
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� WORKERS'COMPENSATION DECLARATION Q
� I HEREBV AFFIRM UNDER PENALTV OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: Z
Z _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF�INSURE FOR WORKERS' _
¢ CAMPENSATION,AS PROVIDED BV SECTION 370oOF THE LABOR CODE,FORTHE PERFORMANCE W
OFTHE WORK FOR WHICH THIS PERMIT'IS ISSUED. �
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w �X I HAVE AND WILL MAINTAIN WORKERS'CAMPENSATION INSURANCE.AS RE�UIRED BY SECTION
Q 370o OF THE LABOR CODE,FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMI715 �� ,z O
ISSUED.MY WORKERS'CAMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION
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� CARRIER A T�i C PLAN REVIEW '
Z POLICY NUMBER ELECTRIC
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� (iHISSEC�IONNEmNOTBE00MREfEDOFh1EPEWMISFORONEHUI�DREDDOLLARS(Et00�ORLESS). PLUMBING
Z I CERTIFY THAT IN THE PERFOPMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
L} SHALL NOT EMPLOY ANY PERSON IN ANV MANNEF SO AS TO BECOME SUBJECT TO THE
(/j WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE
= SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF SECTION 3700 OF THE UBOR n ''
CADE,I SHALL FORTHWITH COMPLY WITH THOSE PROVISIONS. ISSUANCE �S
p DATE: APPLICANT: SMIP � �'. • Sd
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J WARNING:FAILURE TO SECURE VlORKERS'CAMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C
� SUBJECTANEMPLOVERTOCRIMINALPENALTIESANDCIVILFINESUP700NEHUNDREDTHOUSAND ENERGYPERMIT ' I��(� n � �nn�
DOLLARS(f100.000),IN ADDITION TO THE COST OF CAMPENSATION,DAMAGES AS PROVI�ED FOR IN `Y �� „ `���
� SECTION 3708 OF THE LABOR CADE,INTEREST,AND ATTORNEV'S FEES. RETENTION FEE: I , 6"
� CONSTRUCTION LENDING AGENCY PRE-ALT FEE: /✓�
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� I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT 7HERE IS A CONSTRUCTION LENDING AGENCY � - '
� FOR THE PERFOFMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.30W,CIV.C.). - �
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� LENDER'S NAME
F- LENDER'SADDRESS .
� I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTAL F E ES /�� �O
w I AGREE TO CAMP�V WITH ALL qN AND COUNTV ORDINANCES AND STATE LAWS RELATING TO BUILDING � J
� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATNES OF THIS COUNTV TO ENTER UPON THE
� ABOVE-MENTIONED PROPERTY FOfl INSPECTION PURPOSES. '
Z COMMENTS
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m PERMITTE N E(PRINT)
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� SIGNATUR O ERMITTEE DATE • Q /
= RECPT.NO. PAID BY L VALIDATION
~ WHITE—De artment Co YELLOW—Finance Co PINK—Assessor Co GOLDENROD—File Co GREEN—A licant's Co
P PY, PY. PY, PY. PP PY
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FTGS/FORMS/STEEL FHA REQMTS �
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ELECTRIC GRdUND � ; UNQER FLOOR DUCT �
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GROUND P�UMBING � UNDER FLQOR GU��DUIT _______
SLAB GRADE ,_ �_ FIREPLACE FOUNDATION _
TEMP POWER ' ; FIREPLACE BOND BEAM __ __. _
W,4TER SERVlCE� i ' MID HT. BOND BEAM
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ROOF SHEATi-IfNG• IZ,Zf-,�1 .t��!t/ i l_8 FT. BOND BE�!(�r� �
---_ ___ ----------- _____._.. ......
FRAMINGNENTILIATION __ ` � FINAL BOND BEAM __ ____ __� ;
-- ----�- - ----........._...
ROOF COVER ,3�y`ay _ ' PRE-GRA�ING
ROUGH HEATING BENCHIRIG
ROUGH ELECTRIC � , ROUGH GRAdING _ ______
ROUGH P�UMBING � ' FINISN GRADING
' -- --*- -- -....----- ---- --------_..---
SHOWERlTUB TEST � ; POOL ELECTRIG
� _.._._— . � ___..... .__...__ .�---___.____--.-----
EXT. LATH/SIDIN� � ! POOL FENCING
— --— --- � --._.__._ _...___._
WALL INSULATIO�1 ; POOL FINAL �
CEILING INBUTATION � i OFF SITE IMPS. ___ �
DRYWALL NAILING DEDICATI�NS
SEWER FINA�ENG. -----
SEPTIC TANK LANDSCAPE/iRRiG.
SEEP PIT/LL. � ON SITE IMPS.
---- --_____ __.____________
GAS AIR TEST -�— FINAL Z(�NING __ _
FIPJAI CONST. ! �lRE DEPT. FIP�AL
FINAL HEATING j j HEALTH DEPT. FINAL
FiNAL ELECTRIC � � DEV. FEES PAID
FINAL PLUMBIIVG ! ' I ENERGY
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