HomeMy WebLinkAbout17986 (25) � '• --...� � � I
CITY OF DIAMOND BAR ' � `
`----��`` --- DEPARTMENT OF COMMUNTI'Y&DEVELOPMENT SERVICES /�
I
21825 E.Copley Drive
T (909)860-3195 Fax(909)861-3117 l{j �� ES$ �
'�'%���� BUILDING PERMIT APPLICATION FVRMLY I
o� JOBSITE APPLICATI PERMIT --�%�7C�}f{/PlC r1 �r, I
ADDRES _ DATE NUMBER �f v��# v ,
� ISSUE p TYPE OCC
APN LOT TRACT DATE � / � CONST. GROUP
°C OWNER ��
O
�p ADDRESS 'I�OQ'�� ��4\LrcC..� ZONING SETBACKS
Z CITY \C4.��� ZI�� TEL.���o� FRONT RW ❑
o APPLICANT TEL. S DE/SIDE STREET RW ❑
z
¢ CONTRACTO M�'j SIDE ❑
p� ADDRES — u
� CIN W�x`N�+'r ZI�TEL.�'jR��.}'�� PROPOSED USE
o ARCH%ENG/
z DESIGNER
w • NO.DWEL. p NO. NO. •
� ADDRESS
= CITY ZIP TEL. UNITS Y STORIES BEDROOMS
v�
cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
O
I HEREBY AFFIRM UNDER PENALTV OF PERJURV THAT I AM EXEMPT FROM THE CONTRAC70RS LI- Gefe99/CBfPOR
W CENSE LAW FORTHE FOLLOWING REASON(SEC.7031.5 BUSINESSAN�PROFESSIONS CODE:ANV CITV OR (n
U COUNTVWHICHREOUIRESAPERMITTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANVSTRUC-
w TURE,PRIOR TO ITS ISSUANCE,ALSO RE�UIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck
STATEMENT 7HAT HE OR SHE IS LICENSED PURSUANT TO THE PfiOVISIONS OF 7HE CON7RACTORS LI�
� CENSE UW(CHAPTER e(COMMENCING WITH SECTION 7000)OF DIVISION 3 Of TNE BUSINESS AND PRO- � POOUSPB
FESSIONSCODE)ORTHATHEORSHEISEXEMPTTHEREFROMANDTHEBASISFOR7HEALLEGEDEXEMP- (�
� TION.ANVVIOLATIONOFSECTION7031.58YANYAPPLICANTFORAPERMITSUBJECTSiHEAPPLICANTTO Z Re-Roof �
A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLURS(S5o0).):
Z ❑I,ASOWNEROF7HEPROPER7Y,ORMYEMPLOYEESWITHWAGESASTHEIFSOLECOMPENSATION, 0 COmmBfCifll -
WILL DO THE WORK,AND THE STRUCTURE IS NOT IN7ENDED OR OFFERED FOR SALE(SEC.7oa4,BUSI- J
N NESS AND PROFESSIONS CADE:THE CONTRACTORS LICENSE LAW DOES NOT APPLV TO AN OWNER OF �
PROPERTY VhiO BUILDS OR IM PFOVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
� THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR m
� OFFEREDFORSALE.IF,HOWEVER,iHEBUILDINGORIMPFOVEMENTISSOLDWI7HINONEYEAROFCOMPLE-
Z TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR ,
� IMPROVE FOR THE PURPOSE OF SALE).
❑I,AS OWNER OF THE PROPEHTV,AM EXCLUSIVELY CONTRACTING WITH LICENSED CANTRACTORS
� TO CANS7RUCT THE PROJECT(SEC.7oI4,BUSINESS AND PROFESSIONS CODE:7HE CON7RAC70RS LI- V21U2t1Of1 �� ADJ.AREA
W CENSE LAW DOES NOTAPPLV TO AN ONTJER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND
� WHOCONTRACTSFORSUCHPROJECTSWITHACONTRACTOR(S)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE
Y TORS LICENSE LAW.).
� �I AM EXEMPT UNDER SEC. B.6 P.C.FOR THIS REASON Q
� U
,� � Z �-
DATE OWNER �
Z w
� LICENSED CONTRACTORS DECLARATION W
� I HEREBY AFFIRM UNDER PENAL7Y OF PERIURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
d 9(COMMENCING WITH SECTION 7o00)OF DIVISION 30F THE BUSINE55 AND PROFESSIONS CODE,AND Z
`X MV IICENSE IS IN FULL FORCE AND EFFEC7. m � ,
� LICENSE CLASS LIC.NO.
� J
V DATE CONTRACTOR a
W
� WORKERS'COMPENSATION DECLARATION Q
� I HEREBV AFFIRM UNDER PENALTV OF PERJURV ONE OF THE FOLLOWING DECLARATIONS: Z
Z _IHAVEANDWILLMAINTAINACERTIFICATEOGCONSEN7705ELF-INSUREFORWORKERS' _ ,�,
CAMPENSATION,ASPROVIDEDBYSECTION37000FTHELABORCODE,FORTHEPERFORMANCE U
a -OF TH WORK FOF WHICH THIS PERMIT IS ISSUED. W
� �
w HAVEAND WILL MAINTAIN WORKERS'COMPENSA710N INSURANCE,AS REDUIRED BV SEC710N {'� l
Q 37000F THE LABOR CODE,FORTHE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS I I 1
ISSUED.M ORKERS'COMPENSATgLI py`y SURANCE CARFIER AND POLICV NUMBER ARE: CONSTRUCTION V
� CARRIER��`Tv �V(V�/� PLAN REVIEW O
0 POLICY NUMBER `\� �n I �Yl ELECTRIC � �
Z �"�.•—�
Q
Q (fHISSECTIONNEmNOTBE0.MPLEfEDOFTHEPEW-MISFORONEHUI�DREDDOLLARu(5100)ORLESS). PLUMBING
W
Z I CEHTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
(} SHAIL NOT EMPLOY ANY PERSON IN ANV MANNER SO AS TO BECOME SUBJECT TO THE
�/j WORKEfiS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF 1 SHOULD BECAME INSPECTION FEE
SUBJECTTOTHEWORKERS'COMPENSATIONPROV151 NSOFS CTION37000FTHE BOR (1 �
� D I SHALL FORTHWITH COMPLY WIT HOSE PR I510 . ISSUANCE � �+J`
p DATE`� APPLICANT: SMIP 'V�
J WARNING:FAI URE TO SECURE WOFKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SH L BE ENERGY P/C
� SU&IECTANEMPIOYERTOCFIMINALPENALTIESANDCIVILFINE5UP700NEHUNDREDTHOU ND ENERGYPERMIT
DOLLARS(S1oo,o00),IN ADDITION TO THE COS7 OF COMPENSATION,DAMAGES AS PROVIDED F R IN
J SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEV'S FEES. RETENTION FEE: �'�
Q
d CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
O
� I HEREBV AFFIRM UNDER PENALTV OF PERJURV THATTHERE IS ACONSTRUCTION LEN�ING AGENCV
FORTHE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3a97,CIV.C.). .
Z
W
� LENDER'S NAME
� LENDER'SADDRESS
� ICERTIFYTNATIHAVEREADTHISAPPLICATIONANDSTATETFIATTHEABOVEINFOFMATIONISCORRECT. TOTAL FEES / � 7 . �
w I AGREE TO COMPLY WITH ALL CITV AND COUNTV OFDINANCES AND STATE LAWS REUTING TO BUILDING \ J
� CO STRUCTION,ANDHEREBVAUTHORREREPRESENTATNESOFTHISCOUNTYTOENTERUPONTHE 1
ZAB VE-MENTIONED PROPER Y FOR INSPEC710N PURPOSES. COMMENTS v
�
J
�
m P I E NAME RINT) '
Q l(
(/) �J
� I ATURE O MI D TE
_ � RECPT.NO. PAID BY VALIDATION
~ WHITE—D artment Copy,YELLOW—Finance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—Applicant's Copy
� . .c.: �'��;,.�..... .. ... .:H�vi• ry.•;.-+���r+�i(. . .-'�,.�.�. . •..•. . t��. :i.:�.'.0 i � ..� .
'b/� U LL �.J� ��//11YUY�Y VLL' �Irl�
I�'�������� ������ ,. ,
� ��� DG� 0�.�° . � OG�I° �G��1 DGQ4G OG�CC��
SET BACK , �� FLOOR JOIST � i
- ---- ----- ----- �----..---
FTGS/FORMS/STEEL FHA REC�MTS _
;
----. --- —�-----
ELECTRIC GROUND � UNDER FLOOR DUCT
— —.._.— __ ---- --- -�- --.....--
GROUNQ PLUMBING ____ _ I UNDER FLOOR COI�iDUIT i �
------�---------'- --.._..___-
SL.AB GRADE FIREPLACE FDUNDATION _ ' �— _
--- - - -. _ ..._�_._
TEMP POWER __ � _____ __�_ FIREPLACE,BdND BEA[vt �
- -- --___�._� __
WATER SERVICE _ ,_ �_ ' __ MID HT. BOND BEAM
. . � _ - - ,_._ ___-----i _
ROOF SHEATHING ,�n�j� �Z ' _ '
_. ------ — � _._ --- -____ ---- --..
FRAMING/VENTILIATION I��p UZ�� � FINAL E�OND BEAM �
� 8�T. BUND B�AM �
` _�_
___ ___�..�..________. _ - - - -_.
ROOF COVER � � ' PRE-GRADING ;
----�-- -- - ------ ----.._._..------ —_______.
ROUGH HEATING �- BENCHIIVG
ROUGH ELECTRIC _�_/.�!��G61/ __ ROUGH GRADING --._..._ ---
/ i FINISH GRADING
ROUGH PLUMBIfVG ;
-- - -._.._._- --------- ----..__...----
SHOWERrI'UB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL IIVSULATIOiV i POOL FINAL
CEILING IIV�ULATION OFF SITE IMPS.
pRYWALL NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG. ;
SEEP PIT/LL. i ON SITE IMPS. ( .
GAS AIR TEST � FINAL ZONING I
-----
— -�+--�— - --- ---- ------- i
FINAL CONST. (/� • �IRE DEPT. F1NA�
. _ _ ------- -
FINAL HEATING �v I � HEALTH C3EPT. FINAL
__— ______ -_ �--�------- ---_.. �
F1NAL ELECTRIC Z _ _ DEV, FEES PAID
/6�3 �.��- -�- - ---
FIfVAL PLUMBING ' � ENERGY ^ I
- ------ ----- ------ ' --_.
_.__._— __
� � _.
�G�OG� o co , �
CONifVi EfVl"S
_ --�--___— __----
SEPTIC TA�lK SIZE ,
SEEP PIT/U SIZE -----
�
�'/ � —
� _ _ —