HomeMy WebLinkAbout10-1192 _��� CITY OF DIAMOND BAR � ,
DEPARTMENT OF COMMUNTTY 8c DEVELOPMENT SERVICES
w 21660 E.Copley Drive Suite 190 �
(909)860-3195 Fau(909)861-3117 PRES$
������r BUII.DING PERMIT APPLICATION ' .FIRMLY
¢ DDRESS �/�� ��' � APPLICATION PERMIT � P/C
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ISSUE TMPE .I�fGROUP
� APN 40T��TRACT DATE ��"�I� `� CONST.
� OWNER ^I�.-�,i,`�T`F�i-t1.MY"IGc�
ADDRESS ZONING SETBACKS
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APPLICANT TEL. SIDE/SIDE STREET RW ❑
CONTRACTOR SIDE ❑
� CDDRESS TE� PROPOSED US � Y�
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� DESIGNER NO.DWEL. NO. NO.
ADDRESS UNITS � STORIES �_ BEDROOMS
� CITY ZIP TEL.
u� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDER DECLARATION
� SFR/ADD/REM
p I HEREBV AFFIRM UNDER PENALTV OF PEH.IURV TMAT I AM EXEMPT FROM THE CONTRACTOHS l4 Garege/Carport
{�,) CENSEUWfORTHEFOLLOW9dOREA90N(SEC.70.71.68USWESSMIDPROFESSIONSCODE:ANVCITYOR (n
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�Z TURE,PRIOR TO R9 I,RSUANCE,/�LSO REIXl1fiES THE MPLICANT FOR SUCH PERMIT TO FlLE A SIONED w Patio/Deck
STATEAIEHT 7HAT HE OR SME IS LICENSED PURSUANT 70 THE PROVISIONS OF THE CONTRACTORS LI•
� CENSE LAW(CHAPiER Y(COMMENCWO WITH SECTION 7000)OF DIVISqN 3 OF THE WSINESS AND PRO- � PooVSpa �
FESSqNSCOD�ORT/ATMEORSHEI3IXEMPTTHEREFROMANDTHEBA5ISFOR7HEALLEOEDE%EMP- (�
TION.ANY VIOIATION OF SECTION 7031.6 BY ANV APPLICANT FOR A PERMIT 5U&IECTS THE APPUCANT TO Z Re-Rooi
F, ACNIL PENALTY OF NOT MORE THIW FIVE HUNDRED DOlLAHS(f5oo).�:
� ❑4�.70MMEROFTHEPROPERTY,ORMYEMPI.OVEESWITHWAOESASTHEIRSOLECOMPENSATION, CpmmBfCI81 . � �
MALL DO THE WOPo(AND hiE STRUCTURE IS NOT INTEN�m OR OFFERED FOR S/�LE(SEC.70u,BUSI- �
y NE3S AND PiqFESS10N3 COOE:THE CONTRACTORS LICENSE UW OOES NOT MPLY TO AN OWNER OF j
VROPFHfY Nh10 BU0.D5 OP PIPROVES THEREON,AND MRiO DOES SUqi WORN HIMSELF OR HERSELF OR
Q THq0U0H HI$OR HER ONM EMPLOVEES.FHONDED 7HAT SUp1 WPROVEMENTS ME NOT PITENDED OR m
� OFFEFiEDFORSALEIF.HDYIEVER�O��DWOORIMVROVEMINT13SOlDWITHINONEVEAfiOFCOAIPLE. .
� �'TION,THE ONMER-0UILDER WILL HAVE THE BURDEN OF PROVIN�THAT HE OR SHE DID NOT BUILD Oq
IMPROVE FOR THE PURPOSE OF 311LE).
� ❑I,AS OWNER OF 7HE PROPERfY,AM IXCLUSNELY COHTMCTINO WfTH LICENSED CONiRACTORS �
TO CONSTRUCT THE PRO.IECT(9EC.7041,BUSINE55 AND PROFESSIONS CODE:THE ODNTRACTORS LI- V9IU8fIOf1 ADJ.AREA
CEN3E LAW DOES NOTMPLv TO AN OV/NER OFA PROPER7V WFp BUHDS OR IMPROVES THEREON,AND
� WFqCONTMCTSFORSUqiPRQIECf9WItHACONTMCTOR(S)LICENSEDPURSUMITTOTHECONTMG pUANTITY DESCRIPTION F�E .
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❑I AM EXEMPT UHDER SEC. B.i P.C,FOR THIS RFJ�SON �
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DATE OWNER F-
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� LICENSED CONTRACTORS DECLARATION W
� 1 HEREBYAFFIRM UNDER PEIULTY OF PERHIRV 7HAT I AM UCENSED UNDEH PROVI510NS OF CHAP7ER �
� Y(COMMENCR/O WITH SECTION 7000)OF DMSION 7 OF THE BUSINES9 MID PROFESSIONS CODE,AND Z �
� LICENSE EC�SFULL FQRCEAND E�CT. L1C.NO. /� ��f/ . • ✓ - �
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r� WORKERS'COMPENSATION DECLARATION � �
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N1 HEREBV AFFIRAI UNDEH PENKT/OF FERIURY ONE OF THE FOILOWINO DECURATIONS: Z �
� _IHAVEANDWILLMNNTAINACEFiTIFlCATEOFCONSENTTOSELF-INSUREFOqWORKERS' gl
COMPQ1SATpN.AS PROVIDED BV SECTION 3700 OF THE LABOR COOE,FOR 7HE PERFORMMICE (J
OF THE WORK FOH WHICH THIS PERMI7 1S ISSUED. W
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I HAVE AHO WILL MA1NiAIN WORKERS'CAMPENSATION INSURANCE,AS REW IRED BV SECTION
4Q 370o OF hIE UBOR CODE.FOR THE VERFORMANCE OF 7HE WOPo(f-0R WHICH 7HI5 PERMIT IS �/S ��
fSSUED.MY WORKERS'COMPEN 710N IN�CE CARRIER AND POLICV NUMBER AAE: TAUCTION� �
� GRPoER �����
� POLICY NUMBER ��p 11 R�= .�� ELLECTRIC�
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Z I CERTIFV THA7 W THE PERf-0RMANCE OF THE WORK FOR WHlpi THIS PERMIT IS ISSUED.I MECHANICAL
SYIALL NOT EMPLOV ANY PERSON PI ANY AIANNER SOAS TO BECOA/E SU&IECT TO iHE
(/� WORKER5COMPENSATqNLAW50FCALIFORNIA,MIDAOREETHATIFISHOULOBECOME INSPECTIONFEE
SUBJECT TO THE VIORKERS'COMPENSATION P bNSp�,SECTpN �O�OOF THE LABOR .-7
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� DATE: � APPLICANT: __ � L�i, iP . �'C) �
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� WARNINO:FALLURE TO SECURE VIORKERS'COMPENSATION COVERAOE IS UNUWFUL,AND SHALL BE ENERGY P/C
� SUBJECTANEMPLOVERTOCRIMINALPENALTIESANDGVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
DOLURS(itao.000),IN ADDITION TO hiE COST OF COMPENSATION,DAAIAOES AS PROVIDED FOR IN
¢ SECTIDN 37oe OF 7HE LABOH CODE.INTEREST.AND ATfOiWEY'9 FEES. � ENTION E:
OCONSTRUCTION LENDING AGENCY PRE-A EE: '
� I HEREBY AFFIRM UNDER PENAL7V OF PERIURY THAT THERE IS A CANSTqUCTION LENDINO AOENCV �%
Z FOR THE PERFORMANCE OF 7HE WORK FOR WHIp1 THIS PERMIT IS ISSUED(SEC.30�,CIV.C.). ,
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� LENDERS NMIE . , �
� LENDERSADDRESS
� TOTAL FEES �(J, 'J�
� I CEHTIFV THAT I MAVE READ 7HIS APPLICATION AND STATE THAT THE ABOVE INf-0RMATpN IS CORRECT.
w I AaREE TO COMPLY YATH ALL CITV AND COUNTV ORDWMICES AND STATE UWS REl.AT1NO TO BUILDINO
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� CONSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATIVES OF 7H15 COUNTV TO ENTER UPON THE ' . , ' . _
Z ABOVE�AIEMqNED P ERT'FOR INSPECTqN PURPOSES.
� COMMENTS
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� SIO RE PERMITTEE DATE � `
� RECPT.NO. � PAID B � VAUDATION
WHITE—Departmant Copy.YELLOW�'mence Copy,PINK—Assesaor Copy,GOLDENR D--File Copy,GREEN— �
APWk;ant's CoPY
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SET BACK FLOOR JOIST ' �
FTGSIFORMS/S7EEL- � FHA REC�MTS ' '
ELECTRIC GROUND • UNDER FLOOR DUCT
GROUND PLUMBING UNDER FLOOR CUMDUIT
SLAB GRADE FIREPLACE FOUNDATION
TEMP POWER FIREPLACE BOND BEAM
WATER SERVICE MID HT. BOND B�AM •
R�OF SHEATHfNG ,Z 8 Fi: BOND BEAM '� � � • '- ' . �
FRAMtNGNENTILIATtON . � FINAL BOND BERM • '
ROOF COVFR , ' � PRE-GRADING
ROUGH HEATING BENCHlNG
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUN161NG � FINISH GRADING
SHOWER�T'UB TEST POOL ELECTRIC
EXT. �ATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
DRYWALL NAILING DEDICATtONS
SEWER FINAL ENG.
SEPTIC TANK LANDSCAPE/IRRIG.
-SEEP PIT/L.L. ON SITE IMPS.
GAS AlR TEST FINAL ZONING
FlNAI C�NST. FIRE DEPT. FINAL
FINAL HEATING HEALTH DEPT. FINAL �
FiNpL ELECTRiC DEV. FEES PAID
FItJA�PLUMBING ENERGY
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SEPTIC TANK SIZE
SEEP PIT/U SIZE
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