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HomeMy WebLinkAbout17700 (51) � _._'___—___."._._. . , .. . �` CITY OF DIAMOND BAR � DEPARTMENT OF COIvIIvfUMTY&DEVELOPMENT SERVICES 2I825 E.Coptey Drive (909)860-3195 Fax(909)861-3117 PRESS `%.:�� BUILDINGPERMITAPPLICATION FIRMLY � JOBSITE � APPLICATION PERMIT Qv P/C o ADDRESS � DATE G O:— NUMBER�� M $ ISSUE TYPE OCC APN LOT TRAC DATE CONST. GROUP °C OWNER 0 o ADDRE ZONING SEfBACKS gCIT`��.��_ ZI TEL. � FRONT RW ❑ APPLICANT TEL. REAR ❑ � SIDE/SIDE STREET RW O CONTRACT � SIDE � QADDRESS o CITY � ZIP TEL P OP SE USOE o ARCH/ENG/ � T DESIGNER NO.DWE NO. n�, ADDRESS UNITS STORIES BE�ROOMS � CITY ZIP TEL. � DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION � � OWNER-BUILDER DECLARATION SFR/ADD/REM O p 1 HEREBY AFFlRM UNDER PENAITY OF PEiLM1lRV THA71 AA1 EZEMPT fROM THE CONTMCTORS LI• GAreg91C01poR W CENSEUWFORTHEFOLLOWIN(1REASONISEC.70.71.68USWESSANOPROFESSIONSCOOE:N:YCITYOR (n ZCOUNTYYmICHRE�UIRESAPERMITTOCONSTRUCT.ALTER�PROVEDEMOLISH,ORNEPIURANVSTRUC• W P01i0/DeCk W 7URE.PRqR TO ITS 65UANCE,AL50 REOUtRES THE APvl1CANT FOR SUCH FERMIT TO iILE A SIGNED W � STATEAIENT THAT HE OR SHE IS LICENSED PUHSUNJT TCl TNE VRONSIONS OF TNE CdJTRACTORS lb � GENSELAW�dUOTER��C0IAMENCW�YATM5ECT10N70o0)OFDIVISqN70FTNEBU5INE55�NDPRO• LL PooUSpa FESSIONS CODE)OR 7T1AT HE OR SHE IS EXEMPT iHEREFROM AND T11E BASiS FOR TME ALLEQED E%E1AP- TION.M7YVIOL�TIONOFSEGTION70�1.68VANYAPPLICANTfOR�PERMITSU&1[CiSTHEAPPL1CANiTO Z qaRoof � ACMLPENALTYOFNOTMO(iE7WNFNEMUNDREDOOtURS(SSao).): p OI��EROFTHEPROPEHiY.ORMYEMPLOYEE5WI7HWAGESASTNEIR50LECOMPENSA7qN, 0 Commercial Z WILL 00 THE WORK AND THE STRUCNRE IS NOT INTENDED OF OFFERED FOR SnIE(SEC.7ou,BU51• J NESS AND VROFESSIONS CODE:THE CONTMCtORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF � VROPERTYN7fOBULLD40RMPROVESTMEREON.ANDWNODOES5UL11WORKHIMSELFOHHERSELFOR � � iHROL�GHNI50RNENOWNEIIPIOVEES,FROV10E0THA75UCHIMPROVEMEMSARENOTINTENDE00R m w OfFEREDFORSALE1F,/10WEVERTMEBULDINdOR1A1PROVE6IEMIS50LDWRMNONEYEAROFCOMPLE• 0 TqN,TME OWNER-BUILOER NALL HAVE THE BURDEN OF FRONNO iHAT HE OR SNE DID NOT BUILD OR � W PROYE FOR THE PURPOSE OF SALk�. 01,AS OWNER OF TNE FPOPERTY,/JA EX0.USNELV CONTMCTINO N7T}I LICENSEO CONTMCTORS ¢ 70 CONSTRUCT TME GROJECT(SEC.7W�,BUS�NE55 AND PROFESSIONS CODE:THE WNTPACTORS U• V2IUaS10f1 ADJ.AREA W CENSEUWOOESNOTA7PLYTDANOWNEROFAPROVERTYVVHOBUILDSORIMPROVESMEREON,AND � K110CANTMCTSFORSUqIPROJECfSWITHACONTMCTOR(SIUCENSEOPURSUANTTOTMECONTMG QUAN�ITY DESCRIPTION FEE ' � TORSLICENSEUW.1. � O 1 AM E%EIAPT UNDER SEC. 6.1 i.C.FORTHIS REASON U �'S � u" DATE OWNER V . W F¢ LICENSED CONTRACTORS DECLARATION W K IHEREBVAFFIRMUNDERVENALT/OFPERJUHVTHATIAAILICENSEDUNDER7ROVI510NSOFCHAVTER Ur p„ o(COuuENCINONnTM5ECf10NT00010F01VISION30FiMEBUSINESSANOiROFES510N5CODE,AND Z MY LICENSE IS IN FULL FORCE ANO EFiECT. m / 1 � � UCENSE CUSS LIC.NO. �.5�/�'Y � J . V OATE��.=,� CONTRACTOR a - .. . W � WORKERS'COMPENSATION DECLARATION a � U N 1 HEREBY AFFIRM UNDER pENALTV OF GE0.1UR`/ONE O�TME FOLLOWwO OECIARATI0N5: Za � �IIIAVEAN�WILLM�INTNHACERTIFICATEOFCONSENTTOSELHNSUREFORWORKERS' S � COMPENSATION,ASVHOViDE�BY5EC710N77000F7NELABORCODE,FORTHEPERFOqMANCE W OF ri1E VlORK FOR NRi1CH THIS PEi1MlT IS ISSUED. � � �I H�YE ANO YnLL MIUNTAW WORKERS'COMPENSATION INSURANCE.AS RE W IRED BY SECTION O Q770oOFTHELA80RCO0E,FORiHEPERFORMANCEOFTHEWORKFORWNICHTH15PERMITIS ,a� � ISSUED.MYWOitKE 'CO�APENSATIONINSURANCECARRiERANOPOLICYNUMeERARE: CONSTRUCTION 7 CARRiER � �� _ PLAN REVIEN! � POLICYNUMBER � ELECTRIC � (I1a5sECroNMEmN0T8EOD1.FtEfEDOF7/EPERMT6WNONEI�lD�DDOLLA�B��I�lE55} PLUMBING - Z ICERTIFVTHATNTHE7ERFORMANCEOFTMEWORKFORWM�CMTnISPERMiT15155UED,1 MECHANICAL I �"� ;/-\ ��-�'�'� (.�} SMALLNOTEMPLOYANYPERSONINANYMANNERSOASTOBECOMESUBJECTT07NE I � ��-^r� � WORKER5LOMPENSATIONLAWSOFCALIFORNIA,ANOAGREETHATIFISHOULDBEGOME INSPECTIONFEE SUBIECT TO TME WORKERS'C0IAPENSATION iROVISqNS OF SECTION 7700 OF TNE LABOR f . cooe.�sr�ui conT�nr ca.+v�v wm�r�wsE narnnsior�s. ISSUANCE p DATE: APPLICANT. SMIP I � •a w ENERGY PDC � r f � WARN�NQ F��WRE TO SEQIRE VIORNERS'COMPENS�TION COVERAGE IS UNUWFUI.AND SHALL BE 1 �y SUBJECTANfuPLOYERTOCRnAWALGENAL71ESM10CMLFPJESUVTOONEHUNDREDTFIOUSMI� ENERGYPERMIT ��-�'----- � DOLURS(f�OD.000).�NADDITIONTOTHECASTOFCOMPENSATION,DAMAGESASV0.0VIDEDFORIN .___ �v � SECTqN 77a!OFTHE LABOR CODE,INTERESi ANDATTORNEY'S iEES. RETENTION FEE: a CONSTRUCTION LENDING AGENCY PflE•ALT FEE: � IHEREBVAFFiRAlUNOERPENALTYOFGE0.ri1RY7NATTHEREISACONSTRUGTIONIENDINGAGENCY FOR THE OERFORAAANCE OF iHE WORK FOR WNICH iH15 PEFMIT IS ISSUED(SEC.9D97.CIV.G�. � � LENDER'S WUAE � LENDER'SADDPESS //J .� � ICEMIiViHATINAVEPEA0THI5MVLICATIONANDSTATETHATTHEABOVEMFOiUAAT10NISCARRECT. TOTAL FEES ��/� � w IAGREET000IAPLVWITH�ILCIiVANDCOUMYORDINANCESAN�57ATEUWSREUTIN6TO8ULL�IN4 � � CANSTRUCTION,ANDNEFEBVAUT110iUZEREPRESENT117NESOFTHISCWNTYIOENTERUPONTNE ZABOVE-MENTIONEOPROPEiiT'FORINSPECTqNVURPQSES. COMMENTS � �-�n'1 �/!t-� _ m VEflMITTEENAIAE PRI � �t, � L].-�-D'L y SIGNATUREO i E �' ATE � RECPT.�O. PAI�BY /I VALIDATION WHITE—Department Copy,YELLOW—Finance Copy.PINK—Assessor Copy,GOLDENRO�Fi�e Copy,GREEN—Appticant's Copy - � . - .. ... . . � ... . . „ � . , • �. ' .. . .. ,r .V'.....-Lr. .• � ,. '.F.. .. . ... �v . -. . _.• . . . . .. . .. , . - � . . . ��i�;� Q� ���:,�lrQ�� ��.� If�a�F=C�i 40f� c L"-�06�7 _ _ -_' _ �f`l �.,� Et ,R__.�._....._._._. I►�'i r .�..._ Y �..,f w.. �1►a�-��!�E;��i[�,�►"F . �;�.�,r..^ _.__',� �—;r� e� i 5 �a�c;'�C�ii�9 r)'��� li��-'!'1—����,m�:� -----._____�.__._.__ .__:..____-- . ___ . . _ ._.... — _ . _,_. . ---__.___�._.._�.,__�___. _.._ ________..________.____.___.__ 5ET BACK ' I I_FLOOR JO1ST, '. , (_ �� FTGS/FORMS/STEEL �_ �� FHA REQPnTS ELECTRIC GROUND--�- � ' ; UNDER FLf]OR DUCT ,� I GROUND PLU��1BING __�__ I UNDER FLOOR CU��DUIT SLAB GRADE � �_� FIREPL�`.CE FOUt�DATfON � � TEMP POWER ! FIREPLACE BOND 6EAPJ� i WATER SERVICE 1 MID HT. BOND 2EAP� . I ROOF SHEATHING 3/,/f7Z� ,����- 8 FT. &��JD 8EAh1 �' _ • FRAMI�dGNENTILIATION I ��� FIPJAL E30ND BE/IM ROOF COVER I. ._1�jd .��� I � PR�-GRADING ROUGH HEATiNG ( BENCHING ROUGH ELECTRIC , ROUGH GRADING RDUGH PLUMBING ; FINISH uRADING SHOWERlfU6 TEST PGOL ELECTRIC EXT. LATH/SIDING POOL FEPJCI�dG WALL INSULATION POOL FINAL � CEILING IN�ULATION OrF 517 E IMPS. � DRYVJALL NAILING DEDICATIONS SEWER FIfJAL ENG. SEPTIC TANK � LANDSCRPEIIRRIG. SEEP PIT/L.L. � � ON SITE I�APS. GAS AIR TEST FItJAL ZONING FINAL CONST. ! FIRE DEPT. FINA! FINAL HEATING � HEALTH DEPT. FINAL FINAL ELECTRIC � DEV. FEES PAID FINAL PLUMBING � ENERGY � • � �_ 1,�;��{,",C�I.? �'r(C�,�;P. _...__�....._.�.� _ � :�. CUP,�MENTS SEPTIC TANK SIZE SEEP PIT/U SIZE '►vw , I `��'� ��I 4 . \y �!