HomeMy WebLinkAbout16762 (25) �� CITY OF DIAMOND BAR �XPIRED
DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
ai�o E.copiey�;�e s�c�i90 J U N 19 2002
(909)860-3195 Fax(909)861-3117 PRE$S
����9N'� BUILDING PERMTT APPLICATION FIRMLY
� JOBSITE /Jn/�/�M./A��'��[���P�tL��n �J� APPLICATjO PERMIT P/C
o ADDRES97N�f7/v/�'�'/5���r� .� y��� er� DATE D NUMBER ' #
c� ISSUE R �'} TYPE OCC
APN LOT TRACT DATE I l/' CONST. GROUP
� OWNER ��-
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ADD � ZONING SEfBACKS
Z CITY � � TEL. FRONT RW ❑
g APPLICANT T�!? 2 -� �j REAR ❑
� SIDE/SIDE STREET RW ❑
CONTRAC � SIDE ❑
Q ADDR SS
o �iT, d , PROPOSED USE
o ARCWENG/ �
� DESIGNER NO.DWEL. NO. NO.
a. ADDRESS UNITS STORIES BEDROOMS
� CITY ' ZIP TEL.
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDER DECLARATION SFR/ADD/REM
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0 1 HEREBY AFFIRM UHDEH PENALTY OF PERNRY THAT I MI EXEMPT FROM THE CONTRACTORS LI� � Garege/Carport
W CENSEIAWFORTHEFOLIOWINOREASON(SEC.7o31.58USINESSANDPROFESSIONSCODE:ANYCITYOR
U COUNTYNMIGIHEWIRESAPERMRTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC- W Patio/Deck
Z TURE,PRpR TO ITS ISSUANCE,KSO REDUIRES THE APPIICANT FOR SUCH PERMIT TO FILE A SIGNED
� STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTMCTORS LI� W
� CENSE UW(CHACTER Y(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PRO- � PooVSpa
FESSqN5000E)ORTHATHEORSHEISEXEMPT7HEREFROMANDTHEBASISFORhIEALLEGEDEXEMP- (�
TpN.ANVVIOI.ATI0NOF5ECTION7031.5BYANVAPPLICAMFORAPERMITSU&lECTSTHEAPPLICANTTO Z Re-Roof
� A CML VENALTV OF NC7 MORE 7HAN FIVE HUNDRED DOLURS(f5a0).):
� ❑I,ASOWNEROFTHEPROPERTV,ORAIVEMP�OVEESWIhIWAGESASTHEIRSOLECOMPENSATION, � COrt1rtIBfC181 �
YALL DO THE WORK,AND THE STRUCTURE IS NOT IN7ENDED OR OFFERED FOR SALE(SEC.701r,BUSI• J
NESS AND PROFESSIONS CODE:THE CONTRAC70RS LICENSE LAW DOES NOT A7PLY TO AN OWNER OF
� PROPEHf1'NhiO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF Oq HERSELF OR m
CC THROU(iH HIS OR HER OWN EMPLOYEES,7ROVIDED THAT SUGi IMPROVEMENTS ARE NOT INTENDED OR
QOFFEAEDPDRSALEIF,HOWEVER,MEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCOMPLE-
Z ��TqN,THE OWNER�UILDER WILL NAVE hiE BURDEN OF PROVIN�THAT HE OR SHE DID NO7 BUILD OR
� IMPROVE FOR THE PURPOSE OF SALE).
W ❑I,AS OMMER OFTNE PROPEHTV,AM EXCLUSIVELV CON7MCTINO WfTH LICENSED CONTRACTORS
� TO CONSTRUCT THE PRQIECT(SEC.7ou,BUSINESS AND PROFESSIONS CODE:THE CONTRACTOHS LI� V81U8110f1 ADJ.AREA
W CEHSEUWDOESNOTAPPIYTOANOWNEROFAPROPERTYNMOBU1LD50RIMPROVESTHEfiEON,AND
� WIqCONTiUCfSFORSUCHPRQ1EC75WITHACONiRACTOR(S)LICENSEDPURSUAN770THECONTMG QUANTITY DESCRIPTION FEE
� TORS LICEHSE LAW.).
� ❑I AM EJ(EMFT UNDER SEC. B.8 P.C.FOR THIS REASON �
� �
� DATE OMMER �
W
� LICENSED CONTRACTORS DECLARATION W
� I HEREBV AFFIfU/UNDER PENALTV OF PERIURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER
� Y(COMMENCINO N7TH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z 1
MY LICEHSE IS IN FULL FOfiCE AND EFFECT.
LLL � .� �7�..� / �
0 IICENS S LIC.NO. ' �
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V �DATE CONTRACTO a
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� WORKERS'COMPENSATION DECLARATION Q �
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� I HEREBV AFFIRM UNDER PENAL7Y OF PERIURV ONE OF 7HE FOLLOWING DECUMTqNS;
� _I HAVE ANO WILL MAMTAIN A CERTiFICATE OF CONSEN7 TO SELF-INSURE FOR WORKERS' _ ' I
OOMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE,FOR 7HE PERFORMANCE U
Q OF 7HE WORK FOR WHIG1 THIS PEfiM1T IS ISSUED. �
�
_I NAVE MID WILL MAIHTAIN WORKEPS'COIAPENSATION INSURANCE,AS REdUIRED BV SECTION
Q 37o00F THE LABOR CODE,FOR 7HE 7ERFORMANCE OF TNE WORK FOH WHICH THIS PERMIT IS
ISSUED.MV WORKERS'COMPENSATION INSURANCE CARRIER M1D POLICY NUMBER ARE: CONSTRUCTION
j �pq�Ep PLAN REVIEW
Z PaICVNUMBER ELECTRIC
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0 (fF16SEC110NNE�N0TBE00APLEfIDOF7YfPERANTIS M��oaEo o�ora�Ess� PLUMBING
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Z ICERTIFYTHATINTHEPERFORMANCEOFTHEWO FOR HICHTH H SISSUED,I MECHANICAL
(,�J SHALL NOT EMPLOV ANY VERSON IN ANV MANNE O A O BECO CT TO THE
� WORKERS'COMPENSATIONUWSOFCALIFOR ,AN GREET SMOULDBECOME INSPECTIONFEE
SU0.IECT T0 T E WORKERS'COMPENSATION IONS O i N 3700 0F THE LABOR
O /BqDF/1'SH �pRT ITHCOMPIYWITH PROVISI S. ISSUANCE � __ _—
1�,� �,
p DATE. �l/ �� APPLICANP. SMIP
� ENERGY P/C i
J WARNINO:FAiI E TO SECURE WORKERS'CO PENSATION COVERAGE IS UN F ,AN SHALL BE
� SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP 700N UND D THOUSAND ENERGY PERMIT -
DOLURS(i100,000).IN ADDITION TO7HE COST OF COMPENSA710N,DAMAG S AS PR VIDED FOR IN
� SECTION J7oe OF h1E LABOR CODE,INTEREST,AND ATTORNEV'S FEES. RETENTION FEE: �• � �
d CONSTRUCTION LENDING AGENC PRE-ALT FEE: �� � � t
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� I HEFEBV AFFIRM UNDER PENALTV OF PERJURV THAT THERE IS A CONSTRUCTION LENDING AGENCV
d FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PEHMIT IS ISSUED(SEC.7087,CIV.C.). ��
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� LENDER'S NMIE )
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!= LENDER'SADDRE55
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� I CERTIFV THAT I HAVE REAO THIS APPLICATION AND STATE THAT hIE ABOVE MFORMATION IS CORRECT. TOTAL FE ES . 1 7/�� �"U
� 1 AGREE TO COMPLV N7TH ALL CITV AND COUNTY ORDINANCES AND STATE UWS RELATING TO BUILDING V� (A
� CONSTRUCiION,AND HEREBY AUTMORIZE 9EpRESENTATIVES OF THIS COUNN TO EMEH UPON THE
z ABOVE• TIONED PROVERN FOR INSPEEiwN vuarosEs. COMMENTS �
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� m PERMITTEE NAME(PRIHn ^
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� SIGNA7URE OF PERMI TE
= AECPT.NO. PAID BY VALIDATION
~ WHITE Depe ment Copy,YELLOW�inance Copy,PINK—Assessor Copy,GOLDENROD—File Copy,GREEN—Applicant's Copy
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SET BACK � .. ( FLOOR JOIST ; � �
FTGS/FORMS/STEEL � FHA R�E�MTS
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GROUND PLUMBING �__ UNDER FLOOR CU:"�i�=?UIT �
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SLAB GRADE � � _FIREPLAGE FOi1�iC�ATION �
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TEMP POWER � I FIREPLACE BOND BEAM
W,4TER SERVICE MID HT. BOND BEAA4 �
ROOF SNEATHING I 8 FT, BOND BEAM
FRAMIPvGNENTILIATION i rINAL BOND BEAM
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RUUF COVFR _ +� Pr�E-GRADING j ____
ROUCaH HFATING� � ' BENCHING
ROUaFi ��ECTRIC ROUGH GRADING
ROUt�F-i PWfv1BING � FINISH GRADING
SHO'vJER�UB TEST i'OOL ELECTRlC
r=XT. L:ATHiS1DING � ; POOL FENCING _ _
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��'JA1�L IN�UiATION � POOL FINAL i _
� C�ILI�VG IN�ULATION ; OFF SITE IMPS. ' _
DRYt��iLL NAILING DEDICATIONS
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a SEV��ER FINAL ENG.
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� ?'�����` ._:�iEATiNG HEALTH DEPT. FINAL
� � _C�ECTRIC DEV. FEES PAID
. ''.. PLUMBINU �� ENERGY — --
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