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HomeMy WebLinkAbout18697 (19) CITY OF DIAMOND BAR ----�'� ----� DEPARTMENT OF CONIIvfUNTfY&�DEVELOPIviENT SERVICES I 21825 E.Copley Drive '�" (909)860-3195 Fax(909)861-3117 E$$ -��"-»�� BUILDING PERMIT APPLICATION FI Y o� JOBSITE �/�� �/��i/��Q J'rJ���/,GS APPLICATION q � �LPERMIT P/C ADDRESS �d N �� �� 7 DATE � NUMBER # o ISSUE I ,�-� TYPE OCC °r APN LOT TRACT � DATE I �L-. CONST. GROUP p OWNER _ �Y7'I?"�1 T f'!? -�P 7/IQ' � o ADDRESS ZONING SETBACKS � Z CITY ZIP TEL. FRONT RW ❑ � APPLICANT TEL. AEAR ❑ � SIDE/SIDE STREET RW ❑ z Q CONTRACTOR �-O //S ��� SIDE ❑ � ADDRES %L rG�'L �GiG• /� /� �� � CITY %Nd ZIP �TEL. Q � �POSED USE /Z� /LU�`/�� w ARCH/ENG/ • iz DESIGNER NO.DWEL. � NO. NO. a ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � v� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION p� OWNER-BUILDER DECLARATION p � i��� �O�. FJ O I HEREBV AFFIfiM UNDER PENALTV OF PERIURV THAT 1 AM E%EMPT FROM THE CONTRACTORS LI- G8f8(JQ/C3fpOR W CENSEUWFORTHEFOLLOWINGREASON(SEC.7o77.58USINESSANDPROFESSIONSrODE:ANVCITYOR (n U COUNTVNMICHREOUIRESAPERMITTOCONS7RUCT,ALTER,IM?ROVE,DEMOLISH,ORREPAIRANVSTRUC- w TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED w Patio/Deck STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LI- . � CENSE LAW(CHAPTER 9(COMMENCING WI7M SEC710N 7000)OF DIVISION 7 OF THE BUSINESS AND PRO- � PooUSpa FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED E%EMP- (!5 � TION.ANVVIOLATIONOFSECTION7031.5BYANYAPPLICANiFORAPERMRSUBJEC�S'fHEAPPLICANTTO Z �Re-Roof ��`SC � � � A CIVIL PENALTV OF NOT MORE THAN FIVE HUNDRED DOLIARS�f500).): � ❑I,AS OWNER OF THE PROPERTY,OR MV EMPLOV EES WITH WAGES AS 7 HEIR SOLE COMPENSA7iON, Z 0 Commercial WILL DO 7HE WORN,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70��,BU51� J � NESS M1D PROFESSIONS CODE:THE CANTRACTORS LICENSE lAW DOES NO'APPLY TO AN OWNER OF � I PROPER7Y NM110 BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR � Q THROUGHHISORHEROWNEMPLOYEES,PROVIDEDTHATSUCHIMPROVEMENTSARENOTINTENDEDOR m w OFFEREDFORSALE.IF,HOWEVER7HEBUILDINGORIMPROVEMENTISSOLDWITHINONEYEAROFCOM7LE� � ' 0 TqN,THE OWNER�BUILDER WILL MAVE THE BURDEN OF PROVING'HAT HE OR SHE DID NOT BUILD OR � IMPROVE FOR THE PURPOSE OF SALE). li w ❑I,ASOWNEROFTHEPROPERTY,AME%CLUSIVELYCONTRACTINGWITHUCENSEDCONTRACTORS , � TO CANSTRUCT THE PRQIECT(SEC.70�/,BUSINESS AND PROFESSIUNS CODE:THF.CONTRAC70R5 LI- ValUetlOfl � ADJ.AREA � W CENSEUWDOESNOTAPPLVTOANOWNEROFAPROPERTVWF/OdUII.D50RIMPROVESTHEREON,AND � WHOCANTRACTSFORSUCHPR0.IECTSWITHACONTRACTOR(S)I.ICENSEDPURSU�NTTOTHECONTRAC- QUANTITY DESCRIPTION FEE � Y TORS LICENSE LAW.). � ❑I AM EXEMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q � U � — OC � DATE OWNER _ U � Z w � LICENSED CONTRACTORS DECLARATION W � I HEREBY AFFIFM UNDEq PENALTV OF PERJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � d D(COMMENCING WITH SECTION 7oW)OF DIVISION 30F THE BUSINESSAND FP.OFESSiONS CODE.AND Z �X MV UCENSE IS IN FULL FORCE AND EFFECT. � m ' � LICENSECLASS �/�'17 � LIC.NO. Y �` � j U OATE �'�17 ^ d Z� CONTRACTOR ��Nf�OF� d W ' � WORKERS'COMPENSATION DECLARATION Q NI HEREBV AFFIRM UNOER PENALTV OF PERIURY ONE OF THE FOLLOWING DECIAFAT10N5: Z Z ,�I HAVE AND WILL MAINTAIN A CER7IFICA7E OF CONSENT TO SELF�INSURE FOR WORKERS' _ . a COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE,FOFl THE PERFORMANCE W OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. � � w _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION �ryy ///��� 777��� Q 370o OF 7HE LABOR CODE,FOR THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ��/ ,� ISSUED.MV WORKERS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION O J � CARRIER PLAN REVIEW � � POIICV NUMBER Z ELECTRIC ¢ � (iHI55EGTpNNE�NOTBE00MPLEfEDOF71iEPERMRISFORONEMIPDREDDOLLMS�St00�ORLESS). PLUMBING W Z �CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOH WHICH iHIS PERIIIT,IS ISSUED,I MECHANICAL (,�} SMAIL NOT EMPLOY ANV PERSON IN ANV MANNER SO AS TO BECAME SUBJECT TO THE � WORKERS'COMPENSATIONLAWSOFCALIFORNIA,ANDAGREETHATIFISHOULDBECOME INS?ECTIONFEE = SUBJECT TO THE WORKERS'CAMGENSATION PROVISIONS OF SECTION 3700OF THE UBOR _ CODE,I SHALL FORTHWITH COMPIY WITH THOSE PROVISIONS. ISSUANCE � SMIP p DATE: APPLICANT: � J WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHAIL 9E ENEFGY P/C � SU&IECT AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE HUNDRED THOUSAND ENERGY PERMIT DOLURS(f700,000).IN ADDITION TO THE COST OF COMPENSATION,OAMAGES AS PROVIDED FOR IN J SECTION37080FTHELABORCODE,INTEREST,ANDATTORNEV'SFEES. RETENTIONFEE: � •� � - � ' CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � O � I HEFEBV AFFIRM UNDER PENALTV OF PERJURV THATTHERE IS ACONSTRUCTION LENDING AGENCV � FOR THE FERFORMANCE OFTHE WORK FOR WHICH 7HI5 PERMIT IS ISSUED(SEC.3oB7,CIV.C.). Z W � LENDER'S NAME � LENDER'S ADDHE55 � � � I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT TME ABOVE W FORMATION IS CAFRECT. TOTAL FE ES � � �� w I AGREE 10 CAMPLY WITH ALL pTY AND COUNTV ORDINANCES AND STATE LAWS REUTING TO BUILDING � CONSTRUCTION,AND HEi7EBV AUTHORIZE HEPRESENTATNES OF THIS COUNTV TO ENTER UPON THE ZABOVE�MENTIONED PROPERTV FOR INSPECTION PURPOSES. . COMMENTS � �.G�/w- `l„F-c � QP M NAME(VHINT) � �v. .� -oZ SIG UREOFPERMITTEE DATE � RECPT.N PAID BY VALIDATION ~ WHITE—DepaAment Copy,YEL!_OW—Finance Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—ApplicanYs Copy a 6T�' C?� ��t�,��+��� �3�rt�'-i s�9����°�p��9 ���0�� � .. _ � _ . [��' o�~ - � ' ' _ ° � ��,# ' � �� ��: > . . p w � �, �, . � 0 `� D 0 ,� ' ; , �. _ ;� , v . �. � _ � � y D � O .r� � , ..y., , , . ,,.. . . i ..,. �-� .z,. , e. , _,. . ,. , .. . �. .. . u.�� �._ . SET BACK � .__. i__ � j FLG(�F�JOIS� I --- ----- _.__. -- --- — —------ -- FTGS/F�RMS/STEE� ' . � FHA REQt��iTS ! __-------- _ .. .__.�._—_.. :_— __. _.__ .�___ .._--------- � ____ ._.�_. ELECTRIC GROUND � ', UNDER FL�OR DUCT j i - �------ ..__..— - --- -- -- ---- , -__.._ GRUUNQ PLUMBING i � UNDj R FLOOR CO��QUIT _i ' _..__�_—__._..�_---- - _ __._ ' ------ ,... __ ____—__._ SLAB GRADE � _ _ _ _ � � .FIRFPLACE FC�UNDATION_ _ _____ I TEMP POWER - --._ i, ____ ' I �'IFIEPLACE BONQ BEAM_ i____.. _..._. -- --- WATER SERVICE _� _ __ � MID hiT. F3t�rJt� E3EAM ! -- -- -- ---- --__._.--- --- — -- ROOF SHEATHING jG '�j� (%Z ___._._..—� __ ; , 8�� B�N� BEAM i - ----- --- _ _ _ __ —�_ _._._. FRAMINGNENTIUATION I — :--- _.._ ' . � FI(�A' �OPd� �EANi _ _, - ---_.---� _._ --.. ROOF COVER � �� �/ � PRE-GRAL�ING _ __ . { _ _ — ---- --.. _ -•----- ROUGH NEATWG ; BENCHING I - --_----��-.............- __....---- � __---- RUUGH ELECTRIC _ ; .,.... .. .� RnUGH GRADING _ - ---- -- -—1�. . � -- --- -- R(aUGH PLUMBING i ; � FI' NlSH ��RA�ING — --!—._ ..__._� . ....._�----___._._.�- -----_ -----_ ____. ......_. SHOWER/TUBTEST � � POOLELECrRIC --- �------ ------ ---- EXT. LATH/SIDING � ' POQL FENCING I -- -- —`__ __.._______;_ ____ _ _.__ ,__.-- --------_ ....-- WALL INSULATION �- _ POOL FINAL __ i _ CEILING IN�UI.ATION � 0��SITE (MPS. � -- __.____ r__. _. �__.—_ �__.._—._ __ _.._._ --- ---�__� _�_. DRYWALL NAlLING j � � CIEDIC7�TIQNS --- ---_.__ , ---. — _ SEWER ' FINAL ENG. � — --- ------ -.. .. .. 1-------.....-- ,_. ..._.-----, ---+-------_....---- ----- --- � SEP�tIC TANK � LAfvDSCAf��IIRRIC. _ � __ ' ------ -- �--�------- PS. I UN 51TE IM SEEP PIT/L.l. __....__._.____ I --- �� -- ------------..� ._._...___ -- ---- GAS AIR TEST � ; �=11VAt_ZONING FINAL CONST. -i -- � ---- _� ;� F�RE DEPT. FINAL _..--__� ' —^`----- ___ �------- -• t_ ._....__ - ------ FINAI.HEATING , 1 HEALTH DEi'f FlN.AL ------ --�-------____ —_ :----- ----------- FiNAL ELECTRIC I : i DEV. FEES PAID - ' ---- --+-;----- --------- ---- FI�NAL PLUMBINCa I � � ' � i ENEt-�GY i --- � � p �,:.: ��7::��� i ' -- --..._ .._......_-------__—_—'_ --------�._ .__..--------___ CUM M E NTS ___�__._____..___..________._�_.__--- —_- SEPTiC TANK SIZE SEEP PIT/U SIZE ----- —.._—_ _._--_.._. ___-- ---- � --- --- -- .r � � -- ----- o — -- ------— . eo . `� � � �� .� —-----_ ----- ------- . x. �,. �, � ��� �'���� ;°��� . � � --- —