HomeMy WebLinkAbout16123 (20) • i ' \ -- — - — _ 1
i '
� _ ��_ CITY OF DIAMpND BAR
DEPARTMENT OF COMMUNITY 8�DEVELOPMEI�T SERVICES �XP I F�tD
21660 E.Copley Drive Suite 190
f � (909)860-3195 Fax(909)861-3117 J U N 17 ��U2 PRESS
��•��'� BUILDING PERMIT APPLICATION FIRMLY
� JOBSITE APPLICATION 1 PERMIT � P/C
o ADDRESS DATE �� I��1 NUMBER #
c� ISSUE TYPE OCC
.- APN LOT TRACT DATE CONST. GROUP
°C OWNER c a �A �
0
� ADDRESS I S 7 W ZONING SEBACKS
0
Z CITY "fJ i qm o� Q�i'ZIP�Z TEL. FRONT RW ❑
g APPLICANT TEL. REAR ❑
� SIDE/SIDE STREET RW ❑
� CONTRACTOR SIDE ❑
� ADDRESS _ -
� CITY P TEL. PROPOSED USE
w ARCH/ENG/ •
z DESIGNER w / � n NO.DWEL. NO. NO.
� ADDRESS —��
� CITY � , IP TEL. UNITS STORIES BEDROOMS
ti
cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
Q OWNER-BUILDER DECLARATION SFR/ADD/REM
O
1 HEREBY AFFIRM UNDER FENALTY OF 7ERIURV THAT I MI EXEMPT FROM THE CONTRACTORS LI- Geffl9B/CBfpOR
W CENSE UW FORTHE FOLLOWINd REASON(SEC.70.31.6 BUSINESSAND PROFESSIONS CODE:ANV CITY OR (n
U COUNTYWHIq1RE0UIRESAPERMRTOCONSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANYSTRUC- W Patio/Deck
W NRE,VRpR TO ITS ISSUANCE.�LSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SI�NED W
S7ATEMENT hIAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTMCTORS LI-
� CENSE UW(CHAPTER o(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � PooVSpa
FESSIONS CODE)ORTHAT HE OR SHE IS EXEMPT THEREFROM ANO hiE BASIS FOR THE ALLEGED EXEMP-
TION.ANVVqUTqNOFSECTION70.11.6BYANYAPPLICANTFORAPERMITSU&IECTSTHEAPPLICANTTO Z Re-Root ,JD
F ACIVIL PENAL7V OF NOT MOfiE hIAN FIVE HUNDRED OOLLARS(t5oo).):
� ❑I,ASONMEROFTHEPROPERTY,ORMYEMPLOVEESWITHWAGESASTHEIRSOLECOMPENSATION, 0 COlnrtlOfClfl1 � �
WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70/4,BU51- J
� NESS AND VROFESSIONS CODE:TME CONTRACTORS LICENSE UW OOES NOT APPLY TO AN OWNER OF � .
PROPERN WViO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
Q THiqUGH HIS OR HER ONM EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OH m
QOFFEREDPDRSALEIF,HOWEVERTMEBUILDINOORIM7ROVEMEMISSOLDWfTHINONEVEAROFCOMPLE-
Z �TION,THE OWNERAUIIDER WILL HAVE THE BURDEN OF VROVINO hIAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR THE PURPOSE OF SALE).
w ❑I,AS ONMEROFTHE PROPEHTV,AM EXCLUSNELV CONTMCTINC WfTH LICENSED CONTMCTORS
� TO CONSTRUCT THE PRQIECT(SEC.70H,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- V0I118IIOf1 ADJ.AREA
W CENSEUWDOESNO7APPLYTOANONRJEROFAPROPERTVH?109UIL�SORIMPROVES7HEREON,AND
� NM1IOCONTRAGTSFORSUCHPR0.1EC7SWI7HACONTMCTOR(S)LICENSEDPURSUAHTTOTHECONTMG DUANTITY DESCRIPTION FEE �
Y TORS LICENSE UWJ. I
� ❑I AA1 El(EMPT UNDER SEC. B.6 P.C.FOR THIS REASON Q �
3 �
� DATE OWNER ` � V
Z W
F LICENSED CONTRACTORS DECLARATION w
� I HEflEBY AFFIRM UNDER PENALTV OF PERJURV THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
� Y(COMMENCINO WI1H SECTION 7000)OF DIVISION 3 OF 7HE BUSINESS AND PROFESSIONS CODE,AND Z
MY LICENSE IS IN NLL FORCE AND EFFECT. m
L1J
0 LICEHSE CLASS LIC.NO. j '
� J
V DATE CONTRACTOR d
W
� WORKERS'COMPENSATION DECIAFiATION a
� I HEREBV AFFIRM UNDER PENALTV OF PERIURV ONE OF THE FOLIOWING DECURATIONS: �
4J a
� I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSEN7 TO SELF-INSURE FOR WORKERS' 2
� COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE,FOR THE 7ERFORMANCE �U
UF THE WORK fOR NM1iICH THIS PERMIT IS ISSUED. �
�
W _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURAIJCE,�AS REOUIRED BY SEC710N
Q 3700 OF 7HE LABOR COOE,FOfi THE PERFORMANCE OF 7HE WORK FOR WHICH THIS PERMIT IS IQ
ISSUEO.MY WORKEAS'COMPENSATION INSUMNCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION n �'1
jcnnaieR PLAN REVIEW Tfll� TT�T
� POLICV NUMBER
ELECTRIC ll�ll�
� (f1455ECilONNE�NOTBE00AflETmOFh�PERMfiS�ORONEV0.R�DFEDDOLLARS(f10D)OqL6S� PLUMBING
LLJ r'L :)
Z I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH hIIS PERMIT IS ISSUED.I MECHANICAL ��'�'� � .
� SHALL NOT EMPLOV ANY VERSON IN ANY MMINER SO AS TO BECOME SUBJECT TO THE �
� WORKERS'COMPENSATION UWS OF CPLIFORNIA,AND AGHEE THAT IP I SHOULD BECAME INSPECTION FEE _ .. -
SU&IECT TO THE WORNERS'COMPENSATION PHOVISIONS OF SECTION 37000F THE LABOR �+1 T t'dJ1NiV1V1 1!�D.`fx�
� COD[,1 SHALL FORTHWITH CAMPLV WI1H THOSE PROVISIONS. ISSUANCE - �� ��
� SMIP � ..�.1. 1 �f��ll �"L'1 ` �_��
p DATE: APPLICANT: .
� ENERGY P/C
J WARNINO:FAILURE TO SECURE WORKERS'CAMPENSATION CAVERAGE IS UNUWFUL,AND SHAIL BE
� SUaIECT AN EMPLOVER 70 CHIMINAL PENAL71E5 AND CIVIL FINES UP TOONE HUNDRED 7HOUSAN� ENERGY PERMIT
DOLURS(Stoo.000).IN ADDITION TO 7HE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
� SECTbN 370!OF hIE UBOR CODE,INTEREST,AND ATfORNEV'S FEES. RETENTION FEE:
OCQNSTRUCTION LENDING AGENCY PRE-ALT FEE:
� I HEREBV AFFIRM UNDER PENALN OF PERIURY THAT THERE IS A CONSTHUCTION IENDING AGENCY
FOR THE PERFORMANCE OF THE WORK FOR WHICH 7HI5 PENMIT IS ISSUED(SEC.3097,CIV.C.).
Z
W
� LENDER'S NAME
F- LENDER'SADDRE55 .
� TOTAL FEES I O I, l�
� I CER7IFY THAT I HAVE READ THIS APPLICATION AND S7ATE THAT THE ABOVE INFORMATION IS CORRECT.
w I AGREE TO CAMPLV WITH ALL CITY AND COUNTY ORDINANCES AND STATE L4W5 RELATING 70 BUIL�ING
� CONSTRUCTION,AND HEREBY AUTHORIZE REPiiESENTATIVES OF 7HIS COUNTV TO ENTER UPON THE
ZABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. COMMENTS
� �
J
�
m PERMI NAME(P T) �
� r , � �7 /3 al
� SIONA RE P RMITf E � �AT RECPT.NO. PAID BY �I Q VALIDATION
2
~ WHITE—Department Copy,YELLOW—Finance Copy,PINK—Assessor Capy,GOLDENROD—File Copy,GREEN—Applicant's Copy
.�.; . . •. .
CB�Y �� ����IC��� (�Aa�i
9�RS6����'8��91���C��� � �
.,y. • � nY���y� 4 B..` n�� .p .. .Q f MSFib �, D.. �,,0:. D 1 Mn��-D ) O O . �.
R �.' �L:1 '�.��; 4� � .��: �Lu�M1 L�./�UU
'SET BACK � • FLOOR JOIST
' ----- ------- -
FTGS/FORMS/�TEEL ! � i FHA REDMTS
- -- - - - -- -- ------- --___.
ELECTRIC GROUND _ LUNDER FLOOR DUCT
-- -- ___._.__....__...._
GROUND PLUMBING UNDER F�OOR CUMDUIT
SLAB GRA�E I FIREPLACE F�UNDATION ____
TEMP POWER � FIREPLACE BOND BEAM
WATER SERVICE ' MID HT. BOND BEAM
ROOF SHEATHING 8.F7. BOND BEAM
FRAMING.NENTILIATlON � • FINAL BOND BEAM
ROOF COVF_R PRE-GRADING
ROUGH HEATING BENCHING
ROUGH E�ECTRIC ROUGH GRADING
ROUGN PLUMBING ! FINISH GRADING
SHOWER/TUB TEST POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
VVALL;NSULATION POOL FINAL
CEILING INSULATION OFF SITE IMPS.
�RYWAL�NAILING DEDICATIONS
SEWER FINAL ENG.
SEPTiC TAiVK LANDSCAPE/IRRIG.
SEEP P!TlL.L. • ON SITE IMPS.
GAS AiR TEST FINAL Z�NItVG
FI(LRL CONST. FIRE DE�T. FINAL
FlNAL HER?ING HEALTi� E.P,T.FINAL � '' � ,
,
�1t�f.L�LECTRIC DEV. FEE PAID _
� i=,:�iAL PLUMBfNG ENERGY
t --- � ,
� j! �-� � ��N::,�o� � -.
I-'—
� ��1�����5 �
SEPTIG TANK SIZE •
SEEP PIT/�1 SIZE � - - "----
ti; ° � � -
A �
5 ,f
� �
���y}}(���l�f� S
��,\JIiJ �� t aq�♦N�� __ —�
' f
14� _
.J {�
9 `
�,�« � ��. , . � . , � � _—�
�� �� ° r ' --- --