HomeMy WebLinkAbout17224 CTI'1'OF DIAMOND BAR
���----�� --- DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES
� 21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 �UN 1 9 ZOO2 PRESS
�`'%�w�� BUILDING PERMIT APPLICATION FIRMLY
� JOBSITE ��,�� ����OD�IZ�d9e ,� APPLICATION I!��„;�.,,�� NUMBER ����/C
' o ADDRESS_ DATE LJ
� ISSUE TYPE OCC
APN�L/OZ�TRACT DATE CONST. GROUP
p OWNER UHV U �'i�
p ADDRESS ZONING SETBACKS
Z CITY Z�p FRONT RW ❑
o APPLICANT TEL. S DE/SIDE STREET RW ❑
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¢ CONTRACTOR �P�L��'�C�INSTALLERS INC. si�E ❑
ADDRESS 2
� CITY i akawnnd,$�9DZ1� TE PROPOSED USE
o ARCH/ENG/
iz DESIGNER NO.DWEL. NO. NO.
a ADDRESS
� CITY ZIP TEL. UNITS STORIES BEDROOMS
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cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER•BUILDEA DECLARATION SFFl/ADD/REM
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p I HEREBY AFFIRM UNDER PENALTV OF PERJURY THA7 I AM El(EMPT FROM THE CONTRACTORS LI- G8l89B/CBfpOR
W CENSELAWFORTHEFOLLOWINGREASON(SEC.7031.SBUSINESSANDPROFESSIONSCODE:ANVCITVOR (n
U CAUNNWHICHRE�UIRESAPERMITTOCONSTRUC7,ALTER,IMPROVE,DEMOLISH,ORREPAIRANVSTRUC-
w TURE.PRIOR TO ITS ISSUANCE,ALSO REQUIRES THE APPLICAN7 FOR SUCH PERMIT TO FILE A SIGNED W Patio/Deck
STATEMENT 7HAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF 7HE CONTRACTOFS LI-
� CENSE LAW(CHAPTER e(CAMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- � POOVSP2
0 FESSIONSCADE)ORTHATHEORSHEISEXEMPTTHEIiEFROMANDTHEBASISFORTHEALLEGEDEXEMP� (�
V TION.ANYVIOLA710NOFSECTION7037.5BYANYAPPLICANTFOHAPERMITSU&IECTS7HEAPPLICANTTO Z Re-Roof
A CIVIL PENALTY OF NOT MOFiE 7HAN FIVE HUNDRED DOLURS(SSaO).):
Z ❑I,ASOWNEROF7HEPROPER7V,ORMYEMPLOYEESWITHWAGESASTHEIRSOLECOMPENSA710N, � COmmBfCi21 -
WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.7041,BUSI� J
N NESS AN�VROFESSIONS CODE:THE CON7RAC70R5 LICENSE LAW DOES NOT APPLV TO AN OWNER OF �
PROPEi�Y WHO BUILDS OR IM7ROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
� THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED 7HAT SUCH IMPROVEMENTS A{iE NOT INTENDED OR m
w OFFEREDFORSPLE.IF,HOWEVERTMEBUILDINGORIMPROVEMENTISSOLDWI7HINONEVEAROFCOMPLE-
� TION,h1E OWNER�BUILDEH WIIL HAVE THE BURDEN OF PROVING 7HAT HE OR SHE DID NOT BUILD OR
Z IMPROVE FOR THE PURPOSE OF SALE).
_ ❑I,ASOWNEROFTHEPROPERTY,AMEXCLUSIVELVCON7HACTINGWI7HLICENSEDCONTFiACTORS
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[[ TO CONSTRUCT THE PRQIECT(SEC.7011,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- V8IU0flOf1 ADJ.AREA
W CENSE LAW DOES NOTAPPLV TO AN ONRJER OF A PROPERTY WHO BUILDS OR IMPROVES 7HEREON,AND
� WHOCANTRACTSFORSUCHPRQIECTSWITHACONTRACTOR�S)LICENSEDPURSUANTTOTHECONTRAC- QUANTITY DESCRIPTION FEE �
Y 70R5 LICENSE UW.).
� ❑1 MA E%EMPT UNDER SEC. B.8 P.C.FOR THIS REASON Q
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DATE OWNER �
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� LICENSED CONTRACTORS DECLARATION W
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� I HEREBY AFFIRM UNDER PENALTY OF PERJURV THAT 1 AM LICENSED UNDER PROVISIONS OF CHAPTER � � {\
d e(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND Z V
X MV LICENSE IS IN FU/LL�FOARCE AND EFFEC7. J,^
� LICENSE CLASS t/✓ LIC.NO. ��-/ `^�v j
� J
V DATE CONTRACTOR i � a
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� WORKERS'COMPENSATION DECLARATION Q
� I HEREBVAFFI(iM UNDER PENALN OF PERJURY ONE OFTHE FOLLOWING DECLARATIONS: Z
Z _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' _
a COMPENSATION,AS PROVIDED BY SECTION 370o OF THE LABOR CODE,FOR THE PERFORMANCE `U
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
�
w _I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION
Q 37000F THE LABOR CODE,FOHTHE PERFORMANCE OF THE WORK FOR WHICH THIS PERMI715
ISSUED.MY O KERS'COMPENSATION INSURANCE CARRIER AND POLICV NUMBER ARE: CONSTRUCTION
� CARRIER �Z �/yr-o�e/y�D Q PLAN REVIEW
Z POLICV NUMBER '!� iV U 7II ELECTRIC
Q
� (�HISSEGTIONNE�NOTBEOJMPLEfEDOFh1EPEWATISFORONEHUADFiEDDOILARS(f100)ORLESS). PLUMBING
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Z I CERTIFV THAT IN THE PERFOHMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,1 MECHANICAL
� SHALL NOT EMPLOV ANV PERSON IN ANV MANNER SO AS TO BECOME SUBJECT TO THE
� WORKERS'COMPENSATION LAWS OF CALIFORNIA,AND AGREE THAT IF 1 SHOULO BECOME INSPECTION FEE
� SU&IECTTOTHEWORKERS'COMPENSATIONP I SOFSECTION37000FTHELABOR �l�. \
� CODE,ISHALLFORTHWITHCOMPLVWITHTHO I51 N ISSUANCE 0.) l
� SMIP
p DATE: APPLICANT:
J WARNING FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNUWFUL,AND SHALL BE ENERGY P/C
� SU&lEC7ANEMPLOYERTOCRIMINALPENALTIESANDCIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
DOLLARS(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
� SECTION3708OFTHELABORCODE,INTEREST,ANDATTORNEV'SFEES. RETENTIONFEE: �
� CONSTRUCTION LENDING AGENCY PRE-ALT FEE:
O
Q I HEREBV AFFIRM UNDEfi PENALTY OF PERJURV THAT THERE IS A CONSTRUCTION LEN�ING AGENCY
� FOR THE PEfiFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.C.).
Z
W
� LENDER'S NAME
H LENDER'SADDRESS
� TOTAL FEES �j � 6
� I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
w I AGREE TO COMPLV WITH ALL CITV AND COUNTY ORDINANCES AND STATE LAWS REIATING TO BUILDING �
d
� CANSTRUCTION,AND HEREBV AUTHORIZE REPtiESEN7A71VES OF 7HIS COUNTY TO ENTER UPON THE
Z ABOV ENTIONED PROFERTV FOR INSP TION PURPOSES.
o �Q yb�� �%/ COMMENTS
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N PERMITTEE NAME(PRIN7) ��O `/ n 'I
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� SIGNATUREOFPERMITTEE DA7E T—
= RECPT.NO. PAID BY VALIDATION �
~ WHITE—Department Copy,YELLOW—Finance Copy;PINK—Assessor Copy,GOLDENROD--File Copy,GREEN—Applicant's Copy i
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SET BACK ; , FLOOR JOIST I
- - -- �-- _— - -- —. ___.._..__.._._
FTGS/FORMS/STEEL ; � FHA REC.�MTS
---- ---.- -- ._�_._______ _ ---,--; ..... ____ ._._�_�_�._____ ..__________.
ELECTRIC GRdUND ; , UNDER FLOt�R DUCl' �
— --- —__._,_ _ -- -----...--- --._---
GROUND PLUMBING ; UNQER FLOOR CUI�IDUIT ______
SLAB GRADE �_ FIREPLACE FOUNDATION___ __
TEMP POWER ; � FIREPLACE_B�ND BEAM
�
---- -----.------ --._ _ ----- ____ ----_ ____�
WATER SERVICE --- __ ; MID HT. E30ND BEAM ---- ----- --_---
ROOF SHEATHING ' � 8 FT. BOND BEAM i .. .
FRAMIPJG/VENTILIATION � FIiVAL BOND BEAM ___ ; _____
ROOF COVER PRE-GRADING _j _ ___
ROUGH HEATING � BENCHING __ � ____ __
ROUGH ELECTRIC I ROUGH GRADING ___ ___
ROUGH PLUIVIBING ! ' FINISH uRADING _____
SHOWER/TUB TEST � POOL ELECTRIC
EXT. LATWISIDING � ' ; POOL FENCINC.�
— ---- —.__._..._. .._.___— � ------ ----
WALI INSULATION ; POOL FINAL � _
CEIUNG INSULATION ' OFF SITE IMPS.
DRYWALL N,41LIfVG DEDICATIONS _ _
SEWER FINAL ENG.
SEPTIC TANK LANDSGAPE/IRRIG. ��
SEEP PITlL.L. ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL COIVST. � �lRE DEPT. FINA�
- _.._.-- — ..._..______._ _----_—___.
FINAL HEATING � HEALTH DEPT. FINAL _
FINAL ELECTRIC ;_� DEV. FEES PAID
FIfVAL PLUMBING I i ENERGY
� - ------ -
___._
�,�e� -----
C�C G�' o_ C�a
COii�MENTS -- _
SEPTIC TANK SIZE
SEER PIT/U SIZE
� _ � _. ___.._ —__ _._......._._
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