HomeMy WebLinkAbout18036 �,<.,��, ��
CITY OF DIAMOND BAR
----� ��`---- DEPARTMENT OF COMMUNTI'Y&DEVELOPMENT SERVICES
� ; r 21825 E.Copley Drive
- (909)860-3195 Fax(909)861-3117 PRESS
��-»��� BUILDING PERMIT APPLICATION FIRMLY
o DDRIESS_L� � t� ��l'-( y,�/'�"� � DATECATION�j7 �i�PERMIT �P/C
� NUMBER #
� ISSUE �j�/j� TYPE OCC
APN LOT TRACT �
DATE � (/ CONST. GROUP
p OWNER _ �L• c.'1�3,$
ADDRESS��'cC' ZONING SETBACKS
w JL" ^ FRONT RW ❑
Z CITY ZIP TEL.
o APPLICANT TEL. SIDE/SIDE STREET RW ❑
z
Q CONTRACT R � � - SIDE ❑
� ADDRESS �
� CITY /L� C , ZIP TEL. 2 —/ PROPOSED USE
w ARCH/ENG/
z DESIGNER
u� NO.DWEL. NO. NO.
a ADDRESS UNITS STORIES ��. BEDAOOMS
� CITY ZIP TEL.
�
cn DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
O
I HEREBY AFFIFM UNDER PENALTV OF PERJURY THAT I AM EXEMPT FROM THE CANTRACTORS LI- GefeyO/CefpOfi
W CENSEUWFORTHEFOLLOWINGREASON(SEC.7031.SBUSINESSANDPROFESSIONSCODE:ANYCITYOR (n
U COUN7YWHICHREOUIRESAPERMI7TOCANSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANVS7RUC-
W TURE.PRIOR TO ITS ISSUANCE.ALSO REOUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED W Patio/Deck
STATEMENT THAT HE OR SHE IS LICENSED PURSUAN7 TO THE PROVISIONS OF THE CONTRACTORS LI-
� CENSE LAW(CHAPTER B(COMMENCING WITH SECTION 7000)OF DIVISION 3 0F THE BUSINESS AND PRO� � PooVSpa �
FESSIONSCODE)ORTHATHEORSHEISE%EMPTTHEREFROMANDTHEBASISFOR7HEALLEGEDEXEMP- (J
� � TION.ANV VIOUTION OF SECTION 7031.5 BV ANV APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT T0 Z Re-Roof
A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS(SSoo).):
❑I,ASOWNEROFTHEPROPERTY,ORMVEMPLOVEESWI7HWAGESASTHEIRSOLECAMPENSATION, Q
O Commercial -
Z WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70a�,BUSI- J
� NESS AND PROFESSIONS CAOE:THE CONTRACTORS UCENSE lAW DOES NOT APPLY TO AN OWNER OF �
PROPERTV WHO BUILDS OR IMPqOVES 7HEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR
Q THROUGH HIS OR HER OWN EMPLOYEES,PROVIDED THAT SUCH IMPROVEMEN7S ARE NO71N7ENDED OR m
QOFFEREDf-0RSALE.IF,HOWEVER,THEBUILDINGORIMPROVEMENTISSOLDWITHINONEVEAROFCOMPLE-
Z TION,THE OWNER-BUIIDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE�ID NO7 BUIID OR
� IMPROVE FOR THE PURPOSE OF SALE).
❑I,AS OWNER OF THE PROPER7Y,AM EXCIUSIVELV CONTRACTING WITH UCENSED CANTRACTORS /-
� TO CANSTRUCT THE PRQIECT(SEC.7044,BUSINESS AN�PROFESSIONS CODE:THE CONTRACTORS LI� V8IU2IlOf1 t �_�� ADJ.AREA
W CENSEUWDOESNOTAPPLYTOANOWNEROFAPROPER7VWHOBUILDSORIMPROVESTHEREON,AND �
� , WHOCONTRACTSFORSUCHPROJECTSWITHACANTRAC70Fi(S)LICENSEDPURSUAN7707HECONTRAC- QUANTITY DESCRIPTION FEE
Y TORS LICENSE LAW.).
� ❑I AM EXEMPT UNDER SEC. B.d P.C.FOR THIS REASON Q C_ ./J �
� U � (/'f �"
� Q �
DATE OWNER F
0 W / �
� LICENSED CONTRACTORS DECLARATION w
� I HEREBV AFFIRM UNDER PENALTV OF PERJURV 7HA71 AM LICENSED UNDEH PROVISIONS OF CHAPTER � � .
d �(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PROFESSIONS CADE,AND Z
X MY LICENSE IS IN FULL FORCE AND EFFECT.
� LICENSE CLASS J��� / LIC.NO. ��� j G O
V DATE L �/ �'"�Z CONTRACTOR C�--� v a
W
� WORKERS'COMPENSATION DECLARATION �
¢
� I HEREBV AFFIRM UNDER PENALTV OF PERJURV ONE OF THE FOLLOWING DECLARATIONS: Z ��
� I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SEIF-INSURE FOR WORKERS' _
¢ CAMPENSATION,AS PROVIDED BV SECTION 3700 OF THE LABOH CODE,FOR THE PERFOHMANCE W
OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED. �
0
� I HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANC , REOUIRED BV SECTION � O
Q 3700 OF THE LABOR CODE,FOR THE PERFOHMANCE OF THE W N OR WHICH THIS PERMIT IS �I•
ISSUED.MY WORKERS' PFJdS TION INSURANC CARRIE D POLYI�.Y NUMBER ARE: CONSTRUCTION J
� CARRIER // ��Q � x" PLAN REVIEW
ZPOLICV NUMBER ELECTRIC
Q
� (1}iISSECTONNE�NOTBE00f.iPLEfEDOFTHEPERMfi15PoRONEHUPDFEDDOLLPFLS(f100)ORLESS). PLUMBING
Z I CERTIFY THAT INTHE PERFORMANCE OF 7HE WORK FOR WHICM THIS PERMIT IS ISSUED,I MECHANICAL
(� SHALL NOT EMPLOV ANV PERSON IN ANY MANNER 50 AS TO BECAME SUBJECT TO THE
� WOFIKERS'CAMPENSATION LAWS OF CAUFOFiNIA,AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE
� SU&IECT TO THE WORKERS'CAMPENSATION PROVISIONS OF SECTION 3700 Of THE LABOR � '
CADE,ISHALLFORTHWITHCOMPLVWITHTHOSEPROVISIONS. ISSUANCE i ��
� ����� �/�.s► ��
p DATE: APPLICANL �- ��'�� SMIP
J WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C
� SUBJECTANEMPLOYERTOCRIMINALPENALTIESAN�CIVILFINESUPTOONEHUNDREDTHOUSAND ENERGYPERMIT
DOLLARS(5100.000�,IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
J SEC710N 37oe OF THE LABOR CADE,INTEREST,AND AT70RNEV'S fEES. RETENTION FEE:
2
d CONSTRUCTION LENDING AGENCY PRE-ALT FEE: �
O
� I HEREBV AFFIRM UNDER PENAL7Y OF PERIURY THAT THERE IS A CONSTRUC710N LENDING AGENCY
�- FOR THE PERFORMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.C.J. �
Z
W
� LENDER'S NAME
H LENOER'SADDRE55
� I CERTIFY THAT I HAVE READ THIS APPUCATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTAL FE ES /�� 3 v
w I AGREE TO COMPLV WITH ALL CITY AND COUNTV ORDINANCES AND STATE UWS REIATING TO BUILDING
d
CqNSTRUCTION,AND HEREBV AUTHORIZE REPRESENTATNES OF THIS COUNTV TO ENTER UPON THE
Z ABOVE�MENTIONED PROPERT FOR INSPECT�N P RPOSES COMMENTS
/
� � cJ�,/ j �(� Z
m PERMITTEE NA (PRINT)
� �, �—' �_ � ` ����1
N SIGN F PERMITTEE DATE '
= RECPT.NO. PAID BY VALIDATION �
~ WHITE—De artment Co YELLOW—Finance Co PINK—Assessor Co GOLDENROD—File Co GREEN—A plicant's Co
P PY. PY, PY, PY. P PY
, , , . . . .. , , r.w. =t:r:• ., . .
�Q�� �� ������� ���
���������� ������
e 0 ° �� OQ� ; �`�C�G�tt� aY ° � o m, -�� �� ;� �,�.
SET BACK j � __� FLOOR JOIST _ j
FTGS/FORMS/STEEL ; FHA REQMTS �
- --- -�.__. _� --- ------
___..
GR�UND PLUMBING ----. ----- .� UNQER �LOOR DU�T ---- �---.�_
_ � __-- -- ------
ELECTRIC UROUND _ r
--___ ..._—�
; I UNQ�R FLOOR C(J��DUIT , �
- --- -- ---_..._ ....__
SLAB GRAQE � FIREPLACE FOUNQAl"ION ';
TEMP POWER � —� FIREPLACE BONQ BEAM ____ _
WATER SERVICE �_._ _�' - -- ---�-. MID HT. BOND BEAM
- - --------- -- --
ROOF SHEATHING ,�Z���G � � 8 FT'. gOND BEAM I _
- --}--- - - -- __._�..i___ _._ _..
FRAMIIVGNENTILIATI�N ! I FINAI_BOND BEAM �
. - -- - -_.__ - + --- ----
ROOF COVER PRE-GRADING i
ROUGH HE,4TING BENCHI(VG
ROUGH ELECTRIC ; R�UGN GRADING
------r--- ---- ---.__.....-- -______.. _ _..-------
ROUGN PLUMBING ' FINISN i�RADWG
-- -- ' -- ---- -- ------ -----......_------- ---_______.....
SHOWER/TUB TEST � PDOL ELECTRIC
--- -...__. ----------
EXT. LATH/SIDING POOL FENCING
WALL INSULATION POO�FINAL j
---- - ------
CEILIfVG IN�ULATION ; �OFF aITE IMPS. '
- -- - - -_---�-__ ___.._...__. ----- --..__...._.____.-�----__
DRYWALL NAILING DEDI�ATIONS
SEWER ' FINA�ENG.
SEPTIC TANK LANDSCAPE/IRRiG.
SEEP PIT(L.L. ON SiTE IMPS.
- ---- ---- —
GAS AIR TEST i FINA�7{�NING �
FINAL CON�T. � � � , �IRE UEPT. FINAI._��--__ _______.___
FINAL HEATING -�— —� HEALTH DEPT. FINAL
FINA�ELECTRIC I DEV. FEES PAID
-- -- --
FINAL PLUMBING � ENERGY
}- ------- --_�......._._._.---�--- --..__....._..._..
- -------- -� � - -
_ __ _ ' .�u'_�.�����b3o�i�.�e....� i ._
�JI=N U
CONiii/iIEfVTS _
SEPTIC TANK SIZE � ^
SEEP PIT/U SIZE
I� --
� �
� .._._------