HomeMy WebLinkAbout16803 (25) CITY OF DIAMOND BAR EX P I R E D
�- --��`----- DEPARTMENT OF CONBvIUNITY&DEVELOPMENT SERVICES
21825 E.Copley Drive
(909)860-3195 Fax(909)861-3117 J U N 17 2002 PRESS
�"-��*�� BLJILDING PERMIT APPLICATION FIRML
� JOBSITE —] n,� •
o ADDRESS �?' / Nr �A� �i�Y�► D� APPLICATION � O PERMIT ��r`�Q��P/C
DATE � NUMBER ��!�W 1#
� ISSUE TYPE OCC
°r° APN OT TRACT DATE CONST. GROUP
p OWNER �/
� ADDRESS �,2'i J�I• � CG17EI�D A � ZONING SETBACKS
Z CITY 1�. �. ZIP TEL. Si�ol� J77S FRONT RW ❑
� APPLICANT TEL. REAR ❑
� SIDE/SIDE STREET RW ❑
z
¢ CONTRACTOR �R✓L �rfF2C.l�4 SIDE ❑
� ADDRESS � Z PROPOSEDUSE i4R n � �'�C A�QP - �' P/1�
� CITY , / O 'b4�� Zlp A TEL. � 74� 0✓ ,
w ARCH/ENG/ � �v�/�' L+TC 1/��I_.4 TTii,C h o f� � i ��
�z DESIGNER NO.DWEL. �1 NO. NO.
� ADDRESS UNITS S'FU STORIES I BEDROOMS �
� CITY ZIP TEL.
�
cn DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
O
p I HEREBY AFFIRM UNDER PENALTY OF PERIURV 7HA7 1 AM EXEMPT FROM THE CON7RACTORS LI� G8f89B/CBfpOR
W CENSELAWFOq7HEFOLLOWINGREASON(SEC.7031.SBUSINESSANDPfiOFESSIONSCADE:ANYCITYOR (f�
U COUNTYWHICHREOUIqESAPERMITTOCANSTRUCT,ALTER,IMPROVE,DEMOLISH,ORREPAIRANVSTRUC� W P81i0/DBCk
w TURE,PRIOR TO ITS ISSUANCE,ALSO REQUIPES THE APPLICAN7 FOR SUCH PEfiM1T TO FILE A SIGNED W
STATEMENT THA7 HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF 7HE CONTRACTORS LI-
� CENSE LAW(CHAPTER Y(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINE55 AND PRO� � PooVSpa '
Q FESSIONSCADE)ORTHATHEORSHEISEXEMPTTHEREFROMANOTHEBASISFOR7HEALLEGEDE%EMP- (�
V TION.ANVVIOLATIONOFSECTION7o31.5BVANVAPPLICANTFORAPERMITSUBJEC757HEAPPLICANTTO Z RB-ROOf
A CIVIL PENAL7Y OF NOT MORE THAN FIVE HUNDRED DOLLARS(f5ao).):
0 ❑I,ASONTIEROFTHEPROPER7Y,ORMVEMPLOVEESWITHWAGESASTHEIRSOIECAMPENSATION, 0 COff1RIBfC18I -
Z WILL DO THE WORK,AND THE STRUCTURE IS NOT IN7ENDED OR OFFERED FOR SALE(SEC.7041,BU51- J
N NESS AND PROFESSIONS CODE:THE CONTRAC70R5 LICENSE LAW DOES NOT APPLY 70 AN OWNER OF �
PROPEF7rY NT10 BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HEFSELF OR
Q THROUGH HIS OR HER OWN EMPLOVEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OH m
w OFFEREDFORSPLE.IF,HOWEVER711EBUILDINGORIMPROVEMEN7ISSOLDWITHINONEVEAROFCOMPLE-
0 TION,THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NO7 BUILD OR
Z IMPROVE FOR 7HE PURPOSE OF SALE).
_ ❑I,AS OWNER OF THE PROPER7V,AM EXCLUSIVELV CONTRACTING WITH LICENSED CON7RACTORS
W
� 70 CANS7HUCT THE PROJECT(SEC.7041,BUSINESS AND PROFESSIONS CADE:THE CONTRACTORS LI- V81U8fi0� ADJ.AREA
W CENSELAWDOESNOTAPPLY70ANOWNEROFAPROPERTVWHOBUILDSORIMPROVESTHEREON,AND
� WHOCANTRACTSFORSUCHPROJECTSWITHACONTRACTOR(5)LICENSEDPURSUANT70THECONTRAC- QUANTITY DESCRIPTION FEE
Y TORS LICENSE LAW.).
� ❑1 AM EXEMPT UNDEfi SEC. B.8 P.C.FOR THIS REASON Q
� U
� �
DA7E OWNER �
Z W
� LICENSED CONTRACTORS DECLARATION W
� I HEREBV AFFIRM UNDER PENALTV OF PERIURY TMAT I AM LICENSED UNDER PROVISIONS OF CHAPTER �
� 6(COMMENCING WITH SECTION 7000)OF DIVISION 3 0F THE BUSINESS AND PROFESSIONS CODE,AND Z
� X MV LICENSE IS IN FULL FORCE AND EFFEC7.
� LICENSE CIASS C�3 1 UC.NO. d - j
~ DATE 7� I C�" O' CONTRACTOR d
U
w
� WORKERS'COMPENSATION DECLARATION Q
� I HEREBY AFFIRM UNDER PENALTV OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: Z
0 IHAVEANDWILLMAIN7AINACER7IFICA7EOFCqN5ENT705ELF-INSUREFORWORKERS' a
Z
a CAMPENSATION,AS PROVIDED BV SECTION 370o OF THE LABOH CODE,FOR 7HE PERFORMANCE w
Q OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. �
w I HAVE AND WILL MAINTAIN WORKERS'COMPENSA710N INSURANCE,AS REOUIRED BY SECTION ///���/'� ///���
Q 37000F THE LABOR CADE.FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS �(�[ I ��
ISSUED.MV WORKERS'COMPENSA710N INSURANCE CARRIER AND POLICY NUMBER ARE: CONSTRUCTION _i�_
� CARRIER PLAN REVIEW
Z POLICY NUMBER E�ECTRIC
Q
0 (iHISSECIX?NNEmNOTBEOLMREfEDOFTHEPEW.1f�ISWRONEHUI�DREDDOl11JiS(5100)ORLESS). PLUMBING
Z 1 CERTIFV THA7 IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I MECHANICAL
C7 SHALL NOT EMPLOY ANV PERSON IN ANV MAN E SO AS 70 BECOME SUBJECT 70 7HE
� WORKERS'COMPENSATION LAWS OF CALIF D AGREE THAT IF I SHOULD BECOME INSPECTION FEE
= SU&IECT TO THE WORNERS'COMPENSATI � I IONS OF SECTION 3700 OF THE LABOR �
CADE,I S/F�IALL FORTHWITM COMPLV WI E a ovisions. ISSUANCE �
p DATE:�/Q�O APPLICANT: SMIP J /� T(���
J WARNING FAIWRE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,AND SHALL BE ENERGY P/C J/-1 J �_` I
� SUBJECTANEMPLOVERTOCRIMINALPENALTIESANDqVILFINESUPTOONEHUNDHEDTHOUSAND ENERGYPERMIT V
DOLLARS(f100,000�,IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN
� SECTION 3708 OFTHE LABOR CODE,INTEf1E5T,ANDATTORNEY'S FEES. RETENTION FEE: I
� CONSTRUCTION LENDING AGENCY PRE-ALT FEE: I
O , I� I HEREBV AFFIFM UNDER PENALTY OF PERJURV THAT THERE IS ACONSTRl1CTION LENDING AGENCV ._
FOR THE PERFORMANCE OF THE WOflK FOR WHICH THIS PERMIT IS ISSUEO(SEC.3087,CIV.C.). ------- - -'-� �
Z
W
� LENDER'S NAME
� LENDER'SADDRE55
� TOTAL FEES � `Z . �
� I CERTIFV THAT I HAVE fiEAO THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.
w I AGREE TO COMPL WITH ALL CITY AND COUNTV ORDINANCES AND STATE UWS RELATING TO BUILDING
d
� CONSTRUCTION HEREBY AU7HORIZE REPRESEN7A71VE5 OF 7HIS COUN7V 70 EN7Efl UPON THE
Z AeOVE�MENTI E PROPERTY FOR INSPECTION PURPOSES. COMMENTS �
�
J
�
m PERMI E AME(PRINT
� �l��L�W�G��1 ?���"o�
N SIGNATUREOFPERMITTEE DATE
= RECPT.�'O. PAID BY VALIDATION
~ WHITE—De artment Co YELLOW—Finance Co PINK—Assessor Co GOLDENROD—File Co GREEN—A licant's Co
P PY. PY. PY, PY, PP PY
. .. . . . . . - , _�. ,-.._ , . ,
�� I�� �f� [I��Q�Ii��� [�Q�
�G'�l�pC�C�v��� (���C�L�3DD
���, �Q� ��� Q� U � a ``1J� � ' o � ..
SET BACK i �� ' FLOOR JOIST ' ;
.._ -•------ -----__ _ _.._....._ -
FTGS/FC7RMS/STEEL l ; FHA REQMTS � �
i I
_ ------ --- —_____— ___.,...,.._.._.— _.._ __ { ._-- -..--�� ----
ELECTRIC GROUND � UNDER FLOtJR DUCT
-- ---- --- ___._ _ .. ___ ____ _._._--
_._.
GROUND PLUMBING _ UNDER FLOOR CU�IDUIT '
— ----- -----_._______
SLAB GRADE FIREPLACE`FOUNDATION_ _
TEMP POWER FIREPLACE BOND BEAM � __ ___._. ___
W,4TER SERVICE -� � MID HT. B�ND BEAM ___ _
ROOF SHEATHING ^ �Dt --- S FT. BQND BEAM ____ I ___
FRAMING/VENTILIATION FINAI.BOND BEAM �
_ _.._—..----------- -------...------
ROOF COVER ', PRE-GRADING !
ROUGH HEATING BERlCHI(�l{a - i._._.__.___._ �� '— ___.__.____
ROUGH E�ECTRIC __ ROUGH GRADING __ _ ____
ROUGH PLUMBING FINISH uFiADING ____ __ __
SHOWERlTUB TEST � POOL ELECTRIC
EXT. LATH/SIDING POOL FENCING
WALL INSULATION POOL FINAL �
CEILIIVG IN�ULATION OFF SITE IMPS.
DRYWA�L NAIUNG DEDICATIONS
— ---- —�---------..__._..---- - ---
SEWER FINAL EN�. I �
SEPTIC TANK � LANDSGAPEIIRRIG. �— --_ _
SEEP PIT/LL. ' ON SITE IMPS.
GAS AIR TEST FINAL ZONING
FINAL CONST. �IRE DEPT. FI�AL
FINAL HEATING HEALTH DEPT. FINAL
FINAL ELECTRIC DEV. FEES PAID
FIfJAL PLUMBING ENERGY
�
----- ' _� _ � . _
__ C ��� � .. I
� �
_ _ _ � ._� .�_ �. �.� _ _ '_ ' 0�... .��...�...��-a.... . _ j,� ..
CO�iNiERll"V
SEPTIC TANK SIZE
SEEP PIT/U SIZE -�----
� - -----_---- -----___--
i�u � -
, �, ....
�