HomeMy WebLinkAbout18244 (28) CITY OF DIAMOND BAR �
-- -���' --� DEPAR'I'ME?`'T OF COMMUNI"fY&�DEVELOPMENT SERVICES
21825 E.Copley Drive
'� (909)860-3195 Fax(909)861-3117 ��-� �� PRESS
�"%4��� BUILDING PERMIT APPLICATION FIRMLY
QJOBSITE A'!1 LO �� ^r ��_� ./J"2� DATE CATION � • ��'��UMBER � U �/C
Q ADDRESS iri r ,�
� ISSUE TYPE OCC
APN LOT TR/�T _ DATE CONST. GROUP
p OWNER L D�i G f/`�� �i
p ADDRESS �� � /7��. ZONING SETBACKS
Z CITY M d ��.ZIp��"7ElC�� �6/0�9 FRONT q�/y ❑
� APPLICANT ° TEL. REAR �
�� �� SIDE/SIDE STREET RW ❑
CONTRACTOR SIDE p
ADDRESS
� CITY ZIP TEL. PROPOSED USE
oARCWENG/
�z DESIGNER NO.DWEL.
� a ADDRESS � NO.
� CITY ZIP TEL. UNITS STORIES BEDROOMS '
�
� DESCRIPTION SQ.FT. FACTOR PSF ADJ.AREANALUATION
p� OWNER-BUILDER DECLARATION SFR/ADD/REM
O
p I HEREBV AFFIRM UNDER PENALTV OF PERJURV THAT I AM E%EMPT FROM THE CONTRACTORS LI� G8I0 6/C8 R
W CENSEIAWFORTHEFOLLOWINaREASON(SEC.70J1.5BUSINESSANDPFOFESSIONSCODE:ANYLITVOR (n 9 �
U COUNTVN?11CHREWIRESAPERMITTOCONSTRUCT,ALTER.IMPROVE,DEMOLISH,ORREPAIRANVSTRUC-
W NRE,PRIOR TO ITS ISSUANCE,AL50 REOUIqES THE APPLICANT FOR SUCN PERAIIT TO FILE A SIGNED w Patio/Deck
� STATEMENT THAT HE OR SHE IS LICENSED PURSUA/7T TO THE PROVISIONS OF THE CONTRACTORS LI� � �
� CENSE LAW(CNAPTER Y(COMMENCINO WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- POOUSPB
O FESSIONSCODE)ORTHATHEORSHEISExEMPTTHEREFROMANDTME8A515FORTHEALLEGEDEXEMP- (!�
V TION.ANVVIOlAT10NOF5ECTION7071.5BVANVAPPUCANTFORAPERMITSUBJECTS'fNEAPPLICANTTO Z Re-Roof i
A CIVIL PENALTV OF NOT MORE THAN FNE HUNDRED DOLLARS(f500�.):
�� � ❑I,ASOWNEROFTHEPHOPERTV,ORMVEMPLOYEESWITHWAGESASIHEIRSOLECAMPENSATiON, � COrt1R18/Ci81
Z WILL DO THE WORK,AND THE STFUCTURE IS NOT IMENDED OR OFFEREO fOR SALE(SEC.70N,BU51� J
� NESS AND PROFESSIONS CO�E:THE CANTRACTORS LICENSE UW DOES NO�APPLY TO AN OWNER OF �
PROPERTV NTiO BUILDS OR IMPROVES THEREON,/W 0 NM1IO DOES SUCH WORK HIMSELF OR HERSELF OF
2 7HROUGN HIS OR HER OWN EMPLOVEES,PROVIDED TMAT SUC/l IMPROVEMENTS ARE NOT INTENDED OR m
� OFFEREOFORSPLEIF,HOWEVER.TMEBUILDWGORIMPROVEMENTISSOIDWITMINONEVEAROFCOMPLE-
Z TqN,THE OWNER-BUILDER WILL HAVE THE BUflDEN OF PROVINO'FIAT HE OR SHE DID NOT BUILD OR
� IMPROVE FOR 7HE PURPOSE OF SALE).
�yJ ❑4�.+`OWNEROFTHEPqOPERTV,AMEXClUSNELVCANTRACTINOWITNLICENSEDCONTRACTORS
[= TO CONSTRUCT 7HE PR0.IECT(SEC.7ou,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- V81U8�1Of1 � ADJ.AF�EA
W CENSE UW DOES NOTAPPLV TOAN OWNER OF A PROPERTV WHO aU11.D50R IMPROVES THEREON,AND
� NM1IOCONTRACTSFORSUpiPR0.1ECTSWITHACONTRACTOR(S�I.ICENSEDPURSUANTTOTHECONTRAG QUANTITY DESCRIPTION
Y roasucENSEuw.�. FEE
� ❑I AM EXEMPT UNDER SEC. B.8�.C.FOR THIS REASON Q
� U
� DATE OWNER � � IJ , r ¢ �
Z U
¢� LICENSED CONTRACTORS DECLARATION w
2
I MEREBV AFFIRAI UNDER PENALTV OF PERIURV THAT I AM LICENSED UNDER PROV�SIONS OF CHAPTER �
� i(COMMENCIN�WITH SECTION 7o00)OF DIVISION 30F TME BUSINESS AND VP.OFESSIONS CODE,AND Z
LLI MY LICENSE IS W FULL FORCE AND EFFECT. m
� LICENSE CLASS LIC.NO. �
�
V DATE � CONTRACTOR d
W
� WORKERS'COMPENSATION DECLARATION Q
� U
N I HEREBV AFFIRM UNDER PENALTV OF PERIURY ONE OF THE FOLLOWING DECIARATIONS: Z
� _I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORNERS' a
COMPENSATION,ASPROVIDEDBYSECT10N31000FTHElABORCODE,FORTHEPERFORMANCE U
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. W
0 �
Qw _1 HAVE AND WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REOUIRED BV SECTION ' `�„
370o OF THE LABOR CAOE,FOR THE PERf-0RMANCE OF THE WORK FOR WHICH THIS PERMIT IS ' 11 U
ISSVED.MV WOqKERS'CAMPENSATION INSURANCE CARRIER AND POIICY NUMBER ARE: CONSTRUCTION V
� CARRIER PLAN REVIEW �
ZPOLICY NUMBER ELECTRIC
Q
� (nnssEcrtaar+E�No7eeOCf.�atErmoFn+eaEar.�riSw�oNEM�D�ooavasls�ooloa�Ess1 PLUMBING
W
Z I CERTIFV THAT W THE PERFORMANCE OF THE WORIC FOR WHICH THIS PERMIT IS ISSUED.I MECHANICAL �
U' SHALL NOT EMPLOV ANY FERSON IN ANY MANNER SO AS TO BECOME SUBJE�T TO THE
(/) WORI(ERS'COMPENSATqN LAWS OF CALIFORN10.AND AGREE THAT IF I SHOULD BECOME INS?ECTION FEE
SU&IECTTO THE WORKERS'CAMPENSATION PROVISIONS OF SECTION 370o OF THE LABOR
� CODE.I SHALL FOR7HWITH COMPLY WITH THOSE PFOVISIONS. ISSUANCE ' /
�
p DATE: APPLICANT: SMIP
W
J W�RNIN(3:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNUWFUL,AND SHALLBE ENERGY P/C
J
� SUBJECTANEMPLOYERTOCFIMWALPENALTIESANDCIVILFINESUPTOONEHUNDREDTF/OUSAND ENERGYPERMIT
DOLLAAS(floo.000).IN ADDITION TO THE COST OF CONPENSATION,DAMAGES AS PROVIDED FOR IN
J SECTIDN 3]OB OF THE LABOR CODE.INTEREST,AND ATTORNEV'S FEES.
OC RETENTION FEE:
OCONSTRUCTION LENDING AGENCY PRE-ALT FEE: '
� I HEREBV AFFIRM UNDER PENALTV OF PERIUFV THAT THERE IS A CANSTRUCTION LENDING AGENCV
FOR THE PERFOFMANCE OF THE WORN FOR WHICH THIS PERMIT IS ISSUE�(SEC.3007,CIV.C.).
w (�(��
� LENDEN'S NAME
I
� LENDER'SADDRE55 \
w I CERTIFV TMAT I NAVE REPD THIS APPUCATION AND STATE THAT THE ABOVE INFORMATION IS CARRECT. TOTAL F E ES V�
� I AQREE TO COMPLV WITH ALL CITV AND CAUNTV ORDINANCES AND STATE IAWS RELATING TO BUILDING .
� CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS CWNTV TO ENTER UPON THE
Z ABOVE�MENTIONED PR07ERTV FOR INSPECTION PURPOSES. COMMENTS
�
J
�
m PERMITTEE NAME(PRINT) �
Q
v� a ��'
� � SIO AT R PERMITTEE ATE
= RECPT.�O. PAID BY VALIDATION
~ WHITE—De Ament Copy,YELI.OW—Finence Copy,PINK—Assessor Copy,GOLDENRO�File Copy,GREEN—Applicant's Copy
��7`�t' �� �9�e�J����' E3A6�
6�9�����'8��6 f����7FiD
' �o O � � 0 � . �a Q �.-k ��.�;� � � �D�j� . . 'U.M1J�� ,.� � �.
`F
SET BACK . � � FLOOR JOrS-f"�
FTGS/FORMS/STEEL l �FNA REQMTS
ELEGTRIC GROUND j UNDER FLOOR DUCT
GROUND PLUMBING 1 UNDER FLOOR CU�IQUIT
SL�;B GRADE FIREPLACE FC�UNDATION
TEMP POWER FIREPLACE BOND BEAM '
WATER SERVICE MID HT. BOND BEAM
ROOF SHEATHING 8 �. B�f�fD BEAM
FRAMINGNENTILIATION • ' ; FIt�A�BOND BEAM
ROOF COVER PRE-GRADING
ROUGH HEATING , BENCHiNG
ROUGH ELECTRIC ROUGH GRADING
ROUGH PLUMBff�lG FINISH i�RAQING
SHOWERrI"UB TES7 P�OL ELECTRIG
EXT. LATH/SIDING �'-��gZ_�� POOL FENCING _
WALL INSULATION � POOL FiRA�
CEILING INBULATION Q�F SITE IMPS. y
DRYWALL NAILING � DEQiCATi�NS -
SEWER _____ �INALENG. ^^ �<
SEP I IC TANK �� � LAt�lDSCFiF�iIRRiG.
-�- -- --- -
SEEP PIT/LL � ` , I I JN S(TE i?v1PS.
--- -- �----
GAS AIR TEST � �FINAL Zfl�;ING
FINAL CONST. � �_����� FlRE DEPT. FlNAL �
FtNAL NEATING ��HEALTH D�P-G FfNAL • �
FiNAL ELECTRIC � ' � DEV FEES PAID
F1NAL PLUMBlNG I EIJERGY
— � --- - —
4 m a ,,
C�NiMENTS _ __ . _ . ,
SEPTIC TANK SIZE i
SEEP PIT/U SIZE - --LL
� ' � � , :�. , - --- _--__—_
�' � �_�_�._— ---- --
� � � ° '[� --___.__.___ _ _._� �
� � . �` l .' �