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HomeMy WebLinkAbout11638 � CITY OF DIAMOND BAR Q COMMUNITY DEVELOPNIENT DEPARTMENT /' � � 21660 E.Copley Drive Suite 190 PRESS � {909)860-3195 Fax(909)861-3117 �'""' BUILDING PERMIT APPLICATION FIRMLY o� J0851TE ��T' rJ��� �G -�.���� APPLICATION 5 �� PERMIT P/C ADDRESS / DATE NUMBER # $ APN LOT �- TR CT '7 ISSUE TYPE OCC DATE CONST. GROUP p OWNER -� II�� . L�✓.R p ADDRE S,`�,� � ��`I`t.`>R!i ��. 5- ZONING SETBACKS z CITY � 'r� ZIP TEL.c��Y_�x REORT RW � S APPLICANT TEL. SIDE/SIDE STREET RW ❑ � CONTRACTOR �^C'/'L�'�/� SIDE ❑ Q ADDRESS PROPOSED USE w ARCI-UENG/ ZIP TEL �.��,c�^ ��� �C�.��� W DESIGNER NO.DWEL. NO. NO. a ADDRESS UNITS STORIES BEDROOMS � CITY ZIP TEL. � cn DESCRIPTION SQ.FI: FACTOR PSF ADJ.AREANALUATION p� OWNER-BI:ILDER pECLARATION � SFR/ADD/REM I HEREBV AFFIRM UNDER PENALN OF PERJURV THAT I AM E7CEMPT FROM THE CANTRACTORS U- G9f8 JBJC81jlOf[ W CENSEUWFORTHEFt�LLOWMGREASON(SECJo31.5BU51NESSANDPROFE5510NSCODE:ANYGIYON (n U COUNTYWHICHREOUIRESAPERMITTOCANSTRUCT,ALTER,IMVROVE.�ERIOUSH,OHRE7AIRANVSTRUP W PdtiO/OBCk w TURE,PRIOR TO ITS ISSUANCE,ALSO RE�UIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SICNED W STATEMENT THA7 ME OR SHE IS UCENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTOIiS�Lb � CENSE LAW(CHI.PTER s(CAAIMENCING WITH SECTION 7000)OF D�VISION 3 Of THE BUSINESS AND PFO- � POOVSp2 � FE3510NSCODE)ORTHATHEORSNEISEXEMPTTHEREFROMANDTHEBASISFORTHEALLE6EDEXEMP• (� V TION.ANVVIOLATIONOFSECTION7031.5BYANYAPPLICANTFORAPERMITSUBJECTSTHEAPPLICANTTO Z R0-R0o1 A dVll PENALTV OF NOT MORE THAN FNE HUNORED DOLURS(S6�),): ❑I,AS OWNER OF TME PROPER7Y,OR M1'EMPLOVEES WITi WAGES AS iNEIR SOLE fAMPENSATION, � � Commercial NAIL DO THE WORN,ANO THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70ad,BUSI� J � NESS AND PROFESSIONS CODE:7HE CONTqACTORS UCENSE LAW DOES NOT APPLY TO AN OWNER OF � PROPERTY WHO BUILOS OR IMPROVES THEREON,AND YMO DQES SUCH WORK HIMSELF OR HERSELF OR � 7NROUGHHISDRNEROWNEAIPLOVEES,PROVIDEDTHATSUCHIMPRWEUENTSARENOTIN'fENDE00H CO QOFFEREDFORSALEJF,HOWEVER,7HEBUILDINGORIMPR�VEMEN7ISSOLDWITHINONEVEAqOFCAMPLE- Z T�ON,TME OWNER-BUILDEfl WILL HAVE THE BURDEN OF PROYING THAT HE Ofl SHE DIO NbT BUIlO OR � IMPROVEFORTNEPURPOSEOFSALE} W ❑I,ASOWNEROFTHEPROPERTV,AMEXCLUSIVEI,YCONTRACTINGWITHLICENSEDCONiRACTORS Q TO CONS�RUC7 THE PROJECT(SEC.7oa4,BUSINESS AND PROFESSIONS CADE:THE CONTRACTORS LI- V81Ueti0� ADJ.AREA W CENSEUWDOESNOTAPPLYTOANOWNEROFAPqOVERNWHO8UIL0.SOHIMPROVESTHEREON,AN� � WHOCONTRACTSFOqSUCHPROJECTSWITHACONTRACTOR(S�LICENSEOPURSUANTTOTHECONTpAC- Q�fANTITY DESCRIPTION FEE � TORSIICENSELAW.�. ❑I AM EXEMPT UNDER SEC. B.8 V.C.FOR THIS REASON J � ¢ � U LL - � � , DATE OWNER L U , • . � Z W . � LICENSED CONTRACTORS CLAFATION W � I HEREBY 0.FFIRM UNDEA PENA�TY OF PERJURV iHAT I AM LICENSED UNDER PROVISIONS OF CHAPTER � d 9(COMMENCINGWI7HSECTION70o0�OFDIVI510N30F7HEBU51NES5ANOPROFE5510N5CODE,AND Z �X AIVLICENSE�IN FULI F�RCE M1D EfFECT. m � I.ICENSE CU1SS LIC.NO. � � J V DATE CONTFACTOR a W � WORKERS'COMPENSATION OECLARATION Q � I HEREBY pFFIRM VNDEFl PENALT'OF 7ERJURY ONE OF iHE FOLLOWING DECLAMTIONS: Z � _IHAVEANDWILLMAINTAINACERTIFICATEOFCONSENTTOSELF�INSUREFORWORKERS' _ COMPENSATION,AS PROVIOED BV SEC710N 37000F THE LABOR fADE,FOR iHE PERFORMANCE U ¢ OF THE WORK FOH WHICH THIS PEqMiT IS ISSUED. � � w __I HAVE ANO WILL MAINTAIN WORKERS'COMPENSATION INSURANCE,AS REQUII3ED BY SECTION � 910o OF THE LABOR CO�E,FOR THE PERFORMANCE OF THE WOHN FOR WHICH THIS PERMIT IS ISSUED,MV WORHERS'CqMPENSATION INSURANCE CARRIER AND POLICY NLIMBER ARE CONSTRUCTION J � CARFIER PLAN REVIEW � POLICYNUMBER ELECTHIC Q 0 (fHI55ECTaMnE�ra7eeOJbtnErEooFniEPEwntrlSFOHOMEhrJroaEDoawis(Stro)oRLEss�. PLUMBING Z ICERTIFYTHATINTHEPERFORMANCEOFTHEWORKFORWHICHTHISPERMIT�,515S11ED,1 MECHANICAL _ 'U SHALLNOTEMPLOYANYPERSONINANVMANNEFSOASTOBECOMESU9JEC7TOTHE � WORKERS'COMVENSA710NLAWSOFCALIFORNIA.ANDAGREETHAT�FISHOULDBECOME INSPECTIONFEE � SU&IECTTOTHEWORKEFS'COMPENSATIONPROVISIONSOFSECTION37000FTHEUBOR � CODE.I SHALL FORTHWITH C041PLV WITH THOSE PROVISIONS. ISSUANCE _,! I � SMIP `�t r p OATE: APPLICANL � ENERGY P/C ��� � WARNING FAILURE TO SECURE WORKERS'COMPENSRTION CAVERAGE IS UNIAWFUL,MJD SHALL BE LL SU&lEC7ANEMPLOVERTOCRIMINALPENALTIESANOCIVILFINESUPioONEHUNDREOTFI�USAND ENERGYPEFlMIT DOLLARS(5100.000).IN ADDITION TO THE COSTOF COMPENSATION,DAMAGES AS PROVIDED FOR IN � SEC7�ON 37080F THE LABOR COOE.INTEREST,AN�ATTORNEV'S FEES. RETENTION FEE: r d CONSTRUCTION LENOING AGENCY PRE-ALT FEE: O � I HEREBY AFFIHM lJNOER PENALTV OF PERJURY THATiHERE IS ACONSTRUCTION LENOING AGENCY FOA THE PERFORMANCE OF iHE WORK FOR WHICSI THIS PERMIT IS ISSUED(SEC.30D7,CIV.CJ. Z W � LENDEITS NAME f- LENOER'SA�DRESS_ � �N'����' w ICEHTIFVTNATIHAVEqEADTHISAPPIICATIONAND5TAIETHATTNEABOVEINFORAIATIONISCORRECT. TOTAL FEGS �,J � IAGfiEETOCDMPLYWITFIALLCITYANDCOUNTYOR0INANCESANDSTATELAWSRELATINGTOBUI�DING � GONSTRUCTION,ANO HEREBY AUTHOqIZE REPRESENTATIVES OF THIS COUNTV TO ENTER UPON THE -.�. . Z ABOVE�MENTIONED PROPERTY FOR INSPECTItlN PURPOSES. COMMENTS � �,�� CC�F-�' �e��a�r m PEAMITTEENAME(PRINn ' . Q «� C . ...�,... � �����--t�[� � IpNATUREOFPERMIITEE OATE — T� = RECPL NO. 1___���AIO BY� VALIDATIO ~ WHITE—De artment Copy,YELLOW—Finance Co PINK—Assessor Co GOLDENROD—File Co OREEN— pllcanYs bo . �. �. P PY� PY� PY. pP PY - . . :a'1� �G'e�'�vk� *� [.4�r �t,j. �ti. 1w;Y';v .�.� id 'ao M,a,:' e� .—t,: � 7#w ia,wty�� w w. .'��7 w��'fV' f w.. aw .,:� �,, t...�Yi�r� r,.'�;� ".'� �`"� ."k3'r`�' �' Y�."+r� :d��:�'$.;�-L t!�"�i ..�.�A�`'`�' , �F'�,�t"zi�8',a5tp�rw�,� . �,' + rr�.;a,ss��"� ' .. .,�r,., ""'�;"�-" �% CITY OF DIAMOND BAR .._ ,.,. INSPEG`TION RECCIR� _ - _ ..�.,.>, , . � � , . � . o � i � � e_..., SE7 BACI�C_.: __., <:,,, FLOOR JQIST..._ , _ _ FTGSIFORMS/STEEt " FHA FiEQMTS . � - ELECTRIC GROUND � UNO�R FLOOR DUGT �. � ' . „ GROUND PLUMBlNG � ` � UND�R FLOt�F�CUMDUtT ._ � SLAB GRADE _ '-' - `• FIR�PLACE FOUNDATION TEMP POWER . : FIREPLACE BOND SEAM �- s��• ' _ , �_. WA7ER SERVICE ' " , k� ` MiD HT. BOND BEAM , � ROOF SHEATHING � ' 8 FL BOND BEAM ��• % !� ' FRAMINGNEN7ILIATlQN , ,-'"` `� F`INAL BOND BEAM .. _ . ROOF COVER PRE-GRADING �` ROUGH HEATING � ; ,: ; BENCHING _ . ROUGH ELECTRIC � � _�_ � _ , , ROUGH GRADWG , ,,, _ ._. ROUGH PLUMBING_ . ;. _ _. __ ' FINISH iaRADI�G ,, , , ;.. ' , � , SHOWEfi/TUBTEST _;: . . POOLELECTRIC EXT.LATH/SIDING '. POOL FENCING , , . '` WALL IN5ULATION. .. _ __ . -., ., POOL FINAL , _ _ __._____ _ _�.___��_,_ �_ _ , . . . CEIIING INSULATION OF�SITE lMPS. , ORYWALL NAILING QEDICATI�NS "` _. _. SEWER . r.� .� _ ., . ; _ FINAL ENG. � ; ,,. .,,., _.SEPTIC TANK � •' ',�:` : ' �_ ; ;-- ��,,; LANdS�APE/IRRiG. SEEP PIUL'.L. __ , . _ :_: ':':`' ON SITE IMPS. T GAS AIR TEST l-; �.., FINAL ZONlNG � r � ---- - - ., FINAL CUNS7. Ej!���� ` � ��� �IRE DEP7'-FiNAL � �- r y� - , ... , � ::,:. FINAL HEATING � ��~� �p � ' H.EAI�I'H DEPT. FINAL ' � - . FINAL ELECTRIC � " DEV. f=EES PAID = ,,;•� . - ...� �INALPLUM8ING_. _ _ ___.__ ._.. __. __.. E.NERGY ,; „� , _ _. __ __ �.._ -- --- — - --- _. ; ;: .,, , <. -_... . _____.. � . �,A���:: _. __. _ . , ___ . � � _._ _..... _. _. . ,_. .. _ . ._ . _. _ . 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SEEP PIT/U SIZE �---- - — — _ .. - ___.._ . .. -- ---- _ _. _ .. _ '_____"' " "_' _ • `1.�t.S ..e� -.._ ....,_ ..� . _ �, . , � . . „. . .. . . .. . -- :: '��N�.1.�� � ... .. ..J"' .w„\.., � _...... .s:..a�.: ,.�,... ,... .. .,-. r ., . .. .., �, s. .. ..i. u'� .. � .......:�u�. � .... ' . . . . . . . _ � wr� .:b , .. � .. , . ;.s ��, ..,e�a..�.�._��o.�